WorldWideScience

Sample records for care manpower planning

  1. AB Manpower Plan 2007

    CERN Document Server

    Myers, Stephen

    2007-01-01

    The present exercise is not as such a "manpower plan" but a purely budgetary comparison of known plus requested resources with the known commitments over the period 2007-2012. From a purely budgetary point of view, AB will have the capacity to maintain all those recently hired staff who fulfill the criteria for long term employment at CERN. Following this budgetary exercise, AB proposes to perform a CERN-wide staff work plan so as to compare the manpower available to the quantity of work to be done in the totality of the work-packages. If there is a significant mismatch between these two quantities then we propose the following measures which would create personnel economies and allow us to redress the mismatch by increased recruitment: a new job severance scheme; CERN restructuring; use of the new CERN-ITER agreement; more flexibility in transfers from Materials to Personnel budgets. Failing this a re-examination of possible closure of lower priority facilities may be needed.

  2. Manpower development - planning and implementation

    International Nuclear Information System (INIS)

    The demands of a nuclear technology programme on the manpower resources of a developing country are very onerous. Unlike other industries, as well as the planning and operating staff, nuclear technology requires an additional administrative infrastructure to regulate the various activities. To minimize the effect of manpower shortage, the planning and development of manpower resources need to be carried out on a national scale. To introduce a nuclear programme, a special preparatory phase is required. During this phase the special conditions appertaining to the country are first considered, as are the evaluation and then the promotional aspects of the programme. In a second phase, all the partners involved in the implementation are considered, with reference to their roles and interrelationships. Their various tasks and obligations are fully assessed. This is a wide-ranging study covering, in addition to the construction of a nuclear power plant, the industrial collaboration and licensing agreements, and the utility operational training schemes. Finally, the third phase considers the different and necessary educational requirements, and the existent and developed level of the manpower, with respect to the scope and content of the know-how transfer. When all the relevant aspects have been considered, the expansion of the universities and educational establishments must be carried out. This whole phase needs to be started as early as possible because it involves a period of some years. (author)

  3. Agri-Manpower Forecasting and Educational Planning

    Science.gov (United States)

    Ramarao, D.; Agrawal, Rashmi; Rao, B. V. L. N.; Nanda, S. K.; Joshi, Girish P.

    2014-01-01

    Purpose: Developing countries need to plan growth or expansion of education so as to provide required trained manpower for different occupational sectors. The paper assesses supply and demand of professional manpower in Indian agriculture and the demands are translated in to educational requirements. Methodology: The supply is assessed from the…

  4. Manpower Planning Criteria Manual, Construction Grants Section.

    Science.gov (United States)

    Texas State Dept. of Water Resources, Austin.

    This document presents the material developed in conjunction with a project directed to test a methodology that a state water pollution control agency can use in determining its manpower and training needs. Included is a compilation of the manpower planning criteria used to relate numbers and types of personnel with deferred workloads. It also…

  5. Manpower Planning for Wastewater Treatment Plants.

    Science.gov (United States)

    Davies, J. Kenneth; And Others

    This document discusses the components necessary in the development of a forecasting process by which manpower needs can be determined and the development of action programs by which the projected needs may be satisfied. The primary focus of this manual is directed at that person in a state agency who has the responsibility for planning the…

  6. MANPOWER FOR PRIMARY MEDICAL CARE IN IRAN

    Directory of Open Access Journals (Sweden)

    S. Motameni

    1973-03-01

    Full Text Available Iran is a large country with a total area of 1,645,000 square kilometers. The country’s population is estimated at about 31 millions. There is an uneven distribution of the population, varying from 2 to 50 per square kilometer. Sixty per cent of the total population (18 millions is living in nearly 66,000 small and large village’s scattered throughout the country. A total of 10,000 physicians provide the main source of medical manpower, however more than 40% of these physicians are located in the capital city of Teheran. The physician to population ratio for the country is about 1 per 3,000 and the figure reaches 100,000 in some rural areas. Each year a total of 600 graduates is added to the health manpower , but technical and socio-economic handicapping factors make the rural and low-income areas less attractive to the new graduates. In this paper the reconstruction of health services around the concept of Primary Medical Care has been reposed for the country’s health development. Taking into consideration the country’s special geographical and demographic features, two levels of primary care workers have been suggested; the first group with 4 year’s training in curative and preventive services, and the second group at grade 9 level in education. It is foreseen that the two afore-mentioned groups will form a network of auxiliaries to the physicians in extending health services to the remote areas of the country.

  7. Health Manpower Planning: A Comparative Study in Four Countries. Volume 1. Health Manpower References.

    Science.gov (United States)

    Whiteside, Daniel F.; And Others

    The health manpower planning experiences of four countries reported here were presented in a traveling seminar held for member countries of the Pan American Health Organization. Focus was on what should be carried out in any country to coordinate the training of health workers with the operation of health services. Following the introduction, the…

  8. Plan for developing a comprehensive energy manpower information system

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, Lawrence G.

    1979-09-01

    The report is designed to make a beginning in broadening the scope of the comprehensive manpower information system for energy research, development, and demonstration, so that it could cover all manpower related to energy. It develops a plan for this extension, including determining which taxonomies require change, specifying the subsequent stages involved in expanding CEMIS to all energy manpower, and providing the basis for cost estimates for this work. The report is organized as follows: The analytical rationale is described in Chapter II. Chapter III reviews the status of manpower data in a number of energy sectors, notes limitations and gaps in the data, and discusses improvements and additions that should be made. The scope and structure of CEMIS are laid out in Chapter IV, with particular reference to the development of analytical processes, and of analytical linking functions between bodies of data, and a description of their application in anticipating the employment impact of energy changes. The appropriate steps recommended for the further development of CEMIS are described in Chapter V.

  9. NATO Conference on Manpower Planning and Organization Design

    CERN Document Server

    Niehaus, Richard

    1978-01-01

    This volume is the proceedings of the conference entitled "Manpower Planning and Organization Design" which was held in Stresa, Italy, 20-24 June 1977. The Conference was sponsored by the NATO Scientific Affairs Division and organized jointly through the Special Programs Panels on Human Factors and on Systems Science. Two Conference Directors were appointed with overall responsibilities for the programme and for policy, and they were assisted in their tasks by a small advisory panel consisting of Professor A. Charnes (University of Texas), Professor W.W. Cooper (Carnegie Mellon University, now at Harvard University) and Dr. F.A. Heller (TavistQck Institute of Human Relations). Professor R. Florio of Bergamo kindly agreed to become Administrative Director and, as such, was responsible for all the local arrangements. The Conference Directors were further assisted by "national points of contact" appointed from each of the member countries of NATO. These national representatives played a substantial part in the s...

  10. System dynamics of manpower planning strategies under various demand scenarios

    Directory of Open Access Journals (Sweden)

    Michael Mutingi

    2012-09-01

    Full Text Available The development of human resources recruitment and training strategies in a dynamic environment poses a challenge to many policy makers in various organisations. The goal of every human resource manager is to recruit, train and deploy the right personnel at the right place and at the right time in order to meet organizational requirements. We develop a system dynamics simulation model that captures the dynamic behaviour of a typical corporate manpower system. Three major strategies are indentified and simulated under different manpower demand scenarios. Based on a set of performance indices, the impact of the strategies is simulated under assumed demand scenarios including steady increasing, fluctuating, and s-shaped demand. Useful managerial insights are derived from the study. The model is a decision support tool for developing reliable dynamic manpower policies in terms of recruitment, training capacity, available skills, and attrition. This approach can assist organizations to design effective manpower strategies.

  11. Probabilistic approach to long range planning of manpower

    Science.gov (United States)

    Lejk, R. A.

    1967-01-01

    Publication presents a total long range planning model for project oriented organizations. The total model consists of planning systems which originate - /1/ at the project level and consolidate into an overall plan, and /2/ from a budetary ceiling and allocate to the individual projects. Analysis of /1/ and /2/ is provided for management decision making.

  12. Market-Based Manpower Planning with Labour Market Signals.

    Science.gov (United States)

    Van Adams, Arvil; And Others

    1992-01-01

    Labor market planning techniques must take into account the dynamic nature of economies. A better approach than labor needs forecasting is use of labor market signals developed by monitoring wage and employment changes and evaluating training programs. (SK)

  13. Manpower development for nuclear power

    International Nuclear Information System (INIS)

    This Guidebook provides policy-makers and managers of nuclear power programmes with information and guidance on the role, requirements, planning and implementation of manpower development programmes. It presents and discusses the manpower requirements associated with the activities of a nuclear power programme, the technical qualifications of this manpower and the manpower development corresponding to these requirements and qualifications. The Guidebook also discusses the purpose and conditions of national participation in the activities of a nuclear power programme

  14. Manpower Planning for the Wastewater Treatment Workforce of Texas: An Emerging Function. Presented at the Annual Meeting of the Texas Water Utilities Association (58th, College Station, Texas, March, 1976).

    Science.gov (United States)

    Jackson, Tom

    This paper, presented at the 58th annual meeting of the Texas Water Utilities Association, attempts to point out the need for manpower planning for the wastewater treatment workforce of Texas. As reasons for manpower planning, this document discloses estimates of 1400-1500 new jobs, 1300 of which will be in wastewater treatment facilities of 1 MGD…

  15. REPORT ON THE INTER-REGIONAL STUDY TOUR ON MANPOWER ASSESSMENT AND PLANNING IN THE UNION OF SOVIET SOCIALIST REPUBLICS, 8 SEPTEMBER - 5 OCTOBER 1963.

    Science.gov (United States)

    International Labour Organisation, Geneva (Switzerland).

    A MONTH-LONG STUDY TOUR PROVIDED 23 OFFICIALS OF 17 DEVELOPING COUNTRIES WITH AN OPPORTUNITY TO STUDY THE COMPREHENSIVE SYSTEM OF MANPOWER PLANNING AND UTILIZATION EMPLOYED IN THE UNION OF SOVIET SOCIALIST REPUBLICS (USSR) AND TO EXAMINE BASIC PRINCIPLES AND TECHNIQUES WHICH, WITH SUITABLE ADAPTATION, MIGHT HAVE APPLICABILITY TO SIMILAR PROBLEMS…

  16. Health manpower planning in European Union countries: explaining cross national variation.

    NARCIS (Netherlands)

    Martins-Coelho, G.

    2010-01-01

    Introduction: Human resources for health are critical for the performance of health care systems, in organizational, demographic and economic terms. They currently face challenges related to the progressive ageing of the European population, the epidemiological transition and the permanent technolog

  17. Human resource development: the Asian experience in employment and manpower planning - an overview

    OpenAIRE

    Amjad, Rashid

    1987-01-01

    The overview based on country studies included in this volume investigates the extent to which it has been possible to integrate human resource development and give priority to this important goal within the overall planning process. While it is clear that the development of human resources has to compete with other pressing demands for limited resources available for development, the key question still remains whether overall socioeconomic development undertaken has incorporated the preferre...

  18. Health manpower development in Bayelsa State, Nigeria

    Directory of Open Access Journals (Sweden)

    McFubara KG

    2012-11-01

    Full Text Available Kalada G McFubara,1 Elizabeth R Edoni,2 Rose E Ezonbodor-Akwagbe21Department of Community Medicine, Faculty of Clinical Sciences, 2Department of Community Health Nursing, Niger Delta University, Wilberforce Island, NigeriaBackground: Health manpower is one of the critical factors in the development of a region. This is because health is an index of development. Bayelsa State has a low level of health manpower. Thus, in this study, we sought to identify factors necessary for effective development of health manpower.Methods: Three methods were used to gather information, ie, face-to-face interviews, postal surveys, and documentary analysis. Critical incidents were identified, and content and thematic analyses were conducted.Results: There is no full complement of a primary health care workforce in any of the health centers in the state. The three health manpower training institutions have the limitations of inadequate health care educators and other manpower training facilities, including lack of a teaching hospital.Conclusion: Accreditation of health manpower training institutions is a major factor for effective development of health manpower. Public officers can contribute to the accreditation process by subsuming their personal interest into the state's common interest. Bayelsa is a fast-growing state and needs a critical mass of health care personnel. To develop this workforce requires a conscious effort rich in common interests in the deployment of resources.Keywords: health manpower, development, health care education

  19. Advance Care Planning

    Science.gov (United States)

    The thirteenth module of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans explores the attitudes and practices of African Americans related to completion of advance directives, and recommends effective strategies to improve decision-making in the setting of serious, life-threatening illness, in ways that augment patient autonomy and support patient-centered goal-setting and decision-making among African American patients and their families.

  20. Nuclear manpower development

    International Nuclear Information System (INIS)

    The nuclear manpower development project has concentrated on the systemisation and specialization of education and training programs and has actively carried out diverse activities to create new nuclear courses based on the experience of the Nuclear Training and Education Center (NTC) accumulated over the past years. As the demand of education program for training nuclear manpower is increasing due to the remarkable growth of nuclear industry, NTC developed customized education programs making the most use of nuclear experiment equipment and providing practical exercise with research reactor. For improving organizational performance and the development of skilled manpower, KAERI-ACE 2.0 system offered diverse programs addressing the type of occupation and position based on individual competency. Also education on IT was carried out to improve public relations on nuclear and field trips were arranged to encourage local residents' better understanding of the nuclear industry. As a continuous effort, In 2011, NTC specially conducted a survey of employees who are attached to small and medium sized business, and analyzed the present business situations and education requirements for the development of a Pre/under job education program. Prior to this, a briefing session took place for mutual exchange of opinions of industry and academia, based on which a test operation on 'Basic Radiation Education' was carried out. This program has a significance that it was first step toward connection between the nuclear industry and academia as well as an opportunity to educate the employee involved in nuclear engineering field. In 2012, this program is planned to be expanded. With reference to the in-house training, NTC established an 'e-HRD system' providing available resources concerned with education program for cultivating talented personnel. All the education programs are based on individual competency. The e-HRD system will be test operated in 2012 and applied to the

  1. Moving survivorship care plans forward: focus on care coordination.

    Science.gov (United States)

    Salz, Talya; Baxi, Shrujal

    2016-07-01

    After completing treatment for cancer, the coordination of oncology and primary care presents a challenge for cancer survivors. Many survivors need continued oncology follow-up, and all survivors require primary care. Coordinating the shared care of a cancer survivor, or facilitating an informed handoff from oncology to primary care, is essential for cancer survivors. Survivorship care plans are personalized documents that summarize cancer treatment and outline a plan of recommended ongoing care, with the goal of facilitating the coordination of post-treatment care. Despite their face validity, five trials have failed to demonstrate the effectiveness of survivorship care plans. We posit that these existing trials have critical shortcomings and do not adequately address whether survivorship care plans improve care coordination. Moving forward, we propose four criteria for future trials of survivorship care plans: focusing on high-needs survivor populations, tailoring the survivorship care plan to the care setting, facilitating implementation of the survivorship care plan in clinical practice, and selecting appropriate trial outcomes to assess care coordination. When trials meet these criteria, we can finally assess whether survivorship care plans help cancer survivors receive optimal oncology and primary care.

  2. Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review

    Science.gov (United States)

    Dellefield, Mary Ellen

    2006-01-01

    Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…

  3. Care plan for prediabetic patients

    Directory of Open Access Journals (Sweden)

    Marina Nieves Pino Escudero

    2013-09-01

    Full Text Available Diabetes Mellitus type 2 has a growing impact in the survival and well-being of the population. In recent years its incidence has progressively increased at an alarming rate. However, there are some modifiable risks factors directly related with life styles. Nurse plays a fundamental role in the identification of such factors as well as promoting healthy habits for the prevention of the Diabetes Mellitus type 2.This works presents a standardized care plan for prediabetic state, for this, it had been used the NANDA, NOC, NIC classifications.

  4. Nursing care plan standardized breastfeeding

    Directory of Open Access Journals (Sweden)

    Susana de la Flor Picado

    2013-01-01

    Full Text Available The superiority of human milk in feeding the human infant is incontestable. Breastmilk is a living food can´t be copied and is supported by numerous arguments in support of excellence, both biological and anthropometric or economic. Despite it, has been a significant decline in this practice. Scientific advances, sociological changes and the lack f health personnel have contributed to this expense. Currently, both the WHO and UNICEF cone try relaunching excusive breastfeeding as feeding the infant until 6 months of life. Initiatives whit the Baby Friendly Hospital or the Strategic Plan for the Protection, Promotion and Support of Breastfeeding trying to promote the recognition of breastfeeding as irrefutable cornerstone for optimal growth and development of our children.Goal: Unify care criteria and actions to promote breastfeeding initiation and maintenance of the same, improving communication between professionals and between them and patients.Methodology: Care Development Plan following the NANDA taxonomies, NOC, NIC.Conclusions: Standardized work promotes decision making and performance of nursing staff to develop a happy breastfeeding.

  5. VA Health Care and Health Manpower Training Legislation. Hearing before the Subcommittee on Health and Hospitals of the Committee on Veterans' Affairs; United States Senate, Ninety-second Congress. First Session on S.2219, S.2354, S.2355, S.1924, S.2304, S.1635, S.2340, H. J. Res. 748, H. R. 481, and Related Bills.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Senate Committee on Veteran's Affairs.

    Ten legislative bills related to VA health manpower training and education and to veterans' health care were considered at this hearing. The bills concerned the following: (1) establishment of new public nonprofit medical, health profession, and allied health schools and the expansion and improvement of health manpower training programs in VA…

  6. Managed Care Plans: Getting Good Care for Your Child

    Science.gov (United States)

    ... a Pediatrician Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community Healthy Children > Family Life > Medical Home > Health Insurance > Managed Care Plans: Getting Good Care for Your Child Family ...

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

    Data.gov (United States)

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

  8. Manpower Aspects of Higher Education in India.

    Science.gov (United States)

    Khan, Qamar Uddin

    Using data from various published sources, this report reviews the growth of higher education in India over the last 30 years, analyzes employers' needs for higher education graduates since 1950, and suggests guidelines for involving educational planning with manpower planning. The author describes the growth of Indian higher education in the…

  9. Care plans and care planning in long term conditions: a conceptual model

    OpenAIRE

    Burt, J.; J. Rick; Blakeman, T; Protheroe, J; Roland, M; Bower, P.

    2013-01-01

    The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planni...

  10. [Health manpower in Mexico].

    Science.gov (United States)

    Martuscelli, J

    1986-01-01

    Population increase, rural-to-urban migration, excessive population concentration side by side with scattered rural populations, and the economic crisis provide the primary framework for this analysis of health manpower in Mexico. The secondary frame of reference is the primary causes of mortality (in 1981): the leading cause, accidents and violence; the second, heart disease; the third, influenza and pneumonia; and the fourth, enteric diseases and diarrheas. Data are supplied on the number of new physicians graduating (this number rose from 2,493 in 1976 to 14,099 in 1983), and on the number of nurses (about 98,000, of which 40% are professionals). The growth pattern of the contingent of dentists is the same as that of physicians, namely, disproportionate and inefficient. The Federal Government is now trying to set up a National Health System that will fulfill the constitutional right of all Mexican citizens to health protection. On the basis of the disequilibrium apparent in every part of the health sector, the author recommends that educational and health institutions plan and coordinate the training of physicians so that the number of graduates may meet the country's needs, and the quality of their education may be improved.

  11. The Use of Statistics on Repeaters for Educational and Manpower Planning. Lecture-Discussion Paper No. 8.

    Science.gov (United States)

    Verwey, C. T.

    Educational planners are concerned with the inflow of pupils in order to plan for adequate facilities and sufficient teachers. Statistics on repeaters, however, enable the determination of the flow of pupils through and from the educational system. Since repeaters cost educational systems double in the form of expenses for teachers and equipment,…

  12. Computerized Nursing Care Planning Utilizing Nursing Diagnosis

    OpenAIRE

    Crosley, Joan M.

    1984-01-01

    This paper presents a brief description of the beginning phase of a long term project introducing computerized nursing care planning utilizing nursing diagnoses within one nursing department. Areas for future study are proposed.

  13. Manpower management information system /MIS/

    Science.gov (United States)

    Gravette, M. C.; King, W. L.

    1971-01-01

    System of programs capable of building and maintaining data bank provides all levels of management with regular manpower evaluation reports and data source for special management exercises on manpower.

  14. Planning an ambulatory care joint venture.

    Science.gov (United States)

    Harpster, L M

    1988-01-01

    This article discusses ambulatory care joint ventures by hospitals and selected members of their medical staffs and emphasizes the resolution of problems in the early planning stages. Failure to follow an orderly and thoughtful planning process not only risks valuable resources of the venture partners, but also jeopardizes the working relationship between the hospital and its medical staff.

  15. Highlights of the Manpower Report

    Science.gov (United States)

    Manpower, 1975

    1975-01-01

    The article summarizes the 1975 Manpower Report chapters on: the employment and unemployment record; achievements and open issues of public service employment; changing role of women; CETA Progress report; Program responses to manpower needs; manpower impact of government policy and procedure; and Report of the Secretary of Health, Education, and…

  16. Physician manpower expansionism: a policy review.

    Science.gov (United States)

    Bloom, B S; Peterson, O L

    1979-02-01

    A lack of national health goals has allowed physician manpower policy to be dominated by an expansionist philosophy. Scarce resources have been channeled into the production of specialist physicians trained to provide complex and expensive care for uncommon diseases, using other scare and expensive resources and adding to the steep rise in medical care costs. Society seems to want access to primary care--a lack it views with dismay--and simultaneously fears increasing costs of care. Lack of access plus high cost might lead to rash implementation of other inappropriate policies. Success of policy decisions is pure serendipity if made without reliable and relevant information or based on inappropriate data, such as opinions alone. If information is unavailable, then physician manpower decisions should be delayed or, if made, implemented cautiously.

  17. Implicações de custo financeiro e recursos humanos em assistência odontológica no Brasil segundo o modelo escandinavo Implications in terms of costs and manpower of using the Scandinavian dental care model in Brazil

    Directory of Open Access Journals (Sweden)

    Jefferson L. Traebert

    1996-12-01

    Full Text Available Objetivou-se detectar e analisar as implicações em custos e recursos humanos em odontologia de uma hipotética aplicação dos conceitos escandinavos de atenção odontológica no Brasil. Duas sociedades foram escolhidas para serem estudadas: Suécia, país da Escandinávia, e Santa Catarina, Estado da região Sul do Brasil. A análise teórica dessas implicações foi realizada a partir da determinação das necessidades de recursos humanos em odontologia, considerando-se os altos índices de doenças bucais no Estado brasileiro. Utilizou-se o programa de software "Health Through Oral Health" da Organização Mundial da Saúde-Federação Dentária Internacional (1989. Os resultados mostraram alto custo financeiro e a necessidade de se aumentar em até 85% o recurso humano disponível para atuar em saúde bucal no Estado de Santa Catarina. Concluiu-se que os princípios de alta provisão de recursos humanos e financeiros, característicos do modelo escandinavo, não serviriam para serem adotados por Santa Catarina e, extensivamente, pelo Brasil.The implications in terms of dental manpower and costs of applying the Scandinavian system of dental care in Brazil are specified and analysed. Two societies were chosen for study: those of Sweden, in Scandinavia and Santa Catarina, State in southern Brazil. The theoretical analysis of the implications was undertaken on the basis of an estimate of dental and auxiliary manpower required to deal with the high levels of oral disease and needs (caries, teeth needing extraction, periodontal diseases and the need for full dentures in Santa Catarina. This estimate was undertaken by means of the World Health Organization-Fédération Dentaire Internationale (WHO-FDI Model "Health Through Oral Health" (1989. The implications in costs, taking the total Swedish expenditure per dentist as a basis, were calculated and applied to the manpower calles for by the WHO-FDI model. The high costs resulting showed that the

  18. Usage Analysis of a Shared Care Planning System

    OpenAIRE

    Warren, Jim; Gu, Yulong; Humphrey, Gayl

    2012-01-01

    We examined the content of electronically mediated communications in a trial of shared care planning (SCP) for long-term condition management. Software supports SCP by sharing patient records and care plans among members of the multidisciplinary care team (with patient access). Our analysis focuses on a three-month period with 73 enrolled patients, 149 provider-assigned tasks, 64 clinical notes and 48 care plans with 162 plan elements. Results show that content of notes entries is often relat...

  19. A framework for health care planning and control

    OpenAIRE

    Hans, Erwin W.; Houdenhoven, van, M.; Hulshof, Peter J.H.

    2011-01-01

    Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. Unfortunately, health care planning and control lags far behind manufacturing planning and control. Successful manufacturing planning and control concepts can not be directly copied, because of the unique nature of health care delivery. We analyze existing planning and control concepts or frameworks for health care operations management, and find that they do not properly address v...

  20. 42 CFR 441.103 - Alternate plans of care.

    Science.gov (United States)

    2010-10-01

    ... Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases § 441.103 Alternate plans of care. (a) The agency must develop alternate plans of care for each recipient age 65 or older who would... 42 Public Health 4 2010-10-01 2010-10-01 false Alternate plans of care. 441.103 Section...

  1. A Critical Review of Forecasting Models to Predict Manpower Demand

    Directory of Open Access Journals (Sweden)

    James Wong

    2012-11-01

    Full Text Available Forecasting manpower requirements has been useful for economic planners, policy makers and training providers in order to avoid the imbalance of skills in the labour market. Although reviews of the manpower planning models have been conducted previously, with the accumulated experience and the booming of advanced statistical techniques and computer programs, the study of forecasting practices has undrgone considerable changes and achieved maturity during the past decade. This paper assesses the latest employment and manpower dmand estimating methods by examining their rationale, strength and constraints. It aims to identify enhancements for further development of manpower forecasting model for the construction industry and compare the reliability and capacity of different forecasting metodologies. It is cocluded that the top-down forecasting approach is the dominant methodology to forecast occupational manpower demand. It precedes other methodologies by its dynamic nature and sensitivity to aa variety of factors affecting the level and structure of employment. Given the improvement of the data available, advanced modelling techniques and computer programs, manpower planning is likely to be more accessible with improved accuracy at every level of the society.  

  2. How to Create an Anti-Aging Skin Care Plan

    Science.gov (United States)

    ... library Find a dermatologist How to create an anti-aging skin care plan Skin care in your 40s ... Years of research supports each of these recommendations. Anti-aging skin care tips Protect your skin from the ...

  3. 42 CFR 460.106 - Plan of care.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Plan of care. 460.106 Section 460.106 Public Health... ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PACE Services § 460.106 Plan of care. (a) Basic requirement. The interdisciplinary team must promptly develop...

  4. [The child with osteogenesis imperfecta. Care plans].

    Science.gov (United States)

    Fernández Maldonado, Ana I; Gutiérrez Alonso, José Luis

    2002-06-01

    The authors state what is the nursing care to follow with a child affected by imperfect osteogenesis. This treatment is divided into three fundamental parts. In the first part, one plans out the psycho-sociological assistance the parents in question need in order to achieve their acceptance of a child suffering from a serious illness. In the second part, the authors describe the physical and psychological treatment which patients suffering imperfect osteogenesis should receive in order to avoid serious complications which can develop during their growth, treatment directed towards the family and the professional who shall care for this child. Finally in the third part, a child suffering imperfect osteogenesis shall receive the necessary knowledge and skills so that he/she can achieve maximum social integration. PMID:14508948

  5. 42 CFR 409.43 - Plan of care requirements.

    Science.gov (United States)

    2010-10-01

    ... PROGRAM HOSPITAL INSURANCE BENEFITS Home Health Services Under Hospital Insurance § 409.43 Plan of care... HHA during the 60-day episode. (2) Each review of a beneficiary's plan of care must contain the... 60-day period unless the physician documents that the interval without such care is appropriate...

  6. Medical Planning and Care in Radiation Accidents

    International Nuclear Information System (INIS)

    As part of a broad effort intended to mitigate the consequences of radiation accidents, the United States Atomic Energy Commission has developed a program to train physicians and to orient hospital staffs in the treatment of accident victims. Seminars have been conducted to date for approximately 120 physicians on medical planning and care in radiation accidents. This paper presents the scope and specific topics covered in the seminars, together with an analysis of. experience gained during development and presentation of the seminars. More recently the program has been expanded to encompass orientation of hospital administrators and other para-medical personnel on the handling and admittance of victims of radiation accidents. The latter problem is the subject of a new color film premiered at the Symposium. (author)

  7. Communicating Nursing Care Using the Health Level Seven Consolidated Clinical Document Architecture Release 2 Care Plan.

    Science.gov (United States)

    Matney, Susan A; Dolin, Gay; Buhl, Lindy; Sheide, Amy

    2016-03-01

    A care plan provides a patient, family, or community picture and outlines the care to be provided. The Health Level Seven Consolidated Clinical Document Architecture (C-CDA) Release 2 Care Plan Document is used to structure care plan data when sharing the care plan between systems and/or settings. The American Nurses Association has recommended the use of two terminologies, Logical Observation Identifiers Names and Codes (LOINC) for assessments and outcomes and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) for problems, procedures (interventions), outcomes, and observation findings within the C-CDA. This article describes C-CDA, introduces LOINC and SNOMED CT, discusses how the C-CDA Care Plan aligns with the nursing process, and illustrates how nursing care data can be structured and encoded within a C-CDA Care Plan.

  8. Careful Planning Key to Accurate Fixed Reports Assets.

    Science.gov (United States)

    MaRous, Arnold M.

    1986-01-01

    Only with careful planning can school business managers develop fixed asset information and good recordkeeping. Use of a simple inventory system and discussion with school districts already utilizing this system will assist planning. (CJH)

  9. OPTIMAL TRAINING POLICY FOR PROMOTION - STOCHASTIC MODELS OF MANPOWER SYSTEMS

    Directory of Open Access Journals (Sweden)

    V.S.S. Yadavalli

    2012-01-01

    Full Text Available In this paper, the optimal planning of manpower training programmes in a manpower system with two grades is discussed. The planning of manpower training within a given organization involves a trade-off between training costs and expected return. These planning problems are examined through models that reflect the random nature of manpower movement in two grades. To be specific, the system consists of two grades, grade 1 and grade 2. Any number of persons in grade 2 can be sent for training and after the completion of training, they will stay in grade 2 and will be given promotion as and when vacancies arise in grade 1. Vacancies arise in grade 1 only by wastage. A person in grade 1 can leave the system with probability p. Vacancies are filled with persons in grade 2 who have completed the training. It is assumed that there is a perfect passing rate and that the sizes of both grades are fixed. Assuming that the planning horizon is finite and is T, the underlying stochastic process is identified as a finite state Markov chain and using dynamic programming, a policy is evolved to determine how many persons should be sent for training at any time k so as to minimize the total expected cost for the entire planning period T.

  10. Planning the Dutch GP workforce.

    NARCIS (Netherlands)

    Batenburg, R.; Velden, L. van der; Greuningen, M. van

    2010-01-01

    CONTEXT: For a long time, shortages of health care personnel have been a major worldwide concern of health policy makers, professional bodies and patient organisations (cf. OECD, 2008). It is commonly acknowledged that manpower planning can be an important instrument to control shortages (and oversu

  11. Trained manpower resources in Brazil. Estimates and preparations

    International Nuclear Information System (INIS)

    The Brazilian nuclear programme will require by 1990 the installation of at least 10000MW(e) of nuclear power capacity, the implementation of the entire fuel cycle complex, and the creation of a reactor heavy-components manufacturing industry and of a nuclear power plant engineering capability. It has been estimated that such a programme will have to employ, up to 1985, some 7000-8000 people at the engineering and technician levels. The paper summarizes the consequent planning for preparation and qualification of manpower, which, as it involved such large numbers, required not only thorough analyses of sectoral requirements but also careful consideration of depletion rates and losses during the training process. Taking this into account, the Universities and Technical Schools will need to graduate, on average, 450 additional engineers and 550 additional technicians per year during the next ten years. For this purpose, the maximum use of the existing educational system in Brazil will avoid excessive reliance on external sources and will strengthen the local infrastructure. Crash specialization courses have been developed, in conjunction with the Universities, to comply specifically with the requirements of the nuclear programme. Only when no industrial experience can be provided in the country is on-the-job training in foreign firms considered. Training of nuclear power plant operators is also to be a local activity. An Operators Training Centre, by using a plant simulator, is being implemented with a scheduled operational date in the early 1980s. To implement the nuclear manpower programme, the Comissao Nacional de Energia Nuclear has been given the task of promoting and co-ordinating the nuclear academic education, while Empresas Nucleares Brasileiras SA is responsible for specialization and training of personnel in nuclear technology. (author)

  12. Multidisciplinary care planning in the primary care management of completed stroke: a systematic review

    Directory of Open Access Journals (Sweden)

    Erikssen Lars

    2008-08-01

    Full Text Available Abstract Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006, Cochrane Library (Issue 1 2006, and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1 a multi-disciplinary primary care team or 2 through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact

  13. Models for Designing Long-Term Care Service Plans and Care Programs for Older People

    OpenAIRE

    Shogo Kato; Satoko Tsuru; Yoshinori Iizuka

    2013-01-01

    The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans a...

  14. Advance care planning: thinking ahead to achieve our patients' goals.

    Science.gov (United States)

    Cairns, Rosemary

    2011-09-01

    The End of Life Care Strategy for England describes advance care planning (ACP) as a 'voluntary process of discussion about future care...concerns and wishes...values or personal goals for care, their understanding of their illness and prognosis...wishes for types of care or treatment and the availability of these' (Department of Health (DH), 2008). In Scotland, Living and Dying Well: Building on Progress (Scottish Government (SG), 2011) referred to adopting a 'thinking ahead' philosophy.

  15. My Cancer Care Plan as a Web-Solution.

    Science.gov (United States)

    Westman, Bodil; Cornelius, Birgitta

    2016-01-01

    The Swedish National Cancerplan states that patients should be offered an Individual Care Plan (ICP) for the treatment and survivorship care and rehabilitation planning. As there is no web-solution for ICP available, the project aim is to develop a non-commercial web-solution based on communication between the contact nurse and the patient. PMID:27332410

  16. Abbreviated Pandemic Influenza Planning Template for Primary Care Offices

    Energy Technology Data Exchange (ETDEWEB)

    HCTT CHE

    2010-01-01

    The Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices is intended to assist primary care providers and office managers with preparing their offices for quickly putting a plan in place to handle an increase in patient calls and visits, whether during the 2009-2010 influenza season or future influenza seasons.

  17. Advance care planning in South Korea: Social work perspective.

    Science.gov (United States)

    Kwon, Sung Ae; Kolomer, Stacey

    2016-08-01

    As ethical issues arise concerning the continuation of futile medical treatment for dying patients in Korean society, advance directive planning initiatives have been put into place to guide practice. This article describes the awareness and attitudes of social workers in Korea regarding advance care planning and related factors. A total of 246 gerontological/geriatric social workers completed a mailed or in-person survey regarding awareness and attitudes toward advance care planning. Seventy-three percent (n = 180) of the participants reported no knowledge of advance directives. Social workers who emphasized self-determination as a professional value, professed a preference for hospice care, and who were comfortable discussing death were more likely to have a positive attitudes toward advance care planning. This study reinforces the need for the infusion of advance care planning and end-of-life training in social work education in Korea. PMID:27428654

  18. Manpower Division Looks at CETA

    Science.gov (United States)

    American Vocational Journal, 1977

    1977-01-01

    The Manpower Division at the American Vocational Association (AVA) convention in Houston was concerned about youth unemployment and about the Comprehensive Employment and Training Act (CETA)--its problems and possibilities. The panel discussion reported here reveals some differing perspectives and a general consensus--that to improve their role in…

  19. Social Marketing: Planning Before Conceiving Preconception Care

    OpenAIRE

    E. Prue, Christine; Daniel, Katherine Lyon

    2006-01-01

    Social marketing approaches can help to shape the formation of and to create demand for preconception care services. This article describes four components of social marketing, often referred to as the 4 P’s, that should be carefully researched and set in place before a national effort to launch and sustain preconception care services is pursued. First, the product or package of services must be defined and adapted using the latest in scientific and health care standards and must be based on ...

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

    Science.gov (United States)

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

    2016-01-01

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

  1. Managing Health Care After Cancer Treatment: A Wellness Plan

    OpenAIRE

    Moye, Jennifer; Langdon, Maura; Jones, Janice M.; Haggstrom, David; Naik, Aanand D.

    2014-01-01

    Many patients and health care providers lack awareness of both the existence of, and treatments for, lingering distress and disability after treatment. A cancer survivorship wellness plan can help ensure that any referral needs for psychosocial and other restorative care after cancer treatment are identified.

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

    Science.gov (United States)

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

    2016-01-01

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

  3. Quality of Care in Family Planning Program in China

    Institute of Scientific and Technical Information of China (English)

    Zhen-ming XIE; Hong-yan LIU

    2006-01-01

    Objective To sum up the theory of quality care according to the experience of F.P. program in China.Methods The author summarized the QOC theory and draw on its experiences and strength in family planning program in China.Results The theory facilitated the earnest program of the population and family planning program during the tenth five-year plan period, benefited the realization of the innovation of system and mechanism in population and family planning work, and the creation of a nice population environment for the healthy social and economic development in China.Conclusion The development of QOC has displayed a conspicuous theory in China's family planning program.

  4. Advance Care Planning: Medical Issues to Consider

    Science.gov (United States)

    ... cancer or end stage chronic illness accompanied by anorexia (lack of appetite) and cachexia (muscles wasting away ... care and administrative program support. Share this: Twitter Facebook Google Search for: Choosing a Hospice: 16 Questions ...

  5. Action Planning for Daily Mouth Care in Long-Term Care: The Brushing Up on Mouth Care Project

    Directory of Open Access Journals (Sweden)

    Mary E. McNally

    2012-01-01

    Full Text Available Research focusing on the introduction of daily mouth care programs for dependent older adults in long-term care has met with limited success. There is a need for greater awareness about the importance of oral health, more education for those providing oral care, and organizational structures that provide policy and administrative support for daily mouth care. The purpose of this paper is to describe the establishment of an oral care action plan for long-term care using an interdisciplinary collaborative approach. Methods. Elements of a program planning cycle that includes assessment, planning, implementation, and evaluation guided this work and are described in this paper. Findings associated with assessment and planning are detailed. Assessment involved exploration of internal and external factors influencing oral care in long-term care and included document review, focus groups and one-on-one interviews with end-users. The planning phase brought care providers, stakeholders, and researchers together to design a set of actions to integrate oral care into the organizational policy and practice of the research settings. Findings. The establishment of a meaningful and productive collaboration was beneficial for developing realistic goals, understanding context and institutional culture, creating actions suitable and applicable for end-users, and laying a foundation for broader networking with relevant stakeholders and health policy makers.

  6. Careful telemedicine planning limits costly liability exposure.

    Science.gov (United States)

    Edelstein, S A

    1999-12-01

    Recent Federal and state legislation and new payment opportunities from Medicare, Medicaid, and private payers may make it possible to offer telemedicine as a viable, cost-effective alternative to traditional care delivery in communities where access to health care is limited. Originally, nonexistent payment and expensive technology held back telemedicine but, these barriers are giving way to specific applications that can yield dramatic cost savings for group practices in the delivery of medical care while adding features and benefits not typically available in traditional delivery settings. Before joining a telemedicine network, group practices need to negotiate a variety of legal issues related to the corporate practice of medicine, patient confidentiality and privacy, malpractice, informed consent, licensure and credentialing, intellectual property, Medicare and Medicaid payment, fraud and abuse, medical device regulation, and antitrust.

  7. Models for Designing Long-Term Care Service Plans and Care Programs for Older People

    Directory of Open Access Journals (Sweden)

    Shogo Kato

    2013-01-01

    Full Text Available The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans and care programs has not been established yet. In this paper, we propose models for designing long-term care service plans and care programs for older people, both by incorporating the technical issues from previous studies and by redesigning the total methodology according to these studies. Our implementation model consists of “Function,” “Knowledge Structure,” and “Action Flow.” In addition, we developed the concrete knowledgebases based on the Knowledge Structure by visualizing, summarizing, and structuring the inherent knowledge of healthcare/welfare professionals. As the results of the workshop and retrospective verification, the adequacy of the models was suggested, while some further issues were pointed. Our models, knowledgebases, and application make it possible to ensure the quality of long-term care for older people.

  8. Impact of advance care planning on the care of patients with heart failure: study protocol for a randomized controlled trial

    OpenAIRE

    Malhotra, Chetna; Sim, David Kheng Leng; Jaufeerally, Fazlur; Vikas, Nivedita Nadkarni; Sim, Genevieve Wong Cheng; Tan, Boon Cheng; Ng, Clarice Shu Hwa; Tho, Pei Leng; Lim, Jingfen; Chuang, Claire Ya-Ting; Fong, Florence Hui Mei; Liu, Joy; Finkelstein, Eric A.

    2016-01-01

    Background Despite the promise and popularity of advance care planning, there is insufficient evidence that advance care planning helps patients to meet their end-of-life care preferences, especially in Asian settings. Thus, the proposed study aims to assess whether patients with advanced heart failure who are receiving advance care planning have a greater likelihood of receiving end-of-life care consistent with their preferences compared to patients receiving usual care. Secondary objectives...

  9. IAEA activities in manpower development for nuclear power - moving to meet challenges

    International Nuclear Information System (INIS)

    Need for excellence in human performance in all activities involved in nuclear power - The challenge of providing qualified manpower when required - Planning and preparing nuclear power programmes and projects - Design, construction and commissioning of nuclear power plants - Operation and maintenance, plant performance - Safe, reliable and economic operation - the national manpower development effort - Role of foreign assistance and of the IAEA - The Agency's comprehensive programme, objectives, means - Experience - Training courses, guidebooks, standards - Current trends - Examples. (orig.)

  10. Health Care Consumerism: Lessons My 401(k) Plan Taught Me.

    Science.gov (United States)

    Steinberg, Allen T

    2015-01-01

    Changes to the U.S. health care system are here. As we think about how individuals will pay for health care--while actively employed and while retired--our experiences with 401(k) plans provide some valuable lessons. In order to support employees in this new health care world--a challenge arguably more daunting than the 401(k) challenge we faced 20 years ago--some very different types of support are needed. Employers should consider providing their employees with the resources to manage health care changes. PMID:26666089

  11. Health Care Consumerism: Lessons My 401(k) Plan Taught Me.

    Science.gov (United States)

    Steinberg, Allen T

    2015-01-01

    Changes to the U.S. health care system are here. As we think about how individuals will pay for health care--while actively employed and while retired--our experiences with 401(k) plans provide some valuable lessons. In order to support employees in this new health care world--a challenge arguably more daunting than the 401(k) challenge we faced 20 years ago--some very different types of support are needed. Employers should consider providing their employees with the resources to manage health care changes.

  12. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    Science.gov (United States)

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population.

  13. Alzheimer's disease care management plan: maximizing patient care.

    Science.gov (United States)

    Treinkman, Anna

    2005-03-01

    Nurse practitioners have the potential to significantly impact the care of patients with dementia. Healthcare providers can now offer patients medications that will control symptoms and prolong functioning. As a result of ongoing contact with patients, NPs play an important role in assessing and screening patients for AD and educating the patients, families, and caregivers about the disease. Alzheimer's disease is a chronic, progressive illness that requires long-term management. Nurse practitioners should be familiar with available medications and appreciate the need to individualize therapy to maximize efficacy and minimize potential adverse drug reactions.

  14. Strategic Facilities Planning: A Focus On Health Care

    Directory of Open Access Journals (Sweden)

    Ellen D. Hoadley

    2011-01-01

    Full Text Available Turbulent market conditions have forced the health care sector to re-examine its business and operational practices.  Health care has become increasingly complex as decisions and planning are reframed in light of the current lagging economy, an increased demand for services, new global competition, and impending legislation reform.  The stress is felt most keenly within the nation’s hospitals and consortia of health care facilities.  Facility planning decisions are no exception.  Hospital administrators are abandoning the once commonplace rules governing aging infrastructure renovations.  Instead, administrators are basing decisions within their respective strategic context and are attempting to align buildings, services, personnel, and technology to an overall plan that looks at markets, operations, and finances as resources for competitive advantage.  This paper reviews the strategic facilities planning literature and applies those best practices which support this organizational alignment for health care.  An application in the mid-Atlantic demonstrates that hospital facilities, by design, need to support the current and future needs of health care delivery systems, while dated structures impede industry advances.  Health care infrastructure improvements must proactively address technological, regulatory, and financial changes facing the sector.

  15. Homecare Nurses' Decision-Making During Admission Care Planning.

    Science.gov (United States)

    Sockolow, Paulina; Bass, Ellen J; Eberle, Carl L; Bowles, Kathryn H

    2016-01-01

    The re-hospitalization rate of homecare patients within 60 days of hospital discharge is 30%. Enhanced care planning based on better information may reduce this rate. However, very little is known about the homecare admission and care planning processes. The research team collected data during observations of three nursing visits to admit homecare patients in Camden NJ, and conducted thematic content analysis on these data. Human factors methods helped to identify nurse decision-making related to selection of the plan of care problems, non-nursing resources, and the nursing visit pattern. They identified how the electronic health record (EHR) assisted the nurse in visit pattern frequency decisions. Major themes that emerged included reduced efficiency due to use of redundant intra-team communication methods to augment EHR documentation, redundant documentation, and workarounds and reorganization of clinical workflow. PMID:27332156

  16. Homecare Nurses' Decision-Making During Admission Care Planning.

    Science.gov (United States)

    Sockolow, Paulina; Bass, Ellen J; Eberle, Carl L; Bowles, Kathryn H

    2016-01-01

    The re-hospitalization rate of homecare patients within 60 days of hospital discharge is 30%. Enhanced care planning based on better information may reduce this rate. However, very little is known about the homecare admission and care planning processes. The research team collected data during observations of three nursing visits to admit homecare patients in Camden NJ, and conducted thematic content analysis on these data. Human factors methods helped to identify nurse decision-making related to selection of the plan of care problems, non-nursing resources, and the nursing visit pattern. They identified how the electronic health record (EHR) assisted the nurse in visit pattern frequency decisions. Major themes that emerged included reduced efficiency due to use of redundant intra-team communication methods to augment EHR documentation, redundant documentation, and workarounds and reorganization of clinical workflow.

  17. Solving the Puzzle of Child Care: Report of the Cuyahoga County Child Day Care Planning Project.

    Science.gov (United States)

    Child Day Care Planning Project, Cleveland, OH.

    This report describes the Child Day Care Planning Project, which was developed by private and public representatives to meet the needs for child care in Cuyahoga County, Ohio. The project consisted of five major components. The first component, the Data Project, documented the needs and resources of the community. The second component, the Quality…

  18. Exploring the usefulness of comprehensive care plans for children with medical complexity (CMC: a qualitative study

    Directory of Open Access Journals (Sweden)

    Adams Sherri

    2013-01-01

    Full Text Available Abstract Background The Medical Home model recommends that Children with Special Health Care Needs (CSHCN receive a medical care plan, outlining the child’s major medical issues and care needs to assist with care coordination. While care plans are a primary component of effective care coordination, the creation and maintenance of care plans is time, labor, and cost intensive, and the desired content of the care plan has not been studied. The purpose of this qualitative study was to understand the usefulness and desired content of comprehensive care plans by exploring the perceptions of parents and health care providers (HCPs of children with medical complexity (CMC. Methods This qualitative study utilized in-depth semi-structured interviews and focus groups. HCPs (n = 15 and parents (n = 15 of CMC who had all used a comprehensive care plan were recruited from a tertiary pediatric academic health sciences center. Themes were identified through grounded theory analysis of interview and focus group data. Results A multi-dimensional model of perceived care plan usefulness emerged. The model highlights three integral aspects of the care plan: care plan characteristics, activating factors and perceived outcomes of using a care plan. Care plans were perceived as a useful tool that centralized and focused the care of the child. Care plans were reported to flatten the hierarchical relationship between HCPs and parents, resulting in enhanced reciprocal information exchange and strengthened relationships. Participants expressed that a standardized template that is family-centered and includes content relevant to both the medical and social needs of the child is beneficial when integrated into overall care planning and delivery for CMC. Conclusions Care plans are perceived to be a useful tool to both health care providers and parents of CMC. These findings inform the utility and development of a comprehensive care plan template as well as a model of how

  19. Marketing a managed care plan: achieving product differentiation.

    Science.gov (United States)

    Romeo, N C

    1996-01-01

    The health care marketplace is changing dramatically, even without federal reform measures. This is a volatile, yet promising, time to market a managed care plan. Before marketing the product, it is critical that the competition is thoroughly evaluated and consumer and employer needs are researched. The final product should be distinguishable from the competition and address market needs. Promotion can then begin, utilizing a proactive public relations and advertising campaign in addition to traditional methods of marketing.

  20. Reliability of an Interactive Computer Program for Advance Care Planning

    OpenAIRE

    Schubart, Jane R.; Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J.

    2012-01-01

    Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demon...

  1. Changing workforce demographics necessitates succession planning in health care.

    Science.gov (United States)

    Collins, Sandra K; Collins, Kevin S

    2007-01-01

    Health care organizations continue to be plagued by labor shortage issues. Further complicating the already existing workforce challenges is an aging population poised to retire en masse within the next few years. With fewer cohorts in the age group of 25 to 44 years (Vital Speeches Day. 2004:71:23-27), a more mobile workforce (Grow Your Own Leaders: How to Identify, Develop, and Retain Leadership Talent, 2002), and an overall reduction in the number of individuals seeking employment in the health care field (J Healthc Manag. 2003:48:6-11), the industry could be faced with an unmanageable number of vacant positions throughout the organization. Bracing for the potential impact of these issues is crucial to the ongoing business continuity of health care organization. Many health care organizations have embraced succession planning to combat the potential labor famine. However, the health care industry as a whole seems to lag behind other industries in terms of succession planning efforts (Healthc Financ Manage. 2005;59:64-67). This article seeks to provide health care managers with a framework for improving the systematic preparation of the next generation of managers by analyzing the succession planning process. The proposition of these models is to initiate and simplify the gap reduction between theoretical concepts and future organizational application.

  2. Changing workforce demographics necessitates succession planning in health care.

    Science.gov (United States)

    Collins, Sandra K; Collins, Kevin S

    2007-01-01

    Health care organizations continue to be plagued by labor shortage issues. Further complicating the already existing workforce challenges is an aging population poised to retire en masse within the next few years. With fewer cohorts in the age group of 25 to 44 years (Vital Speeches Day. 2004:71:23-27), a more mobile workforce (Grow Your Own Leaders: How to Identify, Develop, and Retain Leadership Talent, 2002), and an overall reduction in the number of individuals seeking employment in the health care field (J Healthc Manag. 2003:48:6-11), the industry could be faced with an unmanageable number of vacant positions throughout the organization. Bracing for the potential impact of these issues is crucial to the ongoing business continuity of health care organization. Many health care organizations have embraced succession planning to combat the potential labor famine. However, the health care industry as a whole seems to lag behind other industries in terms of succession planning efforts (Healthc Financ Manage. 2005;59:64-67). This article seeks to provide health care managers with a framework for improving the systematic preparation of the next generation of managers by analyzing the succession planning process. The proposition of these models is to initiate and simplify the gap reduction between theoretical concepts and future organizational application. PMID:17992105

  3. Mass mobilisation for a realistic manpower plan

    CERN Multimedia

    Association du personnel

    2007-01-01

    The CERN staff turned out in force on Thursday to sign the Staff Association petition. The staff showed in a responsible manner its desire to keep staff numbers at a vital level to guarantee the future of the Organization.

  4. Optimal Manpower Recruitment and Dismissal Decision for Single-type Job

    Institute of Scientific and Technical Information of China (English)

    XudongLi; FengshengTu; YongjianLi; XiaoqiangCai

    2004-01-01

    We consider a manpower planning problem with single employee type over a long planning horizon and analyze the optimal recruitment and dismissal polices. Dynamic demands for manpower must be fulfilled by allocating enough number of employees. Costs for every employee include salary, recruitment and dismissal costs, in particular, setup costs when recruitment/dismissal activities occur. We formulate the problem as a multi-period decision model. Then we analyze properties of the problem and give an improved dynamic programming algorithm to minimize the total cost over the entire planning horizon. We report computational results to illustrate the effectiveness of the approach.

  5. Understanding the Context for Long-Term Care Planning.

    Science.gov (United States)

    Broyles, Ila H; Sperber, Nina R; Voils, Corrine I; Konetzka, R Tamara; Coe, Norma B; Van Houtven, Courtney Harold

    2016-06-01

    Evolving family structure and economic conditions may affect individuals' ability and willingness to plan for future long-term care (LTC) needs. We applied life course constructs to analyze focus group data from a study of family decision making about LTC insurance. Participants described how past exposure to caregiving motivated them to engage in LTC planning; in contrast, child rearing discouraged LTC planning. Perceived institutional and economic instability drove individuals to regard financial LTC planning as either a wise precaution or another risk. Perceived economic instability also shaped opinions that adult children are ill-equipped to support parents' LTC. Despite concerns about viability of social insurance programs, some participants described strategies to maximize gains from them. Changing norms around aging and family roles also affected expectations of an active older age, innovative LTC options, and limitations to adult children's involvement. Understanding life course context can inform policy efforts to encourage LTC planning.

  6. Replacement-ready? Succession planning tops health care administrators' priorities.

    Science.gov (United States)

    Husting, P M; Alderman, M

    2001-09-01

    Nurses' increasing age coupled with health care's rapidly changing environment moves succession planning, originally only a business sector tool, to a top administrative priority. Through active support of your facility's executive leadership and a clear linkage to long range organization objectives, you can implement this progressive procedure.

  7. Evidence Based Order Sets as a Nursing Care Planning System

    OpenAIRE

    LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria

    2002-01-01

    The process for developing the nursing care planning (NCP) function for integration into a clinical information system (CIS) will be described. This NCP system uses evidence based order sets or interventions that are specific to a problem with associated patient focused goals or outcomes. The problem, order set, goal framework will eventually be used by all disciplines in the patient focused record.

  8. Planning health care for patients with Graves’ orbitopathy

    NARCIS (Netherlands)

    Sasim, I.V.; Berendschot, T.T.J.M.; Isterdael, C. van; Mourits, M.P.

    2008-01-01

    Background: To describe disease parameters of patients with Graves’ orbitopathy in a tertiary referral center in order to plan health care resource allocations. To investigate whether the clinical activity and/or the severity of the disease can be used as a predictor of the duration of treatment. Me

  9. Marketing health care to employees: the structure of employee health care plan satisfaction.

    Science.gov (United States)

    Mascarenhas, O A

    1993-01-01

    Providing cost-contained comprehensive quality health care to maintain healthy and productive employees is a challenging problem for all employers. Using a representative panel of metropolitan employees, the author investigates the internal and external structure of employee satisfaction with company-sponsored health care plans. Employee satisfaction is differentiated into four meaningful groups of health care benefits, whereas its external structure is supported by the traditional satisfaction paradigms of expectation-disconfirmation, attribution, and equity. Despite negative disconfirmation, employees register sufficiently high health care satisfaction levels, which suggests some useful strategies that employers may consider implementing.

  10. Planning parenthood: Health care providers' perspectives on pregnancy intention, readiness, and family planning.

    Science.gov (United States)

    Stevens, Lindsay M

    2015-08-01

    A major health care goal in the United States is increasing the proportion of pregnancies that are planned. While many studies examine family planning from the perspective of individual women or couples, few investigate the perceptions and practices of health care providers, who are gatekeepers to medicalized fertility control. In this paper, I draw on 24 in-depth interviews with providers to investigate how they interpret and enact the objective to "plan parenthood" and analyze their perspectives in the context of broader discourses about reproduction, family planning, and motherhood. Interviews reveal two central discourses: one defines pregnancy planning as an individual choice, that is as patients setting their own pregnancy intentions; the second incorporates normative expectations about what it means to be ready to have a baby that exclude poor, single, and young women. In the latter discourse, planning is a broader process of achieving middle-class life markers like a long-term relationship, a good job, and financial stability, before having children. Especially illuminating are cases where a patient's pregnancy intention and the normative expectations of "readiness" do not align. With these, I demonstrate that providers may prioritize normative notions of readiness over a patient's own intentions. I argue that these negotiations of intention and readiness reflect broader tensions in family planning and demonstrate that at times the seemingly neutral notion of "planned parenthood" can mask a source of stratification in reproductive health care. PMID:26151389

  11. Manpower training and development for nuclear power

    International Nuclear Information System (INIS)

    Determination of the manpower required for implementation of a nuclear programme is a very important factor from the national viewpoint, as it is drawn from many sectors of industry. The author provides a case-study of manpower requirements in France. He is in favour of the establishment of a manpower programme within the educational system, involving schools and universities since technicians and engineers have an important role to play throughout the different stages of a nuclear programme. In this context, he describes the IAEA contribution to acquisition of know-how by means of training courses for developing countries. (NEA)

  12. Current status of SMPRs and manpower development for nuclear power

    International Nuclear Information System (INIS)

    The development of SMPRs could make it possible for countries with small electrical grids to use nuclear power. SMPRs are still in the developing stages and none of them have the capability of good plant performance. Most of the SMPRs are in the 300 MWe range and a grid capacity of at least 2000 MWe would be required before such a power plant can be connected to the grid. There is a possibility that SMPRs could generate electricity cheaper coal plants requiring desulphurization. An unexpected increase in coal price and adverse environmental effects could make it necessary to use nuclear power in the future. Qualified manpower is required to plan, build and properly operate a nuclear power plant; and the availability of qualified manpower is a pre-condition for deciding to use nuclear power. There is a possibility that Sri Lanka would be able to use nuclear power in the next 15-20 years and a total dependence upon foreign expertise is neither possible nor desirable. Therefore pre-project activities should be considering such things as teaching nuclear science and engineering in the universities and retraining existing professionals, say from the coal power industry. Adequate emphasis must be given to manpower development and to the need to scheduling this development

  13. Continuity of Care: Sharing the Medication Treatment Plan.

    Science.gov (United States)

    Spahni, Stéphane

    2016-01-01

    The shared medication treatment plan is a key element for supporting the continuity of care. Indeed a substantial amount of emergency hospitalization is linked to medication - 5% to 10% according to some studies. Methods and tools helping all healthcare providers to have a better knowledge of the complete medication plan are therefore required in order to limit side effects linked to an insufficient knowledge of what the patient is taking. The workshop intends to present various initiatives and open the discussion about the limits, pros and cons of various initiatives. PMID:27332315

  14. Manpower development in Africa and the regional manpower development project RAF/0/003. Special evaluation

    International Nuclear Information System (INIS)

    At the start of the Agency's technical co-operation activities in 1958, many of its developing Member States were just embarking on nuclear activities. To make basic nuclear training available for these countries became the first concern of the Agency and initially fellowships constituted more than 80% of the assistance provided. During the 1960s, while the programmes' expert and equipment components grew steadily, fellowships still represented more than 50% of the assistance provided to individual Member States. As counterpart institutions slowly build up small cadres of qualified staff, the share of training in the Agency's programme of technical co-operation became less dominant and, by 1986, only 22% of the funds spent on country programmes were devoted to fellowships. In the Africa region, where the share of fellowship training provided to individual Member States had dropped even below the 20% mark, and where the participation in group training events was the lowest of any region, this was having serious consequences on manpower development, as was pointed out in two separate evaluations. At least some opportunities exist in about 60% of the countries in the region for training in selected areas of nuclear science and technology, but only 20% of the countries provide training up to the MSc/PhD level. The number of trainees in nuclear science and technology graduating each year from national institutions is very small and cannot be considered adequate to satisfy existing manpower needs of the country concerned and of the region as a whole. Very few - if any - opportunities for nuclear training abroad are available for candidates from the region other than those funded by the Agency. There is very little awareness at the national level as to the actual training needs in the nuclear field in most countries of the region, underlining the importance of the role of the Agency, not only as a provider of training, but also as an adviser on assessing training needs at

  15. Care planning and decision-making in teams in Swedish elderly care: a study of interprofessional collaboration and professional boundaries.

    Science.gov (United States)

    Duner, Anna

    2013-05-01

    In front-line practice, joint working between different professionals in health/social care and rehabilitation is regarded as a means to reach a comprehensive assessment of the needs of the older care recipients, leading to decisions on appropriate care and services. The aim of this study was to examine professional collaboration and professional boundaries in interprofessional care planning teams. Two different care planning teams were studied, one performing care planning in the homes of older individuals and the other performing care planning for older people in hospital wards. The empirical data consisted of audio-recorded care planning meetings and interviews with the professionals in the teams. The integration between the professionals involved was most noticeable in the investigation and assessment phase, while it was lower in the planning phase and almost non-existent in decision-making. The home care planning team tended to work in a more integrated manner than the discharge planning team. The importance of clarifying the roles of all professions concerned with needs assessment and care planning for older people became evident in this study. PMID:23343434

  16. China's Experience of Quality Care in Family Planning

    Institute of Scientific and Technical Information of China (English)

    Er-sheng GAO; Wei YUAN; Ning LIU

    2006-01-01

    Objective To evaluate and overview the experience of quality care of family planning of China.Methods The framework of quality care of China was summarized and analyzed, that was clients, technology and management triangle program system.Results The 8 fundamental elements of quality care in China were presented:1) policy environment of QoC, 2) comprehensive services, 3) choice of method, 4) IEC to policy-makers and providers, 5) technical competence, 6) interpersonal communications, 7) institutional guideline and regulation, 8) appropriate constellation of service.Conclusion FP sectors should prepare different constellations of service to meet their individual reproductive health need for different clients and develop institutional guideline and regulation for FP service to follow up in practice. QoC should be a kind of standardized service process.

  17. 42 CFR 456.481 - Admission certification and plan of care.

    Science.gov (United States)

    2010-10-01

    ... Individuals Under Age 21: Admission and Plan of Care Requirements § 456.481 Admission certification and plan of care. If a facility provides inpatient psychiatric services to a recipient under age 21— (a) The... 42 Public Health 4 2010-10-01 2010-10-01 false Admission certification and plan of care....

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

    OpenAIRE

    Kimberly Ramsbottom; Mary Lou Kelley

    2014-01-01

    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...

  19. Cost accounting, management control, and planning in health care.

    Science.gov (United States)

    Siegrist, R B; Blish, C S

    1988-02-01

    Advantages and pharmacy applications of computerized hospital management-control and planning systems are described. Hospitals must define their product lines; patient cases, not tests or procedures, are the end product. Management involves operational control, management control, and strategic planning. Operational control deals with day-to-day management on the task level. Management control involves ensuring that managers use resources effectively and efficiently to accomplish the organization's objectives. Management control includes both control of unit costs of intermediate products, which are procedures and services used to treat patients and are managed by hospital department heads, and control of intermediate product use per case (managed by the clinician). Information from the operation and management levels feeds into the strategic plan; conversely, the management level controls the plan and the operational level carries it out. In the system developed at New England Medical Center, Boston, Massachusetts, the intermediate product-management system enables managers to identify intermediate products, develop standard costs, simulate changes in departmental costs, and perform variance analysis. The end-product management system creates a patient-level data-base, identifies end products (patient-care groupings), develops standard resource protocols, models alternative assumptions, performs variance analysis, and provides concurrent reporting. Examples are given of pharmacy managers' use of such systems to answer questions in the areas of product costing, product pricing, variance analysis, productivity monitoring, flexible budgeting, modeling and planning, and comparative analysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3284338

  20. Cohort effects on the need for health care and implications for health care planning in Canada.

    Science.gov (United States)

    Whittaker, William; Birch, Stephen; MacKenzie, Adrian; Murphy, Gail Tomblin

    2016-01-01

    The sustainability of publicly funded health care systems is an issue for governments around the world. The economic climate limits governments' fiscal capacity to continue to devote an increasing share of public funds to health care. Meanwhile the demands for health care within populations continue to increase. Planning the future requirements for health care is typically based on applying current levels of health service use by age to demographic projections of the population. But changes in age-specific levels of health over time would undermine this 'constant use by age' assumption. We use representative Canadian survey data (Canadian Community Health Survey) covering the period 2001-2012, to identify the separate trends in demography (population ageing) and epidemiology (population health) on self-reported health. We propose an approach to estimating future health care requirements that incorporates cohort trends in health. Overall health care requirements for the population increase as the size and mean age of the population increase, but these effects are mitigated by cohort trends in health-we find the estimated need for health care is lower when models account for cohort effects in addition to age effects. PMID:26586614

  1. Developing a promotion plan for health care marketing.

    Science.gov (United States)

    Hallums, A

    1994-07-01

    Promotion of a health care provider's services is essential for communication with its customers and consumers. It is relevant to an organization's marketing strategy and is an element of what is described as the marketing mix. This paper considers the relationship of promotion to the marketing of services and proposes a plan for the promotion of the organization as a whole which can also be applied to an individual service or specialty. Whilst specific reference is made to an National Health Service (NHS) Trust it is also relevant to a Directly Managed Unit.

  2. Developing a promotion plan for health care marketing.

    Science.gov (United States)

    Hallums, A

    1994-07-01

    Promotion of a health care provider's services is essential for communication with its customers and consumers. It is relevant to an organization's marketing strategy and is an element of what is described as the marketing mix. This paper considers the relationship of promotion to the marketing of services and proposes a plan for the promotion of the organization as a whole which can also be applied to an individual service or specialty. Whilst specific reference is made to an National Health Service (NHS) Trust it is also relevant to a Directly Managed Unit. PMID:7952707

  3. Improving the quality of care in Chinese family planning programme.

    Science.gov (United States)

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

    1994-10-01

    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.

  4. 38 CFR 17.32 - Informed consent and advance care planning.

    Science.gov (United States)

    2010-07-01

    .... (ii) VA Durable Power of Attorney for Health Care. A written instruction on a VA form which designates... will, durable power of attorney for health care, or other advance health care planning document, the... care treatment decisions. Health care agent. An individual named by the patient in a Durable Power...

  5. An overview of the need of manpower supply for a nuclear programme

    International Nuclear Information System (INIS)

    The present paper deals with the need for trained manpower and special features of nuclear power affecting manpower requirements and gives a manpower loading schedule for the different nuclear power activities and programmes for manpower development. (orig./RW)

  6. Care of Patients at the End of Life: Advance Care Planning.

    Science.gov (United States)

    Ackermann, Richard J

    2016-08-01

    Advance directives are legal documents that give instructions about how to provide care when patients develop life-threatening illnesses and can no longer communicate their wishes. Two types of documents are widely used-a living will and a durable power of attorney for health care. Most states also authorize physician orders for life-sustaining treatment. Physicians should encourage patients, particularly those with severe chronic or terminal conditions, to prepare advance directives. Medicare now reimburses billing codes for advance care consultations. Directions regarding cardiopulmonary resuscitation and artificial ventilation often are included in advance care plans, and use of artificial nutrition and hydration (ANH) also should be addressed, particularly for patients with advanced dementia. Evidence shows that in such patients, ANH does not prolong survival, increase comfort, or improve quality of life. Given the lack of benefit, physicians should recommend against use of ANH for patients with dementia. Finally, physicians should encourage use of hospice services by patients whose life expectancy is 6 months or less. Although Medicare and most other health care insurers cover hospice care, and despite evidence that patient and family satisfaction increase when hospice services are used, many patients do not use these services. PMID:27490070

  7. Personnel Policies Forum. Survey No. 83; Effective Utilization of Manpower.

    Science.gov (United States)

    Bureau of National Affairs, Inc., Washington, DC.

    The purpose of this study was to discover what private companies are doing in the field of manpower utilization. Aspects of the subject covered by this survey are manpower audit, motivation, temporary help, handling of job changes, and the union's effect on manpower utilization. Sixty-five percent of the participating companies employ 1,000 or…

  8. Advanced Directives and Advanced Care Planning for Healthcare Professionals.

    Science.gov (United States)

    Booth, Adam T; Lehna, Carlee

    2016-01-01

    The purposes of this study were to assess healthcare professionals' need for information on advanced directives and to implement and evaluate an educational plan for change in knowledge and behaviors related to advanced directives. End-of-life (EOL) care is an important topic for patients to discuss with their families and healthcare professionals (HP). Needs assessment data were collected from healthcare providers at an urban trauma intensive care unit (ICU) in Louisville, Kentucky on concepts related to end-of-life. Next, healthcare professionals participated in an educational intervention focused on: knowledge about advanced directives; communication techniques for healthcare professionals to use with patients and their families; awareness of the patient's level of illness in advanced care planning; and specifics about living wills in Kentucky and how to complete one. Pre- and post-test data were collected to evaluate change in knowledge, capability an average of 8.7 years (SD = 9.1; range = 1.9-35 years) in healthcare and worked an average of 8.4 years (SD = 9.3; range = 4 months to 35 years) in their respective ICUs. Eighty-seven percent did not have an AD in place even though their perceived knowledge about AD remained moderate throughout pre- and post-test scores (3.3 to 3.8 on a 5 point scale, respectively). Total post-test scores revealed a 2% improvement in correct responses. These findings point to the need for education of healthcare providers in the ICU to increase early AD and ACP discussions with patients and their families. PMID:27183766

  9. Health-related quality of life and quality of care in specialized medicare-managed care plans.

    Science.gov (United States)

    Grace, Susan C; Elliott, Marc N; Giordano, Laura A; Burroughs, James N; Malinoff, Rochelle L

    2013-01-01

    Special needs plans (SNPs) were created under the Medicare Modernization Act of 2003 to focus on Medicare beneficiaries who required more coordination of care than most beneficiaries served through the Medicare Advantage program. This research indicates that beneficiaries in 3 types of SNPs show evidence of worse health-related quality of life. Special needs plans demonstrated worse plan performance on the HEDIS osteoporosis testing in older women measure compared with non-SNP Medicare Advantage beneficiaries, but better plan performance on the HEDIS fall risk management measure. Future research should consider broader measures of plan performance, quality of care, and cost.

  10. Evaluation of Cardiology Training and Manpower Requirements.

    Science.gov (United States)

    Adams, Forrest H., Ed.; Mendenhall, Robert C., Ed.

    Begun in June, 1971 and completed in October 1973, the study had the following specific goals: to define the cardiologist's role; to determine cardiology training program objectives; to determine manpower needs for cardiologists; and to determine the educational needs of cardiologists. The major information was sought from all active cardiologists…

  11. Indian manpower for mega nuclear project

    CERN Multimedia

    2003-01-01

    "India is supplying critical scientific manpower and high-tech components needed for building a Large Hadron Collider (LHC) - an accelerator used in particle physics research - a mega scientific project of the European Organisation for Nuclear Research (CERN) worth billions of dollars" (1/2 page).

  12. Yellowstone County Health Manpower and Education Profile.

    Science.gov (United States)

    Callen, John; And Others

    The profile is a concise description of the demographic and economic characteristics, existing health manpower employed, and health education programs for the Yellowstone County area of Montana, one of seven surveyed in the Mountain States region (Idaho, Montana, Wyoming, and Nevada). The first section of the profile provides general population…

  13. MANPOWER FOR CALIFORNIA HOSPITALS, 1964-1975.

    Science.gov (United States)

    California State Commission on Manpower, Automation, and Technology, Sacramento.

    AN EXAMINATION OF THE HOSPITAL AND NURSING AND CONVALESCENT HOME INDUSTRY IN 1964 AND EMPLOYMENT PROJECTIONS ARE PRESENTED AS AN INITIAL CONTRIBUTION TO THE DEVELOPMENT OF AN ONGOING MANPOWER INFORMATION PROGRAM IN THE STATE. DATA WERE COMPILED FROM POPULATION PROJECTIONS BY THE CALIFORNIA DEPARTMENT OF FINANCE, WAGE SURVEY STUDIES BY THE…

  14. Agri-Business Manpower Project Manual.

    Science.gov (United States)

    Amberson, Max L.; And Others

    A final segment of the Montana research effort on agri-business manpower, this report summarizes the methods involved in and the conclusions and recommendations resulting from a study to develop an economical, efficient, and effective method of assessing current and anticipated agri-business employment opportunities and educational needs in…

  15. Employer strategies to combat health care plan fraud.

    Science.gov (United States)

    Pflaum, B B; Rivers, J S

    1991-01-01

    Each year health care fraud drains millions of dollars from employer-sponsored health plans. Historically, employers have taken a rather tolerant view of fraud. As the pressure to manage health plan costs increases, however, many employers are beginning to see the detection and prosecution of fraud as an appropriate part of a cost management program. Fraud in medical insurance covers a wide range of activities in terms of cost and sophistication--from misrepresenting information on a claim, to billing for services never rendered, to falsifying the existence of an entire medical organization. To complicate matters, fraudulent activities can emanate from many, many sources. Perpetrators can include employees, dependents or associates of employees, providers and employees of providers--virtually anyone able to make a claim against a plan. This article addresses actions that employers can take to reduce losses from fraud. The first section suggests policy statements and administrative procedures and guidelines that can be used to discourage employee fraud. Section two addresses the most prevalent form of fraud--provider fraud. To combat provider fraud, employers should set corporate guidelines and should enlist the assistance of employees in identifying fraudulent provider activities. Section three suggests ways to improve fraud detection through the claims payment system--often the first line of defense against fraud. Finally, section four discusses the possibility of civil and criminal remedies and reviews the legal theories under which an increasing number of fraud cases have been prosecuted.

  16. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer

    Science.gov (United States)

    Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.

    2015-01-01

    Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553

  17. Written and computerized care plans. Organizational processes and effect on patient outcomes.

    Science.gov (United States)

    Daly, Jeanette M; Buckwalter, Kathleen; Maas, Meridean

    2002-09-01

    The purpose of this study was to determine how use of a standardized nomenclature for nursing diagnosis and intervention statements on the computerized nursing care plan in a long-term care (LTC) facility would affect patient outcomes, as well as organizational processes and outcomes. An experimental design was used to compare the effects of two methods of documentation: Computer care plan and paper care plan. Twenty participants (10 in each group) were randomly assigned to either group. No statistically significant differences were found by group for demographic data. Repeated measures ANOVA was computed for each of the study variables with type of care plan, written or computerized, as the independent variable. There were no statistically significant differences between participants, group (care plan), within subjects (across time), or interaction (group and time) effects for the dependent variables: Level of care, activities of daily living, perception of pain, cognitive abilities, number of medications, number of bowel medications, number of constipation episodes, weight, percent of meals eaten, and incidence of alteration in skin integrity. There were significantly more nursing interventions and activities on the computerized care plan, although this care plan took longer to develop at each of the three time periods. Results from this study suggest that use of a computerized plan of care increases the number of documented nursing activities and interventions, but further research is warranted to determine if this potential advantage can be translated into improved patient and organizational outcomes in the long-term care setting.

  18. Dental underemployment: a study of uncontrolled dental manpower immigration.

    Science.gov (United States)

    Mann, J; Gat, E; Lubliner, D; Malowanczyk, C; Shwatz, C; Zusman, S; Ela, K

    1993-08-01

    In the 1980s three studies were conducted in Israel utilising different methods of dental manpower evaluations. All identified a large future surplus of dentists. The current study re-evaluates the manpower supply and discusses possible solutions. A random sample of 800 dentists was approached by three mailings and a telephone call follow-up with a response of 49.7 per cent. Almost 90 per cent of dentists reported an undersupply of patients, with a mean working load of 26.3 hours/week, but being willing to add up to 3.4 working hours/week. The oversupply of dentists has been dramatically affected by the addition of almost 1000 dentists who emigrated to Israel in 1991-92. To prevent a significant unemployment rate among dentists and an uncontrolled free market, it is urgently suggested for the benefit of both provider and consumer that; the demand for services be increased and additional financing of dental care be made available, that the total number of dentists be decreased by various measures and that their geographical distribution be improved. If necessary limits should be placed on the number of practices or the number of patients permitted per practice. PMID:8276515

  19. [Specific care plan in different stages of Alzheimer's disease].

    Science.gov (United States)

    Hein, Christophe; Villars, Hélène; Nourhashemi, Fati

    2011-09-01

    The management and follow-up of patients with Alzheimers disease have stage-specific characteristics. In the mild stage, the key challenges are above all to improve the early diagnosis and the communication of the diagnosis. With the patient's agreement, a follow-up should be scheduled to assess, at each stage of the disease, cognitive and functional decline, and detect psycho-behavioral, nutritional or mobility complications. In the moderate or severe stages, prevention and treatment of caregiver burnout should be included in the follow-up. Finally, in the very severe stage, end of life and ethical issues should be considered. The followup and the intervention plan should be adapted to each patient, and require coordination between health care professionals and social workers. However, the practical aspects of the follow-up and the ways in which those can be improved are yet to be defined.

  20. Health care in the Yemen Arab Republic.

    Science.gov (United States)

    Lambeth, S

    1988-01-01

    The Yemen Arab Republic has health-care problems similar to other developing countries yet lacks the abundant oil reserves of its Arabian peninsula neighbors to address these problems. An ambitious 5 year health plan developed in 1977 has been impeded by a lack of material and human resources. The infant mortality rate remains one of the highest in the world, schistosomiasis drains the energy of the people, and tuberculosis and malaria remain endemic. Progress is, however, being made in health-care educational programs within Sanaa University and the Health Manpower Institutes to develop the resources of the Yemeni people to meet the health-care needs of their country. PMID:3225123

  1. The economic evidence for advance care planning: systematic review of evidence

    OpenAIRE

    Dixon, Josie; Matosevic, Tihana; Knapp, Martin

    2015-01-01

    Background: Advance care planning (ACP), a process of discussion and review concerning future care in the event of losing capacity. Aimed at improving the appropriateness and quality of care, it is also often considered a means of controlling health spending at the end of life. Aim: To review and summarise economic evidence on advance care planning. Design: A systematic review of academic literature. Data sources: We searched for English language peer-reviewed journal articles, 1990 to 201...

  2. Dx for a careful approach to moving dual-eligible beneficiaries into managed care plans.

    Science.gov (United States)

    Neuman, Patricia; Lyons, Barbara; Rentas, Jennifer; Rowland, Diane

    2012-06-01

    Policy makers are moving rapidly to develop and test reforms aimed at doing a better job of managing the costs and care for people dually eligible for Medicare and Medicaid. This commentary underscores the importance of pursuing new initiatives to address care coordination and spending concerns. It then focuses on key issues raised by proposals that would shift dual-eligible beneficiaries into managed care plans. The paper describes the heterogeneity and complexity of this population, emphasizing the need for approaches closely tied to the needs of particular subgroups of dual-eligible beneficiaries. It warns against moving too quickly, noting the time and resources required to build capacity to serve patients, secure provider networks, and develop an infrastructure for integrating and managing both Medicare and Medicaid services. The commentary cautions that optimistic savings assumptions might not materialize, raises questions about how savings will be allocated, and highlights the need for accountability as new models are being developed and tested to improve care for a population with complex needs. PMID:22665830

  3. Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

    Science.gov (United States)

    Billings, J Andrew; Bernacki, Rachelle

    2014-04-01

    Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions.

  4. CARES: Carbonaceous Aerosol and Radiative Effects Study Operations Plan

    Energy Technology Data Exchange (ETDEWEB)

    Zaveri, RA; Shaw, WJ; Cziczo, DJ

    2010-07-12

    The CARES field campaign is motivated by the scientific issues described in the CARES Science Plan. The primary objectives of this field campaign are to investigate the evolution and aging of carbonaceous aerosols and their climate-affecting properties in the urban plume of Sacramento, California, a mid-size, mid-latitude city that is located upwind of a biogenic volatile organic compound (VOC) emission region. Our basic observational strategy is to make comprehensive gas, aerosol, and meteorological measurements upwind, within, and downwind of the urban area with the DOE G-1 aircraft and at strategically located ground sites so as to study the evolution of urban aerosols as they age and mix with biogenic SOA precursors. The NASA B-200 aircraft, equipped with the High Spectral Resolution Lidar (HSRL), digital camera, and the Research Scanning Polarimeter (RSP), will be flown in coordination with the G-1 to characterize the vertical and horizontal distribution of aerosols and aerosol optical properties, and to provide the vertical context for the G-1 and ground in situ measurements.

  5. A new horizon for planning services and health care infrastructure for the elderly

    OpenAIRE

    Nauta, N.J.; Perenboom, R.J.M.; Galindo Garre, F.

    2009-01-01

    Since the devolution of capacity planning for care for the elderly in the Netherlands in 1998, no innovations on assessing health needs and on forecasting were made for planning health care services for the elderly. The introduction of Horizon in 2006, which uses needs and deficiencies instead of linear demographic planning has been warmly welcomed. The innovation is to step away from planning on the basis of policies and to forecast demands of services on the basis of actual deficiencies and...

  6. Reliability of an interactive computer program for advance care planning.

    Science.gov (United States)

    Schubart, Jane R; Levi, Benjamin H; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-06-01

    Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83-0.95, and 0.86-0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

  7. Reliability of an Interactive Computer Program for Advance Care Planning

    Science.gov (United States)

    Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-01-01

    Abstract Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83–0.95, and 0.86–0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

  8. States, Congress confront abortion services under Medicaid, health care plan.

    Science.gov (United States)

    1994-01-13

    Abortion coverage under various health care reform proposals has dominated the political reproductive rights debate, while poor women's access to abortion under Medicaid presents a current practical concern. Under the Clinton administration's proposed Health Security Act, abortion would be covered under "services for pregnant women," and Medicaid would eventually be incorporated into the national health plan. A final version is a long way off. For now, the Hyde amendment, limiting Medicaid coverage of abortion, controls the issue. Congress has made only negligible progress in freeing federal funds for Medicaid abortions: only in situations of life endangerment, rape, or incest. States are required to cover abortions that are medically necessary under the new guidelines, which now include pregnancy arising from rape and incest. The federal policy defers to state law on the definition of rape and incest, allowing for reasonable reporting or documentation requirements, while disallowing unduly burdensome regulations by allowing the treating physician reimbursement when the physician certifies that the patient was unable for physical or psychological reasons to comply with the requirement. States disagreeing with the new abortion policy immediately registered their opposition. Utah's health department, which has a "life only" law, has pledged not to implement the new federal policy until there is further clarification. The Health Care Financing Administrator responded by writing that "the decision to implement this policy nationwide was not discretionary." Congress chose not to add statutory language deferring to the states, and under U.S. Constitutional law, where state law or policy conflicts with federal law, federal law takes precedence. The next battle will certainly center on attempts to amend the Hyde amendment itself as well as health care legislation along the "states' option" lines. PMID:12345518

  9. In place of fear: aligning health care planning with system objectives to achieve financial sustainability.

    Science.gov (United States)

    Birch, Stephen; Murphy, Gail Tomblin; MacKenzie, Adrian; Cumming, Jackie

    2015-04-01

    The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase.

  10. Incorporating Age-Specific Plans of Care to Achieve Optimal Perioperative Outcomes.

    Science.gov (United States)

    Mower, Juliana

    2015-10-01

    When developing a nursing plan of care, a perioperative nurse identifies nursing diagnoses during the preoperative patient assessment. The ability to identify age-specific outcomes (ie, infant/child, adolescent, adult, elderly adult) in addition to those that are universally applicable is a major responsibility of the perioperative RN. Having an individualized plan of care is one of the best ways to determine whether desired patient outcomes have been successfully attained. Nursing care plans address intraoperative and postoperative risks and allow for a smooth transfer of care throughout the perioperative experience. A good nursing care plan also includes education for the patient and his or her caregiver. Within an overall plan of care, the use of methods such as a concept or mind map can visually demonstrate the relationships between systems, nursing diagnoses, nursing interventions, and desirable outcomes.

  11. Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity.

    Science.gov (United States)

    Lum, Hillary D; Sudore, Rebecca L

    2016-05-01

    This article provides an approach to advance care planning (ACP) and goals of care communication in older adults with cardiovascular disease and multi-morbidity. The goal of ACP is to ensure that the medical care patients receive is aligned with their values and preferences. In this article, the authors outline common benefits and challenges to ACP for older adults with cardiovascular disease and multimorbidity. Recognizing that these patients experience diverse disease trajectories and receive care in multiple health care settings, the authors provide practical steps for multidisciplinary teams to integrate ACP into brief clinic encounters.

  12. 42 CFR 485.711 - Condition of participation: Plan of care and physician involvement.

    Science.gov (United States)

    2010-10-01

    ... reviewed by a physician, or by a physical therapist or speech pathologist respectively. (a) Standard.... (1) For each patient there is a written plan of care established by the physician or by the physical therapist or speech-language pathologist who furnishes the services. (2) The plan of care for...

  13. [The combination of "Careworks" insurance plan integrated with medical and long-term care insurance].

    Science.gov (United States)

    Sumii, Hiroshi

    2006-11-01

    The social security system in Japan was greatly revolutionized when the long-term care insurance plan began in April 2000. Thus, Japan began the 21st century with two great social insurance plans, that is, medical care insurance and long-term care insurance. Each delivery system is divided: the medical care insurance plan is for the acute stage, and the long-term care is for the chronic stage. Both systems can be intended to cooperate to provide continuous care throughout life. The public health and welfare system has been trying hard to efficiently integrate the medical and long-term care insurance plans. However, it is necessary to establish a new insurance plan for ensuring the integrated adequacy of both insurance systems. One's life is destined to shift from medical care to long-term care at some point. As one ages or becomes disabled, it becomes difficult to lead an independent life with self-decision, and social support become necessary from third parties, instead of from the family or from one's own means. The society imposes the responsibility of payment of the medical and long-term care plan premiums on the individual throughout life. However, the structure of these insurance foundations should be combined under an integrated system, "Careworks", in order to also combine the concepts of length of life from the medicine and the respect of living from the long-term case to improve the social security of the life.

  14. Social Work Discharge Planning in Acute Care Hospitals in Israel: Clients' Evaluation of the Discharge Planning Process and Adequacy

    Science.gov (United States)

    Soskolne, Varda; Kaplan, Giora; Ben-Shahar, Ilana; Stanger, Varda; Auslander, Gail. K.

    2010-01-01

    Objective: To examine the associations of patients' characteristics, hospitalization factors, and the patients' or family assessment of the discharge planning process, with their evaluation of adequacy of the discharge plan. Method: A prospective study. Social workers from 11 acute care hospitals in Israel provided data on 1426 discharged…

  15. Manager's leadership is the main skill for ambulatory health care plan success.

    Science.gov (United States)

    Marin, Gustavo Horacio; Silberman, Martin; Colombo, Maria Virginia; Ozaeta, Belen; Henen, Jaime

    2015-01-01

    To demonstrate effectiveness of ambulatory health care plan implementation among institutions and variables associated with the differences observed. Randomized selection of primary health care (PHC) centers was done. Leadership ability of the plan manager was explored. Univariate/bivariate analyses were performed to observe correlation between variables. Two groups of PHC centers were established according to the efficacy of plan implementation: high and low performance. Differences between groups were observed (592%-1023% more efficacy in controls and practices; P < .001). Leadership was responsible for the main differences observed. Leadership of manager for implementation of the health care plan was the major important variable to reach the best efficacy standards.

  16. LOCATION AND PLANNING OF HEALTH CARE DELIVERY SYSTEM AT THE DISTICT LEVEL

    OpenAIRE

    Rajguru. S. A

    2015-01-01

    There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious, or other coordinate bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often e...

  17. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

    Science.gov (United States)

    2010-10-01

    ..., care planning, and coordination of services. 418.56 Section 418.56 Public Health CENTERS FOR MEDICARE... interdisciplinary group to provide coordination of care and to ensure continuous assessment of each patient's and... care. (e) Standard: Coordination of services. The hospice must develop and maintain a system...

  18. Care plan for the patient with a dependent personality disorder

    Directory of Open Access Journals (Sweden)

    Ana María Ruiz Galán

    2010-11-01

    Full Text Available Personality is unique for each individual and can be defined as the dynamic collection of characteristics relative to emotions, thought and behaviour.Personality trout’s only mean a Personality Disorder (PD when they are inflexible and maladjusted and cause notable functional deterioration or uneasiness.According to Bermudez personality is “the enduring organization of structural and functional features, innate and acquired under the special conditions of each one’s development that shape the particular and specific collection of behaviour to face different situations”.According to the Diagnostic a Statistical Manual of Mental Disorders (DSM-IV, a Personality Disorder is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the person’s culture is pervasive and an inflexible, is stable over time and leads to distress or impairment. The onset of these patterns of behaviour is the beginning of the adulthood and, in rare instances, early adolescence”.There are several types of Personality Disorders (paranoid, schizoid, borderline, antisocial, dependent…. Dependent Personality Disorder is one of the most frequent in the Mental Health Services.People who suffer from this disorder are unable to take a decision by themselves because they don’t have confidence in themselves. They need a lot of social support and affection until the point of deny their individuality by subordinating their desires to other person’s desires and permitting these persons to manage their lives. Maybe they feel desolated by separation and loss and can support any situation, even maltreatment to keep a relationship.As we a deduce this diagnosis is sensible to cultural influences. This work aims to elaborate an standarized plan of cares for the patient with Dependent Personality Disorder by using nursing Diagnosis of NANDA II, Outcomes Criteria (NOC and Interventions Criteria (NIC.

  19. THE FEASIBILITY OF A SYSTEMATIC STUDY OF MANPOWER REQUIREMENTS AND EDUCATION AND TRAINING PROGRAMS OF SELECTED HEALTH OCCUPATIONS.

    Science.gov (United States)

    POLLIARD, FORBES W.

    TO DETERMINE THE FEASIBILITY OF A STUDY, MEETINGS WERE HELD WITH GROUPS INCLUDING PATHOLOGISTS, RADIOLOGISTS, AND COMMUNITY HEALTH AND EDUCATIONAL LEADERS, 30 ADDITIONAL PERSONS CONCERNED WITH HEALTH SERVICES AND EDUCATION WERE INTERVIEWED, DISCUSSIONS WERE HELD WITH OTHER GROUPS AND INDIVIDUALS INTERESTED IN HEALTH MANPOWER RESEARCH AND PLANNING,…

  20. What's the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation.

    Science.gov (United States)

    Kiyota, Ayano; Bell, Christina L; Masaki, Kamal; Fischberg, Daniel J

    2016-08-01

    To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005-2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5-9.9, Pplan of care (aOR=11.6, 95% CI=5.6-23.9, Pplan of care and high pre-consult LOS had the highest odds of in-hospital death (aOR=36.3, 95% CI=14.9-88.5, Pplan of care and shorter pre-consult LOS (aOR=9.8, 95% CI=4.3-22.1, Pplan of care (aOR=4.7, 95% CI=1.8-12.4, P=.002). Our findings suggest that ICU patients who require assistance with plan of care need to be identified early to optimize end-of-life care and avoid in-hospital death.

  1. Strategic plan for geriatrics and extended care in the veterans health administration: background, plan, and progress to date.

    Science.gov (United States)

    Shay, Kenneth; Hyduke, Barbara; Burris, James F

    2013-04-01

    The leaders of Geriatrics and Extended Care (GEC) in the Veterans Health Administration (VHA) undertook a strategic planning process that led to approval in 2009 of a multidisciplinary, evidence-guided strategic plan. This article reviews the four goals contained in that plan and describes VHA's progress in addressing them. The goals included transforming the healthcare system to a veteran-centric approach, achieving universal access to a panel of services, ensuring that the Veterans Affair's (VA) healthcare workforce was adequately prepared to manage the needs of the growing elderly veteran population, and integrating continuous improvement into all care enhancements. There has been substantial progress in addressing all four goals. All VHA health care has undergone an extensive transformation to patient-centered care, has enriched the services it can offer caregivers of dependent veterans, and has instituted models to better integrate VA and non-VA cares and services. A range of successful models of geriatric care described in the professional literature has been adapted to VA environments to gauge suitability for broader implementation. An executive-level task force developed a three-pronged approach for enhancing the VA's geriatric workforce. The VHA's performance measurement approaches increasingly include incentives to enhance the quality of management of vulnerable elderly adults in primary care. The GEC strategic plan was intended to serve as a road map for keeping VHA aligned with an ambitious but important long-term vision for GEC services. Although no discrete set of resources was appropriated for fulfillment of the plan's recommendations, this initial report reflects substantial progress in addressing most of its goals.

  2. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Science.gov (United States)

    2010-10-01

    ... a doctor of medicine, osteopathy, or podiatric medicine. (a) Standard: Plan of care. The plan of..., plan of care, and medical supervision. 484.18 Section 484.18 Public Health CENTERS FOR MEDICARE... HEALTH SERVICES Administration § 484.18 Condition of participation: Acceptance of patients, plan of...

  3. 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

    2014-01-01

    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.

  4. 42 CFR 494.90 - Condition: Patient plan of care.

    Science.gov (United States)

    2010-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... achieve and sustain the prescribed dose of dialysis to meet a hemodialysis Kt/V of at least 1.2 and a... appropriate, timely referrals to achieve and sustain vascular access. The hemodialysis patient must...

  5. A “best practices” strategy to improve quality in Medicaid managed care plans

    OpenAIRE

    Brodsky, Karen L.; Baron, Richard J.

    2000-01-01

    Medicaid managed care is delivered through organizations operating in very heterogeneous environments that confront similar barriers to success. Because Medicaid managed care is implemented differently in each state, health plans have been isolated from each other and have not had an opportunity to learn how others may have surmounted commonly encountered barriers. After interviewing Medicaid health plan medical directors, we developed a learning collaborative model based on shared categories...

  6. [Russian Federation implementation of WHO global efforts plan on workers health care].

    Science.gov (United States)

    Izmerov, N F; Bukhtiyarov, I V; Prokopenko, L V; Shigan, E E

    2015-01-01

    The article deals with problems of implementing global WHO efforts plan on workers health care, Target program of World Labor Organization on work and occupational environment safety "For safe labor", some WLO conventions. The authors justify priority directions of governmental policy on health care for working population in Russia.

  7. Planning for a radiological emergency in health care institutions

    International Nuclear Information System (INIS)

    The possible occurrence of accidents involving sources of ionizing radiation calls for response plans to mitigate the consequences of radiological accidents. An emergency planning framework is suggested for institutions which use medical applications of ionizing radiation. Bearing in mind that the prevention of accidents is of prime importance in dealing with radioactive materials and other sources of ionizing radiation, it is recommended that emergency instructions and procedures address certain aspects of the causes of these radiological events. Issues such as identification of radiological events in medical practices and their consequences, protective measures, planning for an emergency response and maintenance of emergency capacity are considered. (author)

  8. A Review of Advance Care Planning Programs in Long-Term Care Homes: Are They Dementia Friendly?

    Directory of Open Access Journals (Sweden)

    Abigail Wickson-Griffiths

    2014-01-01

    Full Text Available Background. Persons living with dementia in the long-term care home (LTCH setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning (ACP programs that have been developed and their impact in order for LTCH settings to select a program that best suits residents’ needs. Methods. Four electronic databases were searched from 1990 to 2013, for studies that evaluated the impact of advance care planning programs implemented in the LTCH setting. Studies were critically reviewed according to rigour, impact, and the consideration of the values of residents with dementia and their family members according to the Dementia Policy Lens Toolkit. Results and Conclusion. Six ACP programs were included in the review, five of which could be considered more “dementia friendly.” The programs indicated a variety of positive impacts in the planning and provision of end-of-life care for residents and their family members, most notably, increased ACP discussion and documentation. In moving forward, it will be important to evaluate the incorporation of residents with dementia’s values when designing or implementing ACP interventions in the LTCH settings.

  9. Planning and Decision Making about the Future Care of Older Group Home Residents and Transition to Residential Aged Care

    Science.gov (United States)

    Bigby, C.; Bowers, B.; Webber, R.

    2011-01-01

    Background: Planning for future care after the death of parental caregivers and adapting disability support systems to achieve the best possible quality of life for people with intellectual disability as they age have been important issues for more than two decades. This study examined perceptions held by family members, group home staff and…

  10. Grandmother and household viability in Botswana: family planning, child care and survival in changing tswana society.

    OpenAIRE

    Ingstad B

    1989-01-01

    Examines the roles and influence of grandmothers with respect to nutrition, breastfeeding, quality of child care and family planning usage; the maternal grandmother is much more involved with grandchildren than the paternal grandmother. Accordingly this category may be a target for programmes and activities to promote child welfare and family planning.

  11. 76 FR 77392 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

    Science.gov (United States)

    2011-12-13

    ... described marketing as ``activities that promote the purchase of a specific health care plan or explain a product's benefit structure, whether targeted at new or current members'' is overly broad, prohibiting CO... Exchanges and Qualified Health Plans'' (76 FR 41866) has not yet been finalized, we have revised...

  12. Developing a mental health care plan in a low resource setting: the theory of change approach.

    OpenAIRE

    Hailemariam, M; Fekadu, A.; Selamu, M; Alem, A.; Medhin, G; Giorgis, TW; DeSilva, M.; Breuer, E

    2015-01-01

    Background Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an i...

  13. The value of Medicare managed care plans and their prescription drug benefits

    OpenAIRE

    Anne E. Hall

    2007-01-01

    I estimate the welfare, both gross and net, provided by the Medicare managed care program in 1999 through 2002. First, I estimate a model of demand for the benefits offered by managed care plans to Medicare beneficiaries. I then use the demand estimates to form estimates of welfare provided by the program. Medicare beneficiaries derived $14.9 billion of gross welfare per year from the Medicare HMO program. Depending on the amount of selection in the program, the Medicare managed care program ...

  14. Manpower development for the biomedical industry space.

    Science.gov (United States)

    Goh, James C H

    2013-01-01

    The Biomedical Sciences (BMS) Cluster is one of four key pillars of the Singapore economy. The Singapore Government has injected research funding for basic and translational research to attract companies to carry out their commercial R&D activities. To further intensify the R&D efforts, the National Research Foundation (NRF) was set up to coordinate the research activities of different agencies within the larger national framework and to fund strategic R&D initiatives. In recent years, funding agencies began to focus on support of translational and clinical research, particularly those with potential for commercialization. Translational research is beginning to have traction, in particular research funding for the development of innovation medical devices. Therefore, the Biomedical Sciences sector is projected to grow which means that there is a need to invest in human capital development to achieve sustainable growth. In support of this, education and training programs to strengthen the manpower capabilities for the Biomedical Sciences industry have been developed. In recent years, undergraduate and graduate degree courses in biomedical engineering/bioengineering have been developing at a rapid rate. The goal is to train students with skills to understand complex issues of biomedicine and to develop and implement of advanced technological applications to these problems. There are a variety of career opportunities open to graduates in biomedical engineering, however regardless of the type of career choices, students must not only focus on achieving good grades. They have to develop their marketability to employers through internships, overseas exchange programs, and involvement in leadership-type activities. Furthermore, curriculum has to be developed with biomedical innovation in mind and ensure relevance to the industry. The objective of this paper is to present the NUS Bioengineering undergraduate program in relation to manpower development for the biomedical

  15. Strategic planning by the palliative care steering committee of the Middle East Cancer Consortium.

    Science.gov (United States)

    Moore, Shannon Y; Pirrello, Rosene D; Christianson, Sonya K; Ferris, Frank D

    2011-04-01

    High quality comprehensive palliative care is a critical need for millions of patients and families, but remains only a dream in many parts of the world. The failure to do a strategic planning process is one obstacle to advancing education and pain prevention and relief. The Middle Eastern Cancer Consortium Steering Committee attendees completed an initial strategic planning process and identified "developmental steps" to advance palliative care. Underscoring the multi-disciplinary nature of comprehensive palliative care, discipline-specific planning was done (adult and pediatric cancer and medicine, pharmacy, nursing) in a separate process from country-specific planning. Delineating the layers of intersection and differences between disciplines and countries was very powerful. Finding the common strengths and weaknesses in the status quo creates the potential for a more powerful regional response to the palliative care needs. Implementing and refining these preliminary strategic plans will augment and align the efforts to advance palliative care education and pain management in the Middle East. The dream to prevent and relieve suffering for millions of patients with advanced disease will become reality with a powerful strategic planning process well implemented.

  16. [Part I. End-stage chronic organ failures: a position paper on shared care planning. The Integrated Care Pathway].

    Science.gov (United States)

    Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo

    2014-01-01

    In Italy the birth rate decrease together with the continuous improvement of living conditions on one hand, and the health care progress on the other hand, led in recent years to an increasing number of patients with chronic mono- or multi-organ failures and in an extension of their life expectancy. However, the natural history of chronic failures has not changed and the inescapable disease's worsening at the end makes more rare remissions, increasing hospital admissions rate and length of stay. Thus, when the "end-stage" get close clinicians have to engage the patient and his relatives in an advance care planning aimed to share a decision making process regarding all future treatments and related ethical choices such as patient's best interests, rights, values, and priorities. A right approach to the chronic organ failures end-stage patients consists therefore of a careful balance between the new powers of intervention provided by the biotechnology and pharmacology (intensive care), both with the quality of remaining life supplied by physicians to these patients (proportionality and beneficence) and the effective resources rationing and allocation (distributive justice). However, uncertainty still marks the criteria used by doctors to assess prognosis of these patients in order to make decisions concerning intensive or palliative care. The integrated care pathway suggested in this position paper shared by nine Italian medical societies, has to be intended as a guide focused to identify end-stage patients and choosing for them the best care option between intensive treatments and palliative care. PMID:24553592

  17. Pittsburgh as a High Risk Population: The Potential Savings of a Personalized Dental Care Plan.

    Science.gov (United States)

    Ng, Andrew J; Vieira, Alexandre R

    2016-01-01

    Objectives. Little evidence exists for the current standard of two annual preventative care visits. The purpose of this study was investigate this claim by modeling the potential savings of implementing a personalized care plan for high risk individuals in the Pittsburgh region. Methods. Using radiographs from 39 patients in the University of Pittsburgh Dental Registry and DNA Repository database, two models were created to analyse the direct savings of implementing a more aggressive preventative treatment plan and to view the longitudinal cost of increased annual yearly visits. Results. There is a significant decrease (p < 0.001) between original and modeled treatment cost when treatment severity is reduced. In addition, there is a significant decrease in adult lifetime treatment cost (p < 0.001) for up to four annual visits. Conclusions. Patients in high risk populations may see significant cost benefits in treatment cost when a personalized care plan, or higher annual preventative care visits, is implemented. PMID:27006657

  18. Effects of Constraints and Consequences on Plan Complexity in Conversations About End-of-Life Care.

    Science.gov (United States)

    Russell, Jessica

    2015-01-01

    The current study assessed the role of health care provider constraints and perceived consequences on plan complexity for conversations with patients about end-of-life care. Meta-goal constraints, perceived consequences associated with conversational engagement and planning theory provides the basis for research questions and hypotheses posed. Findings suggested that while the meta-goals of efficiency and politeness were each recognized as important, providers indicated greater concern for politeness during patient interactions concerning treatment options. Reported constraints had no impact on plan complexity. Perceived consequences of conversational engagement were predominantly positive and concerned the patient. Findings may enhance the understanding of social workers in their educational role regarding the potential training needs of health care team members in palliative care contexts. PMID:26654064

  19. Evaluating the systematic implementation of the 'Let Me Decide' advance care planning programme in long term care through focus groups: staff perspectives.

    LENUS (Irish Health Repository)

    Cornally, Nicola

    2015-11-01

    The \\'Let Me Decide\\' Advance Care Planning (LMD-ACP) programme offers a structured approach to End-of-Life (EoL) care planning in long-term care for residents with and without capacity to complete an advance care directive\\/plan. The programme was implemented in three homes in the South of Ireland, with a view to improving quality of care at end of life. This paper will present an evaluation of the systematic implementation of the LMD-ACP programme in the homes.

  20. GMENAC report on U.S. physician manpower policies: recommendations and reactions.

    Science.gov (United States)

    Peterson, S E; Rodin, A E

    1983-04-01

    After four years of study in the United States, the Graduate Medical Education National Advisory Committee (GMENAC) concluded that an excess of approximately 70,000 physicians will exist in 1990. Faced with a future surplus, GMENAC recommends that U.S. medical schools decrease enrollment levels by 10 percent relative to the 1978-79 level and severely restrict entrance of foreign medical graduates. Flaws identified in the GMENAC approach relate to the use of the delphi technique, the future role of nonphysician providers, and a lack of reliable data. The GMENAC report may provide impetus for an abrupt shift from expansionism to reductionism in U.S. physician manpower policy. Long range physician manpower planning has erred in the past, necessitating periodic reevaluation of national policy. A continuing balance between supply and demand, although ideal, can probably never be attained. Thus small adjustments in total supply and specialty mix will always be necessary. The GMENAC report, which is the most comprehensive study of U.S. physician manpower to date, requires serious consideration in this context.

  1. PRECISE - pregabalin in addition to usual care: Statistical analysis plan

    NARCIS (Netherlands)

    S. Mathieson (Stephanie); L. Billot (Laurent); C. Maher (Chris); A.J. McLachlan (Andrew J.); J. Latimer (Jane); B.W. Koes (Bart); M.J. Hancock (Mark J.); I. Harris (Ian); R.O. Day (Richard O.); J. Pik (Justin); S. Jan (Stephen); C.-W.C. Lin (Chung-Wei Christine)

    2016-01-01

    textabstractBackground: Sciatica is a severe, disabling condition that lacks high quality evidence for effective treatment strategies. This a priori statistical analysis plan describes the methodology of analysis for the PRECISE study. Methods/design: PRECISE is a prospectively registered, double bl

  2. Emergency planning and long-term care: least paid, least powerful, most responsible.

    Science.gov (United States)

    Covan, Eleanor Krassen; Fugate-Whitlock, Elizabeth

    2010-11-01

    As disasters can occur anywhere, planning to avoid emergencies is an international concern. Our research specifically addresses planning for the needs and safety of a vulnerable population, long-term care residents. Our initial purposes in this evaluation research were to assess the utility of a template to gather emergency management information for individual long-term care communities, to report on how prepared they are to cope with emergencies that have occurred elsewhere in areas like ours, and to assess the effectiveness of employing gerontology students in the planning process. As we began analyzing our data, we realized that it is imperative to consider whether it is possible for long-term care communities to respond effectively to disasters. In our findings we focus on the impact of gender in the planning process, the importance of size with regard to template utility, the positive and negative consequences of student aid, and the fact that gathering plans for individual long-term care communities may have detracted from collaborative community planning. PMID:20924876

  3. Management plan and delivery of care in Graves' ophthalmopathy patients.

    Science.gov (United States)

    Yang, Morgan; Perros, Petros

    2012-06-01

    Most patients with Graves' orbitopathy have mild disease that requires no or minimal intervention. For the minority of patients with moderate or severe disease, multiple medical and surgical treatments may be required at different stages. It is crucial that such patients are monitored closely and treatments applied with care in the right sequence. Medical treatments should be used as early as possible and only during the active phase of the disease. Rehabilitative surgery is indicated in the inactive phase of the disease and should follow the sequence: surgical decompression followed by eye muscle surgery, followed by lid surgery. Delivery of care in a coordinated fashion that makes use of best available expertise is important and best implemented through a Combined Thyroid Eye clinic. PMID:22632367

  4. CARES: Carbonaceous Aerosol and Radiative Effects Study Science Plan

    Energy Technology Data Exchange (ETDEWEB)

    Zaveri, RA; Shaw, WJ; Cziczo, DJ

    2010-05-27

    Carbonaceous aerosol components, which include black carbon (BC), urban primary organic aerosols (POA), biomass burning aerosols, and secondary organic aerosols (SOA) from both urban and biogenic precursors, have been previously shown to play a major role in the direct and indirect radiative forcing of climate. The primary objective of the CARES 2010 intensive field study is to investigate the evolution of carbonaceous aerosols of different types and their effects on optical and cloud formation properties.

  5. Student learning with concept mapping of care plans in community-based education.

    Science.gov (United States)

    Hinck, Susan M; Webb, Patricia; Sims-Giddens, Susan; Helton, Caroline; Hope, Kathryn L; Utley, Rose; Savinske, Deborah; Fahey, Elizabeth M; Yarbrough, Sue

    2006-01-01

    Concept mapping, a learning strategy used to understand key concepts and relationships between concepts, has been suggested as a method to plan and evaluate nursing care. The purpose of this study was to empirically test the effectiveness of concept mapping for student learning and the students' satisfaction with the strategy. A quasi-experimental pre- and posttest design was used to examine the content of concept maps of care plans constructed by junior-level baccalaureate students (n = 23) at the beginning and end of a community-based mental health course. Additionally, students completed a questionnaire to self-evaluate their learning and report their satisfaction with concept mapping. Findings indicated that concept mapping significantly improved students' abilities to see patterns and relationships to plan and evaluate nursing care, and most students (21/23) expressed satisfaction in using the strategy. This study supported concept mapping as an additional learning strategy and has extended knowledge in community-based nursing education.

  6. Web-based collaboration in individual care planning challenges the user and the provider roles – toward a power transition in caring relationships

    Directory of Open Access Journals (Sweden)

    Bjerkan J

    2014-12-01

    Full Text Available Jorunn Bjerkan,1,2 Solfrid Vatne,3 Anne Hollingen4 1Norwegian Research Centre for Electronic Health Records (EHR, Medical Faculty, Norwegian University of Science and Technology, Trondheim, 2Faculty of Health Science, Nord-Trøndelag University College, Levanger, 3Faculty of Health Science, Molde University College, 4Møre og Romsdal Hospital Trust, Molde, Norway Background and objective: The Individual Care Plan (ICP was introduced in Norway to meet new statutory requirements for user participation in health care planning, incorporating multidisciplinary and cross-sector collaboration. A web-based solution (electronic ICP [e-ICP] was used to support the planning and documentation. The aim of this study was to investigate how web-based collaboration challenged user and professional roles. Methods: Data were obtained from 15 semistructured interviews with users and eight with care professionals, and from two focus-group interviews with eight care professionals in total. The data were analyzed using systematic text condensation in a stepwise analysis model. Results: Users and care professionals took either a proactive or a reluctant role in e-ICP collaboration. Where both user and care professionals were proactive, the pairing helped to ensure that the planning worked well; so did pairings of proactive care professionals and reluctant users. Proactive users paired with reluctant care professionals also made care planning work, thanks to the availability of information and the users' own capacity or willingness to conduct the planning. Where both parties were reluctant, no planning activities occurred. Conclusion: Use of the e-ICP challenged the user–professional relationship. In some cases, a power transition took place in the care process, which led to patient empowerment. This knowledge might be used to develop a new understanding of how role function can be challenged when users and care professionals have equal access to health care

  7. Delphi study into planning for care of children in major incidents

    OpenAIRE

    Carley, S; Mackway-Jones, K; Donnan, S

    1999-01-01

    This paper describes a Delphi study used to identify and improve areas of concern in the planning of care for children in major incidents. The Delphi was conducted over three rounds and used a multidisciplinary panel of 22 experts. Experts were selected to include major incident, immediate care, emergency medicine, and paediatric specialists. This paper presents a series of consensus statements that represent the Delphi group's opinion on the management of children in maj...

  8. Improving Olympic health services: what are the common health care planning issues?

    OpenAIRE

    Kononovas, K.; Black, G.; Taylor, J; Raine, R

    2014-01-01

    INTRODUCTION: Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements. HYPOTHESIS: Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care p...

  9. Structure and Function: Planning a New Intensive Care Unit to Optimize Patient Care

    Directory of Open Access Journals (Sweden)

    Jozef Kesecioğlu

    2014-08-01

    Full Text Available To survey the recent medical literature reporting effects of intensive care unit (ICU design on patients’ and family members’ well-being, safety and functionality. Features of ICU design linked to the needs of patients and their family are single-rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. An organization structured on the needs of the patient and their family is mandatory in designing a new intensive care. The main aims in the design of a new department should be patient centered care, safety, functionality, innovation and a future-proof concept.

  10. [Palliative care birth plan: a field of perinatal medicine to build].

    Science.gov (United States)

    Tosello, B; Le Coz, P; Payot, A; Gire, C; Einaudi, M-A

    2013-04-01

    Some couples may choose to continue the pregnancy unable to decide for termination of pregnancy. Such situations recently occurred in neonatology units and may lead to neonatal palliative care. Faced with all uncertainties inherent to medicine and the future of the baby, medical teams must inform parents of different possible outcome step by step. Consistency in the reflection and intentionality of the care is essential among all different stakeholders within the same health team to facilitate support of parents up to a possible fatal outcome. This issue in perinatal medicine seems to be to explore how caregivers can contribute in the construction of parenthood in a context of a palliative care birth plan.

  11. Advance care planning - a multi-centre cluster randomised clinical trial

    DEFF Research Database (Denmark)

    Rietjens, Judith A C; Korfage, Ida J; Dunleavy, Lesley;

    2016-01-01

    BACKGROUND: Awareness of preferences regarding medical care should be a central component of the care of patients with advanced cancer. Open communication can facilitate this but can occur in an ad hoc or variable manner. Advance care planning (ACP) is a formalized process of communication between......, and improve their quality of life. METHODS/DESIGN: We will study the effects of the ACP program Respecting Choices on the quality of life of patients with advanced lung or colorectal cancer. In a phase III multicenter cluster randomised controlled trial, 22 hospitals in 6 countries will be randomised...

  12. Designing an Operational Planning Model for Level-one Iranian Primary Health Care Systems

    Directory of Open Access Journals (Sweden)

    Amir-Ashkan Nasiripour

    2008-01-01

    Full Text Available Introduction: This research was performed in 2008 in order to design an operational planning model for Iranian primary health care systems at level one. Methods: In this applied study, which was done in a descriptive and cross-sectional manner, some countries and international organizations which had comprehensive planning systems and some local organizations were studied. The required data from the selected countries were collected through data collection forms, and for local organizations, the data were collected through interview, and the initial model was presented accordingly. The model was tested via Delphi technique and taking the authorities’ views into account, the required changes were made and the ultimate model was prepared. Results: All the studied overseas and indigenous organizations had programming systems. However, none of the level-one Iranian primary health care units had a coherent planning system, and they did not follow any specific models. Since 2008, the model of operational planning has also been utilized by Iranian Ministry of Health, Care and Medical Education at headquarters levels; however, there was no model at lower levels especially in rural and urban health care centers. In all selected countries, the model of programs included title, objectives or expected results, schedule, activities, budget system and evaluation and monitoring indexes. Though these parts existed in the common models in Iran, no scientific basis could be observed in compiling the operational programs. The mechanism of designing the initial suggested operational planning had eight stages, but after three stages of reviewing by authorities, seven stages were ratified. Conclusion: Utilizing the suggested operational planning model can enhance the level-one performance indicators of health care networks in Iran

  13. Commentary: Personalized health planning and the Patient Protection and Affordable Care Act: an opportunity for academic medicine to lead health care reform.

    Science.gov (United States)

    Dinan, Michaela A; Simmons, Leigh Ann; Snyderman, Ralph

    2010-11-01

    The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates the exploration of new approaches to coordinated health care delivery--such as patient-centered medical homes, accountable care organizations, and disease management programs--in which reimbursement is aligned with desired outcomes. PPACA does not, however, delineate a standardized approach to improve the delivery process or a specific means to quantify performance for value-based reimbursement; these details are left to administrative agencies to develop and implement. The authors propose that coordinated care can be implemented more effectively and performance quantified more accurately by using personalized health planning, which employs individualized strategic health planning and care relevant to the patient's specific needs. Personalized health plans, developed by providers in collaboration with their patients, quantify patients' health and health risks over time, identify strategies to mitigate risks and/or treat disease, deliver personalized care, engage patients in their care, and measure outcomes. Personalized health planning is a core clinical process that can standardize coordinated care approaches while providing the data needed for performance-based reimbursement. The authors argue that academic health centers have a significant opportunity to lead true health care reform by adopting personalized health planning to coordinate care delivery while conducting the research and education necessary to enable its broad clinical application. PMID:20844424

  14. Internal marketing within a health care organization: developing an implementation plan.

    Science.gov (United States)

    Hallums, A

    1994-05-01

    This paper discusses how the concept of internal marketing can be applied within a health care organization. In order to achieve a market orientation an organization must identify the needs and wants of its customers and how these may change in the future. In order to achieve this, internal marketing is a necessary step to the implementation of the organizations marketing strategy. An outline plan for the introduction of an internal marketing programme within an acute hospital trust is proposed. The plan identifies those individuals and departments who should be involved in the planning and implementation of the programme. The benefits of internal marketing to the Trust are also considered.

  15. Exploring the district nurse role in facilitating individualised advance care planning.

    Science.gov (United States)

    Boot, Michelle

    2016-03-01

    Health-care policy recognises the importance of engaging people in making decisions related to the management of their health. Advance care planning (ACP) offers a framework for decision making on end-of-life care. There are positive indicators that ACP enables health professionals to meet people's preferences. However, there are reports of insensitive attempts to engage people in end-of-life care decision making. District nurses are in the ideal position to facilitate ACP, as they have the opportunity to build relationships with the people they are caring for--an antecedent to sensitive ACP--and in recognising and fulfilling this role, they could ameliorate the risk of insensitive ACP. Distric nurse leaders also have a role to play in ensuring that organisational and environmental factors support appropriate ACP facilitation including: training, fostering a team culture that empowers district nurses to recognise and meet their ACP role, and advocating for appropriate ACP evaluation outcome measures. PMID:26940617

  16. Reforming primary care in England--again. Plans for improving the quality of care.

    Science.gov (United States)

    Baker, R

    2000-06-01

    An extensive programme of health service reform has begun in England. Improvement in the quality of care is a key objective of the reforms, and several initiatives are being introduced in response. These include systems to provide national guidance about appropriate treatment and services, a local system to support quality improvement and arrangements to monitor performance, including a new performance framework, an inspection agency and an annual survey of patients. The local quality improvement system has features of particular interest. These include arrangements for setting objectives for quality improvement, the use of various quality improvement methods tailored to local needs and a new system to provide accountability to both the health service and the public. The introduction of clinical governance and all the other reforms presents primary care practitioners with a major challenge. However, if sufficient time is allowed and adequate resources are made available, the reforms do have the potential to improve health care in England. PMID:10944059

  17. CMS proposes prioritizing patient preferences, linking patients to follow-up care in discharge planning process.

    Science.gov (United States)

    2016-03-01

    Hospital providers voice concerns about a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require providers to devote more resources to discharge planning. The rule would apply to inpatients as well as emergency patients requiring comprehensive discharge plans as opposed to discharge instructions. CMS states that the rule would ensure the prioritization of patient preferences and goals in the discharge planning process, and also would prevent avoidable complications and readmissions. However, hospital and emergency medicine leaders worry that community resources are not yet in place to facilitate the links and follow-up required in the proposed rule, and that the costs associated with implementation would be prohibitive. The proposed rule would apply to acute care hospitals, EDs, long-term care facilities, inpatient rehabilitation centers, and home health agencies. Regardless of the setting, though, CMS is driving home the message that patient preferences should be given more weight during the discharge planning process. Under the rule, hospitals or EDs would need to develop a patient-centered discharge plan within 24 hours of admission or registration, and complete the plan prior to discharge or transfer to another facility. Under the rule, emergency physicians would determine which patients require a comprehensive discharge plan. Both the American Hospital Association and the American College of Emergency Physicians worry that hospitals will have to take on more staff, invest in training, and make changes to their electronic medical record systems to implement the provisions in the proposed rule.

  18. CMS proposes prioritizing patient preferences, linking patients to follow-up care in discharge planning process.

    Science.gov (United States)

    2016-03-01

    Hospital providers voice concerns about a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require providers to devote more resources to discharge planning. The rule would apply to inpatients as well as emergency patients requiring comprehensive discharge plans as opposed to discharge instructions. CMS states that the rule would ensure the prioritization of patient preferences and goals in the discharge planning process, and also would prevent avoidable complications and readmissions. However, hospital and emergency medicine leaders worry that community resources are not yet in place to facilitate the links and follow-up required in the proposed rule, and that the costs associated with implementation would be prohibitive. The proposed rule would apply to acute care hospitals, EDs, long-term care facilities, inpatient rehabilitation centers, and home health agencies. Regardless of the setting, though, CMS is driving home the message that patient preferences should be given more weight during the discharge planning process. Under the rule, hospitals or EDs would need to develop a patient-centered discharge plan within 24 hours of admission or registration, and complete the plan prior to discharge or transfer to another facility. Under the rule, emergency physicians would determine which patients require a comprehensive discharge plan. Both the American Hospital Association and the American College of Emergency Physicians worry that hospitals will have to take on more staff, invest in training, and make changes to their electronic medical record systems to implement the provisions in the proposed rule. PMID:26979045

  19. Family participation in care plan meetings : Promoting a collaborative organizational culture in nursing homes

    NARCIS (Netherlands)

    Dijkstra, Ate

    2007-01-01

    In this study, the author evaluated a project in The Netherlands that aimed to promote family members' participation in care plan meetings at a psychogeriatric nursing home. The small-scale pilot project, which was conducted in four wards of the nursing home, was designed to involve families in heal

  20. Using COPE To Improve Quality of Care: The Experience of the Family Planning Association of Kenya.

    Science.gov (United States)

    Bradley, Janet

    1998-01-01

    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…

  1. How Peru introduced a plan for comprehensive HIV prevention and care for transwomen

    Science.gov (United States)

    Salazar, Ximena; Núnez-Curto, Arón; Villayzán, Jana; Castillo, Regina; Benites, Carlos; Caballero, Patricia; Cáceres, Carlos F

    2016-01-01

    Introduction As a group, transwomen in Peru have the highest prevalence of HIV (>20%) in the country, but they have little access to HIV prevention, testing and care services. Until recently, Peru's national HIV programme did not recognize transwomen and had remained essentially static for decades. This changed in December 2014, when the Ministry of Health expressed its commitment to improve programming for transwomen and to involve transwomen organizations by prioritizing the development of a “Targeted Strategy Plan of STIs/HIV/AIDS Prevention and Comprehensive Care for Transwomen.” Discussion A policy dialogue between key stakeholders – Peru's Ministry of Health, academic scientists, civil society, transgender leaders and international agencies – created the conditions for a change in Peru's national HIV policy for transwomen. Supported by the effective engagement of all sectors, the Ministry of Health launched a plan to provide comprehensive HIV prevention and care for transwomen. The five-year plan includes new national guidelines for HIV prevention, care and support, and country-level investments in infrastructure and equipment. In addition to new biomedical strategies, the plan also incorporates several strategies to address structural factors that contribute to the vulnerability of transwomen. We identified three key factors that created the right conditions for this change in Peru's HIV policy. These factors include (1) the availability of solid evidence, based on scientific research; (2) ongoing efforts within the transwomen community to become better advocates of their own rights; and (3) a dialogue involving honest discussions between stakeholders about possibilities of changing the nation's HIV policy. Conclusions The creation of Peru's national plan for HIV prevention and care for transwomen shows that long-term processes, focused on human rights for transwomen in Peru, can lead to organizational and public-policy change. PMID:27431469

  2. National Planning of Vocational and Technical Training, 1972.

    Science.gov (United States)

    Colombo Plan Bureau (Sri Lanka).

    This document contains the proceedings of the fifth of a series of seminars developed by the Colombo Plan Bureau to serve as a catalyst in the planning and development of skilled manpower in the Colombo region of south and southeast Asia. The seminars resulted from a realization that the shortage of technical and skilled manpower in the area is…

  3. Improved operations through manpower management in the oil sector

    International Nuclear Information System (INIS)

    The need for improved operations was never higher than today in the oil industry. The world's demand for energy, especially for oil and natural gas, is rising rapidly and for many years to come. In order to meet this rising demand and to keep price volatility to a minimum; oil companies worldwide are looking for ways to improve operations in order to achieve increased production with decreased costs. This paper describes data from Southern Area Oil Operations (SAOO); an organization within the Saudi Arabian Oil Company (ARAMCO), to show how manpower management can be used to achieve improved operations. For the years 1983 to 2004, manpower management in SAOO focused on addressing both the quantity and quality dimensions of manpower. First, the level of manpower gradually declined by 35% for both the Saudi Arab and Expatriate categories for the entire period. Expatriate labor is defined as labor in three main categories: US/Canadian, UK, and Asians and Other Arabs. Second, the level of training slowly increased to align manpower to better fit organizational functions and work responsibilities. Not only a number of new training and development programs were initiated but also the percentage of employees involved in such programs doubled from 4.5% in 1990 to 8.9% in 2004. Third, technology based initiatives such as the use of computers, Internet, and intranet were heavily introduced to employees in the last 10 yrs. Due to these three changes reduced costs and increased manpower efficiency were achieved. In the period 1983 to 2004 the total labor bill declined by 35% and Net Direct Expenditures NDE by 24% after adjusting for inflation and using 2004 dollars. Net Direct Expenditure NDE is defined by SAOO to be the summation of labor cost, material cost, invoices cost, and net service income. In addition two signs of improved efficiency of manpower were apparent in the same period. First, SAOO manpower, despite its smaller size, could actually sustain an increased

  4. Implementing the Affordable Care Act: choosing an essential health benefits benchmark plan.

    Science.gov (United States)

    Corlette, Sabrina; Lucia, Kevin W; Levin, Max

    2013-03-01

    To improve the adequacy of private health insurance, the Affordable Care Act requires insurers to cover a minimum set of medical benefits, known as "essential health benefits." In implementing this requirement, states were asked to select a "benchmark plan" to serve as a reference point. This issue brief examines state action to select an essential health benefits benchmark plan and finds that 24 states and the District of Columbia selected a plan. All but five states will have a small-group plan as their benchmark. Each state, whether or not it made a benchmark selection, will have a set of essential health benefits that reflects local, employer-based health insurance coverage currently sold in the state. States adopted a variety of approaches to selecting a benchmark, including intergov­ernmental collaboration, stakeholder engagement, and research on benchmark options.

  5. Implementing the Affordable Care Act: choosing an essential health benefits benchmark plan.

    Science.gov (United States)

    Corlette, Sabrina; Lucia, Kevin W; Levin, Max

    2013-03-01

    To improve the adequacy of private health insurance, the Affordable Care Act requires insurers to cover a minimum set of medical benefits, known as "essential health benefits." In implementing this requirement, states were asked to select a "benchmark plan" to serve as a reference point. This issue brief examines state action to select an essential health benefits benchmark plan and finds that 24 states and the District of Columbia selected a plan. All but five states will have a small-group plan as their benchmark. Each state, whether or not it made a benchmark selection, will have a set of essential health benefits that reflects local, employer-based health insurance coverage currently sold in the state. States adopted a variety of approaches to selecting a benchmark, including intergov­ernmental collaboration, stakeholder engagement, and research on benchmark options. PMID:23547335

  6. Menu planning in long-term care: toward resident-centred menus.

    Science.gov (United States)

    Ducak, Kate; Keller, Heather H

    2011-01-01

    Factors that influence the menu planning process in Ontario long-term care (LTC) homes were studied, as were key informants' perspectives on how this process could be improved to promote resident-centred menus. Key informants were interviewed by telephone to obtain qualitative data through standardized open-ended questions. The key informants (n=35) were randomly selected nutrition managers of Ontario LTC homes. Selected registered dietitians from the Ontario Long-Term Care Action Group also participated (n=5). Descriptive thematic analysis was completed on data provided. Three over arching themes emerged from the data as drivers in the menu planning process: resource limitations, Ontario Ministry of Health and Long-Term Care standards, and the accommodation of diverse and evolving preferences. Challenges involving resources include insufficient food labour and raw food funding, the workload involved with altering menus, and providing food items for special diets or preferences. In terms of ministry standards, participants reported barriers to complying with rotation and portion standards. Other common obstacles within LTC homes include accommodating personal preferences, cultural preferences, and therapeutic diets. Ontario LTC homes face numerous challenges in the planning of menus for residents, regardless of a home's size, location, or profit status. Suggestions are aimed at improving the menu planning process and providing high-quality, palatable, and culturally appropriate food in these homes so that menus are resident-centred. PMID:21645428

  7. Implementing advance care planning: a qualitative study of community nurses' views and experiences

    Directory of Open Access Journals (Sweden)

    Kennedy Sheila

    2010-04-01

    Full Text Available Abstract Background Advance care planning (ACP is a process of discussion about goals of care and a means of setting on record preferences for care of patients who may lose capacity or communication ability in the future. Implementation of ACP is widely promoted by policy makers. This study examined how community palliative care nurses in England understand ACP and their roles within ACP. It sought to identify factors surrounding community nurses' implementation of ACP and nurses' educational needs. Methods An action research strategy was employed. 23 community nurses from two cancer networks in England were recruited to 6 focus group discussions and three follow up workshops. Data were analysed using a constant comparison approach. Findings Nurses understood ACP to be an important part of practice and to have the potential to be a celebration of good nursing care. Nurses saw their roles in ACP as engaging with patients to elicit care preferences, facilitate family communication and enable a shift of care focus towards palliative care. They perceived challenges to ACP including: timing, how to effect team working in ACP, the policy focus on instructional directives which related poorly to patients' concerns; managing differences in patients' and families' views. Perceived barriers included: lack of resources; lack of public awareness about ACP; difficulties in talking about death. Nurses recommended the following to be included in education programmes: design of realistic scenarios; design of a flow chart; practical advice about communication and documentation; insights into the need for clinical supervision for ACP practice. Conclusions Nurses working in the community are centrally involved with patients with palliative care needs who may wish to set on record their views about future care and treatment. This study reveals some important areas for practice and educational development to enhance nurses' use and understanding of ACP.

  8. Difficult but necessary conversations--the case for advance care planning.

    Science.gov (United States)

    Scott, Ian A; Mitchell, Geoffrey K; Reymond, Elizabeth J; Daly, Michael P

    2013-11-18

    Many patients at the end of life receive care that is inappropriate or futile and, if given the opportunity to discuss their care preferences well ahead of death, may well have chosen to forgo such care. Advance care planning (ACP) is a process of making decisions about future health care for patients in consultation with clinicians, family members and important others, and to safeguard such decisions if patients were to lose decisional capacity. Although ACP has existed as an idea for decades, acceptance and operationalisation of ACP within routine practice has been slow, despite evidence of its benefits. The chief barriers have been social and personal taboos about discussing the dying process, avoidance by medical professionals of responsibility for initiating, coordinating and documenting discussions about ACP, absence of robust and standardised procedures for recording and retrieving ACP documents across multiple care settings, and legal and ethical concerns about the validity of such documents. For ACP to become part of mainstream patient-centred care, accountable clinicians working in primary care, hospitals and nursing homes must effectively educate colleagues and patients about the purpose and mechanics of ACP, mandate ACP for all eligible patients, document ACP in accessible formats that enable patient wishes to accurately guide clinical management, devise methods for reviewing ACP decisions when clinically appropriate, and evaluate congruence between expressed patient wishes and actual care received. Public awareness campaigns coupled with implementation of ACP programs sponsored by collaborations between hospital and health services, Medicare locals and residential care facilities will be needed in making system-wide ACP a reality.

  9. Planning for the integration of the digital library, clinical decision support, and evidence at the point of care.

    Science.gov (United States)

    Schwartz, Linda Matula; Iobst, Barbara

    2008-01-01

    Integrating knowledge-based resources at the point of care is an important opportunity for hospital library involvement. In the progression of an IAIMS planning grant, the digital library is recognized as pivotal to the success of information domain integration throughout the institution. The planning process, data collection, and evolution of the planning project are discussed.

  10. Talking about sensitive topics during the advance care planning discussion: A peek into the black box

    DEFF Research Database (Denmark)

    Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine;

    2015-01-01

    OBJECTIVE: Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decis...... discussions about sensitive end-of-life issues the healthcare professional will be able to pose and explore sensitive ACP questions in a straightforward manner, if the voices that express empathy and seek to empower the patient in different ways are emphasized....

  11. Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management.

    Science.gov (United States)

    Lawn, Sharon; Delany, Toni; Sweet, Linda; Battersby, Malcolm; Skinner, Timothy

    2015-01-01

    Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.

  12. Care Coordination Challenges Among High-Needs, High-Costs Older Adults in a Medigap Plan

    Science.gov (United States)

    Wells, Timothy S.; Bhattarai, Gandhi R.; Hawkins, Kevin; Cheng, Yan; Ruiz, Joann; Barnowski, Cynthia A.; Spivack, Barney; Yeh, Charlotte S.

    2016-01-01

    Purpose of the Study: Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. Primary Practice Setting: Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). Methodology and Sample: The three groups included the highest needs, highest costs (the “highest group”), the high needs, high costs (the “high group”), and the “all other group.” Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. Results: The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures. On average, the highest group had $102,798 in yearly health care expenditures, compared with $34,610 and $7,634 for the high and all other groups, respectively. Fifty-seven percent of the highest group saw 16 or more different providers annually, compared with 21% and 2% of the high and all other groups, respectively. Finally, 28% of the highest group had prescriptions from at least seven different providers, compared with 20% and 5% of the high and all other groups, respectively. Implications for Case Management Practice: Individuals with high health care needs and costs have visits to numerous health care providers and receive multiple prescriptions for pharmacotherapy. As a result, these individuals can become overwhelmed trying to manage and coordinate their health care needs. Care coordination programs may help these individuals coordinate their care. PMID:27301064

  13. In consumer-directed health plans, a majority of patients were unaware of free or low-cost preventive care.

    Science.gov (United States)

    Reed, Mary E; Graetz, Ilana; Fung, Vicki; Newhouse, Joseph P; Hsu, John

    2012-12-01

    Consumer-directed health plans are plans with high deductibles that typically require patients to bear no out-of-pocket costs for preventive care, such as annual physicals or screening tests, in order to ease financial barriers and encourage patients to seek such care. We surveyed people in California who had a consumer-directed health plan and found that fewer than one in five understood that their plan exempted preventive office visits, medical tests, and screenings from their deductible, meaning that this care was free or had a modest copayment. Roughly one in five said that they had delayed or avoided a preventive office visit, test, or screening because of cost. Those who were confused about the exemption were significantly more likely to report avoiding preventive visits because of cost concerns. Special efforts to educate consumers about preventive care cost-sharing exemptions may be necessary as more health plans, including Medicare, adopt this model. PMID:23213148

  14. Use of a hand-held computer observational tool to improve communication for care planning and psychosocial well-being

    OpenAIRE

    Corazzini, Kirsten; Rapp, Carla Gene; McConnell, Eleanor S.; Anderson, Ruth A.

    2009-01-01

    Staff development nurses in long-term care are challenged to implement training programs that foster quality unlicensed assistive personnel (UAP) care and improve the transfer of their observations to licensed nursing staff for care planning. This study describes the outcomes of a program where UAP recorded behavioral problems of residents to inform care. Findings suggest staff development nurses who aim to improve UAP reporting without simultaneously targeting licensed nursing staff behavior...

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

    OpenAIRE

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

    2006-01-01

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

  16. A review of manpower training for Nigeria's fishing industry

    OpenAIRE

    Olaniawo, A.A.

    1983-01-01

    An examination is made of the organization and administration of fisheries training institutes in Nigeria, highlighting their inadequacies in achieving required goals. A systems approach to fisheries manpower training is described which is based on 4 principles: 1) wholeness; 2) systematization; 3) compatibility; and 4) optimization

  17. Optimization of energy and manpower requirements in Nigerian bakeries

    Energy Technology Data Exchange (ETDEWEB)

    Ekechukwu, O.V.; Madu, A.C.; Nwanya, S.C. [Department of Mechanical Engineering, University of Nigeria, Nsukka (Nigeria); Agunwamba, J.C. [Department Civil Engineering, University of Nigeria, Nsukka (Nigeria)

    2011-01-15

    A study on energy and manpower requirements for the bakery industry in Nigeria was carried out, covering 90 bakeries representing 75% of total registered bakeries in Onitsha city. Analysis of the energy and manpower related time series data, using engineering and statistical tools, resulted in the development of empirical model for the estimation of capacity, manpower and energy requirements in the bakery industry. This empirical model can be used for the design of a new bakery or expansion of existing one. The conditions for optimum inventory and design were determined through this optimization and the results were compared with existing system. The study revealed a huge capital investment which amounts to 5.6 billion Naira annually, a correlation between capacity of the bakery plants and resource usage (manpower, raw materials and energy use), and jobs creation potentials for 960 persons for Onitsha city alone. Diesel contributes 66.75% of total heating energy need, followed by firewood, 22.57% and petrol, 10.68%. Application of optimization techniques could result in 61% savings in inventory costs and cut in energy by about 7.4% with overall cost reduction of 8%. (author)

  18. The Political Economy of Military Manpower Procurement in Peacetime.

    Science.gov (United States)

    Withers, Glenn Alexander

    The study examines military manpower procurement for peacetime. It considers the broad alternative systems of conscription and voluntarism and develops models of demand and supply for military labor to show how these are affected by the choice of procurement system. Empirical applications are made using evidence from Australia, Canada, Great…

  19. High-level manpower movement and Japan's foreign aid.

    Science.gov (United States)

    Furuya, K

    1992-01-01

    "Japan's technical assistance programs to Asian countries are summarized. Movements of high-level manpower accompanying direct foreign investments by private enterprise are also reviewed. Proposals for increased human resources development include education and training of foreigners in Japan as well as the training of Japanese aid experts and the development of networks for information exchange."

  20. The Role of Health Care Provider Goals, Plans, and Physician Orders for Life-Sustaining Treatment (POLST) in Preparing for Conversations About End-of-Life Care.

    Science.gov (United States)

    Russell, Jessica

    2016-09-01

    The Physician Orders for Life-Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed at facilitating elicitation of patient end-of-life care preferences. This study assessed the impact of the POLST document on provider goals and plans for conversations about end-of-life care treatment options. A 2 (POLST: experimental, control) × 3 (topic of possible patient misunderstanding: cardiopulmonary resuscitation, medical intervention, artificially administered nutrition) experimental design was used to assess goals, plan complexity, and strategies for plan alterations by medical professionals. Findings suggested that the POLST had little impact on plan complexity or reaction time with initial plans. However, preliminary evidence suggested that the utility of the POLST surfaced with provider responses to patient misunderstanding, in which differences in conditions were identified. Significant differences in goals reported as most important in driving conversational engagement emerged. Implications for findings are discussed. PMID:27442346

  1. Planned Cardiac Reexploration in the Intensive Care Unit Is a Safe Procedure

    Science.gov (United States)

    LaPar, Damien J.; Isbell, James M.; Mulloy, Daniel P.; Stone, Matthew L.; Kern, John A.; Ailawadi, Gorav; Kron, Irving L.

    2015-01-01

    Background Cardiac surgical reexploration is necessary in approximately 5% of all patients. However, the impact of routine, planned reexploration performed in the intensive care unit (ICU) remains poorly defined. This study evaluated postoperative outcomes after cardiac reexplorations to determine the safety and efficacy of a planned approach in the ICU. Methods All patients undergoing ICU cardiac reexplorations (2000 to 2011) at a single institution were stratified according to a routine, planned ICU approach to reexploration (planned) versus unplanned ICU or operating room reexploration. Patient risk and outcomes were compared by univariate and multivariate analyses. Results 8,151 total patients underwent cardiac operations, including 267 (3.2%) reexplorations (planned ICU = 75% and unplanned ICU = 18%). Among planned ICU reexplorations, 38% of patients had an identifiable surgical bleeding source, and 60% underwent reexploration less than 12 hours after the index procedure. Unplanned ICU reexplorations had a higher Society of Thoracic Surgeons (STS) predicted mortality (5% vs 3%, p < 0.001) and incurred higher observed mortality (37% vs 6%, p < 0.001) and morbidity. Sternal wound infections were rare and were similar between groups (p = 0.81). Furthermore, upon STS mortality risk adjustment, unplanned ICU reexplorations were associated with significantly increased odds of mortality (OR = 26.6 [7.1, 99.7], p < 0.001) compared with planned ICU reexplorations. Conclusions Planned reexploration in the ICU is a safe procedure with acceptable mortality and morbidity and low infection rates. Unplanned reexplorations, however, increase postoperative risk and are associated with high mortality and morbidity. These data argue for coordinated, routine approaches to planned ICU reexploration to avoid delay in treatment for postoperative hemorrhage. PMID:25173720

  2. Supporting parental bonding in the NICU: a care plan for nurses.

    Science.gov (United States)

    Haut, C; Peddicord, K; O'Brien, E

    1994-12-01

    New and improved technology in the NICU has assisted in supporting critically ill neonates, especially those born at very low birth weights. These small patients require the dedicated hand of the NICU staff, but also the love and support of their parents. Family bonding in the NICU is often a very difficult process, which is interrupted by separation of parent and child at birth and continued by the physical constraints of this highly complex critical care environment. Neonatal nurses are most often the front line managers and coordinators of family care in the NICU. They are charged with the challenge of understanding and providing "state of the art" technological care in an environment that must also adapt to the ever changing needs of parents and families who cannot be considered visitors, but an integral part of their infants' care and survival. Each infant and family in the NICU requires individualized assessment and nursing care. This article reviews the process of parental bonding as it relates to the premature or ill infant and provides for nurses a plan of care written to foster and support family bonding in the NICU. Stages of bonding with a sick or premature infant are explored in the context of a theoretical framework of adaptation provided by Sister Callista Roy.

  3. Advance care planning: A systematic review of randomised controlled trials conducted with older adults.

    Science.gov (United States)

    Weathers, Elizabeth; O'Caoimh, Rónán; Cornally, Nicola; Fitzgerald, Carol; Kearns, Tara; Coffey, Alice; Daly, Edel; O'Sullivan, Ronan; McGlade, Ciara; Molloy, D William

    2016-09-01

    Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors. PMID:27451328

  4. The attitudes of social work students toward end-of-life care planning.

    Science.gov (United States)

    Kwon, Sung Ae; Kolomer, Stacey; Alper, Jamie

    2014-01-01

    This study examined the attitudes of social work students toward end-of-life care planning, as well as their degree of willingness to engage in this area of social work practice. Factors associated with their attitudes were measured through structured surveys completed by 102 social work students (N = 102) at a school of social work in the southeast. Results indicated that these social work students tended to have positive attitudes toward end-of-life care planning in general. Moreover, these attitudes were positively associated with preference for pain relief treatment, higher levels of comfort when discussing death, more emphasis on self-determination, and apprehension of conflicts of self-determination. The results of this study underscored the increased societal need for recognition of personal preferences in end-of-life care, higher levels of comfort when discussing death, and an increased commitment of social workers' to maintaining the ethical principle of the client's right to self-determination in end-of-life planning. While this is not surprising, it points to a continuing need to re-assess where the field stands in its preparation of social work professionals who will work closely with people who are dying and their families.

  5. Improving Access to Quality Care in Family Planning: WHO's Four Cornerstones of Evidence-based Guidance

    Institute of Scientific and Technical Information of China (English)

    Shang-chun WU; Yan ZOU; K Church; O Meirik

    2007-01-01

    The four cornerstones of guidance in technique service of family planning are established by WHO based on high quality evidences. They have been updated according to the appearing new evidences, and the consensuses were reached by the international experts in this field. The four documents include Medical Eligibility Criteria for Contraceptive Use, Selected Practice Recommendations for Contraceptive Use, Decision-making Tool for Family Planning Clients and Providers and The Global Handbook for Family Planning Providers. The first two documents mainlyface to the policy-makers and programme managers and were treated as the important references for creating the local guideline. The other two documents were developed for the front-line health-care and family planning providers at different levels, which include plenty of essential technical information to help providers improve their ability in service delivery and counselling. China paid great attention to the introduction and application of WHO guidelines. As soon as the newer editions of these documents were available, the Chinese version would be followed. WHO guidelines have been primarily adapted with the newly issued national guideline, The Clinical Practical Skill Guidelines- Family Planning Part, which was established by China Medical Association. At the same time, the WHO guidelines have been introduced to some of the linicians and family planning providers at different levels. In the future, more special training courses will be introduced to the township level based on the needs of grassroot providers.

  6. Implications of the Clinton health reform plan for older persons and long-term care.

    Science.gov (United States)

    Kane, R L; Kane, R A

    1994-01-01

    The Clinton plan for older persons and those in need of long-term care offers short-term problems and long-term promises. Final judgment depends in part on the level of commitment assumed for various aspects of the plan. In the near term, even under the best scenario, there will be problems of discoordination as certain groups (like the dually eligible and those needing long-term care) are caught in the gaps between the new and the old. In the longer term, there are potential gains from a more integrated system of care that can accommodate both acute and chronic care and eliminate the administrative incentives to shift fiscal responsibility. Medicare was passed in an effort to correct a disparity. It would be ironic if its existence created a new one. At the same time, older persons are currently better served than many uninsured younger persons. Before they open their mouths to grab for the bone in the water, they had best hang on to the one they have. PMID:8014413

  7. Knowledge About and Perceptions of Advance Care Planning and Communication of Chinese-American Older Adults.

    Science.gov (United States)

    Yonashiro-Cho, Jeanine; Cote, Sarah; Enguidanos, Susan

    2016-09-01

    Although advance care planning (ACP) is associated with better care at the end of life, better quality of death, and less psychological distress in survivors, ethnic disparities in ACP completion rates have been documented and may be attributable to lack of knowledge about ACP or differences in cultural values and preferences. Despite rapid increases in the size of the Asian-American population, little is known about ACP preferences of Chinese Americans. The purpose of this study is to explore the knowledge, attitudes, and preferences of older Chinese Americans toward ACP. Focus groups with Chinese older adults (n = 34) were conducted in Mandarin, Cantonese, and English, and transcripts were analyzed using a grounded theory approach. Identified themes included knowledge and experience with ACP and end-of-life care options, health as a factor in timing of ACP and communication, and communication of end-of-life care preferences. Knowledge of and experience with ACP and end-of-life decision-making varied according to focus group, although few participants had an advance directive. Findings suggest that Chinese older adults prefer to use indirect communication strategies, such as commenting on the circumstances of others rather than directly stating their wishes, and informal contexts, such as during a family dinner rather than formal meeting, to convey their care preferences to loved ones and may employ similar tactics when communicating with clinicians. This is particularly important given the recent decision by the Centers for Medicare and Medicaid Services to provide reimbursement to physicians for engaging in advance care planning conversations. PMID:27584825

  8. Developing a national dissemination plan for collaborative care for depression: QUERI Series

    Directory of Open Access Journals (Sweden)

    Rubenstein Lisa V

    2008-12-01

    Full Text Available Abstract Background Little is known about effective strategies for disseminating and implementing complex clinical innovations across large healthcare systems. This paper describes processes undertaken and tools developed by the U.S. Department of Veterans Affairs (VA Mental Health Quality Enhancement Research Initiative (MH-QUERI to guide its efforts to partner with clinical leaders to prepare for national dissemination and implementation of collaborative care for depression. Methods An evidence-based quality improvement (EBQI process was used to develop an initial set of goals to prepare the VA for national dissemination and implementation of collaborative care. The resulting product of the EBQI process is referred to herein as a "National Dissemination Plan" (NDP. EBQI participants included: a researchers with expertise on the collaborative care model for depression, clinical quality improvement, and implementation science, and b VA clinical and administrative leaders with experience and expertise on how to adapt research evidence to organizational needs, resources and capacity. Based on EBQI participant feedback, drafts of the NDP were revised and refined over multiple iterations before a final version was approved by MH-QUERI leadership. 'Action Teams' were created to address each goal. A formative evaluation framework and related tools were developed to document processes, monitor progress, and identify and act upon barriers and facilitators in addressing NDP goals. Results The National Dissemination Plan suggests that effectively disseminating collaborative care for depression in the VA will likely require attention to: Guidelines and Quality Indicators (4 goals, Training in Clinical Processes and Evidence-based Quality Improvement (6 goals, Marketing (7 goals, and Informatics Support (1 goal. Action Teams are using the NDP as a blueprint for developing infrastructure to support system-wide adoption and sustained implementation of

  9. Advance care planning in stroke: influence of time on engagement in the process

    Directory of Open Access Journals (Sweden)

    Green T

    2014-01-01

    Full Text Available Theresa Green1, Shreyas Gandhi2, Tessa Kleissen1, Jessica Simon1,3, Shelley Raffin-Bouchal1, Karla Ryckborst41Faculty of Nursing, University of Calgary, Calgary, AB, Canada; 2Health Sciences, McMaster University, Hamilton, ON, Canada; 3Department of Medicine, University of Calgary, Calgary, AB, Canada; 4Calgary Stroke Program, Alberta Health Services, Calgary, AB, CanadaPurpose: Individuals who experience stroke have a higher likelihood of subsequent stroke events, making it imperative to plan for future medical care. In the event of a further serious health event, engaging in the process of advanced care planning (ACP can help family members and health care professionals (HCPs make medical decisions for individuals who have lost the capacity to do so. Few studies have explored the views and experiences of patients with stroke about discussing their wishes and preferences for future medical events, and the extent to which stroke HCPs engage in conversations around planning for such events. In this study, we sought to understand how the process of ACP unfolded between HCPs and patients post-stroke.Patients and methods: Using grounded theory (GT methodology, we engaged in direct observation of HCP and patient interactions on an acute stroke unit and two stroke rehabilitation units. Using semi-structured interviews, 14 patients and four HCPs were interviewed directly about the ACP process.Results: We found that open and continual ACP conversations were not taking place, patients experienced an apparent lack of urgency to engage in ACP, and HCPs were uncomfortable initiating ACP conversations due to the sensitive nature of the topic.Conclusion: In this study, we identified lack of engagement in ACP post-stroke, attributable to patient and HCP factors. This encourages us to look further into the process of ACP in order to develop open communication between the patient with stroke, their families, and stroke HCPs.Keywords: qualitative, engagement

  10. Advance Care Planning in Norwegian nursing homes-Who is it for?

    Science.gov (United States)

    Thoresen, Lisbeth; Ahlzén, Rolf; Solbrække, Kari Nyheim

    2016-08-01

    Advance care planning (ACP) is an international concept for improving patient autonomy and communication in the context of anticipated deterioration and end-of-life care. In a preparatory conversation, health care professionals facilitate one or more conversations where nursing home residents are invited to reflect on, and articulate wishes and preferences concerning future medical treatment and end-of-life care. Our aim with this study was to increase knowledge of existing ACP practices in Norwegian nursing homes. We wanted to know how nursing home residents, relatives and nursing home staff take part in the conversations, and to what extent these conversations can be regarded as promoting autonomy, legal rights and individual needs for the residents. We conducted participant observation of seven preparatory conversations, followed by interviews with health care staff (together) and resident and relative (together). In the result section, we present an informative case example of an ACP conversation where common and important characteristics running through our data are present. These are further elaborated under the following headings: Life critical questions, Residents' quiet participation in the conversations, the Dying phase - a clinical issue, Nurses and physicians; different domains and Timing. We find that nursing home staff in our study wants to contribute to open awareness, autonomy and a good death, but there are little reflections about the purpose and content of the conversations, how they should be carried out and when, and what frail nursing home residents are able to understand and express in ACP conversations. PMID:27531449

  11. Learning to plan? A critical fiction about the facilitation of professional and practice development plans in primary care.

    Science.gov (United States)

    Elwyn, Glyn; Hocking, Paul; Burtonwood, Ann; Harry, Karan; Turner, Arthur

    2002-11-01

    A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of implementing this change in an independent contractor-based service remain unexplored and the aims of this study were to focus on the facilitator's experience of the issues that hampered or fostered development in general practice. Facilitators of PPDPs were asked to document their experience of supporting 12 practices in an all Wales feasibility study. In order to maintain organisational anonymity while reporting accurate accounts of the obstacles encountered, a method known as critical fiction was employed. This method allowed the authors to write detailed reflective accounts that were then fictionalised. The culture of general practice reflects the development of an independent contractor service that has developed into partnerships that employ some professionals (practice nurses, managers and administrative staff) and collaborate with others in variable arrangements (community nurses, health visitors, midwives and others). Developing organisation-wide systems in so-called 'primary health care teams' is a difficult exercise, given the ethos of autonomous decision-making processes and the lack of experience of 'whole systems' approaches in primary care. The potential for multiprofessional synergy and the evidence that systematic changes lead to sustained health care improvements are well established. But the implementation issues of these concepts have not been addressed. Existing educational policies are based in uniprofessional paradigms and the protected time requirements and funding streams required for PPDPs have not been clarified. PMID:12487843

  12. Hospital and Health Plan Partnerships: The Affordable Care Act's Impact on Promoting Health and Wellness

    Science.gov (United States)

    Vu, Michelle; White, Annesha; Kelley, Virginia P.; Hopper, Jennifer Kuca; Liu, Cathy

    2016-01-01

    Background The Affordable Care Act (ACA) healthcare reforms, centered on achieving the Centers for Medicare & Medicaid Services (CMS) Triple Aim goals of improving patient care quality and satisfaction, improving population health, and reducing costs, have led to increasing partnerships between hospitals and insurance companies and the implementation of employee wellness programs. Hospitals and insurance companies have opted to partner to distribute the risk and resources and increase coordination of care. Objective To examine the ACA's impact on the health and wellness programs that have resulted from the joint ventures of hospitals and health plans based on the published literature. Method We conducted a review of the literature to identify successful mergers and best practices of health and wellness programs. Articles published between January 2007 and January 2015 were compiled from various search engines, using the search terms “corporate,” “health and wellness program,” “health plan,” “insurance plan,” “hospital,” “joint venture,” and “vertical merger.” Publications that described consolidations or wellness programs not tied to health insurance plans were excluded. Noteworthy characteristics of these programs were summarized and tabulated. Results A total of 44 eligible articles were included in the analysis. The findings showed that despite rising healthcare costs, joint ventures prevent hospitals from trading-off quality and services for cost reductions. Administrators believed that partnering would allow the companies to meet ACA standards for improving clinical outcomes at reduced costs. Before the implementation of the ACA, some employers had wellness programs, but these were not standardized and did not need to produce measurable results. The ACA encouraged improvement of employee wellness programs by providing funding for expanded health services and by mandating quality care. Successful workplace health and wellness

  13. Planning for interprofessional change in primary health care: exploring the use of the Interprofessional Resource Centre

    Directory of Open Access Journals (Sweden)

    Patterson C

    2013-05-01

    Full Text Available Christine Patterson,1 Heather Arthur,1,2 Gladys Peachey,1 Julie Vohra,1 David Price,3 Dave Pearson,4 Rob Mariani51School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; 2Heart and Stroke Foundation of Ontario/Michael G DeGroote Endowed Chair in Cardiovascular Nursing Research, McMaster University, Hamilton, ON, Canada; 3Department of Family Medicine, McMaster University, Hamilton, ON, Canada; 4Central West Local Health Integration Network, Brampton, ON, Canada; 5Ascentum Consulting, Ottawa, ON, CanadaImportance: Resources to support change are needed for solo practitioners who are transitioning to family health teams (FHTs which involve multiple health disciplines working together to provide team-based care.Objective: The purpose of this project was: (1 to explore the use of an online resource, the Interprofessional Resource Centre (IRC, when planning for interprofessional change and; (2 to explore the experience of planning interprofessional change.Design and setting: Six FHTs organized under the structure of one Local Health Integrated Network (LHIN in Ontario, Canada.Intervention: Participants in six FHTs were directed to the IRC to support planning interprofessional change. In addition, two of the six FHTs participated in pilot site meetings with investigators where they received in-person support to apply the information from the IRC to an interprofessional activity.Results: Pilot site participants reported the IRC was useful for planning, but they cited lack of time to use it as a key barrier. When planning for interprofessional change, providers experienced challenges with physician buy-in and team dynamics. As a strategy for change, providers would like to learn from other FHTs who have experienced success with interprofessional change; at the LHIN level, they saw a need for more educational opportunities. Participation was found to be low among those only receiving online support.Conclusion and

  14. Role of GIS in social sector planning: can developing countries benefit from the examples of primary health care (PHC) planning in Britain?

    Science.gov (United States)

    Ishfaq, Mohammad; Lodhi, Bilal Khan

    2012-04-01

    Social sector planning requires rational approaches where community needs are identified by referring to relative deprivation among localities and resources are allocated to address inequalities. Geographical information system (GIS) has been widely argued and used as a base for rational planning for equal resource allocation in social sectors around the globe. Devolution of primary health care is global strategy that needs pains taking efforts to implement it. GIS is one of the most important tools used around the world in decentralization process of primary health care. This paper examines the scope of GIS in social sector planning by concentration on primary health care delivery system in Pakistan. The work is based on example of the UK's decentralization process and further evidence from US. This paper argues that to achieve benefits of well informed decision making to meet the communities' needs GIS is an essential tool to support social sector planning and can be used without any difficulty in any environment. There is increasing trend in the use of Health Management Information System (HMIS) in Pakistan with ample internet connectivity which provides well established infrastructure in Pakistan to implement GIS for health care, however there is need for change in attitude towards empowering localities especially with reference to decentralization of decision making. This paper provides GIS as a tool for primary health care planning in Pakistan as a starting point in defining localities and preparing locality profiles for need identification that could help developing countries in implementing the change.

  15. The AB Staff Plan

    CERN Document Server

    Boillot, J; Delahaye, J P; Myers, S; CERN. Geneva. AB Department

    2003-01-01

    The present report summarises the staff plan of the newly created Accelerators and Beams (AB) Division following the restructuring of the Accelerator Sector and covering the period 2003 to 2010. It underlines the refocusing of the staff on priority work, especially the LHC Project and is coherent with the recently adopted CERN Long Term Plan (LTP). It compares the requested and available manpower (both staff and industrial support) for each Project, Programme and Activity (PPA) split in work packages and highlights the missing manpower for each category of personnel.

  16. Fuzzy system dynamics and optimization with application to manpower systems

    Directory of Open Access Journals (Sweden)

    C. Mbohwa

    2012-10-01

    Full Text Available The dynamics of human resource recruitment and training in an uncertain environment creates a challenge for many policy makers in various organisations. In the presence of fuzzy manpower demand and training capacity, many companies fear losing critical human resources when their employees leave. As such, the development of effective dynamic policies for recruitment and training in a fuzzy dynamic environment is imperative. In this frame of mind, a fuzzy systems dynamics modelling approach is proposed to enable the policy maker to develop reliable dynamic policies relating recruitment, training, and available skills, from a systems perspective. It is anticipated in this study that fuzzy system dynamics and optimization approach would help organizations to design effective manpower policies and strategies.

  17. 78 FR 15559 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Science.gov (United States)

    2013-03-11

    ... with the definition used in many of the model acts issued by the National Association of Insurance... Care Act; Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges; Final...; Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges AGENCY: U.S. Office...

  18. Fuzzy system dynamics and optimization with application to manpower systems

    OpenAIRE

    Mbohwa, C; M. Mutingi

    2012-01-01

    The dynamics of human resource recruitment and training in an uncertain environment creates a challenge for many policy makers in various organisations. In the presence of fuzzy manpower demand and training capacity, many companies fear losing critical human resources when their employees leave. As such, the development of effective dynamic policies for recruitment and training in a fuzzy dynamic environment is imperative. In this frame of mind, a fuzzy systems dynamics modelling approach is ...

  19. Selection an Appropriate Leadership Style to Direct Hospital Manpower

    OpenAIRE

    Arab, M.; Tajvar, M; F Akbari

    2006-01-01

    This research has tried to find most proper leadership styles based on a approved model to direct hospital manpower appropriately. The main objective of this research was the comparison between manager’s existing leadership styles and suggested styles to them in order to direct existing styles toward suggested ones. In this cross- sectional study all Qom province hospital managers participated. From the hospital the staff, 385 persons were selected by randomized stratifying sampling. Data wer...

  20. A model linking clinical workforce skill mix planning to health and health care dynamics

    Directory of Open Access Journals (Sweden)

    McDonnell Geoff

    2010-04-01

    Full Text Available Abstract Background In an attempt to devise a simpler computable tool to assist workforce planners in determining what might be an appropriate mix of health service skills, our discussion led us to consider the implications of skill mixing and workforce composition beyond the 'stock and flow' approach of much workforce planning activity. Methods Taking a dynamic systems approach, we were able to address the interactions, delays and feedbacks that influence the balance between the major components of health and health care. Results We linked clinical workforce requirements to clinical workforce workload, taking into account the requisite facilities, technologies, other material resources and their funding to support clinical care microsystems; gave recognition to productivity and quality issues; took cognisance of policies, governance and power concerns in the establishment and operation of the health care system; and, going back to the individual, gave due attention to personal behaviour and biology within the socio-political family environment. Conclusion We have produced the broad endogenous systems model of health and health care which will enable human resource planners to operate within real world variables. We are now considering the development of simple, computable national versions of this model.

  1. Early experience with digital advance care planning and directives, a novel consumer-driven program

    OpenAIRE

    Fine, Robert L.; Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-01-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digi...

  2. Forecasting the manpower demand for quantity surveyors in Hong Kong

    Directory of Open Access Journals (Sweden)

    Paul H K Ho

    2013-09-01

    Full Text Available Recently, there has been a massive infrastructure development and an increasing demand for public and private housing, resulting in a shortage of qualified quantity surveyors. This study aims to forecast the demand for qualified quantity surveyors in Hong Kong from 2013 to 2015. Literature review indicates that the demand for quantity surveyors is a function of the gross values of building, civil engineering and maintenance works. The proposed forecasting method consists of two steps. The first step is to estimate the gross values of building, civil engineering and maintenance works by time series methods and the second step is to forecast the manpower demand for quantity surveyors by causal methods. The data for quantity surveyors and construction outputs are based on the ‘manpower survey reports of the building and civil engineering industry’ and the ‘gross value of construction works performed by main contractors’ respectively. The forecasted manpower demand for quantity surveyors in 2013, 2014 and 2015 are 2,480, 2,632 and 2,804 respectively. Due to the low passing rate of the assessment of professional competence (APC and the increasing number of retired qualified members, there will be a serious shortage of qualified quantity surveyors in the coming three years.

  3. Training of manpower resources at the National Atomic Energy Commission of Argentina

    International Nuclear Information System (INIS)

    The main factors that influenced the development of the manpower resources required by CNEA over its thirty years of life are discussed: a careful specialized training; basic and applied research groups as a basic support for the other activities; teams responsible for the applications and for the concrete realizations of increasing complexity carried out by CNEA, culminating with the nuclear power plants; CNEA's relations with the national educational system regarding nuclear specialization; CNEA's international interaction, either by the participation of foreigners in its internal courses, by the commissioning of Argentinians abroad, and by the cooperation with international agencies in organizing courses, seminars and conferences; the influence of the radiological protection and nuclear safety requirements on the training programs, on nuclear industry, and on the users of radioisotopes and radiations; the importance of feeding the results of each activity back into the system so as to obtain a dynamic programming adapted to the requirements at all times. (M.E.L.)

  4. Training of manpower resources at the National Atomic Energy Commission of Argentina

    Energy Technology Data Exchange (ETDEWEB)

    Ambrosis de Libanati, N. (Comision Nacional de Energia Atomica, Buenos Aires (Argentina). Dept. de Capacitacion y Evaluacion de Personal)

    The main factors that influenced the development of the manpower resources required by CNEA over its thirty years of life are discussed: a careful specialized training; basic and applied research groups as a basic support for the other activities; teams responsible for the applications and for the concrete realizations of increasing complexity carried out by CNEA, culminating with the nuclear power plants; CNEA's relations with the national educational system regarding nuclear specialization; CNEA's international interaction, either by the participation of foreigners in its internal courses, by the commissioning of Argentinians abroad, and by the cooperation with international agencies in organizing courses, seminars and conferences; the influence of the radiological protection and nuclear safety requirements on the training programs, on nuclear industry, and on the users of radioisotopes and radiations; the importance of feeding the results of each activity back into the system so as to obtain a dynamic programming adapted to the requirements at all times.

  5. Where We Are Headed--and Why? A Step-by-Step Guide to Strategic Planning in Center-Based Child Care.

    Science.gov (United States)

    Ratekin, Cindy; Bess, Gary

    1995-01-01

    Argues that strategic planning by all involved in a child care center facilitates planning for the future. This planning includes representation of all parties concerned; attendance at planning events; equal participation; analysis of center's current status; planning sessions in places encouraging creativity; and a skilled, impartial facilitator.…

  6. Third corporate plan September 1991

    International Nuclear Information System (INIS)

    The Science and Engineering Research Council (SERC) published its first Corporate Plan in 1985 and its second in 1989. This third plan comes at a time of considerable change for the Council. Funding is tightly constrained, with the costs of research rising. Changes in funding patterns have made the pursuit of research in the higher-education sector - where the SERC deploys much of its resource -much harder, yet major new challenges and opportunities are opening up. The refocusing of a large organisation like the SERC is not accomplished overnight and needs careful preparation. This plan is therefore an interim document describing some important decisions recently taken and the reviews now being carried out to set future priorities. A fourth plan, to be published early in 1993, will describe the outcome of this reappraisal and set a definitive path towards the end of the century. The aims for the following programmes are stated and the funding objectives stated: the science board materials commission, engineering board, astronomy and planetary science board, nuclear physics board, fellowships, central computing, repayment work administration. Corporate plan actions for the neutron facilities, nuclear structure research, particle physics, information technology, engineering and international cooperation are presented. The impact of the reused plan on the manpower requirements is discussed. (author)

  7. Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components

    Science.gov (United States)

    Huber, Douglas; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren

    2016-01-01

    ABSTRACT Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30–70 percentage points within 1–3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women

  8. Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components.

    Science.gov (United States)

    Huber, Douglas; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren

    2016-09-28

    Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30-70 percentage points within 1-3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women family planning

  9. Corporate compliance plans in health care organizations: a top-down perspective.

    Science.gov (United States)

    Forgione, D A

    1998-01-01

    Recently, at an all-day professional meeting that was targeted at about 100 junior-level health care financial professionals, we covered a whole spectrum of subjects. We covered topics ranging from the Hill-Burton Act to Medicare managed care organizations (MCOs) and capitation; the Stark rules on physician self-referral; the financial incentives within various payment systems for physicians, hospitals, and other providers; Medicare fraud and abuse rules; and the need for well-designed corporate compliance plans. After responding to a number of the participants' questions, I could not help but be reminded of the students every semester who ask me, "Will this be on the test?" In other words, if there are no real teeth in the subject, then they have too many other urgent priorities demanding their attention to give the issue serious consideration. Perhaps this highlights the need for taking corporate compliance planning seriously--starting at the top levels of the organization. It is well documented that leadership attitudes filter downward in any organization. If change for the better is going to take place in the area of corporate compliance, it needs to begin with each of us as individuals, from the top down.

  10. Corporate compliance plans in health care organizations: a top-down perspective.

    Science.gov (United States)

    Forgione, D A

    1998-01-01

    Recently, at an all-day professional meeting that was targeted at about 100 junior-level health care financial professionals, we covered a whole spectrum of subjects. We covered topics ranging from the Hill-Burton Act to Medicare managed care organizations (MCOs) and capitation; the Stark rules on physician self-referral; the financial incentives within various payment systems for physicians, hospitals, and other providers; Medicare fraud and abuse rules; and the need for well-designed corporate compliance plans. After responding to a number of the participants' questions, I could not help but be reminded of the students every semester who ask me, "Will this be on the test?" In other words, if there are no real teeth in the subject, then they have too many other urgent priorities demanding their attention to give the issue serious consideration. Perhaps this highlights the need for taking corporate compliance planning seriously--starting at the top levels of the organization. It is well documented that leadership attitudes filter downward in any organization. If change for the better is going to take place in the area of corporate compliance, it needs to begin with each of us as individuals, from the top down. PMID:9612741

  11. Creating an integrated public sector? Labour's plans for the modernisation of the English health care system

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2002-03-01

    Full Text Available The current Labour Government has embarked on radical public sector reform in England. A so-called ‘Modernisation Agenda’ has been developed that is encapsulated in the NHS Plan—a document that details a long-term vision for health care. This plan involves a five-fold strategy: investment through greater public funding; quality assurance; improving access; service integration and inter-professional working; and providing a public health focus. The principles of Labour's vision have been broadly supported. However, achieving its aims appears reliant on two key factors. First, appropriate resources are required to create capacity, particularly management capacity, to enable new functions to develop. Second, promoting access and service integration requires the development of significant co-ordination, collaboration and networking between agencies and individuals. This is particularly important for health and social care professionals. Their historically separate professions suggest that a significant period of change management is required to allow new roles and partnerships to evolve. In an attempt to secure delivery of its goals, however, the Government has placed the emphasis on further organisational restructuring. In doing so, the Government may have missed the key challenges faced in delivering its NHS Plan. As this paper argues, cultural and behavioural change is probably a far more appropriate and important requirement for success than a centrally directed approach that emphasises the rearrangement of structural furniture.

  12. Palliative care and end-of-life planning in Parkinson's disease.

    Science.gov (United States)

    Walker, Richard William

    2013-04-01

    In Parkinson's disease (PD) typical "palliative care" type symptoms, such as pain, nausea, weight loss and breathlessness can occur throughout the condition, but become more prevalent in later disease stages. Pain may be specifically related to PD, e.g. dystonic pain with wearing off, but is more commonly due to other conditions. The cause can usually be elicited by a careful history and examination, and this guides intervention, both non-pharmaceutical, and pharmaceutical. For example, dystonic pain will respond best to appropriate changes to dopaminergic medication. In later disease stages people have increasing problems with swallowing, and also cognitive impairment. Impaired swallowing may lead to aspiration pneumonia, which is a common cause of hospital admission, and also death. Decisions about interventions towards the end of life, such as insertion of percutaneous endoscopic gastrostomy (PEG) tube for nutrition, can be very challenging, particularly if, as in most cases, the person with PD has not previously expressed their views upon this while they still maintained capacity to make decisions. Advance care planning (ACP) in PD should be encouraged in relation to interventions such as PEG tubes. It may also cover issues such as preferred place of death. Over recent years lower proportions of people have been dying at home, and this is especially true for PD, but home may well be where they would have preferred to die. However, there is little evidence to guide health professionals about how, when, and by whom, ACP should be approached.

  13. A modeling framework for optimal long-term care insurance purchase decisions in retirement planning.

    Science.gov (United States)

    Gupta, Aparna; Li, Lepeng

    2004-05-01

    The level of need and costs of obtaining long-term care (LTC) during retired life require that planning for it is an integral part of retirement planning. In this paper, we divide retirement planning into two phases, pre-retirement and post-retirement. On the basis of four interrelated models for health evolution, wealth evolution, LTC insurance premium and coverage, and LTC cost structure, a framework for optimal LTC insurance purchase decisions in the pre-retirement phase is developed. Optimal decisions are obtained by developing a trade-off between post-retirement LTC costs and LTC insurance premiums and coverage. Two-way branching models are used to model stochastic health events and asset returns. The resulting optimization problem is formulated as a dynamic programming problem. We compare the optimal decision under two insurance purchase scenarios: one assumes that insurance is purchased for good and other assumes it may be purchased, relinquished and re-purchased. Sensitivity analysis is performed for the retirement age.

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

    Directory of Open Access Journals (Sweden)

    Bloom Judy

    2012-08-01

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

  15. The Role of Social Workers in Spiritual Care to Facilitate Coping With Chronic Illness and Self-Determination in Advance Care Planning.

    Science.gov (United States)

    Francoeur, Richard B; Burke, Nancy; Wilson, Alicia M

    2016-01-01

    Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions. To the extent of their individual expertise and competence, social workers should assess and provide spiritual care to clients, including those who either are underserved or prefer not to seek assistance from clergy or chaplains because they feel alienated from religious institutions and representatives. They should also be aware of ethical dilemmas in consulting with spiritual care professionals in developing spiritual interventions. Social work education should address clients' humanistic and existential concerns, beliefs and behaviors of the major religions, and forms of nontraditional religious and spiritual experiences; it should also provide experiential opportunities for engaging with grief and earlier advance care planning. There should be attention to different theodical perspectives of the major religions regarding the problem of good and evil, which may preoccupy even clients who no longer participate in organized religion, because these unresolved existential issues may weaken client coping with chronic conditions and may diminish clarity and self-awareness for engaging authentically and effectively in advance care planning. PMID:27187806

  16. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans.

    Science.gov (United States)

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C

    2015-12-01

    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care.

  17. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans.

    Science.gov (United States)

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C

    2015-12-01

    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care. PMID:25893925

  18. Planning an eLearning Dementia Care Program for Healthcare Teams in Long-Term Care Facilities: The Learners' Perspectives

    Science.gov (United States)

    MacDonald, Colla J.; Stodel, Emma J.; Coulson, Irene

    2004-01-01

    This paper presents a needs analysis conducted to obtain information concerning online dementia care training of healthcare workers in long-term care (LTC) facilities. The resulting information was used to guide the development of an online dementia care training program designed to facilitate the acquisition of skills and knowledge necessary for…

  19. Expected Time To Recruitment In A Two Grade Manpower System

    Directory of Open Access Journals (Sweden)

    J.SRIDHARAN,

    2014-02-01

    Full Text Available In this paper a two graded organization is considered in which depletion of manpower occurs due to its policy decisions. Three mathematical models are constructed by assuming the loss of man-hours and the inter-decision times form an order statistics. Mean and variance of time to recruitment are obtained using an univariate recruitment policy based on shock model approach and the analytical results are numerically illustrated by assuming different distributions for the thresholds. The influence of the nodal parameters on the system characteristics is studied and relevant conclusions are presented.

  20. CLINICAL PSYCHOLOGY – ACTUAL DIRECTION IN GROUNDING OF HEALTH MANPOWER

    Directory of Open Access Journals (Sweden)

    M.G. Kucherov

    2007-09-01

    Full Text Available In 90-ies years of last century in our country happened the crash of the system of values with transition to the standards of capitalistic society, and it lead to the formation of chronicle psychosocial stress of high and medium levels. Medics of all directions started to face functional psychosomatic diseases. Raised the necessity in grounding of health manpower in discipline of clinical psychology, with the learning of psychophisiological bases of diseases and possibilities if their correction. This direction of development of soviet medical education and health service in general seems progressive and prospective.

  1. Early Years of Neutron Scattering and Its Manpower Development in Indonesia

    Science.gov (United States)

    Marsongkohadi

    2008-03-01

    In this paper I shall give a short history of the development of neutron scattering at the Research Centre for Nuclear Techniques (PPTN), in Bandung, and the early development of a more advanced facilities at the Neutron Scattering Laboratory (NSL BATAN), Centre of Technology for Nuclear Industrial Materials, in Serpong. The first research reactor in Indonesia was the TRIGA MARK II in Bandung, which became operational in 1965, with a power of 250 KW, upgraded to 1 MW in 1971, and to 2 MW in 2000. The neutron scattering activities was started in 1967, with the design and construction of the first powder diffractometer, and put in operation in 1970. It was followed by the second instrument, the filter detector spectrometer built in 1975 in collaboration with the Bhabha Atomic Research Centre (BARC), India. A powder diffractometer for magnetic studies was built in 1980, and finally, a modification of the filter detector spectrometer to measure textures was made in 1986. A brief description of the design and construction of the instruments, and a highlight of some research topics will be presented. Early developments of neutron scattering activities at the 30 MW, RSG-GAS reactor in Serpong in choosing suitable research program, which will be mainly centred around materials testing/characterization, and materials/condensed matter researches has been agreed. Instrument planning and layout which were appropriate to carry out the program had been decided. Manpower development for the neutron scattering laboratory is a severe problem. The efforts to overcome this problem has been solved. International Cooperation through workshops and on the job trainings also support the supply of qualified manpower.

  2. Consumer-directed health plans: are medical and health savings accounts viable options for financing American health care?

    Science.gov (United States)

    Masri, Maysoun Demachkie; Oetjen, Reid M; Campbell, Claudia

    2010-01-01

    When Americans voted in November 2008, many had the presidential candidates' positions on health care reform in mind. Health savings accounts, which are high deductible health plans coupled with a tax-protected savings account, are 1 type of consumer-directed health plan (CDHP) that gained strong support from the Bush administration. Despite evidence of the effectiveness of CDHPs in constraining costs in other countries, the Obama health plan contains no mention of their role in future US health reform. This article seeks to provide the reader with a better understanding of how CDHPs can help to improve the use of health resources and reduce national health care expenditures by exploring the history and previous research on several types of consumer-directed plans and by providing a comparative analysis of the use of CDHPs in other countries. PMID:20686396

  3. Exploring motivations to seek and undergo prosthodontic care: an empirical approach using the Theory of Planned Behavior construct

    OpenAIRE

    Vieira AH; Leles CR

    2014-01-01

    Antonio Hélio Vieira, Cláudio Rodrigues Leles Department of Prevention and Oral Rehabilitation, School of Dentistry, Federal University of Goias, Goiania, Goias, Brazil Abstract: Motivations for seeking and undergoing prosthodontic care are poorly understood and are not often explored for clinical purposes when determining treatment need and understanding the factors related to the demand for health care and effective use. This article uses the Theory of Planned Behavi...

  4. Efficacy of an Intervention Based on the Theory of Planned Behavior on Foot Care Performance in Type II Diabetic Patients

    OpenAIRE

    Beiranvand; Asadizaker; Fayazi; Yaralizadeh

    2015-01-01

    Background It is known that health education on foot care is a common strategy for preventing diabetic foot and reducing the rate of lower limb amputation. Objectives To evaluate the efficacy of an intervention based on the theory of planned behavior for improving foot care in patients with type II diabetes in 2013 in Ahvaz, Iran. Patients and Methods In this clinical trial, 69 pat...

  5. Using the diffusion of innovations theory to assess socio-technical factors in planning the implementation of an electronic health record alert across multiple primary care clinics

    Directory of Open Access Journals (Sweden)

    Ching-Pin Lin

    2016-04-01

    Conclusion: Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.

  6. The Excellent Care for All Act's quality improvement plans: reflections on the first year.

    Science.gov (United States)

    Kutty, Sudha; Ladak, Nizar; Muskat, Cyrelle; Paul, Jillian; Orchard, Margo

    2012-01-01

    In 2010, Ontario passed the Excellent Care for All Act (the EFCA Act). Although the purpose of the Act was clear, the legislation itself was relatively non-prescriptive in relation to the mandatory quality improvement plans (QIPs), and hospitals needed direction on how to proceed. A task group was established to develop a common provincial QIP template, along with guidance, support and educational materials. The template was field tested across the province and, subsequently, all hospitals developed their QIPs, posted them publicly, and submitted them to Health Quality Ontario (HQO). Despite challenges including short time frames, limitations in data availability and a variance of skills in performance measurement, the implementation of QIPs in hospitals was a success. Success is part could be attributed to a strong tripartite partnership and good communication channels with hospitals. Hospitals with the most effective QIPs were those whose leaders used the opportunity of a provincially mandated QIP as a lever to drive and legitimize the need to have conversations regarding quality from the boardroom down to the front line. As organizations continue to develop and implement their QIPs, we will see this tremendous quality improvement effort sustained. The QIPs will remain a significant transformational lever to engage the system in improving performance and achieving excellent care for all.

  7. Revolution as a care plan: ethnography, nursing and somatic solidarity in Honduras.

    Science.gov (United States)

    Pine, Adrienne

    2013-12-01

    While diagnosis is not within the biomedical scope of a nurse's work, assessment-an inherently ethnographic exercise-is. In Honduras, as in the United States, nurses' proximity with patients, in terms of both time spent at the bedside and shared class identification (embodied as habitus), mean that nurses are often more effective than physicians in assessment and healing. Following the 2009 coup that brought a violently repressive regime to power in Honduras, subjectivation as citizen healers brought many nurses to assess patient health as a function of neoliberal and political violence. This assessment framed radical struggle that required nurses to block political violence with their own bodies as being a necessary part of patient care. Similarly, as ethnographer, I came to share with nurses and other Hondurans certain violent processes of subjectivation (albeit from a privileged subject position) that strengthened my solidarity with them as well as my deeply embodied investment in their care plan of organizing for radical social change. This paper examines the politicizing impact of the 2009 coup on Honduran auxiliary and professional nurses and the ways in which nurse assessment and ethnographic analysis can overlap and combine in somatic and political solidarity with patients and others resisting state and political violence through their bodies.

  8. A marketing plan for health care in the financial district of San Francisco.

    Science.gov (United States)

    Evans, S

    1987-01-01

    The development of a corporate health marketing program for the Medical Pavilion was based on three assumptions. 1. Medical Pavilion will contribute positively to health care cost containment for employers by providing convenient, quality medical care which will help to reduce employee time lost from work due to physician visits, and through health screening, early diagnosis, and out-patient procedures, decrease unnecessary hospitalization. 2. The level of awareness among chief executive officers, benefits directors, corporate medical directors, and employees will be positively related to utilization of health services at the Medical Pavilion. 3. The Medical Pavilion will be organized on a private practice model; although special programs related to employer coverage and specific benefits may be considered separately. The recommended goals of the corporate health program of the Medical Pavilion were as follows: 1. To develop demographic profiles based on current utilization of medical services in a random sample to corporations in the Financial District. 2. To design a survey of corporate leadership to determine a needs assessment strategy for the development of preventive health services programs to be offered at the Medical Pavilion. 3. To select an advertising and public relations agency; and determine the marketing bridges, for the first year and the following five year period. 4. To evaluate effectiveness of the corporate health marketing plan referral data collected through the Management Information System to be established at the Medical Pavilion.

  9. A marketing plan for health care in the financial district of San Francisco.

    Science.gov (United States)

    Evans, S

    1987-01-01

    The development of a corporate health marketing program for the Medical Pavilion was based on three assumptions. 1. Medical Pavilion will contribute positively to health care cost containment for employers by providing convenient, quality medical care which will help to reduce employee time lost from work due to physician visits, and through health screening, early diagnosis, and out-patient procedures, decrease unnecessary hospitalization. 2. The level of awareness among chief executive officers, benefits directors, corporate medical directors, and employees will be positively related to utilization of health services at the Medical Pavilion. 3. The Medical Pavilion will be organized on a private practice model; although special programs related to employer coverage and specific benefits may be considered separately. The recommended goals of the corporate health program of the Medical Pavilion were as follows: 1. To develop demographic profiles based on current utilization of medical services in a random sample to corporations in the Financial District. 2. To design a survey of corporate leadership to determine a needs assessment strategy for the development of preventive health services programs to be offered at the Medical Pavilion. 3. To select an advertising and public relations agency; and determine the marketing bridges, for the first year and the following five year period. 4. To evaluate effectiveness of the corporate health marketing plan referral data collected through the Management Information System to be established at the Medical Pavilion. PMID:10283139

  10. Brazilian public policies for reproductive health: family planning, abortion and prenatal care.

    Science.gov (United States)

    Guilhem, Dirce; Azevedo, Anamaria Ferreira

    2007-08-01

    This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom. PMID:17614992

  11. Survivorship care planning in a comprehensive cancer center using an implementation framework.

    Science.gov (United States)

    Garcia, Sofia F; Kircher, Sheetal M; Oden, Megan; Veneruso, Aubri; McKoy, June M; Pearman, Timothy; Penedo, Frank J

    2016-05-01

    Cancer survivorship care plans (SCPs) have been recommended to improve clinical care and patient outcomes. Research is needed to establish their efficacy and identify best practices. Starting in 2015, centers accredited by the American College of Surgeons Commission on Cancer must deliver SCPs to patients completing primary cancer treatment with curative intent. We describe how we established routine SCP delivery at the Robert H Lurie Comprehensive Cancer Center in Chicago, Illinois, using the Quality Implementation Framework. We evaluated local practices, gathered clinician and patient stakeholder input, developed customized SCP templates within the electronic health record (EHR), and implemented 2 complementary delivery models. Clinician interviews (n = 41) and survey responses (n = 12), along with input from patients (n = 68) and a patient advisory board (n = 15), indicated support for SCPs and survivorship services. To promote feasible implementation and leverage existing workflows, we harmonized 2 SCP delivery models: integrated care within clinics where patients received treatment, and referral to a centralized survivorship clinic. We are implementing SCP delivery with prominent disease sites and will extend services to survivors of other cancers in the future. We developed four electronic disease-specific SCP templates for breast, colorectal, lung, and prostate cancers and a fifth, generic template that can be used for other malignancies. The templates reduced free-text clinician entry by auto-populating 20% of the fields from existing EHR data, and using drop-down menus for another 65%. Mean SCP completion time is 12 minutes (range, 10-15; n = 64). We designed our framework to facilitate ongoing evaluation of implementation and quality improvement. Funding/sponsorship Robert H Lurie Comprehensive Cancer Center, the Coleman Foundation, and the Lynn Sage Cancer Research Foundation. PMID:27258051

  12. Early experience with digital advance care planning and directives, a novel consumer-driven program.

    Science.gov (United States)

    Fine, Robert L; Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-07-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digital ACP/AD tool, to achieve proportional representation of all 50 states by population size and then reviewed their responses. The 900 participants had an average age of 50.8 years (SD = 16.6); 84% of the men and 91% of the women were in self-reported good health when signing their ADs. Among the respondents, 94% wanted their physicians to consult a supportive and palliative care team if they were seriously ill; nearly 85% preferred cessation of life-sustaining treatments during their final days; 76% preferred to spend their final days at home or in a hospice; and 70% would accept attempted cardiopulmonary resuscitation in limited circumstances. Most respondents wanted an autopsy under certain conditions, and 62% wished to donate their organs. In conclusion, analysis of early experience with this ACP/AD platform demonstrates that individuals of different ages and conditions can engage in an interrogatory process about values, develop ADs that are more nuanced than traditional paper-based ADs in reflecting those values, and easily make changes to their ADs. Online ADs have the potential to remove barriers to ACP/AD and thus further improve patient-centered end-of-life care.

  13. The Manpower Aspect in the Field of Sport

    Directory of Open Access Journals (Sweden)

    Melania Kiswandari

    2012-09-01

    Full Text Available As a result of enhanced professionalism and commercialization in the field of sports, it has become an industry of its own. Professionalism and industrialization are correlated; therefore sports actors’ performance achieved as a result of their professionalism lead to the commercialization, and even to the industrialization of certain (branches of sports. On the other hand, it is considered that industrialization which involves the commercial aspect is able to maintain, and even enhance sports actors’ professionalism/performance. In practice, such correlation is not always directly proportional, but inversely proportional. There have been cases of issues related to sports actors’ welfare not being properly fulfilled, in fact, being far below the general manpower standards applicable to people doing work (workers/laborers. In general such cases include late or non-payment of wages, reducing bonuses, implementation of contract not accordance with the initial agreement, unilateral termination of contract without compensation for damages and others. The frequently arising question is whether sports actors, particularly athletes, have the status of ‘nonemployee’ professionals, or the status of ‘employees’. The various existing opinions related to such issue of status raise certain legal implications, particularly from the manpower aspect which emphasizes the welfare and legal protection of ‘workers’, which are also often experienced by athletes. It is expected that this article will be able to provide to the readers a broader view regarding the status of athletes’ ‘manpower’ status.

  14. Report of New Manpower Researchers Conference. September 22-23, 1971.

    Science.gov (United States)

    Taggart, Robert

    This report contains abstracts and discussions of papers and speeches delivered at the 1971 New Manpower Researchers Conference. These include speeches by Charles Schultze on incentives in the public sector, one by Congressman William Steiger on manpower reform, and one by Maurice Mann on government economic controls. The abstracted topics include…

  15. After the flood. A strategic primary health care plan for homeless and migrant populations during an environmental disaster.

    Science.gov (United States)

    Washington, G T

    1998-01-01

    An environmental crisis, such as a flood, can significantly affect health care delivery and services in a community. Environmental disasters can be particularly devastating to already vulnerable populations such as the homeless and migrants, who, because of social, political, and economic constraints, experience special health care needs. In 1993, after Iowa experienced the worst flood in its history, President Clinton declared the entire state a federal disaster area. Later, the Iowa Department of Public Health received a federal grant to evaluate the health care delivered during the flood and develop a strategic plan to enhance primary health care for the homeless and migrant populations during future environmental disasters. The plan was based on data obtained during and after the flood in three critical areas--communication, health care delivery, and community. These areas were themes that emerged from a series of interviews with representatives from health care agencies and clients themselves. Each theme became the focus of specific, comprehensive recommendations and strategies to meet the daily challenges of the homeless and migrants, as well as to enhance the delivery of primary health care services in the future.

  16. Patient-centered cancer treatment planning: improving the quality of oncology care. Summary of an Institute of Medicine workshop.

    Science.gov (United States)

    Balogh, Erin P; Ganz, Patricia A; Murphy, Sharon B; Nass, Sharyl J; Ferrell, Betty R; Stovall, Ellen

    2011-01-01

    The Institute of Medicine's National Cancer Policy Forum recently convened a workshop on patient-centered cancer treatment planning, with the aim of raising awareness about this important but often overlooked aspect of cancer treatment. A primary goal of patient-centered treatment planning is to engage patients and their families in meaningful, thorough interactions with their health care providers to develop an accurate, well-conceived treatment plan, using all available medical information appropriately while also considering the medical, social, and cultural needs and desires of the patient and family. A cancer treatment plan can be shared among the patient, family, and care team in order to facilitate care coordination and provide a roadmap to help patients navigate the path of cancer treatment. There are numerous obstacles to achieving patient-centered cancer treatment planning in practice. Some of these challenges stem from the patient and include patients' lack of assertiveness, health literacy, and numeracy, and their emotional state and concurrent illnesses. Others are a result of physician limitations, such as a lack of time to explain complex information and a lack of tools to facilitate treatment planning, as well as insensitivity to patients' informational, cultural, and emotional needs. Potential solutions to address these obstacles include better training of health care providers and patients in optimal communication and shared decision making, and greater use of support services and tools such as patient navigation and electronic health records. Other options include greater use of quality metrics and reimbursement for the time it takes to develop, discuss, and document a treatment plan. PMID:22128118

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

    Institute of Scientific and Technical Information of China (English)

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

    2003-01-01

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

  18. Reliability of a patient survey assessing cost-related changes in health care use among high deductible health plan enrollees

    Directory of Open Access Journals (Sweden)

    Galbraith Alison A

    2011-05-01

    Full Text Available Abstract Background Recent increases in patient cost-sharing for health care have lent increasing importance to monitoring cost-related changes in health care use. Despite the widespread use of survey questions to measure changes in health care use and related behaviors, scant data exists on the reliability of such questions. Methods We administered a cross-sectional survey to a stratified random sample of families in a New England health plan's high deductible health plan (HDHP with ≥ $500 in annualized out-of-pocket expenditures. Enrollees were asked about their knowledge of their plan, information seeking, behavior change associated with having a deductible, experience of delay in care due in part to cost, and hypothetical delay in care due in part to cost. Initial respondents were mailed a follow-up survey within two weeks of each family returning the original survey. We computed several agreement statistics to measure the test-retest reliability for select questions. We also conducted continuity adjusted chi-square, and McNemar tests in both the original and follow-up samples to measure the degree to which our results could be reproduced. Analyses were stratified by self-reported income. Results The test-retest reliability was moderate for the majority of questions (0.41 - 0.60 and the level of test-retest reliability did not differ substantially across each of the broader domains of questions. The observed proportions of respondents with delayed or foregone pediatric, adult, or any family care were similar when comparing the original and follow-up surveys. In the original survey, respondents in the lower-income group were more likely to delay or forego pediatric care, adult care, or any family care. All of the tests comparing income groups in the follow-up survey produced the same result as in the original survey. Conclusions In this population of HDHP beneficiaries, we found that survey questions concerning plan knowledge, information

  19. Development of a web-based pharmaceutical care plan to facilitate collaboration between healthcare providers and patients

    NARCIS (Netherlands)

    Geurts, Marlies M E; Ivens, Martijn; van Gelder, Egbert; de Gier, Johan J

    2013-01-01

    BACKGROUND: In medication therapy management there is a need for a tool to document medication reviews and pharmaceutical care plans (PCPs) as well as facilitate collaboration and sharing of patient data between different healthcare providers. Currently, pharmacists and general practitioners (GPs) h

  20. Old-age Care Modes and Facility Planning Based on the Concept of “Continuum of Care”

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Through the comparative analysis on the theories and practical experience of the development of old-age care (OAC) in both China and other countries,and based on the interview and questionnaire survey in Zhejiang Province and Hangzhou City,this paper proposes the research and analysis framework for the old-age service system,i.e.,"OAC mode-OAC service system-OAC facility system." The paper argues that,oriented by OAC mode of "taking community-and home-based care as the main body and institution-based care as supplement," China should build an OAC facility system and planning thoughts that take "continuum of care" as concept and long-term care system as core.Taking Zhejiang Province and Hangzhou City as examples,the paper conducts the optimization research on current OAC facilities planning in terms of hierarchical system,scale,and differentiation,so as to formulate more systematic and operable planning standards for OAC facilities.

  1. Current status of neonatal intensive care in India.

    Science.gov (United States)

    Karthik Nagesh, N; Razak, Abdul

    2016-05-01

    Globally, newborn health is now considered as high-level national priority. The current neonatal and infant mortality rate in India is 29 per 1000 live births and 42 per 1000 live births, respectively. The last decade has seen a tremendous growth of neonatal intensive care in India. The proliferation of neonatal intensive care units, as also the infusion of newer technologies with availability of well-trained medical and nursing manpower, has led to good survival and intact outcomes. There is good care available for neonates whose parents can afford the high-end healthcare, but unfortunately, there is a deep divide and the poor rural population is still underserved with lack of even basic newborn care in few areas! There is increasing disparity where the 'well to do' and the 'increasingly affordable middle class' is able to get the most advanced care for their sick neonates. The underserved urban poor and those in rural areas still contribute to the overall high neonatal morbidity and mortality in India. The recent government initiative, the India Newborn Action Plan, is the step in the right direction to bridge this gap. A strong public-private partnership and prioritisation is needed to achieve this goal. This review highlights the current situation of neonatal intensive care in India with a suggested plan for the way forward to achieve better neonatal care.

  2. Role of Advance Care Planning in Proxy Decision Making Among Individuals With Dementia and Their Family Caregivers.

    Science.gov (United States)

    Kwak, Jung; De Larwelle, Jessica A; Valuch, Katharine O'Connell; Kesler, Toni

    2016-01-01

    Health care proxies make important end-of-life decisions for individuals with dementia. A cross-sectional survey was conducted to examine the role of advance care planning in proxy decision making for 141 individuals with cognitive impairment, Alzheimer's disease, or other types of dementia. Proxies who did not know the preferences of individuals with dementia for life support treatments reported greater understanding of their values. Proxies of individuals with dementia who did not want life support treatments anticipated receiving less support and were more uncertain in decision making. The greater knowledge proxies had about dementia trajectory, family support, and trust of physicians, the more informed, clearer, and less uncertain they were in decision making. In addition to advance care planning, multiple factors influence proxy decision making, which should be considered in developing interventions and future research to support informed decision making for individuals with dementia and their families.

  3. Strategic enterprise resource planning in a health-care system using a multicriteria decision-making model.

    Science.gov (United States)

    Lee, Chang Won; Kwak, N K

    2011-04-01

    This paper deals with strategic enterprise resource planning (ERP) in a health-care system using a multicriteria decision-making (MCDM) model. The model is developed and analyzed on the basis of the data obtained from a leading patient-oriented provider of health-care services in Korea. Goal criteria and priorities are identified and established via the analytic hierarchy process (AHP). Goal programming (GP) is utilized to derive satisfying solutions for designing, evaluating, and implementing an ERP. The model results are evaluated and sensitivity analyses are conducted in an effort to enhance the model applicability. The case study provides management with valuable insights for planning and controlling health-care activities and services. PMID:20703564

  4. The Effects of Guided Careful Online Planning on Complexity, Accuracy and Fluency in Intermediate EFL Learners' Oral Production: The Case of English Articles

    Science.gov (United States)

    Ahmadian, Mohammad Javad

    2012-01-01

    The purpose of the study reported in this article was twofold: First, to see whether guided careful online planning assists intermediate learners of English as a foreign language (EFL) in accurate oral production of English articles ("an/a" and "the"); and, second, to see whether guided careful online planning has any effects on global complexity…

  5. Advance Care Planning Discussions: Why They Should Happen, Why They Don't, and How We Can Facilitate the Process.

    Science.gov (United States)

    Norals, Taira Everett; Smith, Thomas J

    2015-08-01

    Recent data suggest that we are not successfully getting the message across about the importance of advance care planning for patients who have a life-ending illness. Half to three-quarters of patients with incurable cancer think that they might be cured by chemotherapy, radiation, or surgery. The source of this denial may lie with them, it may be traceable to their physicians, or it may be a combination of the two. This avoidance has consequences, since those patients with "prognostic awareness" have end-of-life care pathways that involve little use of the hospital, ICU, end-of-life chemo, or "codes" with almost no chance of success, and much more dying at home with hospice care. If we can successfully initiate advance care planning discussions with our patients and families, their end-of-life processes will improve, resulting in better care, less use of the hospital, and more honoring of newly discerned choices. We show how this can be done in regular oncology practice by introducing the Johns Hopkins "Palliative Care Temporary Tattoo" and by providing some ways to discuss cardiopulmonary resuscitation in settings where it will not be helpful.

  6. A vision of long-term care. To care for tomorrow's elderly, hospitals must plan now, not react later.

    Science.gov (United States)

    Kodner, D L

    1989-12-01

    In the next two decades, rapid, fundamental changes will take place in the way we finance, organize, and provide long-term care services. Because the elderly make up such a large portion of the patient population, America's hospitals should be concerned--and involved. There are six keys to the future of long-term care: a sharp increase in elderly population, a new generation of elderly, restrained government role, intergenerational strains, growing corporate concern, and the rise of "gerotechnology." These trends and countertrends will result in a new look in the long-term care landscape. By the year 2010, changes will include a true public-private financing system, provider reimbursement on the basis of capitation and prospective payment, coordinated access to services, dominant alternative delivery systems, a different breed of nursing homes, fewer staffing problems, patient-centered care, a new importance in housing, and an emphasis on prevention. For hospitals, this future vision of long-term care means that significant opportunities will open up to meet the needs of the elderly-at-risk and to achieve a competitive position in the burgeoning elderly care industry. PMID:10313396

  7. Solving a manpower scheduling problem for airline catering using metaheuristics

    DEFF Research Database (Denmark)

    Ho, Sin C.; Leung, Janny M. Y.

    2010-01-01

    be serviced within a given time-window by a team consisting of a driver and loader. Each driver/loader has the skills to service some, but not all, of the airline/aircraft/ configuration of the jobs. Given the jobs to be serviced and the roster of workers for each shift, the problem is to form teams...... annealing heuristic approach to solve the problem. Computational experiments show that the tabu search approach outperforms the simulated annealing approach, and is capable of finding good solutions.......We study a manpower scheduling problem with job time-windows and job-skills compatibility constraints. This problem is motivated by airline catering operations, whereby airline meals and other supplies are delivered to aircrafts on the tarmac just before the flights take-off.  Jobs (flights) must...

  8. Promoting advance planning for health care and research among older adults: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Bravo Gina

    2012-01-01

    Full Text Available Abstract Background Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/Design Dyads (n = 240 comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance

  9. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction

    Directory of Open Access Journals (Sweden)

    Gausvik C

    2015-01-01

    Full Text Available Christian Gausvik,1 Ashley Lautar,2 Lisa Miller,2 Harini Pallerla,3 Jeffrey Schlaudecker4,5 1University of Cincinnati College of Medicine, 2The Christ Hospital, Cincinnati, OH, USA; 3Department of Family and Community Medicine, 4Division of Geriatric Medicine, University of Cincinnati, Cincinnati, OH, USA; 5Geriatric Medicine Fellowship Program, University of Cincinnati/The Christ Hospital, Cincinnati, OH, USA Abstract: Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR on an acute care for the elderly (ACE unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer

  10. Learning to plan? A critical fiction about the facilitation of professional and practice development plans in primary care.

    NARCIS (Netherlands)

    Elwyn, G.; Hocking, P.; Burtonwood, A.; Harry, K.; Turner, A.

    2002-01-01

    A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of

  11. Tactics research of enterprise's manpower capital investment%论企业人力资本投资策略

    Institute of Scientific and Technical Information of China (English)

    栗会敏; 周霞

    2004-01-01

    In the era of knowledge- driven economy, the manpower capital is the most active factor of production and core of social economic development. This text proceeds with the concept of capital manpower, and probes into the importance of manpower capital investment to the survival and development of enterprises. In order to maximize the income of manpower capital investment, enterprises need to set up corresponding incentive mechanism to inspire the enthusiasm of manpower capital, and it is also the key factors that promoting the development modern economic and the enterprises' success.

  12. Access to Complex Abortion Care Service and Planning Improved through a Toll-Free Telephone Resource Line

    Directory of Open Access Journals (Sweden)

    Wendy V. Norman

    2014-01-01

    Full Text Available Background. Providing equitable access to the full range of reproductive health services over wide geographic areas presents significant challenges to any health system. We present a review of a service provision model which has provided improved access to abortion care; support for complex issues experienced by women seeking nonjudgmental family planning health services; and a mechanism to collect information on access barriers. The toll-free pregnancy options service (POS of British Columbia Women’s Hospital and Health Centre sought to improve access to services and overcome barriers experienced by women seeking abortion. Methods. We describe the development and implementation of a province-wide toll-free telephone counseling and access facilitation service, including establishment of a provincial network of local abortion service providers in the Canadian province of British Columbia from 1998 to 2010. Results. Over 2000 women annually access service via the POS line, networks of care providers are established and linked to central support, and central program planners receive timely information on new service gaps and access barriers. Conclusion. This novel service has been successful in addressing inequities and access barriers identified as priorities before service establishment. The service provided unanticipated benefits to health care planning and monitoring of provincial health care related service delivery and gaps. This model for low cost health service delivery may realize similar benefits when applied to other health care systems where access and referral barriers exist.

  13. The development of KAERI management information system -First year: The development of manpower information management system-

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Shin Bok; Huh, Young Hwan; Lee, Jong Bok; Park, Soo Jin; Lee, Young Jae; Park, Yeon Sik; Jang, Deok Kyu; Park, Seung Deok; Kim, Jong Myeong [Korea Atomic Energy Res. Inst., Taejon (Korea, Republic of)

    1991-12-01

    The purpose of this report is to describe the implementation of the management information system for manpower. This job is the first year`s for development KAERI management information system. It is important to properly manage a manpower to cope with the external circumstances promptly and to maximize the productivity of the organization. This report aims at basic management of manpower and uses multimedia to keep abreast with the times and introduces the concept of GUI (Graphic User Interface) to user for ease access. (Author).

  14. The development of KAERI management information system -First year: The development of manpower information management system-

    International Nuclear Information System (INIS)

    The purpose of this report is to describe the implementation of the management information system for manpower. This job is the first year's for development KAERI management information system. It is important to properly manage a manpower to cope with the external circumstances promptly and to maximize the productivity of the organization. This report aims at basic management of manpower and uses multimedia to keep abreast with the times and introduces the concept of GUI (Graphic User Interface) to user for ease access. (Author)

  15. Daily Care

    Science.gov (United States)

    ... to Know Online Tools Enhancing Daily Life Daily Plan Activities Communication Food & Eating Music & Art Personal Care Incontinence Bathing ... Tweet Email | Print Create a Daily Routine Daily Plan Activities Communication Food/Eating Get Tips on Personal Care Bathing ...

  16. Challenges in physician supply planning: the case of Belgium

    Directory of Open Access Journals (Sweden)

    Léonard Christian

    2010-12-01

    Full Text Available Abstract Introduction Planning human resources for health (HRH is a complex process for policy-makers and, as a result, many countries worldwide swing from surplus to shortage. In-depth case studies can help appraising the challenges encountered and the solutions implemented. This paper has two objectives: to identify the key challenges in HRH planning in Belgium and to formulate recommendations for an effective HRH planning, on the basis of the Belgian case study and lessons drawn from an international benchmarking. Case description In Belgium, a numerus clausus set up in 1997 and effective in 2004, aims to limit the total number of physicians working in the curative sector. The assumption of a positive relationship between physician densities and health care utilization was a major argument in favor of medical supply restrictions. This new regulation did not improve recurrent challenges such as specialty imbalances, with uncovered needs particularly among general practitioners, and geographical maldistribution. New difficulties also emerged. In particular, limiting national training of HRH turned out to be ineffective within the open European workforce market. The lack of integration of policies affecting HRH was noteworthy. We described in the paper what strategies were developed to address those challenges in Belgium and in neighboring countries. Discussion and evaluation Planning the medical workforce involves determining the numbers, mix, and distribution of health providers that will be required at some identified future point in time. To succeed in their task, health policy planners have to take a broader perspective on the healthcare system. Focusing on numbers is too restrictive and adopting innovative policies learned from benchmarking without integration and coordination is unfruitful. Evolving towards a strategic planning is essential to control the effects of the complex factors impacting on human resources. This evolution requires

  17. Involving patients with multimorbidity in service planning: perspectives on continuity and care coordination

    OpenAIRE

    Schiøtz, Michaela L.; Høst, Dorte; Frølich, Anne

    2016-01-01

    Background: The prevalence of multiple comorbid chronic conditions, or multimorbidity, is increasing. Care provided to people with multimorbidity is often fragmented, incomplete, inefficient and ineffective. As part of a research and development project focusing on improving care, we sought to involve patients with multimorbidity in the development process. Objective: To identify opportunities for improving care by understanding how patients from a Danish University Hospital experience care c...

  18. Planning intensive care unit design using computer simulation modeling: optimizing integration of clinical, operational, and architectural requirements.

    Science.gov (United States)

    OʼHara, Susan

    2014-01-01

    Nurses have increasingly been regarded as critical members of the planning team as architects recognize their knowledge and value. But the nurses' role as knowledge experts can be expanded to leading efforts to integrate the clinical, operational, and architectural expertise through simulation modeling. Simulation modeling allows for the optimal merge of multifactorial data to understand the current state of the intensive care unit and predict future states. Nurses can champion the simulation modeling process and reap the benefits of a cost-effective way to test new designs, processes, staffing models, and future programming trends prior to implementation. Simulation modeling is an evidence-based planning approach, a standard, for integrating the sciences with real client data, to offer solutions for improving patient care.

  19. A practical guide to applying lean tools and management principles to health care improvement projects.

    Science.gov (United States)

    Simon, Ross W; Canacari, Elena G

    2012-01-01

    Manufacturing organizations have used Lean management principles for years to help eliminate waste, streamline processes, and cut costs. This pragmatic approach to structured problem solving can be applied to health care process improvement projects. Health care leaders can use a step-by-step approach to document processes and then identify problems and opportunities for improvement using a value stream process map. Leaders can help a team identify problems and root causes and consider additional problems associated with methods, materials, manpower, machinery, and the environment by using a cause-and-effect diagram. The team then can organize the problems identified into logical groups and prioritize the groups by impact and difficulty. Leaders must manage action items carefully to instill a sense of accountability in those tasked to complete the work. Finally, the team leaders must ensure that a plan is in place to hold the gains.

  20. One day at a time: living with frailty: implications for the practice of advance care planning: a multiple case study

    OpenAIRE

    Bramley, Louise

    2016-01-01

    Background: Advance care planning (ACP) was originally designed to promote autonomy and is commonly conceptualised as informing treatment and decisions in the event of a person’s loss of capacity. In the UK, healthcare policy has emphasised the potential for ACP to significantly contribute to improvements in experiences of death and dying for patients and their significant others. Older people with progressive frailty are at high risk of mortality, loss of capacity and increasing dependency o...

  1. Exploring motivations to seek and undergo prosthodontic care: an empirical approach using the Theory of Planned Behavior construct.

    Science.gov (United States)

    Vieira, Antonio Hélio; Leles, Cláudio Rodrigues

    2014-01-01

    Motivations for seeking and undergoing prosthodontic care are poorly understood and are not often explored for clinical purposes when determining treatment need and understanding the factors related to the demand for health care and effective use. This article uses the Theory of Planned Behavior construct to identify factors related to the motivations of edentulous subjects to seek and undergo prosthodontic treatment. The conceptual framework of the Theory of Planned Behavior includes attitude toward behavior, an individual's positive or negative evaluation of self-performance of the particular behavior; the subjective norm, an individual's perception of social normative pressures or relevant others' beliefs that he or she should or should not perform such behavior; and perceived behavioral control, or an individual's perceived ease or difficulty in performing the particular behavior, determined by the total set of accessible control beliefs. These components mediate a subject's intention and behavior toward an object and may also explain health-related behaviors, providing strong predictions across a range of health behaviors. This study suggests categories for each component of the Theory of Planned Behavior, based on clinical evidence and practical reasoning. Attitudes toward behavior include perceived consequences of no treatment, perceived potential benefits and risks of treatment, dental anxiety, previous experiences, and interpersonal abilities of the health care providers. The subjective norm includes the opinions of relevant others, advertisement, professionally defined normative need, perceived professional skills, and technical quality of care. Perceived behavioral control includes subject's time, availability and opportunity, treatment costs, subject's perceived need, and accessibility to dental care. This conceptual model represents a theoretical multidimensional model that may help clinicians better understand the patient's treatment behaviors and

  2. Exploring motivations to seek and undergo prosthodontic care: an empirical approach using the Theory of Planned Behavior construct.

    Science.gov (United States)

    Vieira, Antonio Hélio; Leles, Cláudio Rodrigues

    2014-01-01

    Motivations for seeking and undergoing prosthodontic care are poorly understood and are not often explored for clinical purposes when determining treatment need and understanding the factors related to the demand for health care and effective use. This article uses the Theory of Planned Behavior construct to identify factors related to the motivations of edentulous subjects to seek and undergo prosthodontic treatment. The conceptual framework of the Theory of Planned Behavior includes attitude toward behavior, an individual's positive or negative evaluation of self-performance of the particular behavior; the subjective norm, an individual's perception of social normative pressures or relevant others' beliefs that he or she should or should not perform such behavior; and perceived behavioral control, or an individual's perceived ease or difficulty in performing the particular behavior, determined by the total set of accessible control beliefs. These components mediate a subject's intention and behavior toward an object and may also explain health-related behaviors, providing strong predictions across a range of health behaviors. This study suggests categories for each component of the Theory of Planned Behavior, based on clinical evidence and practical reasoning. Attitudes toward behavior include perceived consequences of no treatment, perceived potential benefits and risks of treatment, dental anxiety, previous experiences, and interpersonal abilities of the health care providers. The subjective norm includes the opinions of relevant others, advertisement, professionally defined normative need, perceived professional skills, and technical quality of care. Perceived behavioral control includes subject's time, availability and opportunity, treatment costs, subject's perceived need, and accessibility to dental care. This conceptual model represents a theoretical multidimensional model that may help clinicians better understand the patient's treatment behaviors and

  3. Developing a Multidisciplinary Team for Disorders of Sex Development: Planning, Implementation, and Operation Tools for Care Providers

    Directory of Open Access Journals (Sweden)

    Mary Elizabeth Moran

    2012-01-01

    Full Text Available In the treatment of patients with disorders of sex development (DSD, multidisciplinary teams (MDTs represent a new standard of care. While DSDs are too complex for care to be delivered effectively without specialized team management, these conditions are often considered to be too rare for their medical management to be a hospital priority. Many specialists involved in DSD care want to create a clinic or team, but there is no available guidance that bridges the gap between a group of like-minded DSD providers who want to improve care and the formation of a functional MDT. This is an important dilemma, and one with serious implications for the future of DSD care. If a network of multidisciplinary DSD teams is to be a reality, those directly involved in DSD care must be given the necessary program planning and team implementation tools. This paper offers a protocol and set of tools to meet this need. We present a 6-step process to team formation, and a sample set of tools that can be used to guide, develop, and evaluate a team throughout the course of its operation.

  4. Providers’ Perspectives on Provision of Family Planning to HIV-Positive Individuals in HIV Care in Nyanza Province, Kenya

    Directory of Open Access Journals (Sweden)

    Sara J. Newmann

    2013-01-01

    Full Text Available Objective. To inform an intervention integrating family planning into HIV care, family planning (FP knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province, Kenya. Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare workers (HCWs from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed contraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration. Data were analyzed descriptively and qualitatively. Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few providers thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe and 36% viewed implants and intrauterine contraceptives as safe; fewer felt comfortable recommending them to HIV-positive women. Overall, providers supported HIV and family planning integration, yet several potential barriers were identified including misunderstandings about contraceptive safety, gendered power differentials relating to fertility decisions, staff shortages, lack of FP training, and contraceptive shortages. Conclusions. These findings suggest the importance of considering issues such as patient flow, provider burden, commodity supply, gender and cultural issues affecting FP use, and provider training in FP/HIV when designing integrated FP/HIV services in high HIV prevalence areas.

  5. The process of advance care planning in HCT candidates and proxies: self-efficacy, locus of control, and anxiety levels.

    Science.gov (United States)

    Duckworth, Katharine E; Forti, Allison M; Russell, Gregory B; Naik, Seema; Hurd, David; McQuellon, Richard P

    2014-11-01

    The purpose of this study was to examine the relationship between hematopoietic cell transplant candidate and proxy advance care planning (ACP) behavior and attitudes. A total of 49 candidates and 44 proxies completed the Advance Directive Attitudes Survey, Multidimensional Health Locus of Control Scale, Family Decision Making Self-Efficacy Scale, and the State-Trait Anxiety Inventory. In all, 45% of candidates reported completing an advance directive (AD), while only 26% had ADs on file; 80% of candidates discussed ACP wishes with their loved ones and 15% discussed ACP wishes with their medical team. The AD completers were significantly (1) older, (2) more positive about ADs, and (3) were less likely to believe that health events happen by chance. Discrepancies between reported ACP behavior and communication with health care practitioners have implications for end-of-life care.

  6. Financial requirements and manpower needs of nuclear energetics for the next fifty years

    International Nuclear Information System (INIS)

    Forecasts on financial and manpower requirements of rich and poor countries for NPPs construction by 2050 showed that the NPPs capacities will increase from 320 up to 2500 GW, whereby the ratio between the rich and poor countries will constitute approximately 2:1. Investments in NPPs construction will equal from 1600 up to 2700 billions dollars. Global need in manpower for NPPs will constitute by 2050 240000 man/year

  7. Manpower Consideration to Reduce Development Time for New Model in Automotive Industry

    Directory of Open Access Journals (Sweden)

    N. M.Z.N. Mohamed

    2005-01-01

    Full Text Available A study of manpower consideration to reduce development time for new model in automotive industry is presented in this study. The approach taken are by studying the existing practice in car development and suggesting various ways for manpower improvement such as through early involvement and input from manufacturing personnel, the proper job scope structure, proper training to the new staffs to accomplish an important task at the specific timing and clear definition of criteria for a Project Manager's appointment.

  8. A Markov decision process approach to optimal control of a multi-level hierarchical manpower system

    OpenAIRE

    Udom, Akaninyene U.

    2013-01-01

    A recurrent problem in manpower control is how to attain the desired structural configuration in an optimal way, since it is possible to reach a desired structural configuration using different control inputs. The major aim of this paper is to develop a Markov Decision Process for optimal control of a Multi-level Hierarchical Manpower System (MHMS) by promotion and interdepartmental transfers. This is examined under control by intervention and contraction cost Markov Decision Process.

  9. Manpower development in the US nuclear power industry

    International Nuclear Information System (INIS)

    This paper reviews the history and current status of the university nuclear education sector and the utility training sector of the United States (US) nuclear power industry. Recently, the number of programs in the university nuclear education sector has declined, and the remaining programs are in need of both strong governmental and industrial assistance if they are to remain a stable source for educating nuclear engineers and health physicists to staff the resurgence of the nuclear power industry. The utility training sector has undergone remarkable development since the TMI-2 accident. Programs to recruit, train, and qualify the variety of personnel needed, as well as the steps to accredit these programs, are being developed on a systematic, industry-wide basis. A number of new technologies for educating and training personnel are emerging which may be used to create or improve learning environments. Manpower development for the US nuclear power industry is a shared responsibility among the universities, the nuclear utilities, and the nuclear suppliers. This shared responsibility can continue to be best discharged by enhancement of the interaction among all parties with respect to evaluating the proper level of cognitive development within the utility training program

  10. Effect of mechanization level on manpower needs in forestry

    Directory of Open Access Journals (Sweden)

    Błuszkowska Urszula

    2014-12-01

    Full Text Available High work consumption in forest operations is above all the result of the character and task realization mode in works undertaken in forestry. Development of mechanization in forest management activities allows to considerably decrease manpower needs. In the present study, there were analyzed the possibilities of reduction of work consumption by improving the mechanization level of forest works. The method was developed to consider the following assessments: 1 variant W1 - basic option comprising factual work consumption values in works carried out on the area administered by the Regional Directorate of State Forests (RDLP; 2 W2 - showing the effect of 25% upgrade of works to a higher level of mechanization; 3 W3 - showing the effect of 50% upgrade of works to a higher level of mechanization; 4 W4 - comprising analogous calculations to those in variant W1 , but work consumption upgrading was 75%. Simulation calculations revealed considerable differences in needs for labor of different categories of forest workers. On the other hand, with increasing mechanization level, there increase the demands concerning worker qualifications, e.g. a harvester operator must be trained for about 2 years, and the training has to include both simulator exercises (first using software and next - harvester simulator and field work under supervision to gain sufficient experience. The introduction of higher levels of mechanization into forest operations, and hence considerable reduction of jobs for unqualified workers who are replaced by qualified employees, can help decreasing work consumption in forest operations.

  11. [About making up for manpower resource of paramedical personnel].

    Science.gov (United States)

    Grekova, I I

    2013-01-01

    The article deals with the analysis of quality of training of paramedical personnel in the medical colleges of Kursk oblast during last ten years. It is established that during last decade the number of graduates of the Kursk medical college has a tendency to decrease. If in 2001 the college graduated 169 medical nurses, 44 feldshers, and 30 midwives (243 in total) then in 2011 graduated 121 medical nurses, 64 feldshers (185 in totals). The number of college entrants with 11th grade is decreasing against the background of increasing of number of college entrants with 9th grade. Basically, the educational institutions are completed with graduates of rural schools whose resources are limited. The graduates from urban schools have no intent to acquire the profession of medical nurse. Hence, in Kursk oblast under annual decrease of number of paramedical personnel concurrently decreases number of graduates of medical colleges. This situation makes quite problematic the making up of manpower resource both in nowadays and in near-term outlook.

  12. Expected Time to Recruitment in A Two - Grade Manpower System Using Order Statistics for Inter-Decision Times and Attrition

    Directory of Open Access Journals (Sweden)

    J. Sridharan

    2014-02-01

    Full Text Available In this paper, a two-grade organization subjected to random exit of personal due to policy decisions taken by the organization is considered. There is an associated loss of manpower if a person quits. As the exit of personnel is unpredictable, a new recruitment policy involving two thresholds for each grade-one is optional and the other mandatory is suggested to enable the organization to plan its decision on recruitment. Based on shock model approach three mathematical models are constructed using an appropriate univariate policy of recruitment. Performance measures namely mean and variance of the time to recruitment are obtained for all the models when (i the loss of man-hours and the inter decision time forms an order statistics (ii the optional and mandatory thresholds follow different distributions. The analytical results are substantiated by numerical illustrations and the influence of nodal parameters on the performance measures is also analyzed.

  13. Lessons from the evolution of 401(k) retirement plans for increased consumerism in health care: an application of behavioral research.

    Science.gov (United States)

    DiCenzo, Jodi; Fronstin, Paul

    2008-08-01

    Employment-based health and retirement benefit programs have followed a similar path of evolution. The relative decision-making roles of the employer and the worker have shifted from the employer to the worker, and workers are more responsible than perhaps they ever have been for their well being--both in terms of their health in general and their financial security during retirement. This shift has been supported, in part, by legislation--namely ERISA, the HMO Act of 1973, the Revenue Act of 1978, and most recently, the Pension Protection Act. This Issue Brief does not pass judgment on this development or address who should bear the responsibilities of preparing workers for retirement or of rationing health care services. The current trend in health care design is toward increased "consumerism." Consumer-driven health is based on the assumption that the combination of greater cost sharing (by workers) and better information about the cost and quality of health care will engage workers to become better health care decision makers. It is hoped that workers will seek important, necessary, high-quality, cost-effective care and services, and become less likely to engage providers and services that are unnecessary and ineffective from either a quality or cost perspective. As employers look ahead toward continually improved plan design, there may be benefits in considering the lessons learned from studying worker behaviors. Specifically, there is evidence about the effects of choice, financial incentives, and information on worker decision making. As a result of research in this area, many retirement plan sponsors have moved toward plan designs and programs that recognize the benefits of well-designed defaults, simplified choices, required active decision making, framing, and commitment to future improvements. With respect to choice, it is now known that more is not always better and may even be worse in some cases. Just as fewer shoppers actually bought a jar of jelly

  14. Thriving Children, Striving Families: A Blueprint for Streamlined Delivery of Child Day Care Collaboration Plan.

    Science.gov (United States)

    Bassler, Elissa J.; And Others

    Upcoming federal and state changes in welfare and social services will have a profound effect on the delivery of early childhood care and education in Illinois. In October, 1995, the Day Care Action Council of Illinois convened a meeting of early childhood experts and advocates. From this retreat, a vision for a new system of the delivery of child…

  15. Comparison of planned menus and centre characteristics with foods and beverages served in New York City child-care centres

    Science.gov (United States)

    Breck, Andrew; Dixon, L Beth; Khan, Laura Kettel

    2016-01-01

    Objective The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served. Design Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition. Setting Child-care centres were located in low-income neighbourhoods in NYC. Results Overall, 87% of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by > 60%. Sweets and water had lower match percentages (40 and 32%, respectively), but water was served 68% of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served. Conclusions In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day. PMID:27280341

  16. Investigating robot navigation in health care with the Giraff telepresence robot

    OpenAIRE

    Kåven, Ove Henrik

    2013-01-01

    The Norwegian public healthcare system will not have the manpower to care for the elderly at the same level as now, unless technological solutions are found to make the most of the available manpower. This thesis investigates potential technologies for allowing the Giraff, a telepresence robot, to navigate and patrol an eldercare center autonomously, thus letting caregivers save time when checking on the care recipients. It describes the design and implementation of a platform to interface wi...

  17. Health Manpower Source Book. Manpower Supply and Educational Statistics for Selected Health Occupations: 1968. Public Health Service Publication Number 263, Section 20.

    Science.gov (United States)

    National Institutes of Health (DHEW), Bethesda, MD. Bureau of Health Professions Education and Manpower Training.

    This publication is a compilation of statistics on supply and education of health manpower in medicine and osteopathy, dentistry, optometry, pharmacy, podiatry, veterinary medicine, nursing, public health, and eight selected allied health occupations. The material is organized by occupations and the following information is presented for each…

  18. Can Individualized Health Care Plans Help Increase Continence in Children with Dysfunctional Elimination Syndrome?

    Science.gov (United States)

    Boisclair-Fahey, Anne

    2009-01-01

    School-age children with dysfunctional elimination syndrome (DES) do not always have school support for their treatment plans, including an every 2-hr voiding schedule. The objective of this study was to increase school support of treatment plans by allowing access to bathrooms, thereby improving continence. An eight-question survey about bathroom…

  19. Quality of dying in nursing home residents dying with dementia: does advanced care planning matter? A nationwide postmortem study.

    Directory of Open Access Journals (Sweden)

    An Vandervoort

    Full Text Available Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life, which is the case for many nursing home residents with dementia. We set out to investigate to what extent (1 advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2 the existence of written advance general practitioner orders are related to the quality of dying of nursing home residents with dementia.Cross-sectional study of deaths (2010 using random cluster-sampling. Representative sample of nursing homes in Flanders, Belgium. Deaths of residents with dementia in a three-month period were reported; for each the nurse most involved in care, GP and closest relative completed structured questionnaires.We identified 101 deaths of residents with dementia in 69 nursing homes (58% response rate. A written advance patient directive was present for 17.5%, GP-orders for 56.7%. Controlling for socio-demographic/clinical characteristics in multivariate regression analyses, chances of having a higher mean rating of emotional well-being (less fear and anxiety on the Comfort Assessment in Dying with Dementia scale were three times higher with a written advance patient directive and more specifically when having a do-not-resuscitate order (AOR 3.45; CI,1.1-11 than for those without either (AOR 2.99; CI,1.1-8.3. We found no association between verbal communication or having a GP order and quality of dying.For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life. These results underpin the importance of advance care planning for people with dementia and beginning this process as early as possible.

  20. Primary health care in South Africa.

    Science.gov (United States)

    Buch, E

    1989-01-01

    Even though most countries have committed to primary health care (PHC), South Africa, a middle-income country, has an inadequate PHC system. The poor system has roots in the colonial period and apartheid reinforces this system. Race, class, and place of residence determine the type of health care individuals receive. South Africa falls far short of all 5 principles of PHC. Just 12% of the health budget goes to 40% of the population who live in the homelands which shows the inequitable distribution of health care resources and inadequate quality health care for all. Similarly, South Africa has not altered its communication and education techniques to improve preventive and promotive health services. It has not implemented any successful national campaigns such as a campaign against diarrhea deaths. South Africa does not make good use of available appropriate technology such as breast feeding, oral rehydration, refrigeration, and the ventilated improved pit latrine which lead to health for all. People in South Africa discuss community participation but it is not likely to occur without general political democracy. Some people have made local attempts at community participation but they tend to use inflexible means and request either cash or contributions in kind from people who have little. The elite in South Africa has not recognized the need to correct socioeconomic inequalities. The Population Development Plan Programme among white farmer-owners has showed some support for a multisectoral approach to improve health care, however. For example, it acknowledges that non-health-care interventions such as better salaries, literacy, and living conditions, lead to better health. The Department of National Health has discussed improved coordination of the budget to allow priority determination of national PHD and manpower plans. Nongovernmental organizations are beginning to use the PHC approach instead of the charitable approach.

  1. The Moses Mabhida Medical Plan: medical care planning and execution at a FIFA2010 stadium; the Durban experience

    Directory of Open Access Journals (Sweden)

    Timothy C Hardcastle

    2010-12-01

    Full Text Available Timothy C Hardcastle1,2, Mergan Naidoo3,4, Sanjay Samlal5,6, Morgambery Naidoo5,6, Timothy Larsen5,6, Muzi Mabasu5,6,7, Sibongiseni Ngema6,81Inkosi Albert Luthuli Hospital, Mayville, South Africa; 2Department of Surgery, University of KwaZulu-Natal, Durban, South Africa; 3Wentworth Hospital, Durban, South Africa; 4Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa; 5Emergency Medical Rescue Service, KwaZulu-Natal, South Africa; 6Department of Health, KwaZulu-Natal, South Africa; 7EMRS 2010 Planning Committee, KwaZulu-Natal, South Africa; 8School of Public Administration and Development Management, University of KwaZulu-Natal, Durban, South AfricaAim: This paper aims to outline the medical services provided at the Moses Mabhida Stadium, Durban, South Africa for the Fédération Internationale de Football Association (FIFA 2010 Soccer World Cup and audit the clinical services delivered to persons seeking medical assistance.Methods: Descriptive report of the medical facilities at the Moses Mabhida Stadium including the staff deployment. Retrospective data review of medical incident reports from the Stadium Medical Team.Results: Medical staffing exceeded the local norms and was satisfactory to provide rapid intervention for all incoming patients. Senior medical presence decreased the transport to hospital rate (TTHR. A total of 316 spectators or support staff were treated during the seven matches played at the stadium. The majority of patients were male (60%, mostly of local origin, with mostly minor complaints that were treated and discharged (88.2% Green codes. The most common complaints were headache, abdominal disorders, and soft-tissue injuries. One fatality was recorded. The patient presentation rate (PPR was 0.66/10,000 and the TTHR was overall 4.1% of all treated patients (0.027/10,000 spectators.Conclusion: There was little evidence to guide medical planning for staffing from the FIFA governing body. Most

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

    Science.gov (United States)

    Ben Oumlil, A; Rao, C P

    1992-01-01

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

  3. 78 FR 69418 - Patient Protection and Affordable Care Act; Exchanges and Qualified Health Plans, Quality Rating...

    Science.gov (United States)

    2013-11-19

    ... endorsed...... X Persistent Medications. Antidepressant Medication Management...... 0105 X Appropriate... Composite Medication Management for People With Asthma. Behavioral Health..... Antidepressant Medication... Prescribed ADHD Medication: Initiation Phase. Cardiovascular Care... Cholesterol Management for Patients...

  4. Norms of care in British and American neurologic practice.

    Science.gov (United States)

    Menken, M; Hopkins, A; DeFriese, G H

    1988-01-01

    At a Consensus Development Conference on the Scope of Neurological Practice in the United Kingdom, 26 British specialists in the field of neurology constructed norms of care for patients with 11 neurologic disorders. For each disorder, these specialists specified the percentage of all patients who should see a physician, as well as the percentage who should see a consultant neurologist, the appropriate duration of the initial patient encounter, and the appropriate frequency of follow-up visits per annum. When compared with American estimates used in health manpower planning, British neurologists generally make a far greater allowance for patient self-care, as well as care by nonphysician health care providers, allow less time for patient encounters, and see a need for follow-up care less frequently. These marked differences in the perceptions of specialists of a normative character may determine, in part, the different "practice styles" of physicians in different regions that cannot be explained in economic terms. Results suggest that the practice style concept should be broadened to include the use of health personnel of many types, the scope of specialty medicine, and the role definition of primary care.

  5. Directors' duty of care to monitor information systems in HMOs: some lessons from the Oxford Health Plan.

    Science.gov (United States)

    O'Byrne, M E

    This paper examines the legal and strategic issues raised by the use of information systems in health maintenance organizations (HMOs) and other managed care organizations. Given the critical nature of information systems to an HMO's business success and regulatory compliance, the large financial investment HMOs make in their systems, and the widely publicized concerns over the year 2000 "millennium bug" problem, information systems are appropriately a matter of concern to an HMO's board of directors. The recent experience of Oxford Health Plans, Inc. offers a case study in the apparent failure of the directors to monitor adequately the in-house development of an information system. The systems disaster which this corporation suffered in 1997 led to a dramatic drop in stock price, from which the company has yet to recover, as well as intense scrutiny by state and federal regulators and countless shareholder derivative actions against the directors. Corporate directors are subject to the fiduciary duty of care. Despite statutes in some states requiring directors to act prudently, state courts almost always apply the standard of gross negligence. As a result, even when directors act without due deliberation in their decision, it is rare that a court will find them to have failed in their duty of care. The business and regulatory community may find otherwise, however, when directors fail to evaluate information systems options carefully and the business suffers as a result. PMID:11187367

  6. Advance care planning for Māori, Pacific and Asian people: the views of New Zealand healthcare professionals.

    Science.gov (United States)

    Frey, Rosemary; Raphael, Deborah; Bellamy, Gary; Gott, Merryn

    2014-05-01

    Despite the benefits of advance care planning (ACP), international research has suggested that in pluralistic and multicultural societies such as New Zealand, significant differences exist in the uptake of ACP between European-based populations and other cultural groups [Crawley (2005)]. The purpose of this study was to therefore explore the views of generalist palliative care providers in both the community and hospital settings regarding the barriers to ACP adoption as well as methods to increase knowledge about ACP among Māori, Pacific and Asian cultural groups within New Zealand society. Eleven individual interviews, two joint interviews and three focus groups were conducted with health and social care professionals with a wide range of knowledge and experience in palliative care. Challenges were related to a number of issues based on culture, including family decision-making style, a need to 'do everything' and a reluctance to discuss issues surrounding dying and death. Suggestions to increase the knowledge of ACP included techniques to improve information access and the utilisation of shared norms and values to assist with discussions between Māori, Pacific and Asian health professionals and their patients and families/whānau. Findings indicate a need for more family/whānau-centred models of ACP, addressed much earlier in the healthcare process and within the community setting.

  7. 42 CFR 441.102 - Plan of care for institutionalized recipients.

    Science.gov (United States)

    2010-10-01

    ... days after approval of the State plan provision for services in institutions for mental disease; and... SPECIFIC SERVICES Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases §...

  8. Exploring motivations to seek and undergo prosthodontic care: an empirical approach using the Theory of Planned Behavior construct

    Directory of Open Access Journals (Sweden)

    Vieira AH

    2014-09-01

    Full Text Available Antonio Hélio Vieira, Cláudio Rodrigues Leles Department of Prevention and Oral Rehabilitation, School of Dentistry, Federal University of Goias, Goiania, Goias, Brazil Abstract: Motivations for seeking and undergoing prosthodontic care are poorly understood and are not often explored for clinical purposes when determining treatment need and understanding the factors related to the demand for health care and effective use. This article uses the Theory of Planned Behavior construct to identify factors related to the motivations of edentulous subjects to seek and undergo prosthodontic treatment. The conceptual framework of the Theory of Planned Behavior includes attitude toward behavior, an individual’s positive or negative evaluation of self-performance of the particular behavior; the subjective norm, an individual’s perception of social normative pressures or relevant others’ beliefs that he or she should or should not perform such behavior; and perceived behavioral control, or an individual’s perceived ease or difficulty in performing the particular behavior, determined by the total set of accessible control beliefs. These components mediate a subject’s intention and behavior toward an object and may also explain health-related behaviors, providing strong predictions across a range of health behaviors. This study suggests categories for each component of the Theory of Planned Behavior, based on clinical evidence and practical reasoning. Attitudes toward behavior include perceived consequences of no treatment, perceived potential benefits and risks of treatment, dental anxiety, previous experiences, and interpersonal abilities of the health care providers. The subjective norm includes the opinions of relevant others, advertisement, professionally defined normative need, perceived professional skills, and technical quality of care. Perceived behavioral control includes subject’s time, availability and opportunity, treatment costs

  9. Exploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life.

    Science.gov (United States)

    Melhado, Lolita; Bushy, Angeline

    2011-11-01

    African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans.

  10. Strategic planning and radiology practice management in the new health care environment.

    Science.gov (United States)

    Sharpe, Richard E; Mehta, Tejas S; Eisenberg, Ronald L; Kruskal, Jonathan B

    2015-01-01

    Current comprehensive health care reform in the United States demands that policy makers, insurers, providers, and patients work in reshaping the health care system to deliver care that is both more affordable and of higher quality. A tectonic shift is under way that runs contrary to the traditional goal of radiology groups to perform and interpret large numbers of imaging examinations. In fact, radiology service requisitions now must be evaluated for their appropriateness, possibly resulting in a reduction in the number of imaging studies performed. To be successful, radiology groups will have to restructure their business practices and strategies to align with the emerging health care paradigm. This article outlines a four-stage strategic framework that has aided corporations in achieving their goals and that can be readily adapted and applied by radiologists. The four stages are (a) definition and articulation of a purpose, (b) clear definition of strategic goals, (c) prioritization of specific strategic enablers, and (d) implementation of processes for tracking progress and enabling continuous adaptation. The authors provide practical guidance for applying specific tools such as analyses of strengths, weaknesses, opportunities, and threats (so-called SWOT analyses), prioritization matrices, and balanced scorecards to accomplish each stage. By adopting and applying these tools within the strategic framework outlined, radiology groups can position themselves to succeed in the evolving health care environment.

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

    Directory of Open Access Journals (Sweden)

    Esra Karaca Çiftçi

    2016-05-01

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

  12. [Oncologic after-care--a patient-oriented concept. Basic diagnostic plan for pediatric oncology patients].

    Science.gov (United States)

    Duffner, U; Sauter, S; Bergsträsser, E; Brandis, M; Niemeyer, C

    1995-01-01

    With intensive treatment many children and young adults with cancer can be cured of their disease. Therefore, the recognition of late effects of therapy will become increasingly important. Future concepts of follow-up care in pediatric oncology will have to serve two purposes: First, to determine the status of the malignant disease with early diagnosis of relapse and second, to recognize relevant side effects of treatment. We present a comprehensive approach of follow-up care which is primarily based on the definition of risk criteria for the development of relevant organ toxicity after different treatment modalities. For each patient a standardized summary of therapy delivered is documented. According to the definition of the risk criteria an individualized schedule for follow-up is decided upon. We hope that this structured concept will result in appropriate patient care while keeping the diagnostic efforts and costs limited. PMID:7564151

  13. Advocacy for eye care

    Directory of Open Access Journals (Sweden)

    Thulasiraj D Ravilla

    2012-01-01

    Full Text Available The effectiveness of eye care service delivery is often dependant on how the different stakeholders are aligned. These stakeholders range from the ministries of health who have the capacity to grant government subsidies for eye care, down to the primary healthcare workers who can be enrolled to screen for basic eye diseases. Advocacy is a tool that can help service providers draw the attention of key stakeholders to a particular area of concern. By enlisting the support, endorsement and participation of a wider circle of players, advocacy can help to improve the penetration and effectiveness of the services provided. There are several factors in the external environmental that influence the eye care services - such as the availability of trained manpower, supply of eye care consumables, government rules and regulations. There are several instances where successful advocacy has helped to create an enabling environment for eye care service delivery. Providing eye care services in developing countries requires the support - either for direct patient care or for support services such as producing trained manpower or for research and dissemination. Such support, in the form of financial or other resources, can be garnered through advocacy.

  14. Role of health sector contingency plan in emergency preparedness and response: Orissa experiences.

    Science.gov (United States)

    Biswas, R; Dasgupta, A

    2009-01-01

    A study was organized to orient the district level health sector disaster managers to review, revise and update the health sector contingency plan (HSCP) against common natural calamities, followed by its execution and evaluation. An inter-state 3 days workshop was organized at Kolkata during the month of October 2004 to review the district level HSCP and its execution in 5 (five) worst affected districts. The District Health Officers, in consultation with the investigators, revised and updated the HSCP. Thereafter, status survey was conducted to examine the implementation of the contingency plan. During flood, the HSCP was found to be followed in the districts. Control room, construction/identification of flood shelter, sanitation and other preventive measures were taken care of, with an exception of Kendra Para, where lack of man power was noted. Technical support, trained manpower, relief materials, ambulance, Communication and information system were present in all the 5 (five) districts. PMID:20108889

  15. Foreign investment in Asia in the 1990s: trends, problems and implications for manpower movements.

    Science.gov (United States)

    Sekiguchi, S

    1992-01-01

    Direct foreign investment (DFI) is described as an international reallocation of managerial resources through which manpower moves across borders bidirectionally. This paper describes the diversity and rapidity of change in DFI for flows among North America, western Europe, Japan, ASEAN, Taiwan, China, Hong Kong, Korea, and Russia, and the implications for manpower movements. The US share of DFI in the Pacific Rim has declined while that of Japan and Western Europe has increased with the newly industrialized economies emerging regionally as net capital exporters. US and western European DFI will increasingly turn toward the Americas and Europe. Diminished US DFI will likely be compensated by Asian intraregional flows led by Japan, South Korea, Singapore, and Hong Kong. As for migration trends, bidirectinal flows of unskilled and professional labor may be stimulated by DFI, but only limited direct effects upon manpower movements should be expected.

  16. Detailed statistical analysis plan for the Danish Palliative Care Trial (DanPaCT)

    DEFF Research Database (Denmark)

    Johnsen, Anna Thit; Petersen, Morten Aagaard; Gluud, Christian;

    2014-01-01

    from being referred to 'early SPC'. DanPaCT is a multicenter, parallel-group, superiority clinical trial with 1:1 randomization. The planned sample size was 300 patients. The primary data collection for DanPaCT is finished. To prevent outcome reporting bias, selective reporting, and data-driven results......, we present a detailed statistical analysis plan (SAP) for DanPaCT here. RESULTS: This SAP provides detailed descriptions of the statistical analyses of the primary and secondary outcomes in DanPaCT. The primary outcome is the change in the patient's 'primary need'. The 'primary need' is a patient...

  17. Evaluation of Underlying Causes of Death in Patients with Dementia to Support Targeted Advance Care Planning

    NARCIS (Netherlands)

    Van De Vorst, Irene E.; Koek, Huiberdina L.; Bots, Michiel L.; Vaartjes, Ilonca

    2016-01-01

    Background: Insight in causes of death in demented patients may help physicians in end-of-life care. Objectives: To investigate underlying causes of death (UCD) in demented patients stratified by age, sex, dementia subtype [Alzheimer's disease (AD), vascular dementia (VaD)] and to compare them with

  18. Menu Planning, Food Consumption, and Sanitation Practices in Day Care Facilities.

    Science.gov (United States)

    Kuratko, Connye N.; Martin, Ruth E.; Lan, William Y.; Chappell, James A.; Ahmad, Mahassen

    2000-01-01

    In 102 day care centers, data were collected on nutritional content of menus, compliance with guidelines, children's food consumption, and safety/sanitation. Although menus exceeded recommended daily allowances, quantities of food were below recommendations. No menu components were consumed by more than 65% of children. Sanitation problems were…

  19. Hazards of Immobility: Bedsores. Adult Residential Care Home, Lesson Plan No. 5.

    Science.gov (United States)

    Lin, Kathleen

    Developed as part of a 104-hour course on adult residential care homes (ARCHs), this 50-minute lesson is designed to enable a student to: (1) define a bedsore; (2) list and describe three major causes of bedsores; (3) identify potential bedsore sites in the back-lying, side-lying, and sitting positions; and (4) calculate the risk for developing…

  20. Individualized Health Care Plans: Supporting Children With Chronic Conditions in the Classroom

    Science.gov (United States)

    Hopkins, Amanda F.; Hughes, Mary-alayne

    2016-01-01

    Due to the major advances in technology and the sciences, advances in the medical treatment options for children with chronic conditions are being made at an astonishing rate. In the health care field, "children with chronic conditions" is a generic phrase that typically refers to children with physical, developmental, behavioral, or…

  1. Physical and Visual Accessibilities in Intensive Care Units: A Comparative Study of Open-Plan and Racetrack Units.

    Science.gov (United States)

    Rashid, Mahbub; Khan, Nayma; Jones, Belinda

    2016-01-01

    This study compared physical and visual accessibilities and their associations with staff perception and interaction behaviors in 2 intensive care units (ICUs) with open-plan and racetrack layouts. For the study, physical and visual accessibilities were measured using the spatial analysis techniques of Space Syntax. Data on staff perception were collected from 81 clinicians using a questionnaire survey. The locations of 2233 interactions, and the location and length of another 339 interactions in these units were collected using systematic field observation techniques. According to the study, physical and visual accessibilities were different in the 2 ICUs, and clinicians' primary workspaces were physically and visually more accessible in the open-plan ICU. Physical and visual accessibilities affected how well clinicians' knew their peers and where their peers were located in these units. Physical and visual accessibilities also affected clinicians' perception of interaction and communication and of teamwork and collaboration in these units. Additionally, physical and visual accessibilities showed significant positive associations with interaction behaviors in these units, with the open-plan ICU showing stronger associations. However, physical accessibilities were less important than visual accessibilities in relation to interaction behaviors in these ICUs. The implications of these findings for ICU design are discussed. PMID:27575795

  2. 75 FR 45158 - Holcim (US) Inc. Corporate Division Including On-Site Leased Workers From Manpower, Office Team...

    Science.gov (United States)

    2010-08-02

    ...., Corporate Division, including on-site leased workers from Manpower and Office Team, Dundee, Michigan. The notice was published in the Federal Register on June 7, 2010 (75 FR 32223). At the request of the State... From Manpower, Office Team and Advance Temporary Services; Dundee, MI; Amended Certification...

  3. Perspectives of expectant women and health care providers on birth plans.

    Science.gov (United States)

    Aragon, Melissa; Chhoa, Erica; Dayan, Riki; Kluftinger, Amy; Lohn, Zoe; Buhler, Karen

    2013-11-01

    Objective : Un plan d’accouchement est un document détaillant les préférences et les attentes d’une femme à l’égard du travail et de l’accouchement. Les recherches empiriques explorant la valeur des plans d’accouchement ont obtenu des résultats contradictoires quant à la question de savoir si ces derniers exercent un effet positif ou négatif sur le travail et l’accouchement, ce qui semble souligner la nécessité de procéder à d’autres études sur le sujet. Cette étude avait pour but de comprendre les points de vue des femmes, des fournisseurs de soins et des accompagnateurs à l’égard de l’utilisation de plans d’accouchement. Méthodes : Un questionnaire transversal a été distribué à un échantillon de commodité de femmes enceintes ou ayant accouché, de fournisseurs de soins et d’accompagnateurs entre janvier 2012 et mars 2012 en Colombie-Britannique. Résultats : En tout, 122 femmes et 110 fournisseurs de soins de santé et accompagnateurs ont rempli le questionnaire. Tant les femmes que leurs fournisseurs de soins et de soutien estimaient que le plan d’accouchement était utile à titre d’outil de communication et d’éducation. Toutefois, les répondants ont souligné que les femmes pourraient être déçues ou mécontentes dans les cas où la mise en œuvre du plan d’accouchement s’avère impossible. Parmi les plus importants éléments du plan d’accouchement qui ont été identifiés, on trouvait la maîtrise de la douleur, les mesures visant le confort (p. ex. mobilité pendant le travail), les préférences postpartum (p. ex. allaitement), l’atmosphère (p. ex. intimité) et les croyances quant à l’accouchement (p. ex. aspects culturels). Conclusion : Il s’agit de la première étude à identifier les avantages et les désavantages de l’utilisation d’un plan d’accouchement, ainsi que les aspects les plus importants d’un tel plan, et ce, tant du point de vue des femmes que de celui de

  4. Developing a national dissemination plan for collaborative care for depression: QUERI Series

    OpenAIRE

    Rubenstein Lisa V; Owen Richard R; Williams John W; Smith Jeffrey L; Chaney Edmund

    2008-01-01

    Abstract Background Little is known about effective strategies for disseminating and implementing complex clinical innovations across large healthcare systems. This paper describes processes undertaken and tools developed by the U.S. Department of Veterans Affairs (VA) Mental Health Quality Enhancement Research Initiative (MH-QUERI) to guide its efforts to partner with clinical leaders to prepare for national dissemination and implementation of collaborative care for depression. Methods An ev...

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

    Directory of Open Access Journals (Sweden)

    Sue Hignett

    2010-01-01

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

  6. Poor planning, communication lead to missteps in care of Ebola patient.

    Science.gov (United States)

    2015-11-01

    A panel of experts examining the diagnosis and care of Thomas Eric Duncan, a patient diagnosed with Ebola Virus Disease (EVD) in the United States in 2014, and the cases of two nurses who contracted EVD while caring for Duncan, has unveiled its findings along with recommendations to prevent many of the missteps that occurred during the crisis. While the independent panel was convened at the direction of Texas Health Resources, the parent company of Texas Health Presbyterian Hospital in Dallas, observers and the panel itself note that the findings should help hospitals, EDs, and communities across the country prepare for the next infectious disease event. The expert panel noted that ED personnel relied too heavily on the electronic medical record (EMR) to communicate with other members of the care team, and that important information, such as the patient's travel history, was not prioritized or highlighted in the EMR. Patient satisfaction and other operational objectives took precedence over patient safety during Duncan's ED visit, according to the expert panel's findings. The clinical team failed to pick up on changes in the patient's clinical status, missing an opportunity to re-evaluate Duncan and properly diagnosis him with EVD during his first visit to the ED. Confusion over the roles and responsibilities of local and federal health authorities, and inadequate preparation for an infectious disease event led to missteps. The expert panel suggests conducting practice drills that include all participating organizations, and hospital leaders should consider infectious disease threats as well as other types of disasters.

  7. Future global manpower shortages in nuclear industries with special reference to india including remedial measures

    International Nuclear Information System (INIS)

    Full text: The Radiation Protection Program of the Environmental Protection Agencies of countries employ scientists, engineers, statisticians, economists, lawyers, policy analysts, and public affairs professionals amongst others. These professionals aim to protect workers, the general public, and the environment from harmful radiation exposures and to provide the technical basis for radiation protection policies and regulations. Professionals include Health physicists, Bio statistician, Radio chemist, Radio ecologist, Radio biologist etc. With a large proportion of the population of the nuclear workforce of many countries now approaching retirement age, existing power plants of these countries will be hard pressed to find enough qualified professionals to support their operations. The potential shortage of skilled manpower not only affects utilities, but also impacts the entire nuclear infrastructure, including national laboratories, federal and state agencies, nuclear technology vendors and manufacturing companies, nuclear construction companies, and university nuclear engineering departments. Manpower requirements exist in the nuclear power industry, universities and research establishments, hospitals, government departments, general industry e.g. radiography, transport, instrumentation etc., specialist contractors, agencies and consultancies serving radiation protection. India is no exception. India has the world's 12 th largest economy. Assuming India's average growth rate p.a. of more than 5%, total GDP by 2050 will increase substantially which will require proportionate increase of manpower for all industries. Also chance of brain drain is very high from developing countries e.g. from India to developed countries because of much higher pay and better lifestyle as there will be shortage of manpower in developed countries as explained above. With population growth to be stabilized in future in India, the working age population may not increase in the year 2030

  8. [The use of the quality function deployment (QFD) in the planning of care].

    Science.gov (United States)

    Matsuda, L M; Evora, Y D; Boan, F S

    1998-01-01

    This research aimed at suggesting an alternative to achieve quality in Nursing Service through an exploratory-descriptive study with 114 patients. A planning model was has been elaborated the steps and actions outlined by the Quality Function Deployment Method. It was based on Total Quality Control management approach. Seventeen steps has been established in order to seek clients' needs and through successive deployment and priority, the main Quality Features and Procedures which supported standardisation and monitoring of proposed actions has been determined. The outcomes showed that this method is feasible for Nursing Service Quality Planning because it has enabled to review the context as a whole, providing major degree of certainty on decisions.

  9. MOD* Lite: An Incremental Path Planning Algorithm Taking Care of Multiple Objectives.

    Science.gov (United States)

    Oral, Tugcem; Polat, Faruk

    2016-01-01

    The need for determining a path from an initial location to a target one is a crucial task in many applications, such as virtual simulations, robotics, and computer games. Almost all of the existing algorithms are designed to find optimal or suboptimal solutions considering only a single objective, namely path length. However, in many real life application path length is not the sole criteria for optimization, there are more than one criteria to be optimized that cannot be transformed to each other. In this paper, we introduce a novel multiobjective incremental algorithm, multiobjective D* lite (MOD* lite) built upon a well-known path planning algorithm, D* lite. A number of experiments are designed to compare the solution quality and execution time requirements of MOD* lite with the multiobjective A* algorithm, an alternative genetic algorithm we developed multiobjective genetic path planning and the strength Pareto evolutionary algorithm.

  10. Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study

    Directory of Open Access Journals (Sweden)

    DeBar Lynn L

    2011-11-01

    Full Text Available Abstract Background Substantial recent research examines the efficacy of many types of complementary and alternative (CAM therapies. However, outcomes associated with the "real-world" use of CAM has been largely overlooked, despite calls for CAM therapies to be studied in the manner in which they are practiced. Americans seek CAM treatments far more often for chronic musculoskeletal pain (CMP than for any other condition. Among CAM treatments for CMP, acupuncture and chiropractic (A/C care are among those with the highest acceptance by physician groups and the best evidence to support their use. Further, recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain--despite their high costs, potential adverse effects, and modest efficacy--suggests the need to evaluate real world outcomes associated with promising non-pharmacological/non-surgical CAM treatments for CMP, which are often well accepted by patients and increasingly used in the community. Methods/Design This multi-phase, mixed methods study will: (1 conduct a retrospective study using information from electronic medical records (EMRs of a large HMO to identify unique clusters of patients with CMP (e.g., those with differing demographics, histories of pain condition, use of allopathic and CAM health services, and comorbidity profiles that may be associated with different propensities for A/C utilization and/or differential outcomes associated with such care; (2 use qualitative interviews to explore allopathic providers' recommendations for A/C and patients' decisions to pursue and retain CAM care; and (3 prospectively evaluate health services/costs and broader clinical and functional outcomes associated with the receipt of A/C relative to carefully matched comparison participants receiving traditional CMP services. Sensitivity analyses will compare methods relying solely on EMR-derived data versus analyses supplementing EMR data with

  11. Continuing Care

    Science.gov (United States)

    ... Care Obesity at Midlife May Speed Alzheimer’s Onset Hello from my mom Easing the Behavior Problems of ... Managers Continuing Care FOR MORE ARTICLES CLICK HERE Hello from my mom Common Estate Planning Errors Alzheimer’s ...

  12. The Feasibility of Establishing Highway Safety Manpower Development and Research Centers at University-Level Institutions. Final Report, Volume I: Study Report.

    Science.gov (United States)

    Chorness, Maury H.; And Others

    To examine the feasibility of establishing Highway Safety Manpower Development and Research (HSMDR) Centers at university-level institutions which would produce three types of manpower--safety specialists, safety professionals, and research manpower, previous National Highway Safety Bureau research studies and approximately 50 federally funded…

  13. Wound Healing and Nutrition: Going Beyond Dressings With a Balanced Care Plan

    OpenAIRE

    Gruen, Douglas

    2010-01-01

    As the largest organ of the body, the human skin protects all subcutaneous tissues. Despite its many attributes, the skin is vulnerable to pressure ulcers. The number of pressure ulcers and venous leg ulcers is on the rise, but healing rates have not improved over the past decade. The reason may be a tendency to focus on one or two fundamentals of wound healing, but not on all 3 fundamentals equally. The 3 fundamentals of wound healing are (1) pressure relief and nursing care, (2) dressings, ...

  14. Workplace Literacy Program (WPL) at Chinatown Manpower Project, Inc. Final Evaluation.

    Science.gov (United States)

    Friedenberg, Joan E.

    This document describes the procedures for and results of the external evaluation of the workplace literacy program for underemployed garment industry workers with low English skills at Chinatown Manpower Project, Inc. in Chinatown in New York City. The document describes the evaluation design and methodology as well as the evaluation results,…

  15. The Educational Production Function: Implications for Educational Manpower Policy. Institute of Public Employment Monograph No. 4.

    Science.gov (United States)

    Heim, John; Perl, Lewis

    This monograph summarizes and evaluates "educational production function analyses"--studies of the relation between inputs and outputs in an education system--in order to aid in educational manpower policy making. In addition, data from New York state school districts and from a large national sample of high school students is subjected to…

  16. Colloquy and workshops: regional implications of the engineering manpower requirements of the National Energy Program

    Energy Technology Data Exchange (ETDEWEB)

    Segool, H. D. [ed.

    1979-05-01

    The crucial interrelationships of engineering manpower, technological innovation, productivity and capital re-formaton were keynoted. Near-term, a study has indicated a much larger New England energy demand-reduction/economic/market potential, with a probably larger engineering manpower requirement, for energy-conservation measures characterized by technological innovation and cost-effective capital services than for alternative energy-supply measures. Federal, regional, and state energy program responsibilities described a wide-ranging panorama of activities among many possible energy options which conveyed much endeavor without identifiable engineering manpower demand coefficients. Similarly, engineering manpower assessment data was described as uneven and unfocused to the energy program at the national level, disaggregated data as non-existent at the regional/state levels, although some qualitative inferences were drawn. A separate abstract was prepared for each of the 16 individual presentations for the DOE Energy Data Base (EDB); 14 of these were selected for Energy Abstracts for Policy Analysis (EAPA) and 2 for Energy Research Abstracts (ERA).

  17. 78 FR 54487 - Abbott Laboratories; Diagnostic-Hematology; Including On-Site Leased Workers From Manpower...

    Science.gov (United States)

    2013-09-04

    ... Workers From Manpower Service Group and ATR International; Santa Clara, California; Amended Certification..., Santa Clara, California. The Department's notice of determination was published in the Federal Register... from ATR International were employed on-site at the Santa Clara, California location of...

  18. Industrial Special Wastes Generated in Iowa and Manpower Characteristics of Employee Handlers, Volume I.

    Science.gov (United States)

    Pierce, David R.

    This document, Vol. I in a set, presents information obtained from a survey of industry in Iowa to determine the use and quantities, distribution, and treatment and disposal practices of hazardous waste generators. Additionally, it tabulated the number and manpower characteristics of employees who are in daily contact with such hazardous…

  19. R&D manpower and technological performance : The impact of demographic and task-related diversity

    NARCIS (Netherlands)

    Faems, D.L.M.; Subramaniam, A.

    2013-01-01

    We assess the impact of R&D manpower diversity on firms' technological performance. Relying on insights from two theoretical perspectives on team diversity (i.e. social categorization perspective and information decision-making perspective), we hypothesize that both demographic and task-related sour

  20. Affordable Care Act Qualified Health Plan Enrollment for AIDS Drug Assistance Program Clients: Virginia's Experience and Best Practices.

    Science.gov (United States)

    McManus, Kathleen A; Rodney, Robert C; Rhodes, Anne; Bailey, Steven; Dillingham, Rebecca

    2016-09-01

    With the implementation of the Affordable Care Act (ACA) in 2014, many safety net resources, including state AIDS Drug Assistance Programs (ADAPs), incorporated ACA Qualified Health Plans (QHPs) into their healthcare delivery model. This article highlights the benefits of the ACA for persons living with HIV. It also describes the range of strategies employed by state ADAPs to enroll patients in QHPs. The Virginia ADAP ACA implementation experience is described to illustrate one ADAP's shift to purchasing QHPs in addition to providing direct medications. Virginia ADAP is in a Medicaid nonexpansion state and funds the full costs of the QHP premiums, deductibles, and medication copayments. Virginia's experience is applicable to other Medicaid nonexpansion states and to state ADAPs in Medicaid expansion states, who are looking for options for their Medicaid ineligible clients. This article provides practical details of Virginia ADAP's ACA implementation as well as insights and best practices at both the state and clinic level.

  1. The search for the Holy Grail: combining decentralised planning and contracting mechanisms in the French health care system.

    Science.gov (United States)

    Bellanger, Martine M; Mossé, Philippe R

    2005-09-01

    France has recently adopted one of the least market-oriented models for reforming its health care system, where competition does not feature at all prominently in the overall policy design. This country has a strong tradition of top-down public administration, and health professionals, trade unions and the general public are all uneasy about the idea of introducing market forces and privatising public health provision. The main reforms discussed in this article were based on planning, rationalisation, cost-containment, efficiency and equity. However, some embryonic changes and emerging practices can be detected which might seem to relate to the 'new public management' approach, and which could also serve as a basis for future market initiatives. PMID:16161194

  2. Barriers to advance care planning at the end of life: an explanatory systematic review of implementation studies.

    Directory of Open Access Journals (Sweden)

    Susi Lund

    Full Text Available Advance Care Plans (ACPs enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges.To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice.An explanatory systematic review of qualitative implementation studies.Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched.Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes.13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations.This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows.

  3. Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies

    Science.gov (United States)

    Lund, Susi; Richardson, Alison; May, Carl

    2015-01-01

    Context Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges. Objective To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice. Design An explanatory systematic review of qualitative implementation studies. Data sources Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched. Methods Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes. Results 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations. Conclusions This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows. PMID:25679395

  4. Efficacy of misoprostol for the treatment of postpartum hemorrhage: current knowledge and implications for health care planning

    Directory of Open Access Journals (Sweden)

    Prata N

    2016-07-01

    Full Text Available Ndola Prata, Karen Weidert Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, Berkeley, CA, USA Background: A myriad of interventions exist to treat postpartum hemorrhage (PPH, ranging from uterotonics and hemostatics to surgical and aortic compression devices. Nonetheless, PPH remains the leading cause of maternal mortality worldwide. The purpose of this article is to review the available evidence on the efficacy of misoprostol for the treatment of primary PPH and discuss implications for health care planning. Data and methods: Using PubMed, Web of Science, and GoogleScholar, we reviewed the literature on randomized controlled trials of interventions to treat PPH with misoprostol and non-randomized field trials with controls. We discuss the current knowledge and implications for health care planning, especially in resource-poor settings. Results: The treatment of PPH with 800 µg of misoprostol is equivalent to 40 IU of intravenous oxytocin in women who have received oxytocin for the prevention of PPH. The same dose might be an option for the treatment of PPH in women who did not receive oxytocin for the prevention of PPH and do not have access to oxytocin for treatment. Adding misoprostol to standard uterotonics has no additional benefits to women being treated for PPH, but the beneficial adjunctive role of misoprostol to conventional uterotonics is important in reducing intra- and postoperative hemorrhage during cesarean section. Conclusion: Misoprostol is an effective uterotonic agent in the treatment of PPH. Clinical guidelines and treatment protocols should be updated to reflect the current knowledge on the efficacy of misoprostol for the treatment of PPH with 800 µg sublingually. Keywords: PPH treatment, uterotonics, low-resource settings, cesarean section, retained placenta

  5. Combining data on health care utilization and socioeconomic status of a defined population: use of a population oriented health information system for regional planning.

    Science.gov (United States)

    Brommels, M; Heinonen, M O; Tuomola, S

    1987-01-01

    Health services planning on a regional or national level needs information on health care utilization as well as data on the population to be served. Health or hospital information systems usually cover services provision and utilization, and population data for planning purposes must be obtained from other sources. In the health information system presented, hospital performance data are combined with census and socioeconomic data of the population. That makes cautious analysis of reasons for variation in health care utilization within the planning area possible. The HIS is regional, including 11 health care providers, and population based, linking data to municipality (38 in all). The system is described, including its structure, input registration, file content and output formats. An output example is presented. Necessary conditions for use of the HIS in planning activities are that the corresponding health care delivery system is comprehensive, the population served well defined, and that good control of patient flow and user behaviour is achieved. Use is limited by the character of information stored in the HIS: it is registered retrospectively and by routine. In a system covering various hospitals and municipalities, engaging different types of clerical and health care personnel, data reliability is also a critical issue.

  6. Automated Telephone Self-Management Support for Diabetes in a Low-Income Health Plan: A Health Care Utilization and Cost Analysis.

    Science.gov (United States)

    Quan, Judy; Lee, Alexandra K; Handley, Margaret A; Ratanawongsa, Neda; Sarkar, Urmimala; Tseng, Samuel; Schillinger, Dean

    2015-12-01

    The objective was to determine whether automated telephone self-management support (ATSM) for low-income, linguistically diverse health plan members with diabetes affects health care utilization or cost. A government-sponsored managed care plan for low-income patients implemented a demonstration project between 2009 and 2011 that involved a 6-month ATSM intervention for 362 English-, Spanish-, or Cantonese-speaking members with diabetes from 4 publicly funded clinics. Participants were randomized to immediate intervention or a wait-list. Medical and pharmacy claims used in this analysis were obtained from the managed care plan. Medical claims included hospitalizations, ambulance use, emergency department visits, and outpatient visits. In the 6-month period following enrollment, intervention participants generated half as many emergency department visits and hospitalizations (rate ratio 0.52, 95% CI 0.26, 1.04) compared to wait-listed participants, but these differences did not reach statistical significance (P=0.06). With adjustment for prior year cost, intervention participants also had a nonsignificant reduction of $26.78 in total health care costs compared to wait-listed individuals (P=0.93). The observed trends suggest that ATSM could yield potential health service benefits for health plans that provide coverage for chronic disease patients in safety net settings. ATSM should be further scaled up to determine whether it is associated with a greater reduction in health care utilization and costs. PMID:26102298

  7. Care staff intentions to support adults with an intellectual disability to engage in physical activity: An application of the Theory of Planned Behaviour

    OpenAIRE

    Martin, Emma; McKenzie, Karen; Newman, Emily; Bowden, Keith; Morris, Paul Graham

    2011-01-01

    Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy diet in those they supported. The present study examined whether the TPB was useful in predicting the intentions of 78 Scottish care staff to support...

  8. Physician Orders for Life Sustaining Treatment in US Nursing Homes: A Case Study of CRNP Engagement in the Care Planning Process

    Directory of Open Access Journals (Sweden)

    Gerald A. Hartle

    2014-01-01

    Full Text Available This case study describes changes in Physician Orders for Life Saving Treatment (POLST status among long-stay residents of a US nursing home who had a certified registered nurse practitioner (CRNP adopt the practice of participating in nursing home staff care plan meetings. The CRNP attended a nonrandomized sample of 60 care plan meetings, each featuring a review of POLST preferences with residents and/or family members. Days since original POLST completion, Charlson Comorbidity Index score, number of hospitalizations since index admission, and other sociodemographic characteristics including religion and payer source were among the data elements extracted via chart review for the sample as well as for a nonequivalent control group of 115 residents also under the care of the medical provider group practice at the nursing home. Twenty-three percent (n=14 of the 60 care conferences attended by the CRNP resulted in a change in POLST status after consultations with the resident and/or family. In all cases, POLST changes involved restated preferences from a higher level of intervention to a lower level of intervention. Fifty-nine percent of the CRNP-attended conferences resulted in the issuance of new medical provider orders. CRNP participation in care conferences may represent a best practice opportunity to revisit goals of care with individuals and their family members in the context of broader interprofessional treatment planning.

  9. [Advance Care Planning and Decisions to limit treatment at the end of life - the view from medical ethics and psychooncology].

    Science.gov (United States)

    Winkler, Eva C; Heußner, Pia

    2016-03-01

    Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment. In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions.

  10. Role of the community matron in advance care planning and 'do not attempt CPR' decision-making: a qualitative study.

    Science.gov (United States)

    Kazmierski, Mandy; King, Nigel

    2015-01-01

    The community matron (CM) is often the key worker caring for patients with chronic, life-limiting, long-term conditions, but these patients are not always recognised as palliative cases. This study explored the experiences of CMs with regard to advance care planning (ACP) and 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision-making to understand whether or not they felt adequately prepared for this aspect of their role, and why. Qualitative data were generated from six CMs using a broad interpretive phenomenological approach. Face-to-face recorded interviews were analysed using template analysis. The study found that although participants faced complex ethical situations around ACP and DNACPR almost on a daily basis, none had received any formal training despite the emphasis on training in national and local guidelines. Participants often struggled to get their patients accepted on to the Gold Standards Framework. The research found variability and complexity of cases to be the main barriers to clear identification of the palliative phase.

  11. Standards and general criteria for the planning and certification of need of megavoltage radiation oncology units in health care facilities

    International Nuclear Information System (INIS)

    Minimum standards and guidelines to be applied by State agencies and New Jersey health systems agencies in the examination of certificate-of-need applications and in the development of planning activities for radiation oncology units in health care facilities are presented. Radiation oncology is a medical discipline devoted to education and research in the use of ionizing radiation for the treatment of neoplastic disease. The proper application of radiation can be directed at either curative or palliative intent. It is an important and effective technique for the management of cancer. Radiotherapy equipment in clinical use is divided into four main categories: superficial, orthovoltage, megavoltage, and treatment planning facilities. Particular attention is given to megavoltage equipment which emits or generates rays over 1,000 kilovolts. These high energy rays effect better penetration of human tissue and are skin-sparing in nature, thus allowing for better tumor-to- skin dose ratios. The regionalization of megavoltage therapy services is discussed. Data on hospital megavoltage facilities in New Jersey for 1974, 1975, and 1976 are provided. The standards and guidelines pertain to utilization, personnel, and general criteria. A form for use by megavoltage radiation therapy units is appended

  12. Development of a web-based pharmaceutical care plan to facilitate collaboration between healthcare providers and patients

    Directory of Open Access Journals (Sweden)

    Marlies ME Geurts

    2014-02-01

    Full Text Available Background To facilitate collaboration between different healthcare providers and to exchange patient data we developed a paper-based tool, which also enabled to plan interventions and follow-up activities: the PCP. Interviews with participating healthcare providers concluded the PCP was a very useful tool to collect and share patient data. A disadvantage was the time spent to collect all information. We therefore developed our PCP into a web-based tool: the web-based PCP (W-PCP.Objectives Development of a W-PCP to (1 provide healthcare providers with information from pharmacist- and GP computer systems and (2 facilitate collaboration between healthcare providers and patients.Method The W-PCP was used in three research lines, two in primary care and one in a hospital setting. Outcomes measures were defined as satisfaction about efficiency and effectiveness during data sharing and documentation in providing care and conducting medication reviews using the W-PCP.First experiences concerning the use of W-PCP in a primary care setting were collected by a questionnaire and interviews with pharmacists and GPs using the W-PCP.Results A questionnaire was sent to 38 healthcare providers. 17 healthcare providers returned the questionnaire. The use of W-PCP resulted in positive experiences from participating healthcare providers. On the basis of experiences and requirements collected, the application will be further developed.Conclusions The W-PCP application can potentially support successful collaboration between different healthcare providers and patients, which is important for medication therapy management. With this application, a successful collaboration between different healthcare providers and patients could be achieved.

  13. Assessment of the Required Manpower for Shiraz University of Medical Sciences hospitals based on Ministry of Health and Medical Education Method, 2012

    Directory of Open Access Journals (Sweden)

    Zahra Kavosi

    2015-01-01

    Full Text Available Introduction: New organization’s success depends on the efficient use of human resources In this study, we aimed to estimate the staffing needs in hospitals of Shiraz University of Medical Sciences (SUMS according to model proposed by the Ministry of Health and Medical Education in 2012. Method: This is a cross-sectional definitive study conducted in three general and six specialized SUMS hospitals. The research tool used was a checklist that determines the number of nurses, paraclinic and service employees and finally the decrease and increase of human resources in the departments of the hospitals regarding Iranian Ministry of Health (MOH issues. The data were collected and analyzed using SPSS software to determine the differences between the current situation in accordance to MOH issues. Results: Results showed that of the nine teaching hospitals of SUMs in 2012, Namazi hospital had 288 redundant staff and Khalili hospital had a shortage of manpower in 8 places . We observeda deficiency in human resources in all the studied hospitals. Also, the distribution of human resources among most of the hospital departments was not conform with MOH issues. Conclusion: Various models have been proposed for estimating human resources of hospitals. Because of better ergometer and time to estimate the correct manpower, the model introduced by the Department of Health is suitable for planning to increase the efficiency and effectiveness of the hospitals.

  14. [The functional planning of a enteral nutrition unit for home care at a hospital in Brazil].

    Science.gov (United States)

    Ribeiro Salomon, Ana Lúcia; Carvalho Garbi Novaes, Maria Rita

    2013-11-01

    Introducción: Con el objeto de garantizar la calidad del producto ofrecido a los clientes en sus domicilios, las unidades hospitalarias necesitan adecuar sus áreas físicas para poder desarrollar todas las actividades especializadas que conlleva la nutrición enteral. Objetivo: Proporcionar una planificación funcional y las herramientas para la reorganización del espacio físico de una unidad de nutrición enteral, describiendo el proceso de preparación, la descripción de sus características y funciones laborales. Métodos. Estudio descriptivo, retrospectivo y documental, proporcionando las herramientas para la planificación funcional y de gestión de calidad en una unidad de preparación de la nutrición enteral en un hospital público del Distrito Federal, Brasil. Los datos fueron recolectados en el período comprendido entre los años 2000 y 2010. Resultados. A través de la creación de un programa de nutrición enteral en el Departamento de Salud Pública del Distrito Federal y según lo dispuesto por la legislación nacional, se efectuó un plan de alta complejidad respecto de la nutrición enteral en atención al perfil demográfico y epidemiológico de la población. Este trabajo consiste en una propuesta de implementación de terapia nutricional dentro de un plan de alta complejidad, y de acuerdo a lo prescrito por la legislación del Ministerio de Salud Brasileño. El número de pacientes atendidos por esta modalidad terapéutica se ha ido incrementando, por consiguiente se hace necesario garantizar la calidad del servicio, por medio de la organización de los espacios funcionales. Conclusión. Por medio de la planificación funcional de un Laboratorio de Nutrición Enteral, se puede garantizar la asistencia nutricional especializada y de calidad, a la población hospitalaria o domiciliaria, tomando las precauciones necesarias en la manipulación de las fórmulas enterales.

  15. Chronic Kidney Disease – Where Next? Predicting Outcomes and Planning Care Pathways

    Directory of Open Access Journals (Sweden)

    Angharad Marks

    2014-07-01

    Full Text Available With the introduction of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative chronic kidney disease (CKD guidelines, CKD has been identified as common, particularly in the elderly. The outcomes for those with CKD can be poor: mortality, initiation of renal replacement therapy, and progressive deterioration in kidney function, with its associated complications. In young people with CKD, the risk of poor outcome is high and the social cost substantial, but the actual number of patients affected is relatively small. In the elderly, the risk of poor outcome is substantially lower, but due to the high prevalence of CKD the actual number of poor outcomes attributable to CKD is higher. Predicting which patients are at greatest risk, and being able to tailor care appropriately, has significant potential benefits. Risk prediction models in CKD are being developed and show promise but thus far have limitations. In this review we describe the pathway for developing and evaluating risk prediction tools, and consider what models we have for CKD prediction and where next.

  16. Quality of Care for Patients with Chronic Respiratory Diseases: Data for Accreditation Plan in Primary Healthcare.

    Science.gov (United States)

    Kurpas, Donata; Szwamel, Katarzyna; Mroczek, Bożena

    2016-01-01

    There are scarce reports in the literature on factors affecting the assessment of the quality of care for patients with chronic respiratory diseases. Such information is relevant in the accreditation process on implementing the healthcare. The study group consisted of 133 adult patients with chronic respiratory diseases and 125 adult patients with chronic non-respiratory diseases. In the present study, the level of satisfaction from healthcare provided by the primary healthcare unit, disease acceptance, quality of life, health behaviors, and met needs were examined, as well as associations between variables with the use of correspondence analysis. The results are that in patients with chronic respiratory diseases an increase in satisfaction depends on the improvement of well-being in the mental sphere. The lack of problems with obtaining a referral to a specialist and a higher level of fulfilled needs also have a positive effect. Additionally, low levels of satisfaction should be expected in those patients with chronic respiratory diseases who wait for an appointment in front of the office for a long time, report problems with obtaining a referral to additional tests, present a low level of health behaviors, and have a low index of benefits.

  17. Care Staff Intentions to Support Adults with an Intellectual Disability to Engage in Physical Activity: An Application of the Theory of Planned Behaviour

    Science.gov (United States)

    Martin, Emma; McKenzie, Karen; Newman, Emily; Bowden, Keith; Morris, Paul Graham

    2011-01-01

    Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy…

  18. The Emerging Microbe Project: Developing Clinical Care Plans Based on Pathogen Identification and Clinical Case Studies.

    Science.gov (United States)

    O'Donnell, Lauren A; Perry, Michael W; Doup, Dane't R

    2015-12-01

    For many students in the health sciences, including doctor of pharmacy (PharmD) students, basic and clinical sciences often appear detached from each other. In the infectious disease field, PharmD students additionally struggle with mastering the diversity of microorganisms and the corresponding therapies. The objective of this study was to design an interdisciplinary project that integrates fundamental microbiology with clinical research and decision-making skills. The Emerging Microbe Project guided students through the identification of a microorganism via genetic sequence analysis. The unknown microbe provided the basis for a patient case that asked the student to design a therapeutic treatment strategy for an infected patient. Outside of lecture, students had two weeks to identify the pathogen using nucleotide sequences, compose a microbiology report on the pathogen, and recommend an appropriate therapeutic treatment plan for the corresponding clinical case. We hypothesized that the students would develop a better understanding of the interplay between basic microbiology and infectious disease clinical practice, and that they would gain confidence and skill in independently selecting appropriate antimicrobial therapies for a new disease state. The exercise was conducted with PharmD students in their second professional year of pharmacy school in a required infectious disease course. Here, we demonstrate that the Emerging Microbe Project significantly improved student learning through two assessment strategies (assignment grades and exam questions), and increased student confidence in clinical infectious disease practice. This exercise could be modified for other health sciences students or undergraduates depending upon the level of clinical focus required of the course.

  19. Measuring patient treatment preferences in end-of-life care research: applications for advance care planning interventions and response shift research.

    Science.gov (United States)

    Schwartz, Carolyn E; Merriman, Melanie P; Reed, George W; Hammes, Bernard J

    2004-04-01

    Understanding the dynamics of patient treatment preferences can be important for end-of life are research, and has particular salience not only to guide a process of advance care planning (ACP) but also as an outcome measure. Ascertaining the reliability and responsiveness of preferences for life-sustaining treatments within and between patients is a necessary foundation for utilizing patient-agent congruence as an outcome for ACP interventions. This study validated a modified version of the Emanuel and Emanuel Medical Directive for use in both research and clinical applications. Seriously ill patients (n = 168) were asked at baseline and 21 days to consider four common end-of-life health state scenarios, to indicate their goals for treatment, and to state their preferences for six specific treatments. We investigated the reliability and validity of this tool. We found that preferences for life-sustaining treatments were highly intercorrelated, and internally consistent across treatments by scenario and across scenarios by treatment. Preferences for pain medications were, however, distinct from preferences for other treatments. Preference scores exhibited stability over follow-up, and demonstrated both concurrent and discriminant validity. We detected a small effect size for change in preferences as a function of health state change, suggesting that re-prioritization response shifts do occur but are small in magnitude in these patient samples over this time frame. We conclude that this measure is reliable and valid for use in clinical settings and for evaluating interventions designed to improve patient-agent congruence about patient preferences for life-sustaining treatments. Clinical applications of the tool are discussed. PMID:15130201

  20. Planning manual for energy resource development on Indian lands. Volume III. Manpower and training

    Energy Technology Data Exchange (ETDEWEB)

    1978-03-01

    This volume addresses ways to bridge the gap between existing tribal skill levels and the skill levels required for higher-paying jobs in energy resource development projects. It addresses opportunities for technical, skilled, and semiskilled employment as well as professional positions, because it is important to have tribal participation at all levels of an operation. Section II, ''Energy-Related Employment Opportunities,'' covers three areas: (1) identification of energy-resource occupations; (2) description of these occupations; and (3) identification of skill requirements by type of occupation. Section III, ''Description of Training Programs,'' also covers three areas: (a) concept of a training-program model; (b) description of various training methods; and (c) an assessment of the cost of training, utilizing different programs. Section IV concentrates on development of a training program for target occupations, skills, and populations. Again this section covers three areas: (i) overview of the development of a skills training program; (ii) identification of target occupations, skills, and populations; and (iii) energy careers for younger tribal members.

  1. The Impacts of well Planned Recruitment and Selection Process on Corporate Performance in Nigerian Banking Industry (A Case Study of First Bank Plc 2004-2011)

    OpenAIRE

    Adeniyi Mudashiru Mustapha; O.A. Ilesanmi; M. Aremu

    2013-01-01

    A sound recruitment programme logically follows a well drawn-up manpower plan. In fact, the quality of the present manpower plan as indeed of every present decision of the organization depends upon the quality of recruitment policies and practices. This paper examines recruitment and selection process. It identifies a typical source by separating recruitment into internal and external and discussed the advantages of each method. The analytical tools used in this study were regression analysis...

  2. Nursing care plans versus concept maps in the enhancement of critical thinking skills in nursing students enrolled in a baccalaureate nursing program.

    Science.gov (United States)

    Sinatra-Wilhelm, Tina

    2012-01-01

    Appropriate and effective critical thinking and problem solving is necessary for all nurses in order to make complex decisions that improve patient outcomes, safety, and quality of nursing care. With the current emphasis on quality improvement, critical thinking ability is a noteworthy concern within the nursing profession. An in-depth review of literature related to critical thinking was performed. The use of nursing care plans and concept mapping to improve critical thinking skills was among the recommendations identified. This study compares the use of nursing care plans and concept mapping as a teaching strategy for the enhancement of critical thinking skills in baccalaureate level nursing students. The California Critical Thinking Skills Test was used as a method of comparison and evaluation. Results indicate that concept mapping enhances critical thinking skills in baccalaureate nursing students.

  3. Technology domains and manpower choice in the restaurant sector

    DEFF Research Database (Denmark)

    Hjalager, Anne-Mette

    1999-01-01

    the opportunities for staff or their unions to exercise control over technological impacts on work conditions. Lack of stability leads to similar difficulties for owners/managers of restaurants to influence the direction of technological development, a development which is mainly in the hands of suppliers......Five principal technology domains are identified: ties for management levels only. 1: Technologies that change the concept of time. 2: Technologies that change the flow of materials. 3: Technologies that change the geographical mobility. 4: Technologies that enhance planning., and 5: Technologies...

  4. Moving toward a United States strategic plan in primary care informatics: a White Paper of the Primary Care Informatics Working Group, American Medical Informatics Association

    Directory of Open Access Journals (Sweden)

    David Little

    2003-06-01

    Full Text Available The Primary Care Informatics Working Group (PCIWG of the American Medical Informatics Association (AMIA has identified the absence of a national strategy for primary care informatics. Under PCIWG leadership, major national and international societies have come together to create the National Alliance for Primary Care Informatics (NAPCI, to promote a connection between the informatics community and the organisations that support primary care. The PCIWG clinical practice subcommittee has recognised the necessity of a global needs assessment, and proposed work in point-of-care technology, clinical vocabularies, and ambulatory electronic medical record development. Educational needs include a consensus statement on informatics competencies, recommendations for curriculum and teaching methods, and methodologies to evaluate their effectiveness. The research subcommittee seeks to define a primary care informatics research agenda, and to support and disseminate informatics research throughout the primary care community. The AMIA board of directors has enthusiastically endorsed the conceptual basis for this White Paper.

  5. Physician migration to the U.S.--foreign aid for U.S. manpower.

    Science.gov (United States)

    Ronaghy, H A; Zeighami, E; Zeighami, B

    1976-06-01

    Data were obtained from the American Medical Association on Iranian physicians practicing in the U.S., and from the Iranian Medical Registry on U.S.-trained Iranian physicians who have returned to practice in Iran. There were 2,066 Iranian physicians practicing in the U.S. in 1972, 1,234 (60%) of whom were not undergoing any training. Only 600 of Iran's 9,535 physicians in 1972 had been trained in the United States. Thus, less than one-third of the specialists who have completed training in the U.S. have returned to practice in Iran. The specialist group with the highest rate of return is the combined surgery subspecialties (neurosurgery, thoracic surgery, orthopedic surgery, and plastic surgery). The specialist groups with the lowest rates of return were pathology, anesthesiology, and psychiatry. A comparison is made of the manpower problems Iran faces and the American problems in the area of physician manpower.

  6. Advance Care Planning in Dementia: Do Family Carers Know the Treatment Preferences of People with Early Dementia?

    Science.gov (United States)

    King, Michael; Jones, Louise; Vickestaff, Victoria; Sampson, Elizabeth L.

    2016-01-01

    = -0.52; CPR, k = -0.07; PABAK = -0.45; tube feeding; k = 0.20; PABAK = -0.22). However, both PWD and carers showed marked uncertainty about their preferences for end of life treatment choices. Relationship quality, carer distress and burden had no influence on agreement. Conclusions This study is the first to have used the LSPQ with PWD in the UK to consider treatment options in hypothetical illness scenarios. Key finding are that family carers had a low to moderate agreement with PWD on preferences for end of life treatment. This underscores how planning for care at the end of life is beset with uncertainty, even when the carer and PWD perceive the care-giving/receiving relationship is good. Families affected by dementia may benefit from early and ongoing practical and emotional support to prepare for potential changes and aid decision making in the context of the realities of care towards the end of life. PMID:27410259

  7. A Rational Approach to Estimating the Surgical Demand Elasticity Needed to Guide Manpower Reallocation during Contagious Outbreaks

    OpenAIRE

    Hsiao-Mei Tsao; Ying-Chou Sun; Der-Ming Liou

    2015-01-01

    Background Emerging infectious diseases continue to pose serious threats to global public health. So far, however, few published study has addressed the need for manpower reallocation needed in hospitals when such a serious contagious outbreak occurs. Aim To quantify the demand elasticity of the major surgery types in order to guide future manpower reallocation during contagious outbreaks. Materials and Methods Based on a nationwide research database in Taiwan, we extracted the monthly volume...

  8. Study on the availability of physical infrastructure and manpower facilities in sub-centers of Chittoor district of Andhra Pradesh

    OpenAIRE

    N Bayapa Reddy; G Ravi Prabhu; Sai, T.S.R.

    2012-01-01

    The sub-centers (SCs) are under constant criticism for their inability to deliver quality services due to the nonavailability of adequate infrastructure, manpower and supply of drugs.A cross-sectional study was conducted in Chittoor District of Andhra Pradesh to assess the availability of physical infrastructure and manpower in the SCs. A total of 34 SCs were selected by multistage and stratified random sampling technique. The data was statistically analyzed by using Microsoft Excel. The defi...

  9. Contribution of Kenyan University Undergraduate Fashion and Apparel Design Programs towards the Manpower Development for the Kenyan Apparel Industry

    OpenAIRE

    Rael Chepchumba Maiyo; Susan Abong’o; David R. Tuigon’g

    2013-01-01

    Worldwide, the contribution of university fashion design training programs towards the manpower development for the fashion and apparel (FA) industry cannot be underestimated. The objective of this paper is to identify the contribution of Kenyan University undergraduate fashion and apparel design programs (UUGFADPs) towards manpower development for Kenyan FA industry. Descriptive survey was used to collect data at Kenyatta, Maseno, Egerton, University of Eldoret (UoE), University of Eastern A...

  10. The impact of technological change on military manpower in the 21st century

    OpenAIRE

    Guthrie, Neale D.

    1990-01-01

    Approved for public release; distribution is unlimited. This thesis analyzed the impact of technological change on military manpower in the future. The scope of the study was very broad in an attempt to capture the wide range of social, economic, organizational and psychological affects that technological change is expected to bring. The review of the literature was divided into four sections; general, discipline-specific, civilian sector forecasts, and military forecasts. The general sect...

  11. Development of a big data application architecture for Navy Manpower, Personnel, Training, and Education

    OpenAIRE

    Caindoy, Khristian C.; Moazzami, Armin; Santos, Anthony M.

    2016-01-01

    Approved for public release; distribution is unlimited Navy Manpower, Personnel, Training, and Education (MPTE) decision makers require improved access to the information obtained from the vast amounts of data contained in a number of disparate databases/data stores in order to make informed decisions and understand second- and third-order effects of those decisions. Toward this end, the research effort of this thesis was two-fold. First, this thesis examined and proposed an end-to-end app...

  12. Discussing dying in the diaspora: attitudes towards advance care planning among first generation Dutch and Italian migrants in rural Australia.

    Science.gov (United States)

    Sinclair, Craig; Smith, Jessica; Toussaint, Yann; Auret, Kirsten

    2014-01-01

    Western cultural practices and values have largely shaped advance care planning (ACP) policies across the world. Low uptake of ACP among ethnic minority groups in Western countries has been interpreted with reference to cultural differences. This paper adopts a life-history approach to explore attitudes towards ACP among older, first-generation Dutch-Australian and Italian-Australian migrants. Thirty people participated in extended ethnographic interviews (N = 17) and group discussions (N = 13) during 2012. Transcripts were thematically analyzed and interpreted using a Foucauldian perspective on knowledge and power. Migration experiences, ongoing contact with the native country and participation in migrant community support networks influenced attitudes towards ACP. Dutch participants framed ACP discussions with reference to euthanasia, and adopted a more individualist approach to medical decision-making. Italian participants often spoke of familial roles and emphasized a family-based decision making style. The importance of migrant identity has been neglected in previous discussions of cultural factors influencing ACP uptake among ethnic minority groups. The unique migration experience should be considered alongside culturally appropriate approaches to decision-making, in order to ensure equitable access to ACP among migrant groups. PMID:24560228

  13. RETROSPECTIVE STUDY OF RELAPAROTOMY IN DEPARTMENT OF OBSTRETRICS, GYNAECOLOGY AND FAMILY PLANNING IN, RURAL TERTIARY CARE HOSPITAL, ANDHRA PRADESH, INDIA

    Directory of Open Access Journals (Sweden)

    Uma Thombarapu, Prabha Devi Kodey, GangadharaRao Koneru

    2015-07-01

    Full Text Available Introduction: Relaparotomy is biggest dilemma to the surgeon and critical to the patient to undergo second surgery within short span of time .It is challenging both physically and mentally to the patient. Aim: Aim of the study was to determine incidence of relaparotomy and its indication, management and outcome in the department of Obstetrics, Gynaecology and Family Planning (OBGYN & FP in NRI Medical College & General Hospital at Guntur District. Materials and Methods: It is a retrospective observational study for the duration of 3 and ½ years. Total number of surgeries -7, 718. Total number of relaparotomy- 27 which include referral cases. Results: Incidence for relaparotomy was 0.34%. Most important cause for relaparotomy was haemorrhagic causes (44.4%, followed by burst abdomen (33.3%. Relaparotomy can increase morbidity, mortality (14.8% of patients with increased hospital stay on an average of 27 days including Intensive Care Unit, further increasing the financial burden to the patient. Conclusion: Emergency relaparotomy is a life saving procedure. Good expertise in selection of primary surgery and right surgical technique, intra operative hemostasis, control of post operative infection can avoid relaparatomy

  14. Workforce education and manpower development: a road map for Singapore

    Science.gov (United States)

    Lim, Tuan-Kay

    2002-05-01

    In recognition of the rapid growth potential of the world market in optics and photonics Singapore is determined to establish itself as an optics hub. Indeed, Singapore's strong industry base in electronics, electrical devices, and semiconductors will complement well the multidisciplinary characteristics of optics and photonics, and will serve as an excellent foundation to develop more optical applications. In addition, Singapore's excellent infrastructure and appropriate industry mix, coupled with its close proximity to the emerging Asian markets would also give it an advantage for undertaking R&D and incubation of new technologies. However, a critical factor for realizing the rapid growth of the optics industry is the adequate and steady supply of qualified personnel at all levels. In this paper, a plan for developing a comprehensive, integrated education and training system is proposed. It is pointed out that the development and implementation of such a system requires the collaboration and dedication of the whole optics and photonics community in Singapore, as well as the support of a global network of optics clusters. In particular, the important roles of the Singapore Centre of Photonics Excellence (SCOPE) and the Photonics Association, Singapore) [PA(S)] is emphasized.

  15. Comparison of forward planning with automated inverse planning for three-dimensional conformal radiotherapy of non-small cell lung cancer without IMRT.

    Science.gov (United States)

    Mendes, Ruheena; Lavrenkov, Konstantin; Bedford, James L; Henrys, Anthony; Ashley, Sue; Brada, Michael

    2006-03-01

    The forward and inverse treatment plans of 10 patients with lung cancer were compared in terms of PTV coverage, sparing of normal lung and time required to generate a plan. The inverse planning produced as good treatment plans as an experienced dosimetrist with considerable reduction in staff time. When translated to other complex sites, inverse non-IMRT planning may have considerable impact on manpower requirements. PMID:16564591

  16. Comparison of forward planning with automated inverse planning for three-dimensional conformal radiotherapy of non-small cell lung cancer without IMRT

    International Nuclear Information System (INIS)

    The forward and inverse treatment plans of 10 patients with lung cancer were compared in terms of PTV coverage, sparing of normal lung and time required to generate a plan. The inverse planning produced as good treatment plans as an experienced dosimetrist with considerable reduction in staff time. When translated to other complex sites, inverse non-IMRT planning may have considerable impact on manpower requirements

  17. Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps in a Medicaid managed care plan: study protocol

    Directory of Open Access Journals (Sweden)

    Ratanawongsa Neda

    2012-01-01

    Full Text Available Abstract Background Health information technology can enhance self-management and quality of life for patients with chronic disease and overcome healthcare barriers for patients with limited English proficiency. After a randomized controlled trial of a multilingual automated telephone self-management support program (ATSM improved patient-centered dimensions of diabetes care in safety net clinics, we collaborated with a nonprofit Medicaid managed care plan to translate research into practice, offering ATSM as a covered benefit and augmenting ATSM to promote medication activation. This paper describes the protocol of the Self-Management Automated and Real-Time Telephonic Support Project (SMARTSteps. Methods/Design This controlled quasi-experimental trial used a wait-list variant of a stepped wedge design to enroll 362 adult health plan members with diabetes who speak English, Cantonese, or Spanish and receive care at 4 publicly-funded clinics. Through language-stratified randomization, participants were assigned to four intervention statuses: SMARTSteps-ONLY, SMARTSteps-PLUS, or wait-list for either intervention. In addition to usual primary care, intervention participants received 27 weekly calls in their preferred language with rotating queries and response-triggered education about self-care, medication adherence, safety concerns, psychological issues, and preventive services. Health coaches from the health plan called patients with out-of-range responses for collaborative goal setting and action planning. SMARTSteps-PLUS also included health coach calls to promote medication activation, adherence and intensification, if triggered by ATSM-reported non-adherence, refill non-adherence from pharmacy claims, or suboptimal cardiometabolic indicators. Wait-list patients crossed-over to SMARTSteps-ONLY or -PLUS at 6 months. For participants who agreed to structured telephone interviews at baseline and 6 months (n = 252, primary outcomes will be

  18. [Parte III. Ethical and juridical aspects in end-stage chronic organ failures. A position paper on a shared care planning].

    Science.gov (United States)

    Barbisan, Camillo; Casonato, Carlo; Palermo Fabris, Elisabetta; Piccinni, Mariassunta; Zatti, Paolo

    2014-01-01

    The specific target of an experts panel was to assess in terms of law and ethics the compliance of a new specific decision making algorithm described in the position paper proposed by the Gruppo di Lavoro Insufficienze Croniche d'Organo, with the main goal of the position paper consisting in the shared care planning process. The following specific aspects were assessed by the experts: a) the impact on case law and statute law of a new clinical pathway shared by scientific societies in light of good clinical practice and scientific evidence; b) the relevance of all tools useful to identify the appropriateness of care pathways, recognizing responsibilities and decision-making skills related to the end of life choices made by all stakeholders involved (healthcare professionals, patients and their beloved ones); c) the consistency of the healthcare professionals duties proposed in the position paper with the Italian legal order; d) the opportunity to take into account the role of all healthcare providers involved in care relationship; e) the consistency of the definition of patient rights at the end of life as proposed in the position paper with the Italian legal order and the relevance in this context of simultaneous palliative care; f) the relevance of shared care planning and its consistency with the proposed operative tools; g) the relevance of the conscientious objection issue and the compliance of management tools proposed in the position paper with the results of ethical and legal considerations; h) considerations about available resources allocation.

  19. [Parte III. Ethical and juridical aspects in end-stage chronic organ failures. A position paper on a shared care planning].

    Science.gov (United States)

    Barbisan, Camillo; Casonato, Carlo; Palermo Fabris, Elisabetta; Piccinni, Mariassunta; Zatti, Paolo

    2014-01-01

    The specific target of an experts panel was to assess in terms of law and ethics the compliance of a new specific decision making algorithm described in the position paper proposed by the Gruppo di Lavoro Insufficienze Croniche d'Organo, with the main goal of the position paper consisting in the shared care planning process. The following specific aspects were assessed by the experts: a) the impact on case law and statute law of a new clinical pathway shared by scientific societies in light of good clinical practice and scientific evidence; b) the relevance of all tools useful to identify the appropriateness of care pathways, recognizing responsibilities and decision-making skills related to the end of life choices made by all stakeholders involved (healthcare professionals, patients and their beloved ones); c) the consistency of the healthcare professionals duties proposed in the position paper with the Italian legal order; d) the opportunity to take into account the role of all healthcare providers involved in care relationship; e) the consistency of the definition of patient rights at the end of life as proposed in the position paper with the Italian legal order and the relevance in this context of simultaneous palliative care; f) the relevance of shared care planning and its consistency with the proposed operative tools; g) the relevance of the conscientious objection issue and the compliance of management tools proposed in the position paper with the results of ethical and legal considerations; h) considerations about available resources allocation. PMID:24553594

  20. Meeting the manpower challenge in the transfer of nuclear power to developing countries

    International Nuclear Information System (INIS)

    One of the constraints to meeting projections of nuclear power's share of energy needs in the United States has been the various manpower problems, ranging from idling of construction manpower because of disruptions in the flow of materials and construction scheduling to the comptetition between various segments of the nuclear industry, government, and educational institutions for the available supply of experienced nuclear-oriented engineering personnel. Similar problems have been encountered in other countries which are presently partially dependent upon nuclear power for energy, and the competition for qualified personnel has become international in scope with considerable migrating of engineers among these nations. The global needs for staffing personnel of nuclear power plants and fuel cycle facilities to 1990 indicate continued stress on the international technical manpower supply. When considering the manpower and training necessary for the execution of a country's first nuclear project, the burden imposed on the purchaser's organization needs to be clearly understood. The work load and the responsibilities that cannot be transferred to other organizations is usually underestimated. In assessing the magnitude of the workload, four important points should be emphasized: (1) The responsibility for the ultimate success or failure of the nuclear project must be borne by the purchaser's organization. Contractors can assume responsibility for the performance of specific tasks but not for the entire project; (2) Even in a turnkey contact, the prime contractor normally will not assume financial responsibility for the performance of the local subcontractors, whose performance must be monitored and controlled by the purchaser's organization; (3) Many areas of a nuclear project involving domestic bureaucracy, politics, regulations, etc., can be dealt with effectively only by nationals. Examples of such areas are customs clearances and import licenses, visas, housing

  1. Developing a strategic marketing plan for physical and occupational therapy services: a collaborative project between a critical access hospital and a graduate program in health care management.

    Science.gov (United States)

    Kash, Bita A; Deshmukh, A A

    2013-01-01

    The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program.

  2. Developing a strategic marketing plan for physical and occupational therapy services: a collaborative project between a critical access hospital and a graduate program in health care management.

    Science.gov (United States)

    Kash, Bita A; Deshmukh, A A

    2013-01-01

    The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program. PMID:23924224

  3. Care staff intentions to support adults with a learning disability to engage in physical activity: an application of the theory of planned behaviour

    OpenAIRE

    Martin, Emma Lavinia

    2010-01-01

    Background: This study investigates whether the Theory of Planned Behaviour is a viable model to predict the intentions of care staff to support adults with a learning disability to take part in physical activity. Previous research has suggested that people with a learning disability take part in less physical activity than those without disabilities. Research also shows that people with a learning disability have additional health needs when compared to the general population. Some condition...

  4. Final Rules for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections Under the Affordable Care Act. Final rules.

    Science.gov (United States)

    2015-11-18

    This document contains final regulations regarding grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, coverage of dependent children to age 26, internal claims and appeal and external review processes, and patient protections under the Affordable Care Act. It finalizes changes to the proposed and interim final rules based on comments and incorporates subregulatory guidance issued since publication of the proposed and interim final rules.

  5. Evaluating and Quantifying User and Carer Involvement in Mental Health Care Planning (EQUIP: Co-Development of a New Patient-Reported Outcome Measure.

    Directory of Open Access Journals (Sweden)

    Penny Bee

    Full Text Available International and national health policy seeks to increase service user and carer involvement in mental health care planning, but suitable user-centred tools to assess the success of these initiatives are not yet available. The current study describes the development of a new reliable and valid, interval-scaled service-user and carer reported outcome measure for quantifying user/carer involvement in mental health care planning. Psychometric development reduced a 70-item item bank to a short form questionnaire using a combination of Classical Test, Mokken and Rasch Analyses. Test-retest reliability was calculated using t-tests of interval level scores between baseline and 2-4 week follow-up. Items were worded to be relevant to both service users and carers. Nine items were removed following cognitive debriefing with a service user and carer advisory group. An iterative process of item removal reduced the remaining 61 items to a final 14-item scale. The final scale has acceptable scalability (Ho = .69, reliability (alpha = .92, fit to the Rasch model (χ2(70 = 97.25, p = .02, and no differential item functioning or locally dependent items. Scores remained stable over the 4 week follow-up period, indicating good test-retest reliability. The 'Evaluating the Quality of User and Carer Involvement in Care Planning (EQUIP' scale displays excellent psychometric properties and is capable of unidimensional linear measurement. The scale is short, user and carer-centred and will be of direct benefit to clinicians, services, auditors and researchers wishing to quantify levels of user and carer involvement in care planning.

  6. Effectiveness of Standardized Nursing Care Plans in Health Outcomes in Patients with Type 2 Diabetes Mellitus: A Two-Year Prospective Follow-Up Study

    OpenAIRE

    Cárdenas-Valladolid, Juan; Salinero-Fort, Miguel A; Gómez-Campelo, Paloma; de Burgos-Lunar, Carmen; Abánades-Herranz, Juan C.; Arnal-Selfa, Rosa; Andrés, Ana López-

    2012-01-01

    Background Implementation of a standardized language in Nursing Care Plans (SNCP) allows for increased efficiency in nursing data management. However, the potential relationship with patientś health outcomes remains uncertain. The aim of this study was to evaluate the effectiveness of SNCP implementation, based on North American Nursing Diagnosis Association (NANDA) and Nursing Interventions Classification (NIC), in the improvement of metabolic, weight, and blood pressure control of Type 2 Di...

  7. The effect of payment reform on physician practices. Part 2. Physicians and health plans prepare for health care's brave new world.

    Science.gov (United States)

    Hettiger, Stacey; Natinsky, Paul; Neller, Joe

    2012-01-01

    In our last installment, we wrote globally about the nature and permanence of trends in physician payment models, particularly the shift from fee-for-service to fee-for-value. In our second communique, we will look specifically at major health plans with which physicians will be working and provide an overview of the payment methods, programs, and demonstrations affecting Michigan physicians and the health care delivery model.

  8. Participation and coordination in Dutch health care policy-making. A network analysis of the system of intermediate organizations in Dutch health care.

    Science.gov (United States)

    Lamping, Antonie J; Raab, Jörg; Kenis, Patrick

    2013-06-01

    This study explores the system of intermediate organizations in Dutch health care as the crucial system to understand health care policy-making in the Netherlands. We argue that the Dutch health care system can be understood as a system consisting of distinct but inter-related policy domains. In this study, we analyze four such policy domains: Finances, quality of care, manpower planning and pharmaceuticals. With the help of network analytic techniques, we describe how this highly differentiated system of >200 intermediate organizations is structured and coordinated and what (policy) consequences can be observed with regard to its particular structure and coordination mechanisms. We further analyze the extent to which this system of intermediate organizations enables participation of stakeholders in policy-making using network visualization tools. The results indicate that coordination between the different policy domains within the health care sector takes place not as one would expect through governmental agencies, but through representative organizations such as the representative organizations of the (general) hospitals, the health care consumers and the employers' association. We further conclude that the system allows as well as denies a large number of potential participants access to the policy-making process. As a consequence, the representation of interests is not necessarily balanced, which in turn affects health care policy. We find that the interests of the Dutch health care consumers are well accommodated with the national umbrella organization NPCF in the lead. However, this is no safeguard for the overall community values of good health care since, for example, the interests of the public health sector are likely to be marginalized.

  9. Health care marketing: the theory of planned behavior applied to patients' choise between private and public providers in the portuguese health care system.

    OpenAIRE

    Ferreira, Filipa Monteiro

    2011-01-01

    Dissertation submitted in partial fulfillment of the requirements for degree of Master in Statistics and Information Management. Purpose - The Portuguese health care system has been evolving throughout the last 35 years with two relevant facts: the public sector has progressed with improvement in all relevant OECD indicators; the private sector has been widened and reinforced. In this framework, it is important to understand how patient’s intention and behavior are built, so health care...

  10. Coordination and Human Resource Planning in the Hawaii Visitor Industry.

    Science.gov (United States)

    Hawaii State Commission on Manpower and Full Employment, Honolulu.

    This report was undertaken in response to a request by the Sixth Legislature, which expressed its concern with the lack of coordination and overall human resource planning in the visitor industry and that the findings of the January 6-7, 1970 Travel Industry Congress had not been fully implemented. The State Commission on Manpower and Full…

  11. Clinician Adoption Patterns and Patient Outcome Results in Use of Evidence-Based Nursing Plans of Care

    OpenAIRE

    Kim, Tae Youn; Lang, Norma M.; Berg, Karen; Weaver, Charlotte; Murphy, Judy; Ela, Sue

    2007-01-01

    Delivery of safe, effective and appropriate health care is an imperative facing health care organizations globally. While many initiatives have been launched in a number of countries to address this need from a medical perspective, a similar focus for generating evidence-based nursing knowledge has been missing [1]. This paper reports on a collaborative evidence-based practice (EBP) research initiative that adds nursing knowledge into computerized care protocols. Here, a brief overview of the...

  12. Evaluation of the Factors Concerning the Unexpected Pregnancy of Women who Applied to the Mother and Child Care and Family Planning Center of Van Province

    Directory of Open Access Journals (Sweden)

    Sebahat Gucuk

    2012-02-01

    Full Text Available Introduction: The purpose of this study is to evaluate the experiences of unexpected pregnancy and the related factors of the women who have applied to our center. Material and Method: The study was planned as a descriptive study which enrolled women in the age range of 15-49 on the basis of volunteerism who have applied to the Mother and Child Care and Family Planning Center of Van Province. The participants were administered a survey in which certain situations were questioned, such as age, educational background, age at first labor, income status, number of living children, miscarriage status, unexpected pregnancy status, the presence of trying to undergo an abortion with alternative methods, and the state of receiving consultancy service on pre- and post-pregnancy family planning. Results: The more increased the educational level of 399 women enrolled in the study, the more significant reduction in unexpected pregnancies was detected (P=0.001. When the educational background and the use of alternative methods to have an abortion were compared, the illiterate women were found to use alternative methods (37.6% at a significantly high ratio (p=0.0001. The average of children number of women with at least one unexpected pregnancy was significantly high (p=0.0001. While the ratio of receiving consultancy on post-pregnancy family planning from health care personnel of the women with unexpected pregnancy was 79.5%, a ratio of 97.9% was detected for the women with planned pregnancy which was significantly different (p=0.0001. Conclusion: The health care personnel may reduce the unexpected pregnancies by training women on family planning in a simple, understandable way and by trying to increase health literacy by taking the dominant social rules in our region into consideration. We consider that the primary healthcare will be more effective and result oriented through newly applied Family Practice in our region. Key Words: Unexpected pregnancy

  13. Health-care district management information system plan: Review of operations analysis activities during calendar year 1975 and plan for continued research and analysis activities

    Science.gov (United States)

    Nielson, G. J.; Stevenson, W. G.

    1976-01-01

    Operations research activities developed to identify the information required to manage both the efficiency and effectiveness of the Veterans Administration (VA) health services as these services relate to individual patient care are reported. The clinical concerns and management functions that determine this information requirement are discussed conceptually. Investigations of existing VA data for useful management information are recorded, and a diagnostic index is provided. The age-specific characteristics of diseases and lengths of stay are explored, and recommendations for future analysis activities are articulated. The effect of the introduction of new technology to health care is also discussed.

  14. Administrative simplification: adoption of operating rules for eligibility for a health plan and health care claim status transactions. Interim final rule with comment period.

    Science.gov (United States)

    2011-07-01

    Section 1104 of the Administrative Simplification provisions of the Patient Protection and Affordable Care Act (hereafter referred to as the Affordable Care Act) establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs. Specifically, in section 1104(b)(2) of the Affordable Care Act, Congress required the adoption of operating rules for the health care industry and directed the Secretary of Health and Human Services to "adopt a single set of operating rules for each transaction * * * with the goal of creating as much uniformity in the implementation of the electronic standards as possible." This interim final rule with comment period adopts operating rules for two Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions: eligibility for a health plan and health care claim status. This rule also defines the term "operating rules" and explains the role of operating rules in relation to the adopted transaction standards. In general, transaction standards adopted under HIPAA enable electronic data interchange through a common interchange structure, thus minimizing the industry's reliance on multiple formats. Operating rules, in turn, attempt to define the rights and responsibilities of all parties, security requirements, transmission formats, response times, liabilities, exception processing, error resolution and more, in order to facilitate successful interoperability between data systems of different entities. PMID:21739765

  15. Higher quality and lower cost with innovative cooling technology. Careful planning of cold rooms and refrigerator rooms; Qualitaets- und Kostenvorteile durch innovative Kuehltechnik. Kuehl- und TK-Raeume vorausschauend planen

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2007-03-15

    Hygienic specifications for gastronomy, catering services and industrial kitchens are very rigid. Cooling is an important element, not least as a result of trends like 'cook and chill'. Problems can be avoided by careful planning. (orig.)

  16. Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana.

    Directory of Open Access Journals (Sweden)

    Fiifi Amoako Johnson

    Full Text Available The Community-based Health Planning and Services (CHPS initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas.Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km.Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

  17. Health advance directives, policy and clinical practice: a perspective on the synergy of an effective advance care planning framework.

    Science.gov (United States)

    Seal, Marion

    2010-03-01

    The delivery of quality care at the end of life should be seamless across all health care settings and independent from variables such as institutional largeness, charismatic leadership, funding sources and blind luck ... People have come to fear the prospect of a technologically protracted death or abandonment with untreated emotional and physical stress.

  18. "My Lesson Plan Was Perfect Until I Tried to Teach": Care Ethics into Practice in Classroom Management

    Science.gov (United States)

    Rabin, Colette; Smith, Grinell

    2016-01-01

    As teacher educators, the authors developed an assignment focused on care ethics to prepare teacher candidates to design classroom-management procedures aimed at cultivating caring community. The teacher candidates revised traditional classroom-management processes, such as class rules, into cocreated norms. They also designed original management…

  19. Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre

    Science.gov (United States)

    Hing (Wong), Albert; Chin, Loh Ee; Ping, Tan Li; Peng, Ng Kok; Kun, Lim Soo

    2016-01-01

    Introduction: Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States. Aim: To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues. Materials and Methods: Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0. Results: Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive. Conclusion: The ACP educational brochure clinically impacts patients’ preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia.

  20. Human resource development: the management, planning and training of health personnel.

    Science.gov (United States)

    Simmonds, S

    1989-09-01

    The morale of health personnel is fast becoming the major factor affecting both the sustainability and the quality of health care world-wide. Low morale mirrors problems ranging from declining balance of payments allocation to GNP, and a lack of support for the health system from the very top down to the rigid application of national pay, grading and career structures, and the stress of not being able to do the job properly. While many of these and other problems have been voiced again and again in the press and in the academic literature, much of the work on health manpower development has focused on the planning and production of personnel. This has been with the aim of producing specific categories of better-trained health workers with relevant qualifications, resulting in a heavy emphasis on a quantitative output. In this paper it is argued that the management of health personnel, the qualitative aspect of staff development, has been relatively neglected. Unless and until the management of human resource development receives the attention it needs, seeds of discontent, disillusion and dissatisfaction will ultimately lead to national health services losing their competitiveness as employers. The sustainability and quality of health programmes will then be in even greater jeopardy than they are at present. The planning, production and management components of health manpower development have developed haphazardly as verticle activities. A new term such as 'human resource development; the management of health personnel' might help ensure the concept of an integrated process contingent on economic, political, organizational and other important circumstances.

  1. Recognition and Emergency Care of Wounds: Bleeding Control and Bandaging. First Responder Training, Lesson Plan No. 1.

    Science.gov (United States)

    Upton, Robert

    Designed for a 40-hour course in first-responder medical training, this lesson plan teaches students how to control bleeding and bandage wounds. This lesson includes discussions on skin, the circulatory system, and blood; describes seven types of wounds; and explains four bleeding control methods. The lesson plan begins with information on the…

  2. Indian experience in the training of manpower for a nuclear power programme

    International Nuclear Information System (INIS)

    In India manpower training for the nuclear power programme started several years before the introduction of nuclear power plants. Early efforts were concentrated on developing manpower in basic sciences related to nuclear power. The setting up of the Bhabha Atomic Research Centre was an important step in this direction. This enabled the first batch of engineers and scientists to be trained on design and operation in the programmes connected with research reactors and use of isotopes in industry, agriculture and medicine. The next step was to establish a Training School in the Centre where young university graduates could be given courses in their own and interconnected disciplines of nuclear sciences. An interdisciplinary approach with teaching by working scientists and engineers and attachment for short periods to the research laboratories is the framework of this training programme. At present about 3000 graduates from this Training School are involved in various capacities in India's nuclear power programme. With the commissioning of the first power reactors, it became necessary to train engineers, scientists and technicians for the operation and maintenance of such systems on a larger scale. For this purpose, a separate training centre at Rajasthan Atomic Power Project was set up. Models, simulators and courses with emphasis on heavy water reactors were introduced. In addition, a number of craftsmen for servicing equipment have also been trained in power station equipment maintenance. The paper describes the development of this programme in its present form. (author)

  3. Scientific and Technical Manpower Projections. Proceedings of the Seminar Including the Formal Papers (Hot Springs, Virginia, April 16-18, 1974).

    Science.gov (United States)

    National Science Foundation, Washington, DC. National Science Board.

    This report contains the proceedings of a seminar conducted by the Ad Hoc Subcommittee on Manpower of the National Science Board. The major topic of the seminar was the scientific and technical manpower projections of supply and demand, since such projections can serve as a major tool in effecting policy decisions. Six major papers were…

  4. Responsibilities to Plan for Ancillary Care Pose Ethical Challenges for Nutrition Research in the Community Setting12

    OpenAIRE

    Merritt, Maria W.; Taylor, Holly A.

    2012-01-01

    Investigators who conduct nutrition research in the community setting, particularly among underserved populations, face the ethical question of whether and how to respond to participants’ unmet health needs. The research ethics literature conceptualizes this question as one of ancillary care (AC): what is the nature and extent of researchers’ ethical responsibilities, if any, to provide or facilitate health care that research participants need but that is not necessary to ensure the safety or...

  5. Inclusivity and dementia: health services planning with individuals with dementia: effective inclusion requires action at multiple levels by individuals with dementia, care partners, service providers and funding organizations.

    Science.gov (United States)

    Whitfield, Kyle; Wismer, Susan

    2006-01-01

    Historically, Alzheimer societies have identified the care partners of persons with dementia as their central clients. This focus is broadening to include the person with the disease, as well. This paper presents the results of a Canadian research study addressing organizational considerations related to effective inclusion of persons with dementia in planning and decision-making about health services and programs. Our findings suggest that effective inclusion requires action at multiple levels by individuals with dementia, care partners and friends; service organizations and providers; and funding organizations. Additional research is needed to explore the applicability of these findings to other organizations in different localities and to examine emergent themes further. Of these, one that has received little attention to date concerns the potential risks associated with effective inclusion.

  6. Care staff intentions to support adults with an intellectual disability to engage in physical activity: an application of the Theory of Planned Behaviour.

    Science.gov (United States)

    Martin, Emma; McKenzie, Karen; Newman, Emily; Bowden, Keith; Morris, Paul Graham

    2011-01-01

    Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy diet in those they supported. The present study examined whether the TPB was useful in predicting the intentions of 78 Scottish care staff to support people with ID to engage in physical activity. Regression analyses indicated that perceived behavioural control was the most significant predictor of both care staff intention to facilitate physical activity and reported physical activity levels of the people they supported. Attitudes significantly predicted care staff intention to support physical activity, but this intention was not itself significantly predictive of reported activity levels. Increasing carers' sense of control over their ability to support clients' physical activity may be more effective in increasing physical activity than changing their attitudes towards promoting activity.

  7. Predictors of dentists’ behaviours in delivering prevention in primary dental care in England: using the theory of planned behaviour

    OpenAIRE

    Yusuf, Huda; Kolliakou, Anna; Ntouva, Antiopi; Murphy, Marie; Newton, Tim; Tsakos, Georgios; Richard G. Watt

    2016-01-01

    BACKGROUND: To explore the factors predicting preventive behaviours among NHS dentists in Camden, Islington and Haringey in London, using constructs from the Theory of Planned Behaviour.METHODS: A cross-sectional survey of NHS dentists working in North Central London was conducted. A self-completed questionnaire based on the theoretical framework of the Theory of Planned Behaviour was developed. It assessed dentists' attitudes, current preventive activities, subjective norms and perceived beh...

  8. Still-Born Autonomy Insurance Plan in Quebec: An Example of a Public Long-Term Care Insurance System in Canada.

    Science.gov (United States)

    Hébert, Réjean

    2016-01-01

    Funding long-term care (LTC) is a challenge under the existing Beveridgean universal healthcare system. The Autonomy Insurance (AI) plan developed in Quebec was an attempt to introduce public LTC insurance into our healthcare system. The AI benefit was based on an assessment of the needs of older people and those with disabilities using a disability scale (SMAF) and case-mix classification system (Iso-SMAF Profiles). Under the plan, the benefit would be used to fund public institutions or purchase services from private organizations. Case managers were responsible for assessments and helping users and their families plan services and decide how to use the AI benefit. Funding AI was based on general tax revenues without capitalized funding, under a separate protected budget program. Projections were made for the additional budget needed to support AI, which would have mitigated the forecast increase in LTC spending due to population aging. All the legal, administrative, funding, training and contractual issues were dealt with, for implementation of the plan in April 2015. Unfortunately, the project was still-born for political reasons, but it demonstrates the feasibility of this essential innovation for Canada. PMID:27230719

  9. Savannah River Site Environmental Implementation Plan

    International Nuclear Information System (INIS)

    Formal sitewide environmental planning at the . Savannah River Site (SRS) began in 1986 with the development and adoption of the Strategic Environmental Plan. The Strategic Environmental Plan describes the philosophy, policy, and overall program direction of environmental programs for the operation of the SRS. The Strategic Environmental Plan (Volume 2) provided the basis for development of the Environmental Implementation Plan (EIP). The EIP is the detailed, comprehensive environmental master plan for operating contractor organizations at the SRS. The EIP provides a process to ensure that all environmental requirements and obligations are being met by setting specific measurable goals and objectives and strategies for implementation. The plan is the basis for justification of site manpower and funding requests for environmental projects and programs over a five-year planning period

  10. Savannah River Site environmental implementation plan

    International Nuclear Information System (INIS)

    Formal sitewide environmental planning at the Savannah River Site (SRS) began in 1986 with the development and adoption of the Strategic Environmental Plan. The Strategic Environmental Plan describes the philosophy, policy, and overall program direction of environmental programs for the operation of the SRS. The Strategic Environmental Plan provided the basis for development of the Environmental Implementation Plan (EIP). The EIP is the detailed, comprehensive environmental master plan for operating contractor organizations at the SRS. The EIP provides a process to ensure that all environmental requirements and obligations are being met by setting specific measurable goals and objectives and strategies for implementation. The plan is the basis for justification of site manpower and funding requests for environmental projects and programs over a five-year planning period

  11. Savannah River Site Environmental Implementation Plan

    Energy Technology Data Exchange (ETDEWEB)

    1989-08-01

    Formal sitewide environmental planning at the . Savannah River Site (SRS) began in 1986 with the development and adoption of the Strategic Environmental Plan. The Strategic Environmental Plan describes the philosophy, policy, and overall program direction of environmental programs for the operation of the SRS. The Strategic Environmental Plan (Volume 2) provided the basis for development of the Environmental Implementation Plan (EIP). The EIP is the detailed, comprehensive environmental master plan for operating contractor organizations at the SRS. The EIP provides a process to ensure that all environmental requirements and obligations are being met by setting specific measurable goals and objectives and strategies for implementation. The plan is the basis for justification of site manpower and funding requests for environmental projects and programs over a five-year planning period.

  12. Using Integer Programming for Airport Service Planning in Staff Scheduling

    OpenAIRE

    Ip, W. H.; Nick Chung; George Ho

    2010-01-01

    Reliability and safety in flight is extremely necessary and that depend on the adoption of proper maintenance system. Therefore, it is essential for aircraft maintenance companies to perform the manpower scheduling efficiently. One of the objectives of this paper is to provide an Integer Programming approach to determine the optimal solutions to aircraft maintenance planning and scheduling and hence the planning and scheduling processes can become more efficient and effective. Another objecti...

  13. Soil pollution in day-care centers and playgrounds in Norway: national action plan for mapping and remediation.

    Science.gov (United States)

    Ottesen, Rolf Tore; Alexander, Jan; Langedal, Marianne; Haugland, Toril; Høygaard, Erik

    2008-12-01

    Systematic geochemical mapping based on sampling and analysis of surface soils (0-2 cm) has been carried out in several Norwegian cities. The soils in the oldest parts of the cities are contaminated with metals (especially Pb) and polycyclic aromatic hydrocarbons (PAH). Due to the fact that children are often in contact with surface soil, it was realized that special focus had to be directed towards soils in day-care centers and playgrounds. The first mapping and remedy program was initiated in Trondheim in 1996. Here, the importance of copper-chromium-arsenic (CCA)-pressure-impregnated wood in playing equipment as a pollution source for soils was documented, and a process was started with the aim to ban this product. Soils from day-care centers in the inner city of Bergen were polluted to a degree that required remediation in 45% out of 87 centers, mainly due to high concentrations of Pb and benzo(a)pyrene. In Oslo, 38% of 700 day-care centers needed remediation due to soil pollution by Pb, BaP, Cd, Hg, Ni and PCB. Removal of CCA-impregnated wood was necessary in more than half of the day-care centers The Norwegian parliament has decided to investigate all outdoor playing areas in day-care centers, playgrounds and schoolyards in Norway, starting in 2007 with day-care centers in the ten largest cities and five most important industrial areas. The Norwegian Institute of Public Health has developed quality criteria for soils in day-care centers and playgrounds for As, Cd, Cr(6+), Hg, Ni, Pb, zinc, PAH(sum16), benzo(a)pyrene, and PCB(sum7). The Geological Survey of Norway has developed guidance for mapping of soil pollution (sampling, chemical analysis and reporting) in day-care centers. Especially the sampling strategy has been developed in the period 1996-2007, and the preferred sampling strategy is to collect at least 10 samples of surface soil (0-2 cm) from (1) "original soil" on the site, (2) artificial man-made "hills", and (3) soils used for growing vegetables

  14. PERSONNEL PLANNING. A COMPARATIVE OUTLOOK

    Directory of Open Access Journals (Sweden)

    Catalin Constantin SAMOILA

    2015-10-01

    Full Text Available From a very wide perspective, planning has raised lots of issues over time. Management and business theory struggle to teach what planning is, and why it is so dramatically important, in a manner which seemingly quotes Antoine de Saint-Exupery -“A goal without a plan is just a wish”, or sets up awareness through Benjamin Franklin’s famous words -“By failing to prepare, you are preparing to fail” [1]. However, some voices are circumspect or balance between the usefulness of plans and planning: “… plans are useless, but planning is indispensable” [2], while others, sporadically but decisively, criticize the entire organizational planning process, presenting it as a total failure [3]. Sometimes the ‘cons’ are right, meaning that real life might bring more surprise than ever expected. Even so, organizations benefit from planning by trying at least to ‘see’ one step forward, and to avoid total uncertainty or critical situations, if not to improve. The military ones are not exempt. Military planning has become the organic environment for such organizations since Napoleonic wars, or even longer ago. This present attempt does not intend to deeply analyze the antagonist advocacies over planning, but to bring under comparison, in a brief manner, the business-shaped theoretical approach of planning, against the real concerns of the Romanian military system in terms of manpower planning.

  15. The Three-Year (1995-1997) Workplace Literacy Program at Chinatown Manpower Project, Inc. Final Evaluation.

    Science.gov (United States)

    Friedenberg, Joan E.

    An external evaluation was conducted of the Workplace Literacy Program at Chinatown Manpower Project, Inc., which provided oral and written job-specific instruction in English as a second language to Chinese garment workers. The program was designed for underemployed garment industry workers with low English proficiency, including seamstresses,…

  16. Immigration and Emigration of Professional and Skilled Manpower During the Post-War Period. Special Study No. 1.

    Science.gov (United States)

    Parai, Louis

    The impact of immigration and emigration on Canada's stock of professional and skilled manpower was analyzed for the period 1946-1963. Although the number of immigrants is recorded by Canadian authorities there is no complete record of emigration from Canada; however, a reasonably reliable picture was obtained from emigration data of other…

  17. 75 FR 41522 - Hewlett Packard, Technical Support Call Center, Including On-Site Leased Workers From Manpower...

    Science.gov (United States)

    2010-07-16

    ... Employment and Training Administration Hewlett Packard, Technical Support Call Center, Including On-Site... workers of Hewlett Packard, Technical Support Call Center, including on-site leased workers from Manpower, Volt, and Adecco, Boise, Idaho. The notice was published in the Federal Register March 12, 2010 (75...

  18. A Study of Career Ladders and Manpower Development for Non-Management Personnel in the Food Service Industry.

    Science.gov (United States)

    State Univ. of New York, Ithaca. School of Hotel Administration at Cornell Univ.

    Because of its failure to provide career ladders for non-management employees, the food service industry is facing increasingly severe manpower shortages and labor turnover. Unnecessary requirements bar entry workers from many jobs, and training opportunities leave much to be desired. This report identifies the problem areas and develops a model…

  19. Designing a Model for Measuring Manpower Productivity in the Project-based Service Organizations (Electricity Company as Case Study

    Directory of Open Access Journals (Sweden)

    Sayyed Mohammad Reza Davoodi

    2013-02-01

    Full Text Available Manpower productivity index is one of the most important productivity measures. This index is the ratio of added-value to number of the employees (or the employee’s salaries. Regarding this fact that manpower cost, annual depreciation, and annual profit is almost fixed and isn’t indicative of the organizations actual performance, therefore measuring added-value in the common methods is fixed and unrealistic and is not function of the organizational performance. Therefore, with respect to the project-based nature of such organizations, a large amount of their budget is spent for the projects in progress and hence measuring the added-value through the common formula and without considering projects means that large amount of the organizations capital and manpower, which are involved in the project implementation, are not considered in measuring added-value. Therefore, in order to measure the actual performance of the organization, the added-value that is gained from the projects future exploitation should be added to its added-value.In the designed model, added-value is calculated so that all of the organizations outputs include current activities and also the investments that will be exploited in the future. As a result, the calculated value is overall reflects of the organizations performance and also manpower productivity is calculated actually.

  20. Clinician Adoption Patterns and Patient Outcome Results in Use of Evidence-Based Nursing Plans of Care

    Science.gov (United States)

    Kim, Tae Youn; Lang, Norma M.; Berg, Karen; Weaver, Charlotte; Murphy, Judy; Ela, Sue

    2007-01-01

    Delivery of safe, effective and appropriate health care is an imperative facing health care organizations globally. While many initiatives have been launched in a number of countries to address this need from a medical perspective, a similar focus for generating evidence-based nursing knowledge has been missing [1]. This paper reports on a collaborative evidence-based practice (EBP) research initiative that adds nursing knowledge into computerized care protocols. Here, a brief overview of the study’s aims, purpose and methodology is presented as well as results of data analysis and lessons learned. The research team examined nurses’ adoption patterns of EBP recommendations with respect to activity tolerance using four-month patient data collected from a pilot hospital. Study findings indicate a need for more focus on the system design and implementation process with the next rollout phase to promote evidence-based nursing practice. PMID:18693871

  1. Understanding the barriers to the utilization of primary health care in a low-income setting: implications for health policy and planning

    Directory of Open Access Journals (Sweden)

    Kurfi Abubakar Muhammed

    2013-06-01

    Full Text Available The essence of primary health care is the provision of essential health services and commodities to individuals and communities using available, acceptable and sustainable resources. However, there has been a growing lack of confidence by the populace as evidenced by poor utilization of the services. This study sought to identify the predominant barriers affecting the utilization of primary health care services in Batsari Local Government in Katsina State, Nigeria. A cluster of 30 households was surveyed in the catchment of the 21 health primary health facilities. A catchment been defined as a household located within 5 km of a primary health center. Using a three digit randomly generated numbers a household was selected. Once selected the start house and twenty-nine contiguous houses were visited. a total of 630 households were surveyed. In all households, questions were asked on the predominant health problems, as well as the major determinants of access and utilization of primary health care services .The results were computed and analyzed using the Statistical Package for Social Sciences software SPSS. Version 17.0 The findings from all the respondents (n=630 showed that majority of the people preferred to seek care from the patent medicine stores (53.63% as against only 7.6% who utilized the primary health care services. The commonest reasons why respondents do not utilize these services were lack of essential drugs, high cost of services as well as inadequate infrastructure in primary healthcare facilities. The study has highlighted some of the multiple factors affecting the utilization of primary healthcare services. It is expected that these findings will guide policy makers in improving healthcare delivery particularly where the need is greatest- at the grassroots-in line with the national health policy and national health strategic development plan.

  2. Optimizing Manpower Allocation for Ground Handling Tasks in Airports using Column Generation

    DEFF Research Database (Denmark)

    Hansen, Anders Dohn; Kolind, Esben

    2008-01-01

    of the staff, synchronization requirements between teams, and union regulations. The problem is solved using column generation in a Branch-and-Price framework. Synchronization between teams is enforced by branching on time windows. The resource constrained shortest path subproblem is solved by a label setting......The Manpower Allocation Problem with Time Windows, Job-Teaming Constraints and a limited number of teams (m-MAPTWTC) is the problem of assigning m teams to a number of tasks, where both teams and tasks are restricted by time windows outside which operation is not possible. Tasks may require several...... individual teams to cooperate. Cooperating teams have to be synchronized with each other. Due to the limited number of teams, some tasks may have to be left unassigned. The objective is to maximize the number of assigned tasks. The problem arises in various crew scheduling contexts where cooperation between...

  3. Solving a manpower scheduling problem for airline catering using tabu search

    DEFF Research Database (Denmark)

    Ho, Sin C.; Leung, Janny M. Y.

    be serviced within a given time-window by a team consisting of a driver and a loader. Each driver/loader has the skills to service some, but not all, of the airline/aircraft/configuration of the jobs. Given the jobs to be serviced and the roster of workers for each shift, the problem is to form teams...... and assign teams and start-times for the jobs, so as to service as many flights as possible. Only teams with the appropriate skills can be assigned to a flight. Workload balance among the teams is also a consideration. We present a model formulation and investigate a tabu-search heuristic approach to solve......We study a manpower scheduling problem with job time-windows and job-skills compatibility constraints. This problem is motivated by airline catering operations, whereby airline meals and other supplies are delivered to aircrafts on the tarmac just before the flights take off. Jobs (flights) must...

  4. [What can be expected of family planning?].

    Science.gov (United States)

    Tallon, F

    1989-04-01

    Growing concern over Rwanda's rapid demographic growth and the development of a family planning program beginning around 1981 have so far had little practical effect on the number of births. Significant mortality reductions resulting from vaccination programs and other development projects may mean that population growth has actually accelerated instead of slowing. Most Rwandans still have the strongly pronatalist attitudes appropriate to an environment with high infant and general mortality rates, small populations, abundant land resources, and a need for manpower and old age security. Lack of services, fear of side effects, and rumors have also hampered acceptance of family planning. Rwanda is 95% rural, but rapid population growth is outstripping agricultural resources. Already in 1984 the average family plot was only .88 hectare, and by the year 2000 it will be half that size. Young people denied employment in agriculture will seek jobs in industry and commerce, but there too the possibilities of absorption are limited. The best employment opportunities will probably be available to the best educated. Between 1962-85, the rate of school enrollment of children aged 7-14 increased from 55-60%, but the total enrollment increased by 150% because of the increased number of children. Acceptance of family planning by substantial numbers of couples will mean significant savings in education. The savings in primary education alone would significantly offset expenditures for family planning. A large part of the funding for family planning in Rwanda is contributed as foreign aid, which could not easily be converted to other development projects, as some critics demand. A more moderate rate of population growth would also mean less expenditure on imports of food and other goods, on health care, on housing, and in all areas where population size is a factor in determining needs. Less reliance on imported food will enable Rwanda to preserve its autonomy. The rising pregnancy

  5. 77 FR 72581 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the...

    Science.gov (United States)

    2012-12-05

    ... From the Federal Register Online via the Government Publishing Office ] Vol. 77 Wednesday, No. 234...-State Plan Issuer Requirements C. Premiums, Rating Factors, Medical Loss Ratios, and Risk Adjustment D... to ensure a level playing field between QHPs and MSPs. Across the country, consumers shopping...

  6. Individual Plans for Children in Transition to Pre-School: A Case Study in One Finnish Day-Care Centre

    Science.gov (United States)

    Turunen, Tuija A.

    2012-01-01

    This paper outlines a case study on teachers' and parents' perspectives on children's individual plans in transition from early childhood education to pre-school in Finland. The study was based on the importance of continuity as a part of positive educational transition experiences. The national curricula, educators' interpretations and parents'…

  7. Socio-demographic variation in perceived illness and the use of primary care: the value of community survey data for primary care service planning.

    Science.gov (United States)

    Bucquet, D; Curtis, S

    1986-01-01

    This paper addresses the question of the prevalence of self reported morbidity in the community and reports on results obtained using the Nottingham Health Profile in a population survey of morbidity. The variation between demographic and social groups and the relationship with GP are considered. The results show that certain aspects of morbidity vary according to social group more markedly than other aspects, and that some dimensions of self reported morbidity are predictive of recent consultation reported by the respondents. The interpretation of data of this sort for health planning purposes is considered. For example, the manual groups were particularly susceptible to tiredness and sleep disturbance, but these were not conditions associated with more frequent consultation. The manual groups also reported higher levels of pain and emotional distress, which were associated with propensity to consult. Other types of morbidity associated with consultation with the general practitioner were physical symptoms of pain and feelings of social isolation, but these did not show a strong class difference. PMID:3775455

  8. Proceedings of the AMCP Partnership Forum: NCPDP Electronic Prior Authorization Standards-Building a Managed Care Implementation Plan.

    Science.gov (United States)

    2015-07-01

    Today's manual prior authorization (PA) process is often viewed by providers, payers, pharmacists, and patients as cumbersome, costly, and inefficient. The recent approval by the National Council for Prescription Drug Programs of a standard transaction for electronic prior authorization (e-PA) has paved the way for more rapid and efficient processing of PA requests. On April 23, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of key stakeholders to explore how to support the process of implementing the new standard transactions for e-PA and to recommend activities and programs that AMCP can promote to speed the adoption of e-PA. This Partnership Forum included individuals from managed care organizations, the pharmaceutical industry, pharmacy benefit managers, electronic prescription hubs or networks, and health information technology vendors. The speakers and panelists recommended that AMCP should develop measurable goals for staged and full implementation of e-PA. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP develop managed care e-PA implementation and e-PA criteria guides, as well as an e-PA scorecard. PMID:26108378

  9. [Part II. Scientific evidence in end-stage chronic organ failure. A position paper on shared care planning].

    Science.gov (United States)

    Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo

    2014-01-01

    The therapeutic options related to chronic organ failure are interconnected to the variability of human biological responses and the personal history and choices of the chronically ill patient on one hand, and with the variable human answers to therapies on the other hand. All these aspects may explain the small number and low quality of studies aimed to define the clinical criteria useful in identifying end-stage chronically ill patients, as highlighted through the 2012-2013 Medline survey performed by the task force. These results prevented the grading of scientific evidence. However, taking into account the evidence based medicine definition, the task force believes the clinical reasoning and the individual experience of clinicians as well as the patients and families preferences cannot be replaced "tout court" with a strict methodological research. Accordingly, the working method selected by the task force members was to draw up a set of clinical parameters based on the available scientific literature, submitting it to a peer review process carried out by an expert panel. This paper discusses a set of clinical parameters included in the clinical decision-making algorithm and shared by nine medical societies. For each chronic organ failure these clinical parameters should be intended not as a rigid cutoff system to make a choice between two selected care options (intensive vs palliative), rather as the starting point for a joint and careful consideration regarding the opportunity to adopt the clinical decision-making algorithm care proposed in Part I. PMID:24553593

  10. Critical care during epidemics

    OpenAIRE

    Rubinson, Lewis; O'Toole, Tara

    2005-01-01

    We recommend several actions that could improve hospitals' abilities to deliver critical care during epidemics involving large numbers of victims. In the absence of careful pre-event planning, demand for critical care services may quickly exceed available intensive care unit (ICU) staff, beds and equipment, leaving the bulk of the infected populace without benefit of potentially lifesaving critical care. The toll of death may be inversely proportional to the ability to augment critical care c...

  11. Care for the Health Care Provider.

    Science.gov (United States)

    Kunin, Sharon Brown; Kanze, David Mitchell

    2016-03-01

    Pretravel care for the health care provider begins with an inventory, including the destination, length of stay, logistical arrangements, type of lodging, food and water supply, team members, personal medical needs, and the needs of the community to be treated. This inventory should be created and processed well in advance of the planned medical excursion. The key thing to remember in one's planning is to be a health care provider during one's global health care travel and not to become a patient oneself. This article will help demonstrate the medical requirements and recommendations for such planning. PMID:26900113

  12. Program plan for US Department of Energy support for nuclear engineering education

    International Nuclear Information System (INIS)

    This document describes the plan developed to address the growing concern for the continued deterioration of nuclear engineering education in the United States and its ability to meet the manpower demands for this Nation's work force requiring nuclear related talent in the foreseeable future

  13. The diverse impact of advance care planning: a long-term follow-up study on patients' and relatives' experiences

    DEFF Research Database (Denmark)

    Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine;

    2015-01-01

    : A qualitative follow-up interview study. Interviews were recorded, transcribed and analysed using thematic synthesis. SETTING/PARTICIPANTS: 3 patients with a life-limiting disease (lung or heart disease), affiliated with a major Danish hospital, and 7 relatives were interviewed 1 year after participating...... issues being 'tucked away'. CONCLUSIONS: The study reveals great diversity in patient and relative experiences of ACP. The study challenges previous research which mainly emphasises ACP as a valuable tool to optimise EOL care. This study stresses the importance of awareness of the highly individual...

  14. Office of Child Care

    Science.gov (United States)

    ... Learn more about the Child Care Rule > OCC Publishes Approved FY 2016-2018 CCDF Plans The Plan ... Instructions Information Memoranda Policy Interpretation Questions Technical Bulletins Administration for Children & Families U.S. Department of Health & Human ...

  15. Measuring nursing essential contributions to quality patient care outcomes.

    Science.gov (United States)

    Wolgast, Kelly A; Taylor, Katherine; Garcia, Dawn; Watkins, Miko

    2011-01-01

    Workload Management System for Nursing (WMSN) is a core Army Medical Department business system that has provided near real-time, comprehensive nursing workload and manpower data for decision making at all levels for over 25 years. The Army Manpower Requirements and Documentation Agency populates data from WMSN into the Manpower Staffing Standards System (Inpatient module within Automated Staffing Assessment Model). The current system, Workload Management System for Nursing Internet (WMSNi), is an interim solution that requires additional functionalities for modernization and integration at the enterprise level. The expanding missions and approved requirements for WMSNi support strategic initiatives on the Army Medical Command balanced scorecard and require continued sustainment for multiple personnel and manpower business processes for both inpatient and outpatient nursing care. This system is currently being leveraged by the TRICARE Management Activity as an interim multiservice solution, and is being used at 24 Army medical treatment facilities. The evidenced-based information provided to Army decision makers through the methods used in the WMSNi will be essential across the Army Medical Command throughout the system's life cycle. PMID:22124876

  16. Careful treatment planning enables safe ablation of liver tumors adjacent to major blood vessels by percutaneous irreversible electroporation (IRE)

    International Nuclear Information System (INIS)

    Irreversible electroporation (IRE) is a tissue ablation method, which relies on the phenomenon of electroporation. When cells are exposed to a sufficiently electric field, the plasma membrane is disrupted and cells undergo an apoptotic or necrotic cell death. Although heating effects are known IRE is considered as non-thermal ablation technique and is currently applied to treat tumors in locations where thermal ablation techniques are contraindicated. The manufacturer of the only commercially available pulse generator for IRE recommends a voltage-to-distance ratio of 1500 to 1700 V/cm for treating tumors in the liver. However, major blood vessels can influence the electric field distribution. We present a method for treatment planning of IRE which takes the influence of blood vessels on the electric field into account; this is illustrated on a treatment of 48-year-old patient with a metastasis near the remaining hepatic vein after a right side hemi-hepatectomy. Output of the numerical treatment planning method shows that a 19.9 cm3 irreversible electroporation lesion was generated and the whole tumor was covered with at least 900 V/cm. This compares well with the volume of the hypodense lesion seen in contrast enhanced CT images taken after the IRE treatment. A significant temperature raise occurs near the electrodes. However, the hepatic vein remains open after the treatment without evidence of tumor recurrence after 6 months. Treatment planning using accurate computer models was recognized as important for electrochemotherapy and irreversible electroporation. An important finding of this study was, that the surface of the electrodes heat up significantly. Therefore the clinical user should generally avoid placing the electrodes less than 4 mm away from risk structures when following recommendations of the manufacturer

  17. [Manpower migrations in the Arab world: the reverse of the New Economic Order].

    Science.gov (United States)

    Halliday, F

    1985-01-01

    Population and petroleum, 2 essential factors in the development of the Arab world, are unequally distributed in the 18 Arab countries. The abstract possibility of mutually beneficial cooperation between the countries with large populations and no oil and those with oil but small populations is far from being realized; on the contrary, growing inequality and deterioration of human and productive resources can be observed in the Arab world. The apparent economic progress of the oil producing states is illusory, because it has permitted them to defer development of their own internal resources such as agriculture, industry, professional training and education in favor of greater dependence on the temporary palliative of petroleum revenues. In 1980, over 3 million Arabs had emigrated toward other Arab countries, where they were joined by approximately 1.8 million non-Arabs. 4 types of Arab migration have been important: movement from the countryside to cities within countries, movement of Arab migrants to non-Arab countries, movement from 1 Arab state to another because of political factors and especially to earn high wages in the oil producing states, and immigration of non-Arabs and especially Asians to Arab countries. 6 of the principal manpower importing countries, Saudi Arabia, Kuwait, Libya, United Arab Emirates, Bahrain, and Qatar, had total labor forces of about 5.2 million in 1985, of which only 41% were nationals. There have been 4 main consequences for the states importing manpower: 1) petroleum production is very capital intensive and creates few jobs; the jobs filled by migrants are mostly in construction and services funded by oil revenues 2) the expansion is temporary because petroleum is a nonrenewable resource; the manpower transfers will therefore not be permanent 3) the migrants represent a large proportion of the labor force and populations of the Gulf oil-producing states, and 4) the migrants are systematically excluded from the political and

  18. Survey of dental manpower resource in Beijing%北京市口腔执业医师人力资源现状分析

    Institute of Scientific and Technical Information of China (English)

    张紫云; 赵丽颖; 孙正

    2014-01-01

    目的:分析2012年北京市口腔医疗机构及口腔医师人力资源现状,为相关部门合理配置口腔卫生人力资源,优化口腔医疗服务体系提供参考。方法获取2012年在北京医师协会注册的口腔执业医师及助理执业医师数据,采用Excel 2007软件录入数据,进行统计分析。结果2012年在北京医师协会注册的口腔执业医师及口腔助理执业医师共5059人,46.52%的口腔医师在政府办医疗机构执业,口腔医师与人口比为1∶4061。67.9%的口腔医师在东城区、西城区、海淀区和朝阳区执业。结论北京市口腔医师人力资源年龄结构较合理,口腔医师人数、职称及学历结构存在区县分布不均衡现象。%Objective To analyze the situation of oral medical institutions and dental manpower resources in 2012 in Beijing and to provide reference for optimization of oral medical service and the rational allocation of oral health human resources. Methods The data of the practicing dentists and assistant dentists registered at Beijing Medical Association in 2012 were obtained,input in the via Excel 2007 software and analyzed. Results There were 5059 practicing dentists and assistant dentists registered at Beijing Medical Association in 2012. 46. 52% of the dentists were employed in the state-owned non-profit oral care institutions. On average, the ratio of dentists to the population was 1∶4061. 67. 9% of the dentists working in Dong Cheng District, Xi Cheng District, Hai Dian District and Chao Yang District. Conclusion In Beijing, the age structure of dental manpower resources was reasonable,but the title,number and degree structure of the dentists in district distribution was imbalanced.

  19. [Physician-assisted suicide and advance care planning--ethical considerations on the autonomy of dementia patients at their end of life].

    Science.gov (United States)

    Gather, Jakov; Vollmann, Jochen

    2014-10-01

    Physician-assisted suicide (PAS), which is currently the subject of intense and controversial discussion in medical ethics, is barely discussed in psychiatry, albeit there are already dementia patients in Germany and other European countries who end their own lives with the assistance of physicians. Based on the finding that patients who ask for medical assistance in suicide often have in mind the loss of their mental capacity, we submit PAS to an ethical analysis and put it into a broader context of patient autonomy at the end of life. In doing so, we point to advance care planning, through which the patient autonomy of the person concerned can be supported as well as respected in later stages of the disease. If patients adhere to their autonomous wish for PAS, physicians find themselves in an ethical dilemma. A further tabooing of the topic, however, does not provide a solution; rather, an open societal and professional ethical discussion and regulation are essential.

  20. The Affordable Care Act's plan for consumer assistance with insurance moves states forward but remains a work in progress.

    Science.gov (United States)

    Grob, Rachel; Schlesinger, Mark; Davis, Sarah; Cohen, Deborah; Lapps, Joshua

    2013-02-01

    The Affordable Care Act provides support for state-run consumer assistance programs to help privately insured consumers who experience problems with their coverage. Its provisions signify the first national commitment to such assistance and to using cases aggregated by these state programs to inform policy. We interviewed state-level administrators and analyzed program documents to assess whether federal support for state-run consumer assistance programs achieved certain goals. We found that some federally supported programs made substantial progress in supporting and empowering patients by reorienting state agencies to become active advocates for their citizens. Yet progress across the country was inconsistent, and there was little evidence that programs addressed systemic problems experienced by consumers. On balance, the consumer assistance provisions of health care reform do not yet ensure protection for all privately insured Americans because of uneven implementation-a problem likely to be of further concern as coverage is expanded and health insurance exchanges come on line in 2014. At the same time, the demonstrated impact of consumer assistance programs in the most innovative states is arguably a useful "proof of concept" for this young federal program.

  1. Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness

    OpenAIRE

    Cabassa, Leopoldo J.; Gomes, Arminda P.; Meyreles, Quisqueya; Capitelli, Lucia; Younge, Richard; Dragatsi, Dianna; Alvarez, Juana; Manrique, Yamira; Lewis-Fernández, Roberto

    2014-01-01

    Background Health-care manager interventions improve the physical health of people with serious mental illness (SMI) and could be widely implemented in public mental health clinics. Local adaptations and customization may be needed to increase the reach of these interventions in the public mental health system and across different racial and ethnic communities. In this study, we describe how we used the collaborative intervention planning framework to customize an existing health-care manager...

  2. Increasing efficacy of primary care-based counseling for diabetes prevention: Rationale and design of the ADAPT (Avoiding Diabetes Thru Action Plan Targeting trial

    Directory of Open Access Journals (Sweden)

    Mann Devin M

    2012-01-01

    Full Text Available Abstract Background Studies have shown that lifestyle behavior changes are most effective to prevent onset of diabetes in high-risk patients. Primary care providers are charged with encouraging behavior change among their patients at risk for diabetes, yet the practice environment and training in primary care often do not support effective provider counseling. The goal of this study is to develop an electronic health record-embedded tool to facilitate shared patient-provider goal setting to promote behavioral change and prevent diabetes. Methods The ADAPT (Avoiding Diabetes Thru Action Plan Targeting trial leverages an innovative system that integrates evidence-based interventions for behavioral change with already-existing technology to enhance primary care providers' effectiveness to counsel about lifestyle behavior changes. Using principles of behavior change theory, the multidisciplinary design team utilized in-depth interviews and in vivo usability testing to produce a prototype diabetes prevention counseling system embedded in the electronic health record. Results The core element of the tool is a streamlined, shared goal-setting module within the electronic health record system. The team then conducted a series of innovative, "near-live" usability testing simulations to refine the tool and enhance workflow integration. The system also incorporates a pre-encounter survey to elicit patients' behavior-change goals to help tailor patient-provider goal setting during the clinical encounter and to encourage shared decision making. Lastly, the patients interact with a website that collects their longitudinal behavior data and allows them to visualize their progress over time and compare their progress with other study members. The finalized ADAPT system is now being piloted in a small randomized control trial of providers using the system with prediabetes patients over a six-month period. Conclusions The ADAPT system combines the influential

  3. The impact of the global budget system on dynamics of dental manpower and utilization of dental services

    Directory of Open Access Journals (Sweden)

    Laura Yueh-Guey Huang

    2016-01-01

    Conclusion: This study has demonstrated a stabilizing effect of the global budget system on dynamics of dental manpower in Taiwan. A relationship between HHI and dentists′ move-out rate has been found. The relationship between municipal socioeconomic status and the density of dentists has also been confirmed. In addition, reduced utilization of amalgam restorations was accompanied by increased utilization of tooth-colored material restorations. Further investigations are indicated.

  4. An operational manpower analysis of the RQ-8 Fire Scout Vertical Take-Off Unmanned Aerial Vehicle (VTUAV)

    OpenAIRE

    Stracker, Matthew C.

    2007-01-01

    In August of 2001 the Secretary of the Navy announced the Navy would expand the work and experimentation in unmanned vehicle systems. After the events of September 11 this was accelerated with the increased urgency to combat terrorism and asymmetric threats. The U.S. Navy is currently undergoing testing and evaluation of the Fire Scout Vertical Take-Off Unmanned Aerial Vehicle (VTUAV) and its integration into the fleet. An in depth analysis of the Fire Scout's manpower requirements is necessa...

  5. A rational approach to estimating the surgical demand elasticity needed to guide manpower reallocation during contagious outbreaks.

    Directory of Open Access Journals (Sweden)

    Hsiao-Mei Tsao

    Full Text Available Emerging infectious diseases continue to pose serious threats to global public health. So far, however, few published study has addressed the need for manpower reallocation needed in hospitals when such a serious contagious outbreak occurs.To quantify the demand elasticity of the major surgery types in order to guide future manpower reallocation during contagious outbreaks.Based on a nationwide research database in Taiwan, we extracted the monthly volumes of major surgery types for the period 1998-2003, which covered the SARS period, in order to carry out a time series analysis. The demand elasticity of each surgery type was then estimated by autoregressive integrated moving average (ARIMA analysis.During the study period, the surgical volumes of most selected surgery types either increased or remained steady. We categorized these surgery types into low-, moderate- and high-elastic groups according to their demand elasticity. Appendectomy, 'open reduction of fracture with internal fixation' and 'free skin graft' were in the low demand elasticity group. Transurethral prostatectomy and extracorporeal shockwave lithotripsy (ESWL were in the high demand elasticity group. The manpower of the departments carrying out the surgeries with low demand elasticity should be maintained during outbreaks. In contrast, departments in charge of surgeries mainly with high demand elasticity, like urology departments, may be in a position to have part of their staff reallocated.Taking advantage of the demand variation during the SARS period in 2003, we adopted the concept of demand elasticity and used a time series approach to figure out an effective index of demand elasticity for various types of surgery that could be used as a rational reference to carry out manpower reallocation during contagious outbreak situations.

  6. Health-related quality of life before planned admission to intensive care: memory over three and six months

    Directory of Open Access Journals (Sweden)

    Tadini Laura

    2010-09-01

    Full Text Available Abstract Background The validity of Health-Related Quality of Life (HRQOL recalled by ICU admitted patients have not been published. The aim of this study was to compare the baseline HRQOL measured before surgery and ICU admission with that recalled at 3 and 6 months in a population of patients with planned ICU admission after surgery. Methods This prospective study was performed in three Italian centres on patients who had undergone General, Orthopaedic or Urologic surgery. All adult patients with planned ICU admission between October 2007 and July 2008 were considered for enrolment. At hospital admission, the Mini Mental Status Examination and EuroQoL (EQ questionnaire (referring to the last two weeks were administered to the patients who consented. Three and six months after ICU admission, the researchers administered by phone the EQ questionnaire and Post-Traumatic Stress Syndrome 14 questions Inventory, asking the patients to rate their HRQOL before surgery and ICU admission. Past medical history demographic and clinical ICU-related variables were collected. Statistical analysis Chi-square test and non parametric statistics were used to compare groups of patients. The EQ-5D was transformed in the time trade-off (TTO to obtain a continuous variable, subsequently analysed using the Intraclass Correlation Coefficient (ICC. Results Of the 104 patients assessed at baseline and discharged from the hospital, 93 had the EQ administered at 3 months, and 89 at 6 months. The ICC for TTO recalled at 3 months vs pre-ICU TTO was 0.851, and that for TTO recalled at 6 months vs pre-ICU TTO was 0.833. The ICC for the EQ-VAS recalled at 3 months vs pre-ICU EQ-VAS was 0.648, and that for the EQ-VAS recalled at 6 months vs pre-ICU EQ-VAS was 0.580. Forty-two (45% patients assessed at 3 months gave the same score in all EQ-5D items as at baseline. They underwent mainly orthopaedic surgery (p 0.011, and perceived the severity of their illness as lower (p 0

  7. The need for providing pharmaceutical care in geriatrics: A case study of diagnostic errors leading to medication-related problems in a patient treatment plan

    Directory of Open Access Journals (Sweden)

    Amna Shah

    2016-01-01

    Full Text Available Background: Geriatric patients are more prone to suffer from medication related problems (MRPs. It may be due to comorbidity of chronic illnesses and/or number of medications prescribed to them as compared to other age groups. Illnesses are sometimes misdiagnosed or left undiagnosed due to aging. Pharmacists have the knowledge about the disease and medication therapy in geriatrics and can provide pharmaceutical care (PC which can supplement decision making of physician, reduce MRPs and improve treatment outcomes. Introduction: This case study highlights the need to provide PC to geriatrics. A diabetic patient presented with hypoglycemia and suspected electrolyte imbalance to the emergency room (ER and was prescribed a treatment plan which had the potential to result in MRPs. Case Presentation: An 80 years old male geriatric patient presented to ER with hypoglycemia. Past medical history revealed Type I DM and CABG. The treatment plan was more focused on resolving signs and symptoms for which no relevant laboratory and diagnostic tests were conducted. Medication therapy was prescribed to the patient on suspected diagnosis and more than one drug of the same therapeutic class was prescribed to the patient making him prone to suffer from MRPs. Conclusion: Incorporating a pharmacist driven PC can help prescribers in establishing diagnosis, selecting rational therapies for co morbidities in geriatrics. It can eliminate unnecessary drug therapy, concomitant use of similar drugs and also reduce the chances of MRPs thereby improving treatment outcomes.

  8. Using the theory of planned behaviour as a process evaluation tool in randomised trials of knowledge translation strategies: A case study from UK primary care

    Science.gov (United States)

    2010-01-01

    Background Randomised trials of knowledge translation strategies for professional behaviour change can provide robust estimates of effectiveness, but offer little insight into the causal mechanisms by which any change is produced. To illustrate the applicability of causal methods within randomised trials, we undertook a theory-based process evaluation study within an implementation trial to explore whether the cognitions of primary care doctors' predicted their test requesting behaviours and, secondly, whether the trial results were mediated by the theoretical constructs. Methods The process evaluation comprised a cross-sectional questionnaire survey of a random 50% sample of the randomised groups of primary care practices in Grampian (NHS Grampian), UK, who took part in a trial of the effect of enhanced feedback and brief educational reminders on test requesting behaviour. The process evaluation was based upon the Theory of Planned Behaviour and focussed on three of the test requesting behaviours that were targeted in the trial -- ferritin, follicle stimulating hormone (FSH), and Helicobacter Pylori serology (HPS). Results The questionnaire was completed by 131 primary care doctors (56%) from 42 (98%) of the sampled practices. Behavioural intention, attitude, and subjective norm were highly correlated for all the tests. There was no evidence that perceived behavioural control was correlated with any of the other measures. Simple linear regression analysis of the rate of test requests on minimum behavioural intentions had R2 of 11.1%, 12.5%, and 0.1% for ferritin, FSH, and HPS requesting, respectively. Mediational analysis showed that the trial results for ferritin and FSH were partially mediated (between 23% and 78% mediation) through intentions. The HPS trial result was not mediated through intention. Conclusions This study demonstrated that a theory-based process evaluation can provide useful information on causal mechanisms that aid not only interpretation of

  9. Using the theory of planned behaviour as a process evaluation tool in randomised trials of knowledge translation strategies: A case study from UK primary care

    Directory of Open Access Journals (Sweden)

    Grimshaw Jeremy M

    2010-09-01

    Full Text Available Abstract Background Randomised trials of knowledge translation strategies for professional behaviour change can provide robust estimates of effectiveness, but offer little insight into the causal mechanisms by which any change is produced. To illustrate the applicability of causal methods within randomised trials, we undertook a theory-based process evaluation study within an implementation trial to explore whether the cognitions of primary care doctors' predicted their test requesting behaviours and, secondly, whether the trial results were mediated by the theoretical constructs. Methods The process evaluation comprised a cross-sectional questionnaire survey of a random 50% sample of the randomised groups of primary care practices in Grampian (NHS Grampian, UK, who took part in a trial of the effect of enhanced feedback and brief educational reminders on test requesting behaviour. The process evaluation was based upon the Theory of Planned Behaviour and focussed on three of the test requesting behaviours that were targeted in the trial -- ferritin, follicle stimulating hormone (FSH, and Helicobacter Pylori serology (HPS. Results The questionnaire was completed by 131 primary care doctors (56% from 42 (98% of the sampled practices. Behavioural intention, attitude, and subjective norm were highly correlated for all the tests. There was no evidence that perceived behavioural control was correlated with any of the other measures. Simple linear regression analysis of the rate of test requests on minimum behavioural intentions had R2 of 11.1%, 12.5%, and 0.1% for ferritin, FSH, and HPS requesting, respectively. Mediational analysis showed that the trial results for ferritin and FSH were partially mediated (between 23% and 78% mediation through intentions. The HPS trial result was not mediated through intention. Conclusions This study demonstrated that a theory-based process evaluation can provide useful information on causal mechanisms that aid not

  10. A novel method for constructing a WIFI positioning system with efficient manpower.

    Science.gov (United States)

    Du, Yuanfeng; Yang, Dongkai; Xiu, Chundi

    2015-01-01

    With the rapid development of WIFI technology, WIFI-based indoor positioning technology has been widely studied for location-based services. To solve the problems related to the signal strength database adopted in the widely used fingerprint positioning technology, we first introduce a new system framework in this paper, which includes a modified AP firmware and some cheap self-made WIFI sensor anchors. The periodically scanned reports regarding the neighboring APs and sensor anchors are sent to the positioning server and serve as the calibration points. Besides the calculation of correlations between the target points and the neighboring calibration points, we take full advantage of the important but easily overlooked feature that the signal attenuation model varies in different regions in the regression algorithm to get more accurate results. Thus, a novel method called RSSI Geography Weighted Regression (RGWR) is proposed to solve the fingerprint database construction problem. The average error of all the calibration points' self-localization results will help to make the final decision of whether the database is the latest or has to be updated automatically. The effects of anchors on system performance are further researched to conclude that the anchors should be deployed at the locations that stand for the features of RSSI distributions. The proposed system is convenient for the establishment of practical positioning system and extensive experiments have been performed to validate that the proposed method is robust and manpower efficient. PMID:25868078

  11. Final report for LDRD project 11-0783 : directed robots for increased military manpower effectiveness.

    Energy Technology Data Exchange (ETDEWEB)

    Rohrer, Brandon Robinson; Rothganger, Fredrick H.; Wagner, John S.; Xavier, Patrick Gordon; Morrow, James Dan

    2011-09-01

    The purpose of this LDRD is to develop technology allowing warfighters to provide high-level commands to their unmanned assets, freeing them to command a group of them or commit the bulk of their attention elsewhere. To this end, a brain-emulating cognition and control architecture (BECCA) was developed, incorporating novel and uniquely capable feature creation and reinforcement learning algorithms. BECCA was demonstrated on both a mobile manipulator platform and on a seven degree of freedom serial link robot arm. Existing military ground robots are almost universally teleoperated and occupy the complete attention of an operator. They may remove a soldier from harm's way, but they do not necessarily reduce manpower requirements. Current research efforts to solve the problem of autonomous operation in an unstructured, dynamic environment fall short of the desired performance. In order to increase the effectiveness of unmanned vehicle (UV) operators, we proposed to develop robots that can be 'directed' rather than remote-controlled. They are instructed and trained by human operators, rather than driven. The technical approach is modeled closely on psychological and neuroscientific models of human learning. Two Sandia-developed models are utilized in this effort: the Sandia Cognitive Framework (SCF), a cognitive psychology-based model of human processes, and BECCA, a psychophysical-based model of learning, motor control, and conceptualization. Together, these models span the functional space from perceptuo-motor abilities, to high-level motivational and attentional processes.

  12. A Novel Method for Constructing a WIFI Positioning System with Efficient Manpower

    Directory of Open Access Journals (Sweden)

    Yuanfeng Du

    2015-04-01

    Full Text Available With the rapid development of WIFI technology, WIFI-based indoor positioning technology has been widely studied for location-based services. To solve the problems related to the signal strength database adopted in the widely used fingerprint positioning technology, we first introduce a new system framework in this paper, which includes a modified AP firmware and some cheap self-made WIFI sensor anchors. The periodically scanned reports regarding the neighboring APs and sensor anchors are sent to the positioning server and serve as the calibration points. Besides the calculation of correlations between the target points and the neighboring calibration points, we take full advantage of the important but easily overlooked feature that the signal attenuation model varies in different regions in the regression algorithm to get more accurate results. Thus, a novel method called RSSI Geography Weighted Regression (RGWR is proposed to solve the fingerprint database construction problem. The average error of all the calibration points’ self-localization results will help to make the final decision of whether the database is the latest or has to be updated automatically. The effects of anchors on system performance are further researched to conclude that the anchors should be deployed at the locations that stand for the features of RSSI distributions. The proposed system is convenient for the establishment of practical positioning system and extensive experiments have been performed to validate that the proposed method is robust and manpower efficient.

  13. Effective Technological Delivery in Nigerian Polytechnics:Need for Academic Manpower Development Policy

    Directory of Open Access Journals (Sweden)

    J. K. Adeyemi

    2004-06-01

    Full Text Available Technical education, especially as provided in the Nigerian polytechnics, leads to the acquisition of practical and applied skills as well as basic scientific knowledge. The production function of the polytechnics in terms of producing quality middle-level manpower through effective teaching delivery depends largely on the quantity and quality of teachers available. However, teacher adequacy is a function of many factors, which include funding, student enrollment overtime, and staff turnover. This article, however, revealed a mismatch between enrollment and available teachers, with huge staff shortfall over the years when the student enrollment was matched with the available teachers, using the ideal teacher-student ratios. Student and teacher projections were carried out based on five-percent annual increase and average teacher-student ratio of 1:12, so as to meet the vision 2010 target year set by the Nigerian government for total development. The projection showed that the polytechnics would require a large additional number of teachers. An all-inclusive funding approach for the polytechnics was recommended so as to increase their financial status, which would allow for improved facilities, workshops, equipment and also improved conditions of service of teachers. We believe that if this was done, more teachers would be attracted from across the world, those who left would return, and new and younger ones will be encouraged to join the teaching force. Such development would to a great extent meet and sustain the anticipated growth for the target year.

  14. Hospitals - MEDICAL_CARE_FACILITIES_MHMP_IN: Medical Care Facilities in Indiana, derived from Essential Facilities Data of the Multi-Hazard Mitigation Planning Data (The Polis Center, Point Shapefile)

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — MEDICAL_CARE_FACILITIES_MHMP_IN.SHP is a point shapefile that shows medical care facilities in Indiana. MEDICAL_CARE_FACILITIES_MHMP_IN.SHP was derived from the...

  15. [Auditing as a tool for ongoing improvement in the Stroke Care Plan of the Region of Aragon].

    Science.gov (United States)

    Gimenez-Munoz, A; Palacin-Larroy, M; Bestue, M; Marta-Moreno, J

    2016-07-16

    Introduccion. El Plan de Atencion al Ictus de Aragon (PAIA) se creo en 2008 en el marco de la Estrategia Nacional en Ictus del Sistema Nacional de Salud. La monitorizacion de la atencion hospitalaria al ictus mediante auditorias periodicas se definio como una de sus lineas de trabajo. Objetivo. Determinar la calidad del proceso asistencial hospitalario prestado al paciente con ictus en Aragon mediante el uso de indicadores de calidad. Materiales y metodos. Se realizaron tres audits (en los años 2008, 2010 y 2012) siguiendo la misma metodologia, basada en la revision retrospectiva de una muestra representativa de ingresos por ictus en cada uno de los hospitales generales del Servicio Aragones de Salud. Se recogio informacion sobre 48 indicadores seleccionados segun su evidencia cientifica o relevancia clinica. Resultados. Se estudiaron 1.011 casos (331 en el primer audit, y 340 en el segundo y en el tercero). Treinta y un indicadores presentaron una mejoria significativa (entre ellos destacan los indicadores de calidad de la historia clinica, de evaluacion neurologica, las medidas preventivas iniciales y, con especial relevancia, la realizacion de test de deglucion), dos sufrieron empeoramiento (relacionados con el tratamiento rehabilitador) y 15 no registraron variaciones significativas. Conclusiones. La implantacion del PAIA ha supuesto una mejoria notable en la mayoria de los indicadores de calidad evaluados, reflejo de una mejora continua en la atencion hospitalaria del ictus. La generalizacion progresiva de la atencion especializada y la creacion de las areas de ictus son algunos de los factores determinantes.

  16. Patient beliefs about medicines and quality of life after a clinical medication review and follow-up by a pharmaceutical care plan: A study in elderly polypharmacy patients with a cardiovascular disorder

    NARCIS (Netherlands)

    Geurts, Marlies M.E.; Stewart, Roy E.; Brouwers, Jacobus R.B.J.; de Graeff, Pieter A.; de Gier, Johan J.

    2015-01-01

    Objective: To determine the effect of a clinical medication review, followed up by a pharmaceutical care plan, on the beliefs about medicines and quality of life (QoL) of older patients with polypharmacy and a cardiovascular disorder. Methods: Patients were randomly assigned to an intervention or co

  17. Managed care innovation and new product development.

    Science.gov (United States)

    Clark, C S; Schuster, T B

    1994-01-01

    This article explores recent innovative activity by managed care payor plans nationwide with particular emphasis on emerging, new relationships between the plans and their purchasers, enrollees, provider panels, and competitors. Because they already practice what advocates of health care reform are now preaching, many managed care plans are leading the charge to transform our health care delivery and financing systems.

  18. A comparative analysis of predictive models of morbidity in intensive care unit after cardiac surgery – Part I: model planning

    Directory of Open Access Journals (Sweden)

    Biagioli Bonizella

    2007-11-01

    Full Text Available Abstract Background Different methods have recently been proposed for predicting morbidity in intensive care units (ICU. The aim of the present study was to critically review a number of approaches for developing models capable of estimating the probability of morbidity in ICU after heart surgery. The study is divided into two parts. In this first part, popular models used to estimate the probability of class membership are grouped into distinct categories according to their underlying mathematical principles. Modelling techniques and intrinsic strengths and weaknesses of each model are analysed and discussed from a theoretical point of view, in consideration of clinical applications. Methods Models based on Bayes rule, k-nearest neighbour algorithm, logistic regression, scoring systems and artificial neural networks are investigated. Key issues for model design are described. The mathematical treatment of some aspects of model structure is also included for readers interested in developing models, though a full understanding of mathematical relationships is not necessary if the reader is only interested in perceiving the practical meaning of model assumptions, weaknesses and strengths from a user point of view. Results Scoring systems are very attractive due to their simplicity of use, although this may undermine their predictive capacity. Logistic regression models are trustworthy tools, although they suffer from the principal limitations of most regression procedures. Bayesian models seem to be a good compromise between complexity and predictive performance, but model recalibration is generally necessary. k-nearest neighbour may be a valid non parametric technique, though computational cost and the need for large data storage are major weaknesses of this approach. Artificial neural networks have intrinsic advantages with respect to common statistical models, though the training process may be problematical. Conclusion Knowledge of model

  19. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers.

    Science.gov (United States)

    Kimmel, Allison L; Wang, Jichuan; Scott, Rachel K; Briggs, Linda; Lyon, Maureen E

    2015-07-01

    Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.

  20. Feedback GAP: study protocol for a cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care

    Directory of Open Access Journals (Sweden)

    Francis Jill

    2010-12-01

    Full Text Available Abstract Background Audit and feedback to physicians is commonly used alone or as part of multifaceted interventions. While it can play an important role in quality improvement, the optimal design of audit and feedback is unknown. This study explores how feedback can be improved to increase acceptability and usability in primary care. The trial seeks to determine whether a theory-informed worksheet appended to feedback reports can help family physicians improve quality of care for their patients with diabetes and/or ischemic heart disease. Methods Two-arm cluster trial was conducted with participating primary care practices allocated using minimization to simple feedback or enhanced feedback group. The simple feedback group receives performance feedback reports every six months for two years regarding the proportion of their patients with diabetes and/or ischemic heart disease who are meeting quality targets. The enhanced feedback group receives these same reports as well as a theory-informed worksheet designed to facilitate goal setting and action plan development in response to the feedback reports. Participants are family physicians from across Ontario who use electronic medical records; data for rostered patients are used to produce the feedback reports and for analysis. Outcomes The primary disease outcomes are the blood pressure (BP, and low-density lipoprotein cholesterol (LDL levels. The primary process measure is a composite score indicating the number of recommended activities (e.g., tests and prescriptions conducted by the family physicians for their patients with diabetes and/or ischemic heart disease within the appropriate timeframe. Secondary outcomes are the proportion of patients whose results meet targets for glucose, LDL, and BP as well as the percent of patients receiving relevant prescriptions. A qualitative process evaluation using semi-structured interviews will explore perceived barriers to behaviour change in response to

  1. Savannah River Site Environmental Implementation Plan. Volume 2, Protection programs

    Energy Technology Data Exchange (ETDEWEB)

    1989-08-01

    Formal sitewide environmental planning at the . Savannah River Site (SRS) began in 1986 with the development and adoption of the Strategic Environmental Plan. The Strategic Environmental Plan describes the philosophy, policy, and overall program direction of environmental programs for the operation of the SRS. The Strategic Environmental Plan (Volume 2) provided the basis for development of the Environmental Implementation Plan (EIP). The EIP is the detailed, comprehensive environmental master plan for operating contractor organizations at the SRS. The EIP provides a process to ensure that all environmental requirements and obligations are being met by setting specific measurable goals and objectives and strategies for implementation. The plan is the basis for justification of site manpower and funding requests for environmental projects and programs over a five-year planning period.

  2. The feasibility analysis of aileron manpower control  in  a  fighter%某型歼击机副翼人力操纵可行性分析

    Institute of Scientific and Technical Information of China (English)

    王建平; 沈燕良; 曹克强

    2001-01-01

    In order to eliminate the suspense of aileron manpower control, the model of feasibility analysis of aileron manpower control was built. Make use of the flying mechanics base principle,this paper analyzed the required power when aileron hydromechanical servomechanism switch to manpower control because of the failure of normal hydraulic power supply in a fighter.Based on it, the article analysed the feasibility of aileron manpower control.The result is,take the suitable process, aileron manpower control is feasible.%为消除飞行人员对副翼人力操纵的疑虑,在建立副翼人力操纵可行性分析模型的基础上,应用飞行力学的基本原理,对某型歼击机因液压系统正常供压部分失效,副翼助力器转换为人力操纵后所需的压杆力进行了定量分析计算。结果表明,在应急情况下,只要处理得当,该型飞机副翼人力操纵是可行的。

  3. Advanced manpower and time saving testing concept for development, production, and maintenance of electro-optical systems

    Science.gov (United States)

    Cabib, Dario; Buckwald, R. A.; Nirkin, Shimon; Lavi, Moshe; Neria, Oded; Ben Yaakov, Claudia; Tzafrir, Efraim; Blau, Moshe; Dolev, Jacob

    2006-05-01

    In all stages of an electro-optics system's life, development, production, and periodic maintenance, a large amount of manpower and time is devoted to testing. Each subsystem separately as well as the system as a whole are tested by a PC controlled test system, which consists of hardware for creation of the appropriate stimuli, and software for tests management and control. A very considerable portion of this manpower and time is devoted by the system manufacturer to configure the test routines, to manually input certain parameter values of the Unit Under Test (UUT) at predefined test nodes, and to reconfigure these routines from time to time, as the needs change during the system's life time. CI has developed the CTE (CI Test Executive), a software package which is a breakthrough in saving manpower and time devoted to electro-optics system testing. The new concept is based on: 1. The CTE can communicate directly with any UUT able to communicate with the outside world through a known protocol, to automatically set the UUT parameters before testing, 2. The user can more easily reconfigure the communication with the UUT through a provided special Excel file, without the help of the test system manufacturer, 3. The interface screen is automatically reconfigured every time the Excel file is changed to build the new test routine, 4. The CTE can simulate the test system stimuli with error injection capability, and simultaneously monitor communication and other hardware functions, 5. Test "verification" signals are provided on-line for the convenience and time saving of the test operator.

  4. Japanese in the Russian Far East (1900s – early 1930s: Manpower problem on Kamchatka and Northern Sakhalin

    Directory of Open Access Journals (Sweden)

    Taisija V. Yudina

    2014-06-01

    Full Text Available The article is devoted to the problem of manpower in the Russian Far East inthe 1900s – early 1930s. The authors examine the total number of workers and employees at the concession enterprises, a percentage ratio of the Russian and foreign workers in the Far East fishery, coal and oil industries, their living and working conditions, salaries etc. The authors especially emphasized the role of Japanese fishery managers in the development of the Kamchatka fishery in pre-revolutionary Russia and in the USSR.

  5. Progressive Care of Obese Patients.

    Science.gov (United States)

    Dambaugh, Lori A; Ecklund, Margaret M

    2016-08-01

    Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36[4]:58-63). PMID:27481802

  6. Defining the role of University of Kentucky HealthCare in its medical market--how strategic planning creates the intersection of good public policy and good business practices.

    Science.gov (United States)

    Karpf, Michael; Lofgren, Richard; Bricker, Timothy; Claypool, Joseph O; Zembrodt, Jim; Perman, Jay; Higdon, Courtney M

    2009-02-01

    In response both to national pressures to reduce costs and improve health care access and outcomes and to local pressures to become a top-20 public research university, the University of Kentucky moved toward an integrated clinical enterprise, UK HealthCare, to create a common vision, shared goals, and an effective decision-making process. The leadership formed the vision and then embarked on a comprehensive and coordinated planning process that addressed financial, clinical, academic, and operational issues. The authors describe in depth the strategic planning process and specifically the definition of UK HealthCare's role in its medical marketplace. They began a rigorous process to assess and develop goals for the clinical programs and followed the progress of these programs through meetings driven by data and attended by the organization's senior leadership. They describe their approach to working with rural and community hospitals throughout central, eastern, and southern Kentucky to support the health care infrastructure of the state. They review the early successes of their strategic approach and describe the lessons they learned. The clinical successes have led to academic gains. The experience of UK HealthCare suggests that good business practices and good public policy are synergistic.

  7. Injection Safety and Practices following Needle Stick Injuries An Occupational Risk to Health Care Providers In Gujarat

    Directory of Open Access Journals (Sweden)

    Harsh D Shah, Bonny H Shah, Hiren R Solanki, Vijay R Agarwal, Priyank A Parmar , Kiran M Narkhede

    2015-01-01

    Full Text Available "Background: An occupational exposure to blood can result from percutaneous (needle stick or other sharps injury and mucocutaneous injury (splash of blood or other body fluids into the eyes, nose or mouth, or blood contact with non-intact skin. Beside transmission of infectious diseases, it indirectly affects health care delivery services especially in developing countries where demand is high in compare with manpower resources. Materials and method: The study was a cross sectional conducted among health care workers from a district of Gujarat. During the study, only one injection per health worker was taken into the consideration for better analysis. Results: Out of 251, 147 (58.56% had needle stick injury in last one year and majority health workers were nursing staff. It was found that there was significant association who had NSIs previously before one year and injuries within last year and injuries occurred while giving the injections (48%. Only 32% of HCWs had done reporting about their NSIs to the concern authority and 20% followed the protocols of post exposure prophylaxis guidelines. Conclusion: Under reporting and lack of sensitivity on needles tick injuries had layered up during the study along with safe injection practices. Close monitoring on injection practices, surveillance on NSIs by quality assurance committee and structured communication plan should be in place to avoid health worker at risk and hazard of needle stick injuries."

  8. Investigation on allocation of nursing manpower resource in dental medical institutions in Liaoning Province%辽宁省口腔护理人力资源配置研究

    Institute of Scientific and Technical Information of China (English)

    刘璐; 常淼; 曲智; 程睿波; 徐艳梅; 路振富; 张颖

    2014-01-01

    目的:对2011年辽宁省口腔医疗机构进行普查,分析了解辽宁省口腔护理人力资源配置状况。方法由各级卫生行政管理部门对所有注册口腔医疗机构逐级下发问卷表格,对辽宁省口腔护理人力资源进行普查。调查内容包括辽宁省口腔护理人力资源的数量、结构、分布。利用 EpiData 3.0软件建立数据库。采用 SPSS13.0软件包对资料进行统计分析,采用频数分布和χ2检验进行口腔护理人力资源状况资料的分析。结果辽宁省口腔护理人力资源共2038人。其中城市1967人,农村71人;就职于公立机构773人,非公立机构1265人。全省口腔护理人力资源结构以26~45岁中青年(59.32%)、“护士”职称(42.74%)、中专及以下学历(50.25%)、口腔综合专业(81.80%)为主。全省医护比为2.76∶1;护椅比为1∶2.81。结论辽宁省口腔护理人力资源数量相对不足,分布不均衡,结构不合理。应从学历、职称、专业等方面优化口腔护理人力资源结构,进而加强我省口腔护理人力资源的合理配置和有效利用。%Objective To investigate the dental medical institutions in Liaoning Province in 201 1 ,and to analyze the allocation of nursing manpower resource in dental medical institutions in Liaoning Province.Methods A mass survey on nursing manpower re-source was conducted in dental medical institutions in Liaoning Province in 201 1 by means of questionnaire investigation,which includ-ed the number,structure,distribution of nursing manpower resource in dental medical institutions in Liaoning Province.Database was created with EpiData 3.0 and analyzed with SPSS 1 3.0.Frequency distribution and univariate analysis(chi square test)were conducted for the allocation of nursing manpower resource.Results The population for dental care in dental medical institutions in Liaoning Province was 2038,with 1 967 in urban areas

  9. Contribution of Kenyan University Undergraduate Fashion and Apparel Design Programs towards the Manpower Development for the Kenyan Apparel Industry

    Directory of Open Access Journals (Sweden)

    Rael Chepchumba Maiyo

    2013-04-01

    Full Text Available Worldwide, the contribution of university fashion design training programs towards the manpower development for the fashion and apparel (FA industry cannot be underestimated. The objective of this paper is to identify the contribution of Kenyan University undergraduate fashion and apparel design programs (UUGFADPs towards manpower development for Kenyan FA industry. Descriptive survey was used to collect data at Kenyatta, Maseno, Egerton, University of Eldoret (UoE, University of Eastern Africa-Baraton (UEAB and fashion and apparel design (FAD firms in Nairobi, Nakuru, Mombasa, Athi River, Eldoret and Kisumu. The target population was Kenyan university departments offering UUGFADPs as well as their graduates. Purposive and snowball sampling were employed to select 208 respondents. Data collection methods were questionnaires, in-depth oral interviews, and document analysis. Qualitative data were coded according to patterns and themes and presented descriptively. Quantitative data was analyzed and summarized using descriptive statistics then presented in tables. Findings indicate that Kenyan UUGFADPs contributed to FA industry through research, training for various roles, job creation and community development. this paper recommends that for the UUGFADPs to give maximum contribution to the apparel industry, the FAD departments and FA industry should establish strong university-industry linkages and that the Kenyan government, through the relevant ministries should support the FA industry by job creation and identification.

  10. Cross-national comparison of human resources for health in the Netherlands and Portugal.

    NARCIS (Netherlands)

    Martins-Coelho, G.; Batenburg, R.

    2010-01-01

    CONTEXT: Manpower is critical for health care systems. It is, however, one of the least strategically planned resources, resulting in mismatches on the health care labour market. There are several approaches available for health manpower planning. Yet little is known about which (if any) is applied

  11. Status of simulation in health care education: an international survey.

    Science.gov (United States)

    Qayumi, Karim; Pachev, George; Zheng, Bin; Ziv, Amitai; Koval, Valentyna; Badiei, Sadia; Cheng, Adam

    2014-01-01

    Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current findings to support simulation in the next developmental stages. PMID:25489254

  12. Treatment of a Frail Older Patient with Diffuse Large B-Cell Lymphoma on Maintenance Dialysis: Attenuated Immunochemotherapy and Adapted Care Plan

    Directory of Open Access Journals (Sweden)

    Luciola de Barros Pontes

    2013-04-01

    Full Text Available Purpose of the Study: Diffuse large B-cell lymphoma (DLBCL is the most common lymphoid malignancy worldwide. Its incidence increases with age and about 40% of cases occur in patients over 70 years. Herein, we describe a case of a frail elderly patient with renal insufficiency and DLBCL treated with R-mini-CHOP. Case Report: A 77-year-old man on maintenance hemodialysis started experiencing persistent fatigue. He was diagnosed with a large mass on the left lobe of the lung. Biopsy demonstrated a DLBCL, CD20 positive. The patient was assigned clinical stage IIBX, with a high age-adjusted international prognosis index. A proper geriatric assessment revealed a frail patient. Thus, an adapted chemotherapy regimen was proposed which consisted of R-mini-CHOP every 21 days, with a reduction of 10% in the doses of doxorubicin and cyclophosphamide. During the treatment, the patient went through regular dialysis sessions, 3 times per week, with an extra session performed 12 h after each chemotherapy administration. The patient experienced no adverse events or grade 3/4 toxicities. After 6 cycles of R-mini-CHOP, the patient achieved unconfirmed complete remission, and consolidation radiotherapy was performed. At the last follow-up, he was still in unconfirmed complete remission, with a progression-free survival of 11.3 months. Conclusions: R-mini-CHOP represented a reasonable treatment option for this patient with renal failure. The oncogeriatric approach led to a successful management of this frail patient, highlighting that an adapted plan of care is a key issue to improve the outcomes of elderly cancer patients.

  13. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE) planning – anxiety, depression, quality of life

    OpenAIRE

    Lyon, Maureen E.; Garvie, Patricia A.; Briggs, Linda; He, Jianping; Malow, Robert; D’Angelo, Lawrence J; McCarter, Robert

    2010-01-01

    Purpose To determine the safety of engaging HIV-positive (HIV+) adolescents in a Family Centered Advance Care (FACE) planning intervention. Patients and methods We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76). Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices® interview, and completion of The Five...

  14. Planning and Implementing Cooperative Education.

    Science.gov (United States)

    Brown, Sylvia J.

    1978-01-01

    Implementing cooperative education requires careful planning, institutional support, and competent staffing. Suggestions for planning, setting objectives, recruiting students, job development, student counseling and placement, liaison with other colleges offices, and institutionalization are described. (Author/LBH)

  15. Planning Ahead: Advanced Heart Failure

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Planning Ahead: Advanced Heart Failure Updated:Jul 7,2016 ... making your preferences known is called advance care planning. It allows you to speak for yourself, even ...

  16. Northern settlement family-style: labor planning and population policy in Noril'sk.

    Science.gov (United States)

    Bond, A R

    1985-01-01

    This paper reviews labor planning and population policies in Noril'sk, a mining and metallurgical settlement in northern Siberia. When the settlement was established in 1935, planners were lacking in ideas about how to recruit workers to staff the mines and smelters and how to retain the labor force once it was in place. From 1935-79, planners followed a forced labor policy dependent upon the labor of prisoners. However, this solution was not adequate for meeting the manpower needs of an economy undergoing rapid technological sophistication. Northern wage increments were introduced after 1945 to recruit skilled workers from other regions. These increments built up over a 4-year period to a maximum of 80% of base pay. A special cost of living bonus was also awarded. Although these inducements facilitated labor recruitment, labor retention remained a major problem. Surveys indicated that workers would prefer improvements in housing and social services to further wage increases. Thus, policy was directed at the housing shortages, poor medical care, and inadequate child care facilities in Noril'sk. Such improvements facilitated labor retention but also contributed to overpopulation. The population doubled between 1956-80, exceeding 180,000 in the latter year. In the early 1980s, selective measures toward population control were implemented to ensure maintenance of living standards (e.g., encouragement of older workers to leave the area upon retirement, more careful screening of recruits). The goal is to stabilize city size at around 250,000. The Noril'sk case illustrates that quality of life investments can alleviate labor retention problems even in the harshest physical environments. Recent policies have advocated productivity-enriching technologies that do not require increments in the labor force.

  17. The Manpower Allocation Problem with Time Windows and Job-Teaming Constraints: A Branch-and-Price Approach

    DEFF Research Database (Denmark)

    Hansen, Anders Dohn; Kolind, Esben; Clausen, Jens

    2009-01-01

    In this paper, we consider the Manpower Allocation Problem with Time Windows, Job-Teaming Constraints and a limited number of teams (m-MAPTWTC). Given a set of teams and a set of tasks, the problem is to assign to each team a sequential order of tasks to maximize the total number of assigned tasks....... Both teams and tasks may be restricted by time windows outside which operation is not possible. Some tasks require cooperation between teams, and all teams cooperating must initiate execution simultaneously. We present an IP-model for the problem, which is decomposed using Dantzig-Wolfe decomposition....... The problem is solved by column generation in a Branch-and-Price framework. Simultaneous execution of tasks is enforced by the branching scheme. To test the efficiency of the proposed algorithm, 12 realistic test instances are introduced. The algorithm is able to find the optimal solution in 11 of the test...

  18. The Manpower Allocation Problem with Time Windows and Job-Teaming Constraints: A Branch-and-Price Approach - Technical Report

    DEFF Research Database (Denmark)

    Hansen, Anders Dohn; Kolind, Esben; Clausen, Jens

    In this paper, we consider the Manpower Allocation Problem with Time Windows, Job-Teaming Constraints and a limited number of teams (m-MAPTWTC). Given a set of teams and a set of tasks, the problem is to assign to each team a sequential order of tasks to maximize the total number of assigned tasks....... Both teams and tasks may be restricted by time windows outside which operation is not possible. Some tasks require cooperation between teams, and all teams cooperating must initiate execution simultaneously. We present an IP-model for the problem, which is decomposed using Dantzig-Wolfe decomposition....... The problem is solved by column generation in a Branch-and-Price framework. Simultaneous execution of tasks is enforced by the branching scheme. To test the efficiency of the proposed algorithm, 12 realistic test instances are introduced. The algorithm is able to find the optimal solution in 11 of the test...

  19. What to include in your birth plan

    Science.gov (United States)

    Pregnancy - birth plan ... Birth plans are guides that parents-to-be make to help their health care providers best support them during ... things to consider before you make a birth plan. This is a great time to learn about ...

  20. Regionalization of neonatal intensive care in Korea

    Directory of Open Access Journals (Sweden)

    Yun Sil Chang

    2011-12-01

    Full Text Available In the current era of low-birth rate in Korea, it is important to improve our neonatal intensive care and to establish an integrative system including a regional care network adequate for both high-risk pregnancies and highrisk newborn infants. Therefore, official discussion for nation-wide augmentation, proper leveling, networking, and regionalization of neonatal and perinatal care is urgently needed. In this report, I describe the status of neonatal intensive care in Korea, as well as nationwide flow of transfer of high-risk newborn infants and pregnant women, and present a short review of the regionalization of neonatal and perinatal care in the Unites States and Japan. It is necessary not only to increase the number of neonatal intensive care unit (NICU beds, medical resources and manpower, but also to create a strong network system with appropriate leveling of NICUs and regionalization. A systematic approach toward perinatal care, that includes both high-risk pregnancies and newborns with continuous support from the government, is also needed, which can be spearheaded through the establishment of an integrative advisory board to propel systematic care forward.

  1. "Lovely pie in the sky plans": a qualitative study of clinicians’ perspectives on guidelines for managing low back pain in primary care in England

    NARCIS (Netherlands)

    F.L. Bishop; A.L. Dima; J. Ngui; P. Little; R. Moss-Morris; N.E. Foster; G.T. Lewith

    2015-01-01

    STUDY DESIGN: A qualitative study in south-west England primary care. OBJECTIVE: To clarify the decision-making processes that result in the delivery of particular treatments to patients with low back pain (LBP) in primary care and to examine clinicians' perspectives on the English National Institut

  2. Health Care Waste Management

    OpenAIRE

    World Bank

    2003-01-01

    Health care waste management (HCWM) is a process to help ensure proper hospital hygiene and safety of health care workers and communities. It includes planning and procurement, construction, staff training and behavior, proper use of tools, machines and pharmaceuticals, proper disposal methods inside and outside the hospital, and evaluation. Its many dimensions require a broader focus than ...

  3. Health care marketing management.

    Science.gov (United States)

    Cooper, P D

    1979-01-01

    Health Care Marketing Management is the process of understanding the needs and the wats of a target market. Its purpose is to provide a viewpoint from which to integrate the analysis, planning, implementation (or organization) and control of the health care delivery system.

  4. Spectator Medical Care.

    Science.gov (United States)

    Carlson, L

    1992-01-01

    Recent world events-including the fear of terrorism during last year's Super Bowl-illustrate how vulnerable spectators can be to medical emergencies during sporting events. A physician who studies and coordinates crowd care for events ranging from the Super Bowl to local fairs gives tips on planning and executing a spectator medical plan.

  5. The Impacts of well Planned Recruitment and Selection Process on Corporate Performance in Nigerian Banking Industry (A Case Study of First Bank Plc 2004-2011

    Directory of Open Access Journals (Sweden)

    Adeniyi Mudashiru Mustapha

    2013-09-01

    Full Text Available A sound recruitment programme logically follows a well drawn-up manpower plan. In fact, the quality of the present manpower plan as indeed of every present decision of the organization depends upon the quality of recruitment policies and practices. This paper examines recruitment and selection process. It identifies a typical source by separating recruitment into internal and external and discussed the advantages of each method. The analytical tools used in this study were regression analysis and analysis of variance (ANOVA to determine the relationship between a well planned recruitment and selection process on corporate performance. Findings revealed that there is a significant relationship between recruitment and selection based on merit and organizational performance; that effective recruitment and selection is a key to organizational commitment; that a well planned recruitment and selection contributes to organizational performance. The paper concludes by drawing the danger potends by poor recruitment and selection as poor recruitment could lead to selection of poor applicants.

  6. An Approach for Safe Medication Assistance in Nursing Homes: A Workshop to Identify Problems of and Plan Measures for Care Workers.

    Science.gov (United States)

    Park, Hyerim; Miki, Akiko; Satoh, Hiroki; Maki, Hideyuki; Asai, Kohei; Konishi, Yukari; Sawada, Yasufumi

    2016-01-01

    We conducted a workshop that aimed to clarify problems with care workers supporting medication use in nursing homes, to propose measures for solving these problems, and to raise awareness of these problems among care workers. Eighteen care workers from different fee-based elderly nursing homes were enrolled in the workshop, and divided into four groups. The participants in these groups identified the issues based on their experiences regarding medication-related incidents, and discussed related problems and viable measures using the KJ method. The issues identified by each group were "dropping a medication", "wrong resident", "refusal to take medication", and "confusion". To resolve these problems, the participants recommended: "conducting study sessions or testing of manuals and medication knowledge", "strengthening monitoring systems", "enhancing information sharing", etc. The involvement of pharmacists was hardly mentioned, despite the workshop being designed for "medication assistance". A post-workshop questionnaire revealed that 88.9% of the participants acknowledged an increased awareness of safe assistance in the use of medication. A follow-up questionnaire, distributed approximately seven months after the workshop, revealed that 82.4% of participants applied the experience and knowledge they learned at the workshop to their work. The workshop seemed to raise awareness and lead to preventive measures for safe medication assistance. Communication between care workers and other health care professionals, such as pharmacists, is important to designing and implementing safe medical care in nursing homes. PMID:27252069

  7. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings – Guideline of the German Society for Hospital Hygiene (DGKH

    Directory of Open Access Journals (Sweden)

    Külpmann, Rüdiger

    2016-02-01

    Full Text Available Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems in hospitals” ( in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  8. Nuclear physics program plan

    International Nuclear Information System (INIS)

    The nuclear physics program objectives, resources, applications and implications of scientific opportunities are presented. The scope of projected research is discussed in conjunction with accelerator facilities and manpower. 25 figs., 2 tabs

  9. Applying human capital management to model manpower readiness a conceptual framework

    OpenAIRE

    Ngin, Pert Chin.

    2005-01-01

    The United States Navy is currently going through a human capital transformation in order to better meet the security challenges of the 21st century. A key component of the plan is the job analysis process, conducted using the SkillsNET methodology, to define job requirements in terms of knowledge, skills, abilities, and tools, in contrast to the current approach of relying on the rating badge and a naval enlisted code associated with the billet. The objective of this thesis is to develop a ...

  10. VOYAGE PLANNING

    Directory of Open Access Journals (Sweden)

    Kazimierz SKÓRA

    2016-09-01

    Full Text Available A sea voyage can be divided into three parts with varying degrees of risk: - from the berth at the port of departure to the pilot disembarkation point - from the pilot disembarkation to another pilot embarkation point near the port of call/destination - from the pilot embarkation point to the berth Results of statistical research into ship accidents at sea point to an increased number of incidents and accidents, including groundings, especially in restricted areas. Such areas are often narrow and have limited depths, while their short straight sections require frequent course alterations, often in varying hydrometeorological conditions. Due to all these factors, the voyage has to be carefully planned and all watchkeeping officers have to be well prepared to conduct the ship safely. The article presents the objectives, scope, legal basis and stages in the process of voyage planning. The compliance with the outlined principles will reduce the level of risk in maritime transport.

  11. Manpower development for nuclear power programme. China. Project findings and recommendations

    International Nuclear Information System (INIS)

    The United Nations Development Program (UNDP) project was conceived in April 1985, implementation was started on preliminary authorization by summer 1986, and it was approved and signed in early 1987. The duration was originally planned for three years with a UNDP input of US$ 1,657.500 (including Government cost sharing of US$ 280,000). The project is now essentially completed with a few items still pending, though committed as firmly planned, and the current cost estimate is US$ 1,707.617. The objective of the project was to assist in establishing long-term training programmes in two training centres in the People's Republic of China (Qinshan and Suzhou) and strengthen the training capabilities at these centres. The two centres are intended to provide specialized comprehensive training in basic and applied nuclear power engineering disciplines as well as in construction, operation and maintenance of nuclear power plants to technical personnel assigned to the nuclear power plants in the People's Republic of China

  12. Information Sharing for Care Coordination

    OpenAIRE

    Amir, Ofra; Grosz, Barbara J.; Stern, Roni; Sanders, Lee M.

    2013-01-01

    Teamwork and care coordination are of increasing importance to health care delivery and patient safety and health. This paper describes our initial work on developing agents that are able to make intelligent information sharing decisions to support a diverse, evolving team of care providers in constructing and maintaining a shared plan that operates in uncertain environments and over a long time horizon.

  13. The development of nuclear power and nuclear manpower training in China

    International Nuclear Information System (INIS)

    There are two nuclear power plants (NPP) in operation in China. The Qinshan NPP was the first that was constructed by China's own efforts and went into operation on 1991. The Daya Bay NPP was constructed using foreign funds, technology and went into operation on 1994. Four nuclear power projects with 8 units were initiated during the State Ninth Five-years Plan. The 8 units are expected for commercial operation between 2002 and 2005. China is preparing for the Tenth Five-Year Plan, in which China will develop the nuclear power at a moderate pace. The 13 universities and colleges were offering nuclear science educations. The students from these universities and college can meet the needs of nuclear institutes and enterprises. China National Nuclear Corporation (CNNC) owns the Graduated School of Nuclear Industry and the Nuclear Industry Administrative Cadre College, which will turn into the nuclear training center in future. Besides, CNNC also owns 4 institutions awarding Doctorate and 9 institutes awarding Master Degree. Many programs for education and training carried out by CNNC are presented, such as direct education supported by CNNC's finances, on job training, education for the second bachelor degree, training for senior economic professionals, research course for senior professionals, short time training course and training for license. China trained nuclear personnel by international cooperation with other countries both through multilateral and bilateral cooperation programs. CNNC has established scientific and economic ties with over 40 countries. CNNC has held diversified training for nuclear industry professionals with our own efforts and with the support from the State for many years. Today, the rapid development of nuclear industry needs more professionals. We must make greater efforts to enhance human resources development. Nuclear Safety is very important for nuclear energy development. Nuclear safety is closely related to each person who works in

  14. 病房护理人力管理系统的开发及应用%Development of Computer System for Nursing Manpower Management

    Institute of Scientific and Technical Information of China (English)

    李红; 张琼瑶; 王小芳; 张秀仪

    2001-01-01

    In order to raise the nursing management level and working efficiency, on the basis of in-patient computer management system and nursing manpower resource utilization index estimation system, nursing manpower management computer system was developed in July 1999. The system had dynamic functions, including nurses' allocation management module, arrangement and checking work attendance, technical file management, manpower resource utilization estimation, etc.. The system was implemented one year in 30 work stations of 19 wards and provided reliable, systemic and rapid data of manpower resource utilization estimation for varied levels of administrators.%为了提高护理科学化管理水平与工作效率,在住院病人计算机管理系统和护理人力资源利用指标评价体系的基础上,于1999年7月开发了病房护理人力管理计算机系统。系统给予动态的功能,包括与工作量相适应的护理人员编配管理模块、排班与考勤、技术档案管理、人力资源利用状况评价等。在本院19个病区的30个工作站实施1年,为各级管理者提供了可靠、系统、快捷的人力资源利用评估资料,使管理者的工作重点转向护理质量的不断改进方面。

  15. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE planning – anxiety, depression, quality of life

    Directory of Open Access Journals (Sweden)

    Maureen E Lyon

    2010-02-01

    Full Text Available Maureen E Lyon1, Patricia A Garvie2, Linda Briggs3, Jianping He4, Robert Malow5, Lawrence J D’Angelo1, Robert McCarter41Children’s National Medical Center and George Washington School of Medicine and Health Sciences, Washington, District of Columbia; 2St Jude Children’s Research Hospital, Memphis, Tennessee; 3Gundersen Lutheran Medical Foundation, Inc., Madison, Wisconsin; 4Children’s Research Institute, Washington, District of Columbia; 5Florida International University, Miami, FloridaPurpose: To determine the safety of engaging HIV-positive (HIV+ adolescents in a Family Centered Advance Care (FACE planning intervention.Patients and methods: We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76. Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices® interview, and completion of The Five Wishes©. The Healthy Living Control (HLC received: Developmental History, Healthy Tips, Future Planning (vocational, school or vocational rehabilitation. Three-month post-intervention outcomes were: completion of advance directive (Five Wishes©; psychological adjustment (Beck Depression, Anxiety Inventories; quality of life (PedsQL™; and HIV symptoms (General Health Self-Assessment.Results: Adolescents had a mean age, 16 years; 40% male; 92% African-American; 68% with perinatally acquired HIV, 29% had AIDS diagnosis. FACE participants completed advance directives more than controls, using time matched comparison (P < 0.001. Neither anxiety, nor depression, increased at clinically or statistically significant levels post-intervention. FACE adolescents maintained quality of life. FACE families perceived their adolescents as worsening in their school (P = 0.018 and emotional (P = 0.029 quality of life at 3 months, compared with controls.Conclusions: Participating

  16. Injection Safety and Practices following Needle Stick Injuries An Occupational Risk to Health Care Providers In Gujarat

    OpenAIRE

    Harsh D Shah, Bonny H Shah, Hiren R Solanki, Vijay R Agarwal, Priyank A Parmar , Kiran M Narkhede

    2015-01-01

    "Background: An occupational exposure to blood can result from percutaneous (needle stick or other sharps injury) and mucocutaneous injury (splash of blood or other body fluids into the eyes, nose or mouth), or blood contact with non-intact skin. Beside transmission of infectious diseases, it indirectly affects health care delivery services especially in developing countries where demand is high in compare with manpower resources. Materials and method: The study was a cross sectional...

  17. Manpower Development to Support Indian Graduate Training School Program of BARC and its Incorporation in University System

    International Nuclear Information System (INIS)

    Conclusions: • Nuclear technology is multidisciplinary, knowledge intensive, and its education and training are constrained by unusual measures demanded by the concerns about radiation and nuclear safety, physical protection of nuclear materials and facilities, and safeguards to prevent diversion of nuclear material. • This requires vast faculty resources as also extraordinary and expensive infrastructure for conducting nuclear education making the task of human resource development in nuclear science and technology a challenging one. • The human resource for the nuclear energy programme in India so far has therefore been developed in-house in the DAE. • However, large requirement of manpower to take forward the growing nuclear energy programme in the country can be met only by extending concurrently the reach of the human resource development activity in nuclear science and technology. • The DAE is therefore supporting the university system in India, and integrating the existing training program with the university system. • It may be emphasized that nuclear education, being a means of preservation and transmission of explicit knowledge, is just one component of nuclear knowledge management (NKM). • The NKM also involves creation of mechanisms to preserve and transmit implicit and tacit knowledge

  18. Momentum: "Developing Masterful Marketing Plans."

    Science.gov (United States)

    Meservey, Lynne D.

    1988-01-01

    Describes how directors can plan and develop a written marketing plan which can increase enrollment at child care centers. Components of successful marketing plans include parent retention; program merchandising; staff and director training; sales promotions; networking; and enrichment programs/fundraising. (NH)

  19. Succession planning: a long-overlooked need.

    Science.gov (United States)

    Kaminsky, R M

    1997-04-01

    As home care organizations become larger and more complex, the time has come to plan for structured succession. A successful planning process enhances organizational cohesiveness and helps ensure the continuity of cost-effective, high-quality patient care through the constant change within home care organizations.

  20. Why nursing care is missed?

    OpenAIRE

    Wiwanitkit V

    2014-01-01

    Nursing care is an important part for success of clinical therapeutics and diagnosis. The problem of nursing care can be seen elsewhere. An important consideration is on missed nursing care. The common elements of missed nursing care usually lie on these scopes: “ambulation, turning, delayed or missed feedings, patient teaching, discharge planning, emotional support, hygiene, intake and output documentation, and surveillance.”