Sample records for care improve efficiency

  1. Integrating hospital administrative data to improve health care efficiency and outcomes: "the socrates story". (United States)

    Lawrence, Justin; Delaney, Conor P


    Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes.

  2. Intensive care unit without walls: seeking patient safety by improving the efficiency of the system. (United States)

    Gordo, F; Abella, A


    The term "ICU without walls" refers to innovative management in Intensive Care, based on two key elements: (1) collaboration of all medical and nursing staff involved in patient care during hospitalization and (2) technological support for severity early detection protocols by identifying patients at risk of deterioration throughout the hospital, based on the assessment of vital signs and/or laboratory test values, with the clear aim of improving critical patient safety in the hospitalization process. At present, it can be affirmed that there is important work to be done in the detection of severity and early intervention in patients at risk of organ dysfunction. Such work must be adapted to the circumstances of each center and should include training in the detection of severity, multidisciplinary work in the complete patient clinical process, and the use of technological systems allowing intervention on the basis of monitored laboratory and physiological parameters, with effective and efficient use of the information generated. Not only must information be generated, but also efficient management of such information must also be achieved. It is necessary to improve our activity through innovation in management procedures that facilitate the work of the intensivist, in collaboration with other specialists, throughout the hospital environment. Innovation is furthermore required in the efficient management of the information generated in hospitals, through intelligent and directed usage of the new available technology.

  3. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care

    Directory of Open Access Journals (Sweden)

    Darko Gvozdanovi_


    Full Text Available In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1 to provide efficient healthcare-related data management in support of decision-making processes; (2 to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

  4. Computer network for improving quality and efficiency of children's primary health care (United States)

    Deutsch, Larry


    Health care is at its best when both the practitioner and patient are well-informed. In many central urban and remote rural areas, however, health care is characterized by a lack of continuity and coordination among providers. In these areas, a local information infrastructure and a patient-centered system of primary care are missing. Decision-making and ability to follow through is hampered, with limited involvement of patients in planning care and insufficient aggregate data for cost analysis, outcome research, community health planning, and other purposes. A Children's Health Network has been designed to extend current information technology to these underserved areas. Our approach to improving quality of individual care and controlling costs emphasizes use of computerized clinical information networks for better decision making and continuity, and secondarily through data aggregation for financial, research, and public health functions. This is in distinction to information systems centered on billing and administrative needs and to cost-control efforts which rely on fiscal and managerial ('gatekeeper') mechanisms. A uniform data base among sites serving the same population will answer several clinical and public health needs.

  5. Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study


    Lamb, Benjamin W; Jalil, Rozh T; Sevdalis, Nick; Vincent, Charles; Green, James S A


    Background The prevalence of multidisciplinary teams (MDT) for the delivery of cancer care is increasing globally. Evidence exists of benefits to patients and healthcare professionals. However, MDT working is time and resource intensive. This study aims to explore members’ views on existing practices of urology MDT working, and to identify potential interventions for improving the efficiency and productivity of the MDT meeting. Methods Members of urology MDTs across the UK were purposively re...

  6. Medical Care Provided Under California's Workers' Compensation Program: Effects of the Reforms and Additional Opportunities to Improve the Quality and Efficiency of Care. (United States)

    Wynn, Barbara O; Timbie, Justin W; Sorbero, Melony E


    Since 2004, significant changes have been made to the California workers' compensation (WC) system. The Commission on Health and Safety and Workers' Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This study synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system. To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations. To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers' Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available. To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost

  7. Improving combustion efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Bulsari, A.; Wemberg, A.; Multas, A. [Nonlinear Solutions Oy (Finland)


    The paper describes how nonlinear models are used to improve the efficiency of coal combustion while keeping NOx and other emissions under desired limits in the Naantali 2 boiler of Fortum Power and Heat Oy. 16 refs., 6 figs.

  8. Improving palliative care.

    LENUS (Irish Health Repository)

    Moran, Sue


    Any service improvement project requires planning, action and evaluation. Using a recognised quality improvement framework can offer a structured approach to implementing and assessing changes to patient care. This article describes how use of the Deming Cycle has helped to identify nurses\\' learning needs.

  9. Improving assisted living care. (United States)

    Gregory, Nancy; Gesell, Sabina B; Widmer, Tom


    In the absence of a national measurement system, private vendors of satisfaction measurement and improvement services have played a crucial role in the quality movement in the assisted living industry. Survey responses from 175 resident-family dyads at 20 facilities were analyzed to identify priorities for service improvement from the customers' perspective. They include improving care provided by aides and management, meal service, and activities. Practical solutions for addressing these issues are presented.

  10. Efficient use of health care resources: the interaction between improved health and reduced health related income loss. (United States)

    Hoel, Michael


    Cost effectiveness is a criterion that is often recommended for prioritizing between different types of health care. A modified use of this criterion can be justified as the outcome of a choice that is made "behind a veil of ignorance." Reduced health will in many cases also gives an income loss that is shared between the patient and society ar large. In the special case where the marginal utilities of health status (measured by QALYs) and income are independent of the health state, an efficient allocation of health resources is characterized by net marginal costs per QALY being equalized across different types of health care. Net marginal costs are equal to gross marginal costs minus the reduction in health related income losses due to treatment. In the general case where marginal utilities depend on the health state this rule must be modified.

  11. Mobile technology: streamlining practice and improving care


    Blake, Holly


    The use of mobile phones in care delivery has the potential to improve the way in which care is delivered. When implemented effectively, mobile technologies can empower patients and enhance communication between patients and their health-care providers. When barriers are recognised and addressed, mobile technologies can change working lives, facilitating rapid access to information and supporting efficiency in practice.

  12. Wind energy efficiency improvements

    Energy Technology Data Exchange (ETDEWEB)

    Hauge Madsen, P.; Badger, J.; Rasmussen, Flemming; Soerensen, Poul


    As we have shown above, wind energy can help to secure energy efficiency in power generation, and research results and tools are being developed that will increase the role of wind energy in the global energy supply. An important instrument is the development of wind turbine technology to reduce capital and operational costs. This has not been the emphasis in this chapter, though; instead we have focused on equally important instruments, namely making best use of the wind resource and available sites, adapting wind farm layout and technology to the increased exploitation of wind, and improving the interaction between wind farms and the power system. With these developments we expect that wind energy can become the backbone of the power system globally and play a major role in creating an efficient and sustainable power system. (Author)

  13. Nuclear energy efficiency improvements

    Energy Technology Data Exchange (ETDEWEB)

    Lauritzen, B.; Nonboel, E. [Technical Univ. of Denmark. DTU Nutech, Roskilde (Denmark); Kyrki-Rajamaeki, R. [Lappeenranta Univ. of Technology (Finland)


    Nuclear energy already today plays an important role in decarbonisation of the electricity sector while providing energy security and being economically competitive. Nuclear energy is characterized by its very high energy density and is well suited for large-scale, baseload electricity supply. Similar to renewable energy sources such as wind, solar or biomass, nuclear power is characterized by an abundant supply of its primary energy source, uranium, but is not limited to the same extent as these renewable energy sources from being an intermittent energy supply or imposing severe restrictions on land-use. Improving energy efficiency of nuclear power plants has contributed to a better utilization of the uranium resources and has helped improving the economic performance of nuclear power plants. This is to a large degree accomplished through optimisation of nuclear fuel assemblies as well as renewing turbines and generators. More importantly however, the overall economy of nuclear power has improved though better plant management leading to higher capacity factors and by extending the lifetimes of existing nuclear power plants. Provided that improved safety, economics and successful waste management can be demonstrated nuclear power is likely to grow in the future. Non-electricity applications may further boost the growth of nuclear energy, especially with the development of new reactor systems allowing for cogeneration of electricity and hydrogen or biofuels for transport. (Author)

  14. Efficiency improvements in transport

    Energy Technology Data Exchange (ETDEWEB)

    Schramm, J. [Technical Univ. of Denmark. DTU Mechanical Engineering, Kgs. Lyngby (Denmark); Christensen, Linda; Jensen, Thomas C. [Technical Univ. of Denmark. DTU Transport, Kgs. Lyngby (Denmark)


    Transport of people, personal belongings and goods in private cars is fundamental to our modern welfare society and economic growth, and has grown steadily over many decades. Motor fuels have been based almost entirely on crude oil for the last century. During the last couple of decades engines built for traditional fuels have become more advanced and efficient; this has reduced fuel consumption by around 40% and emissions by more than 90%. Only in the same time span have we begun to look at alternatives to fossil fuels. Biofuels such as biodiesel, bioethanol, biomethanol and biogas can replace petrol and diesel, and in recent years algae have shown a new potential for diesel fuel. Natural gas is also becoming an interesting fuel due to its large resources worldwide. GTL, CTL and BTL are liquid fuels produced from solid or gaseous sources. GTL and CTL are expensive to produce and not very CO{sub 2}-friendly, but they are easily introduced and need little investment in infrastructure and vehicles. DME is an excellent fuel for diesel engines. Methanol and DME produced from biomass are among the most CO{sub 2}-reducing fuels and at the same time the most energy-efficient renewable fuels. Fuel cell vehicles (FCVs) are currently fuelled by hydrogen, but other fuels are also possible. There are, however, several barriers to the implementation of fuel cell vehicles. In particular, a hydrogen infrastructure needs to be developed. Electric vehicles (EVs) have the advantage that energy conversion is centralised at the power plant where it can be done at optimum efficiency and emissions. EVs have to be charged at home, and also away from home when travelling longer distances. With an acceptable fast charging infrastructure at least 85% of the one-car families in Denmark could be potential EV customers. Range improvements resulting from better batteries are expected to create a large increase in the number of EVs in Denmark between 2020 and 2030. The hybrid electric vehicle

  15. Refines Efficiency Improvement

    Energy Technology Data Exchange (ETDEWEB)



    Refinery processes that convert heavy oils to lighter distillate fuels require heating for distillation, hydrogen addition or carbon rejection (coking). Efficiency is limited by the formation of insoluble carbon-rich coke deposits. Heat exchangers and other refinery units must be shut down for mechanical coke removal, resulting in a significant loss of output and revenue. When a residuum is heated above the temperature at which pyrolysis occurs (340 C, 650 F), there is typically an induction period before coke formation begins (Magaril and Aksenova 1968, Wiehe 1993). To avoid fouling, refiners often stop heating a residuum before coke formation begins, using arbitrary criteria. In many cases, this heating is stopped sooner than need be, resulting in less than maximum product yield. Western Research Institute (WRI) has developed innovative Coking Index concepts (patent pending) which can be used for process control by refiners to heat residua to the threshold, but not beyond the point at which coke formation begins when petroleum residua materials are heated at pyrolysis temperatures (Schabron et al. 2001). The development of this universal predictor solves a long standing problem in petroleum refining. These Coking Indexes have great potential value in improving the efficiency of distillation processes. The Coking Indexes were found to apply to residua in a universal manner, and the theoretical basis for the indexes has been established (Schabron et al. 2001a, 2001b, 2001c). For the first time, a few simple measurements indicates how close undesired coke formation is on the coke formation induction time line. The Coking Indexes can lead to new process controls that can improve refinery distillation efficiency by several percentage points. Petroleum residua consist of an ordered continuum of solvated polar materials usually referred to as asphaltenes dispersed in a lower polarity solvent phase held together by intermediate polarity materials usually referred to as

  16. Orthogeriatric care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Tarazona-Santabalbina FJ


    Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

  17. Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

    Directory of Open Access Journals (Sweden)

    Soumerai Stephen B


    Full Text Available Abstract Background Managed care organizations use a variety of strategies to reduce the cost and improve the quality of medication use. The effectiveness of such policies is not well understood. The objective of this research was to update a previous systematic review of interventions, published between 1966 and 2001, to improve the quality and efficiency of medication use in the US managed care setting. Methods We searched MEDLINE and EMBASE for publications from July 2001 to January 2007 describing interventions targeting drug use conducted in the US managed care setting. We categorized studies by intervention type and adequacy of research design using commonly accepted criteria. We summarized the outcomes of well-controlled strategies and documented the significance and magnitude of effects for key study outcomes. Results We identified 164 papers published during the six-year period. Predominant strategies were: educational interventions (n = 20, including dissemination of educational materials, and group or one-to-one educational outreach; monitoring and feedback (n = 22, including audit/feedback and computerized monitoring; formulary interventions (n = 66, including tiered formulary and patient copayment; collaborative care involving pharmacists (n = 15; and disease management with pharmacotherapy as a primary focus (n = 41, including care for depression, asthma, and peptic ulcer disease. Overall, 51 studies met minimum criteria for methodological adequacy. Effective interventions included one-to-one academic detailing, computerized alerts and reminders, pharmacist-led collaborative care, and multifaceted disease management. Further, changes in formulary tier-design and related increases in copayments were associated with reductions in medication use and increased out-of-pocket spending by patients. The dissemination of educational materials alone had little or no impact, while the impact of group education was inconclusive. Conclusion

  18. Improved wound care product

    DEFF Research Database (Denmark)


    The present invention pertains to use of sodium diacetate (NaHAc 2) as an antimicrobial agent against bacteria growing in biofilms. The aspects of the invention include a wound care product comprising sodium diacetate, a kit comprising a wound care product,and a methodof treating an infected wound....

  19. Improving OR Efficiency. (United States)

    Vassell, Patricia


    The high-cost/high-revenue environment of the OR requires special attention from managers to scrutinize and reduce costs. In the OR, nonlabor cost savings (ie, no staff member will be laid off or reclassified to realize cost savings) can typically be identified most readily. Operational costs in the OR are affected by start times, turnover times, cancellation rates, and adequate supplies, equipment, and staffing. Inefficiency in the OR can increase costs and lead to dissatisfied patients, physicians, and staff members. This article describes concepts that contribute to efficiency in the OR and illustrates the importance of staff member engagement in achieving desired outcomes.

  20. Uniform guidelines improve client care. (United States)

    Barnett, B


    Uniform national guidelines on the delivery of family planning methods and services improve client care, assuming these guidelines are based on current scientific information. Compliance with these guidelines yields safe and efficient delivery of family planning services. Service providers need information, training, supplies, and guidelines to deliver quality services. Guidelines contribute to consistency among family planning programs in different settings. Even though clinics may not provide the same services, the guidelines allow them to provide the same standards of care. Specifically, eligibility criteria, contraindications, and follow-up schedules are the same regardless of the service delivery point. Various international health organizations (such as World Health Organization, USAID, Program for International Training in Health, International Planned Parenthood Federation, and Association for Voluntary Surgical Contraception) have developed guidelines for family planning service delivery. Governments can use these documents to develop national family planning guidelines and policies. They should adapt the guidelines to local needs and consider program resources. After development of the national guidelines, training, workshops, and dissemination of written materials should be provided for policymakers, physicians, nurses, and other health providers. Countries that have either developed or are working to draft their own national guidelines are Cameroon, Ghana, Mexico, and Nepal.

  1. Improving Gas Flooding Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Reid Grigg; Robert Svec; Zheng Zeng; Alexander Mikhalin; Yi Lin; Guoqiang Yin; Solomon Ampir; Rashid Kassim


    This study focuses on laboratory studies with related analytical and numerical models, as well as work with operators for field tests to enhance our understanding of and capabilities for more efficient enhanced oil recovery (EOR). Much of the work has been performed at reservoir conditions. This includes a bubble chamber and several core flood apparatus developed or modified to measure interfacial tension (IFT), critical micelle concentration (CMC), foam durability, surfactant sorption at reservoir conditions, and pressure and temperature effects on foam systems.Carbon dioxide and N{sub 2} systems have been considered, under both miscible and immiscible conditions. The injection of CO2 into brine-saturated sandstone and carbonate core results in brine saturation reduction in the range of 62 to 82% brine in the tests presented in this paper. In each test, over 90% of the reduction occurred with less than 0.5 PV of CO{sub 2} injected, with very little additional brine production after 0.5 PV of CO{sub 2} injected. Adsorption of all considered surfactant is a significant problem. Most of the effect is reversible, but the amount required for foaming is large in terms of volume and cost for all considered surfactants. Some foams increase resistance to the value beyond what is practical in the reservoir. Sandstone, limestone, and dolomite core samples were tested. Dissolution of reservoir rock and/or cement, especially carbonates, under acid conditions of CO2 injection is a potential problem in CO2 injection into geological formations. Another potential change in reservoir injectivity and productivity will be the precipitation of dissolved carbonates as the brine flows and pressure decreases. The results of this report provide methods for determining surfactant sorption and can be used to aid in the determination of surfactant requirements for reservoir use in a CO{sub 2}-foam flood for mobility control. It also provides data to be used to determine rock permeability

  2. Improving efficiency in meat production. (United States)

    Brameld, John M; Parr, Tim


    Selective breeding and improved nutritional management over the past 20-30 years has resulted in dramatic improvements in growth efficiency for pigs and poultry, particularly lean tissue growth. However, this has been achieved using high-quality feed ingredients, such as wheat and soya that are also used for human consumption and more recently biofuels production. Ruminants on the other hand are less efficient, but are normally fed poorer quality ingredients that cannot be digested by human subjects, such as grass or silage. The challenges therefore are to: (i) maintain the current efficiency of growth of pigs and poultry, but using more ingredients not needed to feed the increasing human population or for the production of biofuels; (ii) improve the efficiency of growth in ruminants; (iii) at the same time produce animal products (meat, milk and eggs) of equal or improved quality. This review will describe the use of: (a) enzyme additives for animal feeds, to improve feed digestibility; (b) known growth promoting agents, such as growth hormone, β-agonists and anabolic steroids, currently banned in the European Union but used in other parts of the world; (c) recent transcriptomic studies into molecular mechanisms for improved growth efficiency via low residual feed intake. In doing so, the use of genetic manipulation in animals will also be discussed.

  3. Caseload management skills for improved efficiency. (United States)

    Ervin, Naomi E


    This article provides information about caseload management, which was one of a group of six competencies identified by nurse administrators as needed by new baccalaureate graduates. Caseload management is an important skill for nurses who work with caseloads of patients or clients (e.g., home health nurses, public health nurses, case managers, ambulatory care nurses). Because inadequate information about caseload management is contained in community health nursing textbooks, continuing education and staff development programs need to include caseload management skills to improve the efficiency and quality of nursing care.

  4. Efficiency of a Care Coordination Model: A Randomized Study with Stroke Patients (United States)

    Claiborne, Nancy


    Objectives: This study investigated the efficiency of a social work care coordination model for stroke patients. Care coordination addresses patient care and treatment resources across the health care system to reduce risk, improve clinical outcomes, and maximize efficiency. Method: A randomly assigned, pre-post experimental design measured…

  5. Fuel Efficiencies Through Airframe Improvements (United States)

    Bezos-O'Connor, Gaudy M.; Mangelsdorf, Mark F.; Maliska, Heather A.; Washburn, Anthony E.; Wahls, Richard A.


    The factors of continuing strong growth in air traffic volume, the vital role of the air transport system on the economy, and concerns about the environmental impact of aviation have added focus to the National Aeronautics Research Policy. To address these concerns in the context of the National Policy, NASA has set aggressive goals in noise reduction, emissions, and energy consumption. With respect to the goal of reducing energy consumption in the fleet, the development of promising airframe technologies is required to realize the significant improvements that are desired. Furthermore, the combination of advances in materials and structures with aerodynamic technologies may lead to a paradigm shift in terms of potential configurations for the future. Some of these promising airframe technologies targeted at improved efficiency are highlighted.

  6. Information Technology to Support Improved Care For Chronic Illness


    Young, Alexander S.; Chaney, Edmund; Shoai, Rebecca; Bonner, Laura; Cohen, Amy N.; Doebbeling, Brad; Dorr, David; Goldstein, Mary K.; Kerr, Eve; Nichol, Paul; Perrin, Ruth


    Background In populations with chronic illness, outcomes improve with the use of care models that integrate clinical information, evidence-based treatments, and proactive management of care. Health information technology is believed to be critical for efficient implementation of these chronic care models. Health care organizations have implemented information technologies, such as electronic medical records, to varying degrees. However, considerable uncertainty remains regarding the relative ...

  7. ACO model should encourage efficient care delivery. (United States)

    Toussaint, John; Krueger, David; Shortell, Stephen M; Milstein, Arnold; Cutler, David M


    The independent Office of the Actuary for CMS certified that the Pioneer ACO model has met the stringent criteria for expansion to a larger population. Significant savings have accrued and quality targets have been met, so the program as a whole appears to be working. Ironically, 13 of the initial 32 enrollees have left. We attribute this to the design of the ACO models which inadequately support efficient care delivery. Using Bellin-ThedaCare Healthcare Partners as an example, we will focus on correctible flaws in four core elements of the ACO payment model: finance spending and targets, attribution, and quality performance.

  8. Improving Customer Service in Elderly Care


    Nielsen, Chris


    The elderly care sector is increasingly facing more competition and demanding customers. This leads to a growing pressure on elderly care home providers to find new and improved solutions that will enhance their level of customer service. The will ensure that the elderly service provider is remaining competitive in the elderly care service marketplace. The purpose of this thesis is to identify areas for improvements and propose implementable solutions for enhancing the elderly care custom...

  9. African primary care research: Quality improvement cycles

    Directory of Open Access Journals (Sweden)

    Claire Van Deventer


    Full Text Available Improving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal.

  10. African primary care research: quality improvement cycles. (United States)

    van Deventer, Claire; Mash, Bob


    Improving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal.

  11. An electronic dashboard to improve nursing care. (United States)

    Tan, Yung-Ming; Hii, Joshua; Chan, Katherine; Sardual, Robert; Mah, Benjamin


    With the introduction of CPOE systems, nurses in a Singapore hospital were facing difficulties monitoring key patient information such as critical tasks and alerts. Issues include unfriendly user interfaces of clinical systems, information overload, and the loss of visual cues for action due to paperless workflows. The hospital decided to implement an interactive electronic dashboard on top of their CPOE system to improve visibility of vital patient data. A post-implementation survey was performed to gather end-user feedback and evaluate factors that influence user satisfaction of the dashboard. Questionnaires were sent to all nurses of five pilot wards. 106 valid responses were received. User adoption was good with 86% of nurses using the dashboard every shift. Mean satisfaction score was 3.6 out of 5. User satisfaction was strongly and positively correlated to the system's perceived impact on work efficiency and care quality. From qualitative feedback, nurses generally agreed that the dashboard had improved their awareness of critical patient issues without the hassle of navigating a CPOE system. This study shows that an interactive clinical dashboard when properly integrated with a CPOE system could be a useful tool to improve daily patient care.

  12. Corporate Accounting Policy Efficiency Improvement

    Directory of Open Access Journals (Sweden)

    Elena K. Vorobei


    Full Text Available The article is focused on the issues of efficient use of different methods of tax accounting for the optimization of income tax expenses and their consolidation in corporate accounting policy. The article makes reasoned conclusions, concerning optimal selection of depreciation methods for tax and bookkeeping accounting and their consolidation in corporate accounting policy and consolidation of optimal methods of cost recovery in production, considering business environment. The impact of the selected methods on corporate income tax rates and corporate property tax rates was traced and tax recovery was estimated.

  13. Can health care teams improve primary care practice? (United States)

    Grumbach, Kevin; Bodenheimer, Thomas


    In health care settings, individuals from different disciplines come together to care for patients. Although these groups of health care personnel are generally called teams, they need to earn true team status by demonstrating teamwork. Developing health care teams requires attention to 2 central questions: who is on the team and how do team members work together? This article chiefly focuses on the second question. Cohesive health care teams have 5 key characteristics: clear goals with measurable outcomes, clinical and administrative systems, division of labor, training of all team members, and effective communication. Two organizations are described that demonstrate these components: a private primary care practice in Bangor, Me, and Kaiser Permanente's Georgia region primary care sites. Research on patient care teams suggests that teams with greater cohesiveness are associated with better clinical outcome measures and higher patient satisfaction. In addition, medical settings in which physicians and nonphysician professionals work together as teams can demonstrate improved patient outcomes. A number of barriers to team formation exist, chiefly related to the challenges of human relationships and personalities. Taking small steps toward team development may improve the work environment in primary care practices.

  14. Adenosine improves cardiomyocyte respiratory efficiency. (United States)

    Babsky, A M; Doliba, M M; Doliba, N M; Osbakken, M D


    The role of adenosine on the regulation of mitochondrial function has been studied. In order to evaluate this the following experiments were done in isolated rat cardiomyocites and mitochondria using polarographic techniques. Cardiomyocyte oxygen consumption (MVO2) and mitochondrial respiratory function (State 3 and State 4, respiratory control index, and ADP/O ratio) were evaluated after exposure to adenosine. Cardiomyocyte MVO2 was significantly lower in cells previously exposed to adenosine (10 microM, 15 min or 30 min cell incubation) than in cells not exposed to adenosine (control). Addition of dipyridamole (10 microM) or 8-(p-Sulfophenyl) theophylline (50 microM) to cardiomyocytes before adenosine incubation prevented the adenosine-induced changes in MVO2. Mitochondria obtained from isolated perfused beating heart previously perfused with adenosine (10 microM, 30 min heart perfusion) also resulted in significant increases in ADP/O and respiratory control index compared to matching control. Mitochondria isolated from cardiomyocytes previously exposed to adenosine (10 microM, 15 min or 30 min cell incubation) resulted in a significant increase in mitochondrial ADP/O ratio compared to control. Adenosine-induced decrease in cardiomyocyte MVO2 may be related to an increase in efficiency of mitochondrial oxidative phosphorylation, and more economical use of oxygen, which is necessary for survival under ischemic stress.

  15. Home Care Nursing Improves Cancer Symptom Management (United States)

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  16. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

    Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell


    To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry...... was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators....

  17. Monitoring and improving care in thoracic surgery


    Numan, R.C.


    Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This increasing complexity demands a multidisciplinary approach rearranging pre-, peri- and postoperative care in a way safety, efficiency and high quality are guaranteed. The safety and quality of healthca...

  18. Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care. (United States)

    Fisher, Elisa; Hasselberg, Michael; Conwell, Yeates; Weiss, Linda; Padrón, Norma A; Tiernan, Erin; Karuza, Jurgis; Donath, Jeremy; Pagán, José A


    Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO(®) (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.

  19. The Gains from Improved Market Efficiency

    DEFF Research Database (Denmark)

    Persson, Karl Gunnar; Ejrnæs, Mette

    faster, violations of the law of one price become smaller and hence less persistent. There were also significant gains from improved market efficiency but that improvement took place after the information ‘regime’ shifted from pre-telegraphic communication to a regime with swift transmission...... of information in an era which developed a sophisticated commercial press and telegraphic communication. Improved market efficiency probably stimulated trade more than falling transport costs......This paper looks at the gains from improved market efficiency in long-distance grain trade in the second half of the 19th century when violations of the law of one price were reduced due to improved information transmission. Two markets, a major export centre, Chicago, and a major importer...

  20. Improving plasmonic waveguides coupling efficiency using nanoantennas

    DEFF Research Database (Denmark)

    Andryieuski, Andrei; Malureanu, Radu; Bouillard, Jean-Sebastien;


    Plasmonic waveguides bear a lot of potential for photonic applications. However, one of the challenges for implementing them in devices is the low coupling efficiency to and from optical fibers. We report on our approach to facilitate the coupling efficiency with the use of metallic nanoantennas....... The classical dipole antenna scheme can be improved by changing the nanoantenna geometry, adding constructive elements such as reflecting bars and mirrors and using arrays of antennas. The modelling designates that the coupling efficiency from a vertical fiber to a plasmonic waveguide can be improved more than...

  1. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich


    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection. Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  2. An empirical investigation of the efficiency effects of integrated care models in Switzerland

    Directory of Open Access Journals (Sweden)

    Oliver Reich


    Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency.Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model.Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection.Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

  3. Dynamic culture improves cell reprogramming efficiency. (United States)

    Sia, Junren; Sun, Raymond; Chu, Julia; Li, Song


    Cell reprogramming to pluripotency is an inefficient process and various approaches have been devised to improve the yield of induced pluripotent stem cells. However, the effect of biophysical factors on cell reprogramming is not well understood. Here we showed that, for the first time, dynamic culture with orbital shaking significantly improved the reprogramming efficiency in adherent cells. Manipulating the viscosity of the culture medium suggested that the improved efficiency is mainly attributed to convective mixing rather than hydrodynamic shear stress. Temporal studies demonstrated that the enhancement of reprogramming efficiency required the dynamic culture in the middle but not early phase. In the early phase, fibroblasts had a high proliferation rate, but as the culture became over-confluent in the middle phase, expression of p57 was upregulated to inhibit cell proliferation and consequently, cell reprogramming. Subjecting the over confluent culture to orbital shaking prevented the upregulation of p57, thus improving reprogramming efficiency. Seeding cells at low densities to avoid over-confluency resulted in a lower efficiency, and optimal reprogramming efficiency was attained at a high seeding density with dynamic culture. Our findings provide insight into the underlying mechanisms of how dynamic culture condition regulate cell reprogramming, and will have broad impact on cell engineering for regenerative medicine and disease modeling.

  4. Improving Care for Children With Complex Needs (United States)


    Medically Complex Children; Care Coordination; Case Manager; Care Manager; Collaborative Care; Disease Management; Patient Care Team or Organization; Managed Care; Children With Chronic Conditions; Children With Special Health Care Needs; Shared Care Plan; Patient Care Plan; Health Care and Resource Utilization; Adherence to Care; Functional Status and Productivity; Health Related Quality of Life; Satisfaction With Care; Care Coordinator; Family Experience of Care; Quality Health Care

  5. Improving educational preparation for transcultural health care. (United States)

    Le Var, R M


    There is increasing evidence that the health care needs of people from black and ethnic minority groups in England are not being met. A growing number of initiatives are being undertaken to remedy the situation. Many of them are focused on health care delivery at local and national levels. However, unless the preparation of health care professionals in the area of multi-cultural health care is appropriate and effective, a great deal of corrective action will continue to have to be taken. Despite 1997 having been the European Year Against Racism, it is still necessary to consider what educational preparation should be like. The article draws on identified inadequacies in health care provision as well as examples of initiatives taken to improve care provision. The author identifies deficiencies in educational preparation and proposes a range of actions to be taken. The article is focused on nursing, midwifery and health visiting education in England, but is deemed to be relevant to all health care professionals not only in Europe but other continents, as they become increasingly international and multi-ethnic.

  6. Does participation in health information exchange improve hospital efficiency? (United States)

    Walker, Daniel M


    The federal government allocated nearly $30 billion to spur the development of information technology infrastructure capable of supporting the exchange of interoperable clinical data, leading to growth in hospital participation in health information exchange (HIE) networks. HIEs have the potential to improve care coordination across healthcare providers, leading ultimately to increased productivity of health services for hospitals. However, the impact of HIE participation on hospital efficiency remains unclear. This dynamic prompts the question asked by this study: does HIE participation improve hospital efficiency. This study estimates the effect of HIE participation on efficiency using a national sample of 1017 hospitals from 2009 to 2012. Using a two-stage analytic design, efficiency indices were determined using the Malmquist algorithm and then regressed on a set of hospital characteristics. Results suggest that any participation in HIE can improve both technical efficiency change and total factor productivity (TFP). A second model examining total years of HIE participation shows a benefit of one and three years of participation on TFP. These results suggest that hospital investment in HIE participation may be a useful strategy to improve hospital operational performance, and that policy should continue to support increased participation and use of HIE. More research is needed to identify the exact mechanisms through which HIE participation can improve hospital efficiency.

  7. Sampling considerations for health care improvement. (United States)

    Perla, Rocco J; Provost, Lloyd P; Murray, Sandra K


    Sampling in improvement work can pose challenges. How is it different from the sampling strategies many use with research, clinical trials, or regulatory programs? What should improvement teams consider when determining a useful approach to sampling and a useful sample size? The aim of this article is to introduce some of the concepts related to sampling for improvement. We give specific guidance related to determining a useful sample size to a wider health care audience so that it can be applied to improvement projects in hospitals and health systems.

  8. Improving trauma care in Trinidad and Tobago. (United States)

    Adam, R; Stedman, M; Winn, J; Howard, M; Williams, J I; Ali, J


    Identification of trauma as a major cause of morbidity and mortality in Trinidad and Tobago prompted the establishment of a training programme aimed at improving trauma care in this developing country. An Advanced Trauma Life Support (ATLS) programme for physicians, funded through the Canadian International Development Agency resulted in a statistically significant improvement of in-hospital trauma patient outcome at the Port-of-Spain General Hospital (observed to expected mortality ratio of 3.16 pre-ATLS compared to 1.94 post-ATLS). A recent analysis of all motor vehicle injuries for a shorter period did not confirm this positive impact of the ATLS programme, primarily because a large number of these patients died in the pre-hospital period. Pre-hospital trauma care therefore required urgent attention to complement the positive in-hospital impact of the ATLS programme. A second training programme (the Pre-Hospital Trauma Life Support or PHTLS) for paramedical personnel was thus instituted in 1990. Over 250 physicians have been trained in the ATLS programme and to date over 100 paramedical personnel have been trained in the PHTLS programme. Attempts have also been made to equip the ambulances with more appropriate resuscitative devices in order to improve pre-hospital care. The combination of the PHTLS and the ATLS programme should result in further improvement in the care of patients sustaining major injuries in Trinidad and Tobago.

  9. The Gains from Improved Market Efficiency

    DEFF Research Database (Denmark)

    Persson, Karl Gunnar; Ejrnæs, Mette

    This paper looks at the gains from improved market efficiency in long-distance grain trade in the second half of the 19th century when violations of the law of one price were reduced due to improved information transmission. Two markets, a major export centre, Chicago, and a major importer......, Liverpool, are analyzed. We show that there was a law of one price equilibrium throughout the period but that markets displayed spells of demand- or supply-constrained trade when the law of one price was violated. Over time adjustments back to equilibrium, as measured by the half-life of a shock, become...... faster, violations of the law of one price become smaller and hence less persistent. There were also significant gains from improved market efficiency but that improvement took place after the information ‘regime’ shifted from pre-telegraphic communication to a regime with swift transmission...

  10. Improving Electrical Efficiency of Edm Power Supply (United States)

    Toma, Emanoil; Simion, Carmen Mihaela


    This paper briefly presents the principal types of Pulse Generators for Electrical Discharge Machining and ways to improve electrical efficiency. A resonant converter with series-parallel LCC circuit, for EDM applications, was analyzed by PSpice simulation. The performances of EDM Power Supply were improved by adding an energy recovering - voltage limiter circuit. The shape of current pulse was changed by adding a supplementary MOSFET Switch in parallel with the gap. Two or more converters can be parallelized, in this way output current can be changed. A bloc-schema was conceived for EDM experimental set up

  11. Idaho Chemical Processing Plant Process Efficiency improvements

    Energy Technology Data Exchange (ETDEWEB)

    Griebenow, B.


    In response to decreasing funding levels available to support activities at the Idaho Chemical Processing Plant (ICPP) and a desire to be cost competitive, the Department of Energy Idaho Operations Office (DOE-ID) and Lockheed Idaho Technologies Company have increased their emphasis on cost-saving measures. The ICPP Effectiveness Improvement Initiative involves many activities to improve cost effectiveness and competitiveness. This report documents the methodology and results of one of those cost cutting measures, the Process Efficiency Improvement Activity. The Process Efficiency Improvement Activity performed a systematic review of major work processes at the ICPP to increase productivity and to identify nonvalue-added requirements. A two-phase approach was selected for the activity to allow for near-term implementation of relatively easy process modifications in the first phase while obtaining long-term continuous improvement in the second phase and beyond. Phase I of the initiative included a concentrated review of processes that had a high potential for cost savings with the intent of realizing savings in Fiscal Year 1996 (FY-96.) Phase II consists of implementing long-term strategies too complex for Phase I implementation and evaluation of processes not targeted for Phase I review. The Phase II effort is targeted for realizing cost savings in FY-97 and beyond.

  12. Improving Engine Efficiency Through Core Developments (United States)

    Heidmann, James D.


    The NASA Environmentally Responsible Aviation (ERA) Project and Fundamental Aeronautics Projects are supporting compressor and turbine research with the goal of reducing aircraft engine fuel burn and greenhouse gas emissions. The primary goals of this work are to increase aircraft propulsion system fuel efficiency for a given mission by increasing the overall pressure ratio (OPR) of the engine while maintaining or improving aerodynamic efficiency of these components. An additional area of work involves reducing the amount of cooling air required to cool the turbine blades while increasing the turbine inlet temperature. This is complicated by the fact that the cooling air is becoming hotter due to the increases in OPR. Various methods are being investigated to achieve these goals, ranging from improved compressor three-dimensional blade designs to improved turbine cooling hole shapes and methods. Finally, a complementary effort in improving the accuracy, range, and speed of computational fluid mechanics (CFD) methods is proceeding to better capture the physical mechanisms underlying all these problems, for the purpose of improving understanding and future designs.

  13. Improving air handler efficiency in houses

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain S.


    Although furnaces, air conditioners and heat pumps have become significantly more efficient over the last couple of decades, residential air handlers have typical efficiencies of only 10% to 15% due to poor electric motor performance and aerodynamically poor fans and fan housings. Substantial increases in performance could be obtained through improved air handler design and construction. A prototype residential air handler intended to address these issues has recently been developed. The prototype and a standard production fan were tested in a full-scale duct system and test chamber at LBNL specifically designed for testing heating, ventilation, and air conditioning systems. The laboratory tests compared efficiency, total airflow, sensitivity to duct system flow resistance, and the effects of installation in a smaller cabinet. The test results showed that the prototype air handler had about twice the efficiency of the standard air handler (averaged over a wide range of operating conditions) and was less sensitive to duct system flow resistance changes. The performance of both air handlers was significantly reduced by reducing the clearance between the air handler and cabinet it was placed in. These test results showed that in addition to the large scope for performance improvement, air handler fans need to be tested in the cabinets they operate in.

  14. Improving client-centred care and services : the role of front/back-office configurations

    NARCIS (Netherlands)

    Broekhuis, Manda; de Blok, C.; Meijboom, B.


    Improving client-centred care and services: the role of front/back-officeconfigurations. This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care, welfa


    Directory of Open Access Journals (Sweden)

    R. K. PAL


    Full Text Available Traditional biomass cookstoves have very low efficiency. The improved cookstoves have very high efficiency. These improved cookstoves with high efficiency saves biomass fuels. Biomass can be saved in case of rocket elbow cookstoves. The amount of biomass which can be saved in case of rocket elbow cookstoves is 65.88 MT. More biomass can be saved in case of gasifier fan cookstoves. The amount of biomass which can be saved is 155.71 MT. The pollutants like particulate matter, black carbon, carbon mono-oxide and carbon dioxide emission is lesser in case of rocket elbow cookstoves. The pollutants are least in case of gasifier fan cookstoves. The reduction in particulate matter, black carbon, carbon mono-oxide and carbon dioxide emission in gasifier fan cookstoves is 1.77 MT, 0.24 MT, 0.71 MT & 151.64 MT respectively in comparison to traditional cookstoves. Therefore indoor air pollution is greatly reduced in case of improved cookstoves especially in case of gasifier fan cookstoves as compared to traditional cookstoves.

  16. Practical Strategies to Improve Test Efficiency

    Institute of Scientific and Technical Information of China (English)

    DING Zhigang; WANG Hongcheng; LING Lianghe


    This paper introduces strategies to detect software bugs in earlier life cycle stage in order to improve test efficiency. Static analysis tool is one of the effective methods to reveal software bugs during software development. Three popular static analysis tools are introduced, two of which, PolySpace and Splint, are compared with each other by analyzing a set of test cases generatedd by the authors. PolySpace can reveal 60% bugs with 100% R/W ratio (ratio of real bugs and total warnings), while Splint reveal 73.3% bugs with 44% R/W ratio. And they are good at finding different categories of bugs. Two strategies are concluded to improve test efficiency, under the guideline that static analysis tools should be used in finding different categories of bugs according to their features. The first one aims at finding bugs as many as possible, while the second concentrates to reduce the average time on bug revelation. Experimental data shows the first strategy can find 100% bugs with 60% RAN ratio, the second one find 80% bugs with 66.7% R/W ratio. Experiment results prove that these two strategies can improve the test efficiency in both fault coverage and testing time.

  17. Improving Quality of Emergency Care Through Integration of Mental Health. (United States)

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David


    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.

  18. Practical strategies for increasing efficiency and effectiveness in critical care education. (United States)

    Joyce, Maurice F; Berg, Sheri; Bittner, Edward A


    Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.

  19. Practical strategies for increasing efficiency and effectiveness in critical care education (United States)

    Joyce, Maurice F; Berg, Sheri; Bittner, Edward A


    Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs. PMID:28224102

  20. Health care quality improvement publication trends. (United States)

    Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H


    To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.

  1. Tape write-efficiency improvements in CASTOR

    CERN Document Server

    Murray, S; Cancio, G; Cano, E; Kotlyar, V; Lo Presti, G; Lo Re, G; Ponce, S


    The CERN Advanced STORage manager (CASTOR) is used to archive to tape the physics data of past and present physics experiments. For reasons of physical storage space, all of the tape resident data in CASTOR are repacked onto higher density tapes approximately every two years. Improving the performance of writing files smaller than 2GB to tape is essential in order to keep the time needed to repack all of the tape resident data within a period of no more than 1 year. This paper reports on the solution to writing efficiently to tape that is currently in its early deployment phases at CERN.

  2. The gain from improved market efficiency

    DEFF Research Database (Denmark)

    Ejrnæs, Mette; Persson, Karl Gunnar


    , Liverpool, are analysed. We show that the law of one price equilibrium was an ‘attractor equilibrium'. The implication is that prices converged to that equilibrium in a tâtonnement process. Because of asymmetrically timed information between markets separated by long distances there were periods of excess...... demand as well as excess supply, which triggered off the tâtonnement process. Over time, adjustments to equilibrium, as measured by the half-life of a shock, became faster and violations of the law of one price become smaller. There were significant gains from improved market efficiency, which took place...

  3. Efficiency improvements in pipeline transportation systems

    Energy Technology Data Exchange (ETDEWEB)

    Banks, W. F.; Horton, J. F.


    This report identifies potential energy-conservative pipeline innovations that are most energy- and cost-effective and formulates recommendations for the R, D, and D programs needed to exploit those opportunities. From a candidate field of over twenty classes of efficiency improvements, eight systems are recommended for pursuit. Most of these possess two highly important attributes: large potential energy savings and broad applicability outside the pipeline industry. The R, D, and D program for each improvement and the recommended immediate next step are described. The eight technologies recommended for R, D, and D are gas-fired combined cycle compressor station; internally cooled internal combustion engine; methanol-coal slurry pipeline; methanol-coal slurry-fired and coal-fired engines; indirect-fired coal-burning combined-cycle pump station; fuel-cell pump station; drag-reducing additives in liquid pipelines; and internal coatings in pipelines.

  4. Judgment sampling: a health care improvement perspective. (United States)

    Perla, Rocco J; Provost, Lloyd P


    Sampling plays a major role in quality improvement work. Random sampling (assumed by most traditional statistical methods) is the exception in improvement situations. In most cases, some type of "judgment sample" is used to collect data from a system. Unfortunately, judgment sampling is not well understood. Judgment sampling relies upon those with process and subject matter knowledge to select useful samples for learning about process performance and the impact of changes over time. It many cases, where the goal is to learn about or improve a specific process or system, judgment samples are not merely the most convenient and economical approach, they are technically and conceptually the most appropriate approach. This is because improvement work is done in the real world in complex situations involving specific areas of concern and focus; in these situations, the assumptions of classical measurement theory neither can be met nor should an attempt be made to meet them. The purpose of this article is to describe judgment sampling and its importance in quality improvement work and studies with a focus on health care settings.

  5. MPACT Subgroup Self-Shielding Efficiency Improvements

    Energy Technology Data Exchange (ETDEWEB)

    Stimpson, Shane [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Liu, Yuxuan [Univ. of Michigan, Ann Arbor, MI (United States); Collins, Benjamin S. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Clarno, Kevin T. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)


    Recent developments to improve the efficiency of the MOC solvers in MPACT have yielded effective kernels that loop over several energy groups at once, rather that looping over one group at a time. These kernels have produced roughly a 2x speedup on the MOC sweeping time during eigenvalue calculation. However, the self-shielding subgroup calculation had not been reevaluated to take advantage of these new kernels, which typically requires substantial solve time. The improvements covered in this report start by integrating the multigroup kernel concepts into the subgroup calculation, which are then used as the basis for further extensions. The next improvement that is covered is what is currently being termed as “Lumped Parameter MOC”. Because the subgroup calculation is a purely fixed source problem and multiple sweeps are performed only to update the boundary angular fluxes, the sweep procedure can be condensed to allow for the instantaneous propagation of the flux across a spatial domain, without the need to sweep along all segments in a ray. Once the boundary angular fluxes are considered to be converged, an additional sweep that will tally the scalar flux is completed. The last improvement that is investigated is the possible reduction of the number of azimuthal angles per octant in the shielding sweep. Typically 16 azimuthal angles per octant are used for self-shielding and eigenvalue calculations, but it is possible that the self-shielding sweeps are less sensitive to the number of angles than the full eigenvalue calculation.

  6. Industrial energy-efficiency-improvement program

    Energy Technology Data Exchange (ETDEWEB)


    Progress made by industry toward attaining the voluntary 1980 energy efficiency improvement targets is reported. The mandatory reporting population has been expanded from ten original industries to include ten additional non-targeted industries and all corporations using over one trillion Btu's annually in any manufacturing industry. The ten most energy intensive industries have been involved in the reporting program since the signing of the Energy Policy and Conservation Act and as industrial energy efficiency improvement overview, based primarily on information from these industries (chemicals and allied products; primary metal industry; petroleum and coal products; stone, clay, and glass products; paper and allied products; food and kindred products; fabricated metal products; transportation equipment; machinery, except electrical; and textile mill products), is presented. Reports from industries, now required to report, are included for rubber and miscellaneous plastics; electrical and electronic equipment; lumber and wood; and tobacco products. Additional data from voluntary submissions are included for American Gas Association; American Hotel and Motel Association; General Telephone and Electronics Corporation; and American Telephone and Telegraph Company. (MCW)

  7. Improving energy efficiency in the transportation sector

    Energy Technology Data Exchange (ETDEWEB)

    Plotkin, S.E.


    A primary characteristic of transportation in the United States is its high per capita energy consumption. The average US citizen consumes nearly five times as much energy for transportation as the average Japanese and nearly three times as much as the average citizen of France, Britain, or West Germany. The energy efficiency of US transportation has improved substantially over the past two decades (both absolutely and in comparison to Europe), and US travel volume has grown more slowly than in most of the developed world. However, the United States still consumes more than one-third of the world`s transport energy. Also, 96 percent of US transport energy is in the form of oil products. This is more oil than the United States produces, despite its position as one of the world`s largest oil producers. With current problems and expectation of continued growth in travel and energy use, Congress has increasingly turned to transportation energy conservation - in the form of improvements in the technical efficiency of travel, increases in load factors, reductions in travel demand, shifting to alternative fuels, and shifts to more efficient travel modes - as an important policy goal. For example, the Clean Air Amendments of 1990 incorporate transportation demand management as a critical tool in reducing urban air pollution. Legislation proposed in the 102d Congress sought rigorous new automobile and light truck fuel economy standards. With continued increases in U.S. oil imports, urban traffic congestion, and greenhouse gas emissions, and the failure of many urban areas to meet air quality standards, strong congressional interest in new energy conservation initiates is likely to continue.

  8. Strengthening Nursing Education To Improve End-of-life Care. (United States)

    Ferrell, Betty R.; Virani, Rose; Grant, Marcia


    As the members of the health care team who spend the most time with patients who are facing death, nurses are aware of the need for improved end-of-life (EOL) care and have identified resources to achieve that goal by improving education. A survey of 725 nursing faculty and state boards indicates an awareness of the need for improved EOL care and…

  9. Improvement of Sweep Efficiency in Gasflooding

    Energy Technology Data Exchange (ETDEWEB)

    Kishore Mohanty


    Miscible and near-miscible gasflooding has proven to be one of the few cost effective enhance oil recovery techniques in the past twenty years. As the scope of gas flooding is being expanded to medium viscosity oils in shallow sands in Alaska and shallower reservoirs in the lower 48, there are questions about sweep efficiency in near-miscible regions. The goal of this research is to evaluate sweep efficiency of various gas flooding processes in a laboratory model and develop numerical tools to estimate their effectiveness in the field-scale. Quarter 5-spot experiments were conducted at reservoir pressure to evaluate the sweep efficiency of gas, WAG and foam floods. The quarter 5-spot model was used to model vapor extraction (VAPEX) experiments at the lab scale. A streamline-based compositional simulator and a commercial simulator (GEM) were used to model laboratory scale miscible floods and field-scale pattern floods. An equimolar mixture of NGL and lean gas is multicontact miscible with oil A at 1500 psi; ethane is a multicontact miscible solvent for oil B at pressures higher than 607 psi. WAG improves the microscopic displacement efficiency over continuous gas injection followed by waterflood in corefloods. WAG improves the oil recovery in the quarter 5-spot over the continuous gas injection followed by waterflood. As the WAG ratio increases from 1:2 to 2:1, the sweep efficiency in the 5-spot increases, from 39.6% to 65.9%. A decrease in the solvent amount lowers the oil recovery in WAG floods, but significantly higher amount of oil can be recovered with just 0.1 PV solvent injection over just waterflood. Use of a horizontal production well lowers the oil recovery over the vertical production well during WAG injection phase in this homogeneous 5-spot model. Estimated sweep efficiency decreases from 61.5% to 50.5%. In foam floods, as surfactant to gas slug size ratio increases from 1:10 to 1:1, oil recovery increases. In continuous gasflood VAPEX processes, as the

  10. Diagnosing and improving functioning in interdisciplinary health care teams. (United States)

    Blackmore, Gail; Persaud, D David


    Interdisciplinary teams play a key role in the delivery of health care. Team functioning can positively or negatively impact the effective and efficient delivery of health care services as well as the personal well-being of group members. Additionally, teams must be able and willing to work together to achieve team goals within a climate that reflects commitment to team goals, accountability, respect, and trust. Not surprisingly, dysfunctional team functioning can limit the success of interdisciplinary health care teams. The first step in improving dysfunctional team function is to conduct an analysis based on criteria necessary for team success, and this article provides meaningful criteria for doing such an analysis. These are the following: a common team goal, the ability and willingness to work together to achieve team goals, decision making, communication, and team member relationships. High-functioning interdisciplinary teams must exhibit features of good team function in all key domains. If a team functions well in some domains and needs to improve in others, targeted strategies are described that can be used to improve team functioning.

  11. Structuring diabetes care in general practices: many improvements, remaining challenges.

    LENUS (Irish Health Repository)

    Jennings, S


    BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

  12. Improving Energy Efficiency in CNC Machining (United States)

    Pavanaskar, Sushrut S.

    We present our work on analyzing and improving the energy efficiency of multi-axis CNC milling process. Due to the differences in energy consumption behavior, we treat 3- and 5-axis CNC machines separately in our work. For 3-axis CNC machines, we first propose an energy model that estimates the energy requirement for machining a component on a specified 3-axis CNC milling machine. Our model makes machine-specific predictions of energy requirements while also considering the geometric aspects of the machining toolpath. Our model - and the associated software tool - facilitate direct comparison of various alternative toolpath strategies based on their energy-consumption performance. Further, we identify key factors in toolpath planning that affect energy consumption in CNC machining. We then use this knowledge to propose and demonstrate a novel toolpath planning strategy that may be used to generate new toolpaths that are inherently energy-efficient, inspired by research on digital micrography -- a form of computational art. For 5-axis CNC machines, the process planning problem consists of several sub-problems that researchers have traditionally solved separately to obtain an approximate solution. After illustrating the need to solve all sub-problems simultaneously for a truly optimal solution, we propose a unified formulation based on configuration space theory. We apply our formulation to solve a problem variant that retains key characteristics of the full problem but has lower dimensionality, allowing visualization in 2D. Given the complexity of the full 5-axis toolpath planning problem, our unified formulation represents an important step towards obtaining a truly optimal solution. With this work on the two types of CNC machines, we demonstrate that without changing the current infrastructure or business practices, machine-specific, geometry-based, customized toolpath planning can save energy in CNC machining.

  13. Social networks in improvement of health care. (United States)

    Masic, Izet; Sivic, Suad; Toromanovic, Selim; Borojevic, Tea; Pandza, Haris


    , etc., which gives a special emphasis on public health aspects of information, especially in the field of medicine and health care. The authors of this paper discuss the role and practical importance of social networks in improving the health and solving of health problems without the physical entrance into the health care system. Social networks have their advantages and disadvantages, benefits and costs, especially when it comes to information which within the network set unprofessional people from unreliable sources, without an adequate selection. The ethical aspect of the norms in this segment is still not adequately regulated, so any sanctions for the unauthorized and malicious use of social networks in private and other purposes in order to obtain personal gain at the expense of individuals or groups (sick or healthy, owners of certain businesses and companies, health organizations and pharmaceutical manufacturers, etc.), for which there is still no global or European codes and standards of conduct. Cyber crime is now one of the mostly present types of crime in modern times, as evidenced by numerous scandals that are happening both globally and locally.

  14. Hospital medicine (Part 2): what would improve acute hospital care?

    LENUS (Irish Health Repository)

    Kellett, John


    There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

  15. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria


    Okoli Ugo; Eze-Ajoku Ezinne; Oludipe Modupe; Spieker Nicole; Ekezie Winifred; Ohiri Kelechi


    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

  16. Improving pumping system efficiency at coal plants

    Energy Technology Data Exchange (ETDEWEB)

    Livoti, W.C.; McCandless, S.; Poltorak, R. [Baldor Electric Co. (United States)


    The industry must employ ultramodern technologies when building or upgrading power plant pumping systems thereby using fuels more efficiently. The article discusses the uses and efficiencies of positive displacement pumps, centrifugal pumps and multiple screw pumps. 1 ref., 4 figs.

  17. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.


    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  18. Efficiency improvement of thermal coal power plants

    Energy Technology Data Exchange (ETDEWEB)

    Hourfar, D. [VEBA Kraftwerke Ruhr Ag, Gelsenkirchen (Germany)


    The discussion concerning an increase of the natural greenhouse effect by anthropogenic changes in the composition of the atmosphere has increased over the past years. The greenhouse effect has become an issue of worldwide debate. Carbon dioxide is the most serious emission of the greenhouse gases. Fossil-fired power plants have in the recent past been responsible for almost 30 % of the total CO{sub 2} emissions in Germany. Against this background the paper will describe the present development of CO{sub 2} emissions from power stations and present actual and future opportunities for CO{sub 2} reduction. The significance attached to hard coal as one of today`s prime sources of energy with the largest reserves worldwide, and, consequently, its importance for use in power generation, is certain to increase in the years to come. The further development of conventional power plant technology, therefore, is vital, and must be carried out on the basis of proven operational experience. The main incentive behind the development work completed so far has been, and continues to be, the achievement of cost reductions and environmental benefits in the generation of electricity by increasing plant efficiency, and this means that, in both the short and the long term, power plants with improved conventional technology will be used for environmentally acceptable coal-fired power generation.

  19. Relationships between technical efficiency and the quality and costs of health care in Italy† (United States)

    Nuti, S.; Daraio, C.; Speroni, C.; Vainieri, M.


    Objectives This paper reports the measurement of technical efficiency of Tuscan Local Health Authorities and its relationship with quality and appropriateness of care. Design First, a bias-corrected measure of technical efficiency was developed using the bootstrap technique applied to data envelopment analysis. Then, correlation analysis was used to investigate the relationships among technical efficiency, quality and appropriateness of care. Setting and Participants These analyses have been applied to the Local Health Authorities of Tuscany Region (Italy), which provide not only hospital inpatient services, but also prevention and primary care. All top managers of Tuscan Local Health Authorities were involved in selection of the inputs and outputs for calculating technical efficiency. Main Outcome Measures The main measures used in this study are volume, quality and appropriateness indicators monitored by the multidimensional performance evaluation system developed in the Tuscany Region. Results On average, Tuscan Local Health Authorities experienced 14(%) of bias-corrected inefficiency in 2007. Correlation analyses showed a significant negative correlation between per capita costs and overall performance. No correlation was found in 2007 between technical efficiency and overall performance or between technical efficiency and per capita costs. Conclusions Technical efficiency cannot be considered as an extensive measure of healthcare performance, but evidence shows that Tuscan Local Health Authorities have room for improvement in productivity levels. Indeed, correlation findings suggest that, to pursue financial sustainability, Local Health Authorities mainly have to improve their performance in terms of quality and appropriateness. PMID:21454349

  20. Improving depression care: barriers, solutions, and research needs. (United States)

    Von Korff, M; Katon, W; Unützer, J; Wells, K; Wagner, E H


    Potential solutions for barriers to improved organization of care of depressive illness were identified. These included (1) aligning efforts to improve depression care with broader strategies for improving care of other chronic conditions; (2) increasing the availability of depression case management services in primary care; (3) developing registries and reminder systems to ensure active follow-up of depressed patients; (4) achieving agreement on how depression outcomes should be measured to provide outcomes-based performance standards; (5) providing greater support from mental health specialists for management of depressed patients by primary care providers; (6) campaigns to reduce the stigma associated with treatment of depressive illness; (7) increased dissemination of interventions that activate and empower patients managing a depressive illness; (8) redefining the lack of time of primary care providers for high-quality depression care as issues in organization of care and provider training; and (9) development of incentives (organizational or financial) for high-quality depression care. Research needs were identified according to what has been learned to date. Identified research needs included: studies of approaches to organization of case management, research in new populations (e.g., new diagnostic groups, rural populations, the disadvantaged, the elderly, and those with chronic medical illnesses), research on stepped care and relapse prevention strategies, evaluation of the societal benefits of improved depression care, and multisite trials and meta-analytic approaches that can provide adequate statistical power to assess societal benefits of improved care.

  1. Improving primary health care through technological innovation.

    NARCIS (Netherlands)

    Groenewegen, P.P.; Hutten, J.B.F.


    As a result of policy changes and developments on the demand side, the importance of technology in primary health care will grow fast. An approach to the implementation of new technologies in primary health care is presented in this article. First we describe the main problems in Dutch primary healt

  2. Continuous improvement and TQM in health care: an emerging operational paradigm becomes a strategic imperative. (United States)

    Swinehart, K; Green, R F


    Argues that US health care is in a state of crisis. Escalating costs account for 13 per cent of GNP, making health care the third largest industry in the USA, and spending is expected to increase. Claims health-care providers need to control rising costs, improve productivity and flexibility, adopt appropriate technologies, and maintain competitive levels of quality and value. States that TQM may provide an environment that will focus on quality of patient care and continuous quality improvement at all levels of the organization including the governing body, the administrative, managerial, and clinical areas. Any new national or state health-care plan will force providers to be more efficient while maintaining quality standards. Concludes that it will be strategically imperative that health-care providers ranging from family physicians to major medical centres and suppliers ranging from laboratories to pharmaceutical firms establish methods for making rapid continuous improvement and total quality management the cornerstone of the strategic planning process.

  3. Improving the efficiency of manuscript selection

    Directory of Open Access Journals (Sweden)

    A. Martínez–Abrain


    previous submittal were taken into account. Option b is suggested as an alternative to obliging authors to declare whether or not their submission was previously rejected by another journal, because they think this could prejudice the evaluation of the new submission. However, I believe that the system I propose here would prevent prejudiced evaluations because authors would have the opportunity to upload the response to reviewer’s comments so that second-round reviewers would have the chance to see both the problems previously de¬tected in the manuscript and the defence offered by authors. Although not a perfect system its benefits would probably outweigh the caveats. Such a system would improve the quality of the final paper and facilitate the work load for second–round reviewers and editors. Indeed, some journals already seem to be implementing a solution which is fairly similar to our proposal, asking authors of rejected papers for permission to forward reviewer reports to the new journal chosen by the authors to submit the revised work (see Hochberg et al., 2009. Proposals to reward or punish reviewers depending on their rapidity to elaborate their reports (Hauser & Fehr, 2007 does not foster accumulated quality improvement. Science quality would undoubtedly gain from making previous information concerning a manuscript’s review available to new reviewers, as in a Bayesian framework of inference (Martin et al., 2005 because starting a new each time, as if previous information did not exist, is simply not an efficient way to proceed in science.

  4. Family physicians improve patient health care quality and outcomes. (United States)

    Bowman, Marjorie A; Neale, Anne Victoria


    This issue exemplifies family physicians' ability to provide great care and to continuously improve. For example, beyond other specialty care, the care provided by family physicians is associated with improved melanoma diagnosis and outcomes and improved preventive services for those with a history of breast cancer. Electronic health records are providing new avenues to both assess outcomes and influence care. However, to truly reward quality care, simplistic and readily measurable items such as laboratory results or assessment of the provision of preventive services must be adjusted for risk. Health insurance influences classic preventive care services more than personal health behaviors. The care provided at federally qualified health centers throughout the nation is highly appreciated by the people they serve and is not plagued by the types of disparities in other settings.

  5. Bundled Payments for Care Improvement Chart Book (United States)

    U.S. Department of Health & Human Services — The HHS Assistant Secretary for Policy and Evaluation (ASPE) has conducted several research projects in the area of Medicare acute and post acute care episodes. The...

  6. Early Palliative Care Improves Patients' Quality of Life (United States)

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  7. Improving the Efficiency of Dialogue in Tutoring (United States)

    Kopp, Kristopher J.; Britt, M. Anne; Millis, Keith; Graesser, Arthur C.


    The current studies investigated the efficient use of dialogue in intelligent tutoring systems that use natural language interaction. Such dialogues can be relatively time-consuming. This work addresses the question of how much dialogue is needed to produce significant learning gains. In Experiment 1, a full dialogue condition and a read-only…

  8. Improving quantum sensing efficiency with virtual modes (United States)

    Lanzagorta, Marco; Uhlmann, Jeffrey; Le, Truc; Jitrik, Oliverio; Venegas-Andraca, Salvador E.


    Recent research suggests that quantum radar offers several potential advantages over classical sensing technologies. At present, the primary practical challenge is the fast and efficient generation of entangled microwave photons. To mitigate this limitation we propose and briefly examine a distributed architecture to synthetically increase the number of effectively-distinguishable modes.

  9. Improving managed care value through customer service. (United States)

    Tomczyk, Dennis J


    The ability of managed care providers to deliver high-quality customer service to managed care customers depends on their adoption of basic customer-service principles. To apply these principles effectively, providers need to understand and work to exceed the particular needs and expectations of these customers, which include boards of directors, senior executives, physicians, healthcare providers, clinical and patient financial services managers and staff, employers, brokers, and patients. Although these needs and expectations can be predicted to some extent, providers would be wise to implement regular surveys of customers and an open procedure for soliciting customer feedback about service issues. Better customer service for the broad range of managed care customers translates into higher levels of employer and patient satisfaction, which ultimately benefits providers.

  10. The ReACH Collaborative--improving quality home care. (United States)

    Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A


    Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry.

  11. Veterans' Perspectives on Interventions to Improve Retention in HIV Care.

    Directory of Open Access Journals (Sweden)

    Sophie G Minick

    Full Text Available Poor retention in HIV medical care is associated with increased mortality among patients with HIV/AIDS. Developing new interventions to improve retention in HIV primary care is needed. The Department of Veteran Affairs (VA is the largest single provider of HIV care in the US. We sought to understand what veterans would want in an intervention to improve retention in VA HIV care. We conducted 18 one-on-one interviews and 15 outpatient focus groups with 46 patients living with HIV infection from the Michael E. DeBakey VAMC (MEDVAMC. Analysis identified three focus areas for improving retention in care: developing an HIV friendly clinic environment, providing mental health and substance use treatment concurrent with HIV care and encouraging peer support from other Veterans with HIV.

  12. Improving Test Suites for Efficient Fault Localization


    Baudry, Benoit; Fleurey, Franck; Le Traon, Yves


    selection : 9\\%; International audience; The need for testing-for-diagnosis strategies has been identified for a long time, but the explicit link from testing to diagnosis (fault localization) is rare. Analyzing the type of information needed for efficient fault localization, we identify the attribute (called Dynamic Basic Block) that restricts the accuracy of a diagnosis algorithm. Based on this attribute, a test-for-diagnosis criterion is proposed and validated through rigorous case studies...

  13. Technical efficiency improvement of rice farming in southern Thailand


    Kiatpathomchai, Sirirat; Schmitz, P. Michael; Thongrak, Sutonya


    The objective of this study is to assess the technical efficient frontier of rice farms using input-oriented data envelopment analysis. The frontier represents the minimum applicable level of efficiency of inputs given the current level of yields, technologies, and managerial ability among the farmers which can be used as a benchmark for efficiency improvement of rice farms. Two-stage DEA methodology of efficiency analysis was applied. The empirical results revealed that the technical efficie...

  14. Improving nitrogen efficiency: lessons from Malawi and Michigan. (United States)

    Snapp, S; Borden, H; Rohrbach, D


    Two case studies are presented here of nitrogen (N) dynamics in potato/maize systems. Contrasting systems were investigated from (1) the highland tropics of Dedza, Malawi in southern Africa and (2) the northern temperate Great Lakes region of Michigan. Formal surveys were conducted to document grower perceptions and N management strategies. Survey data were linked with N budgets conducted by reviewing on-farm data from representative farms in the targeted agroecosystems and simulation modeling to estimate N losses. Potential N-loss junctures were identified. Interventions that farmers might accept are discussed. The Malawi system uses targeted application of very small amounts of fertilizer (average 18 kg N ha(-1)) to growing plants. This low rate is on the steep part of plant response to N curve and should serve to enhance efficiency; plant growth, however, is generally stunted in Malawi due to degraded soils and weed competition. Very limited crop yields reduce N efficiency from a simulated 60 kg grain per kg N to an actual of approximately 20 kg grain per kg N (at 40 kg N ha(-1) applied). Legume-intensified systems could improve growth potential and restore N use efficiency through amelioration of soil quality and transfer functions and from biological fixation N inputs. In the Michigan system, N efficiency is enhanced currently through multiple, split applications of N fertilizer tailored to plant growth rate and demand. Fertilizer N rates used by growers, however, averaged 32% higher than recommended rates and 40% higher than N removed in crop product. Application of 50 kg N ha(-1) to cover crops in the fall may contribute to the apparent high potential for N leaching losses. Careful consideration of N credits from legumes and residual soil N would improve N efficiency. Overall, N budgets indicated 0 to 20 kg N ha(-1) loss potential from the Malawi systems and tenfold higher loss potential from current practice in Michigan maize/potato rotations. Best

  15. Improving Nitrogen Efficiency: Lessons from Malawi and Michigan

    Directory of Open Access Journals (Sweden)

    Sieglinde Snapp


    Full Text Available Two case studies are presented here of nitrogen (N dynamics in potato/maize systems. Contrasting systems were investigated from (1 the highland tropics of Dedza, Malawi in southern Africa and (2 the northern temperate Great Lakes region of Michigan. Formal surveys were conducted to document grower perceptions and N management strategies. Survey data were linked with N budgets conducted by reviewing on-farm data from representative farms in the targeted agroecosystems and simulation modeling to estimate N losses. Potential N-loss junctures were identified. Interventions that farmers might accept are discussed. The Malawi system uses targeted application of very small amounts of fertilizer (average 18 kg N ha-1 to growing plants. This low rate is on the steep part of plant response to N curve and should serve to enhance efficiency; plant growth, however, is generally stunted in Malawi due to degraded soils and weed competition. Very limited crop yields reduce N efficiency from a simulated 60 kg grain per kg N to an actual of ~20 kg grain per kg N (at 40 kg N ha-1 applied. Legume-intensified systems could improve growth potential and restore N use efficiency through amelioration of soil quality and transfer functions and from biological fixation N inputs. In the Michigan system, N efficiency is enhanced currently through multiple, split applications of N fertilizer tailored to plant growth rate and demand. Fertilizer N rates used by growers, however, averaged 32% higher than recommended rates and 40% higher than N removed in crop product. Application of 50 kg N ha-1 to cover crops in the fall may contribute to the apparent high potential for N leaching losses. Careful consideration of N credits from legumes and residual soil N would improve N efficiency. Overall, N budgets indicated 0 to 20 kg N ha-1 loss potential from the Malawi systems and tenfold higher loss potential from current practice in Michigan maize/potato rotations. Best management


    Directory of Open Access Journals (Sweden)

    Milan Andrejić


    Full Text Available Distribution of products is largely conditioned by the efficiency of logistics processes. The efficient logistics processes provide loyal and satisfied customers, dominant position on the market and revenue. In this paper new approach for measuring and improving efficiency of logistics processes in distribution channel is proposed. Model based on the Principal Component Analysis – Data Envelopment Analysis approach evaluates efficiency of ordering, warehousing, packaging, inventory management and transport processes as well as distribution channel efficiency. Proposed approach also gives information about corrective actions for efficiency improvement. According results efficiency should be improved in several ways: information system improvement, failures decreasing, utilization increasing and output increasing. The results of proposed approach testing show great applicability of developed approach.

  17. The National Palliative Care Research Center and the Center to Advance Palliative Care: a partnership to improve care for persons with serious illness and their families. (United States)

    Morrison, R Sean; Meier, Diane E


    The elimination of suffering and the cure of disease are the fundamental goals of medicine. While medical advances have transformed previously fatal conditions such as cancer and heart disease into illnesses that people can live with for many years, they have not been accompanied by corresponding improvements in the quality of life for these patients and their families. Living with a serious illness should not mean living in pain or experiencing symptoms like shortness of breath, nausea, or fatigue. Yet, multiple studies over the past decade suggest that medical care for patients with advanced illness is characterized by inadequately treated physical distress; fragmented care systems; poor communication between doctors, patients, and families; and enormous strains on family caregiver and support systems. Palliative care is interdisciplinary care focused on relief of pain and other symptoms and support for best possible quality of life for patients with serious illness, and their families. It is appropriate at the point of diagnosis of a serious illness. It goes beyond hospice care to offer patients and their families treatments focused on improving quality of life while they are receiving life-prolonging and curative treatments. Palliative care programs have been shown to reduce symptoms, improve doctor-patient-family communication and satisfaction with care, as well as enhance the efficiency and effectiveness of hospital services. In the last 5 years alone the number of palliative care programs has more than doubled. This growth is in response to the increasing numbers and needs of Americans living with serious, complex and chronic illnesses, and the realities of the care responsibilities faced by their families. In order to ensure that all persons with serious illness and their families receive the quality of care they deserve, palliative care must become an integral part of the U.S. healthcare landscape. Specifically, persons facing serious illness and their

  18. Nanoimprinted Perovskite Nanograting Photodetector with Improved Efficiency. (United States)

    Wang, Honglei; Haroldson, Ross; Balachandran, Balasubramaniam; Zakhidov, Alex; Sohal, Sandeep; Chan, Julia Y; Zakhidov, Anvar; Hu, Walter


    Recently, organolead halide-based perovskites have emerged as promising materials for optoelectronic applications, particularly for photovoltaics, photodetectors, and lasing, with low cost and high performance. Meanwhile, nanoscale photodetectors have attracted tremendous attention toward realizing miniaturized optoelectronic systems, as they offer high sensitivity, ultrafast response, and the capability to detect beyond the diffraction limit. Here we report high-performance nanoscale-patterned perovskite photodetectors implemented by nanoimprint lithography (NIL). The spin-coated lead methylammonium triiodide perovskite shows improved crystallinity and optical properties after NIL. The nanoimprinted metal-semiconductor-metal photodetectors demonstrate significantly improved performance compared to the nonimprinted conventional thin-film devices. The effects of NIL pattern geometries on the optoelectronic characteristics were studied, and the nanograting pattern based photodetectors demonstrated the best performance, showing approximately 35 times improvement on responsivity and 7 times improvement on on/off ratio compared with the nonimprinted devices. The high performance of NIL-nanograting photodetectors likely results from high crystallinity and favored nanostructure morphology, which contribute to higher mobility, longer diffusion length, and better photon absorption. Our results have demonstrated that the NIL is a cost-effective method to fabricate high-performance perovskite nanoscale optoelectronic devices, which may be suitable for manufacturing of high-density perovskite nanophotodetector arrays and to provide integration with state-of-the-art electronic circuits.

  19. Process improvement in healthcare: Overall resource efficiency

    NARCIS (Netherlands)

    J. de Mast; B. Kemper; R.J.M.M. Does; M. Mandjes; Y. van der Bijl


    This paper aims to develop a unifying and quantitative conceptual framework for healthcare processes from the viewpoint of process improvement. The work adapts standard models from operation management to the specifics of healthcare processes. We propose concepts for organizational modeling of healt

  20. Kaizen: a process improvement model for the business of health care and perioperative nursing professionals. (United States)

    Tetteh, Hassan A


    Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement.

  1. Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes

    Directory of Open Access Journals (Sweden)

    Fromer L


    Full Text Available Len FromerDepartment of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USAAbstract: Current primary care patterns for chronic obstructive pulmonary disease (COPD focus on reactive care for acute exacerbations, often neglecting ongoing COPD management to the detriment of patient experience and outcomes. Proactive diagnosis and ongoing multifactorial COPD management, comprising smoking cessation, influenza and pneumonia vaccinations, pulmonary rehabilitation, and symptomatic and maintenance pharmacotherapy according to severity, can significantly improve a patient's health-related quality of life, reduce exacerbations and their consequences, and alleviate the functional, utilization, and financial burden of COPD. Redesign of primary care according to principles of the chronic care model, which is implemented in the patient-centered medical home, can shift COPD management from acute rescue to proactive maintenance. The chronic care model and patient-centered medical home combine delivery system redesign, clinical information systems, decision support, and self-management support within a practice, linked with health care organization and community resources beyond the practice. COPD care programs implementing two or more chronic care model components effectively reduce emergency room and inpatient utilization. This review guides primary care practices in improving COPD care workflows, highlighting the contributions of multidisciplinary collaborative team care, care coordination, and patient engagement. Each primary care practice can devise a COPD care workflow addressing risk awareness, spirometric diagnosis, guideline-based treatment and rehabilitation, and self-management support, to improve patient outcomes in COPD.Keywords: chronic obstructive pulmonary disease, chronic care model, patient-centered medical home, self-management, interdisciplinary care team, coordination of care



    Nevenka Kovac


    In order to ensure efficient and effective health care, of equal high quality and accessibility, at all the levels of healthcare and across the entire Croatian territory, all operators in health services are required to establish, develop and maintain a system for assuring and improving the quality in healthcare. Legal requirement to introduce quality management systems into healthcare institutions notwithstanding, a quality management system is equally important in regard to the provision of...

  3. Metrics for assessing improvements in primary health care. (United States)

    Stange, Kurt C; Etz, Rebecca S; Gullett, Heidi; Sweeney, Sarah A; Miller, William L; Jaén, Carlos Roberto; Crabtree, Benjamin F; Nutting, Paul A; Glasgow, Russell E


    Metrics focus attention on what is important. Balanced metrics of primary health care inform purpose and aspiration as well as performance. Purpose in primary health care is about improving the health of people and populations in their community contexts. It is informed by metrics that include long-term, meaning- and relationship-focused perspectives. Aspirational uses of metrics inspire evolving insights and iterative improvement, using a collaborative, developmental perspective. Performance metrics assess the complex interactions among primary care tenets of accessibility, a whole-person focus, integration and coordination of care, and ongoing relationships with individuals, families, and communities; primary health care principles of inclusion and equity, a focus on people's needs, multilevel integration of health, collaborative policy dialogue, and stakeholder participation; basic and goal-directed health care, prioritization, development, and multilevel health outcomes. Environments that support reflection, development, and collaborative action are necessary for metrics to advance health and minimize unintended consequences.

  4. Correction, improvement and model verification of CARE 3, version 3 (United States)

    Rose, D. M.; Manke, J. W.; Altschul, R. E.; Nelson, D. L.


    An independent verification of the CARE 3 mathematical model and computer code was conducted and reported in NASA Contractor Report 166096, Review and Verification of CARE 3 Mathematical Model and Code: Interim Report. The study uncovered some implementation errors that were corrected and are reported in this document. The corrected CARE 3 program is called version 4. Thus the document, correction. improvement, and model verification of CARE 3, version 3 was written in April 1984. It is being published now as it has been determined to contain a more accurate representation of CARE 3 than the preceding document of April 1983. This edition supercedes NASA-CR-166122 entitled, 'Correction and Improvement of CARE 3,' version 3, April 1983.

  5. Improving hospital efficiency: a process model of organizational change commitments. (United States)

    Nigam, Amit; Huising, Ruthanne; Golden, Brian R


    Improving hospital efficiency is a critical goal for managers and policy makers. We draw on participant observation of the perioperative coaching program in seven Ontario hospitals to develop knowledge of the process by which the content of change initiatives to increase hospital efficiency is defined. The coaching program was a change initiative involving the use of external facilitators with the goal of increasing perioperative efficiency. Focusing on the role of subjective understandings in shaping initiatives to improve efficiency, we show that physicians, nurses, administrators, and external facilitators all have differing frames of the problems that limit efficiency, and propose different changes that could enhance efficiency. Dynamics of strategic and contested framing ultimately shaped hospital change commitments. We build on work identifying factors that enhance the success of change efforts to improve hospital efficiency, highlighting the importance of subjective understandings and the politics of meaning-making in defining what hospitals change.

  6. Improving organizational climate for excellence in patient care. (United States)

    Arnold, Edwin


    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

  7. Energy efficiency improvement by gear shifting optimization

    Directory of Open Access Journals (Sweden)

    Blagojevic Ivan A.


    Full Text Available Many studies have proved that elements of driver’s behavior related to gear selection have considerable influence on the fuel consumption. Optimal gear shifting is a complex task, especially for inexperienced drivers. This paper presents an implemented idea for gear shifting optimization with the aim of fuel consumption minimization with more efficient engine working regimes. Optimized gear shifting enables the best possible relation between vehicle motion regimes and engine working regimes. New theoretical-experimental approach has been developed using On-Board Diagnostic technology which so far has not been used for this purpose. The matrix of driving modes according to which tests were performed is obtained and special data acquisition system and analysis process have been developed. Functional relations between experimental test modes and adequate engine working parameters have been obtained and all necessary operations have been conducted to enable their use as inputs for the designed algorithm. The created Model has been tested in real exploitation conditions on passenger car with Otto fuel injection engine and On-Board Diagnostic connection without any changes on it. The conducted tests have shown that the presented Model has significantly positive effects on fuel consumption which is an important ecological aspect. Further development and testing of the Model allows implementation in wide range of motor vehicles with various types of internal combustion engines.

  8. Big data analytics to improve cardiovascular care: promise and challenges. (United States)

    Rumsfeld, John S; Joynt, Karen E; Maddox, Thomas M


    The potential for big data analytics to improve cardiovascular quality of care and patient outcomes is tremendous. However, the application of big data in health care is at a nascent stage, and the evidence to date demonstrating that big data analytics will improve care and outcomes is scant. This Review provides an overview of the data sources and methods that comprise big data analytics, and describes eight areas of application of big data analytics to improve cardiovascular care, including predictive modelling for risk and resource use, population management, drug and medical device safety surveillance, disease and treatment heterogeneity, precision medicine and clinical decision support, quality of care and performance measurement, and public health and research applications. We also delineate the important challenges for big data applications in cardiovascular care, including the need for evidence of effectiveness and safety, the methodological issues such as data quality and validation, and the critical importance of clinical integration and proof of clinical utility. If big data analytics are shown to improve quality of care and patient outcomes, and can be successfully implemented in cardiovascular practice, big data will fulfil its potential as an important component of a learning health-care system.

  9. Effects of Quality Improvement System for Child Care Centers (United States)

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace


    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  10. The Coach Is in: Improving Nutritional Care in Nursing Homes (United States)

    Rahman, Anna N.; Simmons, Sandra F.; Applebaum, Robert; Lindabury, Kate; Schnelle, John F.


    Purpose: This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. Methods: In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff…

  11. Improving Patient Safety Culture in Primary Care: A Systematic Review

    NARCIS (Netherlands)

    Verbakel, Natasha J.; Langelaan, Maaike; Verheij, Theo J. M.; Wagner, Cordula; Zwart, Dorien L. M.


    Background: Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which effec

  12. Geospatial Technologies to Improve Urban Energy Efficiency

    Directory of Open Access Journals (Sweden)

    Bharanidharan Hemachandran


    Full Text Available The HEAT (Home Energy Assessment Technologies pilot project is a FREE Geoweb mapping service, designed to empower the urban energy efficiency movement by allowing residents to visualize the amount and location of waste heat leaving their homes and communities as easily as clicking on their house in Google Maps. HEAT incorporates Geospatial solutions for residential waste heat monitoring using Geographic Object-Based Image Analysis (GEOBIA and Canadian built Thermal Airborne Broadband Imager technology (TABI-320 to provide users with timely, in-depth, easy to use, location-specific waste-heat information; as well as opportunities to save their money and reduce their green-house-gas emissions. We first report on the HEAT Phase I pilot project which evaluates 368 residences in the Brentwood community of Calgary, Alberta, Canada, and describe the development and implementation of interactive waste heat maps, energy use models, a Hot Spot tool able to view the 6+ hottest locations on each home and a new HEAT Score for inter-city waste heat comparisons. We then describe current challenges, lessons learned and new solutions as we begin Phase II and scale from 368 to 300,000+ homes with the newly developed TABI-1800. Specifically, we introduce a new object-based mosaicing strategy, an adaptation of Emissivity Modulation to correct for emissivity differences, a new Thermal Urban Road Normalization (TURN technique to correct for scene-wide microclimatic variation. We also describe a new Carbon Score and opportunities to update city cadastral errors with automatically defined thermal house objects.

  13. Ecological Factors Improving Efficiency of Business Activities

    Directory of Open Access Journals (Sweden)

    Kononova G. A.


    Full Text Available The economic importance of optimizing the environmental situation from the perspective of an entrepreneur are assessed in the article. The classification of administrative decisions taken in the course of the business activities is proposed. The authors identified a group of solutions directly providing optimization of environment external to the enterprise, solutions that have an indirect positive impact on the environment and solutions that improve ecology of industrial premises. The nature of economic effect of resulting solutions of various types is taken into account. Vectors of influence of working conditions on the economic results of business activities are described. The nature and strength of the impact of model management decisions results of business activities are defined. Key performance indicators of entrepreneurial activity are identified: employee productivity, the amount of revenue and profitability, solvency, staff stability, the competitiveness of enterprises. Grouping the costs of ecological parameters optimization of the production environment is proposed. Relationship between level of working conditions and socio-psychological climate in the collective enterprise is disclosed. The methods of motivation of entrepreneurs in solving of environmental, production problems are considered. The role of training entrepreneurs engaged of medium and small businesses are underlined especially. Thus, in the article the relationship between environmental and economic problems of entrepreneurial activity is investigated. Role and opportunities of entrepreneurs in solving these problems are defined and structured.

  14. Improving timeliness and efficiency in the referral process for safety net providers: application of the Lean Six Sigma methodology. (United States)

    Deckard, Gloria J; Borkowski, Nancy; Diaz, Deisell; Sanchez, Carlos; Boisette, Serge A


    Designated primary care clinics largely serve low-income and uninsured patients who present a disproportionate number of chronic illnesses and face great difficulty in obtaining the medical care they need, particularly the access to specialty physicians. With limited capacity for providing specialty care, these primary care clinics generally refer patients to safety net hospitals' specialty ambulatory care clinics. A large public safety net health system successfully improved the effectiveness and efficiency of the specialty clinic referral process through application of Lean Six Sigma, an advanced process-improvement methodology and set of tools driven by statistics and engineering concepts.

  15. The Effects of Simulation-based Transvaginal Ultrasound Training on Quality and Efficiency of Care

    DEFF Research Database (Denmark)

    xgz472, xgz472; Ringsted, Charlotte; Rosthøj, Susanne


    OBJECTIVE: To explore the effect of adding simulation-based transvaginal ultrasound training to trainees' clinical training compared with only clinical training on quality of and efficiency of care. BACKGROUND: Simulation-based ultrasound training may be an effective adjunct to clinical training,......, 33.5-55.1) and 19.8% (95% CI, 4.1-32.9) in the intervention and control group, respectively (P = 0.005). CONCLUSIONS: Simulation-based ultrasound training improved quality of care and reduced the need for repeated patient examination and trainee supervision.......OBJECTIVE: To explore the effect of adding simulation-based transvaginal ultrasound training to trainees' clinical training compared with only clinical training on quality of and efficiency of care. BACKGROUND: Simulation-based ultrasound training may be an effective adjunct to clinical training......, but no studies have examined its effects on quality and efficiency of care. METHODS: Trainees from 4 University Hospitals in East Denmark were included (N = 54). Participants were randomized to either simulation-based ultrasound training and clinical training (intervention group, n = 28), or to clinical training...

  16. Government Responsibility in New Rural Cooperative Medical Care System from the Perspective of Equity and Efficiency

    Institute of Scientific and Technical Information of China (English)

    Liuni; GUAN


    Equity and efficiency,as two essential parts of social security,always influence construction of China’s new rural cooperative medical care system.The new rural cooperative medical care system is a rural social security system particularly intended to make it more affordable for the rural poor.It is a multi-channel fundraising system with fund of comprehensive arrangement for serious disease composed by the government,collectives and individuals.Since its implementation,it has made considerable achievements,but there are still many apparent and hidden problems.Through analyzing existing problems in the implementation of new rural cooperative medical care system,from the perspective of equity and efficiency,it reached the conclusion that government should take corresponding responsibilities.At the same time of constantly increasing efficiency,it is recommended to attach importance to the equity,so as to realize the objective of improving the security level of new rural cooperative medical care system.

  17. Using routine data to improve palliative and end of life care. (United States)

    Davies, Joanna M; Gao, Wei; Sleeman, Katherine E; Lindsey, Katie; Murtagh, Fliss E; Teno, Joan M; Deliens, Luc; Wee, Bee; Higginson, Irene J; Verne, Julia


    Palliative and end of life care is essential to healthcare systems worldwide, yet a minute proportion of research funding is spent on palliative and end of life care research. Routinely collected health and social care data provide an efficient and useful opportunity for evaluating and improving care for patients and families. There are excellent examples of routine data research in palliative and end of life care, but routine data resources are widely underutilised. We held four workshops on using routinely collected health and social care data in palliative and end of life care. Researchers presented studies from the UK, USA and Europe. The aim was to highlight valuable examples of work with routine data including work with death registries, hospital activity records, primary care data and specialist palliative care registers. This article disseminates that work, describes the benefits of routine data research and identifies major challenges for the future use of routine data, including; access to data, improving data linkage, and the need for more palliative and end of life care specific data.

  18. Improved particle swarm optimization algorithm for android medical care IOT using modified parameters. (United States)

    Sung, Wen-Tsai; Chiang, Yen-Chun


    This study examines wireless sensor network with real-time remote identification using the Android study of things (HCIOT) platform in community healthcare. An improved particle swarm optimization (PSO) method is proposed to efficiently enhance physiological multi-sensors data fusion measurement precision in the Internet of Things (IOT) system. Improved PSO (IPSO) includes: inertia weight factor design, shrinkage factor adjustment to allow improved PSO algorithm data fusion performance. The Android platform is employed to build multi-physiological signal processing and timely medical care of things analysis. Wireless sensor network signal transmission and Internet links allow community or family members to have timely medical care network services.

  19. The business case for health-care quality improvement. (United States)

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


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

  20. [Strategies for improving care of oncologic patients: SHARE Project results]. (United States)

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio


    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

  1. Improving Energy Efficiency in Industrial Solutions – Walk the Talk

    DEFF Research Database (Denmark)

    Wegener, Dieter; Finkbeiner, Matthias; Holst, Jens-Christian


    This paper describes the outline of the energy efficiency and environmental care policy and management at Siemens Industry Solutions Division. This environmental policy coherently embraces strategic planning, eco-design of energy-efficient industrial processes and solutions, design evaluation...... and finally communication of both environmental and economic performance of solutions to customers. One of the main tools supporting eco-design and evaluation & controlling of derived design solutions is the so called “Eco-Care-Matrix” (ECM). The ECM simply visualizes the eco-efficiency of solutions compared...... to a given baseline. In order to prevent from “green washing” criticism and to ensure “walk the talk” attitude the ECM should be scientifically well-founded using appropriate and consistent methodology. The vertical axis of an ECM illustrates the environmental performance and the horizontal axis describes...

  2. Using COPE To Improve Quality of Care: The Experience of the Family Planning Association of Kenya. (United States)

    Bradley, Janet


    COPE (Client-Oriented, Provider-Efficient) methodology, a self-assessment tool that has been used in 35 countries around the world, was used to improve the quality of care in family planning clinics in Kenya. COPE involves a process that legitimately invests power with providers and clinic-level staff. It gives providers more control over their…

  3. Superefficient Refrigerators: Opportunities and Challenges for Efficiency Improvement Globally

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Nihar; Park, Won Young; Bojda, Nicholas; McNeil, Michael A.


    As an energy-intensive mainstream product, residential refrigerators present a significant opportunity to reduce electricity consumption through energy efficiency improvements. Refrigerators expend a considerable amount of electricity during normal use, typically consuming between 100 to 1,000 kWh of electricity per annum. This paper presents the results of a technical analysis done for refrigerators in support of the Super-efficient Equipment and Appliance Deployment (SEAD) initiative. Beginning from a base case representative of the average unit sold in India, we analyze efficiency improvement options and their corresponding costs to build a cost-versus-efficiency relationship. We then consider design improvement options that are known to be the most cost effective and that can improve efficiency given current design configurations. We also analyze and present additional super-efficient options, such as vacuum-insulated panels. We estimate the cost of conserved electricity for the various options, allowing flexible program design for market transformation programs toward higher efficiency. We estimate ~;;160TWh/year of energy savings are cost effective in 2030, indicating significant potential for efficiency improvement in refrigerators in SEAD economies and China.

  4. Care coordination between specialty care and primary care: a focus group study of provider perspectives on strong practices and improvement opportunities

    Directory of Open Access Journals (Sweden)

    Kim B


    Full Text Available Bo Kim,1,2 Michelle A Lucatorto,3 Kara Hawthorne,4 Janis Hersh,5 Raquel Myers,6 A Rani Elwy,1,7 Glenn D Graham81Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, 2Department of Psychiatry, Harvard Medical School, Boston, MA, 3Office of Nursing Services, Department of Veterans Affairs, 4Chief Business Office, Purchased Care, Washington, DC, 5New England Veterans Engineering Resource Center, Boston, MA, 6SJ Quinney College of Law, University of Utah, Salt Lake City, UT, 7Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, 8Specialty Care Services (10P4E, Department of Veterans Affairs, Washington, DC, USAAbstract: Care coordination between the specialty care provider (SCP and the primary care provider (PCP is a critical component of safe, efficient, and patient-centered care. Veterans Health Administration conducted a series of focus groups of providers, from specialty care and primary care clinics at VA Medical Centers nationally, to assess 1 what SCPs and PCPs perceive to be current practices that enable or hinder effective care coordination with one another and 2 how these perceptions differ between the two groups of providers. A qualitative thematic analysis of the gathered data validates previous studies that identify communication as being an important enabler of coordination, and uncovers relationship building between specialty care and primary care (particularly through both formal and informal relationship-building opportunities such as collaborative seminars and shared lunch space, respectively to be the most notable facilitator of effective communication between the two sides. Results from this study suggest concrete next steps that medical facilities can take to improve care coordination, using as their basis the mutual understanding and respect developed between SCPs and PCPs through relationship-building efforts

  5. A person-centred segmentation study in elderly care: towards efficient demand-driven care. (United States)

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


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

  6. Improving Diabetes Care in the Military Primary Care Clinic: Case Study Review (United States)


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

  7. Melatonin improves spermatogonial stem cells transplantation efficiency in azoospermic mice

    Directory of Open Access Journals (Sweden)

    Mohammadreza Gholami


    Conclusion: Administration of melatonin (20 mg/kg simultaneously with transplantation of spermatogonial stem cells in azoospermia mouse testis increases the efficiency of transplantation and improves structural properties of the testes tissue.

  8. Economic implications of neonatal intensive care unit collaborative quality improvement

    NARCIS (Netherlands)

    Rogowski, JA; Horbar, JD; Plsek, PE; Baker, LS; Deterding, J; Edwards, WH; Hocker, J; Kantak, AD; Lewallen, P; Lewis, W; Lewit, E; McCarroll, CJ; Mujsce, D; Payne, NR; Shiono, P; Soll, RF; Leahy, K


    Objective. To make measurable improvements in the quality and cost of neonatal intensive care using a multidisciplinary collaborative quality improvement model. Design. Interventional study. Data on treatment costs were collected for infants with birth weight 501 to 1500 g for the period of January

  9. Efficiency Improvement and Quality Initiatives Application in Financial Institutions


    MSc. Ajtene Avdullahi; MSc. Vjosa Fejza


    Financial institutions in today’s economy have no longer the luxury to improve profit simply by increasing revenue. These firms, due to the significant measuring reductions in the financial services industry needed to improve operational efficiencies and merely support existing processes with fewer resources. This paper explains the benefits of Lean, Six Sigma, Total Quality Management and Lean Six Sigma that have improved organization's performance, by cutting costs and waste, improving thei...

  10. Refractories for Industrial Processing. Opportunities for Improved Energy Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James G. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Hayden, H. Wayne [Metals Manufacture Process and Controls Technology, Inc., Oak Ridge, TN (United States); Angelini, Peter [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Moore, Robert E. [R.E. Moore Associates, Maricopa, AZ (United States); Headrick, William L. [R.E. Moore Associates, Maricopa, AZ (United States)


    Refractories are a class of materials of critical importance to manufacturing industries with high-temperature unit processes. This study describes industrial refractory applications and identifies refractory performance barriers to energy efficiency for processing. The report provides recommendations for R&D pathways leading to improved refractories for energy-efficient manufacturing and processing.

  11. 10 Inventions on improving keyboard efficiency: A TRIZ based analysis


    Mishra, Umakant


    A keyboard is the most important input device for a computer. With the development of technology a basic keyboard does not want to remain confined within the basic functionalities of a keyboard, rather it wants to go beyond. There are several inventions which attempt to improve the efficiency of a conventional keyboard. This article illustrates 10 inventions from US Patent database all of which have proposed very interesting methods for improving the efficiency of a computer keyboard. Some in...

  12. High-quality chronic care delivery improves experiences of chronically ill patients receiving care

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)


    markdownabstract__Abstract__ Objective. Investigate whether high-quality chronic care delivery improved the experiences of patients. Design. This study had a longitudinal design. Setting and Participants. We surveyed professionals and patients in 17 disease management programs targeting patients wi

  13. Emergency care center turnaround time--an improvement story. (United States)

    Gelrud, Joan; Burroughs, Helen; Koterwas, Joanne


    Emergency department overcrowding is a nationally recognized barrier to patient safety. Other obstacles to efficiency and adequate care in emergency rooms include lengthy patient waits and side-tracked ambulances. This article explores one community hospital's approach to significantly decreasing emergency visit turnaround times while increasing patient satisfaction.

  14. Depression Care Management: Can Employers Purchase Improved Outcomes?

    Directory of Open Access Journals (Sweden)

    Kathryn Rost


    Full Text Available Fourteen vendors are currently selling depression care management products to US employers after randomized trials demonstrate improved work outcomes. The research team interviewed 10 (71.4% of these vendors to compare their products to four key components of interventions demonstrated to improve work outcomes. Five of 10 depression products incorporate all four key components, three of which are sold by health maintenance organizations (HMOs; however, HMOs did not deliver these components at the recommended intensity and/or duration. Only one product delivered by a disease management company delivered all four components of care at the recommended intensity and duration. This “voltage drop,” which we anticipate will increase with product implementation, suggests that every delivery system should carefully evaluate the design of its depression product before implementation for its capacity to deliver evidence-based care, repeating these evaluations as new evidence emerges.

  15. Incentives to improve energy efficiency in EU Grids

    Energy Technology Data Exchange (ETDEWEB)

    Papaefthymiou, G.; Beestermoeller, C.; Gardiner, A.


    The Energy Efficiency Directive (2012/27/EU) includes provisions related to network tariffs and regulation. It is timely therefore to revisit the potential options for energy efficiency in grids, the treatment of energy efficiency in network tariffs and alternative policies for improving energy efficiency. This project builds on work done previously for the European Copper Institute in this area. In this paper, we concentrate on energy efficiency in electricity network design and operation. Other articles in the Directive relate to the role of the network tariffs and regulations in enabling or incentivising the provision of energy efficiency to end users. In section 2, we describe technical efficiency measures to reduce losses (improve energy efficiency) in the grid. Section 3 reviews grid tariffs in three countries to identify whether they provide incentives or disincentives for energy efficiency in the grid. Section 4 discusses and evaluates alternative regulations for energy efficiency in grids. Section 5 concludes and discusses the main components of the optimal policy framework.

  16. Information communication technology: new approach for rural cancer care improvement. (United States)

    Maserat, Elham


    Cancer control aims to reduce the incidence, morbidity, and mortality of cancer and to improve the quality of life of cancer patients. For rural populations this presents particular problems. This article covers challenges of oncology care in rural areas and solutions via applying information communication technology with specialty telemedicine for overcoming problems in prevention, early diagnosis, treatment, and palliative care. In addition, telecommunications infrastructures and frameworks for implementation of telemedicine are described.

  17. Point of care investigations in pediatric care to improve health care in rural areas. (United States)

    Walia, Kamini


    The good quality laboratory services in developing countries are often limited to major urban centers. As a result, many commercially available high-quality diagnostic tests for infectious diseases are neither accessible nor affordable to patients in the rural areas. Health facilities in rural areas are compromised and this limits the usability and performance of the best medical diagnostic technologies in rural areas as they are designed for air-conditioned laboratories, refrigerated storage of chemicals, a constant supply of calibrators and reagents, stable electrical power, highly trained personnel and rapid transportation of samples. The advent of new technologies have allowed miniaturization and integration of complex functions, which has made it possible for sophisticated diagnostic tools to move out of the developed-world laboratory in the form of a "point of care"(POC) tests. Many diagnostic tests are being developed using these platforms. However, the challenge is to develop diagnostics which are inexpensive, rugged and well suited to the medical and social contexts of the developing world and do not compromise on accuracy and reliability. The already available POC tests which are reliable and affordable, like for HIV infection, malaria, syphilis, and some neglected tropical diseases, and POC tests being developed for other diseases if correctly used and effectively regulated after rigorous evaluation, have the potential to make a difference in clinical management and improve surveillance. In order to use these tests effectively they would need to be supported by technically competent manpower, availability of good-quality reagents, and healthcare providers who value and are able to interpret laboratory results to guide treatment; and a system for timely communication between the laboratory and the healthcare provider. Strengthening the laboratories at the rural level can enable utilization of these diagnostics for improving the diagnosis and management of

  18. Pain management improves care and revenue: an interview with ProCare Systems. (United States)

    Davis, F N; Walsh, C


    As provider and managed care organizations continue to look for better ways to control costs and improve patient outcomes, disease management programs are getting an increasing share of their attention. One often-over-looked area with significant potential to improve outcomes, reduce costs, and enhance revenues is pain management. It has been estimated that at least 40 percent of senior citizens suffer from chronic pain, and as the population ages, the number of chronic pain sufferers will only increase. Pain management companies have been forming to meet the current and future demand for comprehensive pain management programs. One such company is ProCare Systems, a single-specialty physician practice management company based in Grand Rapids, Michigan. HFM spoke with Fred N. Davis, MD, president and cofounder of ProCare Systems, and Cyndy Walsh, ProCare System's CEO, about pain management programs and the patient care and financial impact they can effect.

  19. Demonstrating a Conceptual Framework to Provide Efficient Wound Management Service for a Wound Care Center in a Tertiary Hospital. (United States)

    Chen, Yu-Tsung; Chang, Chang-Cheng; Shen, Jen-Hsiang; Lin, Wei-Nung; Chen, Mei-Yen


    Although the benefits of wound care services and multidisciplinary team care have been well elaborated on in the literature, there is a gap in the actual practice of wound care and the establishment of an efficient referral system. The conceptual framework for establishing efficient wound management services requires elucidation.A wound care center was established in a tertiary hospital in 2010, staffed by an integrated multidisciplinary team including plastic surgeons, a full-time coordinator, a physical therapist, occupational therapists, and other physician specialists. Referral patients were efficiently managed following a conceptual framework for wound care. This efficient wound management service consists of 3 steps: patient entry and onsite immediate wound debridement, wound re-evaluation, and individual wound bed preparation plan. Wound conditions were documented annually over 4 consecutive years.From January 2011 to December 2014, 1103 patients were recruited from outpatient clinics or inpatient consultations for the 3-step wound management service. Of these, 62% of patients achieved healing or improvement in wounds, 13% of patients experienced no change, and 25% of patients failed to follow-up. The outcome of wound treatment varied by wound type. Sixty-nine percent of diabetic foot ulcer patients were significantly healed or improved. In contrast, pressure ulcers were the most poorly healed wound type, with only 55% of patients achieving significantly healed or improved wounds.The 3-step wound management service in the wound care center efficiently provided onsite screening, timely debridement, and multidisciplinary team care. Patients could schedule appointments instead of waiting indefinitely for care. Further wound condition follow-up, education, and prevention were also continually provided.

  20. Demonstrating a Conceptual Framework to Provide Efficient Wound Management Service for a Wound Care Center in a Tertiary Hospital (United States)

    Chen, Yu-Tsung; Chang, Chang-Cheng; Shen, Jen-Hsiang; Lin, Wei-Nung; Chen, Mei-Yen


    Abstract Although the benefits of wound care services and multidisciplinary team care have been well elaborated on in the literature, there is a gap in the actual practice of wound care and the establishment of an efficient referral system. The conceptual framework for establishing efficient wound management services requires elucidation. A wound care center was established in a tertiary hospital in 2010, staffed by an integrated multidisciplinary team including plastic surgeons, a full-time coordinator, a physical therapist, occupational therapists, and other physician specialists. Referral patients were efficiently managed following a conceptual framework for wound care. This efficient wound management service consists of 3 steps: patient entry and onsite immediate wound debridement, wound re-evaluation, and individual wound bed preparation plan. Wound conditions were documented annually over 4 consecutive years. From January 2011 to December 2014, 1103 patients were recruited from outpatient clinics or inpatient consultations for the 3-step wound management service. Of these, 62% of patients achieved healing or improvement in wounds, 13% of patients experienced no change, and 25% of patients failed to follow-up. The outcome of wound treatment varied by wound type. Sixty-nine percent of diabetic foot ulcer patients were significantly healed or improved. In contrast, pressure ulcers were the most poorly healed wound type, with only 55% of patients achieving significantly healed or improved wounds. The 3-step wound management service in the wound care center efficiently provided onsite screening, timely debridement, and multidisciplinary team care. Patients could schedule appointments instead of waiting indefinitely for care. Further wound condition follow-up, education, and prevention were also continually provided. PMID:26554805

  1. Concept mapping: a tool for improving patient care. (United States)

    Aberdeen, Suzanne


    This article reviews the use of concept mapping as a person-centred problem-solving aid to assessment, risk management, care evaluation and care planning for nurses. Concept maps are diagrams that are used to organise, represent and create knowledge, and provide a useful framework for critical analysis and problem solving. Concept mapping is discussed and demonstrated in relation to improving the quality of care for patients and as a tool for clinical leadership and teamwork. The benefits of concept mapping for patients' wellbeing and safety, staff satisfaction and team learning are evidenced.

  2. Improving care transitions: current practice and future opportunities for pharmacists. (United States)

    Hume, Anne L; Kirwin, Jennifer; Bieber, Heather L; Couchenour, Rachel L; Hall, Deanne L; Kennedy, Amy K; LaPointe, Nancy M Allen; Burkhardt, Crystal D O; Schilli, Kathleen; Seaton, Terry; Trujillo, Jennifer; Wiggins, Barbara


    During the past decade, patient safety issues during care transitions have gained greater attention at both the local and national level. Readmission rates to U.S. hospitals are high, often because of poor care transitions. Serious adverse drug events (ADEs) caused by an incomplete understanding of changes in complex drug regimens can be an important factor contributing to readmission rates. This paper describes the roles and responsibilities of pharmacists in ensuring optimal outcomes from drug therapy during care transitions. Barriers to effective care transitions, including inadequate communication, poor care coordination, and the lack of one clinician ultimately responsible for these transitions, are discussed. This paper also identifies specific patient populations at high risk of ADEs during care transitions. Several national initiatives and newer care transition models are discussed, including multi- and interdisciplinary programs with pharmacists as key members. Among their potential roles, pharmacists should participate on medical rounds where available, perform medication reconciliation and admission drug histories, apply their knowledge of drug therapy to anticipate and resolve problems during transitions, communicate changes in drug regimens between providers and care settings, assess the appropriateness and patient understanding of drug regimens, promote adherence, and assess health literacy. In addition, this paper identifies barriers and ongoing challenges limiting greater involvement of pharmacists from different practice settings during care transitions. Professional degree programs and residency training programs should increase their emphasis on pharmacists' roles, especially as part of interdisciplinary teams, in improving patient safety during care transitions in diverse practice settings. This paper also recommends that Accreditation Council for Pharmacy Education (ACPE) standards include specific language regarding the exposure of students to

  3. DTU International Energy Report 2012: Energy efficiency improvements

    DEFF Research Database (Denmark)

    Increased energy efficiency can reduce global CO2 emissions over the period to 2050 with up to 25%. On the top of that large profits can be gained for very little investment. Energy efficiency improvements can save investment in new energy infrastructure, cut fuel costs, increase competitiveness...... and increase consumer welfare. Thus, it is natural for DTU International Energy Report 2012 to take up this issue and analyze the global, regional and national challenges in exploiting energy efficiency and promote research and development in energy efficiency....

  4. Method for calculating annual energy efficiency improvement of TV sets

    Energy Technology Data Exchange (ETDEWEB)

    Varman, M. [Department of Mechanical Engineering, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur (Malaysia); Mahlia, T.M.I. [Department of Mechanical Engineering, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur (Malaysia)]. E-mail:; Masjuki, H.H. [Department of Mechanical Engineering, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur (Malaysia)


    The popularization of 24 h pay-TV, interactive video games, web-TV, VCD and DVD are poised to have a large impact on overall TV electricity consumption in the Malaysia. Following this increased consumption, energy efficiency standard present a highly effective measure for decreasing electricity consumption in the residential sector. The main problem in setting energy efficiency standard is identifying annual efficiency improvement, due to the lack of time series statistical data available in developing countries. This study attempts to present a method of calculating annual energy efficiency improvement for TV set, which can be used for implementing energy efficiency standard for TV sets in Malaysia and other developing countries. Although the presented result is only an approximation, definitely it is one of the ways of accomplishing energy standard. Furthermore, the method can be used for other appliances without any major modification.

  5. Costs and benefits of energy efficiency improvements in ceiling fans

    Energy Technology Data Exchange (ETDEWEB)

    Shah, Nihar; Sathaye, Nakul; Phadke, Amol; Letschert, Virginie [Lawrence Berkeley National Lab., CA (United States). Environmental Energy Technology Division


    Ceiling fans contribute significantly to residential electricity consumption, especially in developing countries with warm climates. The paper provides analysis of costs and benefits of several options to improve the efficiency of ceiling fans to assess the global potential for electricity savings and green house gas (GHG) emission reductions. Ceiling fan efficiency can be cost-effectively improved by at least 50% using commercially available technology. If these efficiency improvements are implemented in all ceiling fans sold by 2020, 70 terawatt hours per year could be saved and 25 million metric tons of carbon dioxide equivalent (CO2-e) emissions per year could be avoided, globally. We assess how policies and programs such as standards, labels, and financial incentives can be used to accelerate the adoption of efficient ceiling fans in order to realize potential savings.

  6. [Improving practice and organisation of care: methodology for systematic reviews]. (United States)

    Zaugg, Vincent; Savoldelli, Virginie; Sabatier, Brigitte; Durieux, Pierre


    The number of intervention studies designed to improve quality of care is increasing exponentially, making it difficult to access all available information on a given subject. Systematic reviews are tools that provide health professionals with comprehensive and objective information. This article describes the main phases of a systematic review: formulating the research question, search and selection of studies, data extraction and analysis, assessment of the methodological quality of studies, and synthesis of the results. Interventions designed to improve professional practices and organisation of care have specific characteristics that determine the methodology of systematic reviews. For example, the often substantial heterogeneity between populations, organisations, and intervention settings among studies must be taken into account, which makes meta-analysis more difficult. Knowledge on specific features of systematic reviews designed to improve quality of care is essential to ensure a good review of the literature, or to evaluate the level of evidence of published systematic reviews.

  7. Antenatal care strengthening for improved quality of care in Jimma, Ethiopia

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe;


    in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems....... The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. RESULTS: The continued attention to the ANC provision during implementation stimulated...... of intervention on various outcomes was significantly modified by maternal education. CONCLUSION: The quality of care can be improved in some important aspects with limited resources. Moreover, the study provides strategic perspectives on how to facilitate improved quality of ANC....

  8. Assessing health centre systems for guiding improvement in diabetes care

    Directory of Open Access Journals (Sweden)

    Robinson Gary


    Full Text Available Abstract Background Aboriginal people in Australia experience the highest prevalence of diabetes in the country, an excess of preventable complications and early death. There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to assess the status of systems for chronic illness care in Aboriginal community health centres, and to explore whether more developed systems were associated with better quality of diabetes care. Methods This cross-sectional study was conducted in 12 Aboriginal community health centres in the Northern Territory of Australia. Assessment of Chronic Illness Care scale was adapted to measure system development in health centres, and administered by interview with health centre staff and managers. Based on a random sample of 295 clinical records from attending clients with diagnosed type 2 diabetes, processes of diabetes care were measured by rating of health service delivery against best-practice guidelines. Intermediate outcomes included the control of HbA1c, blood pressure, and total cholesterol. Results Health centre systems were in the low to mid-range of development and had distinct areas of strength and weakness. Four of the six system components were independently associated with quality of diabetes care: an increase of 1 unit of score for organisational influence, community linkages, and clinical information systems, respectively, was associated with 4.3%, 3.8%, and 4.5% improvement in adherence to process standards; likewise, organisational influence, delivery system design and clinical information systems were related to control of HbA1c, blood pressure, and total cholesterol. Conclusion The state of development of health centre systems is reflected in quality of care outcome measures for patients. The health centre systems assessment tool should be useful in assessing and guiding development of systems for improvement of

  9. Do increases in energy efficiency improve environmental quality and sustainability?

    Energy Technology Data Exchange (ETDEWEB)

    Hanley, Nick [Department of Economics, University of Stirling, Stirling, Scotland (United Kingdom); McGregor, Peter G.; Swales, J. Kim; Turner, Karen [Fraser of Allander Institute and Department of Economics, University of Strathclyde, Strathclyde (United Kingdom)


    Governments world-wide increasingly see energy efficiency as an important aspect of sustainability. However, there is a debate in the literature as to whether the impact of improved energy efficiency on reducing energy use might be partially, or more than wholly, offset through 'rebound' and 'backfire' effects. This paper clarifies the theoretical conditions under which such effects would occur and explores their likely significance using a computable general equilibrium (CGE) model of the Scottish economy. We find that for Scotland a general improvement in energy efficiency in the production sectors of the economy initially produces rebound effects that eventually grow into backfire. Energy use ultimately increases in response to an efficiency gain and the ratio of GDP to CO{sub 2} emissions falls. The economic factors underpinning rebound effects are straightforward: energy efficiency improvements result in an effective cut in energy prices, which produces output, substitution, competitiveness and income effects that stimulate energy demands. However, the presence of strong rebound or even backfire does not mean that efficiency-enhancing policies are irrelevant: rather it suggests that such policies operating alone are insufficient to generate environmental improvements. The implication is that a co-ordinated portfolio of energy policies is required. (author)

  10. Potentials and policy implications of energy and material efficiency improvement

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Levine, Mark; Price, Lynn; Martin, Nathan; van den Broek, Richard; Block, Kornelis


    There is a growing awareness of the serious problems associated with the provision of sufficient energy to meet human needs and to fuel economic growth world-wide. This has pointed to the need for energy and material efficiency, which would reduce air, water and thermal pollution, as well as waste production. Increasing energy and material efficiency also have the benefits of increased employment, improved balance of imports and exports, increased security of energy supply, and adopting environmentally advantageous energy supply. A large potential exists for energy savings through energy and material efficiency improvements. Technologies are not now, nor will they be, in the foreseeable future, the limiting factors with regard to continuing energy efficiency improvements. There are serious barriers to energy efficiency improvement, including unwillingness to invest, lack of available and accessible information, economic disincentives and organizational barriers. A wide range of policy instruments, as well as innovative approaches have been tried in some countries in order to achieve the desired energy efficiency approaches. These include: regulation and guidelines; economic instruments and incentives; voluntary agreements and actions, information, education and training; and research, development and demonstration. An area that requires particular attention is that of improved international co-operation to develop policy instruments and technologies to meet the needs of developing countries. Material efficiency has not received the attention that it deserves. Consequently, there is a dearth of data on the qualities and quantities for final consumption, thus, making it difficult to formulate policies. Available data, however, suggest that there is a large potential for improved use of many materials in industrialized countries.

  11. Recovery Act--Class 8 Truck Freight Efficiency Improvement Project

    Energy Technology Data Exchange (ETDEWEB)

    Trucks, Daimler [Daimler Trucks North America Llc, Portland, OR (United States)


    Daimler Trucks North America completed a five year, $79.6M project to develop and demonstrate a concept vehicle with at least 50% freight efficiency improvement over a weighted average of several drive cycles relative to a 2009 best-in-class baseline vehicle. DTNA chose a very fuel efficient baseline vehicle, the 2009 Freightliner Cascadia with a DD15 engine, yet successfully demonstrated a 115% freight efficiency improvement. DTNA learned a great deal about the various technologies that were incorporated into Super Truck and those that, through down-selection, were discarded. Some of the technologies competed with each other for efficiency, and notably some of the technologies complemented each other. For example, we found that Super Truck’s improved aerodynamic drag resulted in improved fuel savings from eCoast, relative to a similar vehicle with worse aerodynamic drag. However, some technologies were in direct competition with each other, namely the predictive technologies which use GPS and 3D digital maps to efficiently manage the vehicles kinetic energy through controls and software, versus hybrid which is a much costlier technology that essentially targets the same inefficiency. Furthermore, the benefits of a comprehensive, integrated powertrain/vehicle approach was proven, in which vast improvements in vehicle efficiency (e.g. lower aero drag and driveline losses) enabled engine strategies such as downrating and downspeeding. The joint engine and vehicle developments proved to be a multiplier-effect which resulted in large freight efficiency improvements. Although a large number of technologies made the selection process and were used on the Super Truck demonstrator vehicle, some of the technologies proved not feasible for series production.

  12. Improvement in quality of hospital care during accreditation

    DEFF Research Database (Denmark)

    Bie Bogh, Søren; Falstie-Jensen, Anne Mette; Hollnagel, Erik;


    OBJECTIVE: To assess changes over time in quality of hospital care in relation to the first accreditation cycle in Denmark. DESIGN, SETTING AND PARTICIPANTS: We performed a multi-level, longitudinal, stepped-wedge, nationwide study of process performance measures to evaluate the impact of a manda......OBJECTIVE: To assess changes over time in quality of hospital care in relation to the first accreditation cycle in Denmark. DESIGN, SETTING AND PARTICIPANTS: We performed a multi-level, longitudinal, stepped-wedge, nationwide study of process performance measures to evaluate the impact...... of a mandatory accreditation programme in all Danish public hospitals. Patient-level data (n = 1 624 518 processes of care) on stroke, heart failure, ulcer, diabetes, breast cancer and lung cancer care were obtained from national clinical quality registries. INTERVENTION: The Danish Healthcare Quality Programme...... was introduced in 2009, aiming to create a framework for continuous quality improvement. MAIN OUTCOME: Changes in week-by-week trends of hospital care during the study period of 269 weeks prior to, during and post-accreditation. RESULTS: The quality of hospital care improved over time throughout the study period...

  13. Spreading The Net: The Multiple Benefits Of Energy Efficiency Improvements

    Energy Technology Data Exchange (ETDEWEB)



    Improving energy efficiency can deliver a range of benefits to the economy and society. However energy efficiency programmes are often evaluated only on the basis of the energy savings they deliver. As a result, the full value of energy efficiency improvements in both national and global economies may be significantly underestimated. This also means that energy efficiency policy may not be optimised to target the potential of the full range of outcomes possible. Moreover, when the merit of energy efficiency programmes is judged solely on reductions in energy demand, programmes are susceptible to criticisms related to the rebound effect when the energy savings are less than expected due to other welfare gains. There are several reasons why the full range of outcomes from energy efficiency policy is not generally evaluated. First, it is due to the non-market, somewhat intangible, nature of the socioeconomic benefits, which makes them difficult to quantify. Second, the effects due to energy efficiency alone can be complex to isolate and to determine causality. Third, evaluators and policy makers working in the energy efficiency sphere are usually energy professionals, working for an energy agency or ministry, with little experience of how energy efficiency might impact other non-energy sectors. The result is an under-appreciation – and related underinvestment – in energy efficiency, and as a consequence, missed opportunities and benefits. These foregone benefits represent the ‘opportunity cost’ of failing to adequately evaluate and prioritize energy efficiency investments. The objective of this report is to fully outline the array of different benefits from improved energy efficiency and investigate their implications for policy design. By better understanding the different benefits arising from energy efficiency it should be easier for policy makers to prioritise the most significant outcomes, in addition to energy savings, in optimising energy efficiency

  14. Linking quality improvement and energy efficiency/waste reduction

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, R.E.; Moore, N.L.


    For some time industry has recognized the importance of both energy efficiency/waste reduction (ee/wr) and quality/manufacturing improvement. However, industry has not particularly recognized that manufacturing efficiency is, in part, the result of a more efficient use of energy. For that reason, the energy efficiency efforts of most companies have involved admonishing employees to save energy. Few organizations have invested resources in training programs aimed at increasing energy efficiency and reducing waste. This describes a program to demonstrate how existing utility and government training and incentive programs can be leveraged to increase ee/wr and benefit both industry and consumers. Fortunately, there are a variety of training tools and resources that can be applied to educating workers on the benefits of energy efficiency and waste reduction. What is lacking is a method of integrating ee/wr training with other important organizational needs. The key, therefore, is to leverage ee/wr investments with other organizational improvement programs. There are significant strides to be made by training industry to recognize fully the contribution that energy efficiency gains make to the bottom line. The federal government stands in the unique position of being able to leverage the investments already made by states, utilities, and manufacturing associations by coordinating training programs and defining the contribution of energy-efficiency practices. These aims can be accomplished by: developing better measures of energy efficiency and waste reduction; promoting methods of leveraging manufacturing efficiency programs with energy efficiency concepts; helping industry understand how ee/wr investments can increase profits; promoting research on the needs of, and most effective ways to, reach the small and medium-sized businesses that so often lack the time, information, and finances to effectively use the hardware and training technologies available.

  15. Improvement of Dye Solar Cell Efficiency by Photoanode Posttreatment

    Directory of Open Access Journals (Sweden)

    Tanja Ivanovska


    Full Text Available The basic concept for efficiency improvement in dye-sensitized solar cells (DSSC is limiting the electron-hole recombination. One way to approach the problem is to improve the photogenerated charge carriers lifetime and consequently reduce their recombination probability. We are reporting on a facile posttreatment of the mesoporous photoanode by using a colloidal solution of TiO2 nanoparticles. We have investigated the outcome of the different sintering temperature of the posttreated photoanodes on their morphology as well as on the conversion efficiency of the DSSC. The DSSCs composed of posttreated photoanodes at 450°C showed an increase in JSC and consequently an increase in efficiency of 10%. Investigations were made to determine the electron recombination via the electrolyte by the OCVD technique. We found that the posttreatment has the effect of reducing the surface trap states and thus increases the electron lifetime, which is responsible for the increase of the overall cell efficiency.

  16. Improving organisational systems for diabetes care in Australian Indigenous communities

    Directory of Open Access Journals (Sweden)

    Robinson Gary


    Full Text Available Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from diabetes. There is an urgent need to understand how Indigenous primary care systems are organised to deliver diabetes services to those most in need, to monitor the quality of diabetes care received by Indigenous people, and to improve systems for better diabetes care. Methods The intervention featured two annual cycles of assessment, feedback workshops, action planning, and implementation of system changes in 12 Indigenous community health centres. Assessment included a structured review of health service systems and audit of clinical records. Main process of care measures included adherence to guideline-scheduled services and medication adjustment. Main patient outcome measures were HbA1c, blood pressure and total cholesterol levels. Results There was good engagement of health centre staff, with significant improvements in system development over the study period. Adherence to guideline-scheduled processes improved, including increases in 6 monthly testing of HbA1c from 41% to 74% (Risk ratio 1.93, 95% CI 1.71–2.10, 3 monthly checking of blood pressure from 63% to 76% (1.27, 1.13–1.37, annual testing of total cholesterol from 56% to 74% (1.36, 1.20–1.49, biennial eye checking by a ophthalmologist from 34% to 54% (1.68, 1.39–1.95, and 3 monthly feet checking from 20% to 58% (3.01, 2.52–3.47. Medication adjustment rates following identification of elevated HbA1c and blood pressure were low, increasing from 10% to 24%, and from 13% to 21% respectively at year 1 audit. However, improvements in medication adjustment were not maintained at the year 2 follow-up. Mean HbA1c value improved from 9.3 to 8.9% (mean difference -0.4%, 95% CI -0.7;-0.1, but there was no improvement in blood pressure or cholesterol control. Conclusion This quality improvement (QI intervention has proved to be highly acceptable in the

  17. Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

    Directory of Open Access Journals (Sweden)

    Tara Sampalli


    Full Text Available Background Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.

  18. Healthcare Commercialization Programs: Improving the Efficiency of Translating Healthcare Innovations From Academia Into Practice (United States)

    Reizes, Ofer; Dempsey, Michael K.


    Academic investigators are generating a plethora of insights and technologies that have the potential to significantly improve patient care. However, to address the imperative to improve the quality, cost and access to care with ever more constrained funding, the efficiency and the consistency with which they are translated into cost effective products and/or services need to improve. Healthcare commercialization programs (HCPs) are described and proposed as an option that institutions can add to their portfolio to improve translational research. In helping teams translate specific healthcare innovations into practice, HCPs expand the skillset of investigators and enhance an institution’s innovation capacity. Lessons learned are shared from configuring and delivering HCPs, which build on the fundamentals of the National Science Foundation’s Innovation Corps program, to address the unique challenges in supporting healthcare innovations and innovators. PMID:27766188

  19. Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach (United States)

    Borden, Timothy C; Bellaire, Laura L; Fletcher, Nicholas D


    The complex nature of the surgical treatment of adolescent idiopathic scoliosis (AIS) requires a wide variety of health care providers. A well-coordinated, multidisciplinary team approach to the care of these patients is essential for providing high-quality care. This review offers an up-to-date overview of the numerous interventions and safety measures for improving outcomes after AIS surgery throughout the perioperative phases of care. Reducing the risk of potentially devastating and costly complications after AIS surgery is the responsibility of every single member of the health care team. Specifically, this review will focus on the perioperative measures for preventing surgical site infections, reducing the risk of neurologic injury, minimizing surgical blood loss, and preventing postoperative complications. Also, the review will highlight the postoperative protocols that emphasize early mobilization and accelerated discharge. PMID:27695340

  20. Antenatal care strengthening for improved quality of care in Jimma, Ethiopia

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe


    increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3...... of intervention on various outcomes was significantly modified by maternal education. CONCLUSION: The quality of care can be improved in some important aspects with limited resources. Moreover, the study provides strategic perspectives on how to facilitate improved quality of ANC.......BACKGROUND: Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention...

  1. Electric motor systems in developing countries: Opportunities for efficiency improvement

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, S.; Monahan, P.; Lewis, P.; Greenberg, S. [Lawrence Berkeley Lab., CA (United States); Nadel, S. [American Council for an Energy-Efficient Economy, Washington, DC (United States)


    This report presents an overview of the current status and efficiency improvement potential of industrial motor systems in developing countries. Better management of electric motor systems is of particular relevance in developing countries, where improved efficiency can lead to increased productivity and slower growth in electricity demand. Motor systems currently consume some 65--80% of the industrial electricity in developing countries. Drawing on studies from Thailand, India, Brazil, China, Pakistan, and Costa Rica, we describe potential efficiency gains in various parts of the motor system, from the electricity delivery system through the motor to the point where useful work is performed. We report evidence of a significant electricity conservation potential. Most of the efficiency improvement methods we examine are very cost-effective from a societal viewpoint, but are generally not implemented due to various barriers that deter their adoption. Drawing on experiences in North America, we discuss a range of policies to overcome these barriers, including education, training, minimum efficiency standards, motor efficiency testing protocols, technical assistance programs, and financial incentives.

  2. Training in data definitions improves quality of intensive care data

    NARCIS (Netherlands)

    Arts, DGT; Bosman, RJ; de Jonge, E; Joore, JCA; de Keizer, NF


    Background Our aim was to assess the contribution of training in data definitions and data extraction guidelines to improving quality of data for use in intensive care scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS)

  3. Mobile phones improve antenatal care attendance in Zanzibar

    DEFF Research Database (Denmark)

    Lund, Stine; Nielsen, Birgitte B; Hemed, Maryam;


    BACKGROUND: Applying mobile phones in healthcare is increasingly prioritized to strengthen healthcare systems. Antenatal care has the potential to reduce maternal morbidity and improve newborns' survival but this benefit may not be realized in sub-Saharan Africa where the attendance and quality o...

  4. [Robotics and improvement of the quality of geriatric care]. (United States)

    Ettore, Éric; Wyckaert, Emeline; David, Renaud; Robert, Philippe; Guérin, Olivier; Prate, Frédéric


    New technologies offer innovations to improve the care of the elderly with Alzheimer's or and other forms of dementia. Robots, endowed with features such as monitoring of physiological parameters, cognitive training or occupational therapy, have appeared. They are not, however, intended to replace humans. Still underutilized, these robots are in development, much like the digital literacy of the elderly.

  5. Potential Global Benefits of Improved Ceiling Fan Energy Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Sathaye, Nakul [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Phadke, Amol [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Shah, Nihar [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Letschert, Virginie [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)


    Ceiling fans contribute significantly to residential electricity consumption, both in an absolute sense and as a proportion of household consumption in many locations, especially in developing countries in warm climates. However, there has been little detailed assessment of the costs and benefits of efficiency improvement options for ceiling fans and the potential resulting electricity consumption and greenhouse gas (GHG) emissions reductions. We analyze the costs and benefits of several options to improve the efficiency of ceiling fans and assess the global potential for electricity savings and GHG emission reductions with more detailed assessments for India, China, and the U.S. We find that ceiling fan efficiency can be cost-effectively improved by at least 50% using commercially available technology. If these efficiency improvements are implemented in all ceiling fans sold by 2020, 70 terrawatt hours per year (TWh/year) could be saved and 25 million metric tons of carbon dioxide (CO2) emissions per year could be avoided, globally. We assess how policies and programs such as standards, labels, and financial incentives can be used to accelerate the adoption of efficient ceiling fans in order to realize this savings potential.

  6. Opportunities for improving phosphorus-use efficiency in crop plants. (United States)

    Veneklaas, Erik J; Lambers, Hans; Bragg, Jason; Finnegan, Patrick M; Lovelock, Catherine E; Plaxton, William C; Price, Charles A; Scheible, Wolf-Rüdiger; Shane, Michael W; White, Philip J; Raven, John A


    Limitation of grain crop productivity by phosphorus (P) is widespread and will probably increase in the future. Enhanced P efficiency can be achieved by improved uptake of phosphate from soil (P-acquisition efficiency) and by improved productivity per unit P taken up (P-use efficiency). This review focuses on improved P-use efficiency, which can be achieved by plants that have overall lower P concentrations, and by optimal distribution and redistribution of P in the plant allowing maximum growth and biomass allocation to harvestable plant parts. Significant decreases in plant P pools may be possible, for example, through reductions of superfluous ribosomal RNA and replacement of phospholipids by sulfolipids and galactolipids. Improvements in P distribution within the plant may be possible by increased remobilization from tissues that no longer need it (e.g. senescing leaves) and reduced partitioning of P to developing grains. Such changes would prolong and enhance the productive use of P in photosynthesis and have nutritional and environmental benefits. Research considering physiological, metabolic, molecular biological, genetic and phylogenetic aspects of P-use efficiency is urgently needed to allow significant progress to be made in our understanding of this complex trait.

  7. Efficient Generation and Selection of Combined Features for Improved Classification

    KAUST Repository

    Shono, Ahmad N.


    This study contributes a methodology and associated toolkit developed to allow users to experiment with the use of combined features in classification problems. Methods are provided for efficiently generating combined features from an original feature set, for efficiently selecting the most discriminating of these generated combined features, and for efficiently performing a preliminary comparison of the classification results when using the original features exclusively against the results when using the selected combined features. The potential benefit of considering combined features in classification problems is demonstrated by applying the developed methodology and toolkit to three sample data sets where the discovery of combined features containing new discriminating information led to improved classification results.

  8. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

    Directory of Open Access Journals (Sweden)

    McDermott Robyn


    health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.

  9. Improving Energy Efficiency In Thermal Oil Recovery Surface Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Murthy Nadella, Narayana


    Thermal oil recovery methods such as Cyclic Steam Stimulation (CSS), Steam Assisted Gravity Drainage (SAGD) and In-situ Combustion are being used for recovering heavy oil and bitumen. These processes expend energy to recover oil. The process design of the surface facilities requires optimization to improve the efficiency of oil recovery by minimizing the energy consumption per barrel of oil produced. Optimization involves minimizing external energy use by heat integration. This paper discusses the unit processes and design methodology considering thermodynamic energy requirements and heat integration methods to improve energy efficiency in the surface facilities. A design case study is presented.

  10. Efficiency improvement for wind energy pumped storage systems

    DEFF Research Database (Denmark)

    Forcos, A.; Marinescu, C.; Teodorescu, Remus


    Integrating wind energy into the grid may raise stability problems. Solutions for avoiding these situations are studied and energy storage methods are suitable for balancing the energy between the wind turbine and grid. In this paper, an autonomous wind turbine pumped storage system is presented....... The focus of this paper is to improve the efficiency of this system, which is small at low power levels. The driving motorpump group of the storage system is the key point presented in this paper for efficiency improving. Two control methods, experimentally implemented for induction machine are presented...

  11. TV Energy Consumption Trends and Energy-Efficiency Improvement Options

    Energy Technology Data Exchange (ETDEWEB)

    Park, Won Young; Phadke, Amol; Shah, Nihar; Letschert, Virginie


    The SEAD initiative aims to transform the global market by increasing the penetration of highly efficient equipment and appliances. SEAD is a government initiative whose activities and projects engage the private sector to realize the large global energy savings potential from improved appliance and equipment efficiency. SEAD seeks to enable high-level global action by informing the Clean Energy Ministerial dialogue as one of the initiatives in the Global Energy Efficiency Challenge. In keeping with its goal of achieving global energy savings through efficiency, SEAD was approved as a task within the International Partnership for Energy Efficiency Cooperation (IPEEC) in January 2010. SEAD partners work together in voluntary activities to: (1) ?raise the efficiency ceiling? by pulling super-efficient appliances and equipment into the market through cooperation on measures like incentives, procurement, awards, and research and development (R&D) investments; (2) ?raise the efficiency floor? by working together to bolster national or regional policies like minimum efficiency standards; and (3) ?strengthen the efficiency foundations? of programs by coordinating technical work to support these activities. Although not all SEAD partners may decide to participate in every SEAD activity, SEAD partners have agreed to engage actively in their particular areas of interest through commitment of financing, staff, consultant experts, and other resources. In addition, all SEAD partners are committed to share information, e.g., on implementation schedules for and the technical detail of minimum efficiency standards and other efficiency programs. Information collected and created through SEAD activities will be shared among all SEAD partners and, to the extent appropriate, with the global public.As of April 2011, the governments participating in SEAD are: Australia, Brazil, Canada, the European Commission, France, Germany, India, Japan, Korea, Mexico, Russia, South Africa, Sweden

  12. Efficiency Improvement and Quality Initiatives Application in Financial Institutions

    Directory of Open Access Journals (Sweden)

    MSc. Ajtene Avdullahi


    Full Text Available Financial institutions in today’s economy have no longer the luxury to improve profit simply by increasing revenue. These firms, due to the significant measuring reductions in the financial services industry needed to improve operational efficiencies and merely support existing processes with fewer resources. This paper explains the benefits of Lean, Six Sigma, Total Quality Management and Lean Six Sigma that have improved organization's performance, by cutting costs and waste, improving their products or services, increasing profitability as well as enhancing customer satisfaction. The applicability of quality management practices in financial institutions in Kosovo is presented and also their efficiency and effectiveness. By analyzing data from Raiffeisen Bank Kosovo, this paper highlights the benefits of Individual and Micro companies customer segment as the result of organizational change and successful application of quality initiatives from financial institutions in Kosovo.

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

    Directory of Open Access Journals (Sweden)

    Meijboom Bert


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


    Energy Technology Data Exchange (ETDEWEB)

    William M. Bond; Salih Ersayin


    This project involved industrial scale testing of a mineral processing simulator to improve the efficiency of a taconite processing plant, namely the Minorca mine. The Concentrator Modeling Center at the Coleraine Minerals Research Laboratory, University of Minnesota Duluth, enhanced the capabilities of available software, Usim Pac, by developing mathematical models needed for accurate simulation of taconite plants. This project provided funding for this technology to prove itself in the industrial environment. As the first step, data representing existing plant conditions were collected by sampling and sample analysis. Data were then balanced and provided a basis for assessing the efficiency of individual devices and the plant, and also for performing simulations aimed at improving plant efficiency. Performance evaluation served as a guide in developing alternative process strategies for more efficient production. A large number of computer simulations were then performed to quantify the benefits and effects of implementing these alternative schemes. Modification of makeup ball size was selected as the most feasible option for the target performance improvement. This was combined with replacement of existing hydrocyclones with more efficient ones. After plant implementation of these modifications, plant sampling surveys were carried out to validate findings of the simulation-based study. Plant data showed very good agreement with the simulated data, confirming results of simulation. After the implementation of modifications in the plant, several upstream bottlenecks became visible. Despite these bottlenecks limiting full capacity, concentrator energy improvement of 7% was obtained. Further improvements in energy efficiency are expected in the near future. The success of this project demonstrated the feasibility of a simulation-based approach. Currently, the Center provides simulation-based service to all the iron ore mining companies operating in northern

  15. Improving regional variation using quality of care measures

    Directory of Open Access Journals (Sweden)

    Scott A Berkowitz


    Full Text Available Scott A Berkowitz1, Gary Gerstenblith1, Robert Herbert2, Gerard Anderson1,21Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Center for Hospital Finance and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAAbstract: There is significant regional variability in the quality of care provided in the United States. This article compares regional performance for three measures that focus on transitions in care, and the care of patients with multiple conditions. Admissions for people with ambulatory care-sensitive conditions, hospital readmissions within 30 days of discharge, and compliance with practice guidelines for people with three chronic conditions (congestive heart failure, chronic obstructive pulmonary disease, and diabetes were analyzed using data drawn from the Centers for Medicare & Medicaid Services’ Standard Analytic Files for 5% of a 2004 national sample of Medicare beneficiaries which was divided by hospital referral regions and regional performance. There were significant regional differences in performance which we hypothesize could be improved through better care coordination and system management.Keywords: performance, quality, chronic condition, ambulatory care, sensitive conditions, readmissions

  16. New directions for hospital strategic management: the market for efficient care. (United States)

    Chilingerian, J A


    An analysis of current trends in the health care industry points to buyers seeking high quality, yet efficient, care as an emerging market segment. To target this market segment, hospitals must be prepared to market the efficient physicians. In the coming years, hospitals that can identify and market their best practicing providers will achieve a competitive advantage.

  17. Improving nurse documentation and record keeping in stoma care. (United States)

    Law, Lesley; Akroyd, Karen; Burke, Linda

    Evidence suggests that nurse documentation is often inconsistent and lacks a coherent and standardized approach. This article reports on research into the use of nurse documentation on a stoma care ward in a large London hospital, and explores the factors that may affect the process of record keeping by nursing staff. This study uses stoma care as a case study to explore the role of documentation on the ward, focusing on how this can be improved. It is based on quantitative and qualitative methods. The medical notes of 56 patients were analysed and in addition, focus groups with a number of nurses were undertaken. Quantitative findings indicate that although 80% of patients had a chart filed in their medical notes, only a small portion of the form was completed by nursing staff. Focus group findings indicate that this is because forms lacked standardization and because the language used was often ambiguous. Staff also felt that such documentation was not viewed by other nurses and so, was not effective in improving patient care. As a result of this study, significant improvements have been made to documentation used on the stoma care ward. This is an important exploration of record keeping within nursing in the context of the Nursing and Midwifery Council's emphasis on the importance of documentation in achieving effective patient outcomes.

  18. Practice improvement, part II: collaborative practice and team-based care. (United States)

    Roett, Michelle A; Coleman, Mary Thoesen


    The Institute of Medicine recommends interprofessional teams to address patients' complex needs. Team care should be structured in a way that uses the highest training levels of its members. Team communication is enhanced through regular meetings (eg, team huddles), and office efficiency is improved through identifying and solving underlying system-level issues (ie, second-order problem solving). Inclusive leadership principles are used to strengthen team practices and meet chronic care model goals. Setting clear goals with measurable outcomes, creating clinical and administrative systems, establishing a clear division of labor among team members who have occupational diversity, and providing ongoing training all facilitate team building. Increasing opportunities for team members to work together, such as with group visits, and providing interprofessional education are ways to encourage adoption of interprofessional practice. Reimbursement for team care includes per member per month payments for such services as care management, pay-for-performance benchmark payments, and payment for non-face-to-face services.

  19. Improving pain care through implementation of the Stepped Care Model at a multisite community health center (United States)

    Anderson, Daren R; Zlateva, Ianita; Coman, Emil N; Khatri, Khushbu; Tian, Terrence; Kerns, Robert D


    Purpose Treating pain in primary care is challenging. Primary care providers (PCPs) receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM) at a large, multisite Federally Qualified Health Center. Methods The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention) cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009). There was no significant change in opioid prescribing. Conclusion Implementation of the SCM-PM resulted in clinically significant improvements in several quality of pain care outcomes. These findings, if sustained, may translate into improved patient outcomes. PMID:27881926

  20. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members


    Kimberly Ramsbottom; Mary Lou Kelley


    Long term care (LTC) homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP) important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descript...

  1. Best Practices Implementation for Hydropower Efficiency and Utilization Improvement

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Brennan T [ORNL; Zhang, Qin Fen [ORNL; March, Patrick [Hydro Performance Processes, Inc.; Cones, Marvin [Mesa Associates, Inc.; Dham, Rajesh [U.S. Department of Energy; Spray, Michael [New West Technologies, LLC.


    By using best practices to manage unit and plant efficiency, hydro owner/operators can achieve significant improvements in overall plant performance, resulting in increased generation and profitability and, frequently, reduced maintenance costs. The Hydropower Advancement Project (HAP) was initiated by the Wind and Hydropower Technologies Program within the U.S. Department of Energy (DOE) Office of Energy Efficiency and Renewable Energy to develop and implement a systematic process with standard methodology, based on the best practices of operations, maintenance and upgrades; to identify the improvement opportunities at existing hydropower facilities; and to predict and trend the overall condition and improvement opportunity within the U.S. hydropower fleet. The HAP facility assessment includes both quantitative condition ratings and data-based performance analyses. However, this paper, as an overview document for the HAP, addresses the general concepts, project scope and objectives, best practices for unit and plant efficiency, and process and methodology for best practices implementation for hydropower efficiency and utilization improvement.

  2. Numerical Processing Efficiency Improved in Experienced Mental Abacus Children (United States)

    Wang, Yunqi; Geng, Fengji; Hu, Yuzheng; Du, Fenglei; Chen, Feiyan


    Experienced mental abacus (MA) users are able to perform mental arithmetic calculations with unusual speed and accuracy. However, it remains unclear whether their extraordinary gains in mental arithmetic ability are accompanied by an improvement in numerical processing efficiency. To address this question, the present study, using a numerical…

  3. Does Competition Improve Public School Efficiency? A Spatial Analysis (United States)

    Misra, Kaustav; Grimes, Paul W.; Rogers, Kevin E.


    Advocates for educational reform frequently call for policies to increase competition between schools because it is argued that market forces naturally lead to greater efficiencies, including improved student learning, when schools face competition. Researchers examining this issue are confronted with difficulties in defining reasonable measures…

  4. A history of industrial statistics and quality and efficiency improvement

    NARCIS (Netherlands)

    de Mast, J.; Coleman, S.; Greenfield, T.; Stewardson, D.; Montgomery, D.C.


    The twentieth century witnessed incredible increases in product quality, while in the same period product priced dropped dramatically. These important improvements in quality and efficiency in industry were the result of innovations in management and engineering. But these developments were supporte

  5. Solution for Improve the Efficiency of Solar Photovoltaic Installation


    Petru Chioncel; Cristian Paul Chioncel; Nicoleta Gillich


    This paper present a solution for improving efficiency of solar photovoltaic installation, realized with fixed solar photovoltaic modules, placed in solar parks or individual installations. The proposed solution to increase the radiation on the solar photovoltaic panels is to use some thin plates covered with a reflective blanket, mounted in front of the solar photovoltaic modules, with the possibility of their adjustment.

  6. Point-of-care technology: integration for improved delivery of care. (United States)

    Gregory, Debbie; Buckner, Martha


    The growing complexity of technology, equipment, and devices involved in patient care delivery can be staggering and overwhelming. Technology is intended to be a tool to help clinicians, but it can also be a frustrating hindrance if not thoughtfully planned and strategically aligned. Critical care nurses are key partners in the collaborations needed to improve safety and quality through health information technology (IT). Nurses must advocate for systems that are interoperable and adapted to the context of care experiences. The involvement and collaboration between clinicians, information technology specialists, biomedical engineers, and vendors has never been more relevant and applicable. Working together strategically with a shared vision can effectively provide a seamless clinical workflow, maximize technology investments, and ultimately improve patient care delivery and outcomes. Developing a strategic integrated clinical and IT roadmap is a critical component of today's health care environment. How can technology strategy be aligned from the executive suite to the bedside caregiver? What is the model for using clinical workflows to drive technology adoption? How can the voice of the critical care nurse strengthen this process? How can success be assured from the initial assessment and selection of technology to a sustainable support model? What is the vendor's role as a strategic partner and "co-caregiver"?

  7. Efficient Adoption and Assessment of Multiple Process Improvement Reference Models

    Directory of Open Access Journals (Sweden)

    Simona Jeners


    Full Text Available A variety of reference models such as CMMI, COBIT or ITIL support IT organizations to improve their processes. These process improvement reference models (IRMs cover different domains such as IT development, IT Services or IT Governance but also share some similarities. As there are organizations that address multiple domains and need to coordinate their processes in their improvement we present MoSaIC, an approach to support organizations to efficiently adopt and conform to multiple IRMs. Our solution realizes a semantic integration of IRMs based on common meta-models. The resulting IRM integration model enables organizations to efficiently implement and asses multiple IRMs and to benefit from synergy effects.

  8. Efficiency improvements by geothermal heat integration in a lignocellulosic biorefinery. (United States)

    Sohel, M Imroz; Jack, Michael


    In an integrated geothermal biorefinery, low-grade geothermal heat is used as process heat to allow the co-products of biofuel production to become available for higher-value uses. In this paper we consider integrating geothermal heat into a biochemical lignocellulosic biorefinery so that the lignin-enriched residue can be used either as a feedstock for chemicals and materials or for on-site electricity generation. Depending on the relative economic value of these two uses, we can maximize revenue of a biorefinery by judicious distribution of the lignin-enriched residue between these two options. We quantify the performance improvement from integrating geothermal energy for an optimized system. We then use a thermodynamic argument to show that integrating geothermal heat into a biorefinery represents an improvement in overall resource utilization efficiency in all cases considered. Finally, possible future technologies for electricity generation are considered which could improve this efficiency further.

  9. Efficient Work Team Scheduling: Using Psychological Models of Knowledge Retention to Improve Code Writing Efficiency

    Directory of Open Access Journals (Sweden)

    Michael J. Pelosi


    Full Text Available Development teams and programmers must retain critical information about their work during work intervals and gaps in order to improve future performance when work resumes. Despite time lapses, project managers want to maximize coding efficiency and effectiveness. By developing a mathematically justified, practically useful, and computationally tractable quantitative and cognitive model of learning and memory retention, this study establishes calculations designed to maximize scheduling payoff and optimize developer efficiency and effectiveness.

  10. Improving air handler efficiency in residential HVAC applications

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain S.; Mingee, Michael D.; Brenner, Douglas E.


    In continuing the development of energy efficiency standards, consideration has turned to air handlers used for heating and air conditioning of consumer residences. These air handlers have typical efficiencies of about 10% to 15% due to poor electric motor performance and aerodynamically poor fans and fan housings. This study was undertaken to examine some of these performance issues, under carefully controlled laboratory conditions, to support potential regulatory changes. In addition, this study examined the performance of a prototype air handler fan assembly that offers the potential for substantial increases in performance. This prototype and a standard production fan were tested in a full-scale duct system and test chamber at LBNL which was specifically designed for testing heating, ventilation, and air conditioning systems. The laboratory tests compared efficiency, total airflow, sensitivity to duct system flow resistance, and the effects of installation in a smaller cabinet. The test results showed that, averaged over a wide range of operating conditions, the prototype air handler had about twice the efficiency of the standard air handler and was less sensitive to duct system flow resistance changes. The performance of both air handlers was significantly reduced by reducing the space between the air handler and the cabinet it was installed in. Therefore any fan rating needs to be performed using the actual cabinet it will be used in.

  11. Improving Midwifery Care in Ugandan Public Hospitals: The Midwives’ Perspective (United States)

    Nabirye, Rose C.; Beinempaka, Florence; Okene, Cindrella; Groves, Sara


    Background A serious shortage of nurses and midwives in public hospitals has been reported in Uganda. In addition, over 80% of the nurses and midwives working in public hospitals have been found to have job stress and only 17% to be satisfied on the job. Stress and lack of job satisfaction affect quality of nursing and midwifery care and puts patients’ lives at risk. This is coupled with rampant public outcry about the deteriorating nursing and midwifery care in Ugandan public hospitals. Objective To explore factors that result in poor quality of midwifery care and strategies to improve this care from the perspective of the midwives. Method It was a qualitative exploratory design. Participants were midwives and their supervisors working in four Regional Referral hospitals in Uganda. Data was collected by FGDs and KIIs. Content analysis was used to analyze the transcribed data from the voice recordings. Results Four major themes emerged from the study. They were organizational (poor work environment and lack of materials/equipment), professional (midwives’ attitudes, lack of supervision), public/consumer issues (interference) and policy issues (remuneration, promotion and retirement). Conclusions and implications for Practice Midwives love their work but they need support to provide quality care. Continuous neglect of midwives’ serious concerns will lead to more shortages as more dissatisfied midwives leave service.

  12. Solar cell nanotechnology for improved efficiency and radiation hardness (United States)

    Fedoseyev, Alexander I.; Turowski, Marek; Shao, Qinghui; Balandin, Alexander A.


    Space electronic equipment, and NASA future exploration missions in particular, require improvements in solar cell efficiency and radiation hardness. Novel nano-engineered materials and quantum-dot array based photovoltaic devices promise to deliver more efficient, lightweight solar cells and arrays which will be of high value to long term space missions. In this paper, we describe issues related to the development of the quantum-dot based solar cells and comprehensive software tools for simulation of the nanostructure-based photovoltaic cells. Some experimental results used for the model validation are also reviewed. The novel modeling and simulation tools for the quantum-dot-based nanostructures help to better understand and predict behavior of the nano-devices and novel materials in space environment, assess technologies, devices, and materials for new electronic systems as well as to better evaluate the performance and radiation response of the devices at an early design stage. The overall objective is to investigate and design new photovoltaic structures based on quantum dots (QDs) with improved efficiency and radiation hardness. The inherently radiation tolerant quantum dots of variable sizes maximize absorption of different light wavelengths, i.e., create a "multicolor" cell, which improves photovoltaic efficiency and diminishes the radiation-induced degradation. The QD models described here are being integrated into the advanced photonic-electronic device simulator NanoTCAD, which can be useful for the optimization of QD superlattices as well as for the development and exploring of new solar cell designs.

  13. COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates

    Directory of Open Access Journals (Sweden)

    Parikh R


    Full Text Available Raj Parikh,1 Trushil G Shah,2 Rajive Tandon2 1Department of Internal Medicine, 2Department of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, USA Introduction: COPD is the third leading cause of death in the world. Utilizing care bundles during acute COPD exacerbations results in fewer complications and lower costs. Our aim was to construct a COPD exacerbation care bundle and evaluate the effects on patient care. Methods: We conducted a prospective analysis of 44 patients admitted with a COPD exacerbation to a single tertiary care facility. Primary outcomes included length of stay, readmission rates, and hospital costs. Secondary outcomes included patient education, pulmonologist follow-up, and timeliness of medication administration. Two cohorts were analyzed: those treated with an electronic COPD care bundle (cases; N=22 versus those treated without the care bundle (controls; N=22. Results: Mean length of stay (51.2 vs 101.1 hours in controls; P-value =0.001, 30-day readmission rates (9.1% vs 54.4% in controls; P-value =0.001, and 60-day readmission rates (22.7% vs 77% in controls; P-value =0.0003 decreased in the care bundle group. Ninety-day hospital costs had a significant difference in the care bundle group (US$7,652 vs US$19,954 in controls; P-value =0.044. Secondary outcomes included a 100% rate of COPD inhaler teaching (vs 27.3% in controls; P-value <0.001, 59.1% rate of pulmonologist follow-up after discharge (vs 18.2% in controls; P-value =0.005, and a mean reduction in time to steroid administration (7.0 hours; P-value =0.015 seen in the care bundle cases. Conclusion: Our significant findings coupled with the recent success of standardized algorithms in managing COPD exacerbations stress the importance of enforcing clinical guidelines that can enhance patient care. We demonstrated improved care for COPD exacerbation patients during hospitalizations, thereby decreasing morbidity and the financial

  14. Activity-based costing for clinical paths. An example to improve clinical cost & efficiency. (United States)

    Asadi, M J; Baltz, W A


    How much does this medical service or surgical procedure cost the hospital to provide? What is the most efficient clinical pathway that maximizes the quality of patient care while minimizing costs? More and more hospitals are discovering that they don't have solid answers to these critically important questions. In an age of managed care and capitation, however, it is imperative for management to know if the patient care services they provide are making or losing money-and by how much. This article discusses how a powerful new tool called activity-based costing (ABC) can be used to help hospitals accurately determine patient care costs. We show how to build a model that combines both clinical and financial data to measure how efficiently the operation allocates human, material and capital resources to provide its services. The modeling approach described in this article can be used to better analyze a wide range of important operational and financial issues, including: How to efficiently allocate resources, and what resources will be needed as patient demand changes-ideal for operational management and planning; How efficiently activities and processes are performed to meet patient needs-effective for measuring performance and improving quality; Determining clinical pathway profitability-essential for understanding where you're making or losing money; Cycle time, throughput and the impact of resource capacity constraints-critical for meeting patient demand; Costs of idle capacity-important for using resources more efficiently. We will illustrate with an example how this modeling technique can be used to develop and implement efficient clinical pathways.

  15. Efficient Terahertz Photoconductive Emitters with Improved Electrode Structures

    Institute of Scientific and Technical Information of China (English)

    Ying-Xin Wang; Yi-Jie Niu; Wei Cheng; Zhi-Qiang Li; Zi-Ran Zhao


    We present the design, fabrication, and characterization of two new types of terahertz photoconductive emitters. One has an asymmetric four-contact electrode structure and the other has an arc-shaped electrode structure, which are all modified from a traditional strip line antenna. Numerical simulations and real experiments confirm the good performance of the proposed antennas. An amplitude increase of about 40% is experimentally observed for the terahertz signals generated from the new structures. The special electrode structure and its induced local bias field enhancement are responsible for this radiation efficiency improvement. Our work demonstrates the feasibility of developing highly efficient terahertz photoconductive emitters by optimizing the electrode structure.

  16. Improving pain care through implementation of the Stepped Care Model at a multisite community health center

    Directory of Open Access Journals (Sweden)

    Anderson DR


    Full Text Available Daren R Anderson,1 Ianita Zlateva,1 Emil N Coman,2 Khushbu Khatri,1 Terrence Tian,1 Robert D Kerns3 1Weitzman Institute, Community Health Center, Inc., Middletown, 2UCONN Health Disparities Institute, University of Connecticut, Farmington, 3VA Connecticut Healthcare System, West Haven, CT, USA Purpose: Treating pain in primary care is challenging. Primary care providers (PCPs receive limited training in pain care and express low confidence in their knowledge and ability to manage pain effectively. Models to improve pain outcomes have been developed, but not formally implemented in safety net practices where pain is particularly common. This study evaluated the impact of implementing the Stepped Care Model for Pain Management (SCM-PM at a large, multisite Federally Qualified Health Center. Methods: The Promoting Action on Research Implementation in Health Services framework guided the implementation of the SCM-PM. The multicomponent intervention included: education on pain care, new protocols for pain assessment and management, implementation of an opioid management dashboard, telehealth consultations, and enhanced onsite specialty resources. Participants included 25 PCPs and their patients with chronic pain (3,357 preintervention and 4,385 postintervention cared for at Community Health Center, Inc. Data were collected from the electronic health record and supplemented by chart reviews. Surveys were administered to PCPs to assess knowledge, attitudes, and confidence. Results: Providers’ pain knowledge scores increased to an average of 11% from baseline; self-rated confidence in ability to manage pain also increased. Use of opioid treatment agreements and urine drug screens increased significantly by 27.3% and 22.6%, respectively. Significant improvements were also noted in documentation of pain, pain treatment, and pain follow-up. Referrals to behavioral health providers for patients with pain increased by 5.96% (P=0.009. There was no

  17. Quality improvement in radiography in a neonatal intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Loovere, L.; Boyle, E.M. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada); Blatz, S. [Dept. of Pediactrics, McMaster Children' s Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Bowslaugh, M.; Kereliuk, M. [Dept. of Radiology, Diagnostic Imaging, Hamilton Health Sciences, Hamilton, Ontario (Canada); Paes, B. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada)], E-mail:


    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  18. Low Impedance Voice Coils for Improved Loudspeaker Efficiency

    DEFF Research Database (Denmark)

    Iversen, Niels Elkjær; Knott, Arnold; Andersen, Michael A. E.


    In modern audio systems utilizing switch-mode amplifiers the total efficiency is dominated by the rather poor efficiency of the loudspeaker. For decades voice coils have been designed so that nominal resistances of 4 to 8 Ohms is obtained, despite modern audio amplifiers, using switch-mode techno......In modern audio systems utilizing switch-mode amplifiers the total efficiency is dominated by the rather poor efficiency of the loudspeaker. For decades voice coils have been designed so that nominal resistances of 4 to 8 Ohms is obtained, despite modern audio amplifiers, using switch......-mode technology, can be designed to much lower loads. A thorough analysis of the loudspeaker efficiency is presented and its relation to the voice coil fill factor is described. A new parameter, the drivers mass ratio, is introduced and it indicates how much a fill factor optimization will improve a driver......’s efficiency. Different voice coil winding layouts are described and their fill factors analyzed. It is found that by lowering the nominal resistance of a voice coil, using rectangular wire, one can increase the fill factor. Three voice coils are designed for a standard 10” woofer and corresponding frequency...

  19. Policy Statement--Using personal health records to improve the quality of health care for children. (United States)


    A personal health record (PHR) is a repository of information from multiple contributors (eg, patient, family, guardians, physicians, and other health care professionals) regarding the health of an individual. The development of electronic PHRs presents new opportunities and challenges to the practice of pediatrics. This policy statement provides recommendations for actions that pediatricians can take to support the development and use of PHRs for children. Pediatric health care professionals must become actively involved in developing and adopting PHRs and PHR systems. The American Academy of Pediatrics supports development of: educational programs for families and clinicians on effective and efficient use of PHRs; incentives to facilitate PHR use and maintenance; and child- and adolescent-friendly standards for PHR content, portability, security, and privacy. Properly designed PHR systems for pediatric care can empower patients. PHRs can improve access to health information, improve coordination of preventive health and health maintenance activities, and support emergency and disaster management activities. PHRs provide support for the medical home for all children, including those with special health care needs and those in foster care. PHRs can also provide information to serve as the basis for pediatric quality improvement efforts. For PHRs to be adopted sufficiently to realize these benefits, we must determine how best to support their development and adoption. Privacy and security issues, especially with regard to children and adolescents, must be addressed.

  20. [Continuous nursing education to improve the quality of health care]. (United States)

    Fumić, Nera; Marinović, Marin; Brajan, Dolores


    Health care and today's medical and technical achievements and approved standards of treatment provide comprehensive quality, safety and traceability of medical procedures respecting the principles of health protection. Continuous education improves the quality of nursing health care and increases the effectiveness of patient care, consequently maintaining and enhancing patient safety. Patient health problems impose the need of appropriate, planned and timely nursing care and treatment. In providing quality nursing care, attention is focused on the patient and his/her needs in order to maintain and increase their safety, satisfaction, independence and recovery or peaceful death, so the health and nursing practices must be systematized, planned and based on knowledge and experience. Health and nursing care of patients at risk of developing acute and chronic wounds or already suffering from some form of this imply preventive measures that are provided through patient education, motivation, monitoring, early recognition of risk factors and causes, and reducing or removing them through the prescribed necessary medical treatment which is safe depending on the patient health status. Except for preventive measures, nursing care of patients who already suffer from some form of acute or chronic wounds is focused on the care and treatment of damaged tissue by providing appropriate and timely diagnosis, timely and proper evaluation of the wound and patient general status, knowledge and understanding of the wide range of local, oral and parenteral therapy and treatment, aiming to increase patient safety by preventing progression of the patient general condition and local wound status and reducing the possibility of developing infection or other complications of the underlying disease. In the overall patient management, through nursing process, medical interventions are implemented and aimed to maintain and optimize health status, prevent complications of existing diseases and

  1. Efficiency of searching the grey literature in palliative care. (United States)

    Cook, A M; Finlay, I G; Edwards, A G; Hood, K; Higginson, I J; Goodwin, D M; Normand, C E; Douglas, H R


    A systematic review into palliative care team effectiveness was undertaken which has, inherent in its methodology, grey literature searching. Over 100 letters were written to a systematically chosen range of service providers, commissioners, and experts in combination with requests for information in six UK national cancer/palliative care organization newsletters. In addition, the System for Information on Grey Literature (SIGLE ) database was searched. As a result, 25 document hard copies were received. The documents were, in all but one case (this one study was also highlighted by the SIGLE search), not relevant as they were predominated by annual reports, service descriptions, and needs assessments. In terms of obtaining unpublished studies for possible inclusion in the review, this comprehensive search was unsuccessful and, therefore, it would appear that grey literature searching is not a useful tool in palliative care systematic reviews.

  2. Improving critical care discharge summaries: a collaborative quality improvement project using PDSA. (United States)

    Goulding, Lucy; Parke, Hannah; Maharaj, Ritesh; Loveridge, Robert; McLoone, Anne; Hadfield, Sophie; Helme, Eloise; Hopkins, Philip; Sandall, Jane


    Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called 'iMobile' is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work

  3. Improving the financial viability of primary care health centers. (United States)

    Finkler, S A; Knickman, J R; Hanson, K L


    This article presents findings from a national demonstration program to improve the long-term financial viability of small not-for-profit primary care health centers. The program initiatives and their implementation are described in some detail. A standard pre/post study design was used to measure the impact of the initiatives on general outcome measures, financial ratios, and the utilization of management techniques. Overall, demonstration centers showed improvement over the study period. Notable short-term improvements included significant growth in the volume of patient visits and increased profit. Observed changes also revealed an increased use of sophisticated management techniques, expected to positively affect longer-term financial health. The findings suggest that improving the financial viability of health centers need not be expensive.

  4. Analyzing demand-side efficiency in global health: an application to maternal care in Vietnam. (United States)

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


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

  5. Improving Hospital Efficiency Through Data-Driven Management (United States)

    Blanchard, Janice C.; Rudin, Robert S.


    Abstract This article presents a case study of how one health system—Health First, in Brevard County, Florida—addressed resource challenges by using Lean thinking enabled by information technology. Examining Health First provides an opportunity to learn about how one hospital system addressed these challenges by making fundamental changes in their operations, in advance of the shift toward accountable care. Three years after Health First embarked on an effort to streamline patient flow and improve throughput, adult transfers within the system have increased by more than 300 percent and emergency department times between admission and inpatient bed occupancy decreased by 37 percent. PMID:28083412

  6. Accidental politicians: How randomly selected legislators can improve parliament efficiency (United States)

    Pluchino, Alessandro; Garofalo, Cesare; Rapisarda, Andrea; Spagano, Salvatore; Caserta, Maurizio


    We study a prototypical model of a Parliament with two Parties or two Political Coalitions and we show how the introduction of a variable percentage of randomly selected independent legislators can increase the global efficiency of a Legislature, in terms of both the number of laws passed and the average social welfare obtained. We also analytically find an “efficiency golden rule” which allows to fix the optimal number of legislators to be selected at random after that regular elections have established the relative proportion of the two Parties or Coalitions. These results are in line with both the ancient Greek democratic system and the recent discovery that the adoption of random strategies can improve the efficiency of hierarchical organizations.

  7. Accidental Politicians: How Randomly Selected Legislators Can Improve Parliament Efficiency

    CERN Document Server

    Pluchino, A; Rapisarda, A; Spagano, S; Caserta, M


    We study a prototypical model of a Parliament with two Parties or two Political Coalitions and we show how the introduction of a variable percentage of randomly selected independent legislators can increase the global efficiency of a Legislature, in terms of both number of laws passed and average social welfare obtained. We also analytically find an "efficiency golden rule" which allows to fix the optimal number of legislators to be selected at random after that regular elections have established the relative proportion of the two Parties or Coalitions. These results are in line with both the ancient Greek democratic system and the recent discovery that the adoption of random strategies can improve the efficiency of hierarchical organizations.

  8. Efficiency Improvement of Vehicular Antenna Systems for Ubiquitous Intelligent Systems

    Directory of Open Access Journals (Sweden)

    Kyubong Yeon


    Full Text Available This paper describes the design of a high-efficiency vehicular roof-mounted antenna for wireless access for vehicular environment (WAVE communication systems used for ubiquitous intelligent systems. The main objective of the ubiquitous intelligent system’s automotive IT technology is to enhance the connectivity among vehicles to ensure seamless communication and to reduce the initial access time using high-performance antenna systems. The efficiency of WAVE communication systems used for ubiquitous intelligent systems depends on the antenna efficiency. The proposed vehicular antenna for WAVE communication systems shows an improvement of approximately 4.77 dB in the return loss, as compared with a conventional antenna system.

  9. Improved efficient routing strategy on two-layer complex networks (United States)

    Ma, Jinlong; Han, Weizhan; Guo, Qing; Zhang, Shuai; Wang, Junfang; Wang, Zhihao


    The traffic dynamics of multi-layer networks has become a hot research topic since many networks are comprised of two or more layers of subnetworks. Due to its low traffic capacity, the traditional shortest path routing (SPR) protocol is susceptible to congestion on two-layer complex networks. In this paper, we propose an efficient routing strategy named improved global awareness routing (IGAR) strategy which is based on the betweenness centrality of nodes in the two layers. With the proposed strategy, the routing paths can bypass hub nodes of both layers to enhance the transport efficiency. Simulation results show that the IGAR strategy can bring much better traffic capacity than the SPR and the global awareness routing (GAR) strategies. Because of the significantly improved traffic performance, this study is helpful to alleviate congestion of the two-layer complex networks.

  10. CEZ's options to improve FGD efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Hulka, Milan [CEZ, a.s., Melnik (Czech Republic); Kraus, Zbynek [CEZ, a.s., Prunerov (Czech Republic); Stonawski, Jaroslav [CEZ, a.s., Detmarovice (Czech Republic)


    CEZ, a s. retrofitted in the 1990s flue gas desulphurisation plants (FGD) supplied by European and Japanese suppliers at eleven of its coal-fired sites within the scope of the first stage of comprehensive modernisation measures. A lot of these installations do not meet the requirements of the EU Directive 2010/75/EU. Therefore, possibilities have to be identified to improve the efficiency of existing plants and retrofit measures have to be planned to improve FGD performance. Final recommendations for each plant are governed by the future operation strategy concept and fuel to be fired. (orig.)

  11. Energy-Efficiency Improvement Opportunities for the Textile Industry

    Energy Technology Data Exchange (ETDEWEB)

    China Energy Group; Hasanbeigi, Ali


    The textile industry is one of the most complicated manufacturing industries because it is a fragmented and heterogeneous sector dominated by small and medium enterprises (SMEs). Energy is one of the main cost factors in the textile industry. Especially in times of high energy price volatility, improving energy efficiency should be a primary concern for textile plants. There are various energy-efficiency opportunities that exist in every textile plant, many of which are cost-effective. However, even cost-effective options often are not implemented in textile plants mostly because of limited information on how to implement energy-efficiency measures, especially given the fact that a majority of textile plants are categorized as SMEs and hence they have limited resources to acquire this information. Know-how on energy-efficiency technologies and practices should, therefore, be prepared and disseminated to textile plants. This guidebook provides information on energy-efficiency technologies and measures applicable to the textile industry. The guidebook includes case studies from textile plants around the world and includes energy savings and cost information when available. First, the guidebook gives a brief overview of the textile industry around the world, with an explanation of major textile processes. An analysis of the type and the share of energy used in different textile processes is also included in the guidebook. Subsequently, energy-efficiency improvement opportunities available within some of the major textile sub-sectors are given with a brief explanation of each measure. The conclusion includes a short section dedicated to highlighting a few emerging technologies in the textile industry as well as the potential for the use of renewable energy in the textile industry.

  12. An Initial Study of Improving English Reading Efficiency

    Institute of Scientific and Technical Information of China (English)



    Reading,as an important medium for human beings to gain knowledge,also plays a major part in the teaching and learning of English.Nevertheless,in practical teaching,we find that the students are quite at a loss at what to do.This article will probe into how to improve the reading efficiency from two aspects:linguistic factors and non-linguistic factors.

  13. Improving the Energy Efficiency of Pumped-Storage Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    Artyukh, S. F., E-mail: [Kharkov Polytechnic Institute (Ukraine); Galat, V. V. [JSC “UkrHydroEnergo” (Ukraine); Kuz’min, V. V. [JSC “Interregional Electricity Association ELTA” (Ukraine); Chervonenko, I. I. [Kharkov Polytechnic Institute (Ukraine); Shakaryan, Yu. G.; Sokur, P. V. [JSC “R& D Center at Federal Grid Company of Unified Energy System” (Russian Federation)


    Possible ways to improve the energy efficiency of hydroelectric generating sets of pumped-storage power plants (PSPPs) are studied. The Kiev PSPP is used as an example to show how its generating sets can be upgraded. It is concluded based on studies conducted that synchronous motor-generators should be replaced with asynchronized motor-generators. The feasibility of changing over the turbine to variable-speed operation is shown.

  14. Solution for Improve the Efficiency of Solar Photovoltaic Installation

    Directory of Open Access Journals (Sweden)

    Petru Chioncel


    Full Text Available This paper present a solution for improving efficiency of solar photovoltaic installation, realized with fixed solar photovoltaic modules, placed in solar parks or individual installations. The proposed solution to increase the radiation on the solar photovoltaic panels is to use some thin plates covered with a reflective blanket, mounted in front of the solar photovoltaic modules, with the possibility of their adjustment.

  15. Improving diabetic foot screening at a primary care clinic: A quality improvement project (United States)

    Allen, Michelle L.; Gunst, Colette


    Background Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. Aim This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Setting A primary health care clinic in the Western Cape province of South Africa Methods A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle. Results HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusion The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle. PMID:27608673

  16. Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

    Directory of Open Access Journals (Sweden)

    Cathy Kande


    Full Text Available Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05 was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90 in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

  17. High Performance Healthcare Buildings: A Roadmap to Improved Energy Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Singer, Brett C.; Tschudi, William F.


    This document presents a road map for improving the energy efficiency of hospitals and other healthcare facilities. The report compiles input from a broad array of experts in healthcare facility design and operations. The initial section lists challenges and barriers to efficiency improvements in healthcare. Opportunities are organized around the following ten themes: understanding and benchmarking energy use; best practices and training; codes and standards; improved utilization of existing HVAC designs and technology; innovation in HVAC design and technology; electrical system design; lighting; medical equipment and process loads; economic and organizational issues; and the design of next generation sustainable hospitals. Achieving energy efficiency will require a broad set of activities including research, development, deployment, demonstration, training, etc., organized around 48 specific objectives. Specific activities are prioritized in consideration of potential impact, likelihood of near- or mid-term feasibility and anticipated cost-effectiveness. This document is intended to be broad in consideration though not exhaustive. Opportunities and needs are identified and described with the goal of focusing efforts and resources.

  18. Improving crop nutrient efficiency through root architecture modifications

    Institute of Scientific and Technical Information of China (English)

    Xinxin Li; Rensen Zeng; Hong Liao


    Improving crop nutrient efficiency becomes an essential consideration for environmentally friendly and sustainable agriculture. Plant growth and development is dependent on 17 essential nutrient elements, among them, nitrogen (N) and phosphorus (P) are the two most important mineral nutrients. Hence it is not surprising that low N and/or low P availability in soils severely constrains crop growth and productivity, and thereby have become high priority targets for improving nutrient efficiency in crops. Root exploration largely determines the ability of plants to acquire mineral nutrients from soils. Therefore, root architecture, the 3-dimensional configuration of the plant’s root system in the soil, is of great importance for improving crop nutrient efficiency. Furthermore, the symbiotic associations between host plants and arbuscular mycorrhiza fungi/rhizobial bacteria, are additional important strategies to enhance nutrient acquisition. In this review, we summarize the recent advances in the current understanding of crop species control of root architecture alterations in response to nutrient availability and root/microbe symbioses, through gene or QTL regulation, which results in enhanced nutrient acquisition.

  19. Improving crop nutrient efficiency through root architecture modifications. (United States)

    Li, Xinxin; Zeng, Rensen; Liao, Hong


    Improving crop nutrient efficiency becomes an essential consideration for environmentally friendly and sustainable agriculture. Plant growth and development is dependent on 17 essential nutrient elements, among them, nitrogen (N) and phosphorus (P) are the two most important mineral nutrients. Hence it is not surprising that low N and/or low P availability in soils severely constrains crop growth and productivity, and thereby have become high priority targets for improving nutrient efficiency in crops. Root exploration largely determines the ability of plants to acquire mineral nutrients from soils. Therefore, root architecture, the 3-dimensional configuration of the plant's root system in the soil, is of great importance for improving crop nutrient efficiency. Furthermore, the symbiotic associations between host plants and arbuscular mycorrhiza fungi/rhizobial bacteria, are additional important strategies to enhance nutrient acquisition. In this review, we summarize the recent advances in the current understanding of crop species control of root architecture alterations in response to nutrient availability and root/microbe symbioses, through gene or QTL regulation, which results in enhanced nutrient acquisition.

  20. Improving personal health records for patient-centered care (United States)

    Feldman, Henry J; Ross, Stephen E; Safran, Charles


    Objective To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines. Design Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors. Measurements Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model. Results Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days. Conclusion Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines. PMID:20190063

  1. New approaches for improving energy efficiency in the Brazilian industry

    Directory of Open Access Journals (Sweden)

    Paulo Henrique de Mello Santana


    Full Text Available The Brazilian government has been promoting energy efficiency measures for industry since the eighties but with very limited returns, as shown in this paper. The governments of some other countries dedicated much more effort and funds for this area and reached excellent results. The institutional arrangements and types of programmes adopted in these countries are briefly evaluated in the paper and provide valuable insights for several proposals put forward here to make more effective the Brazilian government actions directed to overcome market barriers and improve energy efficiency in the local industry. The proposed measures include the creation of Industrial Assessment Centres and an executive agency charged with the coordination of all energy efficiency programmes run by the Federal government. A large share of the Brazilian industry energy consumption comes from energy-intensive industrial branches. According to a recent survey, most of them have substantial energy conservation potentials. To materialize a fair amount of them, voluntary targets concerning energy efficiency gains should start to be negotiated between the Government and associations representing these industrial branches. Credit facilities and tax exemptions for energy-efficient equipment’s should be provided to stimulate the interest of the entrepreneurs and the setting-up of bolder targets.

  2. Evaluating Technical Efficiency of Nursing Care Using Data Envelopment Analysis and Multilevel Modeling. (United States)

    Min, Ari; Park, Chang Gi; Scott, Linda D


    Data envelopment analysis (DEA) is an advantageous non-parametric technique for evaluating relative efficiency of performance. This article describes use of DEA to estimate technical efficiency of nursing care and demonstrates the benefits of using multilevel modeling to identify characteristics of efficient facilities in the second stage of analysis. Data were drawn from, a secondary database including nursing home data from the Online Survey Certification and Reporting System and Minimum Data Set. In this example, 2,267 non-hospital-based nursing homes were evaluated. Use of DEA with nurse staffing levels as inputs and quality of care as outputs allowed estimation of the relative technical efficiency of nursing care in these facilities. In the second stage, multilevel modeling was applied to identify organizational factors contributing to technical efficiency. Use of multilevel modeling avoided biased estimation of findings for nested data and provided comprehensive information on differences in technical efficiency among counties and states.

  3. Improving Integrated Care: Modelling the performance of an online community of practice

    Directory of Open Access Journals (Sweden)

    Ángel Díaz-Chao


    Full Text Available Introduction: This article aims to confirm the following core hypothesis: a Community of Practice’s use of a Web 2.0 platform for communication between primary and hospital care leads to improved primary care and fewer hospital referrals. This core hypothesis will be corroborated by testing a further five partial hypotheses that complete the main hypothesis being estimated.Methods: An ad-hoc questionnaire was designed and sent to a sample group of 357 professionals from the Badalona-Sant Adrià de Besòs Primary Care Service in Catalonia, Spain, which includes nine primary care centres and three specialist care centres. The study sample was formed by 159 respondents. The partial least squares methodology was used to estimate the model of the causal relationship and the proposed hypotheses.Results: It was found that when healthcare staff used social networks and information and communication technologies professionally, and the more contact hours they have with patients, the more a Web 2.0 platform was likely to be used for communication between primary and hospital care professionals. Such use led to improved primary care and fewer hospital referrals according to the opinions of health professionals on its use.Conclusions: The research suggests that the efficiency of medical practice is explained by the intensity of Web 2.0 platform use for communication between primary and specialist care professionals. Public policies promoting the use of information and communication technologies in communities of practice should go beyond the technological dimension and consider other professional, organisational and social determinants.

  4. Using a big conversation to improve care quality. (United States)

    Boyd, Maggie

    The Collaboration for Leadership in Applied Health Research and Care (CLAHRC) compiled a report on the day, in which it noted: "The overriding result was one of inspiration through being heard, having honest, genuine and open dialogue and positively engaging with like-minded people. The event gave many the confidence to try to take things forward and influence others, and there was a sense of the event being an opportunity that gave hope for the future." The next step is to set up a "nursing cabinet"--a stakeholder board that will oversee work to improve "care through the patients' eyes". This will involve health professionals, academics, voluntary organisations and patient groups. Box 1 outlines key actions taken as a result of the event. The report on the day's findings is available on the trust website.

  5. Blood transfusions in critical care: improving safety through technology & process analysis. (United States)

    Aulbach, Rebecca K; Brient, Kathy; Clark, Marie; Custard, Kristi; Davis, Carolyn; Gecomo, Jonathan; Ho, Judy Ong


    A multidisciplinary safety initiative transformed blood transfusion practices at St. Luke's Episcopal Hospital in Houston, Texas. An intense analysis of a mistransfusion using the principles of a Just Culture and the process of Cause Mapping identified system and human performance factors that led to the transfusion error. Multiple initiatives were implemented including technology, education and human behaviour change. The wireless technology of Pyxis Transfusion Verification by CareFusion is effective with the rapid infusion module efficient for use in critical care. Improvements in blood transfusion safety were accomplished by thoroughly evaluating the process of transfusions and by implementing wireless electronic transfusion verification technology. During the 27 months following implementation of the CareFusion Transfusion Verification there have been zero cases of transfusing mismatched blood.

  6. Spica cast care: a collaborative staff-led education initiative for improved patient care. (United States)

    Reed, Cynthia; Carroll, Lee; Baccari, Susan; Shermont, Herminia


    One of the most challenging aspects for nurses caring for incontinent children in spica casts is maintaining healthy skin integrity. Noting an increase in the number of phone calls from parents of discharged children in spica casts concerning diaper rash and skin breakdown, inpatient orthopedics staff nurses lead an interdisciplinary quality improvement and educational initiative. They standardized pediatric spica cast care and education by creating an intranet narrated PowerPoint presentation for staff and parents of children with spica casts. A take-home DVD of this education module is now produced and given to parents, reinforcing nursing discharge teaching and giving parents the opportunity to review these new skills at home as needed. The purpose of this article is to share this experience of improving patient outcomes and empowering other orthopedics nurses to develop creative educational solutions.

  7. Using Evidence-Based Design to Improve Pharmacy Department Efficiency. (United States)

    Greenroyd, Fraser L; Hayward, Rebecca; Price, Andrew; Demian, Peter; Sharma, Shrikant


    Using a case study of a pharmacy department rebuild in the South West of England, this article examines the use of evidence-based design to improve the efficiency and staff well-being with a new design. This article compares three designs, the current design, an anecdotal design, and an evidence-based design, to identify how evidence-based design can improve efficiency and staff well-being by reducing walking time and distance. Data were collected from the existing building and used to measure the efficiency of the department in its current state. These data were then mapped onto an anecdotal design, produced by architects from interviews and workshops with the end users, and an evidence-based design, produced by highlighting functions with high adjacencies. This changed the view on the working processes within the department, shifting away from a focus on the existing robotic dispensing system. Using evidence-based design was found to decrease the walking time and distance for staff by 24%, as opposed to the anecdotal design, which increased these parameters by 9%, and is predicted to save the department 248 min across 2 days in staff time spent walking.

  8. Modified paraffin wax for improvement of histological analysis efficiency. (United States)

    Lim, Jin Ik; Lim, Kook-Jin; Choi, Jin-Young; Lee, Yong-Keun


    Paraffin wax is usually used as an embedding medium for histological analysis of natural tissue. However, it is not easy to obtain enough numbers of satisfactory sectioned slices because of the difference in mechanical properties between the paraffin and embedded tissue. We describe a modified paraffin wax that can improve the histological analysis efficiency of natural tissue, composed of paraffin and ethylene vinyl acetate (EVA) resin (0, 3, 5, and 10 wt %). Softening temperature of the paraffin/EVA media was similar to that of paraffin (50-60 degrees C). The paraffin/EVA media dissolved completely in xylene after 30 min at 50 degrees C. Physical properties such as the amount of load under the same compressive displacement, elastic recovery, and crystal intensity increased with increased EVA content. EVA medium (5 wt %) was regarded as an optimal composition, based on the sectioning efficiency measured by the numbers of unimpaired sectioned slices, amount of load under the same compressive displacement, and elastic recovery test. Based on the staining test of sectioned slices embedded in a 5 wt % EVA medium by hematoxylin and eosin (H&E), Masson trichrome (MT), and other staining tests, it was concluded that the modified paraffin wax can improve the histological analysis efficiency with various natural tissues.

  9. American Organization of Nurse Executives Care Innovation and Transformation program: improving care and practice environments. (United States)

    Oberlies, Amanda Stefancyk


    The American Organization of Nurse Executives conducted an evaluation of the hospitals participating in the Care Innovation and Transformation (CIT) program. A total of 24 hospitals participated in the 2-year CIT program from 2012 to 2013. Reported outcomes include increased patient satisfaction, decreased falls, and reductions in nurse turnover and overtime. Nurses reported statistically significant improvements in 4 domains of the principles and elements of a healthful practice environment developed by the Nursing Organizations Alliance.

  10. Issues of therapeutic communication relevant for improving quality of care. (United States)

    Popa-Velea, O; Purcărea, V L


    Communication issues are extensively considered a topic of high interest for improving the efficacy of the therapeutic act. This article aimed to overview several issues of therapeutic communication relevant for improving quality of care. A number of 15 bibliographic resources on these topics published in peer-reviewed journals between 1975 and 2010, and indexed in PubMed, ProQuest and EBSCO databases were examined, to seek for evidence regarding these data. Results highlight a number of communication problems commonly reported in the literature, such as the lack of physician communicational skills or their deterioration, the persistence of an asymmetric therapeutic communicational model, communication obstacles brought by the disease itself or by several variables pertaining to the patient, including specific demographic and psychological contexts. Equally, literature reports ways of improving therapeutic communication, such as optimizing the clinical interview, better time management techniques or assertiveness. Integration of communication training in the bio-psycho-social model of care and monitoring parameters like adherence and quality of life as tools reflecting also a good therapeutic communication can be valuable future approaches of obtaining better results in this area.

  11. Improving Glycemic Control and Insulin Ordering Efficiency for Hospitalized Patients With Diabetes Through Carbohydrate Counting. (United States)

    Pearson, Kristina K; Reiland, Sarah A; Meara, John G O; Brown, Julie K; Fedraw, Leslie A; Mapes, David L


    Glycemic control in hospitalized patients is challenging but important for optimal outcomes. Insulin dosing through carbohydrate counting may address patient, provider, and institutional factors that complicate hospital glycemic management. On two surgical units at a tertiary care teaching hospital, we pilot tested postmeal insulin dosing based on carbohydrate counting (plus basal insulin) rather than the current process of ordering scheduled premeal insulin without knowledge of the patient's consumption. Analysis assessed hyperglycemia, hypoglycemia, insulin orders, and nurse and provider satisfaction and confidence. On general surgery, mean glucose level improved from 188 to 137 mg/dl (p satisfaction improved for providers (preintervention, 60%; postintervention, 100%), general surgery nurses (preintervention, 72%; postintervention, 100%), and cardiovascular surgery nurses (preintervention, 69%; postintervention, 84%). Confidence in insulin dose accuracy improved for providers (preintervention, 50%; postintervention, 100%), general surgery nurses (preintervention, 59%; postintervention, 100%), and cardiovascular surgery nurses (preintervention, 48%; postintervention, 84%). Carbohydrate counting is effective and efficient and improved staff satisfaction and confidence in hospital mealtime insulin dosing.

  12. Improving the efficiency of solar photovoltaic power system (United States)

    Aribisala, Henry A.

    As the local and national clamor for foreign energy independent United States continues to grow unabated; renewable energy has been receiving increased focus and it's widely believed that it's not only the answer to ever increasing demand for energy in this country, but also the environmentally friendly means of meeting such demand. During the spring of 2010, I was involved with a 5KW solar power system design project; the project involved designing and building solar panels and associated accessories like the solar array mounts and Solar Inverter system. One of the key issues we ran into during the initial stage of the project was how to select efficient solar cells for panel building at a reasonable cost. While we were able to purchase good solar cells within our allocated budget, the issue of design for efficiency was not fully understood , not just in the contest of solar cells performance , but also in the overall system efficiency of the whole solar power system, hence the door was opened for this thesis. My thesis explored and expanded beyond the scope of the aforementioned project to research different avenues for improving the efficiency of solar photo-voltaic power system from the solar cell level to the solar array mounting, array tracking and DC-AC inversion system techniques.

  13. Nurses Improving the Care of Healthsystem Elders: creating a sustainable business model to improve care of hospitalized older adults. (United States)

    Capezuti, Elizabeth A; Bricoli, Barbara; Briccoli, Barbara; Boltz, Marie P


    The Nurses Improving the Care of Healthsystem Elders (NICHE) program helps its more than 450 member sites to build the leadership capabilities to enact system-level change that targets the unique needs of older adults and embeds evidence-based geriatrics knowledge into practice. NICHE received expansion funding to establish a sustainable business model for operations while positioning the program to continue as a leader in innovative senior care programs. The expansion program focused on developing an internal business infrastructure, expanding NICHE-specific resources, creating a Web platform, increasing the number of participating NICHE hospitals, enhancing and expanding the NICHE benchmarking service, supporting research that generates evidence-based practices, fostering interorganizational collaboration, developing sufficient diversified revenue sources, and increasing the penetration and level of activity of current NICHE sites. These activities (improved services, Web-based tools, better benchmarking) added value and made it feasible to charge hospitals an annual fee for access and participation. NICHE does not stipulate how institutions should modify geriatric care; rather, NICHE principles and tools are meant to be adapted to each site's unique institutional culture. This article describes the historical context, the rationale, and the business plan that has resulted in successful organizational outcomes, including financial sustainability of the business operations of NICHE.

  14. Efficiency evaluation for pooling resources in health care: An interpretation for managers

    NARCIS (Netherlands)

    Vanberkel, Peter T.; Boucherie, Richard J.; Hans, Erwin W.; Hurink, Johann L.; Litvak, Nelly


    Subject/Research problem Hospitals traditionally segregated resources into centralized functional departments such as diagnostic departments, ambulatory care centres, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficie

  15. Efficient national surveillance for health-care-associated infections

    NARCIS (Netherlands)

    van Bunnik, B. A. D.; Ciccolini, M.; Gibbons, C. L.; Edwards, G.; Fitzgerald, R.; McAdam, P. R.; Ward, M. J.; Laurenson, I. F.; Woolhouse, M. E. J.


    Background: Detecting novel healthcare-associated infections (HCAI) as early as possible is an important public health priority. However, there is currently no evidence base to guide the design of efficient and reliable surveillance systems. Here we address this issue in the context of a novel patho

  16. Efficient Use of Geothermal Energy in Spas - Call for Improvements (United States)

    Straka, W.; Ponweiser, K.; Gollob, K.; Götzl, G.; Schneider, J. F.


    European partners contributed to the attempt to develop the energy flow calculation model designed for said spa into a numerical planning tool with broad applicability to other technical boundary conditions. This aim could not yet be fully achieved with the given means, by virtue of the fact that huge differences exist among spas, regarding technical design (sometimes accumulations of ad-hoc solutions to past technical problems) as well as characteristic energy demand of the various functional units of the investigated facilities. What could be achieved, though, was a better understanding how the communication between clients and consultants shall be conducted and what steps have to be taken in order to reach the original goal in a subsequent project. Furthermore, it was the ideational aim of our work to set up a network of established players, capable of influencing national developments, and make it a proponent of the envisaged improvements in their home countries and beyond. Among the recommended measures to improve on the energy management of existing thermal spas, on the one hand, there are those that only specialized knowledge can reveal or the proper application of which only painstaking monitoring and calculation can ascertain and which, therefore, will not easily be at the hand of many planners. These include, for example, combining geothermal heat with advanced heating technology (gas condensing boiler, cogeneration plant) for peak load conditions, deciding on the kind of advanced technology to be used (condensing boiler or cogeneration plus heat pump), making consistent said technology with the temperature control system (e.g. substitution of bypass design of heat exchanger control by volume flow control); introducing solar energy, in particular, has to be carefully designed. On the other hand, there are some improvements to be called for, which are meaningful and applicable even as belated additions, and in cases would, on top of this, be obvious to most non

  17. Improving energy efficiency in industrial solutions - Walk the talk

    Energy Technology Data Exchange (ETDEWEB)

    Wegener, D. (Siemens AG. Industry Solutions Div., Erlangen (Germany)); Finkbeiner, M. (Technische Univ. Berlin (TUB). Sustainable Engineering, Berlin (Germany)); Holst, J.-C.; Walachowicz, F. (Siemens AG. Corporate Technology, Berlin (Germany)); Irving Olsen, S. (Technical Univ. of Denmark (DTU). Management Engineering, Kgs. Lyngby (Denmark))


    This paper describes the outline of the energy efficiency and environmental care policy and management at Siemens Industry Solutions Division. This environmental policy coherently embraces strategic planning, eco-design of energy-efficient industrial processes and solutions, design evaluation and finally communication of both environmental and economic performance of solutions to customers. One of the main tools supporting eco-design and evaluation and controlling of derived design solutions is the so called 'Eco-Care-Matrix' (ECM). The ECM simply visualizes the eco-efficiency of solutions compared to a given baseline. In order to prevent from 'green washing' criticism and to ensure 'walk the talk' attitude the ECM should be scientifically well-founded using appropriate and consistent methodology. The vertical axis of an ECM illustrates the environmental performance and the horizontal axis describes the economical customer benefit of one or more green solutions compared to a defined reference solution. Different scientific approaches for quantifying the environmental performance based on life cycle assessment methodology are discussed especially considering the ISO standards 14040/14044:2006. Appropriate ECM application is illustrated using the example of the Siemens MEROS technology (Maximized Emission Reduction of Sintering) for the steel industry. MEROS is currently the most modern and powerful system for cleaning off-gas in sinter plants. As an environmental technology MEROS is binding and removing sulfur dioxide and other acidic gas components present in the off-gas stream by using dry absorbents and additional electrical power. Advantage in the impact category of acidification potential (by desulfurization) is a trade-off to disadvantages in global warming and resource depletion potential caused by use of electricity. Representing different impacts, indicator results for impact categories with different tendencies have to be

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

    NARCIS (Netherlands)

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


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

  19. Indoor climate quality after renovation for improved energy efficiency

    DEFF Research Database (Denmark)

    Gunnarsen, Lars Bo; Løck, Sebastian; Kolarik, Barbara


    The building sector is responsible for approximately 40 % of the Danish energy consumption. As every year less than 1 % of the building stock is rebuild after demolition of old buildings, improved energy efficiency of existing buildings are in focus. In the late seventies to mid-eighties unwise...... energy efficiency retrofitting caused several cases of indoor climate degradation. This project describes possibilities, barriers and methods of combining energy performance and indoor climate enhancements in today’s retrofitting of rental dwellings. The project followed three energy retrofitting...... before and after the retrofitting. The results showed significant energy savings in all projects. There was a marked difference between expected and measured energy consumption in one building and good agreement in the two others indicating a strong impact of good maintenance and operations on energy...


    Energy Technology Data Exchange (ETDEWEB)

    Hemrick, James Gordon [ORNL; Rodrigues-Schroer, Angela [Minteq International, Inc.; Colavito, [Minteq International, Inc.; Smith, Jeffrey D [ORNL


    This paper describes efforts performed at Oak Ridge National Laboratory (ORNL), in collaboration with industrial refractory manufacturers, refractory users, and academic institutions, to improve energy efficiency of U.S. industry through increased furnace efficiency brought about by the employment of novel refractory systems and techniques. Work in furnace applications related to aluminum, gasification, and lime are discussed. The energy savings strategies discussed are achieved through reduction of chemical reactions, elimination of mechanical degradation caused by the service environment, reduction of temperature limitations of materials, and elimination of costly installation and repair needs. Key results of several case studies resulting from a US Department of Energy (DOE) funded research program are discussed with emphasis on applicability of these results to high temperature furnace applications.

  1. The national improvement partnership network: state-based partnerships that improve primary care quality. (United States)

    Shaw, Judith S; Norlin, Chuck; Gillespie, R J; Weissman, Mark; McGrath, Jane


    Improvement partnerships (IPs) are a model for collaboration among public and private organizations that share interests in improving child health and the quality of health care delivered to children. Their partners typically include state public health and Medicaid agencies, the local chapter of the American Academy of Pediatrics, and an academic health care organization or children's hospital. Most IPs also engage other partners, including a variety of public, private, and professional organizations and individuals. IPs lead and support measurement-based, systems-focused quality improvement (QI) efforts that primarily target primary care practices that care for children. Their projects are most often conducted as learning collaboratives that involve a team from each of 8 to 15 participating practices over 9 to 12 months. The improvement teams typically include a clinician, office manager, clinical staff (nurses or medical assistants), and, for some projects, a parent; the IPs provide the staff and local infrastructure. The projects target clinical topics, chosen because of their importance to public health, local clinicians, and funding agencies, including asthma, attention-deficit/hyperactivity disorder, autism, developmental screening, obesity, mental health, medical home implementation, and several others. Over the past 13 years, 19 states have developed (and 5 are exploring developing) IPs. These organizations share similar aims and methods but differ substantially in leadership, structure, funding, and longevity. Their projects generally engage pediatric and family medicine practices ranging from solo private practices to community health centers to large corporate practices. The practices learn about the project topic and about QI, develop specific improvement strategies and aims that align with the project aims, perform iterative measures to evaluate and guide their improvements, and implement systems and processes to support and sustain those improvements

  2. Strength training improves cycling efficiency in master endurance athletes. (United States)

    Louis, Julien; Hausswirth, Christophe; Easthope, Christopher; Brisswalter, Jeanick


    The purpose of this study was to test the effect of a 3-week strength training program of knee extensor muscles on cycling delta efficiency in master endurance athletes. Nine master (age 51.5 ± 5.5 years) and 8 young (age 25.6 ± 5.9 years) endurance athletes with similar training levels participated in this study. During three consecutive weeks, all the subjects were engaged in a strength training program of the knee extensor muscles. Every week, they performed three training sessions consist of 10 × 10 knee extensions at 70% of maximal repetition with 3 min rest between in a leg extension apparatus. Maximal voluntary contraction torque (MVC torque) and force endurance (End) were assessed before, after every completed week of training, and after the program. Delta efficiency (DE) in cycling was evaluated before and after the training period. Before the training period, MVC torque, End, and DE in cycling were significantly lower in masters than in young. The strength training induced a significant improvement in MVC torque in all the subjects, more pronounced in masters (+17.8% in masters vs. +5.9% in young, P < 0.05). DE in cycling also significantly increased after training in masters, whereas it was only a trend in young. A significant correlation (r = 0.79, P < 0.01) was observed between MVC torque and DE in cycling in masters. The addition of a strength training program for the knee extensor muscles to endurance-only training induced a significant improvement in strength and cycling efficiency in master athletes. This enhancement in muscle performance alleviated all the age-related differences in strength and efficiency.

  3. Improving the global efficiency in small hydropower practice (United States)

    Razurel, P.; Gorla, L.; Crouzy, B.; Perona, P.


    The global increase in energy production from renewable sources has seen river exploitation for small hydropower plants to also grow considerably in the last decade. River intakes used to divert water from the main course to the power plant are at the base of such practice. A key issue concern with finding innovative concepts to both design and manage such structures in order to improve classic operational rules. Among these, the Minimal Flow Release (MFR) concept has long been used in spite of its environmental inconsistency.In this work, we show that the economical and ecological efficiency of diverting water for energy production in small hydropower plants can be improved towards sustainability by engineering a novel class of flow-redistribution policies. We use the mathematical form of the Fermi-Dirac statistical distribution to define non-proportional dynamic flow-redistribution rules, which broadens the spectrum of dynamic flow releases based on proportional redistribution. The theoretical background as well as the economic interpretation is presented and applied to three case studies in order to systematically test the global performance of such policies. Out of numerical simulations, a Pareto frontier emerges in the economic vs environmental efficiency plot, which show that non-proportional distribution policies improve both efficiencies with respect to those obtained from some traditional MFR and proportional policies. This picture is shown also for long term climatic scenarios affecting water availability and the natural flow regime.In a time of intense and increasing exploitation close to resource saturation, preserving natural river reaches requires to abandon inappropriate static release policies in favor of non-proportional ones towards a sustainable use of the water resource.

  4. Immediate Care of Open Extremity Fractures: Where Can We Improve?

    Directory of Open Access Journals (Sweden)

    R. Walton


    Full Text Available Clear guidelines are set by the British Orthopaedic Association (BOA and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS on the preoperative management of open fractures. This as well as the clinical consequences of poor management of open fractures means the patient workup for surgery is important as well as the timing of surgery. Experience suggests few patients are managed 100% as per the guidelines and we look to test this hypothesis. A retrospective analysis was undertaken of all open long bone fractures (total 133, excluding hand injuries, which presented to a district general hospital over a 5-year period. The implementation of 7 defined key tasks for initial management was recorded. 101 cases were eligible, with the majority of cases (71.4% having initial orthopaedic assessment outside normal working hours. The mean number of tasks completed was 3.23/7. Assessment out of hours was associated with less tasks being implemented but doctor seniority and the presence of polytrauma made no difference to the quality of acute care. Staff involved in the acute care of open fractures require targeted education to improve the delivery of initial preoperative care. We recommend that other centres assess their performance against this data.

  5. Energy efficiency improvement and cost saving opportunities forpetroleum refineries

    Energy Technology Data Exchange (ETDEWEB)

    Worrell, Ernst; Galitsky, Christina


    The petroleum refining industry in the United States is the largest in the world, providing inputs to virtually any economic sector,including the transport sector and the chemical industry. The industry operates 146 refineries (as of January 2004) around the country,employing over 65,000 employees. The refining industry produces a mix of products with a total value exceeding $151 billion. Refineries spend typically 50 percent of cash operating costs (i.e., excluding capital costs and depreciation) on energy, making energy a major cost factor and also an important opportunity for cost reduction. Energy use is also a major source of emissions in the refinery industry making energy efficiency improvement an attractive opportunity to reduce emissions and operating costs. Voluntary government programs aim to assist industry to improve competitiveness through increased energy efficiency and reduced environmental impact. ENERGY STAR (R), a voluntary program managed by the U.S. Environmental Protection Agency, stresses the need for strong and strategic corporate energy management programs. ENERGY STAR provides energy management tools and strategies for successful corporate energy management programs. This Energy Guide describes research conducted to support ENERGY STAR and its work with the petroleum refining industry.This research provides information on potential energy efficiency opportunities for petroleum refineries. This Energy Guide introduces energy efficiency opportunities available for petroleum refineries. It begins with descriptions of the trends, structure, and production of the refining industry and the energy used in the refining and conversion processes. Specific energy savings for each energy efficiency measure based on case studies of plants and references to technical literature are provided. If available, typical payback periods are also listed. The Energy Guide draws upon the experiences with energy efficiency measures of petroleum refineries worldwide

  6. A Staffing Tool to Improve Efficiency at a Nursing Department

    Directory of Open Access Journals (Sweden)

    M.A. Louly


    Full Text Available The paper suggests a staffing tool to improve efficiency at a nursing department of a local hospital. The managers consider they are understaffed and try to overwhelm the staffing deficit problem through overtime, rather than hiring additional nurses. The estimates indicate that the shortage at the hospital level corresponds to 300 full time equivalent (FTE nurses. However, the huge amount of allocated budget for overtime becomes a concern since the deficit is not accurately estimated. Indeed, the suggested staffing tool shows that some nursing units are unnecessarily overstaffed. Moreover, the current study reveals that the real deficit is of only 215 FTE resulting in a potential saving of 28%.

  7. Research and development of efficient, environmentally improved household gas appliances

    Directory of Open Access Journals (Sweden)

    Adžić Miroljub


    Full Text Available An experimental research and analysis of performance of three domestic house hold gas appliances was carried out. The objective of this work, based on the conducted analysis of the research data, was to improve the appliances’ performance, prefer ably through relative simple modifications, in order to satisfy DIN 4702 emissions and efficiency standards when using different fuels, including natural gas, liquefied petroleum gases and lower quality natural gas. This report summarizes details of this work and how the objectives were achieved. .

  8. Fast reactor core concepts to improve transmutation efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Fujimura, Koji; Kawashima, Katsuyuki [Hitachi Research Laboratory, Hitachi, Ltd., 7-1-1, Omika-cho, Hitachi-shi, Ibaraki, 319-1221 Japan (Japan); Itooka, Satoshi [Hitachi-GE Nuclear Energy, Ltd., 3-1-1, Saiwai-cho, Hitachi-shi, Ibaraki, 317-0073 Japan (Japan)


    Fast Reactor (FR) core concepts to improve transmutation efficiency were conducted. A heterogeneous MA loaded core was designed based on the 1000MWe-ABR breakeven core. The heterogeneous MA loaded core with Zr-H loaded moderated targets had a better transmutation performance than the MA homogeneous loaded core. The annular pellet rod design was proposed as one of the possible design options for the MA target. It was shown that using annular pellet MA rods mitigates the self-shielding effect in the moderated target so as to enhance the transmutation rate.

  9. Improved energy efficiency and optimization of microclimate in buildings

    Directory of Open Access Journals (Sweden)

    Trifunovič Dragišić Vesna


    Full Text Available Nowadays it is possible to reduce energy consumption without losing comfort as a result of using efficient energy saving technologies and advanced environment control methods for buildings. One of the measures to improve energy performance of buildings can be installation of decentralized air intake and exhaust mechanical ventilation systems with plate heat exchangers in apartments making it possible to «return» up to 85% of thermal energy. The article deals with the decentralized system controlled ventilation with heat recovery and alternative solutions heating supply air in residential buildings.

  10. Can district nurses and care home staff improve bowel care for older people using a clinical benchmarking tool? (United States)

    Goodman, Claire; L Davies, Sue; Norton, Christine; Fader, Mandy; Morris, Jackie; Wells, Mandy; Gage, Heather


    A quasi-experimental study tested a clinical benchmarking tool (Essence of Care) to improve bowel-related care for older people living in six care homes. In the intervention care homes, district nurses and care home staff used the clinical benchmarking tool to discuss and plan how to improve bowel care for residents. In the control care homes, staff were provided with detailed information about the residents and continence services contact details. The intervention was acceptable to care home and district nursing staff, and possible to incorporate into existing working patterns. The study did not demonstrate a significant reduction in bowel-related problems, although there was evidence in one care home of reduction in episodes of avoidable faecal incontinence. At an individual level of care, there were observable benefits, and examples of person-centred care were prompted through participating in the intervention and improved staff awareness. Clinical benchmarking tools can be used to structure discussion between district nurses and care home staff to review and plan care for residents. However, it takes time to achieve change and embedding this kind of approach requires either robust pre-existing working relationships or the involvement of a facilitator.

  11. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

    Rosenstock, Steffen Jais; Møller, Morten H; Larsson, Heidi


    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered...... demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality.RESULTS:A total of 13,498 PUB patients (median age 74 years) were included.......10-1.61)), and fewer patients underwent open surgery (4% vs. 6%, RR 0.72 (0.59-0.87)). After controlling for time changes in prognostic factors, rebleeding rates improved (13% vs. 18%, adjusted RR 0.77 (0.66-0.91)). Crude 30-day mortality was unchanged (11% vs. 11%), whereas adjusted mortality decreased...

  12. Efficiency improvements in pipeline transportation systems. Technical report, Task 3

    Energy Technology Data Exchange (ETDEWEB)

    Banks, W. F.; Horton, J. H.


    This report identifies those potential energy-conservative pipeline innovations that are most energy- and cost-effective, and formulates recommendations for the R, D, and D programs needed to exploit those opportunities. From a candidate field of over twenty classes of efficiency improvements, eight systems are recommended for pursuit. Most of these possess two highly important attributes: large potential energy savings and broad applicability outside the pipeline industry. The R, D, and D program for each improvement and the recommended immediate next step are described. The eight programs recommended for pursuit are: gas-fired combined-cycle compressor station; internally cooled internal combustion engine; methanol-coal slurry pipeline; methanol-coal slurry-fired and coal-fired engines; indirect-fired coal-burning combined-cycle pump station; fuel-cycle pump station; internal coatings in pipelines; and drag-reducing additives in liquid pipelines.

  13. Energy efficiency improvement of medical electric tools and devices

    Directory of Open Access Journals (Sweden)

    Meshkov Aleksandr S.


    Full Text Available With the ever-increasing volume of applications of various kinds of electric drives in all spheres of human activity, the issues in improving the efficiency of the electromechanical converters of electric energy, one of the most important components of the electric drive (ED, are becoming increasingly important. Such issues include reducing their weight and size, improving the functional characteristics of these devices to increase their operational life and reducing the cost of manufacture. Taking full advantage of these opportunities relates to the AC and DC single-phase commutator motor (SCM, which is widely used in regulated and high-speed motor drives in medical electric hand tools. The SCM is used in machinery where the load torque has a hyperbolic dependence on the rotational speed and the need to work with a large motor overload due to the “soft” mechanical characteristics of such motors.

  14. Improving search filter development: a study of palliative care literature

    Directory of Open Access Journals (Sweden)

    Tieman Jennifer


    Full Text Available Abstract Background It is difficult to systematically search for literature relevant to palliative care in general medical journals. A previously developed search filter for use on OVID Medline validated using a gold standard set of references identified through hand searching, achieved an unacceptably low sensitivity (45.4%. Retrieving relevant literature is integral to support evidence based practice, and understanding the nature of the incorrectly excluded citations (false negatives using the filter may lead to improvement in the filter's performance. Methods The objectives were to describe the nature of subjects reflected in the false negative citations and to empirically improve the sensitivity of the search filter. A thematic analysis of MeSH terms by three independent reviewers was used to describe the subject coverage of the missed records. Using a frequency analysis of MeSH terms, those headings which could individually contribute at least 2.5% to sensitivity (occurring 19 or more times were added to the search filter. All previously run searches were rerun at the same time as the revised filter, and results compared. Results Thematic analysis of MeSH terms identified thirteen themes reflected in the missing records, none of them intrinsically palliative. The addition of six MeSH terms to the existing search filter (physician-patient relations, prognosis, quality of life, survival rate, treatment outcome and attitude to health led to an increase in sensitivity from 46.3% to 64.7%, offset by a decrease in precision from 72.6% to 21.9%. Conclusion The filter's sensitivity was successfully increased using frequency analysis of MeSH terms, offset by a decrease in precision. A thematic analysis of MeSH terms for the false negative citations confirmed the absence of any intrinsically palliative theme or term, suggesting that future improvements to search filters for palliative care literature will first depend on better identifying how

  15. Improving quality of care in substance abuse treatment using five key process improvement principles. (United States)

    Hoffman, Kim A; Green, Carla A; Ford, James H; Wisdom, Jennifer P; Gustafson, David H; McCarty, Dennis


    Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: (1) understand and involve the customer, (2) fix key problems, (3) pick a powerful change leader, (4) get ideas from outside the organization, and (5) use rapid cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate successful applications of each principle. Results suggest that organizations can successfully integrate and apply the five principles as they develop and test change strategies, improving access and retention in treatment, and agencies' financial status. Upcoming changes requiring increased provision of behavioral health care will result in greater demand for services. Treatment organizations, already struggling to meet demand and client needs, will need strategies that improve the quality of care they provide without significantly increasing costs. The five NIATx principles have potential for helping agencies achieve these goals.

  16. Utilization of Portable Radios to Improve Ophthalmology Clinic Efficiency in an Academic Setting. (United States)

    Davis, Alexander S; Elkeeb, Ahmed M; Vizzeri, Gianmarco; Godley, Bernard F


    Improvement in clinic efficiency in the ambulatory setting is often looked at as an area for development of lean management strategies to deliver a higher quality of healthcare while reducing errors, costs, and delays. To examine the benefits of improving team communication and its impact on clinic flow and efficiency, we describe a time-motion study performed in an academic outpatient Ophthalmology clinic and its objective and subjective results. Compared to clinic encounters without the use of the portable radios, objective data demonstrated an overall significant decreases in mean workup time (15.18 vs. 13.10), room wait (13.10 vs. 10.47), and decreased the total time needed with an MD per encounter (9.45 vs. 6.63). Subjectively, significant improvements were seen in careprovider scores for patient flow (60.78 vs. 84.29), getting assistance (61.89 vs. 88.57), moving patient charts (54.44 vs. 85.71), teamwork (69.56 vs. 91.0), communications (62.33 vs. 90.43), providing quality patient care (76.22 vs. 89.57), and receiving input on the ability to see walk-in patients (80.11 vs. 90.43). For academic purposes, an improvement in engagement in patient care and learning opportunities was noted by the clinic resident-in-training during the pilot study. Portable radios in our pilot study were preferred over the previous method of communication and demonstrates significant improvements in certain areas of clinical efficiency, subjective perception of teamwork and communications, and academic learning.

  17. Rare disease policies to improve care for patients in Europe. (United States)

    Rodwell, Charlotte; Aymé, Ségolène


    Rare diseases are those with a particularly low prevalence; in Europe, diseases are considered to be rare when they affect not more than 5 in 10000 persons in the European Union. The specificities of rare diseases make the area a veritable public health challenge: the limited number of patients and scarcity of knowledge and expertise single rare diseases out as a distinctive domain of high European added-value. The Orphan Medicinal Product Regulation of 1999 was the first European legislative text concerning rare diseases, followed by many initiatives, including recommendations by the Council of Ministers of the European Union in 2009. These initiatives contributed to the development of rare diseases policies at European and national level aimed at improving care for patients with rare diseases. A review of the political framework at European level and in European countries is provided to demonstrate how legislation has created a dynamic that is progressively improving care for patients with rare diseases. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".

  18. Lessons learnt from a primary care asthma improvement project. (United States)

    Lenney, Warren; Clayton, Sadie; Gilchrist, Francis J; Price, David; Small, Iain; Smith, Judy; Sutton, Emma J


    Asthma is a very common disease that can occur at any age. In the UK and in many other countries it is mainly managed in primary care. The published evidence suggests that the key to improving diagnosis and management lies in better training and education rather than in the discovery of new medications. An asthma improvement project managed through the British Lung Foundation is attempting to do this. The project has three pilot sites: two in England supported by the Department of Health and one in Scotland supported by the Scottish Government. If the project is successful it will be rolled out to other health areas within the UK. The results of this project are not yet available. This article highlights the challenges encountered in setting up the project and may well be applicable to other areas in the UK and to other countries where similar healthcare systems exist. The encountered challenges reflect the complex nature of healthcare systems and electronic data capture in primary care. We discuss the differences between general practices in their ability and willingness to support the project, the training and education of their staff on asthma management, governance issues in relation to information technology systems, and the quality of data capture. Virtually all the challenges have now been overcome, but discussing them should ensure that others become aware of them at an early stage should they wish to undertake similar projects in the future.

  19. Improving patient care through student leadership in team quality improvement projects. (United States)

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen


    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  20. Improving care quality and preventing maltreatment in institutional care – a feasibility study with caregivers

    Directory of Open Access Journals (Sweden)

    Katharin eHermenau


    Full Text Available Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and three months following the training workshop. The results showed high demand, good feasibility, high motivation and acceptance of caregivers. They reported improvements in caregiver-child relationships, as well as in the children’s behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, one month before, and three months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach.

  1. Efficiency Improvements of Antenna Optimization Using Orthogonal Fractional Experiments

    Directory of Open Access Journals (Sweden)

    Yen-Sheng Chen


    Full Text Available This paper presents an extremely efficient method for antenna design and optimization. Traditionally, antenna optimization relies on nature-inspired heuristic algorithms, which are time-consuming due to their blind-search nature. In contrast, design of experiments (DOE uses a completely different framework from heuristic algorithms, reducing the design cycle by formulating the surrogates of a design problem. However, the number of required simulations grows exponentially if a full factorial design is used. In this paper, a much more efficient technique is presented to achieve substantial time savings. By using orthogonal fractional experiments, only a small subset of the full factorial design is required, yet the resultant response surface models are still effective. The capability of orthogonal fractional experiments is demonstrated through three examples, including two tag antennas for radio-frequency identification (RFID applications and one internal antenna for long-term-evolution (LTE handheld devices. In these examples, orthogonal fractional experiments greatly improve the efficiency of DOE, thereby facilitating the antenna design with less simulation runs.

  2. Improving thermoelectric energy harvesting efficiency by using graphene

    Directory of Open Access Journals (Sweden)

    Muhammad Usman


    Full Text Available This study is aimed at enhancing the efficiency of a thermoelectric (TE energy harvesting system by using a thick graphene layer. This method is a simple yet effective way to increase the temperature gradient across a conventional TE module by accelerating heat dissipation on the cold side of the system. Aqueous dispersions of graphene were used to prepare a 112-μm thick graphene layer on the cold side of the TE system with aluminum as the substrate material. The maximum efficiency of the proposed system was improved by 25.45 %, as compared to the conventional TE system, which does not have a graphene layer. Additionally, the proposed system shows very little performance deterioration (2.87 % in the absence of enough air flow on the cold side of the system, compared to the case of the conventional system (10.59 %. Hence, the proposed system, when coupled with the latest research on high performance TE materials, presents a groundbreaking improvement in the practical application of the TE energy harvesting systems.

  3. A Count for Quality: Child Care Center Directors on Rating and Improvement Systems (United States)

    Schulman, Karen; Matthews, Hannah; Blank, Helen; Ewen, Danielle


    Quality Rating and Improvement Systems (QRIS)--a strategy to improve families' access to high-quality child care--assess the quality of child care programs, offer incentives and assistance to programs to improve their ratings, and give information to parents about the quality of child care. These systems are operating in a growing number of…

  4. 78 FR 29139 - Medicare Program; Bundled Payments for Care Improvement Model 1 Open Period (United States)


    ... participation in Model 1 of the Bundled Payments for Care Improvement initiative. DATES: Model 1 of the Bundled Payments for Care Improvement Deadline: Interested organizations must submit a Model 1 Open Period... regarding Model 1 of the Bundled Payments for Care Improvement initiative. For additional information...

  5. Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project. (United States)

    Buck, Harleah G; Kolanowski, Ann; Fick, Donna; Baronner, Lawrence


    HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 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 after you register, pay the registration fee, and complete the evaluation form online at In order to obtain contact hours you must: 1. Read the article, "Improving Rural Geriatric Care Through Education: A Scalable, Collaborative Project," found on pages 306-313, 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 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 June 30, 2019. 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. OBJECTIVES Describe the unique nursing challenges that occur in caring for older adults in rural areas. Discuss the

  6. Nurse practitioner care improves renal outcome in patients with CKD. (United States)

    Peeters, Mieke J; van Zuilen, Arjan D; van den Brand, Jan A J G; Bots, Michiel L; van Buren, Marjolijn; Ten Dam, Marc A G J; Kaasjager, Karin A H; Ligtenberg, Gerry; Sijpkens, Yvo W J; Sluiter, Henk E; van de Ven, Peter J G; Vervoort, Gerald; Vleming, Louis-Jean; Blankestijn, Peter J; Wetzels, Jack F M


    Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m(2) per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD.

  7. Efficient perturbation theory to improve the density matrix renormalization group (United States)

    Tirrito, Emanuele; Ran, Shi-Ju; Ferris, Andrew J.; McCulloch, Ian P.; Lewenstein, Maciej


    The density matrix renormalization group (DMRG) is one of the most powerful numerical methods available for many-body systems. It has been applied to solve many physical problems, including the calculation of ground states and dynamical properties. In this work, we develop a perturbation theory of the DMRG (PT-DMRG) to greatly increase its accuracy in an extremely simple and efficient way. Using the canonical matrix product state (MPS) representation for the ground state of the considered system, a set of orthogonal basis functions {| ψi> } is introduced to describe the perturbations to the ground state obtained by the conventional DMRG. The Schmidt numbers of the MPS that are beyond the bond dimension cutoff are used to define these perturbation terms. The perturbed Hamiltonian is then defined as H˜i j= ; its ground state permits us to calculate physical observables with a considerably improved accuracy compared to the original DMRG results. We benchmark the second-order perturbation theory with the help of a one-dimensional Ising chain in a transverse field and the Heisenberg chain, where the precision of the DMRG is shown to be improved O (10 ) times. Furthermore, for moderate L the errors of the DMRG and PT-DMRG both scale linearly with L-1 (with L being the length of the chain). The linear relation between the dimension cutoff of the DMRG and that of the PT-DMRG at the same precision shows a considerable improvement in efficiency, especially for large dimension cutoffs. In the thermodynamic limit we show that the errors of the PT-DMRG scale with √{L-1}. Our work suggests an effective way to define the tangent space of the ground-state MPS, which may shed light on the properties beyond the ground state. This second-order PT-DMRG can be readily generalized to higher orders, as well as applied to models in higher dimensions.

  8. The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive Care Unit (United States)


    AWARD NUMBER: W81XWH-13-2-0011 TITLE: The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive...2016 4. TITLE AND SUBTITLE “The Phase of Illness Paradigm: A Checklist Centric Model to 5a. CONTRACT NUMBER Improve Patient Care in the Burn...shared mental model of patient care amongst clinicians in the BICU and thus enhance distributed cognition (Hutchins 2000) and assist the work of the

  9. Calling For Diversity In Health Care Executive Suites And Evaluation Of Effects On Efficiency Using Data Envelopment Analysis

    Directory of Open Access Journals (Sweden)

    Jocelyn L. Steward


    Full Text Available Adequate diversity in the leadership of health care organizations is a problem that potentially affects overall performance.  In this paper, we propose the application of data envelopment analysis (DEA and strategic human information systems to determine how diversity affects the efficiency, stability, and long-term viability of health care organizations at the organization level.  Data envelopment analysis could also be applied within a given health care organization to examine how the organization’s diversity make-up in its various departments affects relative efficiencies across the departments.  After presenting a brief introduction of DEA, we provide examples of inputs and outputs used in a proposed DEA analysis. We also propose the use of strategic information systems in health care organizations in developing countries at both organization and departmental levels.  We suggest that both developed and developing countries would benefit from using these tools as they seek to control costs and improve health care systems.

  10. Improving the efficiency of deconvolution algorithms for sound source localization

    DEFF Research Database (Denmark)

    Lylloff, Oliver Ackermann; Fernandez Grande, Efren; Agerkvist, Finn T.;


    The localization of sound sources with delay-and-sum (DAS) beamforming is limited by a poor spatial resolution - particularly at low frequencies. Various methods based on deconvolution are examined to improve the resolution of the beamforming map, which can be modeled by a convolution of the unkn...... that FISTA tends to provide an improved spatial resolution and is up to 30% faster and more robust to noise. In the spirit of reproducible research, the source code is available online.......The localization of sound sources with delay-and-sum (DAS) beamforming is limited by a poor spatial resolution - particularly at low frequencies. Various methods based on deconvolution are examined to improve the resolution of the beamforming map, which can be modeled by a convolution...... of the unknown acoustic source distribution and the beamformer's response to a point source, i.e., point-spread function. A significant limitation of deconvolution is, however, an additional computational effort compared to beamforming. In this paper, computationally efficient deconvolution algorithms...

  11. Improving The Efficiency Of Ammonia Electrolysis For Hydrogen Production (United States)

    Palaniappan, Ramasamy

    Given the abundance of ammonia in domestic and industrial wastes, ammonia electrolysis is a promising technology for remediation and distributed power generation in a clean and safe manner. Efficiency has been identified as one of the key issues that require improvement in order for the technology to enter the market phase. Therefore, this research was performed with the aim of improving the efficiency of hydrogen production by finding alternative materials for the cathode and electrolyte. 1. In the presence of ammonia the activity for hydrogen evolution reaction (HER) followed the trend Rh>Pt>Ru>Ni. The addition of ammonia resulted in lower rates for HER for Pt, Ru, and Ni, which have been attributed to competition from the ammonia adsorption reaction. 2. The addition of ammonia offers insight into the role of metal-hydrogen underpotential deposition (M-Hupd) on HER kinetics. In addition to offering competition via ammonia adsorption it resulted in fewer and weaker M-Hupd bonds for all metals. This finding substantiates the theory that M-Hupd bonds favor HER on Pt electrocatalyst. However, for Rh results suggest that M-Hupd bond may hinder the HER. In addition, the presence of unpaired valence shell electrons is suggested to provide higher activity for HER in the presence of ammonia. 3. Bimetals PtxM1-x (M = Ir, Ru, Rh, and Ni) offered lower overpotentials for HER compared to the unalloyed metals in the presence of ammonia. The activity of HER in the presence of ammonia follows the trend Pt-Ir>Pt-Rh>Pt-Ru>Pt-Ni. The higher activity of HER is attributed to the synergistic effect of the alloy, where ammonia adsorbs onto the more electropositive alloying metal leaving Pt available for Hupd formation and HER to take place. Additionally, this supports the theory that the presence of a higher number of unpaired electrons favors the HER in the presence of ammonia. 4. Potassium polyacrylate (PAA-K) was successfully used as a substitute for aqueous KOH for ammonia

  12. Debate on the methods to improve health care. (United States)

    Cairns, J


    In Zambia, free health care is not sustainable, so the community must participate actively in the operation of health services. A well-operated district hospital and health centers within the community must cooperate. A successful cost-effective health system depends on effective leadership of the health care team; use of appropriate technology; delegation of much responsibility to paramedical, nursing, and ancillary staff; and use of the district hospital and its district for postgraduate teaching programs for district health specialists. The health care team consists of medical officers, who are generalists; nurses and midwives; administrators; and an engineer to maintain equipment. Examples of appropriate or intermediate technology include Perkin's traction for most fractures, dynamic skin traction for fracture/dislocations of the elbow in adults or olecranon traction, split skin grafting, musculo-cutaneous or axial flaps, suturing of tendons, spinal anesthesia, draw-over anesthesia, and IV ketamine. In some African countries, including Zambia, medical assistants are trained to deal with some types of general anesthesia. Nurses can be trained to become children's nurses, organizing preventive clinics and being responsible for diagnosis and treatment of all conditions except the most serious. Both medical assistants and nurses can become ophthalmic assistants. Dental therapists can handle many activities usually handled by dentists (e.g., fillings and extractions). Operating nurses can be trained to perform some surgery. In many countries, the training ability of the good district hospital is not used to its potential. The district hospital can form important links by teaching medical students at university centers and the districts. Improvement of health problems in developing countries depends on persons willing to work with the poor and to sacrifice material gain.

  13. Improved nurse-parent communication in neonatal intensive care unit

    DEFF Research Database (Denmark)

    Weis, Janne; Zoffmann, Vibeke; Egerod, Ingrid


    AIMS AND OBJECTIVES: To evaluate and adjust systematic implementation of guided family-centred care in a neonatal intensive care unit. BACKGROUND: Family-centred care is valued in neonatal intensive care units internationally, but innovative strategies are needed to realise the principles. Guided...

  14. Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda

    Directory of Open Access Journals (Sweden)

    Deborah Sitrin


    Full Text Available Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW during pregnancy (0, 1–2, 3+ – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of

  15. Modeling solar cells: A method for improving their efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Morales-Acevedo, Arturo, E-mail: [Centro de Investigacion y de Estudios Avanzados del IPN, Electrical Engineering Department, Avenida IPN No. 2508, 07360 Mexico, D.F. (Mexico); Hernandez-Como, Norberto; Casados-Cruz, Gaspar [Centro de Investigacion y de Estudios Avanzados del IPN, Electrical Engineering Department, Avenida IPN No. 2508, 07360 Mexico, D.F. (Mexico)


    After a brief discussion on the theoretical basis for simulating solar cells and the available programs for doing this we proceed to discuss two examples that show the importance of doing numerical simulation of solar cells. We shall concentrate in silicon Heterojunction Intrinsic Thin film aSi/cSi (HIT) and CdS/CuInGaSe{sub 2} (CIGS) solar cells. In the first case, we will show that numerical simulation indicates that there is an optimum transparent conducting oxide (TCO) to be used in contact with the p-type aSi:H emitter layer although many experimental researchers might think that the results can be similar without regard of the TCO film used. In this case, it is shown that high work function TCO materials such as ZnO:Al are much better than smaller work function films such as ITO. HIT solar cells made with small work function TCO layers (<4.8 eV) will never be able to reach the high efficiencies already reported experimentally. It will also be discussed that simulations of CIGS solar cells by different groups predict efficiencies around 18-19% or even less, i.e. below the record efficiency reported experimentally (20.3%). In addition, the experimental band-gap which is optimum in this case is around 1.2 eV while several theoretical results predict a higher optimum band-gap (1.4-1.5 eV). This means that there are other effects not included in most of the simulation models developed until today. One of them is the possible presence of an interfacial (inversion) layer between CdS and CIGS. It is shown that this inversion layer might explain the smaller observed optimum band-gap, but some efficiency is lost. It is discussed that another possible explanation for the higher experimental efficiency is the possible variation of Ga concentration in the CIGS film causing a gradual variation of the band-gap. This band-gap grading might help improve the open-circuit voltage and, if it is appropriately done, it can also cause the enhancement of the photo-current density.

  16. Improvement of teamwork in health care through interprofessional education

    Directory of Open Access Journals (Sweden)

    Simin Dragana


    Full Text Available Introduction. Collaboration, within and between healthcare teams, facilitates effective healthcare. Internationally, the development of interprofessional education, as a means to facilitate more effective teamwork in health care, has been recognized for over forty years. Objective. The aim of this paper is to evaluate students' attitudes toward the influence of interprofessional education on improvement of collaboration and teamwork. Methods. The research was conducted by interviewing students at the Medical Faculty in Novi Sad in the form of cross-sectional study. The study sample included students from two undergraduate programmes: School of Nursing (n=52 and Integrated Studies of Medicine (n=53. Students admitted to the research had to be exposed to clinical experience. The instrument used in this study was the Readiness for Interprofessional Learning Scale (RIPLS. Results. As many as 93.3% of students indicated that basics of teamwork skills should be obtained prior to graduation, whereas 96.2% considered that interprofessional education would enable them to improve mutual trust and respect. The majority of interviewees indicated that patients would ultimately benefit if healthcare students worked together to solve patient problems. Multivariate procedures MANOVA p<0.05 and discriminative analysis p<0.05 of students' attitudes toward teamwork and collaboration showed significant differences between the students of medicine and nursing. Conclusion. The students of the Integrated Studies of Medicine and School of Nursing had a positive attitude toward the influence of interprofessional education on the improvement of collaboration and teamwork.

  17. Collaborating With Music Therapists to Improve Patient Care. (United States)

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane


    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care.

  18. Demystifying and improving organizational culture in health-care. (United States)

    Pellegrin, Karen L; Currey, Hal S


    Organizational culture is defined as the shared values and beliefs that guide behavior within each organization, and it matters because it is related to performance. While culture is generally considered important, it is mysterious and intangible to most leaders. The first step toward understanding organizational culture is to measure it properly. This chapter describes methods for measuring culture in health-care organizations and how these methods were implemented in a large academic medical center. Because of the consistent empirical link between the dimension of communication, other culture dimensions, and employee satisfaction, special attention is focused in this area. Specifically, a case study of successful communication behaviors during a major "change management" initiative at a large academic medical center is described. In summary, the purpose of this chapter is to demystify the concept of culture and demonstrate how to improve it.

  19. Renewable energy: An efficient mechanism to improve GDP

    Energy Technology Data Exchange (ETDEWEB)

    Chien Taichen [Chung-Hua Institute for Economic Research, Taipei, Taiwan (China)], E-mail:; Hu Jinli [Institute of Business and Management, National Chiao Tung University, Taiwan (China)


    This article analyzes the effects of renewable energy on GDP for 116 economies in 2003 through Structural Equation Modeling (SEM) approach. In order to decipher the mechanism of how the use of renewables improves macroeconomic efficiency, we decompose GDP by the 'expenditure approach'. Although previous theory predicts positive effects of renewables on capital formation and trade balance, the SEM results show that renewables have a significant positive influence on capital formation only. The result that renewables do not have a significant impact on trade balance implies that renewables do not have an import substitution effect. Thus, we confirm the positive relationship between renewable energy and GDP through the path of increasing capital formation, but not for the path of increasing trade balance.

  20. Renewable energy: An efficient mechanism to improve GDP

    Energy Technology Data Exchange (ETDEWEB)

    Chien, Taichen [Chung-Hua Institute for Economic Research, Taipei (China); Hu, Jin-Li [Institute of Business and Management, National Chiao Tung University (China)


    This article analyzes the effects of renewable energy on GDP for 116 economies in 2003 through Structural Equation Modeling (SEM) approach. In order to decipher the mechanism of how the use of renewables improves macroeconomic efficiency, we decompose GDP by the ''expenditure approach''. Although previous theory predicts positive effects of renewables on capital formation and trade balance, the SEM results show that renewables have a significant positive influence on capital formation only. The result that renewables do not have a significant impact on trade balance implies that renewables do not have an import substitution effect. Thus, we confirm the positive relationship between renewable energy and GDP through the path of increasing capital formation, but not for the path of increasing trade balance. (author)

  1. An Efficient and Configurable Preprocessing Algorithm to Improve Stability Analysis. (United States)

    Sesia, Ilaria; Cantoni, Elena; Cernigliaro, Alice; Signorile, Giovanna; Fantino, Gianluca; Tavella, Patrizia


    The Allan variance (AVAR) is widely used to measure the stability of experimental time series. Specifically, AVAR is commonly used in space applications such as monitoring the clocks of the global navigation satellite systems (GNSSs). In these applications, the experimental data present some peculiar aspects which are not generally encountered when the measurements are carried out in a laboratory. Space clocks' data can in fact present outliers, jumps, and missing values, which corrupt the clock characterization. Therefore, an efficient preprocessing is fundamental to ensure a proper data analysis and improve the stability estimation performed with the AVAR or other similar variances. In this work, we propose a preprocessing algorithm and its implementation in a robust software code (in MATLAB language) able to deal with time series of experimental data affected by nonstationarities and missing data; our method is properly detecting and removing anomalous behaviors, hence making the subsequent stability analysis more reliable.

  2. Challenges in biobutanol production: How to improve the efficiency?

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Veronica; Paekkilae, Johanna; Muurinen, Esa; Keiski, Riitta L. [Mass and Heat Transfer Process Laboratory, Department of Process and Environmental Engineering, POB 4300, FI-90014 University of Oulu, Oulu (Finland); Ojamo, Heikki [Bioprocess Engineering Laboratory, Department of Process and Environmental Engineering, POB 4300, FI-90014 University of Oulu, Oulu (Finland)


    There is an increasing interest in the production of chemicals and fuels from renewable resources due to the continuing price increase of fossil resources, the insecurity of the availability of fossil resources in the future, and additionally environmental concerns and legislations. Biobutanol may be produced by the acetone-butanol-ethanol (ABE) fermentation. This paper reviews the biobutanol production bringing up the problems and challenges to overcome. The aim of the paper is to help in finding opportunities to make the process feasible in the near future. The analysis stresses the idea of improving the efficiency of the fermentation stage by altering the up (pretreatment of the raw material) and downstream (product recovery and purification) processes. The paper also explores the biobutanol production from the biorefinery perspective. Finally the review brings up the important role of research in developing and implementing the production of biobutanol by the ABE fermentation. (author)

  3. Improvement in Delay of Information flow in Energy Efficiency Organization

    Directory of Open Access Journals (Sweden)

    Elham Hasanzadeh


    Full Text Available One of the most important issues in task organization is service speed and reduction of delays. High speedin tasks and reduction of delay cause high performance in task organization. So many studies have done inthis field. Some of these studies during the past ten years are redesigning tasks in information process,using the simulation product development, designing and manufacturing managing supply chain, and FINCmethodology which has been used in military of American and Australia.In this article FINC methodology is modified for a business organization. The proposed method applied oninformation flows of current situation of Iran energy efficiency organization. Mind manager software isused for viewing it by social network analysis and then FINC methodology for calculation of delay rate onit. Sum of delay rate with delays in decision nodes was added and then improved.

  4. A new job migration algorithm to improve data center efficiency

    CERN Document Server

    Calzolari, Federico


    The under exploitation of the available resources risks to be one of the main problems for a computing center. The growing demand of computational power necessarily entails more complex approaches in the management of the computing resources, with particular attention to the batch queue system scheduler. In a heterogeneous batch queue system, available for both serial single core processes and parallel multi core jobs, it may happen that one or more computational nodes composing the cluster are not fully occupied, running a number of jobs lower than their actual capability. A typical case is represented by more single core jobs running each one over a different multi core server, while more parallel jobs - requiring all the available cores of a host - are queued. A job rearrangement executed at runtime is able to free extra resources, in order to host new processes. We present an efficient method to improve the computing resources exploitation.

  5. Leanergy(TM): how lean manufacturing can improve energy efficiency. (United States)

    Riche, Jean-Pierre


    Energy efficiency has become a competitive issue for industrial companies. The evolution of energy prices and regulation will make this issue even more important in the future. For several years, the energy-intensive chemical industry has been implementing corrective actions. Helped by the absorption of base load energy consumption by larger production volumes, specific energy consumption (KWh per production unit) has been significantly reduced in recent years. However, most plants have reached the end of their first action plan based on improving the utilities performance. The Leanergy(TM) method developed by the consultancy company Okavango-energy, is a structured approach based on lean manufacturing which widens the scope of saving sources to process and operations. Starting from the analysis of actual production requirements, Okavango is able to adjust consumption to minimum requirements and so remove any energy consumption that does not contribute to the added value creation.

  6. Rapeseed is an efficient energy crop which can still improve

    Directory of Open Access Journals (Sweden)

    Flenet Francis


    Full Text Available The ability of biofuels to contribute efficiently to the replacement of fossil energy and to the reduction of greenhouse gas emissions has been a matter of debate. Hence, there is a need to assess accurately the energy balance of biofuels and their ability to reduce greenhouse gas emissions, in order to evaluate and to improve the benefit for society. In rapeseed, the energy ratio (energy produced per unit of non-renewable energy input is well above 2 whatever the method of calculation. In order to investigate the variability of energy ratios and to identify ways of improvement, a study was conducted in France in 2005 and 2006. The method of mass allocation of input energy was used for calculations, instead of the substitution method, because with this method the results do not depend on the utilization of co-products. Hence, this method is better adapted to follow improvements. A great variability in the energy ratio was observed in 2005 and 2006. Seed yields and energy cost of fertilizer N explained most of this variability. Hence, improvements should focus on increasing yield with little increase in energy cost, and on decreasing wasting of N fertilizer. However the farmer incomes, and the net production of energy per hectare, must also be a matter of concern. The inventories of greenhouse gas emissions of biofuels are still uncertain because of the great variability of soil emissions, due to environmental and management factors. Hence, in order to assess the effect of rapeseed on greenhouse gas emissions, methods based on process-oriented models accounting for these factors must be used. Such models give promising results, but further testing is still needed.

  7. Danish energy efficiency policy: revisited and future improvements

    Energy Technology Data Exchange (ETDEWEB)

    Togeby, Mikael; Dyhr-Mikkelsen, Kirsten (Ea Energy Analyses (Denmark)); Larsen, Anders; Juel Hansen, Morten (Roskilde Univ., Dept. of Society and Globalisation, Roskilde (Denmark)); Bach, Peter (Danish Energy Authority, Copenhagen (Denmark))


    Ten groups of policy instruments for promoting energy efficiency are actively used in Denmark. Among these are the EU instruments such as the CO{sub 2} emissions trading scheme and labelling of appliances, labelling of all buildings, combined with national instruments such as high taxes especially on households and the public sector, obligations for energy companies (electricity, natural gas, district heating, and oil) to deliver documented savings, strict building codes, special instructions for the public sector, and an Electricity Saving Trust. A political agreement from 2005 states that an evaluation of the entire Danish energy efficiency policy portfolio must be carried out before end 2008 and put forward for discussion among governing parties no later than February 2009. A consortium comprising Ea Energy Analyses, Niras, the Dept. of Society and Globalisation (Roskilde Univ.) and 4-Fact was assigned with this task. The evaluation aimed to answer the crucial questions: - Is the overall design of the portfolio of instruments appropriate? - Does the impact of the instruments justify the costs, so that we reach the national goals in a cost efficient way? - Will the current instrument portfolio be able to meet the required reduction in final energy consumption (goal for 2013) and in primary energy consumption (with goals in 2011 and 2020) as planned by parliament? Recommendations were made on how to improve and develop the portfolio using cost effectiveness as well as organisational clarity as criteria in developing the recommendations. The evaluation was completed in December 2008, and this paper presents the main findings and proceeds to discuss the issues from an EU perspective.

  8. Improving robustness and computational efficiency using modern C++

    Energy Technology Data Exchange (ETDEWEB)

    Paterno, M. [Fermilab; Kowalkowski, J. [Fermilab; Green, C. [Fermilab


    For nearly two decades, the C++ programming language has been the dominant programming language for experimental HEP. The publication of ISO/IEC 14882:2011, the current version of the international standard for the C++ programming language, makes available a variety of language and library facilities for improving the robustness, expressiveness, and computational efficiency of C++ code. However, much of the C++ written by the experimental HEP community does not take advantage of the features of the language to obtain these benefits, either due to lack of familiarity with these features or concern that these features must somehow be computationally inefficient. In this paper, we address some of the features of modern C+-+, and show how they can be used to make programs that are both robust and computationally efficient. We compare and contrast simple yet realistic examples of some common implementation patterns in C, currently-typical C++, and modern C++, and show (when necessary, down to the level of generated assembly language code) the quality of the executable code produced by recent C++ compilers, with the aim of allowing the HEP community to make informed decisions on the costs and benefits of the use of modern C++.

  9. Biohydrogen production: strategies to improve process efficiency through microbial routes. (United States)

    Chandrasekhar, Kuppam; Lee, Yong-Jik; Lee, Dong-Woo


    The current fossil fuel-based generation of energy has led to large-scale industrial development. However, the reliance on fossil fuels leads to the significant depletion of natural resources of buried combustible geologic deposits and to negative effects on the global climate with emissions of greenhouse gases. Accordingly, enormous efforts are directed to transition from fossil fuels to nonpolluting and renewable energy sources. One potential alternative is biohydrogen (H2), a clean energy carrier with high-energy yields; upon the combustion of H2, H2O is the only major by-product. In recent decades, the attractive and renewable characteristics of H2 led us to develop a variety of biological routes for the production of H2. Based on the mode of H2 generation, the biological routes for H2 production are categorized into four groups: photobiological fermentation, anaerobic fermentation, enzymatic and microbial electrolysis, and a combination of these processes. Thus, this review primarily focuses on the evaluation of the biological routes for the production of H2. In particular, we assess the efficiency and feasibility of these bioprocesses with respect to the factors that affect operations, and we delineate the limitations. Additionally, alternative options such as bioaugmentation, multiple process integration, and microbial electrolysis to improve process efficiency are discussed to address industrial-level applications.

  10. Biohydrogen Production: Strategies to Improve Process Efficiency through Microbial Routes

    Directory of Open Access Journals (Sweden)

    Kuppam Chandrasekhar


    Full Text Available The current fossil fuel-based generation of energy has led to large-scale industrial development. However, the reliance on fossil fuels leads to the significant depletion of natural resources of buried combustible geologic deposits and to negative effects on the global climate with emissions of greenhouse gases. Accordingly, enormous efforts are directed to transition from fossil fuels to nonpolluting and renewable energy sources. One potential alternative is biohydrogen (H2, a clean energy carrier with high-energy yields; upon the combustion of H2, H2O is the only major by-product. In recent decades, the attractive and renewable characteristics of H2 led us to develop a variety of biological routes for the production of H2. Based on the mode of H2 generation, the biological routes for H2 production are categorized into four groups: photobiological fermentation, anaerobic fermentation, enzymatic and microbial electrolysis, and a combination of these processes. Thus, this review primarily focuses on the evaluation of the biological routes for the production of H2. In particular, we assess the efficiency and feasibility of these bioprocesses with respect to the factors that affect operations, and we delineate the limitations. Additionally, alternative options such as bioaugmentation, multiple process integration, and microbial electrolysis to improve process efficiency are discussed to address industrial-level applications.

  11. Improving Remote Species Identification through Efficient Training Data Collection

    Directory of Open Access Journals (Sweden)

    Claire A. Baldeck


    Full Text Available Plant species identification and mapping based on remotely-sensed spectral signatures is a challenging task with the potential to contribute enormously to ecological studies. Success in this task rests upon the appropriate collection and use of costly field-based training data, and researchers are in need of ways to improve collection efficiency based on quantitative evidence. Using imaging spectrometer data collected by the Carnegie Airborne Observatory for hundreds of field-identified tree crowns in Kruger National Park, South Africa, we developed woody plant species classification models and evaluated how classification accuracy increases with increasing numbers of training crowns. First, we show that classification accuracy must be estimated while respecting the crown as the basic unit of data; otherwise, accuracy will be overestimated and the amount of training data needed to perform successful classification will be underestimated. We found that classification accuracy and the number of training crowns needed to perform successful classification varied depending on the number and spectral separability of species in the model. We also used a modified Michaelis-Menten function to describe the empirical relationship between training crowns and model accuracy, and show how this function may be useful for predicting accuracy. This framework can assist researchers in designing field campaigns to maximize the efficiency of field data collection, and thus the amount of biodiversity information gained from remote species identification models.

  12. Improving the operational efficiency of Phase 2 and 3 trials. (United States)

    Ganju, Jitendra


    The period toward the end of patients' participation in late stage blinded clinical trials is highly resource intensive for the sponsor. Consider first a Phase 3 trial. If the trial is a success, the sponsor has to implement the next steps, which might be filing for approval of the drug with the US Food and Drug Administration (FDA). To shorten the time interval between trial completion and submission of the package to the FDA, sponsors front-load as much work as is possible at risk. The approach is efficient if the trial succeeds but is inefficient if it fails. For a failed trial, the sponsor is unlikely to proceed with the plan that assumed success. Phase 2 trials are also at risk of being inefficient. Many activities, such as planning for drug interaction studies, thorough QT studies, or site selection for Phase 3 trials, are set in motion prior to completion of the Phase 2 trial. The work going on in parallel is wasted if the trial fails. The proposal to improve the efficiency is to let an independent entity provide the sponsor critical information at an earlier time necessary to reevaluate activities ongoing in parallel and external to the trial.

  13. Topping gas turbines improve steam power plant efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Lezuo, A. (Siemens AG, Erlangen (Germany, F.R.). KWU Group)

    An interesting option for improving the efficiency and output of an existing conventional steam power plant is to convert it into a combined steam-and-gas cycle power plant by adding a topping gas turbine. The investment involved is relatively low, the payback period is short, and the low specific fuel consumption makes it possible to save on overall running costs. At the same time, the amount of residue for disposal and also pollutant emissions are drastically reduced. This article describes the configuration of a fully-fired combined-cycle power plant and discusses thermodynamic design and efficiency, operational aspects, emissions and residues and investment and economic viability. Both coal-fired and gas or oil-fired steam power plants can be converted by adding a topping cycle and the investment cost is about 20% of the cost of a new plant with the same output rating as the plant to be converted. Conversion reduces pollutant emission and residues produced (SO{sub 2}, NO{sub x}, CO{sub 2}, dust, ash, gypsum, waste heat). 4 figs.

  14. Root restriction: A tool for improving volume utilization efficiency in bioregenerative life-support systems (United States)

    Graham, Thomas; Wheeler, Raymond


    The objective of this study was to evaluate root restriction as a tool to increase volume utilization efficiency in spaceflight crop production systems. Bell pepper plants (Capsicum annuum cv. California Wonder) were grown under restricted rooting volume conditions in controlled environment chambers. The rooting volume was restricted to 500 ml and 60 ml in a preliminary trial, and 1500 ml (large), 500 ml (medium), and 250 ml (small) for a full fruiting trial. To reduce the possible confounding effects of water and nutrient restrictions, care was taken to ensure an even and consistent soil moisture throughout the study, with plants being watered/fertilized several times daily with a low concentration soluble fertilizer solution. Root restriction resulted in a general reduction in biomass production, height, leaf area, and transpiration rate; however, the fruit production was not significantly reduced in the root restricted plants under the employed environmental and horticultural conditions. There was a 21% reduction in total height and a 23% reduction in overall crown diameter between the large and small pot size in the fruiting study. Data from the fruiting trial were used to estimate potential volume utilization efficiency improvements for edible biomass in a fixed production volume. For fixed lighting and rooting hardware situations, the majority of improvement from root restriction was in the reduction of canopy area per plant, while height reductions could also improve volume utilization efficiency in high stacked or vertical agricultural systems.

  15. Improving the Efficiency of Medical Services Systems: A New Integrated Mathematical Modeling Approach

    Directory of Open Access Journals (Sweden)

    Davood Shishebori


    Full Text Available Nowadays, the efficient design of medical service systems plays a critical role in improving the performance and efficiency of medical services provided by governments. Accordingly, health care planners in countries especially with a system based on a National Health Service (NHS try to make decisions on where to locate and how to organize medical services regarding several conditions in different residence areas, so as to improve the geographic equity of comfortable access in the delivery of medical services while accounting for efficiency and cost issues especially in crucial situations. Therefore, optimally locating of such services and also suitable allocating demands them, can help to enhance the performance and responsiveness of medical services system. In this paper, a multiobjective mixed integer nonlinear programming model is proposed to decide locations of new medical system centers, link roads that should be constructed or improved, and also urban residence centers covered by these medical service centers and link roads under investment budget constraint in order to both minimize the total transportation cost of the overall system and minimize the total failure cost (i.e., maximize the system reliability of medical service centers under unforeseen situations. Then, the proposed model is linearized by suitable techniques. Moreover, a practical case study is presented in detail to illustrate the application of the proposed mathematical model. Finally, a sensitivity analysis is done to provide an insight into the behavior of the proposed model in response to changes of key parameters of the problem.

  16. Improving health promotion using quality improvement techniques in Australian Indigenous primary health care

    Directory of Open Access Journals (Sweden)

    Nikki ePercival


    Full Text Available While some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centres. Our study objectives were to: (a describe the scope and quality of health promotion activities; (b describe the status of health centre system support for health promotion activities; and (c introduce a CQI intervention and examine the impact on health promotion activities and health centres systems over two years. Baseline assessments showed sub-optimal health centre systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health centre systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence based health promotion by engaging front line health practitioners in decision making processes about the design/redesign of health centre systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff and members of the local community to address organisational and policy level barriers.

  17. The new health-care quality: value, outcomes, and continuous improvement. (United States)

    O'Connor, S J; Lanning, J A


    No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

  18. Overall Traveling-Wave-Tube Efficiency Improved By Optimized Multistage Depressed Collector Design (United States)

    Vaden, Karl R.


    Depressed Collector Design The microwave traveling wave tube (TWT) is used widely for space communications and high-power airborne transmitting sources. One of the most important features in designing a TWT is overall efficiency. Yet, overall TWT efficiency is strongly dependent on the efficiency of the electron beam collector, particularly for high values of collector efficiency. For these reasons, the NASA Glenn Research Center developed an optimization algorithm based on simulated annealing to quickly design highly efficient multistage depressed collectors (MDC's). Simulated annealing is a strategy for solving highly nonlinear combinatorial optimization problems. Its major advantage over other methods is its ability to avoid becoming trapped in local minima. Simulated annealing is based on an analogy to statistical thermodynamics, specifically the physical process of annealing: heating a material to a temperature that permits many atomic rearrangements and then cooling it carefully and slowly, until it freezes into a strong, minimum-energy crystalline structure. This minimum energy crystal corresponds to the optimal solution of a mathematical optimization problem. The TWT used as a baseline for optimization was the 32-GHz, 10-W, helical TWT developed for the Cassini mission to Saturn. The method of collector analysis and design used was a 2-1/2-dimensional computational procedure that employs two types of codes, a large signal analysis code and an electron trajectory code. The large signal analysis code produces the spatial, energetic, and temporal distributions of the spent beam entering the MDC. An electron trajectory code uses the resultant data to perform the actual collector analysis. The MDC was optimized for maximum MDC efficiency and minimum final kinetic energy of all collected electrons (to reduce heat transfer). The preceding figure shows the geometric and electrical configuration of an optimized collector with an efficiency of 93.8 percent. The

  19. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

    Directory of Open Access Journals (Sweden)

    Kimberly Ramsbottom


    Full Text Available Long term care (LTC homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide “resident-centred care”; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector.

  20. 45 CFR 98.51 - Activities to improve the quality of child care. (United States)


    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Activities to improve the quality of child care... the quality of child care. (a) No less than four percent of the aggregate funds expended by the Lead...) Activities to improve the quality of child care services may include, but are not limited to: (i)...

  1. Improving fertility care. The role of guidelines, quality indicators and patients.

    NARCIS (Netherlands)

    Mourad, S.M.


    Clinical practice guidelines can help improve the quality of care, and decrease variation in delivered care between settings. However, as guidelines do not implement themselves, efforts should be made to improve current guideline implementation. For clinical fertility care, we performed a large mult


    Energy Technology Data Exchange (ETDEWEB)

    Ronald Dupree


    Upcoming emissions regulations (Tiers 3, 4a and 4b) are imposing significantly higher heat loads on the cooling system than lesser regulated machines. This work was a suite of tasks aimed at reducing the parasitic losses of the cooling system, or improving the design process through six distinct tasks: 1. Develop an axial fan that will provide more airflow, with less input power and less noise. The initial plan was to use Genetic Algorithms to do an automated fan design, incorporating forward sweep for low noise. First and second generation concepts could not meet either performance or sound goals. An experienced turbomachinery designer, using a specialized CFD analysis program has taken over the design and has been able to demonstrate a 5% flow improvement (vs 10% goal) and 10% efficiency improvement (vs 10% goal) using blade twist only. 2. Fan shroud developments, using an 'aeroshroud' concept developed at Michigan State University. Performance testing at Michigan State University showed the design is capable of meeting the goal of a 10% increase in flow, but over a very narrow operating range of fan performance. The goal of 10% increase in fan efficiency was not met. Fan noise was reduced from 0 to 2dB, vs. a goal of 5dB at constant airflow. The narrow range of fan operating conditions affected by the aeroshroud makes this concept unattractive for further development at this time 3. Improved axial fan system modeling is needed to accommodate the numbers of cooling systems to be redesigned to meet lower emissions requirements. A CFD fan system modeling guide has been completed and transferred to design engineers. Current, uncontrolled modeling practices produce flow estimates in some cases within 5% of measured values, and in some cases within 25% of measured values. The techniques in the modeling guide reduced variability to the goal of + 5% for the case under study. 4. Demonstrate the performance and design versatility of a high performance fan. A

  3. Energy Efficiency Improvement Potential in Historical Brick Building


    Žogla, Gatis; Blumberga, Andra; Zvaigznītis, Kristaps; Dzikēvičs, Miķelis; Blumberga, Dagnija; Burinskiene, Marija


    Energy efficiency in historical heritage buildings is viewed as a taboo because these buildings usually are law-protected and no energy efficiency measures that would change the appearance of building are allowed. In this paper we look at a potential of increasing energy efficiency level in historical buildings. Measurements to determine energy efficiency of a historical brick building have been done, which also give the possibility to determine the potential of energy efficiency measures in ...

  4. Options for Improving the Military Child Care System (United States)


    military parents use parental care, our analysis of survey responses revealed that most of these are families headed by an unmarried male military...children while the parent or parents were working or going to school. Parental care (care provided by the mother or father) was an option that the child’s mother , a finding that suggests that at least some single military parents do have other child care options available to them and are

  5. Improving palliative care outcomes for Aboriginal Australians: service providers’ perspectives


    Shahid, Shaouli; Bessarab, Dawn; van Schaik, Katherine D; Aoun, Samar M.; Thompson, Sandra C


    Background: Aboriginal Australians have a lower rate of utilisation of palliative care services than the general population. This study aimed to explore care providers’ experiences and concerns in providing palliative care for Aboriginal people, and to identify opportunities for overcoming gaps in understanding between them and their Aboriginal patients and families. Methods: In-depth, qualitative interviews with urban, rural and remote palliative care providers were undertaken in inpatient a...


    Energy Technology Data Exchange (ETDEWEB)

    Reid B. Grigg; Robert K. Svec


    This document is the First Annual Report for the U.S. Department of Energy under contract No., a three-year contract entitled: ''Improving CO{sub 2} Efficiency for Recovering Oil in Heterogeneous Reservoirs.'' The research improved our knowledge and understanding of CO{sub 2} flooding and includes work in the areas of injectivity and mobility control. The bulk of this work has been performed by the New Mexico Petroleum Recovery Research Center, a research division of New Mexico Institute of Mining and Technology. This report covers the reporting period of September 28, 2001 and September 27, 2002. Injectivity continues to be a concern to the industry. During this period we have contacted most of the CO{sub 2} operators in the Permian Basin and talked again about their problems in this area. This report has a summary of what we found. It is a given that carbonate mineral dissolution and deposition occur in a formation in geologic time and are expected to some degree in carbon dioxide (CO{sub 2}) floods. Water-alternating-gas (WAG) core flood experiments conducted on limestone and dolomite core plugs confirm that these processes can occur over relatively short time periods (hours to days) and in close proximity to each other. Results from laboratory CO{sub 2}-brine flow experiments performed in rock core were used to calibrate a reactive transport simulator. The calibrated model is being used to estimate in situ effects of a range of possible sequestration options in depleted oil/gas reservoirs. The code applied in this study is a combination of the well known TOUGH2 simulator, for coupled groundwater/brine and heat flow, with the chemistry code TRANS for chemically reactive transport. Variability in response among rock types suggests that CO{sub 2} injection will induce ranges of transient and spatially dependent changes in intrinsic rock permeability and porosity. Determining the effect of matrix changes on CO{sub 2} mobility is crucial in

  7. Women's Suggestions for Improving Midwifery Care in The Netherlands

    NARCIS (Netherlands)

    Baas, Carien I.; Erwich, Jan Jaap H. M.; Wiegers, Therese A.; de Cock, T. Paul; Hutton, Eileen K.


    Background: The experience of the care a woman receives during pregnancy and childbirth has an immediate and long-lasting effect on her well being. The involvement of patients and clients in health care has increased over the last decades. The Dutch maternity care system offers an excellent opportun

  8. Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care

    DEFF Research Database (Denmark)

    Nørgaard, Birgitte; Kofoed, Poul-Erik; Ohm Kyvik, Kirsten


    Scand J Caring Sci; 2012; Communication skills training for health care professionals improves the adult orthopaedic patient's experience of quality of care Rationale:  Despite the fact that communication has become a core topic in health care, patients still experience the information provided...... as insufficient or incorrect and a lack of involvement. Objective:  To investigate whether adult orthopaedic patients' evaluation of the quality of care had improved after a communication skills training course for healthcare professionals. Design and methods:  The study was designed as an intervention study...... limitation. Response rates were comparable to those of other studies. Conclusion:  Patients show increased satisfaction with the quality of health care after professionals have attended a communication skills training course, even when implemented in an entire department. Practice implications:  We recommend...

  9. Can we improve service efficiency in CAMHS using the CAPA approach without reducing treatment effectiveness? (United States)

    Fuggle, Peter; McHugh, Annie; Gore, Lucy; Dixon, Emily; Curran, Daniel; Cutinha, Darren


    Health-care systems are under increasing pressure to deliver more care with similar or even less resources and there is concern that this may be achieved at the cost of reduced clinical effectiveness. In Child and Adolescent Mental Health Services (CAMHS), the Choice and Partnership Approach (CAPA) has been widely adopted as a way of increasing the efficient use of limited service resources. Some evaluations have reported increased patient flow and reduced waiting times, but it remains unknown whether such changes have been achieved at a cost of clinical effectiveness. This article describes a pragmatic multi-method evaluation of a CAMHS service reporting service outcomes (client satisfaction, waiting times, and patient flow) and clinical outcomes (clinician-rated clinical outcomes and goals achieved by families). Results showed improved service outcomes (high levels of client satisfaction and reduced waiting times) and an increase in patient flow (49 cases increased to 72 cases over an equivalent time period). Clinical outcomes showed no reduction in effectiveness and a significant improvement against the agreed goals of the intervention. The evaluation suggested that a well-structured goal-focused patient flow system may improve services by increasing patient flow while maintaining high satisfaction levels, without negatively impacting clinical effectiveness.

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

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


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

  11. Modeling of Glass Making Processes for Improved Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Thomas P. Seward III


    The overall goal of this project was to develop a high-temperature melt properties database with sufficient reliability to allow mathematical modeling of glass melting and forming processes for improved product quality, improved efficiency and lessened environmental impact. It was initiated by the United States glass industry through the NSF Industry/University Center for Glass Research (CGR) at Alfred University [1]. Because of their important commercial value, six different types/families of glass were studied: container, float, fiberglass (E- and wool-types), low-expansion borosilicate, and color TV panel glasses. CGR member companies supplied production-quality glass from all six families upon which we measured, as a function of temperature in the molten state, density, surface tension, viscosity, electrical resistivity, infrared transmittance (to determine high temperature radiative conductivity), non-Newtonian flow behavior, and oxygen partial pres sure. With CGR cost sharing, we also studied gas solubility and diffusivity in each of these glasses. Because knowledge of the compositional dependencies of melt viscosity and electrical resistivity are extremely important for glass melting furnace design and operation, these properties were studied more fully. Composition variations were statistically designed for all six types/families of glass. About 140 different glasses were then melted on a laboratory scale and their viscosity and electrical resistivity measured as a function of temperature. The measurements were completed in February 2003 and are reported on here. The next steps will be (1) to statistically analyze the compositional dependencies of viscosity and electrical resistivity and develop composition-property response surfaces, (2) submit all the data to CGR member companies to evaluate the usefulness in their models, and (3) publish the results in technical journals and most likely in book form.

  12. A Cooperative Communication System for the Advancement of Safe, Effective, and Efficient Patient Care (United States)


    Award Number: W81XWH-12-C-0126 TITLE: A Cooperative Communication System for the Advancement of Safe, Effective , and Efficient Patient Care...DATES COVERED 15Aug2014 – 14Aug2015 4. TITLE AND SUBTITLE A Cooperative Communication System for the Advancement of Safe, Effective , and Efficient...cost extension through May 2016. 15. SUBJECT TERMS Cognitive Engineering, Human Factors, Health Information Technology 16. SECURITY CLASSIFICATION OF

  13. Community health workers in primary care practice: redesigning health care delivery systems to extend and improve diabetes care in underserved populations. (United States)

    Collinsworth, Ashley; Vulimiri, Madhulika; Snead, Christine; Walton, James


    New, comprehensive, approaches for chronic disease management are needed to ensure that patients, particularly those more likely to experience health disparities, have access to the clinical care, self-management resources, and support necessary for the prevention and control of diabetes. Community health workers (CHWs) have worked in community settings to reduce health care disparities and are currently being deployed in some clinical settings as a means of improving access to and quality of care. Guided by the chronic care model, Baylor Health Care System embedded CHWs within clinical teams in community clinics with the goal of reducing observed disparities in diabetes care and outcomes. This study examines findings from interviews with patients, CHWs, and primary care providers (PCPs) to understand how health care delivery systems can be redesigned to effectively incorporate CHWs and how embedding CHWs in primary care teams can produce informed, activated patients and prepared, proactive practice teams who can work together to achieve improved patient outcomes. Respondents indicated that the PCPs continued to provide clinical exams and manage patient care, but the roles of diabetes education, nutritional counseling, and patient activation were shifted to the CHWs. CHWs also provided patients with social support and connection to community resources. Integration of CHWs into clinical care teams improved patient knowledge and activation levels, the ability of PCPs to identify and proactively address specific patient needs, and patient outcomes.

  14. [Internationalized medical care services increase need of health care providers to improve English communication skills]. (United States)

    Yang, Chia-Ling


    English is the most important language used in international communication. Nurses today have significantly more opportunities to come into contact with clients of different nationalities. Therefore, English communication abilities are a critical to the effective care of foreign clients. Miscommunication due to language barriers can endanger the health and safety of foreign clients and hinder their access to healthcare resources. Basic English communicate skills allow nurses to better understand the feelings of foreign clients and to affect their satisfaction with healthcare services provided. The majority of clinical nurses in Taiwan are inadequately prepared to communicate with foreign clients or use English when delivering nursing care services. Although English is not an official language in Taiwan, strengthening English communication skills is necessary for Taiwan's healthcare service system. Faced with increasing numbers of foreign clients in their daily work, first-line nursing staffs need more training to improve English proficiency. In order to do so, support from the hospital director is the first priority. The second priority is to motivate nursing staffs to learn English; the third is to incorporate different English classes into the medical system and schedule class times to meet nurse scheduling needs; and the fourth is to establish international medical wards, with appropriate incentives in pay designed to attract and retain nursing staff proficient in English communication.

  15. Improving transitions of care at hospital discharge--implications for pediatric hospitalists and primary care providers. (United States)

    Harlan, Gregory A; Nkoy, Flory L; Srivastava, Rajendu; Lattin, Gena; Wolfe, Doug; Mundorff, Michael B; Colling, Dayvalena; Valdez, Angelika; Lange, Shay; Atkinson, Sterling D; Cook, Lawrence J; Maloney, Christopher G


    Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.

  16. Process Cycle Efficiency Improvement Through Lean: A Case Study

    Directory of Open Access Journals (Sweden)

    P.V. Mohanram


    Full Text Available Lean manufacturing is an applied methodology of scientific, objective techniques that cause work tasks in a process to be performed with a minimum of non-value adding activities resulting in greatly reduced wait time, queue time, move time, administrative time, and other delays. This work addresses the implementation of lean principles in a construction equipment company. The prime objective is to evolve and test several strategies to eliminate waste on the shop floor. This paper describes an application of value stream mapping (VSM. Consequently, the present and future states of value stream maps are constructed to improve the production process by identifying waste and its sources. A noticeable reduction in cycle time and increase in cycle efficiency is confirmed. The production flow was optimized thus minimizing several non-value added activities/times such as bottlenecking time, waiting time, material handling time, etc. This case study can be useful in developing a more generic approach to design lean environment.

  17. A Retrofit Tool for Improving Energy Efficiency of Commercial Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Levine, Mark; Feng, Wei; Ke, Jing; Hong, Tianzhen; Zhou, Nan


    Existing buildings will dominate energy use in commercial buildings in the United States for three decades or longer and even in China for the about two decades. Retrofitting these buildings to improve energy efficiency and reduce energy use is thus critical to achieving the target of reducing energy use in the buildings sector. However there are few evaluation tools that can quickly identify and evaluate energy savings and cost effectiveness of energy conservation measures (ECMs) for retrofits, especially for buildings in China. This paper discusses methods used to develop such a tool and demonstrates an application of the tool for a retrofit analysis. The tool builds on a building performance database with pre-calculated energy consumption of ECMs for selected commercial prototype buildings using the EnergyPlus program. The tool allows users to evaluate individual ECMs or a package of ECMs. It covers building envelope, lighting and daylighting, HVAC, plug loads, service hot water, and renewable energy. The prototype building can be customized to represent an actual building with some limitations. Energy consumption from utility bills can be entered into the tool to compare and calibrate the energy use of the prototype building. The tool currently can evaluate energy savings and payback of ECMs for shopping malls in China. We have used the tool to assess energy and cost savings for retrofit of the prototype shopping mall in Shanghai. Future work on the tool will simplify its use and expand it to cover other commercial building types and other countries.

  18. Electronic Equipment Proposal to Improve the Photovoltaic Systems Efficiency (United States)

    Flores-Mena, J. E.; Juárez Morán, L. A.; Díaz Reyes, J.


    This paper reports a new technique proposal to improve the photovoltaic systems. It was made to design and implement an electronic system that will detect, capture, and transfer the maximum power of the photovoltaic (PV) panel to optimize the supplied power of a solar panel. The electronic system works on base technical proposal of electrical sweeping of electric characteristics using capacitive impedance. The maximum power is transformed and the solar panel energy is sent to an automotive battery. This electronic system reduces the energy lost originated when the solar radiation level decreases or the PV panel temperature is increased. This electronic system tracks, captures, and stores the PV module's maximum power into a capacitor. After, a higher voltage level step-up circuit was designed to increase the voltage of the PV module's maximum power and then its current can be sent to a battery. The experimental results show that the developed electronic system has 95% efficiency. The measurement was made to 50 W, the electronic system works rightly with solar radiation rate from 100 to 1,000 W m - 2 and the PV panel temperature rate changed from 1 to 75°C. The main advantage of this electronic system compared with conventional methods is the elimination of microprocessors, computers, and sophisticated numerical approximations, and it does not need any small electrical signals to track the maximum power. The proposed method is simple, fast, and it is also cheaper.

  19. Strategy for improvement of enteropeptidase efficiency in tag removal processes. (United States)

    Gasparian, Marine E; Bychkov, Maxim L; Dolgikh, Dmitry A; Kirpichnikov, Mikhail P


    Enteropeptidase (synonym: enterokinase, EC is a heterodimeric serine protease of the intestinal brush border that activates trypsinogen by highly specific cleavage of the trypsinogen activation peptide following the sequence (Asp)(4)-Lys. It has also great biotechnological interest because of the unique substrate specificity of the serine protease domain. The high degree of specificity exhibited by enteropeptidase makes it a suitable reagent for cleaving recombinant proteins to remove affinity or other tags. However often unwanted cleavages elsewhere in the protein occurred during cleavage of fusions when high amount of enzyme is required. In this study we have improved the efficiency of fusion proteins cleavage by enteropeptidase by substitution of the Lys residue by Arg in specific cleavage sequence (Asp)(4)-Lys. We have demonstrated that 3-6-fold lower amounts of the catalytic subunit of human and bovine enteropeptidase is required for 95% cleavage of Trx/TRAIL and Trx/FGF-2 fusions with (Asp)(4)-Arg cleavage sequence in comparison to native sequence (Asp)(4)-Lys. As a result, reduced amount of non-specifically cleaved peptide fragments were observed during cleavage of (Asp)(4)-Lys/Arg mutated fusions. These findings overcome limitations of enteropeptidase in tag removal processes during recombinant proteins purification and extend its commercial benefit in the biopharmaceutical industry.


    Energy Technology Data Exchange (ETDEWEB)

    Reid B. Grigg


    The second annual report of ''Improving CO{sub 2} Efficiency for Recovery Oil in Heterogeneous Reservoirs'' presents results of laboratory studies with related analytical models for improved oil recovery. All studies have been undertaken with the intention to optimize utilization and extend the practice of CO{sub 2} flooding to a wider range of reservoirs. Many items presented in this report are applicable to other interest areas: e.g. gas injection and production, greenhouse gas sequestration, chemical flooding, reservoir damage, etc. Major areas of studies include reduction of CO{sub 2} mobility to improve conformance, determining and understanding injectivity changes in particular injectivity loses, and modeling process mechanisms determined in the first two areas. Interfacial tension (IFT) between a high-pressure, high-temperature CO{sub 2} and brine/surfactant and foam stability are used to assess and screen surfactant systems. In this work the effects of salinity, pressure, temperature, surfactant concentration, and the presence of oil on IFT and CO{sub 2} foam stability were determined on the surfactant (CD1045{trademark}). Temperature, pressure, and surfactant concentration effected both IFT and foam stability while oil destabilized the foam, but did not destroy it. Calcium lignosulfonate (CLS) can be used as a sacrificial and an enhancing agent. This work indicates that on Berea sandstone CLS concentration, brine salinity, and temperature are dominant affects on both adsorption and desorption and that adsorption is not totally reversible. Additionally, CLS adsorption was tested on five minerals common to oil reservoirs; it was found that CLS concentration, salinity, temperature, and mineral type had significant effects on adsorption. The adsorption density from most to least was: bentonite > kaolinite > dolomite > calcite > silica. This work demonstrates the extent of dissolution and precipitation from co-injection of CO{sub 2} and

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

    Directory of Open Access Journals (Sweden)

    Di Duro Joseph O


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

  2. The impact of kinetotherapy in the improvement of functional capacity and self care of children with Sechelar Infantile Encephalopathy

    Directory of Open Access Journals (Sweden)

    Ada Petrache


    Full Text Available The purpose of the study was to demonstrate the efficiency of kinetotherapy in the treatment of sechelar infantileencephalopathy (SIE. Methods: we studied 10 children with sechelar infantile encephalopathy, which were admitted in theRecovery Clinical Hospital in Baile Felix. They were submitted to a specific kinetotherapy program for one year. All subjectswere assessed before and after this physical intervention. Results: following this application we obtained good results; allpatients showed an improvement both in motion and respiratory abilities – inhaling and exhaling. The conclusion of this studywas that this treatment proved to be very efficient, in improving functional and self-care capacities of SIE patients.

  3. Improving America's health care system by investing in information technology. (United States)

    Coye, Molly Joel; Bernstein, William S


    Large-scale investment in health care information technology (IT) infrastructure will not take place without leadership by the federal government. But how the federal government supports the financing of health care IT is critical. Health care IT development has multiple aspects, but it is fundamentally a problem of community infrastructure development. A policy approach that has had consistent success in financing our country's essential physical infrastructure in transportation and environmental protection will be well suited to fostering health care IT infrastructure as well. We propose the creation of a health care IT revolving loan fund program to invest public dollars in health care IT infrastructure projects through community-level nonprofit lending agencies.

  4. A Proposed ‘Health Literate Care Model’ Would Constitute A Systems Approach To Improving Patients’ Engagement In Care



    Improving health outcomes relies on patients’ full engagement in prevention, decision-making, and self-management activities. Health literacy, or people’s ability to obtain, process, communicate, and understand basic health information and services, is essential to those actions. Yet relatively few Americans are proficient in understanding and acting on available health information. We propose a Health Literate Care Model to improve patient engagement in health care. As health literacy strate...

  5. Lean Six Sigma in Health Care: Improving Utilization and Reducing Waste. (United States)

    Almorsy, Lamia; Khalifa, Mohamed


    Healthcare costs have been increasing worldwide mainly due to over utilization of resources. The savings potentially achievable from systematic, comprehensive, and cooperative reduction in waste are far higher than from more direct and blunter cuts in care and coverage. At King Faisal Specialist Hospital and Research Center inappropriate and over utilization of the glucose test strips used for whole blood glucose determination using glucometers was observed. The hospital implemented a project to improve its utilization. Using the Six Sigma DMAIC approach (Define, Measure, Analyze, Improve and Control), an efficient practice was put in place including updating the related internal policies and procedures and the proper implementation of an effective users' training and competency check off program. That resulted in decreasing the unnecessary Quality Control (QC) runs from 13% to 4%, decreasing the failed QC runs from 14% to 7%, lowering the QC to patient testing ratio from 24/76 to 19/81.

  6. Efficient improvement of silage additives by using genetic algorithms. (United States)

    Davies, Z S; Gilbert, R J; Merry, R J; Kell, D B; Theodorou, M K; Griffith, G W


    The enormous variety of substances which may be added to forage in order to manipulate and improve the ensilage process presents an empirical, combinatorial optimization problem of great complexity. To investigate the utility of genetic algorithms for designing effective silage additive combinations, a series of small-scale proof of principle silage experiments were performed with fresh ryegrass. Having established that significant biochemical changes occur over an ensilage period as short as 2 days, we performed a series of experiments in which we used 50 silage additive combinations (prepared by using eight bacterial and other additives, each of which was added at six different levels, including zero [i.e. , no additive]). The decrease in pH, the increase in lactate concentration, and the free amino acid concentration were measured after 2 days and used to calculate a "fitness" value that indicated the quality of the silage (compared to a control silage made without additives). This analysis also included a "cost" element to account for different total additive levels. In the initial experiment additive levels were selected randomly, but subsequently a genetic algorithm program was used to suggest new additive combinations based on the fitness values determined in the preceding experiments. The result was very efficient selection for silages in which large decreases in pH and high levels of lactate occurred along with low levels of free amino acids. During the series of five experiments, each of which comprised 50 treatments, there was a steady increase in the amount of lactate that accumulated; the best treatment combination was that used in the last experiment, which produced 4.6 times more lactate than the untreated silage. The additive combinations that were found to yield the highest fitness values in the final (fifth) experiment were assessed to determine a range of biochemical and microbiological quality parameters during full-term silage fermentation. We

  7. Improving care coordination using organisational routines: care pathways as a coordination mechanism

    DEFF Research Database (Denmark)

    Prætorius, Thim


    Purpose: This conceptual article systematically applies theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can...... be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Design/methodology/approach: Theory of routines is systematically applied to the concept of care pathways in order to develop theoretically derived propositions. Findings: Care pathways mirror....... Originality/value: Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination....

  8. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement. (United States)

    Montano, Maria F; Mehdi, Harshal; Nash, David B


    The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting.

  9. Pricing in Noncooperative Interference Channels for Improved Energy Efficiency

    Directory of Open Access Journals (Sweden)

    Chong Zhijiat


    Full Text Available We consider noncooperative energy-efficient resource allocation in the interference channel. Energy efficiency is achieved when each system pays a price proportional to its allocated transmit power. In noncooperative game-theoretic notation, the power allocation chosen by the systems corresponds to the Nash equilibrium. We study the existence and characterize the uniqueness of this equilibrium. Afterwards, pricing to achieve energy-efficiency is examined. We introduce an arbitrator who determines the prices that satisfy minimum QoS requirements and minimize total power consumption. This energy-efficient assignment problem is formulated and solved. We compare our setting to that without pricing with regard to energy-efficiency by simulation. It is observed that pricing in this distributed setting achieves higher energy-efficiency in different interference regimes.

  10. DVB-S2 Spectrum Efficiency Improvement with Hierarchical Modulation


    Meric, Hugo; Piquer, Jose Miguel


    We study the design of a DVB-S2 system in order to maximise spectrum efficiency. This task is usually challenging due to channel variability. Modern satellite communications systems such as DVB-SH and DVB-S2 rely mainly on a time sharing strategy to optimise the spectrum efficiency. Recently, we showed that combining time sharing with hierarchical modulation can provide significant gains (in terms of spectrum efficiency) compared to the best time sharing strategy. However, our previous design...

  11. A new method for improving efficiency of protocol testing

    Institute of Scientific and Technical Information of China (English)

    ZHAO Baohua; JIANG Zhenhai


    Traditional solutions have encountered some bottleneck in ireproving the efficiency of protocol testing.A novel method that records the test sequence dynamically is proposed.Three dynamically reordering algorithms are brought forward in line with difrerent fault conditions.The impact of the new method of testing efficiency is also presented.Simulation results demonstrate that the proposed solution is better than the traditional ones in terms of testing efficiency.

  12. Short and long term improvements in quality of chronic care delivery predict program sustainability. (United States)

    Cramm, Jane Murray; Nieboer, Anna Petra


    Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (pquality changes in the first (pmanagement programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects.

  13. Measuring health care efficiency with a tripartite configuration under the "National" Health Insurance system

    Institute of Scientific and Technical Information of China (English)

    Victor B.Kreng; Yang Shao-wei; Lin Chien-Hsu


    Background The "National" Health Insurance (NHI) in Taiwan,China is a single-payer system that was introduced in 1995 to provide universal health care.It is worth noting that three stakeholders are involved in Taiwan's NHI,which can be seen as a triangular governance regime between the Bureau of "National" Health Insurance (BNHI),the insured and providers.Accordingly,this study intended to assess the efficiency of various different production processes that occur among these stakeholders in Taiwan's NHI system.Methods A two-stage relational Data Envelopment Analysis (DEA) model is adopted to investigate the sub-process efficiencies of the health care resources held by 23 cities and counties through stages Ⅰ or Ⅱ,where the outputs of the first stage serve the inputs of the second.The dataset was collected from the annual reports published by the Department of Health,Taiwan,China.Results Under the proposed framework,the efficiency of the whole process can be obtained from the product of productivity and allocative efficiency.Ten DMUs are efficient either in stages Ⅰ or Ⅱ,with only two DMUs being efficient with regard to both sub-processes.Conclusion The relational DEA model not only demonstrates the physical relationship between the whole process and the sub-process components,but also produces reliable outcomes in efficiency measurement among different stakeholders in Taiwan's NHI system.

  14. Improving Bariatric Patient Transport and Care with Simulation

    Directory of Open Access Journals (Sweden)

    Brad D. Gable


    Full Text Available Introduction: Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics’ knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Methods: Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree to 5 (strongly agree on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p

  15. Improving Adherence to Hand Hygiene among Health Care Workers (United States)

    Maskerine, Courtney; Loeb, Mark


    Increased adherence to hand hygiene is widely acknowledged to be the most important way of reducing infections in health care facilities. Despite evidence of benefit, adherence to hand hygiene among health care professionals remains low. Several behavioral and organizational theories have been proposed to explain this. As a whole, the success of…

  16. [The UHSA, an improvement in the care provision]. (United States)

    Chanty, Jérôme


    Established by the law on the orientation and programming of justice of September 2002, the specially equipped hospital unit (UHSA) provides psychiatric treatment with full medical care to prisoners, in direct cooperation with the prison. In this specific social context, can the organisation of the care and the structure itself represent a lasting solution?

  17. En Route Critical Care: Evolving, Improving & Advancing Capabilities (United States)


    Conference Civilian Partnerships  ECMO Pediatric/Neonatology Consortium  58 y/o Male unresponsive to care  Needed Adult ECMO – USA ECMO MD – USAF...Neonatologist – Civilian Perfusionist – Civilian ECMO RN  Transported to Iowa 36 2011 MHS Conference International AE En Route Medical Care Conference

  18. [The transformation of the healthcare model in Catalonia to improve the quality of care]. (United States)

    Padrosa, Josep Maria; Guarga, Àlex; Brosa, Francesc; Jiménez, Josep; Robert, Roger


    The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current disease-centred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives. The changes the Catalan Health Service (CatSalut) has undergone are principally focused on increasing resolution capacity of the primary level of care, eliminating differences in clinical practice, evolving towards more surgery-centred hospitals, promoting alternatives to conventional hospitalization, developing remote care models, concentrating and organizing highly complex care into different sectors at a territorial level and designing specific health codes in response to health emergencies. The purpose of these initiatives is to improve the effectiveness, quality, safety and efficiency of the system, ensuring equal access for the public to these services and ensuring a territorial balance. These changes should be facilitated and promoted using several different approaches, including implementing shared access to clinical history case files, the new model of results-based contracting and payment, territorial agreements, alliances between centres, harnessing the potential of information and communications technology and evaluation of results.

  19. VA Health Care: Actions Needed to Improve Newly Enrolled Veterans Access to Primary Care (United States)


    primary care provider and support staff—a nurse care manager, clinical associate, and administrative clerk. Letter Page 2 GAO-16-328...Health Eligibility Center, VHA central office—VHA’s Health Resource Center, Office of Primary Care, and Access and Clinical Administration Program ...newly enrolled veterans were able to access primary care from the Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA), and others

  20. Chronic disease management: a review of current performance across quality of care domains and opportunities for improving osteoarthritis care. (United States)

    Brand, Caroline A; Ackerman, Ilana N; Bohensky, Megan A; Bennell, Kim L


    Osteoarthritis is the most prevalent chronic joint disease worldwide. The incidence and prevalence are increasing as the population ages and lifestyle risk factors such as obesity increase. There are several evidence-based clinical practice guidelines available to guide clinician decision making, but there is evidence that care provided is suboptimal across all domains of quality: effectiveness, safety, timeliness and appropriateness, patient-centered care, and efficiency. System, clinician, and patient barriers to optimizing care need to be addressed. Innovative models designed to meet patient needs and those that harness social networks must be developed, especially to support those with mild to moderate disease.

  1. Better Kid Care Program Improves the Quality of Child Care: Results from an Interview Study (United States)

    Ostergren, Carol S.; Riley, David A.; Wehmeier, Jenny M.


    More high quality child care is needed in the United States. This article evaluates the Better Kid Care (BKC) program produced by Pennsylvania State University Extension. Child care staff in Wisconsin were interviewed about changes they had made in their early childhood programs following participation in the BKC program. Findings show that 2…

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

    NARCIS (Netherlands)

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


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

  3. Developing concepts for improved efficiency of robot work preparation

    NARCIS (Netherlands)

    Essers, M.S.; Vaneker, T.H.J.


    SInBot[1] is a large research project that focuses on maximizing the efficient use of mobile industrial robots during medium sized production runs. The system that will be described in this paper will focusses on the development and validation of concepts for efficient work preparation for cells of

  4. Improvement treatments and criteria assessing banks the energy efficiency projects

    Directory of Open Access Journals (Sweden)

    Ryzhkova Anna Vladimirovna


    Full Text Available Stimulate bank lending to businesses for energy efficiency projects is possible by increasing the accuracy of the valuation the project and the effect of its implementation. The paper presents a sequence of procedures and appropriate assessment criteria for energy efficiency projects, which will increase the chances of success of the investment project and to ensure the financial stability of the bank.

  5. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    van de Ven Geertje


    Full Text Available Abstract Background The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. Methods/Design The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory - Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. Discussion A novelty of dementia-care mapping is that it offers an

  6. Improving the quality of care in Chinese family planning programme. (United States)

    Jiang, Y; Geng, Q; Haffey, J; Douglas, E


    The Chinese State Family Planning Commission (SFPC) is the government department responsible for coordinating and implementing the national population and family planning programs. The commission includes about 300,000 family planning workers and 50 million volunteers. Community workers provide IEC and technical services to couples of reproductive age. In July 1991, SFPC began a five year project to train rural family planning workers in contraceptive technology and interpersonal communication and counseling. These workers were important because of their service to a population of 800 million or 75% of total population. The training program was part of an effort to standardize training and institutionalize it throughout the country. The project involved 20 pilot training stations in 19 provinces. The primary task was to train family planning workers at the grassroots level. 80,000 persons were expected to be trained during the five years. Activities included a training needs assessment, development of training curricula and programs, training of workers, and monitoring and evaluation. Training techniques and topics will include participatory training methods, interpersonal communication and counseling, development of audience based training methods, issues of contraceptive choice and quality of care, and counseling issues such as sexually transmitted disease and HIV infection prevention. About 40,000 family planning workers and volunteers were trained by 1992 in counties, townships, and villages. Trainees learned about "informed choice" and the importance of counseling. Feedback from training activities focused on the appreciation for the participatory training methods such as brainstorming, case study, and role play. Workers appreciated the process involved in training as well as the information received. Evaluation showed that clients improved their knowledge and had positive interactions with workers.

  7. Improving efficiency with moderation and the 5M system

    Energy Technology Data Exchange (ETDEWEB)

    Reschke, D.F. (ed.); Bradley, W.G.; Frechen, B.; Lambert, J.; Mueller-Gerbes, H.; Nielsen, J.; Stadelhofer, J.; Westhoff, K.


    This handy volume gives a concise and easy-to-remember overview of the Reschke 5M System that has proved its value in numerous practical cases - both in administration and industry - during the past 40 years. The editor demonstrates that the best solutions to increase the efficiency of an organization can be found through embedding the personnel into the project by the guidance of an Efficiency Moderator. From the contents: Efficiency System - Business Simulator - Efficiency Project Simulator - Checklists - Efficiency Project Case Study - Return on Input 3000:1, an Air-to Air Missile Development Project - Project Status - Appendix. - Edited by D.F. Reschke, head of the Reschke Group, an independent union on senior experts which acts internationally as a group of freelance moderators for companies and administrations. (orig.)

  8. Quality improvement by implementing an integrated oncological care pathway for breast cancer patients

    NARCIS (Netherlands)

    van Hoeve, J.; de Munck, L.; Otter, Renee; de Vries, J.; Siesling, S.


    Background and aim: In cancer care, more and more systemized approaches such as care pathways are used to reduce variation, reduce waiting- and throughput times and to improve quality of care. The aim of this study was to determine whether the implementation of a multidisciplinary breast cancer path

  9. Quality improvement by implementing an integrated oncological care pathway for breast cancer patients

    NARCIS (Netherlands)

    Hoeve, van J.; Munck, de L.; Otter, R.; Vries, de J.; Siesling, S.


    Background and aim In cancer care, more and more systemized approaches such as care pathways are used to reduce variation, reduce waiting- and throughput times and to improve quality of care. The aim of this study was to determine whether the implementation of a multidisciplinary breast cancer pathw

  10. Developing evidence-based maternity care in Iran: a quality improvement study

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem


    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  11. Energy Efficiency Improvement and Cost Saving Oportunities for the Concrete Industry

    Energy Technology Data Exchange (ETDEWEB)

    Kermeli, Katerina; Worrell, Ernst; Masanet, Eric


    The U.S. concrete industry is the main consumer of U.S.-produced cement. The manufacturing of ready mixed concrete accounts for more than 75% of the U.S. concrete production following the manufacturing of precast concrete and masonry units. The most significant expenditure is the cost of materials accounting for more than 50% of total concrete production costs - cement only accounts for nearly 24%. In 2009, energy costs of the U.S. concrete industry were over $610 million. Hence, energy efficiency improvements along with efficient use of materials without negatively affecting product quality and yield, especially in times of increased fuel and material costs, can significantly reduce production costs and increase competitiveness. The Energy Guide starts with an overview of the U.S. concrete industry’s structure and energy use, a description of the various manufacturing processes, and identification of the major energy consuming areas in the different industry segments. This is followed by a description of general and process related energy- and cost-efficiency measures applicable to the concrete industry. Specific energy and cost savings and a typical payback period are included based on literature and case studies, when available. The Energy Guide intends to provide information on cost reduction opportunities to energy and plant managers in the U.S. concrete industry. Every cost saving opportunity should be assessed carefully prior to implementation in individual plants, as the economics and the potential energy and material savings may differ.


    Energy Technology Data Exchange (ETDEWEB)

    Reid B. Grigg; Robert K. Svec; Zhengwen Zeng; Baojun Bai; Yi Liu


    The third annual report of ''Improving CO{sub 2} Efficiency for Recovery Oil in Heterogeneous Reservoirs'' presents results of laboratory studies with related analytical models for improved oil recovery. All studies were designed to optimize utilization and extend the practice of CO{sub 2} flooding to a wider range of reservoirs. Chapter 1 describes the behavior at low concentrations of the surfactant Chaser International CD1045{trademark} (CD) versus different salinity, pressure and temperature. Results of studies on the effects of pH and polymer (hydrolyzed polyacrylamide?HPAM) and CO{sub 2} foam stability after adsorption in the core are also reported. Calcium lignosulfonate (CLS) transport mechanisms through sandstone, description of the adsorption of CD and CD/CLS onto three porous media (sandstone, limestone and dolomite) and five minerals, and the effect of adsorption on foam stability are also reported. In Chapter 2, the adsorption kinetics of CLS in porous Berea sandstone and non-porous minerals are compared by monitoring adsorption density change with time. Results show that adsorption requires a much longer time for the porous versus non-porous medium. CLS adsorption onto sandstone can be divided into three regions: adsorption controlled by dispersion, adsorption controlled by diffusion and adsorption equilibrium. NaI tracer used to characterize the sandstone had similar trends to earlier results for the CLS desorption process, suggesting a dual porosity model to simulate flow through Berea sandstone. The kinetics and equilibrium test for CD adsorption onto five non-porous minerals and three porous media are reported in Chapter 3. CD adsorption and desorption onto non-porous minerals can be established in less than one hour with adsorption densities ranging from 0.4 to 1.2 mg of CD per g of mineral in decreasing order of montmorillonite, dolomite, kaolinite, silica and calcite. The surfactant adsorption onto three porous media takes

  13. Observing nurses has improved my alcohol dependency care. (United States)

    Jaques, Ellise


    My first placement in my first year of nursing training was on a gastrointestinal/hepatology ward. Alongside my mentor, I was caring for a patient who had been withdrawing from alcohol since admission to hospital the previous evening.

  14. Efficiency of hydrogen peroxide in improving disinfection of ICU rooms


    Blazejewski, Caroline; Wallet, Frédéric; Rouzé, Anahita; Le Guern, Rémi; Ponthieux, Sylvie; Salleron, Julia; Nseir, Saad


    Introduction The primary objective of this study was to determine the efficiency of hydrogen peroxide (H2O2) techniques in disinfection of ICU rooms contaminated with multidrug-resistant organisms (MDRO) after patient discharge. Secondary objectives included comparison of the efficiency of a vaporizator (HPV, Bioquell®) and an aerosolizer using H2O2, and peracetic acid (aHPP, Anios®) in MDRO environmental disinfection, and assessment of toxicity of these techniques. Methods This prospective c...

  15. Organizational interventions to implement improvements in patient care: a structured review of reviews.

    NARCIS (Netherlands)

    Wensing, M.J.P.; Wollersheim, H.C.H.; Grol, R.P.T.M.


    BACKGROUND: Changing the organization of patient care should contribute to improved patient outcomes as functioning of clinical teams and organizational structures are important enablers for improvement. OBJECTIVE: To provide an overview of the research evidence on effects of organizational strategi

  16. 高效使用电脑,提高工作效率%Using Computer Efficiently and Improving Working Efficiency

    Institute of Scientific and Technical Information of China (English)



    文章结合实际工作,提出了高效使用电脑提高工作效率的方式方法.%The method that how to use computer efficiently to improve working efficiency is presented integrated with practice.

  17. Using Digital Crumbs from an Electronic Health Record to Identify, Study and Improve Health Care Teams (United States)

    Gray, James E; Feldman, Henry; Reti, Shane; Markson, Larry; Lu, Xiaoning; Davis, Roger B.; Safran, Charles A


    We have developed a novel approach, the Digital Crumb Investigator, for using data collected as a byproduct of Electonic Health Record (EHR) use to help define care teams and care processes. We are developing tools and methods to utilize these routinely collected data to visualize and quantify care networks across acute care and ambulatory settings We have chosen a clinical care domain where clinicians use EHRs in their offices, on the maternity wards and in the neonatal intensive care units as a test paradigm for this technology. The tools and methods we deliver should readily translate to other health care settings that collect behind-the-scenes electronic metadata such as audit trails. We believe that by applying the methods of social networking to define clinical relationships around a patient’s care we will enable new areas of research into the usage of EHRs to promote patient safety and other improvements in care. PMID:22195103

  18. A Proposed mHealth Model for Improving the Quality Care in Hospitals

    Directory of Open Access Journals (Sweden)

    Hussain Abu-Dalbouh


    Full Text Available As the hospitals face increasing demands to participate in a wide range of quality improvement activities, the role and influence of physicians and nurses in these efforts is also increasing. The growing population has led to increase the number of patients in hospital. Therefore, healthcare workers have to see more patients and do more with each patient than ever before. Thus, Hospitals confront challenges with regard tracking patient condition, share information about the patient and difficulty follow up all patients with the lack of the number of specialist physician at all levels. This marks mobile devices an important opportunity for the next generation healthcare delivery. This study proposed a mobile health model that could support hospitals in tracking patient’s progress and improve the quality care in hospitals. It allows physicians and nurses to track the patients’ conditions more efficiently and easily. It also able to assist in crucial clinical decisions 24/7 and available on call wherever physicians to manage their care process from start to finish and from inside and outside the hospital.

  19. Improving operating room efficiency by applying bin-packing and portfolio techniques to surgical case scheduling

    NARCIS (Netherlands)

    Houdenhoven, van M.; Oostrum, van J.M.; Hans, E.W.; Wullink, G.; Kazemier, G.


    BACKGROUND: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques.

  20. VA Health Care: Improved Monitoring Needed for Effective Oversight of Care for Women Veterans (United States)


    Congressional Requesters December 2016 GAO-17-52 United States Government Accountability Office United States Government Accountability Office...2VA health care systems are made up of multiple VAMCs. Established under the Veterans Access, Choice, and Accountability Act of 2014, Choice...on VA’s Provision of Health Care Services to Women Veterans, GAO-09-884T (Washington, D.C.: July 14, 2009) and VA Health Care: Preliminary Findings

  1. Short and long term improvements in quality of chronic care delivery predict program sustainability

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)


    markdownabstractEmpirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this lon

  2. Health care professional development: Working as a team to improve patient care. (United States)

    Babiker, Amir; El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad


    In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.

  3. The Multiple Benefits of Measures to Improve Energy Efficiency

    DEFF Research Database (Denmark)

    Puig, Daniel; Farrell, Timothy Clifford

    Understanding the barriers to, and enablers for, energy efficiency requires targeted information and analysis. This report is a summary of four detailed studies providing new insights on how to promote efficiency in selected priority areas. It complements initiatives such as the so-called energy...... in a scenario where the price of carbon dioxide equivalents was USD 70 per tonne. • In absolute terms, the energy supply and industry sectors show the highest reductions in greenhouse gas emissions attributable to energy efficiency. In relative terms, it is the transport sector that shows the highest levels...... of emission reductions. • The three mitigation scenarios considered suggest that the higher the carbon price, the greater the energy savings, and the larger the economic growth and employment benefits. • While G20 countries account for about 90 percent of total emission reductions in the three mitigation...

  4. A technique to improve crystal channeling efficiency of charged particles

    CERN Document Server

    Tikhomirov, V V


    It is shown that a narrow plane cut near the crystal surface considerably increases the probability of capture into the stable channeling motion of positively charged particles entering a crystal at angles smaller than a quarter of the critical channeling angle with respect to the crystal planes. At smallest incidence angles the capture probability reaches 99 percent. A pair of crystals bent in orthogonal planes and provided with the cuts allows to reach a 99.9 percent efficiency of single-pass deflection of a proton beam with an ultra small divergence. Conditions necessary for efficient single-pass deflection of protons from the LHC beam halo are also discussed.

  5. Improving Chronic Care: Developing and testing disease-management interventions applied in COPD care

    NARCIS (Netherlands)

    K.M.M. Lemmens (Karin)


    textabstractDisease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control health care costs. So far, however, the effects of this strategy remain unclear. The purpose of this thesis was to determine the core elements of dis

  6. Child care at CERN: Recommendations for Improvements of the Child Care Situation at CERN

    CERN Document Server

    Alviggi, M G; Avramidou, R; Barillari, T; Bates, R; Benelli, G; Beolè, S; Berger, N; Boeriu, O; Bölla, G; Bornheim, A; Brigido, F; Calheiros, F; Garrido, M C; Llatas, M C; Chesneanu, D; Conde-Muíño, P; D'Auria, S; De Santo, A; David Tinoco Mendes, A; De La Cruz Burelo, E; Della Volpe, M; Delmastro, M; Demers, S M; Dimovasili, E; Dindar, K; Elder, S; Eno, S; Eschrich, K G; Fonseca Martin, T M; Gagnon, P; Gateau, M; Gemme, C; Gentile, S; Geurts, F; Goldfarb, S; Grabowska-Bold, I; Grothe, M; Hadjidakis, C; Hoffmann, D; Issever, C; Josa-Mutuberria, I; Kandasamy, S; Koblitz, S; Koval'S'Kyi, D; Krivda, M; Lançon, E; Leahu, A E; Leahu, L; Lester, C G; Lipniacka-Wesolowska, A L; List, J; López-Noriega, M; Manca, G; Mariotti, C; Maselli, S; Merkel, P; Nachtman, J; Natale, S; Oldeman, R; Organtini, G; Patterson, R; Pesci, A; Primavera, M; Quadt, A; Rosati, M; Sbarra, C; Teuscher, R; Tique Aires Viegas, F; Trigger, I M; Tuominen, E; Van Lingen, F; Vandoni, G; Vanini, S; Veverkovai, K; Vickey, T; Wang, D; Wells, P; Wengler, T; Wittmer, B; Yumiceva Del Pozo, F X; CERN. Geneva. HR Department


    This is a document summarizing a survey of child care needs of CERN staff and users which was performed in February 2008 by the CERN Child Care Initiative. The document presents the analysis of this data. Conclusions on the minimal facilities size are derived and possible funding source at the European Union are discussed.

  7. Antenatal care strengthening for improved quality of care in Jimma, Ethiopia

    DEFF Research Database (Denmark)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe;


    increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3...

  8. An intelligent partner system for improving chronic illness care

    Directory of Open Access Journals (Sweden)

    Tibor Deutsch


    Full Text Available Chronic care consists of a sequence of actions to treat a specific clinical disorder over time as a function of the ways in which illness progresses and patients respond to management actions. Outcomes depend on physicians' skills to select the actions best suited for their patients and competent self-management. This paper presents the architecture of an intelligent partner system (IPS, which helps to provide doctors with relevant data and skills and empowers chronically ill patients with the information and confidence to manage their health wisely. The services of this intelligent system are presented as 'therapies' for the information-processing 'pathologies' associated with traditional chronic illness care.

  9. Improving breast care: providing, guiding, expertise, and leadership. (United States)

    Granai, Cornelius O; Orr, James W


    Optimal healthcare blends timeless doctor-patient values with state-of-the-art medical knowledge. The physician's role varies from delivering therapies to guiding patients through the healthcare maze to their best decisions. Breast care should not be parceling out of anatomic parts, as if biological relationships do not exist. Instead, it should stem from an understanding of the "total woman"--biological and otherwise--and how important that unity is for quality of life, even when confronting breast cancer. Breast fellowships for gynecologic and general surgeons create superior clinicians and better patient advocates -essential in advancing women-centric care and healthcare leadership.

  10. Efficient Multigrid Methods based on Improved Coarse Grid Correction Techniques

    NARCIS (Netherlands)

    Bin Zubair, H.


    Multigrid efficiency often suffers from inadequate coarse grid correction in different prototypic situations. We select a few problems, where coarse grid correction issues arise because of anisotropic coefficients, non-equidistant or non-uniform grid stretching, or inherent indefiniteness in the par

  11. Policies for improving energy efficiency in the European housing stock

    NARCIS (Netherlands)

    Sunikka, M.M.


    According to EC forecasts, if energy efficiency could be increased 1% annually until 2010, two-thirds of the potential energy saving in the EU could be achieved. This would comply with 40% of the EU's Kyoto obligation to reduce greenhouse gas emissions by 8% on the 1990 level by 2010-12, by cutting


    Directory of Open Access Journals (Sweden)

    Roselaine Cristina Pereira


    Full Text Available Simple and quick hybridization procedures and ways to keep pollen grains viable for long periods are sought in plant breeding programs to provide greater work flexibility. The presentstudy was carried out to assess the efficiency of pollinations made shortly after flower emasculationand the viability of stored pollen from Eucalyptus camaldulensis and Eucalyptus urophylla clones cultivated in Northwestern Minas Gerais State. Controlled pollinations were carried out at zero, one,three, five and seven days after emasculation. Hybridization efficiency was assessed by thepercentage of viable fruits, number of seeds produced per fruit, percentage of viable seeds and also bycytological observation of the pollen development along the style. Flower buds from clones of the twospecies were collected close to anthesis to assess the viability of pollen grain storage. Pollen was thencollected and stored in a freezer (-18oC for 1, 2 and 3 months. Pollen assessed was carried out by invitro and in vivo germination tests. The efficiency of the pollinations varied with their delay and alsobetween species. The greatest pollination efficiency was obtained when they were carried out on thethird and fifth day after emasculation, but those performed simultaneously with emasculationproduced enough seeds to allow this practice in breeding programs. The decrease in pollen viabilitywith storage was not sufficiently significant to preclude the use of this procedure in artificialhybridization.

  13. Improvement of Information Processing Quality in Preproduction Engineering Efficiency Assessment (United States)

    Bakanovskaya, L. N.; Chekardovskaya, I. A.


    The article has considered the method of obtaining, analyzing and processing of expert information using modern software environment of MATLAB computer mathematics that will allow increasing the efficiency of decisions about the expected economic performances (the desired profitability and the desired output of products).

  14. Improving dryer energy efficiency and controllability simultaneously by process modification

    NARCIS (Netherlands)

    Atuonwu, J.C.; Straten, van G.; Deventer, van H.C.; Boxtel, van A.J.B.


    This work establishes a relationship between dryer energy performance and controllability using energy balances and process resiliency analysis. It is shown that using the process gain matrix, the dryer energy efficiency can be reliably calculated with conditions for simultaneous controllability imp

  15. Cambridge journals blog: Improving feed efficiency in dairy production (United States)

    Because the cost of feeding animals is one of the greatest expenses in dairy production (40-60% of production costs), research focused on ways to identify and select for animals that are the most efficient at converting feed into milk has greatly expanded during the last decade. The animal Article o...

  16. Why we need interprofessional education to improve the delivery of safe and effective care

    Directory of Open Access Journals (Sweden)

    Scott Reeves


    Full Text Available Interprofessional education (IPE is an activity that involves two or more professions who learn interactively together to improve collaboration and the quality of care. Research has continually revealed that health and social care professionals encounter a range of problems with interprofessional coordination and collaboration which impact on the quality and safety of care. This empirical work resulted in policymakers across health care education and practice to invest in IPE to help resolve this collaborative failures. It is anticipated that IPE will provide health and social care professionals with the abilities required to work together effectively in providing safe high quality care to patients. Through a discussion of a range of key professional, educational and organization issues related to IPE, this paper argues that this form of education is an important strategy to improve the delivery of safe and effective care

  17. Implementing "lean" principles to improve the efficiency of the endoscopy department of a community hospital: a case study. (United States)

    Laing, Karen; Baumgartner, Katherine


    Many endoscopy units are looking for ways to improve their efficiency without increasing the number of staff, purchasing additional equipment, or making the patients feel as if they have been rushed through the care process. To accomplish this, a few hospitals have looked to other industries for help. Recently, "lean" methods and tools from the manufacturing industry, have been applied successfully in health care systems, and have proven to be an effective way to eliminate waste and redundancy in workplace processes. The "lean" method and tools in service organizations focuses on providing the most efficient and effective flow of service and products. This article will describe the journey of one endoscopy department within a community hospital to illustrate application of "lean" methods and tools and results.

  18. Information provision in fertility care: a call for improvement.

    NARCIS (Netherlands)

    Mourad, S.M.; Hermens, R.P.M.G.; Cox-Witbraad, T.; Grol, R.P.T.M.; Nelen, W.L.D.M.; Kremer, J.A.M.


    BACKGROUND: Adequate information provision is a crucial dimension of high-quality fertility care. Clinical practice guidelines containing consensus-based recommendations may standardize practice between settings. This study was designed for three purposes: (i) to assess actual adherence to recommend

  19. Improving CO2 Efficiency for Recovering Oil in Heterogeneous Reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    Grigg, Reid B.; Svec, Robert K.


    The work strived to improve industry understanding of CO2 flooding mechanisms with the ultimate goal of economically recovering more of the U.S. oil reserves. The principle interests are in the related fields of mobility control and injectivity.

  20. Better Together: Co-Location of Dental and Primary Care Provides Opportunities to Improve Oral Health. (United States)

    Pourat, Nadereh; Martinez, Ana E; Crall, James J


    Community Health Centers (CHCs) are one of the principal safety-net providers of health care for low-income and uninsured populations. Co-locating dental services in primary care settings provides an opportunity to improve access to dental care. Yet this study of California CHCs that provide primary care services shows that only about one-third of them co-located primary and dental care services on-site. An additional one-third were members of multisite organizations in which at least one other site provided dental care. The remaining one-third of CHC sites had no dental care capacity. Policy options to promote co-location include requiring on-site availability of dental services, providing infrastructure funding to build and equip dental facilities, and offering financial incentives to provide dental care and recruit dental providers.

  1. Application of pulse index continuous cardiac output monitoring to improve efficiency of acute heart failure care%应用脉搏指数连续心输出量监测提升急性心力衰竭护理效果

    Institute of Scientific and Technical Information of China (English)

    孙秀月; 张领; 赵书琴


    Objective To ihvestigate the effect of pulse index continuous cardiac output (PiCCO) monitoring to nursing care of acute heart failure care.Methods The clinical data of 43 acute heart failure patients were retrospectively analyzed,patients were given pulse index continuous cardiac output monitoring and care,the patient' s nursing outcomes were observed,and the intrathoracic blood volume,cardiac output and oxygen consumption before and after the intervention were compared.Results After the implementation of PiCCO and nursing intervention,43 patients had no serious complications,improved 42 cases discharged,the other 1 patient in critical condition due to old age and heart function improvement sustained no automatic discharge.Oxygen consumption,cardiac output and intrathoracic blood volume were improved after the intervention,there was a significant difference (P < 0.05) compared to the previous indicators and intervention after intervention.Conclusions Application of pulse index continuous cardiac output can effectively improve patient's clinical parameters such as cardiac output,through the implementation of appropriate care can improve symptoms and reduce complications.%目的 探讨急性心力衰竭患者护理中应用脉搏指数连续心输出量监测(PiCCO)的效果.方法 选取平顶山市第二人民医院收治的43例急性心力衰竭患者作为研究对象,收集患者的临床资料并对其做回顾性分析,对患者实施脉搏指数连续心输出量监测和护理,对患者的护理效果进行观察,并对其干预前后的胸腔内血容量、心排血量与氧耗量进行对比观察.结果 实施PiCCO和护理干预,本研究43例患者均无严重并发症产生,42例好转出院,1例由于病情危重、高龄及心功能持续无改善自动出院.患者干预后的氧耗量、心排血量与胸腔内血容量均有所改善,干预后各项指标与干预前比较差异有统计学意义(P<0.05).结论 应用脉搏指数连续心

  2. Efficiency improvement of silicon nanostructure-based solar cells. (United States)

    Huang, Bohr-Ran; Yang, Ying-Kan; Yang, Wen-Luh


    Solar cells based on a high-efficiency silicon nanostructure (SNS) were developed using a two-step metal-assisted electroless etching (MAEE) technique, phosphorus silicate glass (PSG) doping and screen printing. This process was used to produce solar cells with a silver nitrate (AgNO3) etching solution in different concentrations. Compared to cells produced using the single MAEE technique, SNS-based solar cells produced with the two-step MAEE technique showed an increase in silicon surface coverage of ~181.1% and a decrease in reflectivity of ~144.3%. The performance of the SNS-based solar cells was found to be optimized (~11.86%) in an SNS with a length of ~300 nm, an aspect ratio of ~5, surface coverage of ~84.9% and a reflectivity of ~6.1%. The ~16.8% increase in power conversion efficiency (PCE) for the SNS-based solar cell indicates good potential for mass production.

  3. DC/DC converter with improved rectification for higher efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Maisel, Peter; Saliternig, Martin [Continental AG, Nuernberg (Germany)


    High-power dc-dc converters are an important element of the electrical system of electric vehicles and hybrid electric vehicles. These complex modular components provide the link between the high-voltage level used for the powertrain and the low-voltage bus for the lighting system, engine management and auxiliary needs in the vehicle. The essential requirements for all converters are high efficiency, compact size, lightweight and reliability. A very popular method to increase the efficiency is the synchronous rectification. Parasitic inductances in the commutation circuit and reverse recovery effects can produce a ringing with voltage overshoots at the diodes and the transistors. These spikes can cause higher average power dissipation in the seminconductors and higher EMI (electromagnetic interference).

  4. Alternative Practices to Improve Surface Fleet Fuel Efficiency (United States)


    practices that, if changed, could provide significant fuel savings for fossil fuel ships. Recent and potential future budget cuts give fuel conservation...changed, could provide significant fuel savings for fossil fuel ships. Recent and potential future budget cuts give fuel conservation and efficiency...Figure 1. Navy fossil fuel expenditure for FY 2013 (after Dhoran 2014). .......................1 Figure 2. Fuel curves for a DDG showing GPH burned as

  5. Lighting Retrofitting: improving energy efficiency and lighting quality



    In order to minimize energy consumption for lighting and increasing lighting quality in existing offices old lighting systems can be retrofitted with more efficient luminaires. Additional savings can be achieved by installing a lighting control system. Installation time and costs can be reduced by installing LED luminaires equipped with inbuilt lighting controls. In the case study six rooms were analysed: in two rooms the old lighting system has been retrofitted with LED luminaires with inbui...

  6. Energy Efficiency Improvements Using DC in Data Centres


    Bergqvist, Sofia


    The installed power usage in a data centre will often amount to several megawatts (MW). Thetotal power consumption of the data centres in the world is comparable to that of the airtraffic. The high energy costs and carbon dioxide emissions resulting from the operation of adata centre call for alternative, more efficient, solutions for the power supply design. Oneproposed solution to decrease the energy usage is to use a direct current power supply (DCUPS) for all the servers in the data centr...

  7. Achromatic Fresnel Lens with Improved Efficiency for PV Systems

    Directory of Open Access Journals (Sweden)

    Mario González Montes


    Full Text Available This work is aimed to design and evaluate different achromatic Fresnel lens solutions capable of operating as concentrators aimed at photovoltaic cells systems. Throughout this study, the theoretical parametric design of the achromatic lens will be shown together with a series of simulations to verify the performance of each lens topology. The results will be compared with a standard Fresnel lens to ascertain the validity and effectiveness of the obtained design. Finally, a novel kind of hybrid lens is proposed, which combines the advantages of each type of lens (standard and Fresnel according to the optimal operating region of each design. Efficiency and concentration ratios of each particular lens are shown, regarding lens dimension, light’s incidence angle, or wavelength. Through this innovative achromatic design concentration ratios above 1000 suns, which hardly reach standard Fresnel lenses. Furthermore chromatic dispersion is minimized and the efficiency rate is over 85% of efficiency for a wide spectral range (from 350 nm to 1100 nm.

  8. Food security: increasing yield and improving resource use efficiency. (United States)

    Parry, Martin A J; Hawkesford, Malcolm J


    Food production and security will be a major issue for supplying an increasing world population. The problem will almost certainly be exacerbated by climate change. There is a projected need to double food production by 2050. In recent times, the trend has been for incremental modest yield increases for most crops. There is an urgent need to develop integrated and sustainable approaches that will significantly increase both production per unit land area and the resource use efficiency of crops. This review considers some key processes involved in plant growth and development with some examples of ways in which molecular technology, plant breeding and genetics may increase the yield and resource use efficiency of wheat. The successful application of biotechnology to breeding is essential to provide the major increases in production required. However, each crop and each specific agricultural situation presents specific requirements and targets for optimisation. Some increases in production will come about as new varieties are developed which are able to produce satisfactory crops on marginal land presently not considered appropriate for arable crops. Other new varieties will be developed to increase both yield and resource use efficiency on the best land.

  9. Improving Perinatal Mental Health Care for Women Veterans: Description of a Quality Improvement Program. (United States)

    Katon, Jodie G; Lewis, Lacey; Hercinovic, Selma; McNab, Amanda; Fortney, John; Rose, Susan M


    Purpose We describe results from a quality improvement project undertaken to address perinatal mental healthcare for women veterans. Description This quality improvement project was conducted in a single VA healthcare system between 2012 and 2015 and included screening for depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) three times during the perinatal period, a dedicated maternity care coordinator (MCC), an on-site clinical social worker, and an on-site obstetrician/gynecologist (Ob/gyn). Information on prior mental health diagnosis was collected by the MCC or Ob/gyn. The prevalence of perinatal depressive symptoms and receipt of mental healthcare among those with such symptoms are reported by presence of a pre-pregnancy mental health diagnosis. Assessment Of the 199 women who used VA maternity benefits between 2012 and 2015, 56% (n = 111) had at least one pre-pregnancy mental health diagnosis. Compared to those without a pre-pregnancy mental health diagnosis, those with such a diagnosis were more likely to be screened for perinatal depressive symptoms at least once (61.5% vs. 46.8%, p = 0.04). Prevalence of depressive symptoms was 46.7% among those with a pre-pregnancy mental health diagnosis and 19.2% among those without. Among those with a pre-pregnancy mental health diagnosis and depressive symptoms (n = 35), 88% received outpatient mental healthcare and 77% met with the clinical social worker. Among those without a pre-pregnancy mental health diagnosis and depressive symptoms (n = 8), none received outpatient mental healthcare, but 77.8% met with the clinical social worker. Conclusion Improving perinatal mental healthcare for women veterans requires a multidisciplinary approach, including on-site integrated mental healthcare.

  10. Prerequisites for sustainable care improvement using the reflective team as a work model. (United States)

    Jonasson, Lise-Lotte; Carlsson, Gunilla; Nyström, Maria


    Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

  11. Improving coordination of care centers for the elderly through IT support

    DEFF Research Database (Denmark)

    Johansen, Andreas Kaas; Lauridsen, Frederik Vahr Bjarnø; Manea, Vlad;


    In Denmark, care of elderly people involves numerous and relatively autonomous care providers, including care centers, activity centers, physiotherapists, doctors, and other specialists. However, due to a poor coordination of activities, many elderly experience a lack of continuity of care, missed...... appointments, and general discomfort. In this poster we report on preliminary findings from a project aimed at creating improved IT support for coordination of care for the elderly in a Danish municipality. We propose that in order to successfully support heterogeneous collaboration, our system must address...... the disruptions in the existing routines, minimize the inherent articulation work, and coherently unify their coordination mechanisms....

  12. Utilization of performance appraisal systems in health care organizations and improvement strategies for supervisors. (United States)

    Chandra, Ashish; Frank, Zachary D


    Performance appraisal systems that are designed to objectively evaluate an employee's performance and then outline measures to be taken for improvements are essential for an organization to move ahead. These systems are often organization specific and health care organizations are no exception. However, health care managers seem to be more vocal and have often expressed dissatisfaction with the use of their company's performance appraisal system. This article is based on a case study of a health care organization's current performance appraisal techniques. This organization's current use of performance appraisals are discussed in brief, and strategies for health care organizations to improve their performance appraisal system have also been identified.

  13. Peer pressure and public reporting within healthcare setting: improving accountability and health care quality in hospitals. (United States)

    Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter


    In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.

  14. Integrating Literacy, Culture, and Language to Improve Health Care Quality for Diverse Populations (United States)

    Andrulis, Dennis P.; Brach, Cindy


    Objective To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection. Methods Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed. Results Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP). The lack of integration results in health care that is unresponsive to some vulnerable groups’ needs. A vision for integrated care is presented. Conclusion Clinicians, the health care team, and health care organizations have important roles to play in addressing challenges related to literacy, culture, and language. PMID:17931131

  15. Efficient Satellite Scheduling Based on Improved Vector Evaluated Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Tengyue Mao


    Full Text Available Satellite scheduling is a typical multi-peak, many-valley, nonlinear multi-objective optimization problem. How to effectively implement the satellite scheduling is a crucial research in space areas.This paper mainly discusses the performance of VEGA (Vector Evaluated Genetic Algorithm based on the study of basic principles of VEGA algorithm, algorithm realization and test function, and then improves VEGA algorithm through introducing vector coding, new crossover and mutation operators, new methods to assign fitness and hold good individuals. As a result, the diversity and convergence of improved VEGA algorithm of improved VEGA algorithm have been significantly enhanced and will be applied to Earth-Mars orbit optimization. At the same time, this paper analyzes the results of the improved VEGA, whose results of performance analysis and evaluation show that although VEGA has a profound impact upon multi-objective evolutionary research,  multi-objective evolutionary algorithm on the basis of Pareto seems to be a more effective method to get the non-dominated solutions from the perspective of diversity and convergence of experimental result. Finally, based on Visual C + + integrated development environment, we have implemented improved vector evaluation algorithm in the satellite scheduling.

  16. Treatment Summaries and Follow-Up Care Instructions for Cancer Survivors: Improving Survivor Self-Efficacy and Health Care Utilization (United States)

    Kvale, Elizabeth A.; Rocque, Gabrielle B.; Demark-Wahnefried, Wendy; Martin, Michelle Y.; Jackson, Bradford E.; Meneses, Karen; Partridge, Edward E.; Pisu, Maria


    Background. Treatment summaries and follow-up care plan information should be provided to cancer survivors. This study examines the association of receiving summaries and care plans with cancer survivor self-efficacy for chronic illness management, and whether self-efficacy was associated with health care utilization. Methods. Four hundred forty-one cancer survivors (≥2 years from diagnosis and had completed treatment) ≥65 years old from 12 cancer centers across 5 states completed telephone surveys. Survivors responded to three questions about receiving a written treatment summary, written follow-up plan, and an explanation of follow-up care plans. Respondents completed the Stanford Chronic Illness Management Self-Efficacy Scale and reported emergency room visits and hospitalizations in the past year. Three multiple linear regression models estimated the association of written treatment summary, written follow-up care plan, and verbal explanation of follow-up plan with total self-efficacy score. Log-binomial models estimated the association of self-efficacy scores with emergency room visits and hospitalizations (yes/no). Results. Among survivors, 40% and 35% received a written treatment summary and follow-up care plan, respectively. Seventy-nine percent received an explanation of follow-up care plans. Receiving a verbal explanation of follow-up care instructions was significantly associated with higher self-efficacy scores (β = 0.72, p = .009). Higher self-efficacy scores were significantly associated with lower prevalence ratios of emergency room visits (prevalence ratio, 0.92; 95% confidence interval, 0.88–0.97) and hospitalizations (prevalence ratio, 0.94; 95% confidence interval, 0.89–0.99). Conclusion. Explanation of the follow-up care plan, beyond the written component, enhances survivor self-efficacy for managing cancer as a chronic condition—an important mediator for improving health care utilization outcomes. Implications for Practice: Older

  17. [Community resources prescription for self-care improvement in chronic illnesses. Clinical case management in Primary Health Care]. (United States)

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


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

  18. Aligning health information technologies with effective service delivery models to improve chronic disease care (United States)

    Bauer, Amy M.; Thielke, Stephen M.; Katon, Wayne; Unützer, Jürgen; Areán, Patricia


    Objective Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. Method A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Results Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. Conclusion HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. PMID:24963895

  19. Telestroke a viable option to improve stroke care in India. (United States)

    Srivastava, Padma V; Sudhan, Paulin; Khurana, Dheeraj; Bhatia, Rohit; Kaul, Subash; Sylaja, P N; Moonis, Majaz; Pandian, Jeyaraj Durai


    In India, stroke care services are not well developed. There is a need to explore alternative options to tackle the rising burden of stroke. Telemedicine has been used by the Indian Space Research Organization (ISRO) to meet the needs of remote hospitals in India. The telemedicine network implemented by ISRO in 2001 presently stretches to around 100 hospitals all over the country, with 78 remote/rural/district health centers connected to 22 specialty hospitals in major cities, thus providing treatment to more than 25 000 patients, which includes stroke patients. Telemedicine is currently used in India for diagnosing stroke patients, subtyping stroke as ischemic or hemorrhagic, and treating accordingly. However, a dedicated telestroke system for providing acute stroke care is needed. Keeping in mind India's flourishing technology sector and leading communication networks, the hub-and-spoke model could work out really well in the upcoming years. Until then, simpler alternatives like smartphones, online data transfer, and new mobile applications like WhatsApp could be used. Telestroke facilities could increase the pool of patients eligible for thrombolysis. But this primary aim of telestroke can be achieved in India only if thrombolysis and imaging techniques are made available at all levels of health care.

  20. Chronic disease management: improving care for people with osteoarthritis. (United States)

    Brand, Caroline A; Ackerman, Ilana N; Tropea, Joanne


    Chronic disease management (CDM) service models are being developed for many conditions; however, there is limited evidence to support their effectiveness in osteoarthritis (OA). A systematic review was undertaken to examine effectiveness, cost effectiveness and barriers to the use of osteoarthritis-chronic disease management (OA-CDM) service models. Thirteen eligible studies (eight randomised controlled trial (RCTs)) were identified. The majority focussed on delivery system design (n = 9) and/or providing self-management support (SMS) (n = 8). Overall, reported model effectiveness varied, and where positive impacts on process or health outcomes were observed, they were of small to moderate effect. There was no information about cost effectiveness. There is some evidence to support the use of collaborative care/multidisciplinary case management models in primary and community care and evidence-based pathways/standardisation of care in hospital settings. Multiple barriers were identified. Future research should focus on identifying the effective components of multi-faceted interventions and evaluating cost-effectiveness to support clinical and policy decision-making.

  1. Improved photon counting efficiency calibration using superconducting single photon detectors (United States)

    Gan, Haiyong; Xu, Nan; Li, Jianwei; Sun, Ruoduan; Feng, Guojin; Wang, Yanfei; Ma, Chong; Lin, Yandong; Zhang, Labao; Kang, Lin; Chen, Jian; Wu, Peiheng


    The quantum efficiency of photon counters can be measured with standard uncertainty below 1% level using correlated photon pairs generated through spontaneous parametric down-conversion process. Normally a laser in UV, blue or green wavelength range with sufficient photon energy is applied to produce energy and momentum conserved photon pairs in two channels with desired wavelengths for calibration. One channel is used as the heralding trigger, and the other is used for the calibration of the detector under test. A superconducting nanowire single photon detector with advantages such as high photon counting speed (optical spectroscopy, super resolution microscopy, deep space observation, and so on.

  2. Assuring dairy cattle welfare : towards efficient assessment and improvement

    NARCIS (Netherlands)

    Vries, de M.


      In many countries, there is an increasing interest to assure the welfare of production animals. On-farm assessment of dairy cattle welfare, however, is time-consuming and, therefore, expensive. Besides this, effects of housing and management interventions that are aimed at improving welfare

  3. Improving radiation use efficiency in greenhouse production systems

    NARCIS (Netherlands)

    Li, Tao


    SUMMARY A large increase in agricultural production is needed to feed the increasing world population with their increasing demand per capita. However, growing competition for arable land, water, energy, and the degradation of the environment impose challenges to improve crop produc

  4. Multiplexed lateral flow biosensors: Technological advances for radically improving point-of-care diagnoses. (United States)

    Li, Jia; Macdonald, Joanne


    Lateral flow biosensors are a leading technology in point-of-care diagnostics due to their simplicity, rapidness and low cost. Their primacy in this arena continues through technological breakthroughs such as multiplexing: the detection of more than one biomarker in a single assay. Multiplexing capacity is critical for improving diagnostic efficiency, enhancing the diagnostic precision for specific diseases and reducing diagnostic cost. Here we review, for the first time, the various types and strategies employed for creating multiplexed lateral flow biosensors. These are classified into four main categories in terms of specific application or multiplexing level, namely linear, parameter, spatial and conceptual. We describe the practical applications and implications for each approach and compare their advantages and disadvantages. Importantly, multiplexing is still subject to limitations of the traditional lateral flow biosensor, such as sensitivity and specificity. However, by pushing the limitations of the traditional medium into the multiplex arena, several technological breakthroughs are emerging with novel solutions that further expand the utility of lateral flow biosensing for point-of-care applications.

  5. Improvement of operational efficiency based on fast startup plant concepts

    Energy Technology Data Exchange (ETDEWEB)

    Kurz, Harald; Meinecke, Gero; Ohresser, Sylvia; Pickard, Andreas


    One of the major global challenges of the present time is the reduction of CO2 emissions. Provisions for integration of a CO2 capture plant are already required today in new power plant construction projects in order to enable current plants to also benefit from the possibilities of carbon capture systems to be developed in the future. These provisions for integration should account for the fact that the scrubbing processes are still in the optimization phase. Requisite process parameters may still change in the future. In the development of a plant interface, the paper describes a concept developed by Siemens which ensures maximum flexibility with simultaneous optimization of the plant for the capture process. Emphasis was placed on the following points in the development of this interface and the associated connection concepts: Maximum plant efficiency before and after modification; Maximum flexibility with regard to future process parameters; Optimization of customer investment cash flow; and, Applicability also to existing plants. According to the paper, Siemens can offer a concept which enables future conversion in accordance with the specified criteria. This concept requires no compromises with regard to plant efficiency in process optimization for either current power plant operation without carbon capture or for future operation with carbon capture. The concept also enables retrofitting of existing plants which are not yet capture-ready. However, retrofitting of power plants which are not prepared for operation with carbon capture is considerably more elaborate in most cases, as corridors must frequently still be cleared for the connecting piping.

  6. Improving energy efficiency in robot limbs through hydraulic dangle (United States)

    Whitman, Julian S.; Meller, Mike; Garcia, Ephrahim


    Animals often allow their limbs to swing passively under their own inertia. For example, about 40% of a human walking gait consists of the primarily passive swing phase. Current hydraulic robots employ traditional actuation methods in which fluid power is expended for all limb movements, even when passive dynamics could be utilized. "Dangle" is the ability to allow a hydraulic actuator to freely sway in response to external loads, in which both sides of the actuator are disconnected from pressure and connected to the tank. Dangle offers the opportunity for efficiency gains by enabling the use of momentum, gravity, and external loads to move a limb without expending fluid power. To demonstrate these efficiency gains, this paper presents an experiment that compares the fluid power consumed to actuate a two degree of freedom hydraulic leg following a human walking gait cycle trajectory in both a traditional manner and utilizing dangle. It was shown that the use of dangle can decrease fluid power consumption by 20% by utilizing pendular dynamics during the swing phase. At speeds higher than the free dangling rate, more power must be used to maintain the desired trajectory due to damping inherent in the configuration. The use of dangle as a power saving method when driving hydraulic limbs could increase operation time for untethered hydraulic walking robots.

  7. Improving Charge-Collection Efficiency of Kyoto's SOI Pixel Sensors

    CERN Document Server

    Matsumura, Hideaki; Tanaka, Takaaki; Takeda, Ayaki; Ito, Makoto; Ohmura, Syunichi; Arai, Yasuo; Mori, Koji; Nishioka, Yusuke; Takenaka, Ryota; Kohmura, Takayoshi


    We have been developing X-ray SOIPIXs for next-generation satellites for X-ray astronomy. Their high time resolution ($\\sim10~\\mu$s) and event-trigger-output function enable us to read out without pile-ups and to use anti-coincidence systems. Their performance in imaging spectroscopy is comparable to that in the CCDs. A problem in our previous model was degradation of charge-collection efficiency (CCE) at pixel borders. We measured the response in the sub-pixel scale, using finely collimated X-ray beams at $10~\\mu$m\\Phi$ at SPring-8, and investigated the non-uniformity of the CCE within a pixel. We found that the X-ray detection efficiency and CCE degrade in the sensor region under the pixel circuitry placed outside the buried p-wells (BPW). A 2D simulation of the electric fields shows that the isolated pixel-circuitry outside the BPW creates local minimums in the electric potentials at the interface between the sensor and buried oxide layers. Thus, a part of signal charge is trapped there and is not collecte...

  8. The INTERACT Quality Improvement Program: An Overview for Medical Directors and Primary Care Clinicians in Long-Term Care (United States)

    Ouslander, Joseph G.; Bonner, Alice; Herndon, Laurie; Shutes, Jill


    INTERACT is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and ACOs, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust QAPI program which is being rolled out by the federal government over the next year. PMID:24513226

  9. Improving quality of care among COPD outpatients in Denmark 2008-2011

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra Søgaard; Lange, P.; Thomsen, R.W.;


    OBJECTIVE: To examine whether the quality of care among Danish patients with chronic obstructive pulmonary disease (COPD) has improved since the initiation of a national multidisciplinary quality improvement program. METHODS: We conducted a nationwide, population-based prospective cohort study...... a substantial improvement in the quality of care of COPD in Danish hospitals following the initiation of a national multidisciplinary quality improvement program in 2008. In the forthcoming years, it will be interesting to observe if this will translate into a better prognosis of Danish patients with COPD....... using data from the Danish Clinical Register of COPD (DrCOPD). Since 2008 the register has systematically monitored and audited the use of recommended processes of COPD care. RESULTS: Substantial improvements were observed for all processes of care and registration fulfillment increased to well above 85...

  10. An effective and efficient approach for manually improving geocoded data

    Directory of Open Access Journals (Sweden)

    Knoblock Craig A


    Full Text Available Abstract Background The process of geocoding produces output coordinates of varying degrees of quality. Previous studies have revealed that simply excluding records with low-quality geocodes from analysis can introduce significant bias, but depending on the number and severity of the inaccuracies, their inclusion may also lead to bias. Little quantitative research has been presented on the cost and/or effectiveness of correcting geocodes through manual interactive processes, so the most cost effective methods for improving geocoded data are unclear. The present work investigates the time and effort required to correct geocodes contained in five health-related datasets that represent examples of data commonly used in Health GIS. Results Geocode correction was attempted on five health-related datasets containing a total of 22,317 records. The complete processing of these data took 11.4 weeks (427 hours, averaging 69 seconds of processing time per record. Overall, the geocodes associated with 12,280 (55% of records were successfully improved, taking 95 seconds of processing time per corrected record on average across all five datasets. Geocode correction improved the overall match rate (the number of successful matches out of the total attempted from 79.3 to 95%. The spatial shift between the location of original successfully matched geocodes and their corrected improved counterparts averaged 9.9 km per corrected record. After geocode correction the number of city and USPS ZIP code accuracy geocodes were reduced from 10,959 and 1,031 to 6,284 and 200, respectively, while the number of building centroid accuracy geocodes increased from 0 to 2,261. Conclusion The results indicate that manual geocode correction using a web-based interactive approach is a feasible and cost effective method for improving the quality of geocoded data. The level of effort required varies depending on the type of data geocoded. These results can be used to choose between

  11. Development of a Medical Care Terminal for Efficient Monitoring of Bedridden Subjects

    Directory of Open Access Journals (Sweden)

    Filipe Pereira


    Full Text Available This work is developed in the context of Ambient Assisted Living (AAL and has as main objective the development of a mechatronic system that allows the care of bedridden patients with ongoing medical care handled by a single person. The developed Medical Care Terminal (MCT improves autonomy in home care, safety, comfort, and hygiene of bedridden patients. The MCT has six biomedical sensors and four environmental sensors. Data acquisition and processing is performed using Arduino and LabVIEW platforms, respectively. The proposed solution has, as main feature, its adaptability to the patient needs. One of the MCT functionalities is the remote access to the patient data through the web. The caregiver may request help from a specialist who sends back information in real time to perform first aid assistance. This device has a flexible configuration allowing a fast and cheap reconfiguration according the specific needs of the patient. The proposed mechatronic system intends to meet the needs of bedridden patients improving their quality of life, health, safety, and comfort, while enabling the remote monitoring of the patients.

  12. How to Further Decrease the Efficiency of Care at a Level I Trauma Center: Implement the Amended Resident Work Hours. (United States)

    Schroeppel, Thomas J; Sharpe, John P; Magnotti, Louis J; Weinberg, Jordan A; Croce, Martin A; Fabian, Timothy C


    Work-hour restrictions were amended in 2011 to limit interns to 16 continuous duty hours, essentially requiring a night float system of 12-hour shifts. We hypothesize that there has been no improvement in outcomes after implementation of the amended work-hour restrictions. Outcomes from trauma admissions were queried from the trauma registry from 2009 to 2011 (PRE) and 2011 to 2013 (POST). The primary outcome was mortality with secondary outcomes intensive care unit length of stay (LOS)and LOS. Patients were stratified based on age, mechanism, gender, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Scale, Base Deficit). Outcomes were then compared from admissions PRE to POST. A total of 9178 patients were included in the study population. The mean age was 42 with most being male (72%) and blunt mechanism (81%). Patient populations were well matched except patients in the POST period were slightly older (43 vs 42 years; P = 0.01). Intensive care unit LOS and LOS were higher in the POST period. After adjusted analysis, admission in the POST period was not a predictor of mortality (odds ratio 0.857; confidence interval 0.655-1.12). The POST period was an independent predictor for LOS (β = 0.74; P = 0.002). This study adds to the mounting evidence that the implementation of the amended limits on work hours leads to furthermore decreased efficiency of care.

  13. Innovative semielliptical seismic pattern improving line-change efficiency (United States)

    Walus, Artur; Gucma, Lucjan; Bąk, Andrzej


    The paper presents a new method for conducting turns by vessels towing seismic cables. A comparison was made between the traditional way of turning to indicate the advantages of the proposed pattern. In order to improve the overview of the complete geometry of a towed streamer system, a model of marine seismic research quality coefficients was applied. The turning method was tested onboard a seismic vessel towing eight streamers of 6 km in length. A significant reduction of time required for line-change was achieved (up to 45 % depending on ocean current speed and direction, speed of the vessel, skills of navigating team). The introduced quality coefficient of geophysical research works is based on the mathematical model of positions deviation of streamers geophones with relation to their idealized position. The model was created to be used while the vessel is on a steady course to improve the quality of acquired data; however, it was found useful during line changes as well.

  14. Innovative semielliptical seismic pattern improving line-change efficiency (United States)

    Walus, Artur; Gucma, Lucjan; Bąk, Andrzej


    The paper presents a new method for conducting turns by vessels towing seismic cables. A comparison was made between the traditional way of turning to indicate the advantages of the proposed pattern. In order to improve the overview of the complete geometry of a towed streamer system, a model of marine seismic research quality coefficients was applied. The turning method was tested onboard a seismic vessel towing eight streamers of 6 km in length. A significant reduction of time required for line-change was achieved (up to 45 % depending on ocean current speed and direction, speed of the vessel, skills of navigating team). The introduced quality coefficient of geophysical research works is based on the mathematical model of positions deviation of streamers geophones with relation to their idealized position. The model was created to be used while the vessel is on a steady course to improve the quality of acquired data; however, it was found useful during line changes as well.

  15. Organic Semiconductors for Sprayable Solar Cells: Improving Stability and Efficiency (United States)


    ITO surfaces Issues with poor charge collection from low- conductivity PEDOT/PSS Investigate methods to spray-deposit high performance, soluble, air-stable acceptors to match with polythiophene (specifically, P3HT) donors. The acceptor systems designed and synthesized by also investigated improving the conductivity of the anode by spray-coating gold nanoparticles on top of the PEDOT-PSS layer. Again, for initial

  16. Profit of Chemical Fibre Industry Surges on Efficiency Improvement

    Institute of Scientific and Technical Information of China (English)


    According to data collected from 1935 statistics-worthy Chinese chemical fibre enterprises surveyed by National Bureau of Statistics of China, the total profits reached CNY8.066 billion in Jan. -May, 2010, up 200.08 per cent y/y, 234.78 percentage points higher than the Jan.-May 2009 period. Technology improvement and industrial structural adjustment played a very major role on profi t growth.

  17. A quality improvement study using fishbone analysis and an electronic medical records intervention to improve care for children with asthma. (United States)

    Gold, Jonathan; Reyes-Gastelum, David; Turner, Jane; Davies, H Dele


    Despite expert guidelines, gaps persist in quality of care for children with asthma. This study sought to identify barriers and potential interventions to improve compliance to national asthma prevention guidelines at a single academic pediatric primary care clinic. Using the plan-do-check-act (PDCA) quality improvement framework and fishbone analysis, several barriers to consistent asthma processes and possible interventions were identified by a group of key stakeholders. Two interventions were implemented using the electronic medical record (EMR). Physician documentation of asthma quality measures were analyzed before intervention and during 2 subsequent time points over 16 months. Documentation of asthma action plans (core group P asthma care in a pediatric primary care setting.

  18. Care Coordination Associated with Improved Timing of Newborn Primary Care Visits. (United States)

    Goyal, Neera K; Hall, Eric S; Kahn, Robert S; Wexelblatt, Scott L; Greenberg, James M; Samaan, Zeina M; Brown, Courtney M


    Objective Despite practice recommendations that all newborns be examined within 3-5 days after discharge, many are not seen within this timeframe. Our objective was to determine the association between care coordination and timing of newborn follow-up. Methods This retrospective study evaluated 6251 newborns from eight maternity hospitals who scheduled a primary care appointment at one of two academic pediatric practices over 3.5 years. Two programs were sequentially implemented: (1) newborn discharge coordination, and (2) primary care intake coordination. Primary outcome was days between discharge and follow-up, dichotomized as ≤ or >5 days. Number of rescheduled appointments and loss to follow-up were also assessed. Adjusted relative risks (RR) and odds ratios (OR) were determined by piecewise generalized linear and logistic regression. Results Among 5943 newborns with a completed visit, 52.9 % were seen within 5 days of discharge (mean 6.7 days). After multivariable adjustment, the pre-exposure period (8 months) demonstrated a downward monthly trend in completing early follow-up (RR 0.93, p coordinator implementation and roughly 33 % after primary care coordinator implementation. The latter was also associated with a 13 % monthly decrease in odds of loss to follow-up (OR 0.87, p Care coordination increases adherence among low income families to recommended newborn follow-up after birth hospitalization.

  19. Engineering crassulacean acid metabolism to improve water-use efficiency. (United States)

    Borland, Anne M; Hartwell, James; Weston, David J; Schlauch, Karen A; Tschaplinski, Timothy J; Tuskan, Gerald A; Yang, Xiaohan; Cushman, John C


    Climatic extremes threaten agricultural sustainability worldwide. One approach to increase plant water-use efficiency (WUE) is to introduce crassulacean acid metabolism (CAM) into C3 crops. Such a task requires comprehensive systems-level understanding of the enzymatic and regulatory pathways underpinning this temporal CO2 pump. Here we review the progress that has been made in achieving this goal. Given that CAM arose through multiple independent evolutionary origins, comparative transcriptomics and genomics of taxonomically diverse CAM species are being used to define the genetic 'parts list' required to operate the core CAM functional modules of nocturnal carboxylation, diurnal decarboxylation, and inverse stomatal regulation. Engineered CAM offers the potential to sustain plant productivity for food, feed, fiber, and biofuel production in hotter and drier climates.

  20. The challenge of improving electric arc furnace efficiency

    Energy Technology Data Exchange (ETDEWEB)

    McIntyre, E.H. (Tekon Services Ltd., Whitby, Ontario (Canada)); Goodwill, J.E.; Klesser, D.E. (EPRI, Pittsburgh, PA (United States). Center for Materials Production)


    Electric arc furnace requirements for electrical energy are increasing more rapidly than generation and distribution capacity. Electric arc furnace technology is reviewed with respect to energy requirements. Although the use of water-cooled panels, increased power levels and higher oxygen inputs, for example, all increase the rate of energy loss, they do not necessarily result in an increase in energy losses per ton. The increase in loss rate (energy/hour) may be more than offset by a decrease in cycle time. This article attempts to summarize the impact of various process variable discussed in a recent report on electric arc furnace efficiency issued by the Electric Power Research Institute's (EPRI) Center for Materials Production (CMP). These include meltshop logistics, operating practices, energy input, scrap preheating and pollution control.

  1. Calculation and Improvement on External Quantum Efficiency of OLEDs

    Institute of Scientific and Technical Information of China (English)


    The calculation of the external quantum efficiency(ηext) of organic light-emitting devices(OLEDs) is presented theoretically. The basic idea is to obtain ηext by calculating the fraction of the generated light that can escape through the top surface and the average transmittance over the escape cone. During the calculation, the effects of the interference, absorption and multiple reflections are neglected. Then a result of a typical 8-tris-hydroxyquinoline aluminum(Alq3)-based OLEDs on a planar glass substrate is obtained. And a twice increase in ηext can be achieved by using a high-index-glass substrate with an antireflection coating(SiO2) on substrate surface.

  2. An Improved, Efficient and Cost Effective Software Inspection Meeting Process

    Directory of Open Access Journals (Sweden)

    Dilawar Ali


    Full Text Available Normally, the inspection process is seemed to be just finding defects in software during software development process lifecycle. Software inspection is considered as a most cost effective technique, but if these defects are not properly corrected or handled it would cost you more than double later in the project. This paper focus on the last phase of inspection meeting process showing the importance of Follow-Up Stage in software inspection meeting process. This paper also suggests a set of activities that should be performed during the Rework and Follow-Up Stages so to get inspection meeting results productive and efficient. In this paper we focus on the over the shoulder reviews so to ensure the software quality having less impact on the total software cost.

  3. A revolutionary concept to improve the efficiency of IC antennas (United States)

    Milanesio, D.; Maggiora, R.


    The successful design of an Ion Cyclotron (IC) antenna mainly relies on the capability of coupling high power to the plasma (MW), feature that is currently reached by allowing rather high voltages (tens of kV) on the unavoidable unmatched part of the feeding lines. This requirement is often responsible of arcs along the transmission lines and other unwanted phenomena that considerably limit the usage of IC launchers. In this work, we suggest and describe a revolutionary approach based on high impedance surfaces, which allows to increase the antenna radiation efficiency and, hence, to highly reduce the imposed voltages to couple the same level of power to the plasma. High-impedance surfaces are periodic metallic structures (patches) displaced usually on top of a dielectric substrate and grounded by means of vertical posts usually embedded inside a dielectric, in a mushroom-like shape. In terms of working properties, high impedance surfaces are electrically thin in-phase reflectors, i.e. they present a high impedance, within a given frequency band, such that the image currents are in-phase with the currents of the antenna itself, thus determining a significant efficiency increase. While the usual design of a high impedance surface requires the presence of a dielectric layer, some alternative solutions can be realized in vacuum, taking advantage of double layers ofmetallic patches. After an introductory part on the properties of high impedance surfaces, this work documents both their design by means of numerical codes and their implementation on a scaled mock-up.

  4. A revolutionary concept to improve the efficiency of IC antennas

    Energy Technology Data Exchange (ETDEWEB)

    Milanesio, D.; Maggiora, R. [Politecnico di Torino, Dipartimento di Elettronica e Telecomunicazioni (DET), Torino (Italy)


    The successful design of an Ion Cyclotron (IC) antenna mainly relies on the capability of coupling high power to the plasma (MW), feature that is currently reached by allowing rather high voltages (tens of kV) on the unavoidable unmatched part of the feeding lines. This requirement is often responsible of arcs along the transmission lines and other unwanted phenomena that considerably limit the usage of IC launchers. In this work, we suggest and describe a revolutionary approach based on high impedance surfaces, which allows to increase the antenna radiation efficiency and, hence, to highly reduce the imposed voltages to couple the same level of power to the plasma. High-impedance surfaces are periodic metallic structures (patches) displaced usually on top of a dielectric substrate and grounded by means of vertical posts usually embedded inside a dielectric, in a mushroom-like shape. In terms of working properties, high impedance surfaces are electrically thin in-phase reflectors, i.e. they present a high impedance, within a given frequency band, such that the image currents are in-phase with the currents of the antenna itself, thus determining a significant efficiency increase. While the usual design of a high impedance surface requires the presence of a dielectric layer, some alternative solutions can be realized in vacuum, taking advantage of double layers ofmetallic patches. After an introductory part on the properties of high impedance surfaces, this work documents both their design by means of numerical codes and their implementation on a scaled mock-up.

  5. Geisinger's ProvenCare methodology: driving performance improvement within a shared governance structure. (United States)

    Nolan, Ruth; Wary, Andrea; King, Megan; Laam, Leslie A; Hallick, Susan


    Many performance improvement projects fail because they occur in parallel to the organization's shared governance structure. Leveraging the full potential of its nursing shared governance structure, Geisinger Health System's ProvenCare methodology harnessed the full potential of its staff nurses to create truly reliable workflows that benefit patients and that the team finds professionally satisfying. Using ProvenCare Perinatal and its smoking cessation education intervention and outcomes as an example, the authors describe the ProvenCare methodology.

  6. Comparing the implementation of team approaches for improving diabetes care in community health centers


    Wees, P.J. van der; Friedberg, M.W.; Guzman, E.; Ayanian, J.Z.; Rodriguez, H.P.


    Background Patient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. Methods Mixed m...

  7. Improving health care costing with resource consumption accounting. (United States)

    Ozyapici, Hasan; Tanis, Veyis Naci


    Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

  8. A Stronger Patient Voice Improves Transparency and Care. (United States)

    Wadsworth, Barbara; Harmer, Catherine A


    In the 2nd of a 3-part series on the value of patient and family advisory councils, an early adopter at a large, Magnet®-recognized healthcare system reveals ways in which an environment focused on strong partnerships, a culture of safety, and a commitment to transparency led to the creation of successful councils at multiple hospitals. The authors discuss nursing's integral role in championing and leading the councils, as well as the benefits of a strong patient-family voice in hospital operations and care processes.

  9. [The evaluation of efficacy and efficiency in the health care sector: separate or integrated moments?]. (United States)

    Braga, M; Cislaghi, C


    Studies on efficacy (clinical trials) and efficiency (Cost Benefit) in health care are frequently disjoint and carried on by researchers with different background in distinct moments. The origin of this division can be found in the profound conviction existing in the healthcare researchers that efficiency and efficacy are distinct and distant concepts, the former pertaining to the economist, the latter to the clinician. Many are the factors at the basis of this separation which consequently lead to the divergence between the two sector of analysis; among those, probably the most relevant factor is the distinction, in the healthcare sector, between the consumer (the patient) and the purchaser (private and/or public insurance). In reality, the organizational evolution of the health care systems, the consciousness of the interdependency between health and economic benefits, and the progressive shortage of economic resources for the growing healthcare needs, require a major integration of analyses concerning efficacy and efficiency. On this line of thought is moving the operational research where models such as the Data Envelope Analysis and the Semi-Markov Decisional Models have been developed.

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

    Directory of Open Access Journals (Sweden)

    V. I. Guzeva


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

  11. Methods and technologies to improve efficiency of water use (United States)

    Evans, Robert G.; Sadler, E. John


    The competition for existing freshwater supplies will require a paradigmatic shift from maximizing productivity per unit of land area to maximizing productivity per unit of water consumed. This shift will, in turn, demand broad systems approaches that physically and biologically optimize irrigation relative to water delivery and application schemes, rainfall, critical growth stages, soil fertility, location, and weather. Water can be conserved at a watershed or regional level for other uses only if evaporation, transpiration, or both are reduced and unrecoverable losses to unusable sinks are minimized (e.g., salty groundwater or oceans). Agricultural advances will include implementation of crop location strategies, conversion to crops with higher economic value or productivity per unit of water consumed, and adoption of alternate drought-tolerant crops. Emerging computerized GPS-based precision irrigation technologies for self-propelled sprinklers and microirrigation systems will enable growers to apply water and agrochemicals more precisely and site specifically to match soil and plant status and needs as provided by wireless sensor networks. Agriculturalists will need to exercise flexibility in managing the rate, frequency, and duration of water supplies to successfully allocate limited water and other inputs to crops. The most effective means to conserve water appears to be through carefully managed deficit irrigation strategies that are supported by advanced irrigation system and flexible, state-of-the-art water delivery systems. Nonagricultural water users will need to exercise patience as tools reflecting the paradigmatic shift are actualized. Both groups will need to cooperate and compromise as they practice more conservative approaches to freshwater consumption.

  12. Improvement of operational efficiency based on fast startup plant concepts

    Energy Technology Data Exchange (ETDEWEB)

    Grumann, Ulrich; Kurz, Harald; Meinecke, Gero; Pickard, Andreas


    The power generation sector is currently confronted with new challenges relating to the conservation of dwindling fuel reserves. At the same time we must reduce CO2 emissions in order to counteract global warming. This paper shows that power plant operation, which employs shutdowns during periods of low load demand coupled with the optimization of startup procedures are a key to reducing CO2 emissions and to conserving resources. The startup technology developed by Siemens also offers grid support in the event of naturally occurring failures of renewable energy sources. Additionally, plant profitability is improved due to the resulting savings in fuel.

  13. How can we improve antibiotic prescribing in primary care?

    NARCIS (Netherlands)

    Dyar, Oliver J.; Beović, Bojana; Vlahović-Palčevski, Vera; Verheij, Theo; Pulcini, Céline


    Antibiotic stewardship is a necessity given the worldwide antimicrobial resistance crisis. Outpatient antibiotic use represents around 90% of total antibiotic use, with more than half of these prescriptions being either unnecessary or inappropriate. Efforts to improve antibiotic prescribing need to

  14. Comparing the implementation of team approaches for improving diabetes care in community health centers

    NARCIS (Netherlands)

    Wees, P.J. van der; Friedberg, M.W.; Guzman, E.; Ayanian, J.Z.; Rodriguez, H.P.


    BackgroundPatient panel management and community-based care management may be viable strategies for community health centers to improve the quality of diabetes care for vulnerable patient populations. The objective of our study was to clarify implementation processes and experiences of integrating o

  15. Improving patient handovers from hospital to primary care: a systematic review

    NARCIS (Netherlands)

    Hesselink, G.; Schoonhoven, L.; Barach, P.; Spijker, A.; Gademan, P.; Kalkman, C.; Liefers, J.; Vernooij-Dassen, M.J.F.J.; Wollersheim, H.


    BACKGROUND: Evidence shows that suboptimum handovers at hospital discharge lead to increased rehospitalizations and decreased quality of health care. PURPOSE: To systematically review interventions that aim to improve patient discharge from hospital to primary care. DATA SOURCES: PubMed, CINAHL, Psy

  16. What do primary care physicians and researchers consider the most important patient safety improvement strategies?

    NARCIS (Netherlands)

    Gaal, S.; Verstappen, W.H.J.M.; Wensing, M.J.P.


    BACKGROUND: Although it has been increasingly recognised that patient safety in primary care is important, little is known about the feasibility and effectiveness of different strategies to improve patient safety in primary care. In this study, we aimed to identify the most important strategies by c

  17. Designing and implementing a primary care intervention trial to improve the quality and outcome of care for major depression. (United States)

    Rost, K; Nutting, P A; Smith, J; Werner, J J


    Complex interventions, which have been shown to improve primary care depression outcomes, are difficult to disseminate to routine practice settings. To address this problem, we developed a brief intervention to train primary care physicians and nurses employed by the practice to improve the detection and management of major depression. Before recruitment began, the research team conducted academic detailing conference calls with primary care physicians and nurses, and provided in-person training with nurses and administrative staff. Administrative staff screened over 11,000 patients before their visits to identify those with probable major depression. Primary care physicians delegated increased responsibility to office nurses, who educated over 90% of patients about effective depression treatment and systematically monitored their progress over time. Early results demonstrate that community primary care practices can rebundle traditional team roles over the short-term to provide more systematic mental health treatment without adding additional personnel. A rigorous evaluation of this effort will reduce time-consuming, expensive, and often unsuccessful efforts to "translate" research intervention findings into everyday practice.

  18. Sheep Wool as a Construction Material for Energy Efficiency Improvement

    Directory of Open Access Journals (Sweden)

    Azra Korjenic


    Full Text Available The building sector is responsible for 40% of the current CO2 emissions as well as energy consumption. Sustainability and energy efficiency of buildings are currently being evaluated, not only based on thermal insulation qualities and energy demands, but also based on primary energy demand, CO2 reductions and the ecological properties of the materials used. Therefore, in order to make buildings as sustainable as possible, it is crucial to maximize the use of ecological materials. This study explores alternative usage of sheep wool as a construction material beyond its traditional application in the textile industry. Another goal of this research was to study the feasibility of replacement of commonly used thermal insulations with natural and renewable materials which have better environmental and primary energy values. Building physics, energy and environmental characteristics were evaluated and compared based on hygrothermal simulation and ecological balance methods. The observations demonstrate that sheep wool, compared with mineral wool and calcium silicate, provides comparable thermal insulation characteristics, and in some applications even reveals better performance.

  19. Can double gloves improve surgeon-patient barrier efficiency? (United States)

    Sadat-Ali, Mir; Al-Habdan, Ibrahim; AlBluwi, Mohammed; Corea, J Ran; Al-Othman, Abdallah; Shriyan, Devidas; Moussa, Mohammed; AlDhakheel, Dhakheel; AlOmran, Abdallah


    The aim of this study was to compare double gloves (DGs) with single gloves (SGs) during orthopedic and trauma surgery in prevention of blood contact between patients and surgeons. DGs and SGs were collected after orthopedic operations, tested for size, site, and number of perforations. Medical records were reviewed for age, sex, type of operation, duration, and postoperative wound infection. Data were compared using t-test with level of statistical significance at P < 0.05. Five hundred seven operations yielded 1204 DGs and 830 pairs SGs. In DGs, perforations were detected in 220 outer glove and 39 inner glove (10.7%). In SGs, 226 perforations were detected (13.3%). The incidence of perforations in inner gloves of the double indicator glove was 1.6% (P < 0.001). During surgery, perforations were recognized in DGs in 67% compared with 12% in SGs (P < 0.005). This study confirms that DGs form an efficient barrier between patients and surgeons.


    Directory of Open Access Journals (Sweden)

    G.N. SURYA


    Full Text Available Efficient conversion of electrical energy from one form to another has always been a fascinating domain for researchers. Right from the era of mercury arc rectifiers to present AC-DC-AC two stage converters and cycloconverters, efforts are consistently being laid to minimize the losses involved in conversion process. In the present study the AC-AC conversion topology known as Matrix Converter (MC, is modeled using MATLAB. Venturini’s simplified algorithm is used to determine the switch modulation duty cycle. The model is designedfor conversion of 50 Hz input frequency to 100 Hz and 25 Hz, using a simplified switch modulation strategy. The waveforms generated by MATLAB/simulink confirm the reduction of conversion losses by 12% to 15% with use of proposed model as compared to conventional (PWM converters. It is not intended in this study just to list out various works done so for but to establish the brevity of fundamental concept representing the simplified design along with its application areas mainly the VFDs and Wind Energy Conversion Systems (WECS. The model has also been tested for control of induction motor with 100 HZ and 25 Hz output frequencies. The waveforms of changed frequencies and reduced losses confirm the results anticipated at design stage.

  1. Governing Ideals of Good Care: Quality improvement in mental health care

    NARCIS (Netherlands)

    T. Broer (Tineke)


    textabstractIn the spring of 2008 I attended a conference on the use of coercion in mental health care. A healthcare worker who was also a “practicing patient”, as the program told us, held an impressive lecture that captured the audience from the moment the woman walked to the front. She referred t

  2. Posttraumatic Stress Disorder in Rural Primary Care: Improving Care for Mental Health Following Bioterrorism (United States)

    Tsao, Jennie C. I.; Dobalian, Aram; Wiens, Brenda A.; Gylys, Julius A.; Evans, Garret D.


    Context: Recent bioterrorist attacks have highlighted the critical need for health care organizations to prepare for future threats. Yet, relatively little attention has been paid to the mental health needs of rural communities in the wake of such events. A critical aspect of bioterrorism is emphasis on generating fear and uncertainty, thereby…

  3. CARES: AACN's New Competencies and Recommendations for Educating Undergraduate Nursing Students to Improve Palliative Care. (United States)

    Ferrell, Betty; Malloy, Pam; Mazanec, Polly; Virani, Rose


    Nurses spend the most time of any health care professional caring for patients and families dealing with the challenges of serious illness. The demand for nursing expertise in palliative care is growing as more people are living with chronic, life-limiting illnesses. Nursing faculty must prepare future nurses to meet this demand. The new American Association of Colleges of Nursing Palliative Competencies And Recommendations for Educating undergraduate nursing Students document, released February 2016, identifies the 17 competencies that all undergraduate nursing students should achieve by the time of graduation. This historic document is a revision of the 1998 American Association of Colleges of Nursing Peaceful Death document and is now the guiding framework for undergraduate nursing education. In an effort to support nursing faculty and prepare nursing students to deliver quality palliative care, an innovative, interactive on-line undergraduate End-of-Life Nursing Education Consortium (ELNEC) curriculum is under development and will be released in January 2017. This new curriculum will meet the competencies and recommendations for achieving those competencies outlined in the Competencies And Recommendations for Educating undergraduate nursing Students document.

  4. Improving person-centred care in nursing homes through dementia-care mapping : design of a cluster-randomised controlled trial

    NARCIS (Netherlands)

    van de Ven, Geertje; Draskovic, Irena; Adang, Eddy M M; Donders, Rogier A R T; Post, Aukje; Zuidema, Sytse U; Koopmans, Raymond T C M; Vernooij-Dassen, Myrra J F J


    BACKGROUND: The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the

  5. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial.

    NARCIS (Netherlands)

    Ven, G. van de; Draskovic, I.; Adang, E.M.M.; Donders, R.; Post, A.; Zuidema, S.U.; Koopmans, R.T.C.M.; Vernooij-Dassen, M.J.F.J.


    BACKGROUND: The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the

  6. The basis for improving and reforming long-term care. Part 4: identifying meaningful improvement approaches (segment 2). (United States)

    Levenson, Steven A


    While many aspects of nursing home care have improved over time, numerous issues persist. Presently, a potpourri of approaches and a push to "fix" the problem have overshadowed efforts to correctly define the problems and identify their diverse causes. This fourth and final article in the series (divided between last month's issue and this one) recommends strategies to make sense of improvement and reform efforts. This month's concluding segment covers additional proposed approaches. Despite the challenges of the current environment, all of the proposed strategies could potentially be applied with little or no delay. Despite having brought vast increases in knowledge, the research effort may be losing its traction as a formidable force for meaningful change. It is necessary to rethink the questions being asked and the scope of answers being sought. A shift to overcoming implementation challenges is needed. In addition, it is essential to address issues of jurisdiction (the apparent "ownership" of assessment and decision making over patient problems or body parts) and reductionism (the excessive management of these issues and problems without proper context) that result in fragmented and problematic care. Issues of knowledge and skill also need to be addressed, with greater emphasis on key generic and technical competencies of staff and practitioners, in addition to factual knowledge. There is a need to rethink the approach to measuring performance and trying to improve quality of care and services. There are significant limits to trying to use quality measures to improve outcomes and performance. Ultimately, vast improvement is needed in applying care principles and practices, independent of regulatory sources. Reimbursement needs to be revamped so that it helps promote care that is consistent with human biology and other key concepts. Finally, improving long-term care will require a coordinated societal effort. All social institutions and health care settings need

  7. Volunteering for Clinical Trials Can Help Improve Health Care for Everyone (United States)

    ... of this page please turn Javascript on. Feature: Clinical Trials Volunteering for Clinical Trials Can Help Improve Health Care for Everyone Past ... healthy people to help," says Melanie Modlin about clinical trials. "We have a role to play in helping ...

  8. What can local authorities do to improve the social care-related quality of life of older adults living at home? Evidence from the Adult Social Care Survey. (United States)

    van Leeuwen, K M; Malley, J; Bosmans, J E; Jansen, A P D; Ostelo, R W; van der Horst, H E; Netten, A


    Local authorities spend considerable resources on social care at home for older adults. Given the expected growth in the population of older adults and budget cuts on local government, it is important to find efficient ways of maintaining and improving the quality of life of older adults. The ageing in place literature suggests that policies in other functions of local authorities may have a significant role to play. This study aims to examine the associations between social care-related quality of life (SCRQoL) in older adults and three potential policy targets for local authorities: (i) accessibility of information and advice, (ii) design of the home and (iii) accessibility of the local area. We used cross-sectional data from the English national Adult Social Care Survey (ASCS) 2010/2011 on service users aged 65 years and older and living at home (N=29,935). To examine the association between SCRQoL, as measured by the ASCOT, and three single-item questions about accessibility of information, design of the home and accessibility of the local area, we estimate linear and quantile regression models. After adjusting for physical and mental health factors and other confounders our findings indicate that SCRQoL is significantly lower for older adults who find it more difficult to find information and advice, for those who report that their home design is inappropriate for their needs and for those who find it more difficult to get around their local area. In addition, these three variables are as strongly associated with SCRQoL as physical and mental health factors. We conclude that in seeking to find ways to maintain and improve the quality of life of social care users living at home, local authorities could look more broadly across their responsibilities. Further research is required to explore the cost-effectiveness of these options compared to standard social care services.

  9. [The role and place of pathology services in ensuring and improving the quality of medical care: Organizational and legal aspects]. (United States)

    Timofeev, I V


    The paper considers the legal and organizational issues of the activity of pathology services in improving medical care. It shows the main (diagnostic and medico-organizational) areas of pathology work to improve the quality of medical care.

  10. Incentives and technologies for improving irrigation water use efficiency (United States)

    Bruggeman, Adriana; Djuma, Hakan; Giannakis, Elias; Eliades, Marinos


    The European Water Framework Directive requires Member States to set water prices that provide adequate incentives for users to use water resources efficiently. These new water pricing policies need to consider cost recovery of water services, including financial, environmental and resource cost. Prices were supposed to have been set by 2010. So far the record has been mixed. The European Commission has sent reasoned opinions to a number of countries (Austria, Belgium, Denmark, Estonia, Finland, Germany, Hungary, Netherlands, Sweden) requesting them to adjust their national legislation to include all water services. Unbalanced water pricing may negatively affect the agricultural sector, especially in the southern EU countries, which are more dependent on irrigation water for production. The European Commission is funding several projects that aim to reduce the burden of increasing water prices on farmers by developing innovative technologies and decision support systems that will save water and increase productivity. The FP7 ENORASIS project (grant 282949) has developed a new integrated irrigation management decision support platform, which include high-resolution, ensemble weather forecasting, a GIS widget for the location of fields and sensors and a comprehensive decision support and database management software package to optimize irrigation water management. The field component includes wireless, solar-powered soil moisture sensors, small weather stations, and remotely controlled irrigation valves. A mobile App and a web-package are providing user-friendly interfaces for farmers, water companies and environmental consultants. In Cyprus, agricultural water prices have been set to achieve a cost recovery rate of 54% (2010). The pricing policy takes in consideration the social importance and financial viability of the agricultural sector, an important flexibility provided by the Water Framework Directive. The new price was set at 0.24 euro per m3 for water supply

  11. Energy Efficiency Improvement Opportunities for the Cement Industry

    Energy Technology Data Exchange (ETDEWEB)

    Price, Lynn; Worrell, Ernst; Galitsky, Christina; Price, Lynn


    This report provides information on the energy savings, costs, and carbon dioxide emissions reductions associated with implementation of a number of technologies and measures applicable to the cement industry. The technologies and measures include both state-of-the-art measures that are currently in use in cement enterprises worldwide as well as advanced measures that are either only in limited use or are near commercialization. This report focuses mainly on retrofit measures using commercially available technologies, but many of these technologies are applicable for new plants as well. Where possible, for each technology or measure, costs and energy savings per tonne of cement produced are estimated and then carbon dioxide emissions reductions are calculated based on the fuels used at the process step to which the technology or measure is applied. The analysis of cement kiln energy-efficiency opportunities is divided into technologies and measures that are applicable to the different stages of production and various kiln types used in China: raw materials (and fuel) preparation; clinker making (applicable to all kilns, rotary kilns only, vertical shaft kilns only); and finish grinding; as well as plant wide measures and product and feedstock changes that will reduce energy consumption for clinker making. Table 1 lists all measures in this report by process to which they apply, including plant wide measures and product or feedstock changes. Tables 2 through 8 provide the following information for each technology: fuel and electricity savings per tonne of cement; annual operating and capital costs per tonne of cement or estimated payback period; and, carbon dioxide emissions reductions for each measure applied to the production of cement. This information was originally collected for a report on the U.S. cement industry (Worrell and Galitsky, 2004) and a report on opportunities for China's cement kilns (Price and Galitsky, in press). The information provided in

  12. Mechanistic Understanding of Microbial Plugging for Improved Sweep Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Steven Bryant; Larry Britton


    Microbial plugging has been proposed as an effective low cost method of permeability reduction. Yet there is a dearth of information on the fundamental processes of microbial growth in porous media, and there are no suitable data to model the process of microbial plugging as it relates to sweep efficiency. To optimize the field implementation, better mechanistic and volumetric understanding of biofilm growth within a porous medium is needed. In particular, the engineering design hinges upon a quantitative relationship between amount of nutrient consumption, amount of growth, and degree of permeability reduction. In this project experiments were conducted to obtain new data to elucidate this relationship. Experiments in heterogeneous (layered) beadpacks showed that microbes could grow preferentially in the high permeability layer. Ultimately this caused flow to be equally divided between high and low permeability layers, precisely the behavior needed for MEOR. Remarkably, classical models of microbial nutrient uptake in batch experiments do not explain the nutrient consumption by the same microbes in flow experiments. We propose a simple extension of classical kinetics to account for the self-limiting consumption of nutrient observed in our experiments, and we outline a modeling approach based on architecture and behavior of biofilms. Such a model would account for the changing trend of nutrient consumption by bacteria with the increasing biomass and the onset of biofilm formation. However no existing model can explain the microbial preference for growth in high permeability regions, nor is there any obvious extension of the model for this observation. An attractive conjecture is that quorum sensing is involved in the heterogeneous bead packs.

  13. Improving the efficiency of abdominal aortic aneurysm wall stress computations. (United States)

    Zelaya, Jaime E; Goenezen, Sevan; Dargon, Phong T; Azarbal, Amir-Farzin; Rugonyi, Sandra


    An abdominal aortic aneurysm is a pathological dilation of the abdominal aorta, which carries a high mortality rate if ruptured. The most commonly used surrogate marker of rupture risk is the maximal transverse diameter of the aneurysm. More recent studies suggest that wall stress from models of patient-specific aneurysm geometries extracted, for instance, from computed tomography images may be a more accurate predictor of rupture risk and an important factor in AAA size progression. However, quantification of wall stress is typically computationally intensive and time-consuming, mainly due to the nonlinear mechanical behavior of the abdominal aortic aneurysm walls. These difficulties have limited the potential of computational models in clinical practice. To facilitate computation of wall stresses, we propose to use a linear approach that ensures equilibrium of wall stresses in the aneurysms. This proposed linear model approach is easy to implement and eliminates the burden of nonlinear computations. To assess the accuracy of our proposed approach to compute wall stresses, results from idealized and patient-specific model simulations were compared to those obtained using conventional approaches and to those of a hypothetical, reference abdominal aortic aneurysm model. For the reference model, wall mechanical properties and the initial unloaded and unstressed configuration were assumed to be known, and the resulting wall stresses were used as reference for comparison. Our proposed linear approach accurately approximates wall stresses for varying model geometries and wall material properties. Our findings suggest that the proposed linear approach could be used as an effective, efficient, easy-to-use clinical tool to estimate patient-specific wall stresses.

  14. Interdisciplinary diabetes care teams operating on the interface between primary and specialty care are associated with improved outcomes of care: findings from the Leuven Diabetes Project

    Directory of Open Access Journals (Sweden)

    Mathieu Chantal


    Full Text Available Abstract Background Type 2 diabetes mellitus is a complex, progressive disease which requires a variety of quality improvement strategies. Limited information is available on the feasibility and effectiveness of interdisciplinary diabetes care teams (IDCT operating on the interface between primary and specialty care. A first study hypothesis was that the implementation of an IDCT is feasible in a health care setting with limited tradition in shared care. A second hypothesis was that patients who make use of an IDCT would have significantly better outcomes compared to non-users of the IDCT after an 18-month intervention period. A third hypothesis was that patients who used the IDCT in an Advanced quality Improvement Program (AQIP would have significantly better outcomes compared to users of a Usual Quality Improvement Program (UQIP. Methods This investigation comprised a two-arm cluster randomized trial conducted in a primary care setting in Belgium. Primary care physicians (PCPs, n = 120 and their patients with type 2 diabetes mellitus (n = 2495 were included and subjects were randomly assigned to the intervention arms. The IDCT acted as a cornerstone to both the intervention arms, but the number, type and intensity of IDCT related interventions varied depending upon the intervention arm. Results Final registration included 67 PCPs and 1577 patients in the AQIP and 53 PCPs and 918 patients in the UQIP. 84% of the PCPs made use of the IDCT. The expected participation rate in patients (30% was not attained, with 12,5% of the patients using the IDCT. When comparing users and non-users of the IDCT (irrespective of the intervention arm and after 18 months of intervention the use of the IDCT was significantly associated with improvements in HbA1c, LDL-cholesterol, an increase in statins and anti-platelet therapy as well as the number of targets that were reached. When comparing users of the IDCT in the two intervention arms no significant differences

  15. Efficiency Improvement of HIT Solar Cells on p-Type Si Wafers


    Chun-You Wei; Chu-Hsuan Lin; Hao-Tse Hsiao; Po-Chuan Yang; Chih-Ming Wang; Yen-Chih Pan


    Single crystal silicon solar cells are still predominant in the market due to the abundance of silicon on earth and their acceptable efficiency. Different solar-cell structures of single crystalline Si have been investigated to boost efficiency; the heterojunction with intrinsic thin layer (HIT) structure is currently the leading technology. The record efficiency values of state-of-the art HIT solar cells have always been based on n-type single-crystalline Si wafers. Improving the efficiency ...

  16. Crossing the quality chasm: lessons from health care quality improvement efforts in England


    Madhok, Rajan


    The second report from the US Institute of Medicine Crossing the Quality Chasm, highlighted the deficiencies in health care quality in the USA, analyzed the contributory factors, and proposed 13 recommendations for improvements. Clearly, the challenges are enormous. Can anything be learned from the experiences of other countries? This article describes the author's experiences of health care quality improvement efforts in the National Health Service in England and their implications for the U...

  17. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study. (United States)

    Rix, Elizabeth F; Barclay, Lesley; Stirling, Janelle; Tong, Allison; Wilson, Shawn


    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the "costly" crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system.

  18. A novel educational programme to improve knowledge regarding health care-associated infection and hand hygiene. (United States)

    Fitzpatrick, Maureen; Everett-Thomas, Ruth; Nevo, Igal; Shekhter, Ilya; Rosen, Lisa F; Scheinman, Stephen R; Arheart, Kristopher L; Birnbach, David J


    Lack of hand hygiene by health-care workers is the most significant cause of health care-associated infection. This programme was designed to make health-care workers want to wash their hands, to change their knowledge regarding hand hygiene and health care-associated infection, and influence practice. Improvement between pre- and post-test scores was statistically significant. Compliance is a multifactorial problem that involves knowledge and behaviour. Educational awareness and frequent reminders are critical to maintain high rates of hand hygiene compliance.

  19. Improving Dryer and Press Efficiencies Through Combustion of Hydrocarbon Emissions

    Energy Technology Data Exchange (ETDEWEB)

    Sujit Banerjee


    Emission control devices on dryers and presses have been legislated into the industry, and are now an integral part of the drying system. These devices consume large quantities of natural gas and electricity and down-sizing or eliminating them will provide major energy savings. The principal strategy taken here focuses on developing process changes that should minimize (and in some cases eliminate) the need for controls. A second approach is to develop lower-cost control options. It has been shown in laboratory and full-scale work that Hazardous Air Pollutants (HAPs) emerge mainly at the end of the press cycle for particleboard, and, by extension, to other prod-ucts. Hence, only the air associated with this point of the cycle need be captured and treated. A model for estimating terpene emissions in the various zones of veneer dryers has been developed. This should allow the emissions to be concentrated in some zones and minimized in others, so that some of the air could be directly released without controls. Low-cost catalysts have been developed for controlling HAPs from dryers and presses. Catalysts conventionally used for regenerative catalytic oxidizers can be used at much lower temperatures for treating press emissions. Fluidized wood ash is an especially inexpensive mate-rial for efficiently reducing formaldehyde in dryer emissions. A heat transfer model for estimating pinene emissions from hot-pressing strand for the manufacture of flakeboard has been constructed from first principles and validated. The model shows that most of the emissions originate from the 1-mm layer of wood adjoining the platen surface. Hence, a simple control option is to surface a softwood mat with a layer of hardwood prior to pressing. Fines release a disproportionate large quantity of HAPs, and it has been shown both theo-retically and in full-scale work that particles smaller than 400 µm are principally responsible. Georgia-Pacific is considering green

  20. Final Scientific Report - "Improved Fuel Efficiency from Nanocomposite Tire Tread"

    Energy Technology Data Exchange (ETDEWEB)

    Dr. Andrew Myers


    Rolling resistance, a measure of the energy lost as a tire rotates while moving, is a significant source of power and fuel loss. Recently, low rolling resistant tires have been formulated by adding silica to tire tread. These "Green Tires" (so named from the environmental advantages of lower emissions and improved fuel economy) have seen some commercial success in Europe, where high fuel prices and performance drive tire selection. Unfortunately, the higher costs of the silica and a more complicated manufacturing process have prevented significant commercialization - and the resulting fuel savings - in the U.S. In this project, TDA Research, Inc. (TDA) prepared an inexpensive alternative to silica that leads to tire components with lower rolling resistance. These new tire composite materials were processed with traditional rubber processing equipment. We prepared specially designed nanoparticle additives, based on a high purity, inorganic mineral whose surface can be easily modified for compatibility with tire tread formulations. Our nanocomposites decreased energy losses to hysteresis, the loss of energy from the compression and relaxation of an elastic material, by nearly 20% compared to a blank SBR sample. We also demonstrated better performance than a leading silica product, with easier production of our final rubber nanocomposite.

  1. MOC Efficiency Improvements Using a Jacobi Inscatter Approximation

    Energy Technology Data Exchange (ETDEWEB)

    Stimpson, Shane [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Collins, Benjamin [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Kochunas, Brendan [Univ. of Michigan, Ann Arbor, MI (United States)


    In recent weeks, attention has been given to resolving the convergence issues encountered with TCP0 by trying a Jacobi (J) inscatter approach when group sweeping, where the inscatter source is constructed using the previous iteration flux. This is in contrast to a Gauss-Seidel (GS) approach, which has been the default to-date, where the scattering source uses the most up-to-date flux values. The former is consistent with CASMO, which has no issues with TCP0 convergence. Testing this out on a variety of problems has demonstrated that the Jacobi approach does indeed provide substantially more stability, though can take more outer iterations to converge. While this is not surprising, there are improvements that can be made to the MOC sweeper to capitalize on the Jacobi approximation and provide substantial speedup. For example, the loop over groups, which has traditionally been the outermost loop in MPACT, can be moved to the interior, avoiding duplicate modular ray trace and coarse ray trace setup (mapping coarse mesh surface indexes), which needs to be performed repeatedly when group is outermost.

  2. Improving Energy Efficient Clustering Method for Wireless Sensor Network

    Directory of Open Access Journals (Sweden)

    Md. Imran Hossain


    Full Text Available Wireless sensor networks have recently emerged as important computing platform. These sensors are power-limited and have limited computing resources. Therefore the sensor energy has to be managed wisely in order to maximize the lifetime of the network. Simply speaking, LEACH requires the knowledge of energy for every node in the network topology used. In LEACHs threshold which selects the cluster head is fixed so this protocol does not consider network topology environments. We proposed IELP algorithm, which selects cluster heads using different thresholds. New cluster head selection probability consists of the initial energy and the number of neighbor nodes. On rotation basis, a head-set member receives data from the neighboring nodes and transmits the aggregated results to the distant base station. For a given number of data collecting sensor nodes, the number of control and management nodes can be systematically adjusted to reduce the energy consumption, which increases the network life.The simulation results show that the performance of IELP has an improvement of 39% over LEACH and 20% over SEP in the area of 100m*100m for m=0.1, α =2 where advanced nodes (m and the additional energy factor between advanced and normal nodes (α.

  3. Efficiency and competition in the Dutch non-life insurance industry: Effects of the 2006 health care reform

    NARCIS (Netherlands)

    Bikker, Jaap; Popescu, Adelina


    This paper investigates the cost efficiency and competitive behaviour of the non-life – or property and casualty – insurance market in the Netherlands over the period 1995-2012. We focus on the 2006 health care reform, where public health care insurance has been included in the non-life insurance se

  4. End-stage renal disease: a proving ground for quality improvement in health care. (United States)

    Rutherford, W E; Gibney, R


    This article chronicles the health care quality improvement efforts that relate to patients with end stage renal disease (ESRD). The emphasis is on quality improvement as a management system as opposed to the quality improvements that resulted from strictly technical dialysis-related issues. The government has exercised considerable oversight on the ESRD program because of its growth and cost. History has shown that quality assurance (QA) has had little effect on improving quality or decreasing cost. The philosophy, methods, and tools of continuous quality improvement (CQI) have been shown to work in health care. CQI is a management system that offers hope for higher quality affordable health care. Computer technology is at last sophisticated enough to permit the collection of large amounts of clinical data at the point of care. This will permit CQI methods and tools to be applied generally at reasonable costs. Physicians in general and nephrologists in particular are beginning to understand the managed care environment. They are beginning to understand the paradigm shift that is required to effect the changes necessary for physicians to assume their leadership role in health care. This article reviews the quality efforts of the past and present. It discusses the strengths and weaknesses of efforts to improve quality and lastly presents a vision for the future.

  5. Implementing practice management strategies to improve patient care: the EPIC project. (United States)

    Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna


    Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

  6. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities. (United States)

    Greene, Laurence; Moreo, Kathleen


    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high

  7. Bundled Payments for Care Improvement: Lessons Learned in the First Year. (United States)

    Althausen, Peter L; Mead, Lisa


    The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a system for higher quality and more coordinated care at a lower cost to Medicare. It is currently an optional program for physician groups, hospitals and post-acute care providers to benefit financially from improved care models and cost containment measures. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. Under this initiative, there are certain fraud and abuse waivers in place that allow gainsharing among BPCI organizations and approved providers so long as certain requirements are met. Our practice entered this initiative for total joint arthroplasty episodes of care as well as the hip and femur fracture episode of care. The first year experience demonstrated that a significant learning curve is required. Keys for success include appropriate patient selection for elective surgery, implant pricing control, adherence to preoperative and postoperative protocols, diligent postcare care management, and appropriate choice of metrics to maximize gainsharing potential. Ultimately, the BPCI program has been a successful venture, saving our hospitals over $1.6 million in 2015. In the process, this provided an additional revenue stream for our physicians while decreasing the overall cost of care.

  8. Pilot program to improve self-management of patients with heart failure by redesigning care coordination. (United States)

    Shaw, Jessica D; O'Neal, Daniel J; Siddharthan, Kris; Neugaard, Britta I


    Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF). Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF. Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support) to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients. Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors. Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.

  9. Making Meaningful Improvements to Direct Care Worker Training Through Informed Policy: Understanding How Care Setting Structure and Culture Matter. (United States)

    Kemeny, M Elizabeth; Mabry, J Beth


    Well-intentioned policy governing the training of direct care workers (DCWs) who serve older persons, in practice, may become merely a compliance issue for organizations rather than a meaningful way to improve quality of care. This study investigates the relationships between best practices in DCW training and the structure and culture of long term support service (LTSS) organizations. Using a mixed-methods approach to analyzing data from 328 licensed LTSS organizations in Pennsylvania, the findings suggest that public policy should address methods of training, not just content, and consider organizational variations in size, training evaluation practices, DCW integration, and DCW input into care planning. Effective training also incorporates support for organizations and supervisors as key aspects of DCWs' learning and working environment.

  10. Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives. (United States)

    Glasser, Irene; Wang, Fei; Reardon, Jane; Vergara, Cunegundo D; Salvietti, Ralph; Acevedo, Myrtha; Santana, Blanca; Fortunato, Gil


    We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation.

  11. Comparison of steam sterilization conditions efficiency in the treatment of Infectious Health Care Waste. (United States)

    Maamari, Olivia; Mouaffak, Lara; Kamel, Ramza; Brandam, Cedric; Lteif, Roger; Salameh, Dominique


    Many studies show that the treatment of Infectious Health Care Waste (IHCW) in steam sterilization devices at usual operating standards does not allow for proper treatment of Infectious Health Care Waste (IHCW). Including a grinding component before sterilization allows better waste sterilization, but any hard metal object in the waste can damage the shredder. The first objective of the study is to verify that efficient IHCW treatment can occur at standard operating parameters defined by the contact time-temperature couple in steam treatment systems without a pre-mixing/fragmenting or pre-shredding step. The second objective is to establish scientifically whether the standard operation conditions for a steam treatment system including a step of pre-mixing/fragmenting were sufficient to destroy the bacterial spores in IHCW known to be the most difficult to treat. Results show that for efficient sterilization of dialysis cartridges in a pilot 60L steam treatment system, the process would require more than 20 min at 144°C without a pre-mixing/fragmenting step. In a 720L steam treatment system including pre-mixing/fragmenting paddles, only 10 min at 144°C are required to sterilize IHCW proved to be sterilization challenges such as dialysis cartridges and diapers in normal conditions of rolling.

  12. Energy Audit as a Tool for Improving System Efficiency in Industrial Sector

    Directory of Open Access Journals (Sweden)

    Gopi Srinath,


    Full Text Available This paper presents the characteristics of energy consumption in industrial sector, the methodology and results of energy audits (EA performed in industrial sites and potentials for energy efficiency (EE improvements. The present state of industrial energy in India could be characterized by significant technological out-of–date, low energy efficiency and low level of environmental protection. Presented analysis of the results of conducted energy audits in selected industrial companies in previous period has shown the significant potentials for energy efficiency improvements in industrial sector (upgrading or replacement of equipment in the industrial energy sources and processes, introduction of energy management, improvement of steam supply and condensate return systems, the waste heat utilization, introduction of energy efficiency technology, improvement of energy efficiency in electrical equipment, usage of waste materials etc.

  13. A woman-led approach to improving postnatal care. (United States)

    Fryer-Croxall, Claire; Bailey, Elizabeth


    As a large NHS teaching trust we see 6,000 women a year who birth with us. Newly appointed as a modern matron, I noted that poor experience on our postnatal ward has always been a key issue in the complaints we receive and from the feedback that our women give to us. The ImPosE (improving postnatal experience) project was launched in December 2013. This brought together members of the multidisciplinary team who were committed to developing our postnatal ward and improving it for our women and their families. We used a quality management approach, putting 'customer' experience at the core, and implemented a varied package of changes as directed by feedback from service users.

  14. Better tests, better care: improved diagnostics for infectious diseases. (United States)

    Caliendo, Angela M; Gilbert, David N; Ginocchio, Christine C; Hanson, Kimberly E; May, Larissa; Quinn, Thomas C; Tenover, Fred C; Alland, David; Blaschke, Anne J; Bonomo, Robert A; Carroll, Karen C; Ferraro, Mary Jane; Hirschhorn, Lisa R; Joseph, W Patrick; Karchmer, Tobi; MacIntyre, Ann T; Reller, L Barth; Jackson, Audrey F


    In this IDSA policy paper, we review the current diagnostic landscape, including unmet needs and emerging technologies, and assess the challenges to the development and clinical integration of improved tests. To fulfill the promise of emerging diagnostics, IDSA presents recommendations that address a host of identified barriers. Achieving these goals will require the engagement and coordination of a number of stakeholders, including Congress, funding and regulatory bodies, public health agencies, the diagnostics industry, healthcare systems, professional societies, and individual clinicians.

  15. Prescription data improve the medication history in primary care

    DEFF Research Database (Denmark)

    Glintborg, Bente; Andersen, S K; Poulsen, H E


    Incomplete medication lists increase the risk of medication errors and adverse drug effects. In Denmark, dispensing data and pharmacy records are available directly online to treating physicians. We aimed (1) to describe if use of pharmacy records improved the medication history among patients...... consulting their general practitioner and (2) to characterise inconsistencies between the medication history reported by the patient and the general practitioner's recordings....

  16. Interdisciplinary diabetes care teams operating on the interface between primary and specialty care are associated with improved outcomes of care: findings from the Leuven Diabetes Project.

    NARCIS (Netherlands)

    Borgermans, L.D.A.; Goderis, G.; Broeke, C. Van Den; Verbeke, G.; Carbonez, A.; Ivanova, A.; Mathieu, C.; Aertgeerts, B.; Heyrman, J.; Grol, R.P.T.M.


    BACKGROUND: Type 2 diabetes mellitus is a complex, progressive disease which requires a variety of quality improvement strategies. Limited information is available on the feasibility and effectiveness of interdisciplinary diabetes care teams (IDCT) operating on the interface between primary and spec


    Directory of Open Access Journals (Sweden)

    O. I. Apolikhin


    Programme on the territory of theVoronezh region they deployed 7 Interdistrict (ITC and 1 regional centre. The most difficult clinical cases were sent to the Federal urology center - research Institute of urology. They humiliated 140 experts from the region, with 80 of them they studied using remote sensing technology. For the realisation of the Program it was established an Advisory portal, which considered 498 clinical cases of prostate cancer, with 28 of specialists in various stages of the region took an active part in distance counseling.      From 2009 to 2013 an improvement of a number of indicators was marked: increase in the absolute number of patients with newly diagnosed prostate cancer from 451 to 603 cases, a localized increase in the share stages with 60.3% to 71.2 %, a decrease of deaths within one year from the date of diagnosis for prostate cancer from 14.6% to 6.5% and deaths among all registered patients with prostate cancer from 10.4% to 5.5%, reducing the proportion of clinically insignificant PCA from 36.4 to 14.1%.Conclusions. "PC module" of integrated phased standardized program "Urology" is a universal tool for solving the problems of improving the organization of medical care for prostate cancer, as well as the principles of operation can be used in other diseases of urology and other medical fields. Clinical and economic efficiency and the versatility of the basis for its recommendations as a priority in the organization of medical care at a cancer on the entire territory of the Russian Federation.

  18. Effect of Self–Care Educational Program to Improving Quality of Life among Elderly Referred to Health Centers in Zanjan

    Directory of Open Access Journals (Sweden)

    Fatemeh Salimi


    Full Text Available Background and Objectives: Since elderlies are susceptible to various impairments due to different physical and mental problems, they need more attention and abiding and efficient self-care program for their health promotion. The present study investigated the effect of self-care training program on quality of life of elderlies. Materials and Methods: This pre- and post-quasi-experimental study was carried out on 160 elderly clients selected from eight health care centers in Zanjan, Iran. The elderlies were selected by randomized sampling and assigned to two groups of experimental (n = 80 and control (n = 80 groups. The experimental group participated in the self-care training program for six sessions of one hour. The study instruments were questionnaires regarding demographic information and short-form health survey (SF-36. Data analysis was performed using SPSS-22 software by independent t-test, Mann-Whitney and chi-squared. Results: The finding showed a significant difference in mean scores of quality of life between the experimental and control groups after the intervention (P < 0.001. Conclusions: Self-care education to elderlies about the practices of proper nutrition, exercise, rest and medication can prevent several problems and help them to improve their quality of lives.

  19. Scotland's Knowledge Network: translating knowledge into action to improve quality of care. (United States)

    Wales, A; Graham, S; Rooney, K; Crawford, A


    The Knowledge Network ( is Scotland's online knowledge service for health and social care. It is designed to support practitioners to apply knowledge in frontline delivery of care, helping to translate knowledge into better health-care outcomes through safe, effective, person-centred care. The Knowledge Network helps to combine the worlds of evidence-based practice and quality improvement by providing access to knowledge about the effectiveness of clinical interventions ('know-what') and knowledge about how to implement this knowledge to support individual patients in working health-care environments ('know-how'). An 'evidence and guidance' search enables clinicians to quickly access quality-assured evidence and best practice, while point of care and mobile solutions provide knowledge in actionable formats to embed in clinical workflow. This research-based knowledge is complemented by social networking services and improvement tools which support the capture and exchange of knowledge from experience, facilitating practice change and systems improvement. In these cases, the Knowledge Network supports key components of the knowledge-to-action cycle--acquiring, creating, sharing and disseminating knowledge to improve performance and innovate. It provides a vehicle for implementing the recommendations of the national Knowledge into Action review, which outlines a new national approach to embedding knowledge in frontline practice and systems improvement.

  20. Follow-up care for breast cancer survivors: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Chopra I


    Full Text Available Ishveen Chopra,1 Avijeet Chopra2 1Department of Pharmacy Administration, Duquesne University, Pittsburgh, PA, USA; 2Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, USA Background: Appropriate follow-up care is important for improving health outcomes in breast cancer survivors (BCSs and requires determination of the optimum intensity of clinical examination and surveillance, assessment of models of follow-up care such as primary care-based follow-up, an understanding of the goals of follow-up care, and unique psychosocial aspects of care for these patients. The objective of this systematic review was to identify studies focusing on follow-up care in BCSs from the patient's and physician's perspective or from patterns of care and to integrate primary empirical evidence on the different aspects of follow-up care from these studies. Methods: A comprehensive literature review and evaluation was conducted for all relevant publications in English from January 1, 1990 to December 31, 2013 using electronic databases. Studies were included in the final review if they focused on BCS’s preferences and perceptions, physician's perceptions, patterns of care, and effectiveness of follow-up care. Results: A total of 47 studies assessing the different aspects of follow-up care were included in the review, with a majority of studies (n=13 evaluating the pattern of follow-up care in BCSs, followed by studies focusing on BCS's perceptions (n=9 and preferences (n=9. Most of the studies reported variations in recommended frequency, duration, and intensity of follow-up care as well as frequency of mammogram screening. In addition, variations were noted in patient preferences for type of health care provider (specialist versus non-specialist. Further, BCSs perceived a lack of psychosocial support and information for management of side effects. Conclusion: The studies reviewed, conducted in a range of settings, reflect variations in

  1. Maximizing root/rhizosphere efficiency to improve crop productivity and nutrient use efficiency in intensive agriculture of China. (United States)

    Shen, Jianbo; Li, Chunjian; Mi, Guohua; Li, Long; Yuan, Lixing; Jiang, Rongfeng; Zhang, Fusuo


    Root and rhizosphere research has been conducted for many decades, but the underlying strategy of root/rhizosphere processes and management in intensive cropping systems remain largely to be determined. Improved grain production to meet the food demand of an increasing population has been highly dependent on chemical fertilizer input based on the traditionally assumed notion of 'high input, high output', which results in overuse of fertilizers but ignores the biological potential of roots or rhizosphere for efficient mobilization and acquisition of soil nutrients. Root exploration in soil nutrient resources and root-induced rhizosphere processes plays an important role in controlling nutrient transformation, efficient nutrient acquisition and use, and thus crop productivity. The efficiency of root/rhizosphere in terms of improved nutrient mobilization, acquisition, and use can be fully exploited by: (1) manipulating root growth (i.e. root development and size, root system architecture, and distribution); (2) regulating rhizosphere processes (i.e. rhizosphere acidification, organic anion and acid phosphatase exudation, localized application of nutrients, rhizosphere interactions, and use of efficient crop genotypes); and (3) optimizing root zone management to synchronize root growth and soil nutrient supply with demand of nutrients in cropping systems. Experiments have shown that root/rhizosphere management is an effective approach to increase both nutrient use efficiency and crop productivity for sustainable crop production. The objectives of this paper are to summarize the principles of root/rhizosphere management and provide an overview of some successful case studies on how to exploit the biological potential of root system and rhizosphere processes to improve crop productivity and nutrient use efficiency.

  2. Towards improving care for children with diabetes in Kuwait. (United States)

    Shaltout, A A; Qabazard, M A; al Khawari, M; Bushnaq, R; Abdella, N A; Abdul Salam, R; Mughal, H


    Presents the results of a medical audit of the records of 199 children diagnosed as diabetic and admitted to Al-Amiri Hospital, Kuwait. Uses the measurement of glycosylated haemoglobin (HbA1) to indicate the levels of control achieved. Finds that the degree of glycaemic control compares favourably with studies done in other hospitals, but unfavourably with specialized diabetic clinics. Proposes that glycaemic control could be improved by provision of the services of specialized support staff such as dietitian, educator, psychologist and health visitor.

  3. Observational Study Using the Tools of Lean Six Sigma to Improve the Efficiency of the Resident Rounding Process (United States)

    Chand, David V.


    Background Recent focus on resident work hours has challenged residency programs to modify their curricula to meet established duty hour restrictions and fulfill their mission to develop the next generation of clinicians. Simultaneously, health care systems strive to deliver efficient, high-quality care to patients and families. The primary goal of this observational study was to use a data-driven approach to eliminate examples of waste and variation identified in resident rounding using Lean Six Sigma methodology. A secondary goal was to improve the efficiency of the rounding process, as measured by the reduction in nonvalue-added time. Methods We used the “DMAIC” methodology: define, measure, analyze, improve, and control. Pediatric and family medicine residents rotating on the pediatric hospitalist team participated in the observation phase. Residents, nurses, hospitalists, and parents of patients completed surveys to gauge their attitudes toward rounds. The Mann-Whitney test was used to test for differences in the median times measured during the preimprovement and postimprovement phases, and the Student t test was used for comparison of survey data. Results and Discussion Collaborative, family-centered rounding with elimination of the “prerounding” process, as well as standard work instructions and pacing the process to meet customer demand (takt time), were implemented. Nonvalue-added time per patient was reduced by 64% (P  =  .005). Survey data suggested that team members preferred the collaborative, family-centered approach to the traditional model of rounding. Conclusions Lean Six Sigma provides tools, a philosophy, and a structured, data-driven approach to address a problem. In our case this facilitated an effort to adhere to duty hour restrictions while promoting education and quality care. Such approaches will become increasingly useful as health care delivery and education continue to transform. PMID:22655134

  4. Quality in transitional care of the elderly: Key challenges and relevant improvement measures

    Directory of Open Access Journals (Sweden)

    Marianne Storm


    Full Text Available Introduction: Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures.Methodology: Included in the study were elderly patients (75+ receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41 were carried out by two researchers.Results: Six main challenges with belonging descriptions have been identified: (1 next of kin (bridging providers, advocacy, support, information brokering, (2 patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions, (3 health care personnel's competence (professional, system, awareness of others’ roles, (4 information exchange (oral, written, electronic, (5 context (stability, variability, change incentives, number of patient handovers and (6 patient assessment (complex clinical picture, patient description, clinical assessment.Conclusion: Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.

  5. Independent practice associations and physician-hospital organizations can improve care management for smaller practices. (United States)

    Casalino, Lawrence P; Wu, Frances M; Ryan, Andrew M; Copeland, Kennon; Rittenhouse, Diane R; Ramsay, Patricia P; Shortell, Stephen M


    Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.

  6. What are the effective ways to translate clinical leadership into health care quality improvement?

    Directory of Open Access Journals (Sweden)

    McSherry R


    Full Text Available Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks. Keywords: governance

  7. The Scottish Emergency Care Summary – an evaluation of a national shared record system aiming to improve patient care: technology report

    Directory of Open Access Journals (Sweden)

    Libby MM Morris


    Full Text Available Background In Scotland, out-of-hours calls are all triaged by the National Health Service emergency service (NHS24 but the clinicians receiving calls have no direct access to patient records.Objective To improve the safety of patient care in unscheduled consultations when the usual primary care record is not available.Technology The Emergency Care Summary (ECS is a record system offering controlled access to medication and adverse reactions details for nearly every person registered with a general practice in Scotland. It holds a secure central copy of these parts of the GP practice record and is updated automatically twice daily. It is accessible under specified unplanned clinical circumstances by clinicians working in out-of-hours organisations, NHS24 and accident and emergency departments if they have consent from the patient and a current legitimate relationship for that patient’s care.Application We describe the design of the security model, management of data quality, deployment, costs and clinical benefits of the ECS over four years nationwide in Scotland, to inform the debate on the safe and effective sharing of health data in other nations.Evaluation Forms were emailed to 300 NHS24 clinicians and 81% of the 113 respondents said that the ECS was helpful or very helpful and felt that it changed their clinical management in 20% of cases.Conclusion The ECS is acceptable to patients and helpful for clinicians and is used routinely for unscheduled care when normal medical records are unavailable. Benefits include more efficient assessment and reduced drug interaction, adverse reaction and duplicate prescribing.

  8. SUM (Service Unit Management): An Organizational Approach To Improved Patient Care. (United States)

    Jelinek, Richard C.; And Others

    To evaluate the effectiveness of Service Unit Management (SUM) in reducing costs, improving quality of care, saving professional nursing time, increasing personnel satisfaction, and setting a stage for further improvements, a national questionnaire survey identified the characteristics of SUM units, and compared the performance of a total of 55…

  9. The Impact of Elderly Care Competence and Quality Improvement Programme in Four Swedish Municipalities (United States)

    Westerberg, Kristina; Hjelte, Jan


    During a number of years Swedish municipalities have work with improvement of competence and long-term quality in elderly care. The overall aim of the present study was to compare different learning activities (workplace improvement and/or courses), and to relate these activities to learning climate, learning strategies, and perception of care…

  10. Improving food and fluid intake for older adults living in long-term care

    DEFF Research Database (Denmark)

    Keller, Heather; Beck, Anne Marie; Namasivayam, Ashwini


    Poor food and fluid intake and malnutrition are endemic among older adults in long-term care (LTC), yet feasible and sustainable interventions that target key determinants and improve person-centered outcomes remain elusive. Without a comprehensive study addressing a range of determinants...... for the development and testing of interventions to improve food and fluid intake of older adults living in LTC....

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

    NARCIS (Netherlands)

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


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

  12. Improving patient-centredness in partnership with female patients: a cluster RCT in fertility care

    NARCIS (Netherlands)

    Huppelschoten, A.G.; Nelen, W.L.D.M.; Westert, G.P.; Golde, R.J.T. van; Adang, E.M.M.; Kremer, J.A.M.


    QUESTION: What is the effect of a multifaceted intervention with participation of patients on improvement of patient-centredness in fertility care? SUMMARY ANSWER: A multifaceted intervention with participation of patients did not improve total patient-centredness scores provided by women in fertili

  13. Delivery of maternal health care in Indigenous primary care services: baseline data for an ongoing quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Kwedza Ru K


    Full Text Available Abstract Background Australia's Aboriginal and Torres Strait Islander (Indigenous populations have disproportionately high rates of adverse perinatal outcomes relative to other Australians. Poorer access to good quality maternal health care is a key driver of this disparity. The aim of this study was to describe patterns of delivery of maternity care and service gaps in primary care services in Australian Indigenous communities. Methods We undertook a cross-sectional baseline audit for a quality improvement intervention. Medical records of 535 women from 34 Indigenous community health centres in five regions (Top End of Northern Territory 13, Central Australia 2, Far West New South Wales 6, Western Australia 9, and North Queensland 4 were audited. The main outcome measures included: adherence to recommended protocols and procedures in the antenatal and postnatal periods including: clinical, laboratory and ultrasound investigations; screening for gestational diabetes and Group B Streptococcus; brief intervention/advice on health-related behaviours and risks; and follow up of identified health problems. Results The proportion of women presenting for their first antenatal visit in the first trimester ranged from 34% to 49% between regions; consequently, documentation of care early in pregnancy was poor. Overall, documentation of routine antenatal investigations and brief interventions/advice regarding health behaviours varied, and generally indicated that these services were underutilised. For example, 46% of known smokers received smoking cessation advice/counselling; 52% of all women received antenatal education and 51% had investigation for gestational diabetes. Overall, there was relatively good documentation of follow up of identified problems related to hypertension or diabetes, with over 70% of identified women being referred to a GP/Obstetrician. Conclusion Participating services had both strengths and weaknesses in the delivery of maternal

  14. Improving energy efficiency: Strategies for supporting sustained market evolution in developing and transitioning countries

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, S.


    This report presents a framework for considering market-oriented strategies for improving energy efficiency that recognize the conditions of developing and transitioning countries, and the need to strengthen the effectiveness of market forces in delivering greater energy efficiency. It discusses policies that build markets in general, such as economic and energy pricing reforms that encourage competition and increase incentives for market actors to improve the efficiency of their energy use, and measures that reduce the barriers to energy efficiency in specific markets such that improvement evolves in a dynamic, lasting manner. The report emphasizes how different policies and measures support one another and can create a synergy in which the whole is greater than the sum of the parts. In addressing this topic, it draws on the experience with market transformation energy efficiency programs in the US and other industrialized countries.

  15. 76 FR 28022 - Increasing Market and Planning Efficiency Through Improved Software; Notice of Technical... (United States)


    ... power flow modeling, including general real-time optimal power flow software and algorithm advancements, adaptive transmission ratings and generator modeling, full or partial AC optimal power flow models... algorithm advancements, asset flexibility, potential improvements to pricing, efficient modeling...

  16. Identification of Ways to Improve Military Construction for Energy-Efficient Facilities. (United States)


    identify all processes of MCA that impact building energy efficiency and ways of improving them. ,,’, *% Executive Order 12003, Relating to the...process which ’" would increase building energy efficiency and (2) preliminary development of an accept- 0 ance testing program for ItVAC systems...unfamiliar with or confused about a building’s systems, they may disconnect or bypass components critical to building energy efficiency . Second, a full

  17. A Proportional Resonant Control Strategy for Efficiency Improvement in Extended Range Electric Vehicles


    Xiaoyuan Wang; Haiying Lv; Qiang Sun; Yanqing Mi; Peng Gao


    The key to control the range extender generation system is to improve the efficiency and reduce the emissions of the electric vehicle (EV). In this paper, based on the purpose of efficiency optimization, both engine and generator are matched to get a public high efficiency region, and a partial power following control strategy was presented. The engine speed is constant in the defined power range, so the output power regulation of the range extender is only realized by the adjustment of the t...

  18. Identifying entry points to improve fertilizer use efficiency in Taihu Basin, China

    NARCIS (Netherlands)

    Ma, Li; Feng, S.; Reidsma, P.; Qu, F.; Heerink, N.


    Overuse of fertilizers in China causes environmental problems and high costs for farmers. In this paper we aim to identify entry points to improve fertilizer use efficiency in Taihu Basin, China. We use stochastic frontier analysis to estimate the technical and fertilizer use efficiency of rice prod

  19. Use of a PERT Chart to Improve Efficiency of the Dissertation. (United States)

    Hudson, Shannon M; Laken, Marilyn A


    Efficiencies are needed to speed the dissertation process and graduation of prospective new faculty. We used a workflow process, the PERT chart, to organize and manage the many time-delimited tasks necessary for a complex dissertation. This article presents a case example that describes our experience and timely completion of the dissertation. PERT charts are useful tools to improve efficiency in nursing education.

  20. Improving the efficiency of a chemotherapy day unit: Applying a business approach to oncology

    NARCIS (Netherlands)

    Lent, van Wineke A.M.; Goedbloed, N.; Harten, van W.H.


    Aim: To improve the efficiency of a hospital-based chemotherapy day unit (CDU). - Methods: The CDU was benchmarked with two other CDUs to identify their attainable performance levels for efficiency, and causes for differences. Furthermore, an in-depth analysis using a business approach, called lean