WorldWideScience

Sample records for care observational study

  1. Effective population management practices in diabetes care - an observational study

    DEFF Research Database (Denmark)

    Frølich, Anne; Bellows, Jim; Nielsen, Bo Friis;

    2010-01-01

    Of fifteen diabetes care management practices, our data indicate that high performance is most associated with provider alerts and more weakly associated with action plans and with guideline distribution and training. Lack of convergence in the literature on effective care management practices...... suggests that factors contributing to high performance may be highly context-dependent or that the factors involved may be too numerous or their implementation too nuanced to be reliably identified in observational studies....

  2. Primary care nursing role and care coordination: an observational study of nursing work in a community health center.

    Science.gov (United States)

    Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret

    2012-05-01

    Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination. PMID:22686111

  3. How do patients with a Turkish background evaluate their medical care in Germany? An observational study in primary care

    Directory of Open Access Journals (Sweden)

    Goetz K

    2015-11-01

    Full Text Available Katja Goetz,1 Jessica Bungartz,2 Joachim Szecsenyi,1 Jost Steinhaeuser3 1Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany; 2Praxis Medizin im Zentrum, München, Germany; 3Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany Background: Patients’ evaluation of medical care is an essential dimension of quality of care and an important aspect of the feedback cycle for health care providers. The aim of this study was to document how patients with a Turkish background evaluate primary care in Germany and determine which aspects of care are associated with language abilities.Methods: The study was based on an observational design. Patients with a Turkish background from German primary care practices completed the EUROPEP (European Project on Patient Evaluation of General Practice Care questionnaire consisting of 23 items. Seventeen primary care practices were involved with either German (n=8 or Turkish (n=9 general practitioners (GPs.Results: A convenience sample of 472 patients with a Turkish background from 17 practices participated in the study (response rate 39.9%. Practices with a German GP had a lower response rate (19.6% than those with a Turkish GP (57.5%. Items evaluated the highest were “keeping data confidential” (73.4% and “quick services for urgent health problems” (69.9%. Subgroup analysis showed lower evaluation scores from patients with good or excellent German language abilities. Patients who consulted a Turkish GP had higher evaluation scores.Conclusion: The evaluation from patients with a Turkish background living in Germany with either Turkish or German GPs showed lower scores than patients in other studies in Europe using EUROPEP. However, our results had higher evaluation scores than those of Turkish patients evaluating GPs in Turkey. Therefore, different explanation models for these findings should be explored in future studies

  4. Characterisation of sleep in intensive care using 24-hour polysomnography: an observational study

    OpenAIRE

    Elliott, Rosalind; McKinley, Sharon; Cistulli, Peter; Fien, Mary

    2013-01-01

    Introduction Many intensive care patients experience sleep disruption potentially related to noise, light and treatment interventions. The purpose of this study was to characterise, in terms of quantity and quality, the sleep of intensive care patients, taking into account the impact of environmental factors. Methods This observational study was conducted in the adult ICU of a tertiary referral hospital in Australia, enrolling 57 patients. Polysomnography (PSG) was performed over a 24-hour pe...

  5. Observational studies of depression in primary care: what do we know?

    OpenAIRE

    Gunn Jane; Gilchrist Gail

    2007-01-01

    Abstract Background We undertook a systematic review of observational studies of depression in primary care to determine 1) the nature and scope of the published studies 2) the methodological quality of the studies; 3) the identified recovery and risk factors for persistent depression and 3) the treatment and health service use patterns among patients. Methods Searches were conducted in MEDLINE, CINAHL and PsycINFO using combinations of topic and keywords, and Medical Subject Headings in MEDL...

  6. Access, quality, and costs of care at physician owned hospitals in the United States: observational study

    Science.gov (United States)

    Orav, E John; Jena, Anupam B; Dudzinski, David M; Le, Sidney T; Jha, Ashish K

    2015-01-01

    Objective To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. Design Observational study. Setting Acute care hospitals in 95 hospital referral regions in the United States, 2010. Participants 2186 US acute care hospitals (219 POHs and 1967 non-POHs). Main outcome measures Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share. Results The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. Conclusion Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care. PMID:26333819

  7. Observational studies of depression in primary care: what do we know?

    Directory of Open Access Journals (Sweden)

    Gunn Jane

    2007-05-01

    Full Text Available Abstract Background We undertook a systematic review of observational studies of depression in primary care to determine 1 the nature and scope of the published studies 2 the methodological quality of the studies; 3 the identified recovery and risk factors for persistent depression and 3 the treatment and health service use patterns among patients. Methods Searches were conducted in MEDLINE, CINAHL and PsycINFO using combinations of topic and keywords, and Medical Subject Headings in MEDLINE, Headings in CINAHL and descriptors in PsycINFO. Searches were limited to adult populations and articles published in English during 1985–2006. Results 40 articles from 17 observational cohort studies were identified, most were undertaken in the US or Europe. Studies varied widely in aims and methods making it difficult to meaningfully compare the results. Methodological limitations were common including: selection bias of patients and physicians; small sample sizes (range 35–108 patients at baseline and 20–59 patients at follow-up; and short follow-up times limiting the extent to which these studies can be used to inform our understanding of recovery and relapse among primary care patients with depression. Risk factors for the persistence of depression identified in this review were: severity and chronicity of the depressive episode, the presence of suicidal thoughts, antidepressant use, poorer self-reported quality of life, lower self-reported social support, experiencing key life events, lower education level and unemployment. Conclusion Despite the growing interest in depression being managed as a chronic illness, this review identified only 17 observational studies of depression in primary care, most of which have included small sample sizes and been relatively short-term. Future research should be large enough to investigate risk factors for chronicity and relapse, and should be conducted over a longer time frame.

  8. Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies.

    Directory of Open Access Journals (Sweden)

    Concepció Violan

    Full Text Available INTRODUCTION: Multimorbidity is a major concern in primary care. Nevertheless, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. The aim of this study is to systematically review studies of the prevalence, patterns and determinants of multimorbidity in primary care. METHODS: Systematic review of literature published between 1961 and 2013 and indexed in Ovid (CINAHL, PsychINFO, Medline and Embase and Web of Knowledge. Studies were selected according to eligibility criteria of addressing prevalence, determinants, and patterns of multimorbidity and using a pretested proforma in primary care. The quality and risk of bias were assessed using STROBE criteria. Two researchers assessed the eligibility of studies for inclusion (Kappa= 0.86. RESULTS: We identified 39 eligible publications describing studies that included a total of 70,057,611 patients in 12 countries. The number of health conditions analysed per study ranged from 5 to 335, with multimorbidity prevalence ranging from 12.9% to 95.1%. All studies observed a significant positive association between multimorbidity and age (odds ratio [OR], 1.26 to 227.46, and lower socioeconomic status (OR, 1.20 to 1.91. Positive associations with female gender and mental disorders were also observed. The most frequent patterns of multimorbidity included osteoarthritis together with cardiovascular and/or metabolic conditions. CONCLUSIONS: Well-established determinants of multimorbidity include age, lower socioeconomic status and gender. The most prevalent conditions shape the patterns of multimorbidity. However, the limitations of the current evidence base means that further and better designed studies are needed to inform policy, research and clinical practice, with the goal of improving health-related quality of life for patients with multimorbidity. Standardization of the definition and assessment of multimorbidity is essential in order to better understand this

  9. Podiatric care for diabetic patients with foot problems: an observational study.

    NARCIS (Netherlands)

    Rijken, P.M.; Dekker, J.; Lankhorst, G.J.; Dekker, E.; Bakker, K.; Dooren, J.; Rauwerda, J.A.

    1999-01-01

    The aims of this study were to describe podiatric care for diabetic patients with foot problems and to explore the changes in knowledge, self-care behaviour and physical functioning after podiatric care. the treatment characteristics of 26 diabetic patients referred to podiatry were assessed. Prior

  10. Translation of clinical prediction rules for febrile children to primary care practice: an observational cohort study

    Science.gov (United States)

    van Ierland, Yvette; Elshout, Gijs; Berger, Marjolein Y; Vergouwe, Yvonne; de Wilde, Marcel; van der Lei, Johan; Mol, Henriëtte A; Oostenbrink, Rianne

    2015-01-01

    Background Clinical prediction rules (CPRs) to identify children with serious infections lack validation in low-prevalence populations, which hampers their implementation in primary care practice. Aim To evaluate the diagnostic value of published CPRs for febrile children in primary care. Design and setting Observational cohort study among febrile children (<16 years) who consulted five GP cooperatives (GPCs) in the Netherlands. Method Alarm signs of serious infection and clinical management were extracted from routine clinical practice data and manually recoded with a structured electronic data-entry program. Eight CPRs were selected from literature. CPR-variables were matched with alarm signs and CPRs were applied to the GPC-population. ‘Referral to emergency department (ED)’ was used as a proxy outcome measure for ‘serious infection’. CPR performance was assessed by calibration analyses, sensitivity, specificity, and area under the ROC-curve (ROC-area). Results A total of 9794 GPC-contacts were eligible, 54% male, median age 2.3 years (interquartile range 1.0–4.6 years) and 8.1% referred to ED. Frequencies of CPR-variables varied from 0.5% (cyanosis, drowsy) to 25% (temperature ≥40°C). Alarm signs frequently included in CPRs were ‘ill appearance’, ‘inconsolable’, and ‘abnormal circulatory or respiratory signs’. The height of the CPR’s predicted risks generally corresponded with being (or not being) referred to the ED in practice. However, calibration-slopes indicated that three CPRs underestimated the risk of serious infection in the GPC-population. Sensitivities ranged from 42% to 54%, specificities from 68% to 89%. ROC-areas ranged from 0.52 to 0.81, with best performance of CPRs for children aged <3 months. Conclusion Published CPRs performed moderately well in the primary out-of-hours care population. Advice is given on how to improve translation of CPRs to primary care practice. PMID:25824182

  11. Prospective and observational study of antimicrobial drug utilization in medical intensive care unit in a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Drupad HS

    2016-01-01

    Full Text Available Objectives: 1 The objective of this study was to assess the prescribing patterns of anti-microbial drugs. 2 Rationality of drug use in the medical ICU of a tertiary care hospital.Materials and Methods: After taking approval from the Institutional ethical committee, study was undertaken over a period of 6 months. A prospective observational study was conducted to assess the prescription pattern of antibiotic usage in the medical ICU. Standard Proforma was used to collect the information regarding antibiotics, its dose, duration, first line of antibiotics and second line of antibiotics and adverse drug reactions. Data was analysed using descriptive statistics with help of SPSS software.Results: Total 202 cases were admitted to the ICU during study period. Respiratory conditions (33.2%, febrile illness (15.3%, poisoning (15.3% and CNS (12.9% illnesses were commonly reported to ICU. Cephalosporins (81.7% were commonly prescribed followed by Nitroimidazoles (30.2% and Penicillin (16.3%. Ceftriaxone (43.1% and cefixime (38.6% were commonly used followed by Pipercillin + Tazobactum combination (9.4%. No adverse reactions were reported during the study period.Conclusion: In conclusion, a wide spectrum of clinical diagnoses and a variety of drugs were utilized from various drug classes. Results showed that Cephalosporins were extensively used in ICU. The number of drugs prescribed by generic names was low in the ICU and effort must be made to encourage prescribing by generic names. Rational usage of antimicrobial agents in ICU should be encouraged by following strict Hospital antimicrobial policy.

  12. The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly

    DEFF Research Database (Denmark)

    Sprung, Charles L; Artigas, Antonio; Kesecioglu, Jozef;

    2012-01-01

    RATIONALE:: Life and death triage decisions are made daily by intensive care unit physicians. Admission to an intensive care unit is denied when intensive care unit resources are constrained, especially for the elderly. OBJECTIVE:: To determine the effect of intensive care unit triage decisions on...... mortality and intensive care unit benefit, specifically for elderly patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with an explicit request for...... accepted to the intensive care unit, 1,194 (18%) rejected; 3,795 (49%) were =65 yrs. Refusal rate increased with increasing patient age (18-44: 11%; 45-64: 15%; 65-74: 18%; 75-84: 23%; >84: 36%). Mortality was higher for older patients (18-44: 11%; 45-64: 21%; 65-74: 29%; 75-84: 37%; >84: 48%). Differences...

  13. Health Care Consumption during Pregnancy in relation to Maternal Body Mass Index : A Swedish Population Based Observational Study

    OpenAIRE

    Lindholm, Elisabeth S.; Daniel Altman; Margareta Norman; Marie Blomberg

    2015-01-01

    Objective. To assess whether antenatal health care consumption is associated with maternal body mass index (BMI). Design. A register based observational study. Methods. The Swedish Medical Birth Register, the Maternal Health Care Register, and the Inpatient Register were used to determine antenatal health care consumption according to BMI categories for primiparous women with singleton pregnancies, from 2006 to 2008, n = 71,638. Pairwise comparisons among BMI groups are obtained post hoc by T...

  14. Injury mortality and accessibility to emergency care in Japan: an observational epidemiological study

    Science.gov (United States)

    Nakamura, Takashi; Okayama, Masanobu; Aihara, Masakazu; Kajii, Eiji

    2014-01-01

    Background Unintentional injury is a major cause of death across the globe. The accessibility to emergency medical services may affect the rate of preventable trauma deaths. The purpose of this study was to analyze the accessibility to emergency medical hospitals in municipalities in Japan and to clarify whether accessibility was associated with the mortality rate attributed to unintentional injuries. Methods An observational epidemiological study was conducted in all 1,742 municipalities in Japan. Measurements assessed were population size, accessibility to emergency hospitals, and mortality rates attributed to unintentional injuries. Accessibility of each municipality to their nearest emergency hospital was calculated with a computer simulation using a geographic information system. After calculating demographic statistics and the Gini coefficient of accessibility, multivariate analyses were used to examine the correlation between accessibility time and mortality. Municipalities were divided into six groups according to accessibility time, and we then performed a correlation analysis between accessibility time and mortality using analysis of covariance. Results The median time of accessibility to emergency hospitals was 34.5 minutes. The Gini coefficient of accessibility time was 0.410. A total of 385 municipalities (23.4%) had an accessibility time of over 60 minutes. Accessibility was significantly related to mortality (beta coefficient =0.006; P30 minutes, and the mortality rate in municipalities with an accessibility time of 30–45 minutes was lower than that in municipalities with an accessibility time of 60–90 minutes (P<0.001). Conclusion The geographical disparities for emergency care accessibility were related to the rate of death by unintentional injury. Improving accessibility to emergency hospitals could help decrease the mortality rate of preventable trauma. Meanwhile, our findings suggest the need for substantially shorter accessibility times to

  15. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

    OpenAIRE

    Bencsik Gabor; Marjanek Zsuzsanna; Gartner Bela; Kocsi Szilvia; Paloczi Balazs; Antek Csaba (1967-) (aneszteziológus); Medve Laszlo; Kanizsai Peter; Gondos Tibor

    2011-01-01

    Abstract Background Despite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI) continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs) in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clini...

  16. Evaluation of hospital-wide computerised decision support in an intensive care unit: an observational study.

    Science.gov (United States)

    Santucci, W; Day, R O; Baysari, M T

    2016-07-01

    We conducted an observational study with interviews in a 12-bed general/neurological intensive care unit (ICU) at a teaching hospital in Sydney, Australia, to determine whether hospital-wide computerised decision support (CDS) embedded in an electronic prescribing system is used and perceived as useful by doctors in an ICU setting. Twenty doctors were shadowed by the observer while on ward rounds (33.6 hours) and non-ward rounds (28 hours) in the ICU. These doctors were also interviewed to explore views of CDS. We found that computerised alerts were triggered frequently in the ICU (n=166, in 59% of orders), less than half of the alerts were read by doctors and only four alerts resulted in a medication order being changed. Pre-written orders were utilised frequently, however reference material was rarely accessed. Interviews with doctors revealed a willingness to use CDS features; however the primary barrier to use was lack of customisation for the ICU setting. Doctors working in the ICU triggered a high number of alerts when prescribing, 40% more alerts than doctors working on general wards of the same hospital. Certain procedures in place in the ICU (e.g. daily microbiology ward rounds) made many alerts redundant in this setting. Lack of customisation for the ICU led to dissatisfaction with CDS and infrequent use of some CDS features. PMID:27456183

  17. The Eldicus prospective, observational study of triage decision making in European intensive care units: Part I-European Intensive Care Admission Triage Scores (EICATS)

    DEFF Research Database (Denmark)

    Sprung, Charles L; Baras, Mario; Iapichino, Gaetano;

    2012-01-01

    OBJECTIVE:: Life and death triage decisions are made daily by intensive care unit physicians. Scoring systems have been developed for prognosticating intensive care unit mortality but none for intensive care unit triage. The objective of this study was to develop an intensive care unit triage...... decision rule based on 28-day mortality rates of admitted and refused patients. DESIGN:: Prospective, observational study of triage decisions from September 2003 until March 2005. SETTING:: Eleven intensive care units in seven European countries. PATIENTS:: All patients >18 yrs with a request for intensive...... score. Cutoff values for 99.5% specificity were determined. Of 6796 patients, 5602 were admitted and 1194 rejected. The initial refusal score included age, diagnosis, systolic blood pressure, pulse, respirations, creatinine, bilirubin, PaO2, bicarbonate, albumin, use of vasopressors, Glasgow Coma Scale...

  18. Nursing Team Leader handover in the intensive care unit contains diverse information and lacks structure: An observational study

    OpenAIRE

    Spooner, A. J.; Aitken, L. M.; Corley, A.; Fraser, J. F.; Chaboyer, W.

    2016-01-01

    Background: Despite a proliferation of evidence and the development of standardised tools to improve communication at handover, evidence to guide the handover of critical patient information between nursing team leaders in the intensive care unit is limited. Objective: The study aim was to determine the content of information handed over during intensive care nursing team leader shift-to-shift handover. Design: A prospective observational study. Setting: A 21-bed medical/s...

  19. Temporal Artery versus Bladder Thermometry during Adult Medical-Surgical Intensive Care Monitoring: An Observational Study

    OpenAIRE

    Stelfox Henry T; Straus Sharon E; Ghali William A; Conly John; Laupland Kevin; Lewin Adriane

    2010-01-01

    Abstract Background We sought to evaluate agreement between a new and widely implemented method of temperature measurement in critical care, temporal artery thermometry and an established method of core temperature measurement, bladder thermometry as performed in clinical practice. Methods Temperatures were simultaneously recorded hourly (n = 736 observations) using both devices as part of routine clinical monitoring in 14 critically ill adult patients with temperatures ranging ≥1°C prior to ...

  20. Patient satisfaction and side effects in primary care: An observational study comparing homeopathy and conventional medicine

    Directory of Open Access Journals (Sweden)

    Thurneysen André

    2008-09-01

    Full Text Available Abstract Background This study is part of a nationwide evaluation of complementary medicine in Switzerland (Programme Evaluation of Complementary Medicine PEK and was funded by the Swiss Federal Office of Public Health. The main objective of this study is to investigate patient satisfaction and perception of side effects in homeopathy compared with conventional care in a primary care setting. Methods We examined data from two cross-sectional studies conducted in 2002–2003. The first study was a physician questionnaire assessing structural characteristics of practices. The second study was conducted on four given days during a 12-month period in 2002/2003 using a physician and patient questionnaire at consultation and a patient questionnaire mailed to the patient one month later (including Europep questionnaire. The participating physicians were all trained and licensed in conventional medicine. An additional qualification was required for medical doctors providing homeopathy (membership in the Swiss association of homeopathic physicians SVHA. Results A total of 6778 adult patients received the questionnaire and 3126 responded (46.1%. Statistically significant differences were found with respect to health status (higher percentage of chronic and severe conditions in the homeopathic group, perception of side effects (higher percentage of reported side effects in the conventional group and patient satisfaction (higher percentage of satisfied patients in the homeopathic group. Conclusion Overall patient satisfaction was significantly higher in homeopathic than in conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to three times fewer side effects than conventional care

  1. Retention in Care of Adult HIV Patients Initiating Antiretroviral Therapy in Tigray, Ethiopia: A Prospective Observational Cohort Study

    OpenAIRE

    Bucciardini, Raffaella; Fragola, Vincenzo; Abegaz, Teshome; Lucattini, Stefano; Halifom, Atakilt; Tadesse, Eskedar; Berhe, Micheal; Pugliese, Katherina; Binelli, Andrea; De Castro, Paola; Terlizzi, Roberta; Fucili, Luca; Di Gregorio, Massimiliano; Mirra, Marco; Olivieri, Erika

    2015-01-01

    Introduction Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia. Methods We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) loc...

  2. Continuing professional development for volunteers working in palliative care in a tertiary care cancer institute in India: A cross-sectional observational study of educational needs

    Directory of Open Access Journals (Sweden)

    Jayita Kedar Deodhar

    2015-01-01

    Full Text Available Context: Training programs for volunteers prior to their working in palliative care are well-established in India. However, few studies report on continuing professional development programs for this group. Aims: To conduct a preliminary assessment of educational needs of volunteers working in palliative care for developing a structured formal continuing professional development program for this group. Settings and Design: Cross-sectional observational study conducted in the Department of Palliative Medicine of a tertiary care cancer institute in India. Materials and Methods: Participant volunteers completed a questionnaire, noting previous training, years of experience, and a comprehensive list of topics for inclusion in this program, rated in order of importance according to them. Statistical Analysis Used: Descriptive statistics for overall data and Chi-square tests for categorical variables for group comparisons were applied using Statistical Package for Social Sciences version 18. Results: Fourteen out of 17 volunteers completed the questionnaire, seven having 5-10-years experience in working in palliative care. A need for continuing professional development program was felt by all participants. Communication skills, more for children and elderly specific issues were given highest priority. Spiritual-existential aspects and self-care were rated lower in importance than psychological, physical, and social aspects in palliative care. More experienced volunteers (>5 years of experience felt the need for self-care as a topic in the program than those with less (<5-years experience ( P < 0.05. Conclusions: Understanding palliative care volunteers′ educational needs is essential for developing a structured formal continuing professional development program and should include self-care as a significant component.

  3. Drug utilization pattern in acute coronary syndrome at tertiary care hospital: a prospective cross-sectional observational study

    OpenAIRE

    Praveen Choudhary; Jitendra M. Agrawal; Malhotra, Supriya D.; Varsha J.

    2016-01-01

    Background: To study the pattern of utilization of drug in the patients of Acute Coronary Syndrome at tertiary care hospital. Methods: Prospective cross-sectional observational drug utilization study was conducted in patients of acute coronary syndrome admitted in ICCU, for the period of two months. Data was collected in preformed Case record form. Analysis was done by using drug use indicators, demographic pattern, morbidity pattern of disease, pattern of drug use. Data analysed using Mic...

  4. Epidemiology of acute kidney injury in Hungarian intensive care units: a multicenter, prospective, observational study

    Directory of Open Access Journals (Sweden)

    Bencsik Gabor

    2011-09-01

    Full Text Available Abstract Background Despite the substantial progress in the quality of critical care, the incidence and mortality of acute kidney injury (AKI continues to rise during hospital admissions. We conducted a national, multicenter, prospective, epidemiological survey to evaluate the importance of AKI in intensive care units (ICUs in Hungary. The objectives of this study were to determine the incidence of AKI in ICU patients; to characterize the differences in aetiology, illness severity and clinical practice; and to determine the influencing factors of the development of AKI and the patients' outcomes. Methods We analysed the demographic, morbidity, treatment modality and outcome data of patients (n = 459 admitted to ICUs between October 1st, 2009 and November 30th, 2009 using a prospectively filled in electronic survey form in 7 representative ICUs. Results The major reason for ICU admission was surgical in 64.3% of patients and medical in the remaining 35.7%. One-hundred-twelve patients (24.4% had AKI. By AKIN criteria 11.5% had Stage 1, 5.4% had Stage 2 and 7.4% had Stage 3. In 44.0% of patients, AKI was associated with septic shock. Vasopressor treatment, SAPS II score, serum creatinine on ICU admission and sepsis were the independent risk factors for development of any stage of AKI. Among the Stage 3 patients (34 50% received renal replacement therapy. The overall utilization of intermittent renal replacement therapy was high (64.8%. The overall in-hospital mortality rate of AKI was 49% (55/112. The ICU mortality rate was 39.3% (44/112. The independent risk factors for ICU mortality were age, mechanical ventilation, SOFA score and AKI Stage 3. Conclusions For the first time we have established the incidence of AKI using the AKIN criteria in Hungarian ICUs. Results of the present study confirm that AKI has a high incidence and is associated with high ICU and in-hospital mortality.

  5. Temporal Artery versus Bladder Thermometry during Adult Medical-Surgical Intensive Care Monitoring: An Observational Study

    Directory of Open Access Journals (Sweden)

    Stelfox Henry T

    2010-08-01

    Full Text Available Abstract Background We sought to evaluate agreement between a new and widely implemented method of temperature measurement in critical care, temporal artery thermometry and an established method of core temperature measurement, bladder thermometry as performed in clinical practice. Methods Temperatures were simultaneously recorded hourly (n = 736 observations using both devices as part of routine clinical monitoring in 14 critically ill adult patients with temperatures ranging ≥1°C prior to consent. Results The mean difference between temporal artery and bladder temperatures measured was -0.44°C (95% confidence interval, -0.47°C to -0.41°C, with temporal artery readings lower than bladder temperatures. Agreement between the two devices was greatest for normothermia (36.0°C to Conclusions Temporal artery thermometry produces somewhat surprising disagreement with an established method of core temperature measurement and should not to be used in situations where body temperature needs to be measured with accuracy.

  6. Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study.

    NARCIS (Netherlands)

    Dillen, S.M.E. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.

    2015-01-01

    Background/objective: To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs’ compliance with the Five A’s Model for behavioral counseling in primary care, and the use of different communication styles.

  7. Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study

    NARCIS (Netherlands)

    Dillen, S.M. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.

    2015-01-01

    BACKGROUND/OBJECTIVE: To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs' compliance with the Five A's Model for behavioral counseling in primary care, and the use of different communication styles.

  8. FALCIPARUM MALARIA – IT’S VARIED PRESENTATION : AN OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Prabhu

    2015-08-01

    Full Text Available Today we are witnessing a change in the scenario of Malaria in India with respect to increase in the incidence of falciparum malaria, drug resistant strains and some vivax presentations changing from benign to malignant type. With varied mani festations falciparum malaria forms a DD to all acute febrile illness especially in endemic areas. With 70 - 100 million cases annually, India is becoming the capital for all malarial problems of the world. AIM OF THE STUDY: To study the varied presentation of confirmed falciparum malaria patients and their treatment out come at a tertiary care hospital. MATERIALS AND METHODS: This is a hospital based cross sectional study for three years – from 01 Jan . 2011 to 31 Dec . 2013 based on the hospital records (C ase sheets with demographic profile, C linical features, I nvestigations & treatment outcomes . RESULTS: 72 patients confirmed by blood smear examination were included in the study. Majority were males (66.66% and belonged to the age group of 21 - 50 years (72.22% and majority were admitted in post - monsoon months (66.66%. 77.77% of patients were referred from various centers and 27.77% with complications. Only 55.55% had classical fever and chills and 35.7% had host of atypical manifestations with 19.64% of patients presented to various departments. All the patients were treated mainly with Artemisinin group (ACT and 89.28% patients recovered in 7 - 21 days. The mortality was 12.5%. CONCLUSION: The present study explains the importance of knowing the diverse mode of presentation of falciparum malaria. Early diagnosis, early referral and early initiation of ACT will decrease the mortality and morbidity.

  9. Etiological spectrum of recurrent jaundice in adults: A retrospective observational study from a tertiary care center

    Directory of Open Access Journals (Sweden)

    Gouranga Santra

    2016-01-01

    Full Text Available Introduction: Studies regarding etiological spectrum of recurrent jaundice are rare. We conducted this study to identify the causes of recurrent jaundice in a tertiary care center. Materials and Methods: Frequency of different causes of recurrent jaundice was assessed from 130 patients attended General Medicine Department over a period of 3 years. Recurrent jaundice was considered when patients had more than one episodes of jaundice with serum bilirubin ≥3 mg/dl since childhood. Recurrent jaundice was diagnosed from past medical records, records of follow-up visits, and current clinical presentation. Causes were identified from past and present medical records of history, clinical and laboratory examinations. Results: Causes of recurrent jaundice included prehepatic (30%, hepatic (59.23%, and posthepatic (10.77 % disorders. Prehepatic disorders were Gilbert′s syndrome (GS, megaloblastic anemia, autoimmune haemolytic anemia, Wilson′s disease, G6PD deficiency, etc. Hepatic disorders were exacerbations of alcoholic hepatitis, hepatitis B and C, autoimmune hepatitis, congestive cardiac failure, sarcoidosis, benign recurrent intrahepatic cholestasis, eclampsia, pregnancy induced cholestasis, falciparum malaria, drug induced liver injury (DILI, etc. Posthepatic causes were choledocholithiasis, recurrent pancreatitis, periampullary carcinoma, choledochal cyst, ascariasis, hemobilia, HIV cholangiopathy, autoimmune pancreatitis, etc. Prehepatic jaundice cases were younger. The highest level of total bilirubin was seen in alcoholic hepatitis, DILI, and hepatitis B. Alcoholic hepatitis was the most common cause of recurrent jaundice (19.23%. GS was the most common prehepatic cause. Mean age was lowest in GS and highest in DILI. Conclusion: Etiological spectrum of recurrent jaundice includes many prehepatic, hepatic or posthepatic disorders. A larger study may enlarge the spectrum.

  10. Time standards of nursing in Primary Health Care: an observational study.

    Science.gov (United States)

    Bonfim, Daiana; Fugulin, Fernanda Maria Togeiro; Laus, Ana Maria; Peduzzi, Marina; Gaidzinski, Raquel Rapone

    2016-02-01

    OBJECTIVE To determine time standards for interventions and activities conducted by nursing professionals in Family Health Units (FHU) in Brazil to substantiate the calculation of work force. METHOD This was an observational study carried out in 27 FHU, in 12 municipalities in 10 states, in 2013. In each unit, nursing professionals were observed every 10 minutes, for eight work hours, on five consecutive days via the work sampling technique. RESULTS A total of 32,613 observations were made, involving 47 nurses and 93 nursing technicians/assistants. Appointments were the main intervention carried out by nurses, with a mean time of 25.3 minutes, followed by record-keeping, which corresponded to 9.7%. On average, nursing technicians/assistants spent 6.3% of their time keeping records and 30.6 intervention minutes on immunization/vaccination control. CONCLUSION The study resulted in standard times of interventions carried out by the FHU nursing team, which can underpin the determination of nursing staff size and human resource policies. Furthermore, the study showed the panorama of interventions currently employed, allowing for the work process to be reviewed and optimized. PMID:27007429

  11. Time standards of nursing in Primary Health Care: an observational study

    Directory of Open Access Journals (Sweden)

    Daiana Bonfim

    2016-02-01

    Full Text Available Abstract OBJECTIVE To determine time standards for interventions and activities conducted by nursing professionals in Family Health Units (FHU in Brazil to substantiate the calculation of work force. METHOD This was an observational study carried out in 27 FHU, in 12 municipalities in 10 states, in 2013. In each unit, nursing professionals were observed every 10 minutes, for eight work hours, on five consecutive days via the work sampling technique. RESULTS A total of 32,613 observations were made, involving 47 nurses and 93 nursing technicians/assistants. Appointments were the main intervention carried out by nurses, with a mean time of 25.3 minutes, followed by record-keeping, which corresponded to 9.7%. On average, nursing technicians/assistants spent 6.3% of their time keeping records and 30.6 intervention minutes on immunization/vaccination control. CONCLUSION The study resulted in standard times of interventions carried out by the FHU nursing team, which can underpin the determination of nursing staff size and human resource policies. Furthermore, the study showed the panorama of interventions currently employed, allowing for the work process to be reviewed and optimized.

  12. Predictors for Delayed Emergency Department Care in Medical Patients with Acute Infections – An International Prospective Observational Study

    Science.gov (United States)

    Hausfater, Pierre; Amin, Devendra; Amin, Adina; Haubitz, Sebastian; Conca, Antoinette; Reutlinger, Barbara; Canavaggio, Pauline; Sauvin, Gabrielle; Bernard, Maguy; Huber, Andreas; Mueller, Beat; Schuetz, Philipp

    2016-01-01

    Introduction In overcrowded emergency department (ED) care, short time to start effective antibiotic treatment has been evidenced to improve infection-related clinical outcomes. Our objective was to study factors associated with delays in initial ED care within an international prospective medical ED patient population presenting with acute infections. Methods We report data from an international prospective observational cohort study including patients with a main diagnosis of infection from three tertiary care hospitals in Switzerland, France and the United States (US). We studied predictors for delays in starting antibiotic treatment by using multivariate regression analyses. Results Overall, 544 medical ED patients with a main diagnosis of acute infection and antibiotic treatment were included, mainly pneumonia (n = 218; 40.1%), urinary tract (n = 141; 25.9%), and gastrointestinal infections (n = 58; 10.7%). The overall median time to start antibiotic therapy was 214 minutes (95% CI: 199, 228), with a median length of ED stay (ED LOS) of 322 minutes (95% CI: 308, 335). We found large variations of time to start antibiotic treatment depending on hospital centre and type of infection. The diagnosis of a gastrointestinal infection was the most significant predictor for delay in antibiotic treatment (+119 minutes compared to patients with pneumonia; 95% CI: 58, 181; p<0.001). Conclusions We found high variations in hospital ED performance in regard to start antibiotic treatment. The implementation of measures to reduce treatment times has the potential to improve patient care. PMID:27171476

  13. Immigrants’ use of emergency primary health care in Norway: a registry-based observational study

    Directory of Open Access Journals (Sweden)

    Sandvik Hogne

    2012-09-01

    Full Text Available Abstract Background Emigrants are often a selected sample and in good health, but migration can have deleterious effects on health. Many immigrant groups report poor health and increased use of health services, and it is often claimed that they tend to use emergency primary health care (EPHC services for non-urgent purposes. The aim of the present study was to analyse immigrants’ use of EPHC, and to analyse variations according to country of origin, reason for immigration, and length of stay in Norway. Methods We conducted a registry based study of all immigrants to Norway, and a subsample of immigrants from Poland, Germany, Iraq and Somalia, and compared them with native Norwegians. The material comprised all electronic compensation claims for EPHC in Norway during 2008. We calculated total contact rates, contact rates for selected diagnostic groups and for services given during consultations. Adjustments for a series of socio-demographic and socio-economic variables were done by multiple logistic regression analyses. Results Immigrants as a whole had a lower contact rate than native Norwegians (23.7% versus 27.4%. Total contact rates for Polish and German immigrants (mostly work immigrants were 11.9% and 7.0%, but for Somalis and Iraqis (mostly asylum seekers 31.8% and 33.6%. Half of all contacts for Somalis and Iraqis were for non-specific pain, and they had relatively more of their contacts during night than other groups. Immigrants’ rates of psychiatric diagnoses were low, but increased with length of stay in Norway. Work immigrants suffered less from respiratory and gastrointestinal infections, but had more injuries and higher need for sickness certification. All immigrant groups, except Germans, were more often given a sickness certificate than native Norwegians. Use of interpreter was reduced with increasing length of stay. All immigrant groups had an increased need for long consultations, while laboratory tests were most often used

  14. Rapidly increasing use of proton pump inhibitors prescribed in primary care: a nationwide observational study

    DEFF Research Database (Denmark)

    Haastrup, Peter; Jarbøl, Dorte Ejg; Hansen, Jane Møller

    not been a change in indications for use of PPIs in the same time range. Use of ulcerogenic drugs among the elderly has stagnated. Reimbursement modifications do not seem to have had a substantial influence on the steadily increasing use of PPIs. Conclusions: Use of PPIs has increased substantially...... covering the entire Danish population of currently 5.5 million inhabitants. The register was searched September 2012 for the ADs proton-pump inhibitors (PPIs) and histamine-2-receptor antagonists. The variables turnover, paid reimbursement, volume sold, sector (primary vs. hospital), age, gender and number...... prophylaxis could be an indication for prescribing ADs to that age group. Results: PPIs are the far most commonly prescribed AD and 96.5 % are prescribed in primary care. Use of PPIs has increased by 243 % through the past decade. Both number of users and the average individual use has increased. There has...

  15. Professional quality of life and organizational changes: a five-year observational study in Primary Care

    Directory of Open Access Journals (Sweden)

    Cortes-Rubio Jose

    2007-07-01

    Full Text Available Abstract Background The satisfaction and the quality of life perceived by professionals have implications for the performance of health organizations. We have assessed the variations in professional quality of life (PQL and their explanatory factors during a services management decentralization process. Methods It was designed as a longitudinal analytical observational study in a Health Area in Madrid, Spain. Three surveys were sent out during an ongoing management decentralization process between 2001 and 2005. The professionals surveyed were divided into three groups: Group I (97.3% physicians, group II (92.5% nurses and group III (auxiliary personnel. Analysis of the tendency and elaboration of an explanatory multivariate model was made. The PQL -35 questionnaire, based on Karasek's demand-control theory, was used to measure PQL. This questionnaire recognizes three PQL dimensions: management support (MS, workload (WL and intrinsic motivation (IM. Results 1444 responses were analyzed. PQL increased 0.16 (CI 95% 0.04 – 0.28 points in each survey. Group II presents over time a higher PQL score than group I of 0.38 (IC 95% 0.18 – 0.59 points. There is no difference between groups I and III. For each point that MS increases, PQL increases between 0.44 and 0.59 points. PQL decreases an average of between 0.35 and 0.49 point, for each point that WL increases. Age appears to have a marginal association with PQL (CI 95% 0.00 – 0.02, as it occurs with being single or not having a stable relationship (CI 95% 0.01 – 0.41. Performing management tasks currently or in the past is related to poorer PQL perception (CI 95% -0.45 – -0.06, and the same occurs with working other than morning shifts (CI 95% -0.03 – -0.40 points. PQL is not related to sex, location of the centre (rural/urban, time spent working in the organization or contractual situation. Conclusion With the improvement in work control and avoiding increases in workloads, PQL

  16. Assessment and Availability of Trauma Care Services in a District Hospital of South India; A Field Observational Study

    OpenAIRE

    Pallavi Sarji Uthkarsh; Gopalkrishna Gururaj; Sai Sabharish Reddy; Mandya Siddalingaiah Rajanna

    2016-01-01

    Objective: To assess the availability of trauma care services in a district referral hospital of Southern India. Methods: This was a cross-sectional study being performed during 2013 in a tertiary healthcare centre in Southern Indian. A detailed assessment of trauma care services was done in a 400 bed speciality hospital which is an apex referral hospital in the public health system using a check list based on WHO guidelines for evaluation of essential trauma care services, along with in-d...

  17. European Practice Assessment of Cardiovascular risk management (EPA Cardio: protocol of an international observational study in primary care

    Directory of Open Access Journals (Sweden)

    van Lieshout Jan

    2009-01-01

    Full Text Available Abstract Background Despite important improvements in available prevention and treatment, cardiovascular diseases (CVD remain an important cause of morbidity and mortality. Not all high-risk patients and patients with CVD have healthy lifestyles and receive the best possible healthcare. Internationally comparative data are needed to compare cardiovascular risk management in different countries, and to examine the impact of improvement programs and others factors. Objectives This study aims to provide internationally comparative data on cardiovascular risk management provided in primary care and on health-related lifestyles of patients in Europe. The study will also explore the views of doctors and patients on innovative preventive services for CVDs. Design and methods An observational cross-sectional study is planned. In 10 European countries, stratified samples of 36 practices per country will be recruited. In each practice, three samples of 15 patients each will be sampled: patients with coronary heart disease, patients at high risk for CVD, and healthy adult patients. The quality of cardiovascular risk management has been specified in terms of 44 performance indicators that resulted from an international Delphi-procedure with general practitioners. Most indicators are based on medical records, and some on a structured interview with a contact person of the practice. Lifestyle (smoking, physical exercise, diet will be measured with previously validated questionnaires that are completed by patients. Additional measures include practice characteristics and exposure to programs to improve cardiovascular care.

  18. Observational study in primary health care: Symptoms control of gastroesophageal reflux disease and influence on the quality of life

    Directory of Open Access Journals (Sweden)

    Krstić Miodrag

    2013-01-01

    Full Text Available Introduction. Gastroesophageal reflux disease (GERD is a common disease in primary care. The most effective medicamentous treatment is proton pump inhibitors (PPI. Objective. Observational study conducted in 13 primary health care centers from the whole Serbia with the aim to collect local epidemiology data on GERD and to investigate the intensity and frequency of disease symptoms and the quality of life of patients treated with proton pump inhibitors by using a Patient’s Questionnaire. Methods. Adult GERD patients treated with PPI were under follow-up for two months. The investigators evaluated typical symptoms and gave global assessment of disease severity. The patients filled-in the Patient’s Questionnaire on disease symptoms and quality of life. At the study end, the investigators evaluated the importance of the Patient’s Questionnaire in the management of these patients. Results. The study included 828 patients (66.3% female of mean age 54.8 years. The most common life habits were coffee consumption (86.1%, exposure to stress (81.7%, smoking (45.7% and alcohol consumption (25%. With PPI therapy a statistically significant reduction of typical GERD symptoms of any intensity was detected as evaluated by the investigators (p<0,001, as well as the reduction in the frequency of all symptoms and accompanying discomforts of the quality of life, as estimated by the patients (p<0.001. In 92.2% of the patients the investigators evaluated the Patient’s Questionnaire to be of significant help. Conclusion. Primary health care physicians evaluated the Patient’s Questionnaire as an important tool in the investigation of the disease symptoms and the quality of life of patients with GERD. The intensity and frequency of symptoms were reduced, and the quality of life of patients with GERD was improved by therapy with PPI.

  19. An open model cross sectional observational study of hyponatremic patients in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Harsha Gopinath

    2016-03-01

    Conclusions: In the present study, hypertension was found a major risk factor for hyponatremia. Common causes of hyponatremia found are intake of diuretics and excessive renal loss. Most of the hypertensive patients in the present study group were on thiazide or potassium sparing diuretics. Diabetes mellitus and dyslipidemia were important co-morbidities of hyponatremia. [Int J Res Med Sci 2016; 4(3.000: 713-717

  20. Maternal near miss events: a prospective observational study in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Gazala Yasmin

    2016-09-01

    Conclusions: This study concludes hemorrhage and hypertensive disorders to be the leading causes for maternal near miss. Hence evaluation of the circumstances surrounding near-miss can give us an idea to know the exact etiology, treat it in its early stage and prevent death. [Int J Reprod Contracept Obstet Gynecol 2016; 5(9.000: 3088-3093

  1. Assessing the Use of Mobile Health Technology by Patients: An Observational Study in Primary Care Clinics

    OpenAIRE

    Ramirez, Veronica; Johnson, Emily; Gonzalez, Cesar; Ramirez, Vanessa; Rubino, Barbara; Rossetti, Gina

    2016-01-01

    Background There is significant potential for mobile health technology to improve health outcomes for patients with chronic diseases. However, there is a need for further development of mobile health technology that would help to improve the health of lower-income communities. Objective The study objective was to assess mobile phone and app usage among a culturally diverse patient population, and to determine whether patients would be interested in using mobile health technology to help manag...

  2. Testing initiatives increase rates of HIV diagnosis in primary care and community settings: an observational single-centre cohort study.

    Directory of Open Access Journals (Sweden)

    Prini Mahendran

    Full Text Available The primary objective was to examine trends in new HIV diagnoses in a UK area of high HIV prevalence between 2000 and 2012 with respect to site of diagnosis and stage of HIV infection.Single-centre observational cohort study.An outpatient HIV department in a secondary care UK hospital.1359 HIV-infected adults.Demographic information (age, gender, ethnicity, and sexual orientation, site of initial HIV diagnosis (Routine settings such as HIV/GUM clinics versus Non-Routine settings such as primary care and community venues, stage of HIV infection, CD4 count and seroconversion symptoms were collated for each participant.There was a significant increase in the proportion of new HIV diagnoses made in Non-Routine settings (from 27.0% in 2000 to 58.8% in 2012; p<0.001. Overall there was a decrease in the rate of late diagnosis from 50.7% to 32.9% (p=0.001. Diagnosis of recent infection increased from 23.0% to 47.1% (p=0.001. Of those with recent infection, significantly more patients were likely to report symptoms consistent with a seroconversion illness over the 13 years (17.6% to 65.0%; p<0.001.This is the first study, we believe, to demonstrate significant improvements in HIV diagnosis and a shift in diagnosis of HIV from HIV/GUM settings to primary practice and community settings due to multiple initiatives.

  3. Study protocol—investigation of the Delirium Observation Screening Scale (DOSS) for the routine detection of delirium in the care home setting: a prospective cohort study

    Science.gov (United States)

    Teale, Elizabeth; Young, John; Siddiqi, Najma; Munyombwe, Theresa; Harrison, Jennifer; Schuurmanns, Marieke

    2016-01-01

    Introduction Delirium is a common and distressing condition associated with frailty, dementia and comorbidity. These are common in long-term care settings. Residents in care homes are therefore at particular risk of delirium. Despite this, methods to detect delirium in care homes are lacking, with existing diagnostic tools taking too long, or requiring specific training to deliver. This limits their feasibility for use for the routine detection of delirium by care home staff. Routine screening for delirium in care homes would allow timely attention to exacerbating factors to attenuate the episode, and facilitate future research into delirium in the care home environment. Methods Residents from 4 large care homes will be asked to consent (or their consultees asked to provide a declaration of agreement) to participate in the study. Care home staff will administer the 25-item Delirium Observation Screening Scale (DOSS)—a delirium screening tool based on observed behaviours—and this will be tested against the research standard Confusion Assessment Method (CAM) administered by trained research assistants performed two times per week for all participating residents. Analysis Sensitivity, specificity, positive and negative predictive values, likelihood ratios and a diagnostic OR will be calculated for the detection of delirium with the 25-item DOSS. The feasibility of routine delirium screening and the scaling properties of the 25-item DOSS will also be explored. Ethics and Dissemination For residents lacking capacity to participate, a consultee will be approached for a declaration of agreement for inclusion in the study. Results will be published in peer-reviewed journals and disseminated in written format to clinical commissioning groups, general practitioners and relevant third parties. Trial registration number ISRCTN14608554. PMID:27324706

  4. The Staffordshire Arthritis, Musculoskeletal, and Back Assessment (SAMBA Study: a prospective observational study of patient outcome following referral to a primary-secondary care musculoskeletal interface service

    Directory of Open Access Journals (Sweden)

    Jordan Kelvin P

    2010-04-01

    Full Text Available Abstract Background Recent healthcare policy has shifted the management of musculoskeletal conditions in the UK away from secondary care towards Clinical Assessment and Treatment Services at the primary-secondary care interface. However, little is known about the outcome of patients with musculoskeletal conditions referred from primary care to Clinical Assessment and Treatment Services or how best to identify those patients at high risk of poor outcome in this setting. We describe the protocol for a twelve-month prospective observational study which aims to describe the outcome of patients referred to musculoskeletal and back pain services at the primary-secondary care interface and to develop simple prognostic measures to guide clinical prioritisation and triage. Methods/Design All patients referred over a twelve-month period from primary care to musculoskeletal and back pain clinics in the primary-secondary care interface Clinical Assessment and Treatment Service in North Staffordshire will be mailed a postal questionnaire prior to their consultation. This will collect information on quality of life, general health, anxiety and depression, pain, healthcare utilisation including medication use, occupational characteristics, and socio-demographics. At the consultation in the interface clinic, the clinical diagnosis, investigations requested, and clinical interventions will be recorded. Follow-up data for the twelve-month period subsequent to recruitment will be collected via mailed follow-up questionnaires at 6 and 12 months, and review of medical records. Discussion This twelve-month prospective observational study of patients referred to a musculoskeletal Clinical Assessment and Treatment Service will assess the management and outcome of musculoskeletal care at the primary-secondary care interface as proposed in the Musculoskeletal Services Framework.

  5. Impact of Palliative Care Consultation Service on Terminally Ill Cancer Patients: A 9-Year Observational Cohort Study in Taiwan.

    Science.gov (United States)

    Lu, Ching-Yi; Shen, Wen-Chi; Kao, Chen-Yi; Wang, Hung-Ming; Tang, Shu-Chuan; Chin, Tsu-Ling; Chi, Chuan-Chuan; Yang, Jin-Mei; Chang, Chih-Wen; Lai, Ying-Fen; Yeh, Ya-Chi; Hung, Yu-Shin; Chou, Wen-Chi

    2016-03-01

    The palliative care consultation service (PCCS) that has been enthusiastically promoted in Taiwan since 2005 was designed to provide comprehensive end-of-life care for terminally ill patients with qualified interdisciplinary specialists in acute care ward setting. This study aims to evaluate the impact of PCCS on terminally ill cancer patients.A total of 10,594 terminal cancer patients who were referred to PCCS from a single medical center in Taiwan between 2006 and 2014 were enrolled. The percentages of patients' and their families' disease awareness, do-not-resuscitate (DNR) designation, refusal and acceptance of palliative care among terminally ill cancer patients were analyzed retrospectively.At the beginning of PCCS, the percentages of disease awareness among patients and their family were increased from 25.4% to 37.9% (P = 0.007) and from 61.2% to 84.7% between 2006 and 2014 (P = 0.001), respectively. Patients' disease awareness after PCCS referral between 2006 and 2014 was increased from 47.1% to 64.5% (P = 0.016). Family's awareness of diagnosis and prognosis after PCCS referral researched to a steady plateau, 94.1% to 97.8% in different year cohort (P = 0.34). The percentage of DNR designation rate at the beginning of PCCS (in 2006) was 15.5%, and the designation rate was increased annually and finally reached to 42.0% in 2014 (P = 0.004). The percentage of DNR consents after PCCS was also improved from 44.0% in 2006 up to 80.0% in 2014 (P = 0.005). PCCS refusal rate decreased gradually and dropped to 1.6% in 2014 (P = 0.005). The percentage of PCCS utilization was increased 5-fold during the 9-year period after the promotion of PCCSIn the program of PCCS promotion, an increasing trend of PCCS utilization, better patients' and their families' awareness of diagnosis and prognosis, more consent to DNR, more patients were discharged with stable condition at the end of PCCS and a decrease refusal rate of end-of-life palliative care

  6. Medication Errors in an Internal Intensive Care Unit of a Large Teaching Hospital: A Direct Observation Study

    Directory of Open Access Journals (Sweden)

    Saadat Delfani

    2012-06-01

    Full Text Available Medication errors account for about 78% of serious medical errors in intensive care unit (ICU. So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6% occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported.

  7. Observation report Moshi, Tanzania 2002. A study of the maternal health care in Moshi using WHO`s "charracteristics of a well-organised system of formal maternity care"

    OpenAIRE

    2005-01-01

    Background: We were two medical students who went to Moshi, Tanzania, in the Kilimanjaro region the Summer 2002 to study the maternity health care system. During eight weeks we were collecting data from two primary health care centres, one regional hospital and one university hospital. We were studying family planning, antenatal care and delivery service, and we spent most of the period in labour wards. Method: Through participant observation, interviews and data collection from delivery ...

  8. Correlation between patient quality of life in palliative care and burden of their family caregivers: a prospective observational cohort study

    OpenAIRE

    Krug, Katja; Miksch, Antje; Peters-Klimm, Frank; Engeser, Peter; Szecsenyi, Joachim

    2016-01-01

    Background: Family caregivers play a key role in palliative care at home, and understanding the interdependencies in the constellation of patient, family caregivers and service providers is important. As few longitudinal studies have examined the influence of patient quality of life (QoL) in palliative care on burden of family caregivers, the aim of this study was to identify correlations between changing patient QoL and changing burden of family caregivers that need consideration in patient ...

  9. Evaluation of a website providing information on regional health care services for patients with rheumatoid arthritis: an observational study

    OpenAIRE

    Meesters, Jorit J L; de Boer, Ingeborg G.; van den Berg, Marleen H; Fiocco, Marta; Vliet Vlieland, Thea P. M.

    2011-01-01

    Studies on the effectiveness of information provision for patients with arthritis through the Internet are scarce. This study aimed to describe rheumatoid arthritis (RA) patients’ knowledge and information needs before and after launching a website providing information on regional health care services for patients with rheumatic conditions. The intervention consisted of a weekly updated website comprising practical information on regional health care services for patients with arthritis. In ...

  10. Intravenous Mistletoe Treatment in Integrative Cancer Care: A Qualitative Study Exploring the Procedures, Concepts, and Observations of Expert Doctors

    Directory of Open Access Journals (Sweden)

    Gunver S. Kienle

    2016-01-01

    Full Text Available Background. Mistletoe therapy (MT is widely used in patient-centered integrative cancer care. The objective of this study was to explore the concepts, procedures, and observations of expert doctors, with a focus on intravenous MT. Method. A qualitative interview study was conducted with 35 highly experienced doctors specialized in integrative and anthroposophic medicine. Structured qualitative content analysis was applied. For triangulation, the results were compared with external evidence that was systematically collected, reviewed, and presented. Results. Doctors perform individualized patient assessments that lead to multimodal treatment approaches. The underlying goal is to help patients to live with and overcome disease. Mistletoe infusions are a means of accomplishing this goal. They are applied to stabilize disease, achieve responsiveness, induce fever, improve quality of life, and improve the tolerability of conventional cancer treatments. The doctors reported long-term disease stability and improvements in patients’ general condition, vitality, strength, thermal comfort, appetite, sleep, pain from bone metastases, dyspnea in pulmonary lymphangitis carcinomatosa, fatigue, and cachexia; chemotherapy was better tolerated. Also patients’ emotional and mental condition was reported to have improved. Conclusion. Individualized integrative cancer treatment including MT aims to help cancer patients to live well with their disease. Further research should investigate the reported observations.

  11. Trends in long-term opioid prescribing in primary care patients with musculoskeletal conditions: an observational database study.

    Science.gov (United States)

    Bedson, John; Chen, Ying; Hayward, Richard A; Ashworth, Julie; Walters, Kate; Dunn, Kate M; Jordan, Kelvin P

    2016-07-01

    Long-term opioids may benefit patients with chronic pain but have also been linked to harmful outcomes. In the United Kingdom, the predominant source of opioids is primary care prescription. The objective was to examine changes in the incidence, length, and opioid potency of long-term prescribing episodes for musculoskeletal conditions in UK primary care (2002-2013). This was an observational database study (Clinical Practice Research Datalink, 190 practices). Participants (≥18 years) were prescribed an opioid for a musculoskeletal condition (no opioid prescribed in previous 6 months), and issued ≥2 opioid prescriptions within 90 days (long-term episode). Opioids were divided into short- and long-acting noncontrolled and controlled drugs. Annual incidence of long-term opioid episodes was determined, and for those still in a long-term episode, the percentage of patients prescribed each type 1 to 2 years, and >2 years after initiation. Annual denominator population varied from 1.25 to 1.38 m. A total of 76,416 patients started 1 long-term episode. Annual long-term episode incidence increased (2002-2009) by 38% (42.4-58.3 per 10,000 person-years), remaining stable to 2011, then decreasing slightly to 55.8/10,000 (2013). Patients prescribed long-acting controlled opioids within the first 90 days of long-term use increased from 2002 to 2013 (2.3%-9.9%). In those still in a long-term opioid episode (>2 years), long-acting controlled opioid prescribing increased from 3.5% to 22.6%. This study has uniquely shown an increase in prescribing long-term opioids to 2009, gradually decreasing from 2011 in the United Kingdom. The trend was towards increased prescribing of controlled long-acting opioids and earlier use. Further research into the risks and benefits of opioids is required. PMID:27003191

  12. Assessment and Availability of Trauma Care Services in a District Hospital of South India; A Field Observational Study

    Directory of Open Access Journals (Sweden)

    Pallavi Sarji Uthkarsh

    2016-04-01

    Full Text Available Objective: To assess the availability of trauma care services in a district referral hospital of Southern India. Methods: This was a cross-sectional study being performed during 2013 in a tertiary healthcare centre in Southern Indian. A detailed assessment of trauma care services was done in a 400 bed speciality hospital which is an apex referral hospital in the public health system using a check list based on WHO guidelines for evaluation of essential trauma care services, along with in-depth interviews of hospital stake holders and key informants. Results: The hospital had physical infrastructure in terms of emergency room, inpatient wards, operation theatres, intensive care unit and blood bank facilities. The recently constructed designated building for trauma care services was not operational and existing facilities were used beyond capacity. A designated trauma team was lacking and speciality services for managing polytrauma were deficient and thus, existing personnel were performing multiple tasks. Neurosurgeons and rehabilitative nursing staff were unavailable, and a radiographer was not available on a 24/7 basis. Existing nursing personnel had not received any formal training in trauma care and standard operating protocols were not available for trauma care. Resources for acute resuscitation were partially adequate. The hospital lacked adequate resources to manage head, abdomen, chest and spine injuries, and most of the polytrauma cases were referred to nearby city hospitals. Conclusion: District hospital, the only referral hospital in public health system for trauma victims of that region, had inadequate resources to manage trauma victims, which was probably responsible for delay in trauma care, improper referrals, high cost of care and poor outcomes.

  13. A prospective observational study of paediatric cardiac surgery outcomes in a postoperative intensive care unit in Iran

    International Nuclear Information System (INIS)

    Objective: To evaluate the incidence of complications, morbidity and mortality, and the associated risk factors with mortality at a Paediatric Cardiology Intensive Care Unit of a developing country. Methods: The prospective observational study was conducted at Shahid Modarres Hospital, Tehran, Iran, from August 2009 to July 2010. A total of 202 patients were monitored from the time they entered the Paediatric Cardiology Intensive Care Unit till their final discharge. SPSS 16 was used for statistical analysis and p <0.05 was considered statistically significant. Results: Of the total, 107 (53%) were male and 95 (47%) were female. The mean age of the patients was 4.5+-4.9 years (range: 2 days to 18 years). Among the patients 59 (29.2%) had complications and 25 (12.37%) of them died. A total of 177 (87.6%) survived and were discharged. Infants (p =0.012), cyanotic congenital heart disease (p = 0.002), longer duration of cardiopulmonary bypass (p=0.027), longer aortic cross-clamp time (p=0.038), longer mechanical ventilation time (p <0.006), and early post-operative period (p = 0.05) were associated factors for mortality. According to regression analysis, cyanotic congenital heart disease, longer intubation time, and early post-operative period were major factors for mortality (p = 0.01, p <0.001, and p = 0.001) respectively. Conclusion: Critically ill cyanotic young infants in the first 24 hours after operation experienced high mortality. Prolonged mechanical ventilation was also associated with high mortality. (author)

  14. The etiological diagnosis and outcome in patients of acute febrile encephalopathy: A prospective observational study at tertiary care center

    Directory of Open Access Journals (Sweden)

    Aniyang Modi

    2012-01-01

    Full Text Available Background: Acute febrile encephalopathy (AFE is a clinical term used to an altered mental state that either accompanies or follows a short febrile illness and is characterized by a diffuse and nonspecific brain insult manifested by a combination of coma, seizures, and decerebration. Objective: To identify the etiological diagnosis and outcome in adult patients with AFE. Settings and Design: A prospective observational study was done in patients aged 14 years or above who were admitted with AFE at a tertiary care center in northwest India. Materials and Methods: The non-infectious causes of unconsciousness were excluded and then only a diagnosis of AFE was considered. Cerebrospinal fluid (CSF analysis and imaging of brain was done to determine the possible etiology. Outcome was assessed at 1 month of follow-up after discharge by using modified Rankin Scale (mRS. Data were analyzed and presented as mean, median, and percentages. A P value of 3 in 14 patients with AVE (P 3 in six patients with AVE and in the rest it was ≤1 (P < 0.001. Conclusions: In this study, pyogenic meningitis was the leading cause of AFE, followed by AVE and cerebral malaria. The outcome in cases with AVE can be fatal or more disabling than other etiologies.

  15. An observational study of emergency department utilization among enrollees of Minnesota Health Care Programs: financial and non-financial barriers have different associations

    OpenAIRE

    Shippee, Nathan D.; Shippee, Tetyana P.; Hess, Erik P.; Beebe, Timothy J.

    2014-01-01

    Background Emergency department (ED) use is costly, and especially frequent among publicly insured populations in the US, who also disproportionately encounter financial (cost/coverage-related) and non-financial/practical barriers to care. The present study examines the distinct associations financial and non-financial barriers to care have with patterns of ED use among a publicly insured population. Methods This observational study uses linked administrative-survey data for enrollees of Minn...

  16. Clinical profile of acute kidney injury in a pediatric intensive care unit from Southern India: A prospective observational study

    Directory of Open Access Journals (Sweden)

    Sriram Krishnamurthy

    2013-01-01

    Full Text Available Background: Although the term acute renal failure was replaced by acute kidney injury (AKI recently, there is a paucity of data on the incidence and profile of AKI in critically ill children from the developing world. Objectives: The objective of this study is to determine the incidence, etiology, short term outcome and predictors of fatality in critically ill children admitted to the pediatric intensive care unit (PICU with AKI, aged 1 month to 13 years. Materials and Methods: In this prospective observational study, from June 2010 to March 2011, 215 children admitted to the PICU were screened for AKI, defined according to the AKI Network criteria. The patients with AKI were followed-up until discharge/death. Their clinical and biochemical data were recorded. Results: The incidence of AKI among 215 patients screened was 54 (25.1%. The common etiologies were infections, [34 (62.9%], acute glomerulonephritis (7.6%, snake envenomation (5.7%, hemolytic uremic syndrome (3.8% and congestive cardiac failures (3.8%. Among infections, pneumonia and septicemia constituted 26.5% each, meningoencephalitis accounted for 23.5%, and dengue, scrub typhus, tuberculosis and malaria constituted 9.3% of children with AKI. 27.8% of patients required dialysis. Overall mortality was 46.3%. On logistic regression analysis, requirement of mechanical ventilation was an independent predictor of fatality in AKI. Conclusions: Besides the high incidence of AKI in critically ill-children admitted to the PICU (25.1%, the condition was associated with adverse outcomes, including high mortality (46.3% and need for dialysis (27.8%. Infections dominated the etiological profile. Requirement of mechanical ventilation predicted an adverse outcome in our patient population.

  17. Study on workloads of human care worker with the introduction of IT system - the characteristics of work loads by observational research and the suggestions for KAIZEN.

    Science.gov (United States)

    Mizuno, Yuki; Yoshikawa, Toru; Matsuda, Fumiko; Takeuchi, Yuriko; Motegi, Nobuyuki; Ikegami, Thor; Sakai, Kazuhiro

    2012-01-01

    The purpose of this study was to clarify the characteristic of workloads on human care worker with the introduction of IT system, and suggested the support measures for KAIZEN in Japan. The investigation method is workflow line and hearing with a focus on work observation. The objects were 8 human care workers of the acute hospital that introduced an electronic system. By the introduction of the electronic chart, the nurse station sojourn time decreased, sickroom sojourn time increased, and time about direct nursing care to a patient increased. In addition, access to patient information became easy, and the offer of the health care service based on correct information came to be possible in real time. By The point of workflow line, it was effect that moving lengths decreased in order to install the electronic chart in patients' rooms. Though, it was a problem that it hasn't formed where to place the instruments such as sphygmomanometer, clinical thermometer and others. PMID:22317644

  18. Involvement in emergency situations by primary care doctors on-call in Norway - a prospective population-based observational study

    Directory of Open Access Journals (Sweden)

    Hunskaar Steinar

    2010-03-01

    Full Text Available Abstract Background Primary care doctors on-call in the emergency primary health care services in Norway are, together with the ambulances, the primary resources for handling emergencies outside hospitals. There is a lack of reliable data for Norway on how often the primary care doctors are alerted and on their responses in the most urgent emergency cases. The aim of this study was to investigate how doctors on-call are involved in red responses (highest priority, using three different emergency medical communication centres (EMCC as catchment area for a prospective population-based study. Methods In the period from October to December 2007 three dispatch centres covering approximately 816 000 inhabitants prospectively recorded all acute emergency cases. Ambulance records, air ambulance records and records from the doctors on-call were collected. NACA score was used to define the severity of the emergencies. Results 5 105 cases were classified as red responses during the period. We have complete basic recordings (AMIS forms from all and resaved ambulance records, air ambulance records and records from doctors on-call in 89% of the cases. Ambulances were alerted in 96% and doctors on-call in 47% of the cases, but there were large differences between the three EMCCs. Doctors on-call responded with call-out in 42% of the alerted cases. 28% of all patients were taken to a casualty clinic, 46% were admitted to hospital by a doctor and 24% were taken directly to hospital by ambulances. In total, primary care doctors on-call took active part in 42% of all red response cases, and together with GPs' daytime activity the primary health care services were involved in 50% of the cases. 29% of the cases were classified as life-threatening. Call-out by doctors on-call were found to be more frequent in life-threatening situations compared with not life-threatening situations. Conclusion Doctors on-call and GPs on daytime were involved in half of all red

  19. Insomnia among patients with advanced disease during admission in a Palliative Care Unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors

    OpenAIRE

    Renom-Guiteras, Anna; Planas, José; Farriols, Cristina; Mojal, Sergi; Miralles, Ramón; Silvent, Maria A; Ruiz-Ripoll, Ada I

    2014-01-01

    Background The aims of this study were: 1) to assess the frequency of insomnia among patients during admission in a Palliative Care Unit (PCU); 2) to study the association between emotional distress and insomnia, taking physical, environmental and other psychological factors into account. Methods Prospective observational study including patients consecutively admitted to a PCU during eight months, excluding those with severe cognitive problems or too low performance status. Insomnia was asse...

  20. Burden and outcomes of pressure ulcers in cancer patients receiving the Kerala model of home based palliative care in India: Results from a prospective observational study

    Directory of Open Access Journals (Sweden)

    Biji M Sankaran

    2015-01-01

    Full Text Available Aim: To report the prevalence and outcomes of pressure ulcers (PU seen in a cohort of cancer patients requiring home-based palliative care. Materials and Methods: All patients referred for home care were eligible for this prospective observational study, provided they were living within a distance of 35 km from the institute and gave informed consent. During each visit, caregivers were trained and educated for providing nursing care for the patient. Dressing material for PU care was provided to all patients free of cost and care methods were demonstrated. Factors influencing the occurrence and healing of PUs were analyzed using logistic regression. Duration for healing of PU was calculated using the Kaplan Meier method. P < 0.05 are taken as significant. Results: Twenty-one of 108 (19.4% enrolled patients had PU at the start of homecare services. None of the patients developed new PU during the course of home care. Complete healing of PU was seen in 9 (42.9% patients. The median duration for healing of PU was found to be 56 days. Median expenditure incurred in patients with PU was Rs. 2323.40 with a median daily expenditure of Rs. 77.56. Conclusions: The present model of homecare service delivery was found to be effective in the prevention and management of PUs. The high prevalence of PU in this cohort indicates a need for greater awareness for this complication. Clinical Trial Registry Number: CTRI/2014/03/004477

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

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

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

  3. Prospective observational study of emergency airway management in the critical care environment of a tertiary hospital in Melbourne.

    Science.gov (United States)

    Dyett, J F; Moser, M S; Tobin, A E

    2015-09-01

    The objective of this study is to describe the population of patients receiving emergency airway management outside operating theatres at our institution, a tertiary referral centre in Melbourne. A registry of all patients receiving emergency airway management in the emergency department, ICU and on the wards as part of Medical Emergency Response teams' care, was prospectively collected. There were 128 adults and one paediatric patient requiring emergency airway management recruited to the study. Data for analysis included patient demographics, pre-oxygenation and apnoeic oxygenation, staff, drugs, details of laryngoscopic attempts, adjuncts, airway manoeuvres, complications sustained and method of confirmation of endotracheal tube placement. Over a 12-month period, there were 139 intubations of 129 patients, requiring a total of 169 attempts. Respiratory failure was the most common indication for intubation. Intubation was successful on the first episode of laryngoscopy in 116 (83.5%) patients. Complications occurred in 48 patients. In the cohort of patients without respiratory failure, nasal cannulae apnoeic oxygenation significantly reduced the incidence of hypoxaemia (0 out of 31 [0.0%] versus 10 out of 60 [16.7%], P=0.016; absolute risk reduction 16.7%; number needed to treat: 6). Waveform capnography was used to confirm endotracheal tube placement in 133 patients and there were four episodes of oesophageal intubation, all of which were recognised immediately. In the critical care environment of our institution, emergency airway management is achieved with a first-attempt success rate that is comparable to overseas data. Nasal cannulae apnoeic oxygenation appears to significantly reduce the risk of hypoxaemia in patients without respiratory failure and the use of waveform capnography eliminates episodes of unrecognised oesophageal intubation. PMID:26310407

  4. Impact of an educational intervention on errors in death certification: An observational study from the intensive care unit of a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Afzal Azim

    2014-01-01

    Full Text Available Background: A high incidence of errors occur while filling up death certificates in hospitals. The purpose of this study was to analyze the impact of an educational intervention on errors in death certification in an intensive care unit (ICU. Patients admitted to ICUs by virtue of being critically ill have a higher mortality than other hospitalized patients. This study was designed to see if any improvement could be brought about in filling death certificates. Materials and Methods: Educating sessions, interactive workshops, and monthly audits for the department resident doctors were conducted. One hundred and fifty death certificates were audited for major and minor errors (75 before and 75 after the educational intervention over a period of 18 months. Fisher′s exact test was applied to statistically analyze the data. Results: There was a significant decrease in major errors like mechanism without underlying cause of death (60.0 vs. 14.6%, P < 0.001, competing causes (88.0 vs. 13.3%, P < 0.001, and improper sequencing (89.3 vs. 36.0%, P < 0.001. There was also a significant decrease in minor errors such as use of abbreviations (89.3 vs. 29.3%, P < 0.001 and no time intervals (100.0 vs. 22.6%, P < 0.001. Conclusion: Authors conclude that death certification errors can be significantly reduced by educational interventional programs.

  5. "Needs Expressed" and "Offers of Care": An Observational Study of Mothers with Somatisation Disorder and Their Children

    Science.gov (United States)

    Bialas, Ivona; Craig, Tom K. J.

    2007-01-01

    Background: The abnormal illness behaviours characterising somatisation disorder may be learnt responses acquired through exposure to parental illness and health anxiety in childhood. In this observational study we explore this hypothesis by examining patterns of interaction in mothers and their school age children. Method: A sample of 136 mother…

  6. Structural abnormalities and persistent complaints after an ankle sprain are not associated: An observational case control study in primary care

    NARCIS (Netherlands)

    J. van Ochten (John); M.C.E. Mos (Marinka C E); N. Van Putte-Katier (Nienke); E.H.G. Oei (Edwin); P.J.E. Bindels (Patrick); S.M. Bierma-Zeinstra (Sita); M. van Middelkoop (Marienke)

    2014-01-01

    textabstractBackground Persistent complaints are very common after a lateral ankle sprain. Aim To investigate possible associations between structural abnormalities on radiography and MRI, and persistent complaints after a lateral ankle sprain. Design and setting Observational case control study on

  7. An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India

    OpenAIRE

    Nandini Chatterjee; Chandan Chattopadhyay; Nilanjan Sengupta; Chanchal Das; Nilendu Sarma; Salil K Pal

    2014-01-01

    Background: Diabetes mellitus and its impact on the human body have been extensively dissected over the years. However, skin which is the largest organ in the body, has received minimum attention. Therefore, this study was designed to analyze the prevalence and pattern of skin disorders among diabetic patients from Eastern region of India. Materials and Methods: This is an observational study, conducted in the General Medicine and Endocrinology departments of a Medical College and Hospital in...

  8. Prospective Observational Study of Adverse Drug Reactions of Anticancer Drugs Used in Cancer Treatment in a Tertiary Care Hospital

    OpenAIRE

    V. K. Saini; Sewal, R. K.; Ahmad, Yusra; B Medhi

    2015-01-01

    Adverse drug reactions associated with the use of anticancer drugs are a worldwide problem and cannot be ignored. Adverse drug reactions can range from nausea, vomiting or any other mild reaction to severe myelosuppression. The study was planned to observe the suspected adverse drug reactions of cancer chemotherapy in patients aged >18 years having cancer attending Postgraduate Institute of Medical Education and Research, Chandigarh. During the study period, 101 patients of breast cancer and ...

  9. Observations of group care worker-child interaction in residential youth care: Pedagogical interventions and child behavior

    NARCIS (Netherlands)

    Bastiaanssen, I.L.W.; Delsing, M.J.M.H.; Geijsen, L.; Kroes, G.; Veerman, J.W.; Engels, R.C.M.E.

    2014-01-01

    The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children. The aim of the current study was to observe the pedagogical interventions of group care work

  10. Observational study to assess prescription cost and its relation to the socioeconomic status of the patients in psychiatry outpatient department in a tertiary care hospital

    OpenAIRE

    Sumit G. Goyal; Dnyaneshwar G. Kurle; Balwant D. Samant

    2016-01-01

    Background: To analyse the cost of prescriptions and to determine the relationship between socioeconomic status of the patients and the cost of prescriptions. Methods: A prospective, observational study was conducted in psychiatry OPD of a tertiary care hospital from August 2007 to January 2008. 300 patients of either sex and irrespective of age suffering from mental disorders were included. Information about the socioeconomic status of the patient was analysed on the basis of Kuppuswami's...

  11. Adherence to process of care quality indicators after percutaneous coronary intervention in Ontario, Canada: a retrospective observational cohort study

    OpenAIRE

    Czarnecki, Andrew; Prasad, Treesa J; Wang, Julie; Wijeysundera, Harindra C; Cheema, Asim N.; Dz̆avík, Vladimír; Natarajan, Madhu K.; Simpson, Chris S.; So, Derek Y.; Syed, Jaffer; Tu, Jack V.; Ko, Dennis T

    2015-01-01

    Background Public reporting of percutaneous coronary intervention (PCI) outcomes has been established in many jurisdictions to ensure optimal delivery of care. The majority of PCI report cards examine in-hospital mortality, but relatively little is known regarding the adherence to processes of care. Methods A modified Delphi panel comprising cardiovascular experts was assembled to develop a set of PCI quality indicators. Indicators such as prescription of aspirin, dual antiplatelet therapy, s...

  12. Construct validity of the Chelsea critical care physical assessment tool: an observational study of recovery from critical illness

    OpenAIRE

    Corner, Evelyn J; Soni, Neil; Handy, Jonathan M.; Stephen J Brett

    2014-01-01

    Introduction Intensive care unit-acquired weakness (ICU-AW) is common in survivors of critical illness, resulting in global weakness and functional deficit. Although ICU-AW is well described subjectively in the literature, the value of objective measures has yet to be established. This project aimed to evaluate the construct validity of the Chelsea Critical Care Physical Assessment tool (CPAx) by analyzing the association between CPAx scores and hospital-discharge location, as a measure of fu...

  13. Usage of documented pre-hospital observations in secondary care: a questionnaire study and retrospective comparison of records

    OpenAIRE

    Knutsen, Geir Olav; Fredriksen, Knut

    2013-01-01

    Background: The patient handover is important for the safe transition from the pre-hospital setting to secondary care. The loss of critical information about the pre-hospital phase may impact upon the clinical course of the patient. Methods: University Hospital Emergency Care registrars answered a questionnaire about how they perceive clinical documentation from the ambulance services. We also reviewed patient records retrospectively, to investigate to what extent eight selecte...

  14. Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

    Directory of Open Access Journals (Sweden)

    Arthur Kwizera

    2015-01-01

    Full Text Available Aim. Delirium is common among mechanically ventilated patients in the intensive care unit (ICU. There are little data regarding delirium among mechanically ventilated patients in Africa. We sought to determine the burden of delirium and associated factors in Uganda. Methods. We conducted a multicenter prospective study among mechanically ventilated patients in Uganda. Eligible patients were screened daily for delirium using the confusional assessment method (CAM-ICU. Comparisons were made using t-test, chi-squares, and Fisher’s exact test. Predictors were assessed using logistic regression. The level of statistical significance was set at P<0.05. Results. Of 160 patients, 81 (51% had delirium. Median time to onset of delirium was 3.7 days. At bivariate analysis, history of mental illness, sedation, multiorgan dysfunction, neurosurgery, tachypnea, low mean arterial pressure, oliguria, fevers, metabolic acidosis, respiratory acidosis, anaemia, physical restraints, marital status, and endotracheal tube use were significant predictors. At multivariable analysis, having a history of mental illness, sedation, respiratory acidosis, higher PEEP, endotracheal tubes, and anaemia predicted delirium. Conclusion. The prevalence of delirium in a young African population is lower than expected considering the high mortality. A history of mental illness, anaemia, sedation, endotracheal tube use, and respiratory acidosis were factors associated with delirium.

  15. Progressive multifocal leucoencephalopathy in HIV/AIDS: Observational study from a tertiary care centre in northern India

    Directory of Open Access Journals (Sweden)

    S K Sharma

    2013-01-01

    Full Text Available Background & objectives: Progressive multifocal leucoencephalopathy (PML is seen mostly in advanced human immunodeficiency virus (HIV infection. Little is known about the epidemiology and disease course of these patients from India. This study was aimed to determine the frequency of PML in patients with HIV/AIDS, and the clinical features and survival of these patients. Methods: The charts of HIV/AIDS patients with PML seen over a period of five years (2006-2011 at the Antiretroviral treatment (ART centre at a tertiary care centre in New Delhi, India, were retrospectively reviewed. Results: Of 1465 patients with HIV/AIDS, 18 (1.2% were diagnosed with PML; four were laboratory confirmed and 14 had consistent clinical and radiological features. PML was the initial presentation of HIV infection in 10 (56% patients, and 16 (89% patients had CD4 count less than 200/μl. Insidious onset focal limb weakness (78% and visual disturbance (28% were common symptoms. Magnetic resonance imaging (MRI of the brain revealed characteristic white matter lesions in all the patients. The estimated median survival was 7.6 months (95% CI, 0-20 months. Interpretation & conclusions: Our results show that the patients present late to access treatment with advanced immunosuppression at presentation. PML is associated with high morbidity and mortality despite institution of highly active antiretroviral therapy (HAART. There is a need to address the lacuna in diagnostic and management services for these patients in India.

  16. Guided online treatment in routine mental health care: an observational study on uptake, drop-out and effects

    Directory of Open Access Journals (Sweden)

    Kenter Robin

    2013-01-01

    Full Text Available Abstract Background Due to limited resources patients in the Netherlands often have to wait for a minimum of six weeks after registration for mental health care to receive their first treatment session. Offering guided online treatment might be an effective solution to reduce waiting time and to increase patient outcomes at relatively low cost. In this study we report on uptake, drop-out and effects of online problem solving treatment that was implemented in a mental health center. Methods We studied all 104 consecutive patients aged 18–65 years with elevated symptoms of depression, anxiety and/or burnout who registered at the center during the first six months after implementation. They were offered a five week guided online treatment. At baseline, five weeks and twelve weeks we measured depressive (BDI-II, anxiety (HADS-A and burnout symptoms (MBI. Results A total of 55 patients (53% agreed to start with the online treatment. Patients who accepted the online treatment were more often female, younger and lower educated than those who refused. There were no baseline differences in clinical symptoms between the groups. There were large between group effect sizes after five weeks for online treatment for depression (d = 0.94 and anxiety (d = 1.07, but not for burnout (d = −.07. At twelve weeks, when both groups had started regular face-to-face treatments, we no longer found significant differences between the groups, except for anxiety (d = 0.69. Conclusion The results of this study show that the majority of patients prefer online guided online treatment instead of waiting for face-to-face treatment. Furthermore, online PST increases speed of recovery and can therefore be offered as a first step of treatment in mental healthcare.

  17. A STUDY OF SEASONAL VARIATION OBSERVED IN OCCURRENCE OF IMMINENT ECLAMPSIA AND ECLAMPSIA AT TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Ashutosh

    2016-02-01

    Full Text Available BACKGROUND Eclampsia is an occurrence of seizures in women with pre-eclampsia. It is a leading cause of maternal mortality and morbidity in India. Their etiology is poorly understood even today. Seasonal variation is considered as one of the cause. AIMS AND OBJECTIVES To see the frequency of occurrence of imminent eclampsia and eclampsia during rainy (June to August and winter (October to December season. MATERIALS AND METHOD This is a descriptive, retrospective, observational and analytical study on seasonal variations in admission of imminent eclampsia and eclampsia patients in Department of Obstetrics and Gynaecology in KIMS, Karad, from 2012 to 2014. RESULT Among 9122 total number of admissions in Department of Obstetrics and Gynaecology 7678 got delivered in our institute. In which 4150 deliveries occurred in rainy season in which imminent eclampsia were 55 (1.3%, eclampsia cases were 42 (1.01%. While 3528 cases delivered in winter in which imminent eclampsia were 28 (0.7% and eclampsia were 24 (0.68%. The study showed frequency of imminent eclampsia and eclampsia being more common in rainy season than that of winter season. CONCLUSION In our study, we observed the seasonal variation in occurrence of imminent eclampsia and eclampsia. Number of cases of both imminent eclampsia and eclampsia was more common in rainy season. Regular health checkup, availability of health facilities and prompt referral to tertiary hospital can decrease mortality and morbidity of patient.

  18. Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman: an observational study

    Directory of Open Access Journals (Sweden)

    Vernby Åsa

    2006-12-01

    Full Text Available Abstract Background A good patient-physician interaction is particularly important in chronic diseases like diabetes. There are so far no published data regarding the interaction between the primary health-care providers and patients with type 2 diabetes in Oman, where diabetes is a major and growing health problem. This study aimed at exploring how health-care providers interact with patients with type 2 diabetes at primary health-care level in Muscat, Oman, focusing on the consultation environment, and some aspects of care and information. Methods Direct observations of 90 consultations between 23 doctors and 13 diabetes nurses concerned with diabetes management during their consultations with type 2 diabetes patients in six primary health-care centres in the Muscat region, using checklists developed from the National Diabetes Guidelines. Consultations were assessed as optimal if more than 75% of observed aspects were fulfilled and sub-optimal if less than 50% were fulfilled. Results Overall 52% of the doctors' consultations were not optimal. Some important aspects for a positive consultation environment were fulfilled in only about half of the doctors' consultations: ensuring privacy of consultation (49%, eye contact (49%, good attention (52%, encouraging asking questions (47%, and emphasizing on the patients' understanding of the provided information (52%. The doctors enquired about adverse effects of anti-diabetes drugs in less than 10% of consultations. The quality of the nurses' consultations was sub-optimal in about 75% of 85 consultations regarding aspects of consultation environment, care and information. Conclusion The performance of the primary health-care doctors and diabetes nurses needs to be improved. The role of the diabetes nurses and the teamwork should be enhanced. We suggest a multidisciplinary team approach, training and education to the providers to upgrade their skills regarding communication and care. Barriers to

  19. TREATMENT OUTCOME PROFILE OF NON RESOLVING PNEUMONIA AMONG HOSPITALIZED COMMUNITY ACQUIRED PNEUMONIA PATIENTS IN TERTIARY CARE CENTRE: AN OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Raveendra

    2014-07-01

    Full Text Available : BACKGROUND: Most of the times, a Community Acquired Pneumonia (CAP patient is being treated with empirical antibiotics by best guess method by the clinician. Patient who did not show expected clinical improvement or resolution on chest x- ray after 2 weeks of antibiotics is considered as unresolved or non-resolving pneumonia and is a major problem, contributing to increased mortality and morbidity in the medical wards. AIM OF STUDY: 1.Tostudy the clinical profile of unresolved pneumonia among CAP. 2. To know the treatment outcome in these cases. MATERIALS & METHODS: 80 hospitalized CAP patients who did not improve either clinically or radiologically after 2 weeks of broad spectrum antibiotics were included in the study. Details of these patients including investigations done at other higher centers were recorded and patients were followed up for 6 months or till death. RESULTS: Unresolved pneumonia was commonly observed in patients more than 50 years. Pulmonary tuberculosis was the commonest cause, followed by MDR varieties of CAP, Bronchogenic carcinoma. Multiple risk factors were noted, which includes cigarette smoking, alcohol, COPD, Diabetes, HIV positive status. Elderly age, multiple risk factors, antibiotic abuse and resistance resulted in majority of the cases. CONCLUSION: This study highlights the importance of early recognition and appropriate treatment of CAP to prevent unresolved pneumonia and use of invasive and latest investigations to recognize unresolved pneumonia, to decrease mortality and morbidity.

  20. An observational study of cutaneous manifestations in diabetes mellitus in a tertiary care Hospital of Eastern India

    Directory of Open Access Journals (Sweden)

    Nandini Chatterjee

    2014-01-01

    Full Text Available Background: Diabetes mellitus and its impact on the human body have been extensively dissected over the years. However, skin which is the largest organ in the body, has received minimum attention. Therefore, this study was designed to analyze the prevalence and pattern of skin disorders among diabetic patients from Eastern region of India. Materials and Methods: This is an observational study, conducted in the General Medicine and Endocrinology departments of a Medical College and Hospital in Eastern India. The data were collected prospectively and systematically in a pre-established proforma designed by us, where clinical findings along with investigations were recorded. Results: Six hundred and eighty (680 diabetic patients were examined, there were (64.8% male and (35.1% were female, of them 95.3% were Type 2 diabetics while 4.7% were Type 1. Five hundred and three patients (503 out of six hundred and eighty. i.e. 73.9% were found to have skin lesions. Thirteen (13 (41% Type1 diabetics demonstrated skin lesions commonest being diabetic xerosis, infections and diabetic hand. Among Type2 diabetics 490(75.61% showed skin lesions. Here infections, xerosis, hair loss beneath the knees, diabetic dermopathy were the most frequent. Majority of patients (67% had combination of more than one type of skin lesion. There was statistically significant correlation of skin lesions with duration of diabetes, however similar correlation could not be demonstrated regarding metabolic control. Conclusion: Involvement of skin is inevitable and multifarious in diabetes mellitus. Higher prevalence is seen in Type 2 diabetic population. The duration of diabetes is positively correlated with lesions and infective dermatologic manifestations were associated with higher HbA1C values.

  1. Bidirectional Assessment of Stress, job satisfaction and work ability of Educators in day care centres: a real-time observation study - the study protocol (BASE

    Directory of Open Access Journals (Sweden)

    Kusma Bianca

    2010-06-01

    Full Text Available Abstract Background Occupational demands of educators are not very well researched. Nevertheless their work is subject to several requirements. Whether these demands have an effect on the work ability and the health status of employees has also not been examined. Furthermore it is unclear if the ownership type of day care centres have an influence on job satisfaction and work ability of the pedagogical staff and what kind of resources do exist. Previous studies were mainly based on questionnaire data. Objective data does not exist. Therefore the aim of this investigation is to collect precise data relating to work of educators. Methods Effects of different types of ownership of day care centres on job satisfaction and work ability of educators will be assessed with the help of objective real time studies in combination with multi-level psycho diagnostic measurements. Discussion The present study is the first of its kind. Up to now there are no computer-based real time studies on workflow of pedagogical staff with regard to assess their work-related stress. Following an exhaustive documentation of educators work processes the day-to-day task can be estimated and approaches for prevention can be developed. This can substantially contribute to an overall improvement of child care in Germany.

  2. Bidirectional Assessment of Stress, job satisfaction and work ability of Educators in day care centres: a real-time observation study - the study protocol (BASE)

    OpenAIRE

    Kusma Bianca; Nienhaus Albert; Spallek Michael; Quarcoo David; Groneberg David A; Mache Stefanie

    2010-01-01

    Abstract Background Occupational demands of educators are not very well researched. Nevertheless their work is subject to several requirements. Whether these demands have an effect on the work ability and the health status of employees has also not been examined. Furthermore it is unclear if the ownership type of day care centres have an influence on job satisfaction and work ability of the pedagogical staff and what kind of resources do exist. Previous studies were mainly based on questionna...

  3. Cardiovascular risk management in patients with coronary heart disease in primary care: variation across countries and practices. An observational study based on quality indicators

    Directory of Open Access Journals (Sweden)

    van Lieshout Jan

    2012-10-01

    Full Text Available Abstract Background Primary care has an important role in cardiovascular risk management (CVRM and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD in primary care and explored the impact of practice size. Methods In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records. Practice samples were stratified according to practice size and urbanisation; patients were selected using coded diagnoses when available. CVRM was measured on the basis of internationally validated quality indicators. In the analyses practice size was defined in terms of number of patients registered of visiting the practice. We performed multilevel regression analyses controlling for patient age and sex. Results We included 181 practices (63% of the number targeted. Two countries included a convenience sample of practices. Data from 2960 CHD patients were available. Some countries used methods supplemental to coded diagnoses or other inclusion methods introducing potential inclusion bias. We found substantial variation on all CVRM indicators across practices and countries. We computed aggregated practice scores as percentage of patients with a positive outcome. Rates of risk factor recording varied from 55% for physical activity as the mean practice score across all practices (sd 32% to 94% (sd 10% for blood pressure. Rates for reaching treatment targets for systolic blood pressure, diastolic blood pressure and LDL cholesterol were 46% (sd 21%, 86% (sd 12% and 48% (sd 22% respectively. Rates for providing recommended cholesterol lowering and antiplatelet drugs were around 80%, and 70% received influenza vaccination. Practice size was not associated to indicator scores with one exception: in Slovenia larger practices performed better. Variation was more related to differences between

  4. An observational study to assess an electronic point-of-care wound documentation and reporting system regarding user satisfaction and potential for improved care.

    Science.gov (United States)

    Florczak, Beth; Scheurich, Anne; Croghan, John; Sheridan, Philip; Kurtz, Debra; McGill, William; McClain, Bonny

    2012-03-01

    The integration of information technology into daily patient care potentially provides a means to standardize care and enable continuous quality improvement through improved communication among care teams. A 2-month observational study was conducted on 38 residents with pressure ulcers at a 51-bed skilled nursing facility to rate the Ease of Use and Wound Management Effectiveness of a point-of-care electronic wound documentation system. Nine nurses evaluated the use of handheld "smart phone" devices equipped with a digital camera to document pressure ulcer assessment and treatment at point of care. Ease of Use (five items) was scored on a 5-point Likert scale (5 = very easy); Wound Management Effectiveness (eight items) was scored on a 5-point Likert scale (5 = very effective). Statistically significant mean changes in nurses' ratings were found for baseline compared to 2-month follow-up by paired t-test. Ease of Use ratings across the five criteria increased from an overall mean of 3.3 at baseline to 4.7 at follow-up (P = 0.5), while Wound Management Effectiveness increased from an overall mean of 3.3 at baseline to 4.4 at follow-up (P = 0.5) . The greatest gains for single items were reviewing wound progress (mean difference = 2.35; P = 0.000) and recognizing changes in wound status (mean difference = 1.78; P = 0.001) within the Ease of Use and Wound Management Effectiveness scales, respectively. The smallest change occurred in reading charts and notes (mean difference = 0.89) and ability to determine resident's risk level (mean difference = 0.39). Further research is needed to assess use of a wound documentation system in this and other settings, as well as to ascertain validity and reliability. PMID:22391956

  5. The impact of childhood acute rotavirus gastroenteritis on the parents’ quality of life: prospective observational study in European primary care medical practices

    Directory of Open Access Journals (Sweden)

    Domingo Javier

    2012-05-01

    Full Text Available Abstract Background Rotavirus (RV is the commonest cause of acute gastroenteritis in infants and young children worldwide. A Quality of Life study was conducted in primary care in three European countries as part of a larger epidemiological study (SPRIK to investigate the impact of paediatric rotavirus gastroenteritis (RVGE on affected children and their parents. Methods A self-administered questionnaire was linguistically validated in Spanish, Italian and Polish. The questionnaire was included in an observational multicentre prospective study of 302 children aged Results Questionnaire responses showed that acute RVGE in a child adversely affects the parents’ daily life as well as the child. Parents of children with RVGE experience worry, distress and impact on their daily activities. RVGE of greater clinical severity (assessed by the Vesikari scale was associated with higher parental worries due to symptoms and greater changes in the child’s behaviour, and a trend to higher impact on parents’ daily activities and higher parental distress, together with a higher score on the symptom severity scale of the questionnaire. Conclusions Parents of a child with acute RVGE presenting to primary care experience worry, distress and disruptions to daily life as a result of the child’s illness. Prevention of this disease through prophylactic vaccination will improve the daily lives of parents and children.

  6. An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: acute kidney injury

    OpenAIRE

    El-Abdellati, Esmael; Eyselbergs, Michiel; Sirimsi, Halil; Van Hoof, Viviane; Wouters, Kristien; Verbrugghe, Walter; Jorens, Philippe G

    2013-01-01

    Background Because neither the incidence and risk factors for rhabdomyolysis in the ICU nor the dynamics of its main complication, i.e., rhabdomyolysis-induced acute kidney injury (AKI) are well known, we retrospectively studied a large population of adult ICU patients (n = 1,769). Methods CK and sMb (serum myoglobin) and uMb (urinary myoglobin) were studied as markers of rhabdomyolysis and AKI (RIFLE criteria). Hemodialysis and mortality were used as outcome variables. Results Prolonged surg...

  7. Drug utilization pattern in acute coronary syndrome at tertiary care hospital: a prospective cross-sectional observational study

    Directory of Open Access Journals (Sweden)

    Praveen Choudhary

    2016-04-01

    Conclusions: The present study provides valuable insight about the overall pattern of drug used in Acute Coronary syndrome. Physician should be encouraged to prescribe drugs with generic name. [Int J Basic Clin Pharmacol 2016; 5(2.000: 513-516

  8. Assessment of adherence to cardiovascular medicines in rural population: An observational study in patients attending a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Gouranga Santra

    2015-01-01

    Full Text Available Introduction: Nonadherence to cardiovascular medicines is a major concern. It increases the morbidity and mortality of cardiovascular patients. The work was conducted to evaluate the adherence to cardiovascular medicines in patients of rural India. Methods: The study was conducted in the Department of Medicine involving rural patients with essential hypertension (HTN, congestive cardiac failure (CCF, and ischemic heart disease (IHD over 12 months period. Patients were prescribed with cardiovascular medicines at the initial visit and adherence to medicines was assessed in the subsequent visit. Four items Morisky's Medication Adherence Scale (MMAS-4 was used for assessing medication adherence. Patients were considered adherent to medication if they answered negatively to all four questions. Results: Overall adherence to medication was 20.83%, 28.37% and 32% in HTN, CCF, and IHD patients, respectively. Nonadherence was highest in patients of HTN. Among the four reasons of nonadherence assessed by MMAS-4, carelessness was the most common and forgetfulness was the least common cause of nonadherence in all the three groups of patients. Conclusion: Patients of rural India adhere poorly to cardiovascular medicines. Nonadherence should be considered as a public health problem. Strategies for detecting the level of adherence of cardiovascular medicines, its barriers, and subsequent interventions should be developed by policy-makers to reduce morbidity and mortality due to cardiovascular disorders.

  9. A prolonged observational study of tracheal tube displacements: Benchmarking an incidence <0.5-1% in a medical-surgical adult intensive care unit

    OpenAIRE

    Kapadia, Farhad N.; Pandurang C. Tekawade; Nath, Shruti S.; Pachpute, Sharad S.; Saverkar, Sanjay S.; Bhise, Rupali A.; Chavan, Aarti C.; Varghese, Sholly J.; Vidya U. Kantak; Kshirsagar, Rohini V.; Vaishali A. Neve; Samona O. D′souza

    2014-01-01

    Background and Aims: Tracheal tubes are commonly used in intensive care unit (ICU) and lead to complications like displacements. The primary aim of the study was to evaluate if the rate of tracheal tube displacement benchmarked at

  10. The Staffordshire Arthritis, Musculoskeletal, and Back Assessment (SAMBA) Study: a prospective observational study of patient outcome following referral to a primary-secondary care musculoskeletal interface service

    OpenAIRE

    Jordan Kelvin P; Hider Samantha L; Dawes Peter; Zwierska Irena; Roddy Edward; Packham Jon; Stevenson Kay; Hay Elaine

    2010-01-01

    Abstract Background Recent healthcare policy has shifted the management of musculoskeletal conditions in the UK away from secondary care towards Clinical Assessment and Treatment Services at the primary-secondary care interface. However, little is known about the outcome of patients with musculoskeletal conditions referred from primary care to Clinical Assessment and Treatment Services or how best to identify those patients at high risk of poor outcome in this setting. We describe the protoco...

  11. Post-ICU discharge and outcome: rationale and methods of the The French and euRopean Outcome reGistry in Intensive Care Units (FROG-ICU) observational study

    OpenAIRE

    Mebazaa, Alexandre; Chiara Casadio, Maria; Azoulay, Elie; Guidet, Bertrand; Jaber, Samir; Lévy, Bruno; Payen, Didier; Vicaut, Eric; Resche-Rigon, Matthieu; Gayat, Etienne

    2015-01-01

    Background Previous studies have demonstrated that ICU (intensive care unit) survivors have decreased long-term survival rates compared to the general population. However, knowledge about how to identify ICU survivors with higher risk of death and the adjustable factors associated with mortality is still lacking. Methods and Design The FROG-ICU (the French and European Outcome Registry in Intensive Care Units) study is a prospective, observational, multicenter cohort study where ICU survivors...

  12. Study Design of the Microcirculatory Shock Occurrence in Acutely Ill Patients (microSOAP: an International Multicenter Observational Study of Sublingual Microcirculatory Alterations in Intensive Care Patients

    Directory of Open Access Journals (Sweden)

    Namkje A. R. Vellinga

    2012-01-01

    Full Text Available Objective. Sublingual microcirculatory alterations are associated with an adverse prognosis in several critical illness subgroups. Up to now, single-center studies have reported on sublingual microcirculatory alterations in ICU patient subgroups, but an extensive evaluation of the prevalence of these alterations is lacking. We present the study design of an international multicenter observational study to investigate the prevalence of microcirculatory alterations in critically ill: the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP. Methods. 36 ICU’s worldwide have participated in this study aiming for inclusion of over 500 evaluable patients. To enable communication and data collection, a website, an Open Clinica 3.0 database, and image uploading software have been designed. A one-session assessment of the sublingual microcirculation using Sidestream Dark Field imaging and data collection on patient characteristics has been performed in every ICU patient >18 years, regardless of underlying disease. Statistical analysis will provide insight in the prevalence and severity of sublingual alterations, its relation to systemic hemodynamic variables, disease, therapy, and outcome. Conclusion. This study will be the largest microcirculation study ever performed. It is expected that this study will also establish a basis for future studies related to the microcirculation in critically ill.

  13. A prolonged observational study of tracheal tube displacements: Benchmarking an incidence <0.5-1% in a medical-surgical adult intensive care unit

    Directory of Open Access Journals (Sweden)

    Farhad N. Kapadia

    2014-01-01

    Full Text Available Background and Aims: Tracheal tubes are commonly used in intensive care unit (ICU and lead to complications like displacements. The primary aim of the study was to evaluate if the rate of tracheal tube displacement benchmarked at <1% per patient and <0.5% per tracheal tube day, could be sustained over a prolonged period. The secondary aim was to document the patterns of all forms airway accident and to evaluate their consequences. Subjects and Methods: This was a prospective observational study of Intubated and ventilated patients in a General Medical-Surgical Adult ICU. The incidence of accidental extubation, self extubation, partial displacement and blockages of tracheal tubes were recorded. Results: The overall tracheal tube displacement rate was 61/10,112 (0.6% per patient and 61/28,464 (0.22% per tracheal tube day. There were 30 additional incidents of blockage, kinking or biting of the tracheal tube. Physiological consequences-69 were mild, 10 moderate, 12 major and one death. Of the 91 accidents, 30 were partly and 30 were completely preventable. 76 incidents involved an endotracheal tube (54 displaced, 12 blocked and 10 bitten-kinked and 15 a tracheostomy tube (seven displaced and eight blocked. Accidents were more common in medical than surgical patients (medical = 48, cardiac surgical = 17 and other surgical/trauma = 26. Conclusion: Tracheal tube displacement rate in a mixed medical-surgical adult ICU was maintained below the pre-set benchmark of <1% per patient and <0.5% per intubated day over nearly a decade.

  14. An observational study to evaluate the maternal and neonatal outcome of forceps delivery in a tertiary care government hospital of a cosmopolitan city of India

    OpenAIRE

    Akanksha Lamba; Ramanjeet Kaur; Zulaihuma Muzafar

    2016-01-01

    Background: Operative vaginal delivery using obstetric forceps is a practice that dates back several centuries. Modern obstetrics practice has witnessed an increase in the caesarean section rates. The goal of forceps delivery is to mimic spontaneous vaginal birth, thereby expediting delivery with a minimum of maternal or neonatal morbidity. The main objective of study was to evaluate the maternal and neonatal outcome of forceps assisted deliveries in a tertiary care hospital over a period of ...

  15. Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study

    OpenAIRE

    Santos, Paulo Roberto; Monteiro, Diego Levi Silveira

    2015-01-01

    Background Acute kidney injury (AKI) is common among intensive care unit (ICU) patients and is associated with high mortality. Type of ICU, category of admission diagnosis, and socioeconomic characteristics of the region can impact AKI outcomes. We aimed to determine incidence, associated factors and mortality of AKI among trauma and non-trauma patients in a general ICU from a low-income area. Methods We studied 279 consecutive patients in an ICU during a follow-up of one year. Patients with ...

  16. Pattern of management and outcome of dengue fever in pediatric in-patients in a tertiary care hospital: a prospective observational study

    Directory of Open Access Journals (Sweden)

    Zainab Ghazala

    2014-06-01

    Conclusion: Antibiotics and vitamin K though not a part of standard World Health Organization guidelines was seen to be an important part of management. Supportive care with judicious fluid management during the critical and recovery period with continuous monitoring is required for all patients. Further comparative studies are needed to establish the role of antibiotics and other supportive measures like zinc and folic acid on the outcome of the disease. [Int J Basic Clin Pharmacol 2014; 3(3.000: 534-538

  17. Hospitalization and ambulatory care in imported-malaria: evaluation of trends and impact on mortality. A prospective multicentric 14-year observational study

    OpenAIRE

    Casalino, Enrique; Etienne, Aurélie; Mentré, France; Houzé, Sandrine; ,

    2016-01-01

    Background Hospitalization is usually recommended for imported malaria. The goal of the present study is to evaluate the evolution in clinical pathways while measuring their impact on mortality. Methods This is a 14-year prospective observational study divided into three periods. We evaluated for adult (≥15 years) and paediatric (

  18. Evaluating integrated headache care: a one-year follow-up observational study in patients treated at the Essen headache centre

    Directory of Open Access Journals (Sweden)

    Diener Hans C

    2011-10-01

    Full Text Available Abstract Background Outpatient integrated headache care was established in 2005 at the Essen Headache Centre in Germany. This paper reports outcome data for this approach. Methods Patients were seen by a neurologist for headache diagnosis and recommendation for drug treatment. Depending on clinical needs, patients were seen by a psychologist and/or physical therapist. A 5-day headache-specific multidisciplinary treatment programme (MTP was provided for patients with frequent or chronic migraine, tension type headache (TTH and medication overuse headache (MOH. Subsequent outpatient treatment was provided by neurologists in private practice. Results Follow-up data on headache frequency and burden of disease were prospectively obtained in 841 patients (mean age 41.5 years after 3, 6 and 12 months. At baseline mean headache frequency was 18.1 (SD = 1.6 days per month, compared to measurement at 1 year follow-up a mean reduction of 5.8 (SD = 11.9 headache days per month was observed in 486 patients (57.8% after one year (TTH patients mean: -8.5 days per month; migraine mean: -3.2 days per month, patients with migraine and TTH mean: -5.9 days per month. A reduction in headache days ≥ 50% was observed in 306 patients (36.4% independent of diagnosis, while headache frequency remains unchanged in 20.9% and increase in 21.3% of the patient. Conclusion Multidisciplinary outpatient headache centres offer an effective way to establish a three-tier treatment offer for difficult headache patients depending on clinical needs.

  19. Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room

    OpenAIRE

    Megeus, Veronika; Nilsson, Kerstin; Karlsson, Jon; Eriksson, Bengt I.; Andersson, Annette Erichsen

    2015-01-01

    Background More knowledge is needed about task intensity in relation to hand hygiene in the operating room during anesthetic care in order to choose effective improvement strategies. The aim of this study was to explore the indications and occurrence of hand hygiene opportunities and the adherence to hand hygiene guidelines during routine anesthetic care in the operating room. Methods Structured observational data on hand hygiene during anesthetic care during 94 surgical procedures was collec...

  20. Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

    Directory of Open Access Journals (Sweden)

    Veen Robert ER

    2011-07-01

    Full Text Available Abstract Background Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs. Method GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs within 13 European Countries. General Practitioners (GPs recruited consecutive patients with an acute cough. GPs completed a case report form (CRF and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study. Results The main challenges fell within three domains as follows: i selecting, setting up and maintaining PCNs; ii designing local context-appropriate data collection tools and efficient data management systems; and iii gaining commitment and trust from all involved and maintaining enthusiasm. The main solutions for each domain were: i appointing key individuals (National Network Facilitator and Coordinator with clearly defined tasks, involving PCNs early in the development of study materials and procedures. ii rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress; iii providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos

  1. Insights into the problem of alarm fatigue with physiologic monitor devices: a comprehensive observational study of consecutive intensive care unit patients.

    Directory of Open Access Journals (Sweden)

    Barbara J Drew

    Full Text Available PURPOSE: Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing "alarm fatigue" which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO(2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms. RESULTS: A total of 2,558,760 unique alarms occurred in the 31-day study period: arrhythmia, 1,154,201; parameter, 612,927; technical, 791,632. There were 381,560 audible alarms for an audible alarm burden of 187/bed/day. 88.8% of the 12,671 annotated arrhythmia alarms were false positives. Conditions causing excessive alarms included inappropriate alarm settings, persistent atrial fibrillation, and non-actionable events such as PVC's and brief spikes in ST segments. Low amplitude QRS complexes in some, but not all available ECG leads caused undercounting and false arrhythmia alarms. Wide QRS complexes due to bundle branch block or ventricular pacemaker rhythm caused false alarms. 93% of the 168 true ventricular tachycardia alarms were not sustained long enough to warrant treatment. DISCUSSION: The excessive number of physiologic monitor alarms is a complex interplay of inappropriate user settings, patient conditions, and algorithm deficiencies. Device solutions should focus on use of all available ECG leads to identify non-artifact leads and leads with adequate QRS amplitude. Devices should provide prompts to aide in more appropriate tailoring of alarm settings to individual patients. Atrial fibrillation alarms should be limited to new onset and termination of the arrhythmia and delays for ST-segment and other parameter

  2. Implementation of continuous renal replacement therapy with regional citrate anticoagulation on a surgical and trauma intensive care unit: impact on clinical and economic aspects—an observational study

    OpenAIRE

    Hafner, Sebastian; Stahl, Wolfgang; Fels, Theresa; Träger, Karl; Georgieff, Michael; Wepler, Martin

    2015-01-01

    Background Regional citrate anticoagulation (RCA) is being increasingly used during continuous renal replacement therapy (CRRT) in intensive care units as an alternative to systemic heparin anticoagulation. However, due to its availability in a variety of solutions and dialysis systems, RCA is still considered a complex intervention, possibly leading to confusion and pitfalls in everyday practice. We therefore tested retrospectively if the introduction of RCA as a new anticoagulation strategy...

  3. Transfusão de sangue em terapia intensiva: um estudo epidemiológico observacional Blood transfusion in intensive care: an epidemiological observational study

    Directory of Open Access Journals (Sweden)

    José Rodolfo Rocco

    2006-09-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A transfusão de concentrado de hemácias (CHA é muito freqüente no centro de tratamento intensivo (CTI, mas as conseqüências da anemia nos pacientes gravemente enfermos ainda são obscuras. Os objetivos desse estudo foram avaliar a freqüência, as indicações, os limiares transfusionais e o prognóstico dos pacientes criticamente enfermos que receberam CHA. MÉTODO: Estudo prospectivo de coorte realizado no CTI médico-cirúrgico de um Hospital Universitário durante 16 meses. Foram coletados dados demográficos, clínicos e os relacionados a transfusão de CHA. Regressão logística binária foi utilizada após as análises univariadas. RESULTADOS: Dos 698 pacientes internados, 244 (35% foram transfundidos com CHA. Os pacientes clínicos e em pós-operatório de urgência foram mais transfundidos. Os limiares transfusionais foram: hematócrito = 22,8% ± 4,5% e hemoglobina = 7,9 ± 1,4 g/dL. Os pacientes transfundidos receberam em média 4,4 ± 3,7 CHA e apresentaram maior letalidade no CTI (39,8% versus 13,2%; p 5 unidades e escore SAPS II. CONCLUSÕES: A transfusão de CHA é freqüente no CTI, particularmente nos pacientes internados por problemas clínicos e após cirurgias de emergência, com internação prolongada, em VM e com cirrose hepática. O limiar transfusional observado foi mais baixo que aquele assinalado pela literatura. A transfusão de CHA foi associada com maior letalidade.BACKGROUND AND OBJECTIVES: Packed red blood cell (PRBC transfusion is frequent in intensive care unit (ICU. However, the consequences of anemia in ICU patients are poorly understood. Our aim was to evaluate the prevalence, indications, pre-transfusion hematocrit and hemoglobin levels, and outcomes of ICU patients transfused with PRBC. METHODS: Prospective cohort study conducted at a medical-surgical ICU of a teaching hospital during a 16-month period. Patients' demographic, clinical, laboratory and transfusion-related data

  4. A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

    DEFF Research Database (Denmark)

    Jakobsen, Louise M.; Jorgensen, Anette F. B.; Thomsen, Birthe L.;

    2015-01-01

    -observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. RESULTS: Higher levels of regulation requirements were associated with lower depressive symptoms at the individual...... of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model. CONCLUSIONS: Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both...

  5. Caring school leadership: a South African study

    OpenAIRE

    Van der Vyver, C.P.; Van der Westhuizen, P C; Meyer, L.W.

    2014-01-01

    The research pivoted on the question whether South African school principals fulfilled their caring role towards teachers. The aims of the study were threefold. First, to determine how principals rated their care-giving, secondly to determine whether significant discrepancies existed between principals’ rating of their care-giving and teachers’ experiences thereof and thirdly to identify the determinants of care that contributed the most and the least towards principals’ care-givi...

  6. An observation of impact of neurological consultations in intensive care patients: Case series of 23 patients

    OpenAIRE

    Kanwalpreet Sodhi; Rupinder Singh Bhatia; Siddhartha Garg; Anupam Shrivastava

    2013-01-01

    Objective: The objective of the present study was to assess the impact of neurological consultation and intervention upon patient outcome in intensive care unit (ICU). Settings: A retrospective observational study was conducted in the 24-bedded multispecialty ICU of a 350 bedded tertiary care hospital over 8 months period, from January 2011 to August 2011. Critically, ill-patients with varied neurological symptomatology affecting the course of illness and ICU discharge were included. Neurolog...

  7. Intensive care for the adult population in Ireland: a multicentre study of intensive care population demographics

    OpenAIRE

    ,

    2008-01-01

    Introduction This prospective observational study was conducted to describe the nature of the intensive care population across Ireland, identify adherence to international benchmarks of practice, and describe patient outcomes in critically ill patients. Methods A prospective observational multicentre study of demographics and organ failure incidence was carried out over a 10-week period in 2006 across the intensive care units (ICUs) of 14 hospitals in both the Republic and Northern Ireland. R...

  8. Direct observation of the nutrition care practices of Australian general practitioners

    Directory of Open Access Journals (Sweden)

    Ball LE

    2014-06-01

    Full Text Available INTRODUCTION: Nutrition care refers to nutrition-related advice or counselling provided by health professionals in an attempt to improve the nutrition behaviour of patients. AIM: The aim of this study was to describe the practices of a sample of Australian general practitioners (GPs when providing nutrition care to adult patients. METHODS: Eighteen GPs (13 male, 5 female were observed by fourth-year medical students during their general practice rotation. Each GP was observed for five consultations that included nutrition care, totalling 90 observed consultations. In each consultation, students completed a 31-item nutrition care checklist of nutrition care practices that could feasibly occur in a standard consultation. Each practice was marked with either a ‘yes’ (completed, ‘no’ (did not complete or ‘completed by practice nurse prior to or after the consultation’. RESULTS: Twenty-eight nutrition care practices were observed at least once. The most frequently observed practices were measuring and discussing blood pressure (76.7%; n=69, followed by general questions about current diet (74.4%; n=67. Approximately half of the consultations included a statement of a nutrition-related problem (52.2%; n=47, and the provision of nutrition advice that focused on a nutrient (45.6%; n=41 or food group (52.2%; n=47. Consultations with male GPs, as well as GPs with more than 25 years of experience, were associated with an increased number of nutrition care practices per consultation. DISCUSSION: The GPs performed nutrition care practices in varying frequencies. Further research is required to identify the most effective GP nutrition care practices to improve the nutrition behaviour of patients.

  9. The diagnosis of urinary tract infections in young children (DUTY: protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness

    Directory of Open Access Journals (Sweden)

    Downing Harriet

    2012-07-01

    Full Text Available Abstract Background Urinary tract infection (UTI is common in children, and may cause serious illness and recurrent symptoms. However, obtaining a urine sample from young children in primary care is challenging and not feasible for large numbers. Evidence regarding the predictive value of symptoms, signs and urinalysis for UTI in young children is urgently needed to help primary care clinicians better identify children who should be investigated for UTI. This paper describes the protocol for the Diagnosis of Urinary Tract infection in Young children (DUTY study. The overall study aim is to derive and validate a cost-effective clinical algorithm for the diagnosis of UTI in children presenting to primary care acutely unwell. Methods/design DUTY is a multicentre, diagnostic and prospective observational study aiming to recruit at least 7,000 children aged before their fifth birthday, being assessed in primary care for any acute, non-traumatic, illness of ≤ 28 days duration. Urine samples will be obtained from eligible consented children, and data collected on medical history and presenting symptoms and signs. Urine samples will be dipstick tested in general practice and sent for microbiological analysis. All children with culture positive urines and a random sample of children with urine culture results in other, non-positive categories will be followed up to record symptom duration and healthcare resource use. A diagnostic algorithm will be constructed and validated and an economic evaluation conducted. The primary outcome will be a validated diagnostic algorithm using a reference standard of a pure/predominant growth of at least >103, but usually >105 CFU/mL of one, but no more than two uropathogens. We will use logistic regression to identify the clinical predictors (i.e. demographic, medical history, presenting signs and symptoms and urine dipstick analysis results most strongly associated with a positive urine culture result. We will

  10. Do the methods used to analyse missing data really matter? An examination of data from an observational study of Intermediate Care patients

    Directory of Open Access Journals (Sweden)

    Kaambwa Billingsley

    2012-06-01

    Full Text Available Abstract Background Missing data is a common statistical problem in healthcare datasets from populations of older people. Some argue that arbitrarily assuming the mechanism responsible for the missingness and therefore the method for dealing with this missingness is not the best option—but is this always true? This paper explores what happens when extra information that suggests that a particular mechanism is responsible for missing data is disregarded and methods for dealing with the missing data are chosen arbitrarily. Regression models based on 2,533 intermediate care (IC patients from the largest evaluation of IC done and published in the UK to date were used to explain variation in costs, EQ-5D and Barthel index. Three methods for dealing with missingness were utilised, each assuming a different mechanism as being responsible for the missing data: complete case analysis (assuming missing completely at random—MCAR, multiple imputation (assuming missing at random—MAR and Heckman selection model (assuming missing not at random—MNAR. Differences in results were gauged by examining the signs of coefficients as well as the sizes of both coefficients and associated standard errors. Results Extra information strongly suggested that missing cost data were MCAR. The results show that MCAR and MAR-based methods yielded similar results with sizes of most coefficients and standard errors differing by less than 3.4% while those based on MNAR-methods were statistically different (up to 730% bigger. Significant variables in all regression models also had the same direction of influence on costs. All three mechanisms of missingness were shown to be potential causes of the missing EQ-5D and Barthel data. The method chosen to deal with missing data did not seem to have any significant effect on the results for these data as they led to broadly similar conclusions with sizes of coefficients and standard errors differing by less than 54% and 322

  11. Personality traits in chronic daily headache patients with and without psychiatric comorbidity: an observational study in a tertiary care headache center

    OpenAIRE

    Rausa, Marialuisa; Cevoli, Sabina; Sancisi, Elisa; Grimaldi, Daniela; Pollutri, Gabriella; Casoria, Michela; Grieco, Daniela; Bisi, Alberto; Cortelli, Pietro; Pozzi, Euro; Pierangeli, Giulia

    2013-01-01

    Background Previous studies suggest that patients with Chronic Daily Headache (CDH) have higher levels of anxiety and depressive disorders than patients with episodic migraine or tension-type headache. However, no study has considered the presence of psychiatric comorbidity in the analysis of personality traits. The aim of this study is to investigate the prevalence of psychiatric comorbidity and specific personality traits in CDH patients, exploring if specific personality traits are associa...

  12. Electronic health record-based assessment of oral corticosteroid use in a population of primary care patients with asthma: an observational study

    OpenAIRE

    Allen-Ramey, Felicia C; Nelsen, Linda M; Leader, Joseph B; Mercer, Dione; Kirchner, Henry Lester; Jones, James B

    2013-01-01

    Background Oral corticosteroid prescriptions are often used in clinical studies as an indicator of asthma exacerbations. However, there is rarely the ability to link a prescription to its associated diagnosis. The objective of this study was to characterize patterns of oral corticosteroid prescription orders for asthma patients using an electronic health record database, which links each prescription order to the diagnosis assigned at the time the order was placed. Methods This was a retrospe...

  13. Expanding a Care Network for People with Dementia and their Carers Through Musicking: Participant Observation with

    Directory of Open Access Journals (Sweden)

    Mariko Hara

    2011-07-01

    Full Text Available Normal 0 0 2 false false false EN-US JA X-NONE MicrosoftInternetExplorer4 Music use in dementia care often takes place within a music therapy context, where music therapy sessions aim to reduce agitated behaviour, access emotions or enhance inter-personal communication. Such sessions usually take place within care homes and their effect has been evaluated by a number of studies. However, there is little research on music use that takes place outside of care homes (e.g. in community centres for people with dementia who are cared for at home by their family. This paper discusses this type of music use, focusing on the meaning of weekly local music making activities in relation to every day dementia care. I use empirical data from a study of a community based music activity called "Singing for the Brain" (SFTB run by the Alzheimer's Society in the UK. The data was collected through extensive participant observation research and interviews with organisers, carers and care receivers. The preliminary findings from the data analysis are discussed: how SFTB can be seen as a ecological practice; its various “spin-off’ effects in the everyday care of the members with dementia; how SFTB, together with other local music groups, constitute the music and care world in the town; and how this develops into fluid support networks to support local people with dementia and their carers.

  14. Caring School Leadership: A South African Study

    Science.gov (United States)

    van der Vyver, Cornelius P.; van der Westhuizen, Philip C.; Meyer, L. W.

    2014-01-01

    The research pivoted on the question whether South African school principals fulfilled their caring role towards teachers. The aims of the study were threefold. First, to determine how principals rated their care-giving, secondly to determine whether significant discrepancies existed between principals' rating of their care-giving and…

  15. 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...

  16. B-type natriuretic peptide measurement in primary care; magnitude of associations with cardiovascular risk factors and their therapies. Observations from the STOP-HF (St. Vincent's Screening TO Prevent Heart Failure) study.

    LENUS (Irish Health Repository)

    Conlon, Carmel M

    2012-02-01

    BACKGROUND: An effective prevention strategy for heart failure in primary care requires a reliable screening tool for asymptomatic ventricular dysfunction. Preliminary data indicate that B-type natriuretic peptide (BNP) may be suitable for this task. However, for the most effective use of this peptide, the interrelationships between associated risk factors and their therapies on BNP, and in particular their magnitude of effect, needs to be established in a large primary care population. Therefore, the objective of the study was to establish the extent of the association between BNP, cardiovascular risk factors and their therapies. METHODS: BNP measurement and clinical review was preformed on 1122 primary care patients with cardiovascular risk factors. Multivariate analyses identified significant associates of BNP concentrations which were further explored to establish the magnitude of their association. RESULTS: Associates of BNP were age (1.36-fold increase in BNP\\/decade), female (1.28), beta-blockers (1.90), myocardial infarction (1.36), arrhythmia (1.98), diastolic blood pressure; all p<0.01. A novel method was devised that plotted median BNP per sliding decade of age for the various combinations of these principal associates. CONCLUSIONS: The data presented underline the importance of considering several clinical and therapeutic factors when interpreting BNP concentrations. Most of these variables were associated with increased concentrations, which may in part explain the observed false-positive rates for detecting ventricular dysfunction using this peptide. Furthermore, the design of studies or protocols using BNP as an endpoint or a clinical tool should take particular account of these associations. This analysis provides the foundation for age, risk factor and therapy adjusted reference ranges for BNP in this setting.

  17. Effects of the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) on biomedical outcomes, observed cardiovascular events and cardiovascular risks in primary care: a longitudinal comparative study

    OpenAIRE

    Jiao, Fang Fang; Fung, Colman Siu Cheung; Wong, Carlos King Ho; Wan, Yuk Fai; Dai, Daisy; Kwok, Ruby; Lam, Cindy Lo Kuen

    2014-01-01

    Background To assess whether the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) led to improvements in biomedical outcomes, observed cardiovascular events and predicted cardiovascular risks after 12-month intervention in the primary care setting. Methods A random sample of 1,248 people with diabetes enrolled to RAMP-DM for at least 12 months was selected and 1,248 people with diabetes under the usual primary care were matched by age, sex...

  18. Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals -- interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies

    Directory of Open Access Journals (Sweden)

    English Mike

    2011-12-01

    Full Text Available Abstract Background We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we use data from these multiple studies and insights gained from being participants in and observers of the intervention process to provide our explanation of how intervention effects were achieved as part of an effort to better understand implementation in low-income hospital settings. Methods Initial hypotheses were generated to explain the variation in intervention effects across place, time, and effect measure (indicator based on our understanding of theory and informed by our implementation experience and participant observations. All data sources available for hospitals considered as cases for study were then examined to determine if hypotheses were supported, rejected, or required modification. Data included transcriptions of interviews and group discussions, field notes and that from the detailed longitudinal quantitative investigation. Potentially useful explanatory themes were identified, discussed by the implementing and research team, revised, and merged as part of an iterative process aimed at building more generic explanatory theory. At the end of this process, findings were mapped against a recently reported comprehensive framework for implementation research. Results A normative re-educative intervention approach evolved that sought to reset norms and values concerning good practice and promote 'grass-roots' participation to improve delivery of correct care. Maximal effects were achieved when this strategy and external support supervision helped

  19. Nurses' experiences of futile care at intensive care units: a phenomenological study.

    Science.gov (United States)

    Yekefallah, Leili; Ashktorab, Tahereh; Manoochehri, Houman; Hamid, Alavi Majd

    2015-01-01

    The concept and meaning of futile care depends on the existing culture, values, religion, beliefs, medical achievements and emotional status of a country. We aimed to define the concept of futile care in the viewpoints of nurses working in intensive care units (ICUs). In this phenomenological study, the experiences of 25 nurses were explored in 11 teaching hospitals affiliated to Social Security Organization in Ghazvin province in the northwest of Iran. Personal interviews and observations were used for data collection. All interviews were recorded as well as transcribed and codes, subthemes and themes were extracted using Van Manen's analysis method. Initially, 191 codes were extracted. During data analysis and comparison, the codes were reduced to 178. Ultimately, 9 sub-themes and four themes emerged: uselessness, waste of resources, torment, and aspects of futility.Nurses defined futile care as "useless, ineffective care giving with wastage of resources and torment of both patients and nurses having nursing and medical aspects" As nurses play a key role in managing futile care, being aware of their experiences in this regard could be the initial operational step for providing useful care as well as educational programs in ICUs. Moreover, the results of this study could help nursing managers adopt supportive approaches to reduce the amount of futile care which could in turn resolve some of the complications nurses face at these wards such as burnout, ethical conflicts, and leave. PMID:25946928

  20. Who cares in England and Wales? The Positive Care Law: cross-sectional study

    OpenAIRE

    Shaw, Mary; Dorling, Danny

    2004-01-01

    Background: The inverse care law proposing that medical services are distributed inversely to population health needs, and that this law operates more completely where medical care is most exposed to market forces, was first suggested by Tudor Hart in 1971. This paper considers whether an inverse care law can be observed for the provision of informal care as well as for medical care.

  1. Compliance of Healthcare Workers with Hand Hygiene Practices in Neonatal and Pediatric Intensive Care Units: Overt Observation

    OpenAIRE

    Ayşe Karaaslan; Eda Kepenekli Kadayifci; Serkan Atıcı; Uluhan Sili; Ahmet Soysal; Gülcan Çulha; Yasemin Pekru; Mustafa Bakır

    2014-01-01

    Background. The objective of this study was to assess the compliance of hand hygiene (HH) of healthcare workers (HCWs) in the neonatal and pediatric intensive care unit in a tertiary university hospital in Istanbul. Methods. An observational study was conducted on the compliance of HH for the five World Health Organization (WHO) indications. HCWs were observed during routine patient care in day shift. The authors also measured the technique of HH through hand washing or hand hygiene with alco...

  2. Observational Studies: Matching or Regression?

    Science.gov (United States)

    Brazauskas, Ruta; Logan, Brent R

    2016-03-01

    In observational studies with an aim of assessing treatment effect or comparing groups of patients, several approaches could be used. Often, baseline characteristics of patients may be imbalanced between groups, and adjustments are needed to account for this. It can be accomplished either via appropriate regression modeling or, alternatively, by conducting a matched pairs study. The latter is often chosen because it makes groups appear to be comparable. In this article we considered these 2 options in terms of their ability to detect a treatment effect in time-to-event studies. Our investigation shows that a Cox regression model applied to the entire cohort is often a more powerful tool in detecting treatment effect as compared with a matched study. Real data from a hematopoietic cell transplantation study is used as an example. PMID:26712591

  3. Epidemiology studies in critical care

    OpenAIRE

    Martin, Greg

    2006-01-01

    Epidemiology studies are an essential part of clinical research, often forming the foundation for studies ranked more highly in the hierarchy of evidence-based medicine. Studies of sepsis to date have been conducted on local, regional, national and international scales, with the majority conducted in the past 5 years. Longitudinal epidemiology studies convey an important additional aspect of the healthcare burden from disease, and may additionally serve to compare the effectiveness and effici...

  4. Explaining the effects of a multifaceted intervention to improve inpatient care in rural Kenyan hospitals -- interpretation based on retrospective examination of data from participant observation, quantitative and qualitative studies

    OpenAIRE

    English Mike; Nzinga Jacinta; Mbindyo Patrick; Ayieko Philip; Irimu Grace; Mbaabu Lairumbi

    2011-01-01

    Abstract Background We have reported the results of a cluster randomized trial of rural Kenyan hospitals evaluating the effects of an intervention to introduce care based on best-practice guidelines. In parallel work we described the context of the study, explored the process and perceptions of the intervention, and undertook a discrete study on health worker motivation because this was felt likely to be an important contributor to poor performance in Kenyan public sector hospitals. Here, we ...

  5. Observational study assessing demographic, economic and clinical factors associated with access and utilization of health care services of patients with multiple sclerosis under treatment with interferon beta-1b (EXTAVIA.

    Directory of Open Access Journals (Sweden)

    Georgios Hadjigeorgiou

    Full Text Available Multiple sclerosis (MS results in an extensive use of the health care system, even within the first years of diagnosis. The effectiveness and accessibility of the health care system may affect patients' quality of life. The aim of the present study was to evaluate the health care resource use of MS patients under interferon beta-1b (EXTAVIA treatment in Greece, the demographic or clinical factors that may affect this use and also patient satisfaction with the health care system. Structured interviews were conducted for data collection. In total, 204 patients (74.02% females, mean age (SD 43.58 (11.42 years were enrolled in the study. Analysis of the reported data revealed that during the previous year patients made extensive use of health services in particular neurologists (71.08% visited neurologists in public hospitals, 66.67% in private offices and 48.53% in insurance institutes and physiotherapists. However, the majority of the patients (52.45% chose as their treating doctor private practice neurologists, which may reflect accessibility barriers or low quality health services in the public health system. Patients seemed to be generally satisfied with the received health care, support and information on MS (84.81% were satisfied from the information provided to them. Patients' health status (as denoted by disease duration, disability status and hospitalization needs and insurance institute were found to influence their visits to neurologists. Good adherence (up to 70.1% to the study medication was reported. Patients' feedback on currently provided health services could direct these services towards the patients' expectations.

  6. The emerging primary care workforce: preliminary observations from the primary care team: learning from effective ambulatory practices project.

    Science.gov (United States)

    Ladden, Maryjoan D; Bodenheimer, Thomas; Fishman, Nancy W; Flinter, Margaret; Hsu, Clarissa; Parchman, Michael; Wagner, Edward H

    2013-12-01

    Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors' preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012-2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation-funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team. PMID:24128622

  7. Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

    Directory of Open Access Journals (Sweden)

    Kessy Flora

    2011-05-01

    Full Text Available Abstract Background The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. Methods Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. Results The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". Conclusions Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker

  8. [Semantic and conceptual equivalence of the observable indicatorsof Nursing Home Care Quality Instrument].

    Science.gov (United States)

    Oliveira, Wagner Ivan Fonseca de; Hernández, Pedro Jesus Saturno; Sousa, Kelienny de Meneses; Piuvezam, Grasiela; Gama, Zenewton André da Silva

    2016-06-01

    Long-term care facilities (LTCFs) for the elderly are an important health care alternative in the world, though Brazil does not yet have a valid instrument to monitor the quality of these institutions. This study sought to describe the initial stages of the cross-cultural adaptation of the Observable Indicators of Nursing Home Care Quality (OIQ) instrument used to assess the quality of care in LTCFs. Conceptual equivalence was conducted to assess the relevance and feasibility of the OIQ within the Brazilian context, using the Content Validity Index (CVI). The operational, idiomatic and semantic equivalence was then performed. This item consisted of 5 phases: (1) two translations; (2) the respective back translations; (3) formal appraisal; (4) review; and (5) application of the pre-test in three LTCFs. Significant changes were made to ensure the validity of the OIQ. The CVI instrument for the Brazilian contextwas 94.3% (viability) and 95.3% (relevance). The OIQ proved to be easy to understand and apply in the pre-test. Cross-cultural adaptation of the OIQ contributes to assessing and improving quality in Brazilian LTCFs, though the findings should be complemented by a psychometric evaluation of the instrument. PMID:27383357

  9. Nurses Use of Critical Care Pain Observational Tool in Patients with Low Consciousness

    Directory of Open Access Journals (Sweden)

    Ahmad-Ali Asadi-Noghabi

    2015-07-01

    Full Text Available Objectives: The diagnosis of pain in patients with low consciousness is a major challenge in the intensive care unit (ICU. Therefore, the use of behavioral tools for pain assessment could be an effective tool to manage pain in this group of patients. The aim of this study was to determine the effects on pain management by nurses using a critical care pain observational tool in patients with a decreased level of consciousness. Methods: Our research used a before and after design to evaluate the ability of nurses to manage pain in patients with low consciousness. A total of 106 ICU nurses were included in the study. The study was divided into three phases: pre-implementation, implementation, and post-implementation. The researchers first observed the nurses management of pain in their patients; this was done three times using a checklist following tracheal suctioning and position change procedures. The nurses were then taught how to apply the critical-care pain observational tool (CPOT. Post-implementation of the tool, the researchers re-evaluated trained the nurses’ pain management. Results: Performance scores after training improved with relation to the nurses diagnosis of pain, pharmacological and nonpharmacological actions, reassessment of pain, and re-relieving of any pain. However, use of the tool did not improve the recording of the patient’s pain and the relief measures used. Conclusion: Use of the CPOT can increase nurse’s sensitivity to pain in non-conscious patients and drive them to track and perform pain management.

  10. Observational Study of Travelers' Diarrhea.

    Science.gov (United States)

    Meuris

    1995-03-01

    Background: European air travelers returning from Algeria, Egypt, Mexico, Morocco, and Tunisia were interviewed about their experience of travelers' diseases upon arrival in Brussels. Diarrhea was mentioned by 37% of the adults and 27% of the children. These subjects were questioned about the types of measures taken, type and duration of drug treatment (if any), and about duration of diarrhea and side effects experienced. Methods: Final analysis was performed based on 2160 interviews. The largest proportion of diarrhea was reported in the age group 15-24 years (46%). Results: The majority of the 2160 subjects had opted for drug treatment (81%): 927 subjects for loperamide alone, 235 for loperamide in combination with nifuroxazide, and 178 for nifuroxazide alone. Other drugs had been used less frequently. The median time to recovery was 2.4 days with loperamide compared to 3.2 days with nifuroxazide and to 3.4 days for the no-treatment group. Conclusions: A stratification of the results by severity of the diarrhea suggests a rank of antidiarrheal potency as follows: loperamide > nifuroxazide > no-drug treatment. The side effect with the highest incidence was constipation (2.4% with loperamide). (J Travel Med 2:11-15, 1995) Travelers' diarrhea is usually defined as the passage of at least three unformed stools per day or any number of such stools when accompanied by fever, abdominal cramping, or vomiting. The definition may be broadened to include more trivial bowel disturbance.1,2 The duration of this self-limited disease generally is 3 to 5 days. Medical intervention aims at shortening the duration of disease, thus allowing the sufferer to resume his or her usual activities at an early stage. A shortened period of recovery to physical well-being has obvious favorable economic implications if the traveler is on business and may help the maintenance of a desired level of quality of life while a traveler is on holiday. An observational study of various medical

  11. Caring Teaching as a Moral Practice: An Exploratory Study on Perceived Dimensions of Caring Teaching

    Directory of Open Access Journals (Sweden)

    Khalil Gholami

    2012-01-01

    Full Text Available Caring teaching is a conceptual framework used to gain an insight into the moral aspect of teaching. Using a quantitative research approach, we studied 556 teachers in order to explore their perceived dimensions of caring teaching. Drawing on existing literature, we found that caring teaching has been elaborated in line with two broad concepts: personal care and academic care. Considering these concepts, we developed the Caring Teaching Scale with which we identified four dimensions of caring teaching: the nurturing of a student's character, didactical bias, awareness, and respectful didactics. A meta-analysis reflection suggests that the nurturing of students' characters and awareness represent personal care while didactical bias and respectful didactics call for academic care. Further analysis showed that these teachers attached more pedagogical value to personal care. Controlling for two demographic variables, we found statistically significant differences with regard to gender and caring teaching.

  12. Physical Therapy Observation and Assessment in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Byrne, Eilish; Campbell, Suzann K.

    2013-01-01

    This article presents the elements of the Observation and Assessment section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy assessments presented in this path are evidence-based and the suggested timing of these assessments is primarily based on practice knowledge from expert…

  13. UFOs: Observations, Studies and Extrapolations

    CERN Document Server

    Baer, T; Barnes, M J; Bartmann, W; Bracco, C; Carlier, E; Cerutti, F; Dehning, B; Ducimetière, L; Ferrari, A; Ferro-Luzzi, M; Garrel, N; Gerardin, A; Goddard, B; Holzer, E B; Jackson, S; Jimenez, J M; Kain, V; Zimmermann, F; Lechner, A; Mertens, V; Misiowiec, M; Nebot Del Busto, E; Morón Ballester, R; Norderhaug Drosdal, L; Nordt, A; Papotti, G; Redaelli, S; Uythoven, J; Velghe, B; Vlachoudis, V; Wenninger, J; Zamantzas, C; Zerlauth, M; Fuster Martinez, N

    2012-01-01

    UFOs (“ Unidentified Falling Objects”) could be one of the major performance limitations for nominal LHC operation. Therefore, in 2011, the diagnostics for UFO events were significantly improved, dedicated experiments and measurements in the LHC and in the laboratory were made and complemented by FLUKA simulations and theoretical studies. The state of knowledge is summarized and extrapolations for LHC operation in 2012 and beyond are presented. Mitigation strategies are proposed and related tests and measures for 2012 are specified.

  14. Peripheral artery disease assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherothrombosis - CAREFUL Study: A national, multi-center, cross-sectional observational study

    Directory of Open Access Journals (Sweden)

    Tabak Omur

    2011-01-01

    Full Text Available Abstract Background To investigate the presence of peripheral artery disease (PAD via the ankle brachial index (ABI in patients with known cardiovascular and/or cerebrovascular diseases or with at least one risk factor for atherothrombosis. Methods Patients with a history of atherothrombotic events, or aged 50-69 years with at least one cardiovascular risk factor, or > = 70 years of age were included in this multicenter, cross-sectional, non-interventional study (DIREGL04074. Demographics, medical history, physical examination findings, and physician awareness of PAD were analyzed. The number of patients with low ABI ( Results A total of 530 patients (mean age, 63.4 ± 8.7 years; 50.2% female were enrolled. Hypertension and dyslipidemia were present in 88.7% and 65.5% of patients, respectively. PAD-related symptoms were evident in about one-third of the patients, and at least one of the pedal pulses was negative in 6.5% of patients. The frequency of low ABI was 20.0% in the whole study population and 30% for patients older than 70 years. Older age, greater number of total risk factors, and presence of PAD-related physical findings were associated with increased likelihood of low ABI (p Conclusion Our results indicate that advanced age, greater number of total risk factors and presence of PAD-related physical findings were associated with increased likelihood of low ABI. These findings are similar to those reported in similar studies of different populations, and document a fairly high prevalence of PAD in a Mediterranean country.

  15. Drug reaction with eosinophilia and systemic symptoms: Observations from a tertiary care institution

    Directory of Open Access Journals (Sweden)

    Sarita Sasidharanpillai

    2014-01-01

    Full Text Available Background: Drug reaction with eosinophilia and systemic symptoms (DRESS is a severe drug reaction which can mimic a viral infection, an autoimmune disease or a neoplastic disease. Aims: To study the clinical and epidemiological aspects of DRESS and to identify the precipitating drugs. Methods: All patients admitted to the dermatology ward of our tertiary care hospital from 1 st October 2010 to 30 th September 2013 with probable or definite DRESS as per the RegiSCAR scoring system were included in this prospective study. The clinical manifestations observed in the study population were studied and the common offending drugs were identified. Results: During the 3 year study period, 26 patients fulfilled criteria for probable or definite DRESS. In more than 50% of cases, the culprit drug was phenytoin. Most common symptoms observed were fever, rash and facial edema. Liver was the most common internal organ affected. Most of the patients responded to withdrawal of the drug and administration of steroids for 3-6 weeks. One patient with dapsone-induced DRESS died. Conclusions: Intense facial erythema and edema and an elevated eosinophil count were not found to be bad prognostic factors. In most instances the flare ups during the course of the disease could be managed with a slower tapering of steroids. More prospective studies on DRESS are required to assess the prognostic factors and to formulate better diagnostic criteria.

  16. Expanding a Care Network for People with Dementia and their Carers Through Musicking: Participant Observation with

    OpenAIRE

    Mariko Hara

    2011-01-01

    Music use in dementia care often takes place within a music therapy context, where music therapy sessions aim to reduce agitated behaviour, access emotions or enhance inter-personal communication. Such sessions usually take place within care homes and their effect has been evaluated by a number of studies. However, there is little research on music use that takes place outside of care homes (e.g. in community centres) for people with dementia who are cared for at home by their family. This...

  17. Study of Early Child Care and Youth Development (SECCYD)

    Science.gov (United States)

    ... NICHD Science Advances Supported Networks, Programs & Initiatives NICHD Study of Early Child Care and Youth Development (SECCYD) ... Sunsetted/For Reference Only The NICHD started the Study of Early Child Care and Youth Development (SECCYD), ...

  18. An observation of impact of neurological consultations in intensive care patients: Case series of 23 patients

    Directory of Open Access Journals (Sweden)

    Kanwalpreet Sodhi

    2013-01-01

    Full Text Available Objective: The objective of the present study was to assess the impact of neurological consultation and intervention upon patient outcome in intensive care unit (ICU. Settings: A retrospective observational study was conducted in the 24-bedded multispecialty ICU of a 350 bedded tertiary care hospital over 8 months period, from January 2011 to August 2011. Critically, ill-patients with varied neurological symptomatology affecting the course of illness and ICU discharge were included. Neurological consult sought for, investigations ordered by the neurologist, interventions carried out, treatment started and the impact of such treatment on the outcome of patients were noted. The length of ICU stay was also noted. Results: Over a period of 8 months, there were 864 ICU admissions. On neurological consult, 23 patients had a positive finding affecting the outcome: 5 patients were diagnosed to have parkinson′s disease, 4 patients had neuromuscular disease, 9 patients had high creatinine phosphokinase levels, 2 patients had restless legs syndrome and 3 patients were diagnosed to have seizure disorder. Conclusions: On being examined and investigated by neurologist, a variety of co-existing neurological disorders could be diagnosed and if managed early, patients had a faster recovery, rapid weaning and early discharge from the ICU.

  19. Transitional care in skilled nursing facilities: a multiple case study

    OpenAIRE

    Toles, Mark; Colón-Emeric, Cathleen; Naylor, Mary D; Barroso, Julie; Anderson, Ruth A.

    2016-01-01

    Background Among hospitalized older adults who transfer to skilled nursing facilities (SNF) for short stays and subsequently transfer to home, twenty two percent require additional emergency department or hospital care within 30 days. Transitional care services, that provide continuity and coordination of care as older adults transition between settings of care, decrease complications during transitions in care, however, they have not been examined in SNFs. Thus, this study described how exis...

  20. Teacher-Child Interactions during Mealtimes: Observations of Toddlers in High Subsidy Child Care Settings

    Science.gov (United States)

    Hallam, Rena A.; Fouts, Hillary N.; Bargreen, Kaitlin N.; Perkins, Kelley

    2016-01-01

    In the U.S., experiences of infants and toddlers in group care are often overshadowed by the policy and research focus on preschool education just prior to formal school entry. When infant-toddler care is studied, it is often described relative to the global quality of classroom environments. Little research has focused on the day-to-day…

  1. Nurses' Perceptions of Futile Care: A Qualitative Study.

    Science.gov (United States)

    Aghabarary, Maryam; Nayeri, Nahid Dehghan

    2016-01-01

    Health care professionals believe that futile care must not be provided; however, there is no clear agreement over the definition and the manifestations of futile care. The aim of this study was to explore Iranian nurses' perceptions of futile care. In this qualitative exploratory study, the conventional content analysis approach was used for collecting and analyzing the study data. Three main themes were extracted from the data: nonfutility of care: care tantamount with outcome; sense of burnout; and subjectivity and relativity of medical futility concept. PMID:26633723

  2. Transforming youth care through online simulation gaming. Aligning the positions of practitioners and observers

    Directory of Open Access Journals (Sweden)

    Kees JM van Haaster

    2014-09-01

    Full Text Available Transforming youth care through online simulation gaming. Aligning the positions of practitioners and observersThe youth care service in the Netherlands is currently undergoing a major transition from national and regional finance and control to localized regulation and responsibility. The aim is to initiate a transformation towards greater intervention value and to support greater self-reliance in social networks. Effective youth care depends largely on the quality of the network exchange. If efficiency is our concern, we should look into the methods and techniques of network exchange. When it comes to solving hard problems, the significance of situational knowledge construction and network coordination must not be underrated. Professional deliberation is directed toward understanding, acting and analysis. We need smart and flexible ways to direct systems information from practice to network reflection, and to guide results from network consultation to practice.This article presents a proposal for a case study, as a follow-up to a recent dissertation about online simulation gaming for youth care network exchange (Van Haaster, 2014. The results of that research show that it is a valuable exercise to model intricate issues from practice using simulation game design and that youth care professionals appreciate the relevance, usability and usefulness of this new tool. The question in this paper is how to develop a practicable approach using online simulation gaming to improve patterns of action and reflection on dilemmas and hard-to-solve problems in youth care practice. Child-rearing conditions and family behaviour are usually enhanced through sequences of exploration, experimentation and evaluation. Step-by-step progressions are characterized by balancing acting and thinking. The author elaborates this observation through a model that alternates acting in practice with retrospect and prospect reflection in online game sessions

  3. Quality of pharmaceutical care at the pharmacy counter: patients’ experiences versus video observation

    Directory of Open Access Journals (Sweden)

    Koster ES

    2016-03-01

    Full Text Available Ellen S Koster,1 Lyda Blom,1 Marloes R Overbeeke,1 Daphne Philbert,1 Marcia Vervloet,2 Laura Koopman,2,3 Liset van Dijk2 1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, the Netherlands; 2Netherlands Institute of Health Services Research (NIVEL, Utrecht, the Netherlands; 3National Health Care Institute, Diemen, the Netherlands Introduction: Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences.Objective: To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations.Methods: Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients’ experiences regarding information provision, medication counseling, and pharmacy staff’s communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients’ experiences was calculated.Results: In total, 109 encounters were included for analysis. For the domains “medication counseling” and “communication style”, agreement between patients’ experiences and observations was very high (>90%. Less agreement (45% was found for “information provision”, which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients’ questioning behavior.Conclusion: A questionnaire is useful to assess the quality of medication counseling and pharmacy staff’s communication style, but might be less suitable to evaluate information provision and pharmacy staff’s encouragement of patients’ questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during

  4. Does prenatal care benefit maternal health? A study of post-partum maternal care use.

    Science.gov (United States)

    Liu, Tsai-Ching; Chen, Bradley; Chan, Yun-Shan; Chen, Chin-Shyan

    2015-10-01

    Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section. PMID:26189913

  5. A qualitative study on hypertensive care behavior in primary health care settings in Malaysia

    Directory of Open Access Journals (Sweden)

    Shima R

    2014-11-01

    Full Text Available Razatul Shima,1,3 Mohd Hairi Farizah,1,2 Hazreen Abdul Majid1,2 1Department of Social and Preventive Medicine; 2Centre for Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Ministry of Health Malaysia, Putrajaya, Malaysia Purpose: The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes in primary health clinic settings. Patients and methods: A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.Results: There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.Conclusion: Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their

  6. A Comprehensive Observational Coding Scheme for Analyzing Instrumental, Affective, and Relational Communication in Health Care Contexts

    OpenAIRE

    Siminoff, Laura A.; STEP, MARY M.

    2011-01-01

    Many observational coding schemes have been offered to measure communication in health care settings. These schemes fall short of capturing multiple functions of communication among providers, patients, and other participants. After a brief review of observational communication coding, the authors present a comprehensive scheme for coding communication that is (a) grounded in communication theory, (b) accounts for instrumental and relational communication, and (c) captures important contextua...

  7. Quality of pharmaceutical care at the pharmacy counter: patients’ experiences versus video observation

    Science.gov (United States)

    Koster, Ellen S; Blom, Lyda; Overbeeke, Marloes R; Philbert, Daphne; Vervloet, Marcia; Koopman, Laura; van Dijk, Liset

    2016-01-01

    Introduction Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences. Objective To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Methods Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients’ experiences regarding information provision, medication counseling, and pharmacy staff’s communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients’ experiences was calculated. Results In total, 109 encounters were included for analysis. For the domains “medication counseling” and “communication style”, agreement between patients’ experiences and observations was very high (>90%). Less agreement (45%) was found for “information provision”, which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients’ questioning behavior. Conclusion A questionnaire is useful to assess the quality of medication counseling and pharmacy staff’s communication style, but might be less suitable to evaluate information provision and pharmacy staff’s encouragement of patients’ questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during the encounter. When using questionnaires to get insight into information provision, observations of encounters are very informative to validate the patient questionnaires and make necessary adjustments. PMID:27042025

  8. IMPACT ON HEALTH CARE DELIVERY SYSTEM DUE TO THE WORST FLOOD OF THE CENTURY IN KASHMIR, INDIA: AN OBSERVATIONAL ANALYSIS

    Directory of Open Access Journals (Sweden)

    Kouser

    2014-12-01

    Full Text Available INTRODUCTION: Flood is the most common natural disaster in the world both in the developed and developing nations. This year one of the greatest floods, worst in over a decade hit the nation in Jammu and Kashmir on 7th September 2014, due to continuous downpour for about 4 days. Study design: Observational. RESULTS: SKIMS Medical College and Hospital, Bemina was inundated first followed by the oldest tertiary care SMHS hospital. Health care was affected at all the three levels viz. primary, secondary and tertiary the total losses to the health care was estimated to be 200 million. CONCLUSION: More than 1.5 million of the population was affected. People were rendered homeless. Unlike flash flood the present flood in Kashmir was a plain flood which occurs due to extensive rainfall lasting several days.

  9. Older Persons’ Transitions in Care (OPTIC: a study protocol

    Directory of Open Access Journals (Sweden)

    Cummings Greta G

    2012-12-01

    Full Text Available Abstract Background Changes in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH residents and necessitate transitions between NHs and Emergency Departments (EDs. During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adults who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to: 1. define successful and unsuccessful elements of transitions from multiple perspectives; 2. develop and test a practical tool to assess transition success; 3. assess transition processes in a discrete set of transfers in two study sites over a one year period; 4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS, and EDs, on transition success; and 5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH – ED transitions. Methods/Design This is a mixed-methods observational study incorporating an integrated knowledge translation (IKT approach. It uses data from multiple levels (facility, care unit, individual and sources (healthcare providers, residents, health records, and administrative databases. Discussion Key to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and

  10. Ways of learning: Observational studies versus experiments

    Science.gov (United States)

    Shaffer, T.L.; Johnson, D.H.

    2008-01-01

    Manipulative experimentation that features random assignment of treatments, replication, and controls is an effective way to determine causal relationships. Wildlife ecologists, however, often must take a more passive approach to investigating causality. Their observational studies lack one or more of the 3 cornerstones of experimentation: controls, randomization, and replication. Although an observational study can be analyzed similarly to an experiment, one is less certain that the presumed treatment actually caused the observed response. Because the investigator does not actively manipulate the system, the chance that something other than the treatment caused the observed results is increased. We reviewed observational studies and contrasted them with experiments and, to a lesser extent, sample surveys. We identified features that distinguish each method of learning and illustrate or discuss some complications that may arise when analyzing results of observational studies. Findings from observational studies are prone to bias. Investigators can reduce the chance of reaching erroneous conclusions by formulating a priori hypotheses that can be pursued multiple ways and by evaluating the sensitivity of study conclusions to biases of various magnitudes. In the end, however, professional judgment that considers all available evidence is necessary to render a decision regarding causality based on observational studies.

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

    OpenAIRE

    Hermenau, Katharin; Kaltenbach, Elisa; Mkinga, Getrude; Hecker, Tobias

    2015-01-01

    Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy...

  12. Observation on dengue cases from a virus diagnostic laboratory of a tertiary care hospital in north India

    OpenAIRE

    Om Prakash; Desh Deepak Singh; Geetika Mishra; Shantanu Prakash; Arvind Singh; Shikha Gupta; Jasmeet Singh; Danish Nasar Khan; Parul Jain; Anamika Vishal; Manoj Kumar Pandey; Amita Jain

    2015-01-01

    Background & objectives: The epidemiology of dengue fever (DF) is complex in the Indian subcontinent as all the four serotypes are circulating. This study reports observations on dengue cases from a virus diagnostic laboratory of a north Indian tertiary care hospital catering to areas in and around Lucknow, Uttar Pradesh. Methods: Serum samples were obtained from suspected cases of dengue referred to the virus diagnostic laboratory during 2011 to 2013, and detailed history was taken on a ...

  13. STRengthening analytical thinking for observational studies

    DEFF Research Database (Denmark)

    Altman, Douglas G.; le Cessie, Saskia; Abrahamowicz, Michal;

    2014-01-01

    The validity and practical utility of observational medical research depends critically on good study design, excellent data quality, appropriate statistical methods and accurate interpretation of results. Statistical methodology has seen substantial development in recent times. Unfortunately, ma...

  14. Observing Protein & Energy Nutrition (OPEN) Study

    Science.gov (United States)

    The Observing Protein and Energy Nutrition (OPEN) Study was designed to assess dietary measurement error by comparing results from self-reported dietary intake data with four dietary biomarkers: doubly labeled water and urinary nitrogen, sodium, and potassium.

  15. Postoperative Residual Curarization: Clinical Observation in the Post-anesthesia Care Unit

    Directory of Open Access Journals (Sweden)

    Ming-Shan Chen

    2008-08-01

    Full Text Available Background: Neuromuscular blocking agents (NMBAs are widely used during the inductionand maintenance of anesthesia. Postoperative residual curarization(PORC following the use of NMBAs still occurs even though intermediateactingNMBAs were used. Train-of-four (TOF stimulation is used to quantifythe degree of neuromuscular blockade. The TOF ratio of 0.7 in the adductorpollicis muscle was associated with normal respiratory function.Pharyngeal function returned to normal while the TOF ratio reached 0.9. Theaim of this study was to survey the PORC in the post-anesthesia care unit(PACU.Methods: In this observational study, 308 patients who received general anesthesiawith NMBAs were enrolled. Residual curarization was evaluated using theTOF-Watch acceleromyograph upon arrival in the PACU. Three consecutiveTOF stimulations were applied and recorded at 15-second intervals. Twothresholds of TOF ratios (0.9 and 0.7 were used to assess the presence ofresidual curarization.Results: TOF ratios less than 0.7 and 0.9 were observed in 15 (5%, and 97 (31%patients, respectively. The differences of the TOF ratios between the maleand female patients were significant (p = 0.014. In terms of weight, the differencesbetween the patients with ratios > 0.9 and ≦ 0.9 were significant (p= 0.013. There were 67, 49, 15, and three patients who received reversalmedication in the > 0.9 group, ≦ 0.9 and > 0.7 group, and ≦ 0.7 group,respectively. The differences of the TOF ratios between the patients whoreceived and those who did not receive reversal medication were not significant(p = 0.91.Conclusion: PORC is still a clinical problem in the modern PACU. Objective neuromuscularmonitoring needs to be performed to ensure patient safety.

  16. Video techniques and data compared with observation in emergency trauma care

    OpenAIRE

    Mackenzie, C; Xiao, Y.

    2003-01-01

    Video recording is underused in improving patient safety and understanding performance shaping factors in patient care. We report our experience of using video recording techniques in a trauma centre, including how to gain cooperation of clinicians for video recording of their workplace performance, identify strengths of video compared with observation, and suggest processes for consent and maintenance of confidentiality of video records. Video records are a rich source of data for documentin...

  17. Mental disorders in cancer patients: observations at a tertiary care centre in Pakistan

    International Nuclear Information System (INIS)

    To study the frequencies of metal disorders among adult cancer patients in relation to their age, gender, marital status and type of malignancy. Socio-demographic characteristics and cancer diagnoses were recorded on a data capture form. diagnoses of metal disorders were made on the basis of diagnostic and statistical manual (DSM-IV) fourth edition. Shuakat Khanum Memorial Hospital and Research Centre. Two hundred and twenty newly diagnosed cancer patients were interviewed by a clinical psychologist before commencing any cancer treatment. Diagnosis of any metal disorder was transcribed using DSM-IV criteria and data thus collected were analyzed using SPSS for Windows. Observed frequencies of various metal disorders were compared with respect to patient's age, gender, martial status and type of cancer. Sixty five percent patients presented with various mental disorder. Adjusting disorders and mood disorders accounted for 34% each, while anxiety disorder was seen in 30% and remaining had delirium and somatoform disorders. Mental disorders were more common in males, and in younger age group. The oncologist and physicians treating cancer patients should carefully evaluate their patients for symptom of associated mental disorder and provide the required clinical support. (author)

  18. [The Strengthening the Reporting of Observational Studies in Epidemiology [STROBE] statement: guidelines for reporting observational studies

    DEFF Research Database (Denmark)

    Elm, E. von; Altman, D.G.; Egger, M.;

    2008-01-01

    Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed rec...

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

    Science.gov (United States)

    Divatia, Jigeeshu V.; Amin, Pravin R.; Ramakrishnan, Nagarajan; Kapadia, Farhad N.; Todi, Subhash; Sahu, Samir; Govil, Deepak; Chawla, Rajesh; Kulkarni, Atul P.; Samavedam, Srinivas; Jani, Charu K.; Rungta, Narendra; Samaddar, Devi Prasad; Mehta, Sujata; Venkataraman, Ramesh; Hegde, Ashit; Bande, BD; Dhanuka, Sanjay; Singh, Virendra; Tewari, Reshma; Zirpe, Kapil; Sathe, Prachee

    2016-01-01

    Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). Patients and Methods: An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. Results: On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. Conclusions: The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

  20. Radiotherapy care experience: an anthropological study

    International Nuclear Information System (INIS)

    An anthropological study has been carried out in order to evaluate the need expressed by patients undergoing radiotherapy treatment. The study was mostly qualitative and based on the radiotherapy experiences of 13 women with breast cancer and six men with head and neck cancer. A 24-year-old female anthropologist spent one year in the department of radiotherapy at the Bergonie Institute in Bordeaux. She collected data on patients' needs through the observation of their experience of treatment and personal interviews. These were put in context, analyzed both by qualitative and quantitative methods. The results pointed out the need for more information on the different steps of treatment and the patient's need 'for a smile'front the medical team; in other words, emphatic support. (author)

  1. [Critical reading of analytical observational studies].

    Science.gov (United States)

    García Villar, C; Marín León, I

    2015-11-01

    Analytical observational studies provide very important information about real-life clinical practice and the natural history of diseases and can suggest causality. Furthermore, they are very common in scientific journals. The aim of this article is to review the main concepts necessary for the critical reading of articles about radiological studies with observational designs. It reviews the characteristics that case-control and cohort studies must have to ensure high quality. It explains a method of critical reading that involves checking the attributes that should be evaluated in each type of article using a structured list of specific questions. It underlines the main characteristics that confer credibility and confidence on the article evaluated. Readers are provided with tools for the critical analysis of the observational studies published in scientific journals. PMID:26123855

  2. Variability in the Initial Costs of Care and One-Year Outcomes of Observation Services

    Directory of Open Access Journals (Sweden)

    Abbass, Ibrahim

    2015-05-01

    Full Text Available Introduction: The use of observation units (OUs following emergency departments (ED visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs and the one-year outcomes. Methods: The author retrospectively investigated medical insurance claims of 22,962 privately insured patients (2009-2011 admitted to 41 OUs. Outcomes included the one-year chest pain/cardiovascular related costs and primary and secondary outcomes. Primary outcomes included myocardial infarction, congestive heart failure, stroke or cardiac arrest, while secondary outcomes included revascularization procedures, ED revisits for angina pectoris or chest pain and hospitalization due to cardiovascular diseases. The author aggregated the adjusted costs and prevalence rates of outcomes for patients over OUs, and computed the weighted coefficients of variation (WCV to compare variations across OUs. Results: There was minimal variability in the initial costs of care (WCV=2.2%, while the author noticed greater variability in the outcomes. Greater variability were associated with the adjusted cardiovascular-related costs of medical services (WCV=17.6% followed by the adjusted prevalence odds ratio of patients experiencing primary outcomes (WCV=16.3% and secondary outcomes (WCV=10%. Conclusion: Higher variability in the outcomes suggests the need for more standardization of the observation services for chest pain patients. [West J Emerg Med. 2015;16(3:395–400.

  3. Structured personal care of type 2 diabetes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP)

    DEFF Research Database (Denmark)

    Hansen, Lars Jørgen; Siersma, Volkert Dirk; Beck-Nielsen, Henning; Olivarius, Niels

    2013-01-01

    This study is a 19 year observational follow-up of a pragmatic open multicentre cluster-randomised controlled trial of 6 years of structured personal diabetes care starting from diagnosis.......This study is a 19 year observational follow-up of a pragmatic open multicentre cluster-randomised controlled trial of 6 years of structured personal diabetes care starting from diagnosis....

  4. 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...

  5. Challenges for Infants’ Home Care: a Qualitative Study

    OpenAIRE

    Zeinab Hemati; Mahboobeh Namnabati; Friba Taleghani

    2016-01-01

    Background Home care is an acceptable strategy for the relationship between family and healthcare team and implementation of healthcare interventions, and infants’ nurses could play an important role in enhancing the capability of families and promoting child health in this area. This study examined challenges facing infants’ home care from nurses’ viewpoints in Iranian culture.Materials and MethodsA qualitative design was used to explain challenges facing infants’ home care from nurses’ view...

  6. Implementing a stepped-care approach in primary care: results of a qualitative study

    OpenAIRE

    Franx Gerdien; Oud Matthijs; de Lange Jacomine; Wensing Michel; Grol Richard

    2012-01-01

    Abstract Background Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC) was initiated in the Netherlands. Methods Alongside the QIC, an intervention study using a controlled before-and-after design was performed. Part of the study was a process evaluation, utilizing semi-structu...

  7. Diffusion of a collaborative care model in primary care: a longitudinal qualitative study

    OpenAIRE

    Vedel Isabelle; Ghadi Veronique; De Stampa Matthieu; Routelous Christelle; Bergman Howard; Ankri Joel; Lapointe Liette

    2013-01-01

    Background Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs). The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model's diffusion process. Methods We conducted a longitudinal case study based on the Diffusion of Innovations Th...

  8. Palliative care making a difference in rural Uganda, Kenya and Malawi: three rapid evaluation field studies

    Directory of Open Access Journals (Sweden)

    Bettega Nadia

    2011-05-01

    Full Text Available Abstract Background Many people live and die in pain in Africa. We set out to describe patient, family and local community perspectives on the impact of three community based palliative care interventions in sub-Saharan Africa. Methods Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: interviews with key informants, observations of clinical encounters and the local health and social care context, and routine data from local reports and statistics. Results We interviewed 33 patients with advanced illness, 27 family carers, 36 staff, 25 volunteers, and 29 community leaders and observed clinical care of 12 patients. In each site, oral morphine was being used effectively. Patients valued being treated with dignity and respect. Being supported at home reduced physical, emotional and financial burden of travel to, and care at health facilities. Practical support and instruction in feeding and bathing patients facilitated good deaths at home. In each country mobile phones enabled rapid access to clinical and social support networks. Staff and volunteers generally reported that caring for the dying in the face of poverty was stressful, but also rewarding, with resilience fostered by having effective analgesia, and community support networks. Conclusions Programmes were reported to be successful because they integrated symptom control with practical and emotional care, education, and spiritual care. Holistic palliative care can be delivered effectively in the face of poverty, but a public health approach is needed to ensure equitable provision.

  9. Embedding clinical interventions into observational studies.

    Science.gov (United States)

    Newman, Anne B; Avilés-Santa, M Larissa; Anderson, Garnet; Heiss, Gerardo; Howard, Wm James; Krucoff, Mitchell; Kuller, Lewis H; Lewis, Cora E; Robinson, Jennifer G; Taylor, Herman; Treviño, Roberto P; Weintraub, William

    2016-01-01

    Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed. PMID:26611435

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

    NARCIS (Netherlands)

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

    2006-01-01

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

  11. A Pilot Study of Nurses' Experience of Giving Spiritual Care

    Science.gov (United States)

    Deal, Belinda

    2010-01-01

    Using spiritual and religious resources gives patients and families strength to cope during a crisis, but nurses often do not offer spiritual care (Kloosterhouse & Ames, 2002). The purpose of this phenomenological study was to explore nurses" lived experience of giving spiritual care. A descriptive phenomenological approach was used to interview 4…

  12. Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era.

    Science.gov (United States)

    Barbero, Umberto; D'Ascenzo, Fabrizio; Nijhoff, Freek; Moretti, Claudio; Biondi-Zoccai, Giuseppe; Mennuni, Marco; Capodanno, Davide; Lococo, Marco; Lipinski, Michael J; Gaita, Fiorenzo

    2016-01-01

    Background. A large number of clinical and laboratory markers have been appraised to predict prognosis in patients with stable angina, but uncertainty remains regarding which variables are the best predictors of prognosis. Therefore, we performed a meta-analysis of studies in patients with stable angina to assess which variables predict prognosis. Methods. MEDLINE and PubMed were searched for eligible studies published up to 2015, reporting multivariate predictors of major adverse cardiac events (MACE, a composite endpoint of death, myocardial infarction, and revascularization) in patients with stable angina. Study features, patient characteristics, and prevalence and predictors of such events were abstracted and pooled with random-effect methods (95% CIs). Major adverse cardiovascular event (MACE) was the primary endpoint. Results. 42 studies (104,559 patients) were included. After a median follow-up of 57 months, cardiovascular events occurred in 7.8% of patients with MI in 6.2% of patients and need for repeat revascularization (both surgical and percutaneous) in 19.5% of patients. Male sex, reduced EF, diabetes, prior MI, and high C-reactive protein were the most powerful predictors of cardiovascular events. Conclusions. We show that simple and low-cost clinical features may help clinicians in identifying the most appropriate diagnostic and therapeutic approaches within the broad range of outpatients presenting with stable coronary artery disease. PMID:27239372

  13. Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era

    Directory of Open Access Journals (Sweden)

    Umberto Barbero

    2016-01-01

    Full Text Available Background. A large number of clinical and laboratory markers have been appraised to predict prognosis in patients with stable angina, but uncertainty remains regarding which variables are the best predictors of prognosis. Therefore, we performed a meta-analysis of studies in patients with stable angina to assess which variables predict prognosis. Methods. MEDLINE and PubMed were searched for eligible studies published up to 2015, reporting multivariate predictors of major adverse cardiac events (MACE, a composite endpoint of death, myocardial infarction, and revascularization in patients with stable angina. Study features, patient characteristics, and prevalence and predictors of such events were abstracted and pooled with random-effect methods (95% CIs. Major adverse cardiovascular event (MACE was the primary endpoint. Results. 42 studies (104,559 patients were included. After a median follow-up of 57 months, cardiovascular events occurred in 7.8% of patients with MI in 6.2% of patients and need for repeat revascularization (both surgical and percutaneous in 19.5% of patients. Male sex, reduced EF, diabetes, prior MI, and high C-reactive protein were the most powerful predictors of cardiovascular events. Conclusions. We show that simple and low-cost clinical features may help clinicians in identifying the most appropriate diagnostic and therapeutic approaches within the broad range of outpatients presenting with stable coronary artery disease.

  14. Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era

    Science.gov (United States)

    Barbero, Umberto; D'Ascenzo, Fabrizio; Nijhoff, Freek; Moretti, Claudio; Biondi-Zoccai, Giuseppe; Mennuni, Marco; Capodanno, Davide; Lococo, Marco; Lipinski, Michael J.; Gaita, Fiorenzo

    2016-01-01

    Background. A large number of clinical and laboratory markers have been appraised to predict prognosis in patients with stable angina, but uncertainty remains regarding which variables are the best predictors of prognosis. Therefore, we performed a meta-analysis of studies in patients with stable angina to assess which variables predict prognosis. Methods. MEDLINE and PubMed were searched for eligible studies published up to 2015, reporting multivariate predictors of major adverse cardiac events (MACE, a composite endpoint of death, myocardial infarction, and revascularization) in patients with stable angina. Study features, patient characteristics, and prevalence and predictors of such events were abstracted and pooled with random-effect methods (95% CIs). Major adverse cardiovascular event (MACE) was the primary endpoint. Results. 42 studies (104,559 patients) were included. After a median follow-up of 57 months, cardiovascular events occurred in 7.8% of patients with MI in 6.2% of patients and need for repeat revascularization (both surgical and percutaneous) in 19.5% of patients. Male sex, reduced EF, diabetes, prior MI, and high C-reactive protein were the most powerful predictors of cardiovascular events. Conclusions. We show that simple and low-cost clinical features may help clinicians in identifying the most appropriate diagnostic and therapeutic approaches within the broad range of outpatients presenting with stable coronary artery disease. PMID:27239372

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

    OpenAIRE

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

    2015-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

  17. Effective factors in providing holistic care: A qualitative study

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh

    2015-01-01

    Full Text Available Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses′ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  18. Experiences of person-centred care - patients’ perceptions: qualitative study

    OpenAIRE

    Alharbi, Tariq Saleem J; Carlström, Eric; Ekman, Inger; Jarneborn, Anders; Olsson, Lars-Eric

    2014-01-01

    Background Patient care models have been implemented and documented worldwide. Many studies have focused on features that hinder and facilitate the shift to such models, including the implementation process, staff involvement, resistance to new models and cultural dimensions. However, few studies have identified the potential effects of such new care models from a patient perspective. The aim of the present study was to investigate whether patients did in fact perceive the intentions of partn...

  19. Quality of life related to oral mucositis of patients undergoing haematopoietic stem cell transplantation and receiving specialised oral care with low-level laser therapy: a prospective observational study.

    Science.gov (United States)

    Bezinelli, L M; Eduardo, F P; Neves, V D; Correa, L; Lopes, R M G; Michel-Crosato, E; Hamerschlak, N; Biazevic, M G H

    2016-07-01

    Oral mucositis is a painful condition that occurs in 80% of patients who undergo haematopoietic stem cell transplantation (HSCT). Our objective was to determine the impact of mucositis on quality of life (QoL) of patients subjected to HSCT treated with low-level laser therapy (LLLT). Patients were evaluated: (1) on the first day of treatment; (2) 5 days after autologous or 8 days after allogeneic transplantation; (3) once bone marrow had integrated; and (4) 30 days after discharge. Clinical evaluation was performed using the World Health Organization criteria; oral health QoL was measured using the Oral Health Impact Profile (OHIP-14); and mucositis symptoms with the Patient-Reported Oral Mucositis Symptom (PROMS) scale. The higher the score, the lower the patient's QoL. The OHIP-14 responses showed that at D + 5/D + 8, all domains had the highest scores, while at times 1 and 4, the scores were lower. In the PROMS scale, all domains scored worst at time 2, and the differences between the scores at the four times were statistically significant. The study has shown that QoL improves over time in patients undergoing LLLT therapy for mucositis prevention. PMID:26087364

  20. Compliance of Healthcare Workers with Hand Hygiene Practices in Neonatal and Pediatric Intensive Care Units: Overt Observation

    Directory of Open Access Journals (Sweden)

    Ayşe Karaaslan

    2014-01-01

    Full Text Available Background. The objective of this study was to assess the compliance of hand hygiene (HH of healthcare workers (HCWs in the neonatal and pediatric intensive care unit in a tertiary university hospital in Istanbul. Methods. An observational study was conducted on the compliance of HH for the five World Health Organization (WHO indications. HCWs were observed during routine patient care in day shift. The authors also measured the technique of HH through hand washing or hand hygiene with alcohol-based disinfectant. Results. A total of 704 HH opportunities were identified during the observation period. Overall compliance was 37.0% (261/704. Compliance differed by role: nurses (41.4% and doctors (31.9% [P=0.02, OR: 1.504, CI 95%: 1.058–2.137]. HCWs were more likely to use soap and water (63.6% compared to waterless-alcohol-based hand hygiene (36.3% [P<0.05]. Conclusion. Adherence to hand hygiene practice and use of alcohol-based disinfectant was found to be very low. Effective education programs that improve adherence to hand hygiene and use of disinfectants may be helpful to increase compliance.

  1. Measuring the Quality of Observational Study Data in an International HIV Research Network

    OpenAIRE

    Duda, Stephany N; Shepherd, Bryan E.; Gadd, Cynthia S; Masys, Daniel R.; McGowan, Catherine C.

    2012-01-01

    Observational studies of health conditions and outcomes often combine clinical care data from many sites without explicitly assessing the accuracy and completeness of these data. In order to improve the quality of data in an international multi-site observational cohort of HIV-infected patients, the authors conducted on-site, Good Clinical Practice-based audits of the clinical care datasets submitted by participating HIV clinics. Discrepancies between data submitted for research and data in t...

  2. Doctors’ and nurses’ views on patient care for type 2 diabetes: an interview study in primary health care in Oman

    OpenAIRE

    Noor Abdulhadi, Nadia M.; Al-Shafaee, Mohammed Ali; Wahlström, Rolf; Hjelm, Katarina

    2012-01-01

    Aim This study aimed at exploring the experiences of primary health-care providers of their encounters with patients with type 2 diabetes, and their preferences and suggestions for future improvement of diabetes care. Background Barriers to good diabetes care could be related to problems from health-care providers’ side, patients’ side or the health-care system of the country. Treatment of patients with type 2 diabetes has become a huge challenge in Oman, where the prevalence has increased to...

  3. CCN Activity of Organic Aerosols Observed Downwind of Urban Emissions during CARES

    Energy Technology Data Exchange (ETDEWEB)

    Mei, Fan; Setyan, Ari; Zhang, Qi; Wang, J. X.

    2013-12-17

    During the Carbonaceous Aerosols and Radiative Effects Study (CARES), activation fraction of size-resolved aerosol particles and aerosol chemical composition were characterized at the T1 site (~60 km downwind of Sacramento, California) from 10 June to 28 June 2010. The hygroscopicity of CCN-active particles (KCCN) with diameter from 100 to 170 nm, derived from the size-resolved activated fraction, varied from 0.10 to 0.21, with an average of 0.15, which was substantially lower than that proposed for continental sites in earlier studies. The low KCCN value was due to the high organic volume fraction, averaged over 80% at the T1 site. The derived KCCN exhibited little diurnal variation, consistent with the relatively constant organic volume fraction observed. At any time, over 90% of the size selected particles with diameter between 100 and 171nm were CCN active, suggesting most particles within this size range were aged background particles. Due to the large organic volume fraction, organic hygroscopicity (Korg) strongly impacted particle hygroscopicity and therefore calculated CCN concentration. For vast majority of the cases, an increase of Korg from 0.03 to 0.18, which are within the typical range, doubled the calculated CCN concentration. Organic hygroscopicity was derived from KCCN and aerosol chemical composition, and its variations with the fraction of total organic mass spectral signal at m/z 44 (f44) and O:C were compared to results from previous studies. Overall, the relationships between Korg and f44 are quite consistent for organic aerosol (OA) observed during field studies and those formed in smog chamber. Compared to the relationship between Korg and f44, the relationship between Korg and O:C exhibits more significant differences among different studies, suggesting korg may be better parameterized using f44. A

  4. The NOAA Satellite Observing System Architecture Study

    Science.gov (United States)

    Volz, Stephen; Maier, Mark; Di Pietro, David

    2016-01-01

    NOAA is beginning a study, the NOAA Satellite Observing System Architecture (NSOSA) study, to plan for the future operational environmental satellite system that will follow GOES and JPSS, beginning about 2030. This is an opportunity to design a modern architecture with no pre-conceived notions regarding instruments, platforms, orbits, etc. The NSOSA study will develop and evaluate architecture alternatives to include partner and commercial alternatives that are likely to become available. The objectives will include both functional needs and strategic characteristics (e.g., flexibility, responsiveness, sustainability). Part of this study is the Space Platform Requirements Working Group (SPRWG), which is being commissioned by NESDIS. The SPRWG is charged to assess new or existing user needs and to provide relative priorities for observational needs in the context of the future architecture. SPRWG results will serve as input to the process for new foundational (Level 0 and Level 1) requirements for the next generation of NOAA satellites that follow the GOES-R, JPSS, DSCOVR, Jason-3, and COSMIC-2 missions.

  5. Study of the effect of humanistic nursing care model wards in Children Caring Ward School on the nurses' caring ability

    Institute of Scientific and Technical Information of China (English)

    Jiao He; De-Ying Hu; Yi-Lan Liu; Li-Fen Wu; Lian Liu

    2016-01-01

    Objective: To understand the effect of humanistic nursing care model wards in Children Caring Ward School (CCWS) on the nurses' caring ability. Methods: Questionnaire 25 nurses of humanistic nursing care model wards in CCWS using the Nkongho Caring Ability Inventory (CAI) before and after implement the humanistic nursing care model, including reform the systems of nursing care, introduce humanistic care model, implement the humanistic care, to measure the nurses' caring ability. Results: The nurses' caring ability had significantly developed on total, cognition dimension, courage dimension and patience dimension after all measures considered (p Conclusions: The humanistic nursing care model wards in CCWS has a positive effect on the nurses' caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients' satisfaction.

  6. Providers' response to child eating behaviors: A direct observation study.

    Science.gov (United States)

    Tovar, Alison; Vaughn, Amber E; Fallon, Megan; Hennessy, Erin; Burney, Regan; Østbye, Truls; Ward, Dianne S

    2016-10-01

    Child care providers play an important role in feeding young children, yet little is known about children's influence on providers' feeding practices. This qualitative study examines provider and child (18 months -4 years) feeding interactions. Trained data collectors observed 200 eating occasions in 48 family child care homes and recorded providers' responses to children's meal and snack time behaviors. Child behaviors initiating provider feeding practices were identified and practices were coded according to higher order constructs identified in a recent feeding practices content map. Analysis examined the most common feeding practices providers used to respond to each child behavior. Providers were predominately female (100%), African-American (75%), and obese (77%) and a third of children were overweight/obese (33%). Commonly observed child behaviors were: verbal and non-verbal refusals, verbal and non-verbal acceptance, being "all done", attempts for praise/attention, and asking for seconds. Children's acceptance of food elicited more autonomy supportive practices vs. coercive controlling. Requests for seconds was the most common behavior, resulting in coercive controlling practices (e.g., insisting child eat certain food or clean plate). Future interventions should train providers on responding to children's behaviors and helping children become more aware of internal satiety and hunger cues. PMID:27328098

  7. Nursing Care Aesthetic in Iran: A Phenomenological Study

    Science.gov (United States)

    Radmehr, Maryam; Ashktorab, Tahereh; Abedsaeedi, Zhila

    2015-01-01

    Background: Despite the emphasis of contemporary nursing theories on the belief that nursing is a science and an art in care, published studies show that only the nursing science has developed. Many experts believe that by recognizing and perceiving this concept, the clinical field can develop aesthetic knowledge in nursing and education of students. Objectives: The purpose of this study was to explain clients and nurses perspective of nursing care aesthetics. Patients and Methods: Using an interpretive phenomenology, 12 clients and 14 nurses were interviewed. Participants in this study were purposefully selected and their experiences were analyzed using Van Manen’s hermeneutic phenomenological framework. Results: Emerged themes were as follows: subjective description, overt spirituality, opening desperate impasse, sense of unity, continue to shine, and painful pass and pleasing. According the participants experiences, nursing care aesthetics includes subjective description of spiritual and desirable caring behaviors combined with sense of unity and sympathy between the nurse and the patients, which leads to opening in desperate impasse with creating the feeling of satisfaction and peace in the patient. It is a shining of clinical capabilities and an action beyond what should be combined with a decorating care that leads to a pleasant ending against the pain and suffering of the others for the nurse. Conclusions: Many caring behaviors associate with aesthetic experience for both patients and nurses and despite two different views, findings of this study showed that these experiences were similar in most cases. The aesthetics of nursing care was defined as what reflects the holistic nature of nursing with an emphasis on spirituality and skill. Results of this study are effective in identification of the values existed in nurse caring behaviors and developing of profession by instruction, implementation, and evaluation them. PMID:26339668

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

    Science.gov (United States)

    Bader, Lisa

    2014-01-01

    With the advances of technology and treatment in the field of neonatal care, researchers can now study how the brains of preterm infants are different from full-term infants. The differences are significant, and the outcomes are poor overall for premature infants as a whole. Caregivers at the bedside must know that every interaction with the preterm infant affects brain development-it is critical to the developmental outcome of the infant. The idea of neuroprotection is not new to the medical field but is a fairly new idea to the NICU. Neuroprotection encompasses all interventions that promote normal development of the brain. The concept of brain-oriented care is a necessary extension of developmental care in the NICU. By following the journey of 26-week preterm twin infants through a case study, one can better understand the necessity of brain-oriented care at the bedside. PMID:25161134

  9. AwareCare: development and validation of an observational measure of awareness in people with severe dementia.

    Science.gov (United States)

    Clare, Linda; Whitaker, Rhiannon; Quinn, Catherine; Jelley, Hannah; Hoare, Zoe; Woods, Bob; Downs, Murna; Wilson, Barbara

    2012-01-01

    Signs of sensory and perceptual awareness can be observed in people with very severe dementia, and may be influenced by the extent to which the environment offers appropriate stimulation. We developed an observational tool, AwareCare, which care staff can use to identify signs of awareness in residents with very severe dementia, based on the concept of the Wessex Head Injury Matrix (WHIM). Using WHIM items as a guide, and following focus groups with care staff and family members, an expert panel identified 28 environmental stimuli and 35 response categories for the initial version of AwareCare. After baseline assessments of cognition, well-being and quality of life were taken, 40 residents were observed individually for 30 minutes on 5 occasions. Based on the observational data, 10 stimulus categories and 14 response categories were identified for further analysis and formed the final version of AwareCare. All participants showed awareness to varying degrees. Social stimuli elicited the most responses. Greater awareness was associated with better cognitive function, self-care, mobility, and responsiveness, but not with proxy-rated quality of life. Understanding the nature of awareness in this group is an important element in ensuring appropriate levels of interaction and stimulation, and hence enhancing quality of care. PMID:22264147

  10. Attempted suicide : Studies of attitudes and psychiatric care

    OpenAIRE

    Samuelsson, Mats

    1997-01-01

    Suicide risk among patients referred to psychiatric care after attempted suicide,attitudes of nursing personnel towards suicidal patients and the impact of a trainingprogram in suicidology for psychiatric nursing personnel were studied in the presentwork. Furthermore, the patients perspective on psychiatric care given to them aftera suicide attempt as well as work environment, suicidal feelings and attempted suicideamong psychiatric nursing personnel were investigated. S...

  11. Diagnosis of Asthma in Primary Health Care: A Pilot Study

    OpenAIRE

    Karin C. Ringsberg; Paula Bjärneman; Ronny Larsson; Elisabeth Wallström; Olle Löwhagen

    2014-01-01

    Some patients with an asthma diagnosis have a poor controlled asthma. One explanation may be an incorrect diagnosis. Aim. The aim of the study was to diagnose and classify patients with non-infectious lower respiratory tract problems in primary health care using internationally applied diagnostic criteria and diagnostic tests. Patients and Methods. New adult patients visiting a primary health care centre due to lower airway problems were included. The diagnostic tests included FEV1, FVC, PEF,...

  12. Overview of the Ocean Observer Satellite Study

    Science.gov (United States)

    Cunningham, J. D.; McGuire, J. P.; Pichel, W. G.; Gerber, A. J.

    2002-12-01

    A two-year study of ocean satellite remote sensing requirements and instrument/satellite options is nearing completion. This Ocean Observer Study was sponsored by the U.S. Dept. of Commerce/Dept. of Defense/National Aeronautics and Space Administration Integrated Program Office, whose mission is to develop the future U.S. National Polar-Orbiting Operational Environmental Satellite System (NPOESS). A comprehensive Ocean Observer User Requirements Document has been drafted by a team of over 150 government, academic, and private sector scientists, engineers, and administrators. Included are requirements for open and coastal ocean surface, cryospheric, hydrologic, and some land/hazard and atmospheric boundary layer parameters. This document was then used as input to the instrument and satellite study (conducted by the Jet Propulsion Laboratory) which produced five different instrument/satellite configuration options designed to address the maximum number of requirements which will not be met with the already-approved NPOESS instruments. Instruments studied include a synthetic aperture radar (SAR), an altimeter, and a hyper-spectral coastal infrared/visible imager. After analyzing the alternatives, it appears that one of the best options is a two-satellite system consisting of (1) an altimeter mission in the Topex/Poseidon orbit carrying both wide-swath and delayed doppler altimeters, and (2) a multi-polarization, multi-frequency, multi-mode interferometric SAR mission including a coastal imager in a polar sun-synchronous orbit. This paper summarizes the user requirements process, briefly describes the notional satellite configuration, and presents some of the capabilities of the instruments.

  13. Ambivalent implications of health care information systems: a study in the Brazilian public health care system

    Directory of Open Access Journals (Sweden)

    João Porto de Albuquerque

    2011-01-01

    Full Text Available This article evaluates social implications of the "SIGA" Health Care Information System (HIS in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

  14. AECL's excavation stability study - summary of observations

    International Nuclear Information System (INIS)

    The Excavation Stability Study (ESS) was conducted at the 420 Level of the Underground Research Laboratory (URL) to evaluate stability and the extent of excavation damage in tunnels as a function of tunnel geometry and orientation, geology, and excavation method. A series of ovaloid and circular openings were used to achieve different boundary stress levels and near-field stress distributions to assess the effect of tunnel geometry on damage development. Several of these openings had sections in both granite and granodiorite lithology, providing a comparison of damage in rock types with different strength characteristics. Damage around circular tunnels (one excavated by drill-and-blast, the other by mechanical means) was also investigated. The study.showed that mechanically stable openings can be excavated in the most adverse stress conditions at the 420 Level of the URL. In addition, it was shown that tunnel stability is sensitive to tunnel shape, variations in geology, and to some extent, the excavation method. Findings of the study are relevant in developing design criteria, and in assessing the feasibility of constructing large ovaloid openings in adverse stress conditions. This report summarizes the preliminary observations related to tunnel stability and excavation damage. (author). 8 refs., 7 tabs., 23 figs

  15. Integration of leprosy control into general health care system: observations from a state with low endemicity.

    Science.gov (United States)

    Pandey, A; Patel, R

    2005-01-01

    The study was undertaken as part of operational research to assess the level of integration of leprosy services into general health care system in 24 low or moderately endemic states/union territories by the Ministry of Health and Family Welfare, Government of India. Himachal Pradesh was one of the nine randomly selected states for the study. Out of the 12 districts in the State, 2 were selected randomly for the study. In each of the selected districts, 8 health facilities (that included a district hospital, an urban hospital/urban health centre, an Employees' State Insurance Hospital, a community health centre and a primary health centre) and 9 sub-centres were surveyed. Selection was done randomly at each stage. Data were collected on training in leprosy of general health care staff, availability of drugs for MDT in the system and maintenance of leprosy records by the staff of the system. The study showed mixed results. About half (53.2%) of the existing medical officers, 83.9% of health supervisors and 96.8% of multi-purpose workers were trained in leprosy. But only 31.3% of medical officers were able to diagnose leprosy and most of them were relying on vertical staff and skin specialists for confirmation. MDT services were provided by 20% of rural and 66.7% of urban health facilities that were acting as treatment centres. None of the health facilities had 3 months' stock of all types of blister packs, as per the guidelines of the Government of India. None of the sub-centres was involved in MDT delivery. However, reporting as per SIS formats was universal. The study emphasized the need for training and better management of MDT drug stock. PMID:16353521

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  17. Patient safety in primary care has many aspects: an interview study in primary care doctors and nurses.

    NARCIS (Netherlands)

    Gaal, S.; Laarhoven, E. van; Wolters, R.J.; Wetzels, R.; Verstappen, W.H.J.M.; Wensing, M.J.P.

    2010-01-01

    RATIONALE, AIMS AND OBJECTIVES: Scientific definitions of patient safety may be difficult to apply in routine health care delivery. It is unknown what primary care workers consider patient safety. This study aimed to clarify the concept of patient safety in primary care. METHODS: We held 29 semi-str

  18. Commitment to patient care: An exploratory study among registered nurses in Bophutatswana

    Directory of Open Access Journals (Sweden)

    J.N. Mekwa

    1992-09-01

    Full Text Available In this second article on the commitment to patient care the methodology and results of the study are briefly described and discussed The research method was a non-experimental qualitative survey, using several data-gathering methods such as semi-structured interviews with registered nurses and patients, the examination of nurses? and patients' records and non-participant observations. Although the responses of nurses and patients indicated that both groups considered commitment to be essential to patient care, the examination of patient records, nurses' evaluation reports and observations showed lack of commitment in practice. Various reasons for this are explored and recommendations made.

  19. What makes primary care effective for people in poverty living with multiple chronic conditions?: study protocol

    Directory of Open Access Journals (Sweden)

    Barbeau David

    2010-11-01

    Full Text Available Abstract Background The inverse care law persists: people living in poverty have the greatest needs and face considerable challenges in getting the care they need. Evidence reveals that GPs encounter difficulties in delivering care to poor patients, while many of those patients feel stigmatized by healthcare professionals. Patients living in poverty report negative healthcare experiences and unmet healthcare needs. Indeed, there is a growing recognition in primary care research of the importance of addressing the capabilities and social conditions of the poor when delivering care. Few studies have looked at the factors contributing to effective and "socially responsive" care for people living in poverty. Methods/Design Our study adopts a qualitative ethnographic approach in four healthcare organizations in deprived areas of metropolitan Montreal (Québec, Canada, using patient shadowing techniques and interviews. Data will be collected through fieldwork observations and informal interviews with patients before and after consultations. We will observe medical consultations, care organization activities, and waiting areas and reception of patients. We will conduct a total of 36 individual interviews with 12 GPs and 24 patients. The interviews will be audio-recorded and transcribed for purposes of analysis. The analysis consists of debriefing sessions, coding and interpretive analysis. Discussion This study aims to investigate how positive healthcare interactions between physicians and patients can improve the management of chronic conditions. We hypothesize that factors related to care organization, to healthcare professionals' experience and to patients may enhance the quality of healthcare interactions, which may have positive impacts for preventing and managing chronic conditions. Our study will provide a unique set of data grounded in the perspectives of healthcare professionals and of patients living in poverty.

  20. Primary care clinicians' attitudes towards point-of-care blood testing: a systematic review of qualitative studies.

    OpenAIRE

    Jones, CH; Howick, J; Roberts, NW; Price, CP; Heneghan, C; Plüddemann, A; Thompson, M.

    2013-01-01

    BACKGROUND: Point-of-care blood tests are becoming increasingly available and could replace current venipuncture and laboratory testing for many commonly used tests. However, at present very few have been implemented in most primary care settings. Understanding the attitudes of primary care clinicians towards these tests may help to identify the barriers and facilitators to their wider adoption. We aimed to systematically review qualitative studies of primary care clinicians' attitudes to poi...

  1. Health care professionals' perceptions towards lifelong learning in palliative care for general practitioners: a focus group study

    OpenAIRE

    Pype, Peter; Symons, Linda; Wens, Johan; Van den Eynden, Bart; Stes, Ann; Deveugele, Myriam

    2014-01-01

    Background: There is a growing need for palliative care. The majority of palliative patients prefer their general practitioner (GP) to organize their palliative home care. General practitioners need a range of competences to perform this task. However, there has been no general description so far of how GPs keep these competences up-to-date. The present study explores current experiences, views and preferences towards training and education in palliative care among GPs, palliative home-care p...

  2. Factors influencing job valuation: a comparative study of critical care and non-critical care nurses.

    Science.gov (United States)

    Chaboyer, W; Najman, J; Dunn, S

    2001-04-01

    This study sought to identify the relationship between three predictor variables, perceived collaboration with medical staff, autonomy and independent actions and an outcome, the value hospital nurses placed on their work. In total 189 critical care and 366 non-critical care nurses completed a mailed survey. Critical care nurses perceived themselves to have a more collaborative relationship with the medical staff, described performing actions independent of medical orders more frequently and perceived their jobs to have more value than non-critical care nurses. However the latter group perceived themselves to have more autonomy in their work. Within both groups collaboration and autonomy were significantly, but weak to moderately correlated with job valuation. Simply expanding the work hospital nurses do is unlikely to result in nurses valuing their jobs more, however promoting an environment of respect and sharing between the medical and nursing staff and supporting nurses when they act in an autonomous fashion may positively influence nurses' perceptions of their work. PMID:11223056

  3. Implementing Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons Learned and Effects Observed.

    Science.gov (United States)

    Schubert, Cathy C; Myers, Laura J; Allen, Katie; Counsell, Steven R

    2016-07-01

    In a randomized clinical trial, Geriatric Resources for Assessment and Care of Elders (GRACE), a model of care that works in collaboration with primary care providers (PCPs) and patient-centered medical homes to provide home-based geriatric care management focusing on geriatric syndromes and psychosocial problems commonly found in older adults, improved care quality and reduced acute care use for high-risk, low-income older adults. To assess the effect of GRACE at a Veterans Affairs (VA) Medical Center (VAMC), veterans aged 65 and older from Marion County, Indiana, with PCPs from four of five VAMC clinics who were not on hospice or dialysis were enrolled in GRACE after discharge home from an acute hospitalization. After an initial home-based transition visit to GRACE enrollees, the GRACE team returned to conduct a geriatric assessment. Guided by 12 protocols and input from an interdisciplinary panel and the PCP, the GRACE team developed and implemented a veteran-centric care plan. Hospitalized veterans from the fifth clinic, who otherwise met enrollment criteria, served as a usual-care comparison group. Demographic, comorbidity, and usage data were drawn from VA databases. The GRACE and comparison groups were similar in age, sex, and burden of comorbidity, although predicted risk of 1-year mortality in GRACE veterans was higher. Even so, GRACE enrollment was associated with 7.1% fewer emergency department visits, 14.8% fewer 30-day readmissions, 37.9% fewer hospital admissions, and 28.5% fewer total bed days of care, saving the VAMC an estimated $200,000 per year after program costs during the study for the 179 veterans enrolled in GRACE. Having engaged, enthusiastic VA leadership and GRACE staff; aligning closely with the medical home; and accommodating patient acuity were among the important lessons learned during implementation. PMID:27305428

  4. Guided care: cost and utilization outcomes in a pilot study.

    Science.gov (United States)

    Sylvia, Martha L; Griswold, Michael; Dunbar, Linda; Boyd, Cynthia M; Park, Margaret; Boult, Chad

    2008-02-01

    Guided Care (GC) is an enhancement to primary care that incorporates the operative principles of disease management and chronic care innovations. In a 6-month quasi-experimental study, we compared the cost and utilization patterns of patients assigned to GC and Usual Care (UC). The setting was a community-based general internal medicine practice. The participants were patients of 4 general internists. They were older, chronically ill, community-dwelling patients, members of a capitated health plan, and identified as high risk. Using the Adjusted Clinical Groups Predictive Model (ACG-PM), we identified those at highest risk of future health care utilization. We selected the 75 highest-risk older patients of 2 internists at a primary care practice to receive GC and the 75 highest-risk older patients of 2 other internists in the same practice to receive UC. Insurance data were used to describe the groups' demographics, chronic conditions, insurance expenditures, and utilization. Among our results, at baseline, the GC (all targeted patients) and UC groups were similar in demographics and prevalence of chronic conditions, but the GC group had a higher mean ACG-PM risk score (0.34 vs. 0.20, p insurance expenditures, hospital admissions, hospital days, and emergency department visits (p > 0.05). There were larger differences in insurance expenditures between the GC and UC groups at lower risk levels (at ACG-PM = 0.10, mean difference = $4340; at ACG-PM = 0.6, mean difference = $1304). Thirty-one of the 75 patients assigned to receive GC actually enrolled in the intervention. These results suggest that GC may reduce insurance expenditures for high-risk older adults. If these results are confirmed in larger, randomized studies, GC may help to increase the efficiency of health care for the aging American population. PMID:18279112

  5. Antibiotic prescribing patterns in out-of-hours primary care: A population-based descriptive study

    NARCIS (Netherlands)

    Huibers, L.; Moth, G.; Christensen, M.B.; Vedsted, P.

    2014-01-01

    Abstract Objective. To describe the frequency and characteristics of antibiotic prescribing for different types of contacts with the Danish out-of-hours (OOH) primary care service. Design. Population-based observational registry study using routine registry data from the OOH registration system on p

  6. A retrospective study of drug prescribing pattern in burns patients in a tertiary care rural hospital

    Directory of Open Access Journals (Sweden)

    Palak Agrawal

    2015-06-01

    Conclusions: Females are more vulnerable to burn injuries. Polypharmacy was observed in prescriptions. Systemic antibiotic should be used with caution to prevent emergence of resistant microorganisms. Results of the present study indicate that some aspects of drug treatment need to be rationalized in order to achieve better patient care. [Int J Res Med Sci 2015; 3(6.000: 1446-1452

  7. Palliative care for cancer patients in a primary health care setting:Bereaved relatives' experience, a qualitative group interview study

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde;

    2008-01-01

    Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary...... care setting to explore barriers and facilitators for delivery of good palliative home care. Methods: Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results: Three main categories of experience were identified: 1) The health professionals' management, where a...... need to optimize was found. 2) Shared care, which was lacking. 3) The relatives' role, which needs an extra focus. Conclusion: Relatives experience insufficient palliative care mainly due to organizational and cultural problems among professionals. Palliative care in primary care in general needs...

  8. Relinquishing the Practices of a Lifetime: Observations on ageing, caring and literacies

    Directory of Open Access Journals (Sweden)

    Mary Hamilton

    2008-10-01

    Full Text Available This paper draws on ethnographic and case study data from a variety of sources to explore the changing social practices of literacy across the lifespan. It explores the new literacy demands that people encounter with age when dealing with life events in a range of social domains. These include increased leisure; travel; changing family and peer relationships as a result of death and loss; issues of health and disability and accessing new technologies. It reveals how literacy is implicated in peoples' changing sense of time, place and history; how the older person’s identity as a literate actor may be interrupted by both institutional and informal processes of caring and their disengagement from spheres of activity that were previously central markers of their identity. Ageing thus involves both expansion and retreat from familiar literacy practices.

  9. Practice nurse involvement in primary care depression management: an observational cost-effectiveness analysis

    OpenAIRE

    Gray, Jodi; Haji Ali Afzali, Hossein; Beilby, Justin; Holton, Christine; Banham, David; Karnon, Jonathan

    2014-01-01

    Background Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the manageme...

  10. Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives.

    Science.gov (United States)

    Glasser, Irene; Wang, Fei; Reardon, Jane; Vergara, Cunegundo D; Salvietti, Ralph; Acevedo, Myrtha; Santana, Blanca; Fortunato, Gil

    2016-10-01

    We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation. PMID:26807853

  11. Improving care quality and preventing maltreatment in institutional care - a feasibility study with caregivers.

    Science.gov (United States)

    Hermenau, Katharin; Kaltenbach, Elisa; Mkinga, Getrude; Hecker, Tobias

    2015-01-01

    Institutionalized children in low-income countries often face maltreatment and inadequate caregiving. In addition to prior traumatization and other childhood adversities in the family of origin, abuse and neglect in institutional care are linked to various mental health problems. By providing a manualized training workshop for caregivers, we aimed at improving care quality and preventing maltreatment in institutional care. In Study 1, 29 participating caregivers rated feasibility and efficacy of the training immediately before, directly after, and 3 months following the training workshop. The results showed high demand, good feasibility, high motivation, and acceptance of caregivers. They reported improvements in caregiver-child relationships, as well as in the children's behavior. Study 2 assessed exposure to maltreatment and the mental health of 28 orphans living in one institution in which all caregivers had been trained. The children were interviewed 20 months before, 1 month before, and 3 months after the training. Children reported a decrease in physical maltreatment and assessments showed a decrease in mental health problems. Our approach seems feasible under challenging circumstances and provides first hints for its efficacy. These promising findings call for further studies testing the efficacy and sustainability of this maltreatment prevention approach. PMID:26236248

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

    Directory of Open Access Journals (Sweden)

    Katharin eHermenau

    2015-07-01

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

  13. Compassion fatigue: A Study of critical care nurses in Turkey

    OpenAIRE

    Dikmen, Yurdanur; Aydın, Yasemin; Tabakoğlu, Pınar

    2016-01-01

    This study was conducted to determine the level of compassion fatigue which experienced by nurses who work in intensive care units and factors that affecting it.In a cross sectional design, critical nurses were surveyed by using questionnaire and  compassion fatigue (CF) subscale of the Professional Quality of Life Scale (ProQOL R-IV) to measure levels of compassion fatigueat a large National Education and ResearchHospital located in northwestof Turkey. A total of 69 critical care nurses part...

  14. A Comparative Study on the Palliative Care in Romania and France

    Directory of Open Access Journals (Sweden)

    Mariana ENACHE

    2013-03-01

    Full Text Available The palliative care has old tradition, as the single support and relief of suffering in terminally ill patients form, until the release of antibiotics and the development of modern medical technologies, investigation, diagnosis and treatment. In the 1960s the palliative care was officially recognized as a medical field, focused on the psycho-emotional and spiritual aspects without neglecting, however, the physical aspects of care. Further evolution differed on a country basis.The health insurance systems in Romania and France are based on the same principle of solidarity. The history of the two palliative care systems has close start. In this context, we propose a comparative study to identify the differences and similarities between the systems of palliative care in the two countries. Certain evaluation criteria were selected for this purpose, in order to ensure a complex approach for this type of service. We have used the methods of study documentation and direct observation through an internship performed in a clinic in France, Groupe Hospitalier Saint Augustine-Malestroit.In spite of the chronic low funding of the health system, non-challenging and lean health legislation, the system of palliative care has developed slowly, but progressively, in Romania. Though, the level of services is far below the needs. This is imposing a rigorous analysis of the factors affecting the quality of life of patients and the development of services strongly dependent on these.The French health care system is an example of good practice regarding availability of health care, health care related services, accessibility to the patient, and the legal frame: national policies, legislation, financial planning models and quality control, training and human resources, including the emotional and spiritual support like patient special needs, family support, support for pediatric patients and their families, religious and psychological assistance, staff issues.

  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. STUDY OF MATERNAL MORTALITY IN A TERTIARY CARE HOSPITAL

    OpenAIRE

    Sandhya Devi; Madhuri; Sarada Bai; Srividya

    2015-01-01

    BACKGROUND: A woman dies from complications of child birth every minute . The major causes for maternal mortality in India are uncontrolled fertility , inaccessibility or inadequate utilization of health care facilities , illiteracy , ignorance and gender discrimination . OBJECTIV ES: (1 ) To identify various causes of maternal deaths in a teaching hospital . (2 ) To study the profile of population attending the tertiary hos...

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

    Science.gov (United States)

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

    2012-01-01

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

  18. Compliance of health care workers with hand hygiene practices: independent advantages of overt and covert observers.

    Directory of Open Access Journals (Sweden)

    Sung-Ching Pan

    Full Text Available BACKGROUND: Evaluation and feedback of hand hygiene (HH compliance are important elements of the WHO multimodal strategy for hospital infection control. Overt observation is recommended, but it may be confounded by Hawthorne effect. Covert observation offers the opportunity to decrease observer bias. In this study we conducted a one year hospital-wide HH promotion program that included medical students (MS as covert observers. METHODS: HH compliance for the five WHO indications was determined by trained and validated observers. The overt observers consisted of eleven infection control nurses (ICNs and two unit HH ambassadors (UAs in each of 83 wards. The covert observers consisted of nine MS during their rotating clinical clerkships. Feedback was provided to department heads and staff each quarter. RESULTS: Of the 23,333 HH observations 76.0% were by MS, 5.3% by ICNs and 18.7% by UAs. The annual compliance rates were MS 44.1%, ICNs 74.4% and UAs 94.1%; P<0.001. The MS found significantly lower annual compliance rates for 4/5 HH indications compared to ICNs and UAs; P<0.05. The ICNs reported significantly improvement from the first to the fourth quarter; P<0.001. This was associated with feedback from the MS of very poor compliance by nurses during the first quarter. CONCLUSIONS: Based on these findings we recommend a two-pronged approach to HH programs. The role of ICNs and UAs is to educate, serve as role models, establish, sustain good HH practices and provide direct feedback. The role of the covert observers is to measure compliance and provide independent feedback.

  19. Quality of Life in Depressed Patients in UK Primary Care: The FINDER Study

    OpenAIRE

    Lenox-Smith, Alan; Macdonald, Mark T. B.; Reed, Catherine; Tylee, Andre; Peveler, Robert; Quail, Deborah; Wildgust, Hiram J.

    2013-01-01

    Objectives To investigate the impact of depression and its treatment on health-related quality of life (HRQoL) in a naturalistic, primary care setting in the UK. Methods The Factors Influencing Depression Endpoints Research (FINDER) study was a European, 6-month, prospective, observational study designed to estimate HRQoL in patients with a clinical diagnosis of depression. This paper examines primary care patients recruited in the UK. HRQoL was measured at baseline and at 3 and 6 months afte...

  20. Quality and safety in transitional care of the elderly: The study protocol of a case study research design (Phase 1)

    OpenAIRE

    Aase, Karina; Laugaland, Kristin A; Dyrstad, Dagrunn Nåden; Storm, Marianne

    2013-01-01

    Introduction: Although international studies have documented that patients ’ transitions between care providers are associated with the risk of adverse events and uncoordinated care, research directed towards the quality and safety of transitional care between primary and secondary health and care services, especially for the elderly receiving care from multiple healthcare providers due to complex health problems, is lacking. This study investigates how differ...

  1. Interprofessional rhetoric and operational realities: an ethnographic study of rounds in four intensive care units.

    Science.gov (United States)

    Paradis, Elise; Leslie, Myles; Gropper, Michael A

    2016-10-01

    Morning interprofessional rounds (MIRs) are used in critical care medicine to improve team-based care and patient outcomes. Given existing evidence of conflict between and dissatisfaction among rounds participants, this study sought to better understand how the operational realities of care delivery in the intensive care unit (ICU) impact the success of MIRs. We conducted a year-long comparative ethnographic study of interprofessional collaboration and patient and family involvement in four ICUs in tertiary academic hospitals in two American cities. The study included 576 h of observation of team interactions, 47 shadowing sessions and 40 clinician interviews. In line with best practices in ethnographic research, data collection and analysis were done iteratively using the constant comparative method. Member check was conducted regularly throughout the project. MIRs were implemented on all units with the explicit goals of improving team-based and patient-centered care. Operational conditions on the units, despite interprofessional commitment and engagement, appeared to thwart ICU teams from achieving these goals. Specifically, time constraints, struggles over space, and conflicts between MIRs' educational and care-plan-development functions all prevented teams from achieving collaboration and patient-involvement. Moreover, physicians' de facto control of rounds often meant that they resembled medical rounds (their historical predecessors), and sidelined other providers' contributions. This study suggests that the MIRs model, as presently practiced, might not be well suited to the provision of team-based, patient-centered care. In the interest of interprofessional collaboration, of the optimization of clinicians' time, of high-quality medical education and of patient-centered care, further research on interprofessional rounds models is needed. PMID:26704051

  2. Usability and perceived usefulness of Personal Health Records for preventive health care: a case study focusing on patients' and primary care providers' perspectives.

    Science.gov (United States)

    Ant Ozok, A; Wu, Huijuan; Garrido, Melissa; Pronovost, Peter J; Gurses, Ayse P

    2014-05-01

    Personal Health Records (PHR) are electronic applications for individuals to access, manage and share their health information in a secure environment. The goal of this study was to evaluate the usefulness and usability of a Web-based PHR technology aimed at improving preventive care, from both the patients' and primary care providers' perspectives. We conducted a multi-method descriptive study that included direct observations, concurrent think-aloud, surveys, interviews and focus groups in a suburban primary care clinic. Patients found the tailored health recommendations useful and the PHR easy to understand and use. They also reported asking useful health-related questions to their physicians because of using the system. Generally, care providers were interested in using the system due to its useful content and impact on patient activation. Future successful systems should be better integrated with hospital records; put more emphasis on system security; and offer more tailored health information based on comprehensive health databases. PMID:24119975

  3. Mucocutaneous manifestations of acquired hypoparathyroidism: An observational study

    Directory of Open Access Journals (Sweden)

    Somenath Sarkar

    2012-01-01

    Full Text Available Hypoparathyroidism is a disorder of calcium and phosphorus metabolism due to decreased secretion of parathyroid hormone. Hypoparathyroidism can be hereditary and acquired. Acquired hypoparathyroidism usually occurs following neck surgery (thyroid surgery or parathyroid surgery. Along with systemic manifestations, hypoparathyroidism produces some skin manifestations. Lack of study regarding mucocutaneous manifestations of acquired hypoparathyroidism prompted us to undertake this study. To evaluate the mucocutaneous manifestations of acquired hypoparathyroidism. An observational study done in a tertiary care hospital of Kolkata by comprehensive history taking, through clinical examination and relevant laboratory investigations. Twenty-one patients were included in the study. The commonest form of acquired hypoparathyroidism was neck surgery (thyroidectomy and parathyroidectomy operation. Mucocutaneous manifestations were present in 76.19% of patients. The most frequent mucocutaneous manifestation was found in the hairs like the loss of axillary hair (61.9%, loss of pubic hair (52.38%, coarsening of body hair (47.62%, and alopecia areata (9.52%. The nail changes noted were brittle and ridged nail, followed by onycholysis, onychosezia, and onychomedesis. The most common skin features were xerotic skin in 11 patients (52.38%, followed by pellagra-like skin pigmentation, pustular psoriasis and acne form eruption, bullous impetigo, etc. Mucosa was normal in all the cases excepting the one which showed oral candidiasis.

  4. [Economic assessment, a field between clinical research and observational studies].

    Science.gov (United States)

    Launois, Robert

    2003-01-01

    Health technology assessments propose to study the differential impact of health interventions in a complex care system which is characterised by the multitude of individual behaviours and the diverse nature of the institutions involved. Current systems for data collection lend themselves poorly to this rigorous analysis of efficacy of treatments in the actual situations where they are used. Randomised trials endeavour to neutralise any parasitic interference which could compromise testing for a causal relationship between the treatment administered and the result obtained. Their methodology which establishes the term ceteris paribus in the principle of good practice lends itself poorly to an analysis of individual behaviour. Observational studies are start from actual treatment situations to describe them as reliably as possible. By definition, however, these assume that the natural course of events is not deviated by any intervention. The absence of an experimental plan increases the likelihood of bias and makes it more difficult to test for causal relationships. They lend themselves poorly to testing for incremental efficacy. The two instruments to be preferred are decisional analysis and quasi-experimental studies. Decisional analysis help to avoid the problems of external validity associated with randomised clinical trials by associating parameters which are extracted from data obtained from everyday practice. Quasi-experimental studies or pragmatic trials are based on the reality of behaviour of the prescriber and his/her patients; their impact on efficacy, quality of life social costs of the disease and of treatments may be identified under normal conditions of use. PMID:12609811

  5. The boundaries of care work: a comparative study of professionals and volunteers in Denmark and Australia.

    Science.gov (United States)

    Overgaard, Charlotte

    2015-07-01

    This paper explores the manner in which two hospices--one located in Denmark and one in Australia--negotiate and determine the boundaries of volunteer workers vis-à-vis paid staff. A comparative case study approach was used to juxtapose organisations with similar activity fields located in different welfare state systems, i.e. a social democratic welfare state and a liberal welfare state. This study involved non-participant observation of volunteers at work and unstructured interviews with volunteers, staff and management in the hospices (n = 41). Data were collected between August 2012 and February 2013. Data were managed using NVivo and analysed thematically. A key finding is that volunteers in the Danish hospice were excluded from all direct care work due to the effective monopoly of the professional care providers, whereas the Australian volunteers participated in the provision of care to the extent that risk could be eliminated or mitigated to an acceptable level. The findings suggest two different models of the roles of volunteers in tension with professional care providers. Both models recognise that volunteers add to the level of care delivered by the organisations and allow for a discussion that moves away from the normative discussions of 'not taking somebody's job', while also recognising that volunteers must be more than just the 'nice extra' if they are to be of any real value to the organisation and to care receivers. PMID:25442013

  6. Treatment and follow-up results of children with electrical burn who observed in burn intensive care unit

    Directory of Open Access Journals (Sweden)

    Çiğdem Aliosmanoğlu

    2011-06-01

    Full Text Available Electrical burns are infrequent relative to other injuries, but they are associated with high morbidity and mortality. The aim of this study was to assess management and follow-up results of pediatric patients’ who observed in intensive care unit and also review the precautions for preventing electrical burns.Materials and methods: Totally 22 patients aged under 17 years who were observed in the burn intensive care unit of Şanlıurfa Education and Research Hospital during the period between July 2009-October 2010. Cases were investigated retrospectively. The patients’ age, gender, total burn surface area, length of stay in hospital, musculo-skeletal system complication, cardiovascular system complication, kidney damage and attempts were recorded.Results: Of the 22 cases, 19 (86.3% were male and 3 (13.7% were female. The mean age of the patients was 11.5 years. In 10 (45.4% children burns were occurred in workplace and working area and 12 (54.6% were occurred in the home environment. Depth of burns were third degree in 10 (45.4% children and second degree in 12 (54.6%. The mean percentage of burn surface area was 25.9%. The mean length of stay in hospital was 17 days. Debridement and grafting were performed to 12 (54.6% cases and 10 (45.4% children were treated with dressings. No patient had increased creatinine kinase levels, oliguria, myoglobuinuria and arrhythmia. The mean hospitalization time was 17 days.Conclusion: Nearly half of patients underwent debridement plus grafting. None of our patients developed renal failure other severe system dysfunction.

  7. A person-centred segmentation study in elderly care: towards efficient demand-driven care.

    Science.gov (United States)

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

    2014-07-01

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

  8. Patient's view of dialysis care: development of a taxonomy and rating of importance of different aspects of care. CHOICE study. Choices for Healthy Outcomes in Caring for ESRD.

    Science.gov (United States)

    Rubin, H R; Jenckes, M; Fink, N E; Meyer, K; Wu, A W; Bass, E B; Levin, N; Powe, N R

    1997-12-01

    Quality assessment efforts to enhance public accountability in dialysis care and to support provider efforts to improve care have lacked patient input. To develop brief patient evaluation or satisfaction surveys suitable for busy clinical settings, knowing patients' priorities can be helpful in deciding which aspects of care should be tracked. We conducted a study to identify salient attributes of dialysis care and to rank the importance of these attributes from the perspective of dialysis patients. We analyzed the content of patient focus group transcripts to characterize dialysis care from the patients' perspective. We then surveyed 86 patients to determine how patients would rank the importance of each aspect to quality of dialysis care. The 18 broad aspects of care identified in the focus group included: (1) care provided by nephrologists, (2) care provided by other physicians (nonnephrologists), (3) care provided by dialysis center nurses, (4) care provided by social workers and psychologists, (5) care provided by dieticians, (6) clergy, (7) care provided by technicians and physician assistants/nurse practitioners, (8) care provided by dialysis center staff in general, (9) supplies, (10) treatment choice and effectiveness, (11) patient education and training, (12) self-care, (13) dialysis machines, (14) unit environment and policies, (15) cost containment, (16) billing, (17) cost of care, and (18) health outcomes. Items ranked in the top 10 by both groups of patients included issues related to nephrologists, other doctors, nurses, and patient education and training. Compared with hemodialysis patients, peritoneal dialysis patients gave higher ratings to hospital doctors' and nurses' attention to cleanliness when working with access sites, how correct the nephrologist's instructions to patients are, whether emergency room doctors check with nephrologists, the amount of information patients get about their diet, and how well nurses answer patients' questions

  9. 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

  10. RADIOLOGICAL PATTERN OF LUNG CANCER – A PROSPECTIVE OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Allena Prem

    2015-10-01

    Full Text Available This was performed to observe various radiological presentations of lung cancer at the initial evaluation and to elicit correlation to histopathological diagnosis in all patients to a tertiary chest care hospital. AIM: To study various radiological presentations among lung cancer patients Method: we included all the patients with lung cancer reviewed during a 12mth period between March 2012 to November 2014 who had a definite tissue diagnosis and whose staging based on CT thorax were available. RESULTS: 65 patients were evaluated. Right sided lesions predominated with 60% and on left side being 40%. On either side put together, upper lobe 46.15% & middle lobe 36.9% and lower lobe 16.9%.Based on location of tumor 26% of the lesions are peripherally located, 24.5% are central localization, 13.8% are located intermedially. Radiological pattern of presentation: 67% of the cases presented as mass lesions, 9% as obstructive pneumonitis and 23% as combined mass with collapse and 23.07% as pleural effusion. Histological pattern of presentation: squamous cell carcinoma is most common type with 49.23%, adeno 33%, small cell 15%, others 1.5% Most of the cases presented to the hospital in stage IV with 56.36% and stage IIIA 16.36% and stage IIIB as 18.18%. CONCLUSION: we observed most of the lung cancers presented as mass lesion with peripherally located tumor and the most common histological type is squamous cell carcinoma, presented at advanced stages.

  11. Taking good care of myself: a qualitative study on self-care behavior among Chinese persons with a permanent colostomy.

    Science.gov (United States)

    Tao, Hui; Songwathana, Praneed; Isaramalai, Sang-arun; Wang, Qingxi

    2014-12-01

    In Chinese culture, as a possible consequence of Confucianism, caring for the sick is considered a moral obligation of family members, while self-care is only the basis of fulfilling filial piety. This qualitative study aims to explore the self-care behavior among persons with a permanent colostomy in a Chinese cultural context of emphasizing the role of family caregiving. Data from in-depth interviews with seven Chinese adults at a university hospital in southwest China were analyzed using content analysis. Informants' self-care behavior was characterized by "taking good care of myself," which underlined individuals' efforts to manage colostomy-related impacts involving: (i) taking care of my colostomy with a proper degree of independence; (ii) taking care of my life by dealing with limitations; (iii) taking care of my mood in a positive way. Findings revealed that informants' self-care behavior was linked to their Confucian beliefs in family obligations, and also influenced by a happy-go-lucky outlook of life, a likely product of Taoism. The information is useful for nurses to design a culturally appropriate care plan to improve self-care behavior and proper family caregiving. PMID:25370020

  12. Magnetosheath cavities: case studies using Cluster observations

    OpenAIRE

    Katırcıoğlu, F. T.; Z. Kaymaz; D. G. Sibeck; Dandouras, I.

    2009-01-01

    This paper presents examples of magnetosheath cavities in Cluster spacecraft observations. The cavities are accompanied by high energy particles in the magnetosheath and characterized by depressed magnetic fields and densities. Flow speeds decrease and temperatures increase within the cavities. All magnetosheath parameters show increased variability within the cavities when the energetic particle flux is high. We predict outward motion of the magnetopause boundary in respons...

  13. Volunteering in dementia care – a Norwegian phenomenological study

    Directory of Open Access Journals (Sweden)

    Söderhamn U

    2012-02-01

    Full Text Available Ulrika Söderhamn1, Bjørg Landmark2,3, Live Aasgaard2, Hilde Eide3, Olle Söderhamn11Center for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 2Institute of Research and Development for Nursing and Care Services, Municipality of Drammen, Drammen, Norway; 3Faculty of Health Sciences, Buskerud University College, Drammen, NorwayIntroduction: The number of people suffering from dementia will increase dramatically in the future, and this will be a great challenge and concern for health care services. It is assumed that volunteers will strengthen community health care services more in the future than they do today.Aim: The aim of this study was to elucidate lived experiences of working as a volunteer in an activity center with adapted activities for home-dwelling people with early stage dementia.Methods: Qualitative interviews were implemented in a group of nine female volunteers from an activity center in southern Norway. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method. Results: Volunteering in an activity center for home-dwelling people with early stage dementia was reported to provide experiences of being useful and feeling satisfied with performing a good job. It was an advantage for the volunteers to have had experiences from life in general, but also as a health professional or as being the next of kin of a dementia sufferer. It was important for the volunteers to focus on the dementia sufferer and show caring behavior, and interaction with and the appreciation of the health care professionals were also important. The volunteers were motivated by being able to have influence and participate in the planning of the work, to be a part of the social setting, and to learn. However, for some volunteers it was difficult to adjust to an appropriate role.Conclusion: In order to promote volunteering in a caring context, mutual

  14. Patient Safety Incidents in Hospice Care: Observations from Interdisciplinary Case Conferences

    OpenAIRE

    Oliver, Debra Parker; Demiris, George; Wittenberg-Lyles, Elaine; Gage, Ashley; Dewsnap-Dreisinger, Mariah L.; Luetkemeyer, Jamie

    2013-01-01

    Background: In the home hospice environment, issues arise every day presenting challenges to the safety, care, and quality of the dying experience. The literature pertaining to the safety challenges in this environment is limited.

  15. Observational Study of Solar Magnetic Active Phenomena

    Indian Academy of Sciences (India)

    Hongqi Zhang

    2006-06-01

    The electric current separated into two parts reflected the quantative properties of heterogeneity and chirality of magnetic field, and defined them as the shear and twist components of current. We analyze the basic configuration and evolution of superactive region NOAA 6580-6619-6659. It is found that the contribution of the twist component of current cannot be reflected in the normal analysis of the magnetic shear and gradient of the active regions. The observational evidence of kink magnetic ropes generated from the subatmosphere cannot be found completely in some super delta active regions.

  16. Viewing eCare through Nurses' Eyes: A Phenomenological Study

    Science.gov (United States)

    Willey, Jeffrey Allan

    2013-01-01

    Published research suggests that the future of health care will be dependent on new technologies that serve to decrease the need for increased numbers of critical-care nurses while also increasing the quality of patient care delivery. The eCare technology is one technology that provides this service in the intensive care unit (ICU) setting. The…

  17. Maryland Child Care Choices Study: Changes in Child Care Arrangements of Young Children in Maryland. Publication #2014-57

    Science.gov (United States)

    Krafft, Caroline; Davis, Elizabeth E.; Tout, Kathryn

    2014-01-01

    The purpose of this series is to summarize key findings and implications from the Maryland Child Care Choices study, a longitudinal survey of parents who were applying for Temporary Assistance for Needy Families (TANF) in 2011. Families in the Maryland Child Care Choices study had at least one child age six or younger and lived in one of the…

  18. Using theory to improve low back pain care in Australian Aboriginal primary care: a mixed method single cohort pilot study

    OpenAIRE

    Lin, Ivan B; Coffin, Juli; O’Sullivan, Peter B.

    2016-01-01

    Background Low back pain (LBP) care is frequently discordant with research evidence. This pilot study evaluated changes in LBP care following a systematic, theory informed intervention in a rural Australian Aboriginal Health Service. We aimed to improve three aspects of care; reduce inappropriate LBP radiological imaging referrals, increase psychosocial oriented patient assessment and, increase the provision of LBP self-management information to patients. Methods Three interventions to improv...

  19. Geomagnetic Observations for Main Field Studies

    DEFF Research Database (Denmark)

    Matzka, Jürgen; Chulliat, A.; Mandea, M.;

    2010-01-01

    Direct measurements of the geomagnetic field have been made for more than 400 years, beginning with individual determinations of the angle between geographic and magnetic North. This was followed by the start of continuous time series of full vector measurements at geomagnetic observatories...... and the beginning of geomagnetic repeat stations surveys in the 19th century. In the second half of the 20th century, true global coverage with geomagnetic field measurements was accomplished by magnetometer payloads on low-Earth-orbiting satellites. This article describes the procedures and instruments...... for magnetic field measurements on ground and in space and covers geomagnetic observatories, repeat stations, automatic observatories, satellites and historic observations. Special emphasis is laid on the global network of geomagnetic observatories....

  20. Rainbow of Chaos: A study into the Theory and Practice of Integrated Primary Care

    OpenAIRE

    Valentijn, Pim Peter

    2016-01-01

    This thesis aimed to contribute to a better understanding of what integrated primary care is, and how it can be achieved by focussing on the collaboration processes that underlie the development of integrated primary care. The first part of this thesis operationalized the concept of integrated care from a primary care perspective. The second part of this thesis described the collaboration mechanisms among integrated care projects that were part of a national integrated primary care study in T...

  1. Study of nurses′ knowledge about palliative care: A quantitative cross-sectional survey

    OpenAIRE

    Venkatesan Prem; Harikesavan Karvannan; Kumar, Senthil P; Surulirajan Karthikbabu; Nafeez Syed; Vaishali Sisodia; Saroja Jaykumar

    2012-01-01

    Context: Studies have documented that nurses and other health care professionals are inadequately prepared to care for patients in palliative care. Several reasons have been identified including inadequacies in nursing education, absence of curriculum content related to pain management, and knowledge related to pain and palliative care. Aims: The objective of this paper was to assess the knowledge about palliative care amongst nursing professionals using the palliative care knowledge tes...

  2. What Is Popular Music Studies? Some Observations

    Science.gov (United States)

    Cloonan, Martin

    2005-01-01

    Popular Music Studies (PMS) is now taught in over 20 higher education institutions (HEIs) in the UK and numerous others across the world. This article outlines the constituent parts of PMS in the UK and questions its status as a discipline in its own right. It concludes by arguing that, having established itself, PMS will need to deal with two key…

  3. 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

  4. Japanese Bereaved Family Members' Perspectives of Palliative Care Units and Palliative Care: J-HOPE Study Results.

    Science.gov (United States)

    Kinoshita, Satomi; Miyashita, Mitsunori; Morita, Tatsuya; Sato, Kazuki; Shoji, Ayaka; Chiba, Yurika; Miyazaki, Tamana; Tsuneto, Satoru; Shima, Yasuo

    2016-06-01

    The study purpose was to understand the perspectives of bereaved family members regarding palliative care unit (PCU) and palliative care and to compare perceptions of PCU before admission and after bereavement. A cross-sectional questionnaire survey was conducted, and the perceptions of 454 and 424 bereaved family members were obtained regarding PCU and palliative care, respectively. Family members were significantly more likely to have positive perceptions after bereavement (ranging from 73% to 80%) compared to before admission (ranging from 62% to 71%). Bereaved family members who were satisfied with medical care in the PCU had a positive perception of the PCU and palliative care after bereavement. Respondents younger than 65 years of age were significantly more likely to have negative perceptions of PCU and palliative care. PMID:25852202

  5. AN EPIDEMIOLOGICAL STUDY OF POISONING IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Stephen

    2015-05-01

    Full Text Available AIMS : The aim of this retrospective study was to analyze the rate and chara cteristics of acute poisoning cases admitted to adult intensive care unit ( ICU in a tertiary care medical college hospital. We report clinical features , demographic data , laboratory results , mortality rate , and the results of our treatment in cases who ca me with the history of poisoning. METHODS: The study was done in patients admitted with history of poisoning under the department of medicine at RRMCH Hospital , Bengaluru from December 2013 to November 2014. This study includes 84 poisoning Patients who we re admitted to ICU care. Detailed history , clinical examination and laboratory inv est igations were done in all patients. Ventilator support and supportive treatment was instituted to required patients as p er our ICU criteria of intubation and Ventilation. Data was collected in structured format and analyzed. RESULTS: Majority of the cases were due to organophosphorus compound poisoning ( n=47 , 61% . Others had consumed drugs which included analgesics , carbomates , anti - hypertensive , spirit , benzodiazepines. A mongst these , 4 had consumed aluminum phosphide and all 4 of them died. In some history did not reveal the identity of the drugs. The most common indication for mechanical ventilation in these patients was respiratory failure due to OP poisoning. CONCLUSIO N: Pesticides were the main cause of poisoning ( 68.97% . The reasons being agriculture based economics , poverty due to poor agricultural yield and easy availability of pesticides. Patient education by conducting community based public awareness camps and l ectures might also help in bringing down the incidence of poisoning. The mortality could be decreased by enhanced ICU care , better medical management , appropriate supportive therapy and further restrictions on the highly toxic pesticides.

  6. Developing ontologies in OWL: An observational study

    OpenAIRE

    Dzbor, Martin; Motta, Enrico; Buil-Aranda, C.; Gómez-Pérez, José Manuel; Görlitz, Olaf; Lewen, Holger

    2006-01-01

    As is known in the human-computer interaction (HCI) domain, interactions involve the user, the technology, and the ways they work together. We expand these notions to human-ontology interaction with the aim to investigate how users interact with the networked ontologies in a realistic ontology lifecycle. In this paper, we describe a user study that we have carried out in order to improve our understanding of the level of support provided by current ontology engineering tools in the context en...

  7. Data Extraction and Management in Networks of Observational Health Care Databases for Scientific Research: A Comparison of EU-ADR, OMOP, Mini-Sentinel and MATRICE Strategies

    OpenAIRE

    Gini, Rosa; Schuemie, Martijn; Brown, Jeffrey; Ryan, Patrick; Vacchi, Edoardo; Coppola, Massimo; Cazzola, Walter; Coloma, Preciosa; Berni, Roberto; Diallo, Gayo; Oliveira, José Luis; Avillach, Paul; Trifirò, Gianluca; Rijnbeek, Peter; Bellentani, Mariadonata

    2016-01-01

    Introduction: We see increased use of existing observational data in order to achieve fast and transparent production of empirical evidence in health care research. Multiple databases are often used to increase power, to assess rare exposures or outcomes, or to study diverse populations. For privacy and sociological reasons, original data on individual subjects can’t be shared, requiring a distributed network approach where data processing is performed prior to data sharing. Case Descriptions...

  8. Is the quality of primary healthcare services influenced by the healthcare centre’s type of ownership?—An observational study of patient perceived quality, prescription rates and follow-up routines in privately and publicly owned primary care centres

    OpenAIRE

    Maun, Andy; Wessman, Catrin; Sundvall, Pär-Daniel; Thorn, Jörgen; Björkelund, Cecilia

    2015-01-01

    Background Primary healthcare in Sweden has undergone comprehensive reforms, including freedom of choice regarding provider, freedom of establishment and increased privatisation aiming to meet demands for quality and availability. In this system privately and publicly owned primary care centres with different business models (for-profit vs non-profit) coexist and compete for patients, which makes it important to study whether or not the type of ownership influences the quality of the primary ...

  9. [Managing comprehensive care: a case study in a health district in Bahia State, Brazil].

    Science.gov (United States)

    Santos, Adriano Maia Dos; Giovanella, Ligia

    2016-01-01

    This study analyzed management of comprehensive care in a health district in Bahia State, Brazil, at the political, institutional, organizational, and healthcare practice levels and the challenges for establishing coordinated care between municipalities. The information sources were semi-structured interviews with administrators, focal groups with healthcare professionals and users, institutional documents, and observations. A comprehensive and critical analysis was produced with dialectical hermeneutics as the reference. The results show that the Inter-Administrators Regional Commission was the main regional governance strategy. There is a fragmentation between various points and lack of communications linkage in the network. Private interests and partisan political interference overlook the formally agreed-upon flows and create parallel circuits, turning the right to health into currency for trading favors. Such issues hinder coordination of comprehensive care in the inter-municipal network. PMID:27027458

  10. Management of rheumatic chorea: an observational study

    Directory of Open Access Journals (Sweden)

    Araújo Alexandra Prufer de Queiroz Campos

    2002-01-01

    Full Text Available BACKGROUND: Rheumatic chorea (RC has recently been linked to an antibody-mediated immune mechanism. OBJECTIVE/METHOD: To verify if this knowledge reflected in management changes we conceived a descriptive study. RESULTS: The medical charts of 20 children (13 females aged 6 to 12 years (mean 8 years, diagnosed as RC from June 1996 to June 1999, were reviewed. All patients received some medical treatment. Haloperidol was the most prescribed medication (15 patients - 75 %. Sulpiride, diazepam and valproate were also used as symptomatic treatment. Imune-modulating therapy with prednisone was prescribed for seven children. The shortest course of chorea (16 days occurred in a patient treated with prednisone. CONCLUSION: Prednisone has been prescribed for rheumatic chorea besides the traditional symptomatic approach. A great variety of antichoreic drugs are being employed.

  11. Observational study of children with aerophagia.

    Science.gov (United States)

    Loening-Baucke, Vera; Swidsinski, Alexander

    2008-09-01

    Aerophagia is a rare disorder in children. The diagnosis is often delayed, especially when it occurs concomitantly with constipation. The aim of this report is to increase awareness about aerophagia. This study describes 2 girls and 7 boys, 2 to 10.4 years of age, with functional constipation and gaseous abdominal distention. The abdomen was visibly distended, nontender, and tympanitic in all. Documenting less distention on awakening helped to make the diagnosis. Air swallowing, belching, and flatulence were infrequently reported. The rectal examination often revealed a dilated rectal ampulla filled with gas or stool and gas. The abdominal X-ray showed gaseous distention of the colon in all and of the stomach and small bowel in 8 children. Treatment consisted of educating parents and children about air sucking and swallowing, encouraging the children to stop the excessive air swallowing, and suggesting to them not to use drinking straws and not to drink carbonated beverages. The aerophagia resolved in all in 2 to 20 months (mean=8 months). PMID:18445758

  12. What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program

    Directory of Open Access Journals (Sweden)

    Jann Paquette-Warren

    2006-10-01

    Full Text Available Objective: To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. Design: Qualitative method of focus groups. Setting/Participants: The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. Method: Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. Main findings: Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. Conclusion: Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting.

  13. A mobile hospice nurse teaching team’s experience: training care workers in spiritual and existential care for the dying - a qualitative study

    OpenAIRE

    Tornøe, Kirsten; Danbolt, Lars Johan; Kvigne, Kari; Sørlie, Venke

    2015-01-01

    Background Nursing home and home care nursing staff must increasingly deal with palliative care challenges, due to cost cutting in specialized health care. Research indicates that a significant number of dying patients long for adequate spiritual and existential care. Several studies show that this is often a source of anxiety for care workers. Teaching care workers to alleviate dying patients’ spiritual and existential suffering is therefore important. The aim of this study is to illumin...

  14. Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

    Directory of Open Access Journals (Sweden)

    Bailey Kerry A

    2010-08-01

    Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

  15. Acute Myocardial Infarction Quality of Care: The Strong Heart Study

    Science.gov (United States)

    Best, Lyle G.; Butt, Amir; Conroy, Britt; Devereux, Richard B.; Galloway, James M.; Jolly, Stacey; Lee, Elisa T.; Silverman, Angela; Yeh, Jeun-Liang; Welty, Thomas K.; Kedan, Ilan

    2014-01-01

    Objectives Evaluate the quality of care provided patients with acute myocardial infarction and compare with similar national and regional data. Design Case series. Setting The Strong Heart Study has extensive population-based data related to cardiovascular events among American Indians living in three rural regions of the United States. Participants Acute myocardial infarction cases (72) occurring between 1/1/2001 and 12/31/2006 were identified from a cohort of 4549 participants. Outcome measures The proportion of cases that were provided standard quality of care therapy, as defined by the Healthcare Financing Administration and other national organizations. Results The provision of quality services, such as administration of aspirin on admission and at discharge, reperfusion therapy within 24 hours, prescription of beta blocker medication at discharge, and smoking cessation counseling were found to be 94%, 91%, 92%, 86% and 71%, respectively. The unadjusted, 30 day mortality rate was 17%. Conclusion Despite considerable challenges posed by geographic isolation and small facilities, process measures of the quality of acute myocardial infarction care for participants in this American Indian cohort were comparable to that reported for Medicare beneficiaries nationally and within the resident states of this cohort. PMID:21942161

  16. Prescription and cost-analysis of antiemetic medication use in pediatric wards: a prospective observational study

    OpenAIRE

    Maulik M. Patel; Rana, Devang A.; Patel, Varsha J.; Manish Patel

    2014-01-01

    Background: Use of anti-emetic drugs in pediatric population is often warranted, but choice of drug remains questionable within pediatricians. Objective of current study is: to study prescribing pattern and to calculate cost of antiemetic drug therapy in pediatric wards. Methods: A prospective, observational study was conducted in pediatric wards of a tertiary care hospital of over 14 month’s duration. Institutional ethics committee approval was obtained and written informed consent o...

  17. An observational study on cough in children: epidemiology, impact on quality of sleep and treatment outcome

    OpenAIRE

    De Blasio, Francesco; Dicpinigaitis, Peter V; Rubin, Bruce K; De Danieli, Gianluca; Lanata, Luigi; Zanasi, Alessando

    2012-01-01

    Background Cough is one of the most frequent symptoms in children and is the most common symptom for which children visit a health care provider. Methods This is an observational study on acute cough associated with upper respiratory tract infection (URTI) in children. The study evaluates the epidemiology and impact of cough on quality of sleep and children's activities, and the outcome of cough with antitussive treatments in pediatric routine clinical practice. Study assessments were perform...

  18. A conceptual framework for interprofessional shared decision making in home care: Protocol for a feasibility study

    OpenAIRE

    Murray Mary-Anne; Fraser Kimberley; Dumont Serge; Desroches Sophie; Brière Nathalie; Stacey Dawn; Légaré France; Sales Anne; Aubé Denise

    2011-01-01

    Abstract Background Shared decision making (SDM) is fundamental to informed consent and client-centered care. So far, SDM frameworks have been limited to the client-physician dyad, even though care is increasingly delivered by interprofessional (IP) teams. IP collaboration is especially essential in home care, one of health care's most rapidly growing areas. This study will assess whether it is possible to practice SDM in IP home care. Methods/Design We will use a qualitative case study and a...

  19. Cost Analysis of Prenatal Care Using the Activity-Based Costing Model: A Pilot Study

    OpenAIRE

    Gesse, Theresa; Golembeski, Susan; Potter, Jonell

    1999-01-01

    The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.

  20. The Effects of Staff Training on the Types of Interactions Observed at Two Group Homes for Foster Care Children

    Science.gov (United States)

    Crosland, Kimberly A.; Dunlap, Glen; Sager, Wayne; Neff, Bryon; Wilcox, Catherine; Blanco, Alfredo; Giddings, Tamela

    2008-01-01

    Objectives: An extensive literature base exists for behavioral parent training; however, few studies have focused on training direct care staff at group home and residential facilities for children. This study was conducted to determine whether a behavioral staff training program consisting of classroom training and in-home feedback would improve…

  1. Study Of Maternal And Fetal Outcome In Twin Gestation At Tertiary Care Teaching Hospital

    OpenAIRE

    Bangal, Vidyadhar B; Patel, Shrutiben M; Khairnar, Devendra N

    2012-01-01

    Twin gestation is considered as high risk pregnancy due to associated high maternal morbidity and perinatal mortality in comparison with singleton pregnancies .Overall, the rate of twin gestation is on rise due to inadvertent use of ovulation induction drugs in assisted reproductive techniques. This observational study was carried out to find the maternal and perinatal outcome in 100 cases of twin gestation delivered at tertiary care referral hospital over a period of fifteen months. It was o...

  2. Challenges of Change: A Qualitative Study of Chronic Care Model Implementation

    OpenAIRE

    Hroscikoski, Mary C.; Solberg, Leif I.; Sperl-Hillen, JoAnn M.; Harper, Peter G.; McGrail, Michael P.; Crabtree, Benjamin F.

    2006-01-01

    PURPOSE The Chronic Care Model (CCM) provides a conceptual framework for transforming health care for patients with chronic conditions; however, little is known about how to best design and implement its specifics. One large health care organization that tried to implement the CCM in primary care provided an opportunity to study these issues.

  3. A pilot study: Reiki for self-care of nurses and healthcare providers.

    Science.gov (United States)

    Brathovde, Angela

    2006-01-01

    The purpose of this study was to determine if Reiki energy therapy, level I, was taught as a self-care practice to healthcare providers, would their caring perceptions change? Methodological triangulation technique, including a self-report caring scale and interviews, was used, demonstrating positive changes in perceptions of participants' caring behaviors. PMID:16518156

  4. The Obstacles against Nurse-Family Communication in Family-Centered Care in Neonatal Intensive Care Unit: a Qualitative Study

    OpenAIRE

    Zahra Hadian Shirazi; Farkhondeh Sharif; Mahnaz Rakhshan; Narjes Pishva; Faezeh Jahanpour

    2015-01-01

    Introduction: Communication is one of the key principles in Family-Centered Care (FCC). Studies have shown some drawbacks in communication between families and nurses. Therefore, the present study aimed to recognize the obstacles against nurse-family communication in FCC in Neonatal Intensive Care Unit (NICU). Methods: This qualitative study was conducted on 8 staff nurses in 2 NICUs affiliated to Shiraz University of Medical Sciences selected through purposive sampling. The data were collect...

  5. Top 20 Research Studies of 2014 for Primary Care Physicians.

    Science.gov (United States)

    Ebell, Mark H; Grad, Roland

    2015-09-01

    A team of primary care clinicians with expertise in evidence-based medicine performed monthly surveillance of more than 110 English-language clinical research journals during 2014, and identified 255 studies that had the potential to change how family physicians practice. Each study was critically appraised and summarized, focusing on its relevance to primary care practice, validity, and likelihood that it could change practice. A validated tool was used to obtain feedback from members of the Canadian Medical Association about the clinical relevance of each POEM (patient-oriented evidence that matters) and the benefits they expect for their practice. This article, the fourth installment in this annual series, summarizes the 20 POEMs based on original research studies judged to have the greatest impact on practice for family physicians. Key studies for this year include advice on symptomatic management and prognosis for acute respiratory infections; a novel and effective strengthening treatment for plantar fasciitis; a study showing that varenicline plus nicotine replacement is more effective than varenicline alone; a network meta-analysis concluding that angiotensin-converting enzyme inhibitors are preferred over angiotensin II receptor blockers; the clear benefits of initial therapy with metformin over other agents in patients with diabetes mellitus; and important guidance on the use of anticoagulants. PMID:26371571

  6. EBM in primary care: a qualitative multicenter study in Spain

    Directory of Open Access Journals (Sweden)

    Calderón Carlos

    2011-08-01

    Full Text Available Abstract Background Evidence based medicine (EBM has made a substantial impact on primary care in Spain over the last few years. However, little research has been done into family physicians (FPs' attitudes related to EBM. The present study investigates FPs' perceptions of EBM in the primary care context. Methods This study used qualitative methodology. Information was obtained from 8 focus groups composed of 67 FPs from 47 health centers in 4 autonomous regions in Spain. Intentional sampling considered participants' previous education in EBM, and their experience as tutors in family medicine or working groups' members of the Spanish Society of Family Practice. Sociological discourse analysis was used with the support of the MAXqda software. Results were validated by means of triangulation among researchers and contrast with participants. Results Findings were grouped into three main areas: 1 The tug-of-war between the "science" of EBM and "experience" in the search for good clinical practice in primary care; 2 The development of EBM sensemaking as a reaction to contextual factors and interests; 3 The paradox of doubt and trust in the new EBM experts. The meaning of EBM was dynamically constructed within the primary care context. FPs did not consider good clinical practice was limited to the vision of science that EBM represents. Its use appeared to be conditioned by several factors that transcended the common concept of barriers. Along with concerns about its objectivity, participants showed a tendency to see EBM as the use of simplified guidelines developed by EBM experts. Conclusions The identification of science with EBM and its recognition as a useful but insufficient tool for the good clinical practice requires rethinking new meanings of evidence within the primary care reality. Beyond the barriers related to accessing and putting into practice the EBM, its reactive use can determine FPs' questions and EBM development in a direction not

  7. Diffusion of a collaborative care model in primary care: a longitudinal qualitative study

    Directory of Open Access Journals (Sweden)

    Vedel Isabelle

    2013-01-01

    Full Text Available Background Although collaborative team models (CTM improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs. The objectives of this study are to understand: (1 how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2 the model's diffusion process. Methods We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 PCPs and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics. Results Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM's diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM's compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices. Opinion leaders played a key role in the diffusion of the CTM among PCPs. Conclusion CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians.

  8. Observations on the birth and subsequent care of twin offspring by a lone pair of wild emperor tamarins (Saguinus imperator).

    Science.gov (United States)

    Windfelder, T L

    2000-10-01

    The birth of emperor tamarin (Saguinus imperator) twins was observed in the wild. The mother was a member of lone pair in a marked population of emperor tamarins in the Manu National Park, Peru. This report describes the birth and provides subsequent information on infant care and survival. Despite some difficulties, this lone pair of relatively young, primiparous emperor tamarins was able to successfully raise twin offspring to the age of at least 1 month. PMID:11051446

  9. Health-care cost of diabetes in South India: A cost of illness study

    OpenAIRE

    Akari, Sadanandam; Mateti, Uday Venkat; Kunduru, Buchi Reddy

    2013-01-01

    Objective: The objective of this study is to analyze the health-care cost by calculating the direct and indirect costs of diabetes with co-morbidities in south India. Methods: A prospective observational study was conducted at Rohini super specialty hospital (India). Patient data as well as cost details were collected from the patients for a period of 6 months. The study was approved by the hospital committee prior to the study. The diabetic patients of age >18 years, either gender were inclu...

  10. Observations and reflections of communication in health care - could Transactional Analysis be used as an effective approach?

    International Nuclear Information System (INIS)

    This paper advocates a model of communication, known as Transactional Analysis (TA), as being highly consonant with communication skills and reflective practice in radiography. The paper reviews the history of TA, from its earliest inception and applications, to its most recent use in the observation and discussions of health care communication. Finally it considers the application of this model to the profession of radiography as an observation/reflection tool and how it might be used to improve the practice of communication with patients

  11. Developmentally supportive neonatal care : A study of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) in a Swedish environment

    OpenAIRE

    Westrup, Björn

    2003-01-01

    A family-centred, developmentally supportive approach to newborn intensive care, referred to as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has attracted considerable interest in recent years. Studies performed in North America have reported that NIDCAP improves short-term growth, decreases the need for respiratory support, decreases the length and cost of hospitalisation, and improves neurodevelopment. The aim of the present study was to ch...

  12. Implementing a stepped-care approach in primary care: results of a qualitative study.

    NARCIS (Netherlands)

    Franx, G.C.; Oud, M.; Lange, J.; Wensing, M.J.; Grol, R.P.

    2012-01-01

    BACKGROUND: Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC) was initiated in t

  13. Alarming signs of serious infections in febrile children: Studies in primary care and hospital emergency care

    NARCIS (Netherlands)

    Y. van Ierland (Yvette)

    2013-01-01

    markdownabstract__Abstract__ Children constitute a substantial part of the workload of physicians in primary care and hospital emergency care. In the Netherlands, about 70% of the 3.9 million inhabitants less than 20 years of age had one or more contacts with their general practitioner (GP) in 2011

  14. Self-care coping strategies in people with diabetes: a qualitative exploratory study

    OpenAIRE

    O'Sullivan Tony; Bradley Colin P; Collins Margaret M; Perry Ivan J

    2009-01-01

    Abstract Background The management of diabetes self-care is largely the responsibility of the patient. With more emphasis on the prevention of complications, adherence to diabetes self-care regimens can be difficult. Diabetes self-care requires the patient to make many dietary and lifestyle changes. This study will explore patient perceptions of diabetes self-care, with particular reference to the burden of self-care and coping strategies among patients. Methods A maximum variation sample of ...

  15. A survey-based study of knowledge of Alzheimer’s disease among health care staff

    OpenAIRE

    Smyth Wendy; Fielding Elaine; Beattie Elizabeth; Gardner Anne; Moyle Wendy; Franklin Sara; Hines Sonia; MacAndrew Margaret

    2013-01-01

    Abstract Background Continued aging of the population is expected to be accompanied by substantial increases in the number of people with dementia and in the number of health care staff required to care for them. Adequate knowledge about dementia among health care staff is important to the quality of care delivered to this vulnerable population. The purpose of this study was to assess knowledge about dementia across a range of health care staff in a regional health service district. Methods K...

  16. Towards implementing coordinated healthy lifestyle promotion in primary care : a mixed method study

    OpenAIRE

    Thomas, Kristin; Bendtsen, Preben; Krevers, Barbro

    2015-01-01

    Background: Primary care is increasingly being encouraged to integrate healthy lifestyle promotion in routine care. However, implementation has been suboptimal. Coordinated care could facilitate lifestyle promotion practice but more empirical knowledge is needed about the implementation process of coordinated care initiatives. This study aimed to evaluate the implementation of a coordinated healthy lifestyle promotion initiative in a primary care setting. Methods: A mixed method, convergent, ...

  17. Seniors’ perspectives on care: a case study of the Alex Seniors health clinic, Calgary

    OpenAIRE

    Shaw, Marta; Rypien, Candace; Drummond, Neil; Harasym, Patricia; Nixon, Lara

    2015-01-01

    Background Primary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to th...

  18. Barriers to and facilitators of care for hemodialysis patients; a qualitative study

    OpenAIRE

    Nobahar, Monir; Tamadon, Mohammad Reza

    2016-01-01

    Introduction: Patients undergoing hemodialysis require direct and continuous care. Identifying the barriers to and factors facilitating hemodialysis care can improve care quality. Objectives: The aim of this study was to assess the barriers and facilitators of care for hemodialysis patients. Patients and Methods: This study was conducted as a qualitative study and it utilized content analysis approach. The study was performed in hemodialysis ward of Kowsar hospital in Semnan, in 2014. We used...

  19. The importance of study design strategies in gender bias research: the case of respiratory disease management in primary care

    OpenAIRE

    Ruiz‐Cantero, Maria Teresa; Ronda, Elena; Álvarez‐Dardet, Carlos

    2007-01-01

    Background: Most research on gender bias has been carried out in hospitals and focuses mainly on severe diseases. Consequently, little is known about gender bias in relation to other illnesses and healthcare settings. Aim: To explore the existence of gender bias in the management of patients seeking primary care for respiratory complaints. Method: An observational, prospective blind follow-up study was performed in a primary care centre in Alicante, Spain. 830 patients were monitored fr...

  20. Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital

    OpenAIRE

    Arnold, R.; van Teijlingen, E.; Ryan, K.; Holloway, I

    2014-01-01

    Objective To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Design Qualitative ethnographic study. Setting A maternity hospital, Afghanistan. Population Doctors, midwives and care assistants. Methods Six weeks of observation followed by 22 semi-structured interviews and four informal group discussion...

  1. Improving research on primary care patients with mental health problems: observations from an investigator.

    Science.gov (United States)

    Rost, Kathryn

    1999-06-01

    BACKGROUND AND AIMS OF THE MANUSCRIPT: The purpose of this manuscript is to define under-recognized perspectives that the primary care research field needs to integrate into research initiatives, and to discuss practical strategies to ensure the successful implementation of these initiatives. METHODS: Perspectives and strategies were identified through personal experience, informal discussion with ten senior investigators in the field and a selected literature review. RESULTS: Research on improving treatment for the mental health problems of primary care patients will progress more rapidly if investigators explore the usefulness of a competing demands framework, integrate a readiness to change perspective in developing more individualized interventions for providers and patients, evaluate interventions for their effect on productivity and test alternative interventions particularly in patients who fail to benefit from currently accepted treatment. The implementation of these initiatives will be more successful if research teams define unique scientific agendas, invest energy in pursuing questions whose value is undisputed by multiple parties, increase the rate of inter-institutional exchange between senior and junior investigators, pilot test assumptions that affect project budget and timeline, build in a limited amount of slack time in early phases of project implementation and network effectively. IMPLICATIONS FOR FURTHER RESEARCH: Investigator efforts to define critical questions for the primary care management of mental health problems will be enhanced if they revisit the definition of their research agendas in the light of new perspectives that are emerging in the field. Similarly, the implementation of these agendas will be strengthened if investigators make conscious attempts to use one or more of the strategies suggested. PMID:11967412

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

    Directory of Open Access Journals (Sweden)

    Masoud Kianpour

    2013-02-01

    Full Text Available Introduction   This study lies at the intersection of the sociology of emotions and medical sociology, investigating emotion management among a rather unknown category of medical personnel –Hospital Chaplains. Sociologists of emotions seek to understand how emotions can be socially influenced in terms of both experience and expression. They believe emotions can be influenced by such institutions as culture and religion. As a result, not only do societies and subcultures have different patterns of expressing emotions according to their own norms and characteristics, but there are also different ways of managing emotions in social institutions. For example, in North American healthcare system, hospital chaplaincy is institutionalized, like other members of the medical team, to provide spiritual and religious care, which is often accompanied with emotional support, requiring therefore emotion management. In order to explore emotional experiences that chaplains undergo as a result of working in hospital and dealing with people who are emotionally overwhelmed, the author utilized insights from interactional and symbolic interactionist, phenomenological, and ethnomethodological approaches within the sociology of emotions and spoke with different chaplains from five faith traditions. The aim was to understand how chaplains perform interpersonal emotion management, what techniques, strategies and skills are involved in dealing with people’s emotions, and how performing emotion management in healthcare institutions brings religion and spirituality at the forefront of a secular society.       Material and Methods   This is a qualitative study based on in-depth interviewing with hospital chaplains working in different hospitals in the Toronto area. Toronto has a large number of hospitals and medical/healthcare institutions, most of which have a spiritual care department in which a number of full-time and part-time chaplains work to provide

  3. Validation and Evaluation of Two Observational Pain Assessment Tools in a Trauma and Neurosurgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Jane Topolovec-Vranic

    2013-01-01

    Full Text Available BACKGROUND: Studies have demonstrated that patients in the intensive care unit experience high levels of pain. While many of these patients are nonverbal at some point during their stay, there are few valid tools available to assess pain in this group.

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

    Directory of Open Access Journals (Sweden)

    Jan S. Jukema

    2015-11-01

    Full Text Available Background: The practice of nursing is shaped partly by nurses’ professional perspective of good care, guided by a nursing framework. An example is the framework of preservative care, which defines good nursing care for vulnerable older people in nursing homes. Currently we lack an understanding of how this framework could help nurses in training; it may be a useful developmental aid for undergraduate nursing students but so far there are no empirical data to support this. Aim: The purpose of this study is to explore how helpful a particular framework can be in the learning journey of two undergraduate nursing students. The study draws on narrative and reflective accounts, guided by the question: ‘How does preservative care as a framework of good care help two undergraduate nursing students develop their caring for older people?’ Methods: This was a reflective case study, in which two students – experienced registered nurses (non-graduates following a part-time education programme – reflected on their practices, using preservative care as a framework for taking care of older people. They kept reflective journals and received constructive feedback from the author of the preservative care framework (the first author. Their data were analysed in three steps. Findings: Both students reported gaining profound help from the framework in their evaluations of daily practices, although they rated the help differently in terms of demanding and rewarding experiences. The framework was particularly helpful in developing qualities in three domains: person-centredness, professional role and specific nursing competencies. Conclusions: The results of our study indicate how using a particular nursing framework made a difference to the practice of two undergraduate nursing students. Exploring the meaning and place of particular nursing frameworks in nursing education is necessary to establish their potential benefits for students. Implications for

  5. STUDY OF MATERNAL MORTALITY IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sandhya Devi

    2015-05-01

    Full Text Available BACKGROUND: A woman dies from complications of child birth every minute . The major causes for maternal mortality in India are uncontrolled fertility , inaccessibility or inadequate utilization of health care facilities , illiteracy , ignorance and gender discrimination . OBJECTIV ES: (1 To identify various causes of maternal deaths in a teaching hospital . (2 To study the profile of population attending the tertiary hospital . Methodology : A retrospective study was conducted in a tertiary hospital over a period of 2 years (January 2013 - December 2014 and data was analysed manually using case sheets and maternal death audit forms . RESULTS: In the study period , there were 11636 deliveries and 97 maternal deaths . The direct causes accounted for 77 maternal deaths with haemorrhage , hype rtension and sepsis as leading causes of maternal mortality . Conclusion : Emphasis on health education , need for regular antenatal checkups and proper training of health personnel is required to reduce maternal mortality .

  6. Father involvement in infant care: two longitudinal studies.

    Science.gov (United States)

    Rustia, J G; Abbott, D

    1993-12-01

    Data collected from two samples of fathers in separate longitudinal studies were compared. One sample consisted of 53 first-time fathers and the other of 69 multiple-time fathers. A post-test only time-series design was used for both studies, and both employed the same procedures and instruments. The studies examined role enactment of fathers with different child-caring experiences using role-theory concepts. Fathers' normative expectations, personal expectations, and personal learning about parenting were tested to determine if they were predictive of paternal role performance. The findings seem to indicate that the culture of fatherhood has changed more rapidly than the conduct of fatherhood. PMID:8288416

  7. Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care.

    LENUS (Irish Health Repository)

    Cullen, Walter

    2009-01-01

    BACKGROUND: Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched \\'controls\\' and to develop and pilot test a valid study instrument. METHODS: A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status. RESULTS: Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation. CONCLUSION: Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words).

  8. Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care.

    LENUS (Irish Health Repository)

    Cullen, Walter

    2012-02-01

    BACKGROUND: Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched \\'controls\\' and to develop and pilot test a valid study instrument. METHODS: A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status. RESULTS: Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation. CONCLUSION: Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words).

  9. Review, Synthesis and Recommendations of Seven Foster Care Studies in California, 1974.

    Science.gov (United States)

    Children's Research Inst. of California, Sacramento.

    This document, prepared by California Review and Synthesis of Foster Care Studies project reviews and combines the major recommendations of seven recent California studies of foster care. These studies were: (1) Children Waiting, State Dept. of Social Welfare, 1972; (2) Report on Foster Care in California Joint Legislative Audit Committee, 1973;…

  10. Informal and Formal Kinship Care Populations: A Study in Contrasts.

    Science.gov (United States)

    McLean, Beth; Thomas, Rebecca

    1996-01-01

    Contrasts a group of informal kinship care providers in Philadelphia (KIDS'n'KIN Program) with two "formal" kinship care groups in Baltimore and California, examining similarities and differences in child and caregiver demographies and service needs. Presents the program's response to the needs of informal kinship care providers. (Author/SD)

  11. Innovation in patient-centered care: lessons from a qualitative study of innovative health care organizations in Washington State

    Directory of Open Access Journals (Sweden)

    Reed Peter

    2012-12-01

    Full Text Available Abstract Background Growing interest in the promise of patient-centered care has led to numerous health care innovations, including the patient-centered medical home, shared decision-making, and payment reforms. How best to vet and adopt innovations is an open question. Washington State has been a leader in health care reform and is a rich laboratory for patient-centered innovations. We sought to understand the process of patient-centered care innovation undertaken by innovative health care organizations – from strategic planning to goal selection to implementation to maintenance. Methods We conducted key-informant interviews with executives at five health plans, five provider organizations, and ten primary care clinics in Washington State. At least two readers of each interview transcript identified themes inductively; final themes were determined by consensus. Results Innovation in patient-centered care was a strategic objective chosen by nearly every organization in this study. However, other goals were paramount: cost containment, quality improvement, and organization survival. Organizations commonly perceived effective chronic disease management and integrated health information technology as key elements for successful patient-centered care innovation. Inertia, resource deficits, fee-for-service payment, and regulatory limits on scope of practice were cited as barriers to innovation, while organization leadership, human capital, and adaptive culture facilitated innovation. Conclusions Patient-centered care innovations reflected organizational perspectives: health plans emphasized cost-effectiveness while providers emphasized health care delivery processes. Health plans and providers shared many objectives, yet the two rarely collaborated to achieve them. The process of innovation is heavily dependent on organizational culture and leadership. Policymakers can improve the pace and quality of patient-centered innovation by setting targets

  12. Special observation in the care of psychiatric inpatients: a literature review.

    Science.gov (United States)

    Bowers, L; Park, A

    2001-12-01

    This paper summarizes the results of a search of electronic databases for papers on special observation (SO). Published studies to date about SO are entirely descriptive. No evaluative research appears to have taken place, leaving the procedure based on clinical pragmatism and tradition. Something between 3%-20% of admissions receive some form of SO during their stay and the rate of usage varies widely between wards. SO is used as a method of controlling and containing the most disturbed patients who are considered to be imminently at risk of harming themselves or others. Such patients tend to be younger and suffering from acute psychosis or depression. Which professional staff have the authority to initiate and terminate SO varies from place to place, as does its duration. The financial costs have been crudely assessed and are reported to be very high, perhaps up to 20% of the nursing budget for a hospital. Further variation exists on who is allowed to carry out SO. Nurses frequently make unofficial modifications to the procedure based upon their own individual judgments and assessments, and policies vary widely among hospitals. There is little agreement between authorities on what nurses should do during SO, although there is some evidence that it can, under certain circumstances, be therapeutic. However there is also evidence that nurses find SO stressful and patients dislike it. PMID:11881179

  13. "Doctor, Why Didn't You Adopt My Baby?" Observant Participation, Care, and the Simultaneous Practice of Medicine and Anthropology.

    Science.gov (United States)

    Sufrin, Carolyn

    2015-12-01

    Medical anthropology has long appreciated the clinical encounter as a rich source of data and a key site for critical inquiry. It is no surprise, then, that a number of physician-anthropologists have used their clinical insights to make important contributions to the field. How does this duality challenge and enhance the moral practice and ethics of care inherent both to ethnography and to medicine? How do bureaucratic and professional obligations of HIPAA and the IRB intersect with aspirations of anthropology to understand human experience and of medicine to heal with compassion? In this paper, I describe my simultaneous fieldwork and clinical practice at an urban women's jail in the United States. In this setting, being a physician facilitates privileged access to people and spaces within, garners easy trust, and enables an insider perspective more akin to observant participation than participant observation. Through experiences of delivering the infants of incarcerated pregnant women and of being with the mothers as they navigate drug addiction, child custody battles, and re-incarceration, the roles of doctor and anthropologist become mutually constitutive and transformative. Moreover, the dual practice reveals congruities and cracks in each discipline's ethics of care. Being an anthropologist among informants who may have been patients reworks expectations of care and necessitates ethical practice informed by the dual roles. PMID:25697337

  14. Developing a framework of service convenience in health care: An exploratory study for a primary care provider.

    Science.gov (United States)

    Tuzovic, Sven; Kuppelwieser, Volker

    2016-01-01

    From retail health clinics and online appointment scheduling to (mobile) kiosks that enable patient check-in and automate the collection of copays and open balances, convenience has become an important topic in the health care sector over the last few years. While service convenience has also gained much interest in academia, one common limitation is that authors have adopted a "goods-centered" perspective focusing primarily on retail settings. Results of this exploratory study reveal that health care service convenience encompasses seven different dimensions: decision, access, scheduling, registration and check-in, transaction, care delivery, and postconsultation convenience. Implications and future research suggestions are discussed. PMID:27215644

  15. Changes in primary care physician’s management of low back pain in a model of interprofessional collaborative care: an uncontrolled before-after study

    Directory of Open Access Journals (Sweden)

    Mior Silvano

    2013-02-01

    Full Text Available Abstract Background Tracking how clinicians treat patients provides an opportunity to explore how the clinical management of common musculoskeletal disorders evolves over time. We present an uncontrolled before-after study of a primary care physician’s management of low back pain and describe how his involvement in an interprofessional collaborative practice was associated with a change in the management of patients with low back pain. Method Data from the electronic medical record of one primary care physician who participated in a study of a model of chiropractic-medical collaboration were retrospectively collected. Records of a sample of consecutive patients prior to the start (i.e. pre-study, n = 51 and at the end of the collaborative study (i.e. study, n = 49 were collected. Results Demographics were similar in both groups but median number of physician visits (2.5 and 1.0, average prescriptions per patients (1.24 and 0.47, and total number of narcotic prescriptions (14 and 6 differed between pre-study and study groups, respectively. Separate analysis of only the records of low back pain study patients revealed that 61% were referred for chiropractic care during the study period. Patients who were not referred had more neurological deficits and leg pain but back pain severity and average number of prescriptions was about the same. Referred patients in the study group had about 25% fewer physician visits and imaging requests. Conclusion Based on this study of a single primary care physician, we hypothesize that doctors may change their prescribing behaviours and consultation rate for patients with low back pain when engaged in interprofessional collaborative care. Further research is required to test this observation in the population.

  16. Alarming signs of serious infections in febrile children: Studies in primary care and hospital emergency care

    OpenAIRE

    van Ierland, Yvette

    2013-01-01

    markdownabstract__Abstract__ Children constitute a substantial part of the workload of physicians in primary care and hospital emergency care. In the Netherlands, about 70% of the 3.9 million inhabitants less than 20 years of age had one or more contacts with their general practitioner (GP) in 2011. Primary out-ofhours care is annually visited by approximately 600,000 children younger than 14 years of age and hospital emergency departments (EDs) by nearly 400,000 children in this age group. F...

  17. Top 20 Research Studies of 2015 for Primary Care Physicians.

    Science.gov (United States)

    Ebell, Mark H; Grad, Roland

    2016-05-01

    In 2015, a group of primary care clinicians with expertise in evidence-based practice performed monthly surveillance of more than 110 English-language clinical research journals. They identified 251 studies that addressed a primary care question and had the potential to change practice if valid (patient-oriented evidence that matters, or POEMs). Each study was critically appraised and disseminated to subscribers via e-mail, including members of the Canadian Medical Association who had the option to use a validated tool to assess the clinical relevance of each POEM and the benefits they expect for their practice. This article, the fifth installment in this annual series, summarizes the 20 POEMs based on original research studies judged to have the greatest clinical relevance for family physicians. Key recommendations include questioning the need for backup throat cultures; avoiding early imaging and not adding cyclobenzaprine or oxycodone to naproxen for patients with acute low back pain; and encouraging patients with chronic or recurrent low back pain to walk. Other studies showed that using a nicotine patch for more than eight weeks has little benefit; that exercise can prevent falls that cause injury in at-risk older women; and that prostate cancer screening provides a very small benefit, which is outweighed by significant potential harms of screening and associated follow-up treatment. Additional highly rated studies found that tight glycemic control provides only a small cardiovascular benefit in patients with type 2 diabetes mellitus at the expense of hypoglycemic episodes; that treating mild hypertension can provide a modest reduction in stroke and all-cause mortality; that sterile gloves are not needed for minor uncomplicated skin procedures; that vasomotor symptoms last a mean of 7.4 years; and that three regimens have been shown to provide the best eradication rates for Helicobacter pylori infection. PMID:27175953

  18. Routine general practice care for panic disorder within the lifestyle approach to managing panic study

    OpenAIRE

    Lambert, Rodney A.

    2012-01-01

    Routine general practice (GP) care is rarely comprehensively described in clinical trials. This paper examines routine GP care within the lifestyle approach to managing panic (LAMP) study. The aim of this paper is to describe/discuss routine GP care for panic disorder (PD) patients within both study arms in the LAMP study. An unblinded pragmatic randomised controlled trial in 15 East of England GP practices (2 primary care trusts). Participants met Diagnostic and Statistical Manual of Mental ...

  19. Interpreting the quality of health care database studies on the comparative effectiveness of oral anticoagulants in routine care

    Directory of Open Access Journals (Sweden)

    Schneeweiss S

    2013-09-01

    Full Text Available Sebastian Schneeweiss, Krista F Huybrechts, Joshua J Gagne Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA Background: Dabigatran, an oral direct thrombin inhibitor, has now been available for 2 years in the US for the prevention of stroke in patients with nonvalvular atrial fibrillation, and direct Xa inhibitors are also starting to enter the market. Studies examining the effects of new oral anticoagulants in health care databases are beginning to emerge. The purpose of this study was to describe the validity of early published observational studies on the comparative safety and effectiveness of new oral anticoagulants in patients with atrial fibrillation. Methods: We identified published nonrandomized post-marketing studies (articles or conference abstracts or posters and critically appraised their internal validity, with a particular focus on their ability to control confounding and other biases. Results: Two full-length journal articles, three conference posters, two conference presentation abstracts, and a US Food and Drug Administration analysis form the basis of the early comparative effectiveness and safety experience with new oral anticoagulants. Some published studies exhibit substantial biases and have insufficient precision for several important endpoints. Several studies suffer from biases arising from comparing ongoing users of the older drug, warfarin, who seem to tolerate it, to initiators of the new treatment who may have switched from warfarin or have had no prior experience with anticoagulants. Analyses tended to not adjust or not adjust adequately for confounding, and unsound propensity score application was also observed. Several studies introduced selection bias by excluding patients who died during follow-up and by restricting the study population to those with continuous database enrollment following cohort entry. We

  20. Connecting Primary Health Care: A Comprehensive Pilot Study.

    Science.gov (United States)

    Maghsoudloo, Mehran; Abolhassani, Farid; Lotfibakhshaiesh, Nasrin

    2016-07-01

    The collection of data within the primary health care facilities in Iran is essentially paper-based. It is focused on family's health, monitoring of non-infectious and infectious diseases. Clearly due to the paper-based nature of the tasks, timely decision making at most can be difficult if not impossible. As part of an on-going electronic health record implementation project at Tehran University of Medical Sciences, for the first time in the region, based on a comprehensive pilot project, four urban healthcare facilities are connected to their headquarters and beyond, covering all aspects of primary health care, for the last four years. Without delving into the technical aspects of its software engineering processes, the progress of the implementation is reported, selection of summarized data is presented, and experience gained thus far are discussed. Four years passed and if time is any important reason to go by, then it is safe to accept that the software architecture and electronic health record structural model implemented are robust and yet extensible. Aims and duration of a pilot study should be clearly defined prior to start and managed till its completion. Resistance to change and particularly to information technology, apart from its technical aspects, is also based on human factors. PMID:27424015

  1. Fatal poisonings in Oslo: a one-year observational study

    Directory of Open Access Journals (Sweden)

    Heyerdahl Fridtjof

    2010-06-01

    Full Text Available Abstract Background Acute poisonings are common and are treated at different levels of the health care system. Since most fatal poisonings occur outside hospital, these must be included when studying characteristics of such deaths. The pattern of toxic agents differs between fatal and non-fatal poisonings. By including all poisoning episodes, cause-fatality rates can be calculated. Methods Fatal and non-fatal acute poisonings in subjects aged ≥16 years in Oslo (428 198 inhabitants were included consecutively in an observational multi-centre study including the ambulance services, the Oslo Emergency Ward (outpatient clinic, and hospitals, as well as medico-legal autopsies from 1st April 2003 to 31st March 2004. Characteristics of fatal poisonings were examined, and a comparison of toxic agents was made between fatal and non-fatal acute poisoning. Results In Oslo, during the one-year period studied, 103 subjects aged ≥16 years died of acute poisoning. The annual mortality rate was 24 per 100 000. The male-female ratio was 2:1, and the mean age was 44 years (range 19-86 years. In 92 cases (89%, death occurred outside hospital. The main toxic agents were opiates or opioids (65% of cases, followed by ethanol (9%, tricyclic anti-depressants (TCAs (4%, benzodiazepines (4%, and zopiclone (4%. Seventy-one (69% were evaluated as accidental deaths and 32 (31% as suicides. In 70% of all cases, and in 34% of suicides, the deceased was classified as drug or alcohol dependent. When compared with the 2981 non-fatal acute poisonings registered during the study period, the case fatality rate was 3% (95% C.I., 0.03-0.04. Methanol, TCAs, and antihistamines had the highest case fatality rates; 33% (95% C.I., 0.008-0.91, 14% (95% C.I., 0.04-0.33, and 10% (95% C.I., 0.02-0.27, respectively. Conclusions Three per cent of all acute poisonings were fatal, and nine out of ten deaths by acute poisonings occurred outside hospital. Two-thirds were evaluated as accidental

  2. Usual hospital care versus post-abortion care for women with unsafe abortion: a case control study from Sri Lanka

    OpenAIRE

    Arambepola, Carukshi; Lalini C. Rajapaksa; Galwaduge, Chandani

    2014-01-01

    Background Good quality post-abortion-care (PAC) is essential to prevent death and long-term complications following unsafe abortion, especially in countries with restrictive abortion laws. We assessed the PAC given to women following an unsafe abortion, compared to the routine hospital care following spontaneous abortion or unintended pregnancy carried to term in Sri Lanka. Methods A case–control study was conducted in Sri Lanka among 171 cases following unsafe abortion, 638 controls followi...

  3. Identifying Markers of Dignity-Conserving Care in Long-Term Care: A Modified Delphi Study.

    Directory of Open Access Journals (Sweden)

    Genevieve N Thompson

    Full Text Available Ensuring that people living in nursing homes (NHs are afforded with dignity in their daily lives is an essential and humane concern. Promoting dignity-conserving care is fundamentally important. By nature, however, this care is all-encompassing and holistic, and from current knowledge it is challenging to create explicit strategies for measuring dignity-conserving care. In practice the majority of current NH indicators of quality care are derived from information that is routinely collected on NH residents using the RAI-Minimum Data Set (MDS. In this regard, issues that are more tangible to resident dignity such as being treated with respect, compassion, and having opportunities to engage with others are not adequately captured in current NH quality of care indicators. An initial set of markers was created by conducting an integrative literature review of existing markers and indicators of dignity in the NH setting. A modified Delphi process was used to prioritize essential dignity-conserving care markers for use by NH providers, based on factors such as the importance to fostering a culture of dignity, the impact it may have on the residents, and how achievable it is in practice. Through this consensus building technique, we were able to develop a comprehensive set of markers that capture the range and diversity of important dignity-conserving care strategies for use in NHs. The final 10 markers were judged as having high face validity by experts in the field and have explicit implications for enhancing the provision of daily dignified care to NH residents. These markers make an important addition to the traditional quality indicators used in the NH setting and as such, bridge an important gap in addressing the psychosocial and the less easily quantified needs of NH residents.

  4. Study protocol: Intensive care anxiety and emotional recovery (Icare) - A prospective study

    OpenAIRE

    Castillo, M.; Aitken, L. M.; Cooke, M. L.

    2013-01-01

    Background Survivors of intensive care units (ICUs) commonly present with symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) during recovery. A number of factors have been identified as predictors of these adverse emotional outcomes, but the role of state anxiety during critical illness in the development of these emotional problems remains unknown. Purpose The Intensive Care Anxiety and Emotional Recovery (ICARe) study protocol proposes the development of a s...

  5. They know! - do they? A qualitative study of residents and relatives views on advance care planning, end-of-life care, and decision-making in nursing homes.

    OpenAIRE

    Bollig, Georg; Gjengedal, Eva; Rosland, Jan Henrik

    2015-01-01

    Background: Residents living in long-term care facilities are a vulnerable population. For many residents, a nursing home is their place of death. Palliative care and end-of-life decisions are important components of their care provision. Aim: To study the views of cognitively able residents and relatives on advance care planning, end-of-life care, and decision-making in nursing homes. Design: A qualitative study with in-depth interviews with nursing home residents and focus group inter...

  6. Eating Disorders in the General Practice : A Case-Control Study on the Utilization of Primary Care

    NARCIS (Netherlands)

    Van Son, Gabrielle E.; Hoek, Hans W.; Van Hoeken, Daphne; Schellevis, Francois G.; Van Furth, Eric F.

    2012-01-01

    Objective To investigate primary care utilization between patients with an eating disorder (ED) and other patient groups, and between the ED subgroups anorexia nervosa (AN) and bulimia nervosa (BN). Method The present study was an observational casecontrol study. In total, 167 patients with ED were

  7. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care

    NARCIS (Netherlands)

    Schafer, W.L.; Boerma, W.G.; Kringos, D.S.; Maeseneer, J. De; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    ABSTRACT: BACKGROUND: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects

  8. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care.

    NARCIS (Netherlands)

    Schäfer, W.L.A.; Boerma, W.G.W.; Kringos, D.S.; Maeseneer, J. de; Gress, S.; Heinemann, S.; Rotar-Pavlic, D.; Seghieri, C.; Svab, I.; Berg, M.J. van den; Vainieri, M.; Westert, G.P.; Willems, S.; Groenewegen, P.P.

    2011-01-01

    Background: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary c

  9. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study

    Science.gov (United States)

    Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.

    2015-01-01

    Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Methods Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through “Embrace,” an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Results Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes “Struggling with health,” “Increasing dependency,” “Decreasing social interaction,” “Loss of control,” and “Fears;” and 2) Experiences with Embrace, with the themes “Relationship with the case manager,” “Interactions,” and “Feeling in control, safe, and secure”. The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants’ ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. Conclusion The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging. PMID:26489096

  10. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Sophie L W Spoorenberg

    Full Text Available Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs.Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach.Responses of participants concerned two focus areas: 1 Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2 Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system.The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

  11. What Makes for Good Collaboration and Communication in Maternity Care? A Scoping Study

    NARCIS (Netherlands)

    van Helmond, L.; Korstjens, I.; Mesman, J.; Nieuwenhuijze, M.; Horstman, K.; Scheepers, H.; Spaanderman, M.; Keulen, J.; de Vries, R.

    2015-01-01

    BACKGROUND: Good communication and collaboration are critical to safe care for mothers and babies. OBJECTIVE: To identify factors associated with good collaboration and communication among maternity care professionals and between both professionals and parents. METHOD: Scoping study. We searched Pub

  12. Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital – a qualitative study of health professionals’ experiences

    Directory of Open Access Journals (Sweden)

    Unni Alice Dahl

    2014-04-01

    Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital.  Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews. Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.

  13. Negative health care experiences of immigrant patients: a qualitative study

    Directory of Open Access Journals (Sweden)

    Stronks Karien

    2011-01-01

    Full Text Available Abstract Background Negative events are abusive, potentially dangerous or life-threatening health care events, as perceived by the patient. Patients' perceptions of negative events are regarded as a potentially important source of information about the quality of health care. We explored negative events in hospital care as perceived by immigrant patients. Methods Semi-structured individual and group interviews were conducted with respondents about negative experiences of health care. Interviews were transcribed and analyzed using a framework method. A total of 22 respondents representing 7 non-Dutch ethnic origins were interviewed; each respondent reported a negative event in hospital care or treatment. Results Respondents reported negative events in relation to: 1 inadequate information exchange with care providers; 2 different expectations between respondents and care providers about medical procedures; 3 experienced prejudicial behavior on the part of care providers. Conclusions We identified three key situations in which negative events were experienced by immigrant patients. Exploring negative events from the immigrant patient perspective offers important information to help improve health care. Our results indicate that care providers need to be trained in adequately exchanging information with the immigrant patient and finding out specific patient needs and perspectives on illness and treatment.

  14. Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study.

    Directory of Open Access Journals (Sweden)

    Annemarije L Kruis

    Full Text Available BACKGROUND: Guideline recommendations for chronic obstructive pulmonary disease (COPD are based on the results of large pharmaceutically-sponsored COPD studies (LPCS. There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care. OBJECTIVE: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials. METHODS: Baseline data of seven primary care databases (n=3508 from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria. RESULTS: Overall, patients included in the LPCS were younger (mean difference (MD-2.4; p=0.03, predominantly male (MD 12.4; p=0.1 with worse lung function (FEV1% MD -16.4; p<0.01 and worse quality of life scores (SGRQ MD 15.8; p=0.01. There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with ≥ 1 and ≥ 2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had ≥ 1 exacerbations per year and 12% had ≥ 2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN to 42% (ECLIPSE, UPLIFT. CONCLUSION: Primary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care

  15. Do Effects of Early Child Care Extend to Age 15 Years? Results from the NICHD Study of Early Child Care and Youth Development

    Science.gov (United States)

    Vandell, Deborah Lowe; Belsky, Jay; Burchinal, Margaret; Steinberg, Laurence; Vandergrift, Nathan

    2010-01-01

    Relations between nonrelative child care (birth to 4 1/2 years) and functioning at age 15 were examined (N = 1,364). Both quality and quantity of child care were linked to adolescent functioning. Effects were similar in size as those observed at younger ages. Higher quality care predicted higher cognitive-academic achievement at age 15, with…

  16. The study of optimal nursing position in health care delivery system in Iran

    OpenAIRE

    Shahshahani, Maryam Sadat; Salehi, Shayesteh; Rastegari, Mohammad; Rezayi, Abdollah

    2010-01-01

    BACKGROUND: In the recent decade, due to the overwhelming importance of health and prevention of diseases, nurses, the greatest part of the health care system, are acting in any position of the health care delivery system; because nursing have a key role in promotion of health and health care everywhere. The objective of this research was to study the desired positions of nursing in the health care delivery system in Iran. METHODS: This was a triangulation study done on three steps during 200...

  17. The relationship between GPs and hospital consultants and the implications for patient care: a qualitative study

    OpenAIRE

    Sampson, Rod; Barbour, Rosaline; Wilson, Philip

    2016-01-01

    Background Improving the quality of care of at the medical primary-secondary care interface is both a national and a wider concern. In a qualitative exploration of clinicians’ relationship at the interface, we want to study how both GPs and hospital specialists regard and behave towards each other and how this may influence patient care. Method A qualitative interview study was carried out in primary and secondary care centres in NHS Highland health board area, Scotland. Eligible clinicians (...

  18. Advantages of a Warfarin Protocol for Long-term Care Pharmacists: a Retrospective Cohort Study

    OpenAIRE

    Sargent, Randall; Brocklebank, Cynthia; Tam-Tham, Helen; Williamson, Tyler; Quail, Patrick; Turner, Diana; Drummond, Neil

    2016-01-01

    Background Warfarin is an anticoagulant prescribed to 12% of long-term care residents to reduce the risk of thrombo-embolism. This study used indicators to compare warfarin management by pharmacists to usual care. Methods This was a retrospective cohort study comparing a pharmacist-managed warfarin protocol with usual care of qualified warfarin recipients at long-term care facilities (two protocol, one control) in Calgary, Alberta. We compared the proportion of international normalized ratio ...

  19. Patient Assessment of Chronic Illness Care (PACIC) in Type 2 Diabetes: A Longitudinal Study.

    Science.gov (United States)

    Aung, Eindra; Ostini, Remo; Dower, Jo; Donald, Maria; Coll, Joseph R; Williams, Gail M; Doi, Suhail A R

    2016-06-01

    The Patient Assessment of Chronic Illness Care (PACIC) was designed to measure care congruent with several elements of the chronic care model (CCM), including self-management support and delivery system design. However, support for the a priori 5-subscale structure of the PACIC in previous research has been conflicting. Thus, we aim to investigate psychometric characteristics of the PACIC including the content and stability of its construct over time. A population-based prospective cohort study of patients with type 2 diabetes was conducted in Queensland, Australia, from 2008 (N = 3,761) to 2010 (N = 3,040). Participants completed annually the 20-item PACIC as well as measures of providers' adherence to guideline-recommended self-management support activities. We used exploratory factor analysis to determine its factor structure and examined internal consistency as well as agreement between the PACIC at baseline with repeated measurements at follow-up after 1 and 2 years. We also determined a criterion-related validity using multinomial logistic regression to explore PACIC's association with providers' self-management support. A one-factor structure was deemed optimal according to our findings. High internal consistency and moderate agreement within the scales over time were observed. Higher PACIC scores predicted better providers' self-management support. In conclusion, the PACIC is a reliable, valid, and reproducible instrument for assessment of diabetes care, and we recommend its promotion and use as a single scale rather than subscales as originally proposed. PMID:25380699

  20. An observational study of driver distraction in England.

    OpenAIRE

    Sullman, Mark J. M.

    2012-01-01

    This study set out to investigate the proportion of UK drivers who engage in some form of distracting behaviour whilst driving. Data were collected by roadside observation in six urban centres in the South of England. The observations took place on randomly selected roads at three different time periods during two consecutive Tuesdays. The data revealed that 14.4% of the 7168 drivers observed were found to be engaged in a distracting activity. The most frequently observed distraction was talk...

  1. Caval filters in intensive care: a retrospective study

    Science.gov (United States)

    Ferraro, F; Di Gennaro, TL; Torino, A; Petruzzi, J; d’Elia, A; Fusco, P; Marfella, R; Lettieri, B

    2014-01-01

    Aim To evaluate the effectiveness of a caval vein filter (CVF) peri-implant monitoring protocol in order to reduce pulmonary embolism (PE) mortality and CVF-related morbidity. Background The reduction in mortality from PE associated with the use of CVF is affected by the risk of increase in morbidity. Therefore, CVF implant is a challenging prophylactic or therapeutic option. Nowadays, we have many different devices whose rational use, by applying a strict peri-implant monitoring protocol, could be safe and effective. Materials and methods We retrospectively studied 62 patients of a general Intensive Care Unit (ICU) scheduled for definitive, temporary, or optional bedside CVF implant. A peri-implant monitoring protocol including a phlebocavography, an echo-Doppler examination, and coagulation tests was adopted. Results In our study, no thromboembolic recurrence was registered. We implanted 48 retrievable and only 20 definitive CVFs. Endothelial adhesion (18%), residual clot (5%), cranial or caudal migration (6%), microbial colonization of the filter in the absence of clinical signs of infection (1%), caval thrombosis (1%), and pneumothorax (1%) were reported. Deep-vein thrombosis (DVT) was reported (8%) as early complication. All patients with DVT had a temporary or optional filter implanted. However, in our cohort, definitive CVFs were reserved only to 32% of patients and they were not associated with DVT as complication. Conclusion CVF significantly reduces iatrogenic PE without affecting mortality. Generally, ICU patients have a transitory thromboembolic risk, and so the temporary CVF has been proved to be a first-line option to our cohort. A careful monitoring may contribute to a satisfactory outcome in order to promote CVF implant as a safe prophylaxis option. PMID:25395837

  2. Team Interactions in Specialized Palliative Care Teams: A Qualitative Study

    OpenAIRE

    Klarare, Anna; Hagelin, Carina Lundh; Fürst, Carl Johan; Fossum, Bjoorn

    2013-01-01

    Background: Teamwork is a standard of care in palliative care and that is emphasized by leading organizations. When interdisciplinary teams communicate their varied assessments, outcomes may be more than additive due to the synthesis of information. Interprofessionality does not guarantee multidimensionality in health care interventions, however, and that interprofessional teams promote collaboration may be questioned. Aim: The aim was to explore team interaction among team members in special...

  3. Providing end-of-life care in care homes for older people: a qualitative study of the views of care home staff and community nurses.

    Science.gov (United States)

    Goddard, Cassie; Stewart, Frances; Thompson, Genevieve; Hall, Sue

    2013-02-01

    The study aimed to explore the views of care home staff (CHS) and community nurses (CNs) on providing end-of-life care (EOLC) in care homes. Participants were randomly selected and qualitative interviews conducted with 80 CHS and 10 CNs. Themes emerging from the data included the following: The meaning of EOLC; starting EOLC; dying in the care home; stress of providing EOLC; improving EOLC; and the role of the CN. CHS felt that planning for the end of life was important before residents reached the dying phase, which some found difficult to determine. Although CHS wished to avoid residents being transferred to hospital to die, they acknowledged that improvements in their skills and the resources available to them were needed to manage EOLC effectively. CNs were critical of the EOLC provided in some care homes, reporting tensions over their relationship with CHS. As the number of older people who die in care homes increases, there is a need to overcome these barriers to provide good EOLC. PMID:25473926

  4. The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings: A cross-sectional study.

    Science.gov (United States)

    Wong, Martin C S; Wang, Harry H X; Kwan, Mandy W M; Chan, Wai Man; Fan, Carmen K M; Liang, Miaoyin; Li, Shannon Ts; Fung, Franklin D H; Yeung, Ming Sze; Chan, David K L; Griffiths, Sian M

    2016-08-01

    The prevalence of diabetes mellitus has been increasing both globally and locally. Primary care physicians (PCPs) are in a privileged position to provide first contact and continuing care for diabetic patients. A territory-wide Reference Framework for Diabetes Care for Adults has been released by the Hong Kong Primary Care Office in 2010, with the aim to further enhance evidence-based and high quality care for diabetes in the primary care setting through wide adoption of the Reference Framework.A valid questionnaire survey was conducted among PCPs to evaluate the levels of, and the factors associated with, their adoption of the Reference Framework.A total of 414 completed surveys were received with the response rate of 13.0%. The average adoption score was 3.29 (SD 0.51) out of 4. Approximately 70% of PCPs highly adopted the Reference Framework in their routine practice. Binary logistic regression analysis showed that the PCPs perceptions on the inclusion of sufficient local information (adjusted odds ratio [aOR] = 4.748, 95%CI 1.597-14.115, P = 0.005) and reduction of professional autonomy of PCPs (aOR = 1.859, 95%CI 1.013-3.411, P = 0.045) were more likely to influence their adoption level of the Reference Framework for diabetes care in daily practices.The overall level of guideline adoption was found to be relatively high among PCPs for adult diabetes in primary care settings. The adoption barriers identified in this study should be addressed in the continuous updating of the Reference Framework. Strategies need to be considered to enhance the guideline adoption and implementation capacity. PMID:27495018

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

    Science.gov (United States)

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

    2011-09-01

    Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating

  6. Do Effects of Early Child Care Extend to Age 15 Years? Results From the NICHD Study of Early Child Care and Youth Development

    OpenAIRE

    Vandell, Deborah Lowe; Belsky, Jay; Burchinal, Margaret; Vandergrift, Nathan; STEINBERG, LAURENCE

    2010-01-01

    Relations between nonrelative child care (birth to 4 ½ years) and functioning at age 15 were examined (N = 1364). Both quality and quantity of child care were linked to adolescent functioning. Effects were similar in size as those observed at younger ages. Higher quality care predicted higher cognitive-academic achievement at age 15, with escalating positive effects at higher levels of quality. The association between quality and achievement was mediated, in part, by earlier child care effect...

  7. Prescription pattern in indoor patients of cardiovascular diseases: a descriptive study in a tertiary care hospital attached to a government medical college

    OpenAIRE

    Pravin S. Rathod; Praveenkumar T. Patil; Rekha P. Lohar; A. W. Patil

    2016-01-01

    Background: In India, one of the leading causes of death is cardiovascular diseases (CVDs). The study of prescription pattern ensures rational pharmacotherapy and assures quality medical care to the patients. Hence the present study was conducted to observe the prescription pattern of drugs among the indoor patients of cardiovascular diseases in a tertiary care hospital attached to a Government Medical college. Methods: A retrospective observational study of 9 month duration was undertaken...

  8. Resource Use Study in COPD (RUSIC): A prospective Study to Quantify the Effects of COPD Exacerbations on Health Care Resource Use Among COPD Patients

    OpenAIRE

    J Mark FitzGerald; Haddon, Jennifer M; Carole Bradley-Kennedy; Lisa Kuramoto; Ford, Gordon T; The RUSIC Study Group

    2007-01-01

    BACKGROUND: There is increasing interest in health care resource use (HRU) in Canada, particularly in resources associated with acute exacerbations of chronic obstructive pulmonary disease (COPD).OBJECTIVE: To identify HRU due to exacerbations of COPD.METHODS: A 52-week, multicentre, prospective, observational study of HRU due to exacerbations in patients with moderate to severe COPD was performed. Patients were recruited from primary care physicians and respirologists in urban and rural cent...

  9. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)

    DEFF Research Database (Denmark)

    Vandenbroucke, Jan P; von Elm, Erik; Altman, Douglas G;

    2014-01-01

    Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical conside...

  10. Do integrated care structures foster processes of integration? A quasi-experimental study in frail elderly care from the professional perspective

    OpenAIRE

    Janse, Benjamin; Huijsman, Robbert; de Kuyper, Ruben Dennis Maurice; Fabbricotti, Isabelle Natalina

    2016-01-01

    Objective This study explores the processes of integration that are assumed to underlie integrated care delivery. Design A quasi-experimental design with a control group was used; a new instrument was developed to measure integration from the professional perspective. Setting and participants Professionals from primary care practices and home-care organizations delivering care to the frail elderly in the Walcheren region of the Netherlands. Intervention An integrated care intervention specifi...

  11. Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries

    OpenAIRE

    Stepurko, Tetiana; Pavlova, Milena; Groot, Wim

    2016-01-01

    Background: The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with...

  12. Retrospective Study of the Survival of Patients who Underwent Cardiopulmonary Resuscitation in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Moreira Daniel Martins

    2002-01-01

    Full Text Available OBJECTIVE: To evaluate clinical and evolutive characteristics of patients admitted in an intensive care unit after cardiopulmonary resuscitation, identifying prognostic survival factors.METHODS: A retrospective study of 136 patients admitted between 1995 and 1999 to an intensive care unit, evaluating clinical conditions, mechanisms and causes of cardiopulmonary arrest, and their relation to hospital mortality.RESULTS: A 76% mortality rate independent of age and sex was observed. Asystole was the most frequent mechanism of death, and seen in isolation pulmonary arrest was the least frequent. Cardiac failure, need for mechanical ventilation, cirrhosis and previous stroke were clinically significant (p<0.01 death factors.CONCLUSION: Prognostic factors supplement the doctor's decision as to whether or not a patient will benefit from cardiopulmonary resuscitation.

  13. Bacteriological study of urinary tract infection in antenatal care patients

    Directory of Open Access Journals (Sweden)

    Srivastava Ritu, Singh Brij N, Begum Rehana, Yadav Ramesh

    2014-04-01

    Full Text Available Aims & Objective: To isolate and diagnose the Uropathogens and its antibiotic sensitivity pattern in anti-natal care patient suffering from Urinary tract Infections. Material and Methods: 150 samples were collected by consent pregnant women between the age group of 18 to 40 years. A midstream clean catch is adequate, provided by all pregnant women’s through given careful instructions. For enumeration of bacteria we perform standard loop techniques method. The number of colonies counted or estimated, and this number used to calculate the number of viable bacteria per ml of urine. The bacterial strains were identified by colonies character stick, gram staining, morphological and biochemical character. The bacterial strains identification was done up to genus and species level. The antibiotics sensitivity test of bacterial strains was done as per CLSI guidelines by Kirby-Baure Disc Diffusion Methods. Results: The significant bactiurea was found in 50 patients among 150 patients used. The most commonly isolated bacteria was Escherichia coli 23(40% Klebsiellaaerogens 11 (22% Staphylococcus aureus 10 (20% Pseudomonas aerugenosa 4(8%.The incidence of bacteriuria among in their first pregnancy was 22.2%.The higher incidence of UTI in 2nd and 3rd trimester was found to have 31.4% & 40%. These studies were showing high level of resistance to first line antibiotics such as Cotrimaxozole. Conclusion: To minimizing the complication of the pregnant women should be educated about the physiology of pregnancy clinical presentation includes asymptomatic bacteria, acute cystitis & pyelonephritis. Pregnant women should be screened for asymptomatic bacteriuria by urine culture and treated with appropriate antibiotics. After the post treatment pregnant women should be examine again to confirm post treatment urine sterility.

  14. The PERS(2) ON score for systemic assessment of symptomatology in palliative care: a pilot study.

    Science.gov (United States)

    Masel, E K; Berghoff, A S; Schur, S; Maehr, B; Schrank, B; Simanek, R; Preusser, M; Marosi, C; Watzke, H H

    2016-07-01

    The comprehensive assessment of symptoms is the basis for effective, individualised palliative treatment. Established scoring systems provide in-depth information but are often lengthy and hence unsuitable. We introduce the PERS(2) ON score as a short and practically feasible score to evaluate symptom burden. Fifty patients admitted to a Palliative Care Unit rated seven items, i.e. pain, eating (loss of appetite/weight loss), rehabilitation (physical impairment), social situation (possibility for home care), suffering (anxiety/burden of disease/depression), O2 (dyspnoea) and nausea/emesis, on a scale ranging from 0 (absence) to 10 (worst imaginable), resulting in a score ranging from 0 to 70. Assessments were performed at admission, 7 days after admission and at the day of discharge. Symptom intensity scores were calculated, and change over time was evaluated. A significant improvement was observed from the PERS²ON score between admission and 7 days (P evaluation to evaluation on the day of discharge was observed (P = 0.001; paired t-test). This study provides initial evidence that the PERS²ON score is both feasible and sensitive to changes of the most prominent symptoms in palliative care. It may be useful in clinical practice to direct palliative treatment strategies and provide targeted symptom management. PMID:26564404

  15. Poor communication may impair optimal asthma care : a qualitative study

    NARCIS (Netherlands)

    Moffat, Mandy; Cleland, Jennifer; van der Molen, Thys; Price, David

    2007-01-01

    Background. Despite asthma being primarily managed in general practice and primary care, there is little research into the issues and tools which may impact on managing poorly controlled asthma in this setting. Objective. To explore the views of health care professionals (HCPs) towards asthma guidel

  16. Hospital Door Handle Design and Their Contamination with Bacteria: A Real Life Observational Study. Are We Pulling against Closed Doors?

    OpenAIRE

    Wojgani, H.; Kehsa, C.; Cloutman-Green, E.; Gray, C.; Gant, V.; Klein, N

    2012-01-01

    Objective To determine whether microbial contamination of door handles in two busy intensive care units and one high dependency unit was related to their design, location, and usage. Design Observational study of the number of viable bacteria on existing door handles of different design at defined entry/exit points with simultaneous data collection of who used these doors and how often. Setting Two busy specialised intensive care units and one high dependency unit in a tertia...

  17. Barriers and Facilitators in Pain Management in Long-Term Care Institutions: A Qualitative Study

    Science.gov (United States)

    Fox, Patricia; Solomon, Patricia; Raina, Parminder; Jadad, Alejandro R.

    2004-01-01

    The purpose of this study was to identify barriers to the management of pain in long-term care institutions. Formal caregivers practising in four long-term care institutions in Hamilton, Ontario participated in eight focus groups. Participants included 6 physicians, 19 registered nurses, 8 registered practical nurses, 13 health care aides and 8…

  18. Transforming Medical Care: Case Study of an Exemplary, Small Medical Group

    OpenAIRE

    Solberg, Leif I.; Hroscikoski, Mary C.; Sperl-Hillen, JoAnn M.; Harper, Peter G.; Crabtree, Benjamin F.

    2006-01-01

    PURPOSE Most published descriptions of organizations providing or improving quality of care concern large medical groups or systems; however, 90% of the medical care in the United States is provided by groups of no more than 20 physicians. We studied one such group to determine the organizational and cultural attributes that seem related to its achievements in care quality.

  19. Effectiveness of a Care Coordination Model for Stroke Survivors: A Randomized Study

    Science.gov (United States)

    Claiborne, Nancy

    2006-01-01

    This study evaluated the effectiveness of systematically integrating biopsychosocial interventions with coordinated delivery of care for outpatients recovering from stroke. Care coordination coordinates resources across the health care system and routinely addresses the psychological and social risks affecting patient outcomes, while monitoring…

  20. Dermatological disorders during pregnancy: a study from tertiary care hospital

    OpenAIRE

    Krina B. Patel; Ruchin Patel; Nisha Sharma

    2016-01-01

    Background: Various types of physiological and pathological mucocutaneous changes are commonly observed during pregnancy. Infectious, non-infectious and pregnancy specific dermatoses are seen during pregnancy. This study was carried out with an aim of studying association of various dermatosis with pregnancy and to find out incidence of pregnancy specific dermatoses v/s non-specific dermatosis. Methods: Total 131 pregnant female presenting with complain of skin lesions were included in stu...

  1. The explanatory models of depression and anxiety in primary care: a qualitative study from India

    Directory of Open Access Journals (Sweden)

    Andrew Gracy

    2012-09-01

    Full Text Available Abstract Background The biggest barrier to treatment of common mental disorders in primary care settings is low recognition among health care providers. This study attempts to explore the explanatory models of common mental disorders (CMD with the goal of identifying how they could help in improving the recognition, leading to effective treatment in primary care. Results The paper describes findings of a cross sectional qualitative study nested within a large randomized controlled trial (the Manas trial. Semi structured interviews were conducted with 117 primary health care attendees (30 males and 87 females suffering from CMD. Main findings of the study are that somatic phenomena were by far the most frequent presenting problems; however, psychological phenomena were relatively easily elicited on probing. Somatic phenomena were located within a biopsychosocial framework, and a substantial proportion of informants used the psychological construct of ‘tension’ or ‘worry’ to label their illness, but did not consider themselves as suffering from a ‘mental disorder’. Very few gender differences were observed in the descriptions of symptoms but at the same time the pattern of adverse life events and social difficulties varied across gender. Conclusion Our study demonstrates how people present their illness through somatic complaints but clearly link their illness to their psychosocial world. However they do not associate their illness to a ‘mental disorder’ and this is an important phenomenon that needs to be recognized in management of CMD in primary settings. Our study also elicits important gender differences in the experience of CMD.

  2. Measuring the adequacy of antenatal health care: a national cross-sectional study in Mexico

    Science.gov (United States)

    Heredia-Pi, Ileana; Darney, Blair G; Reyes-Morales, Hortensia; Lozano, Rafael

    2016-01-01

    Abstract Objective To propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care. Methods In a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012. This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending in live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to identify correlates of adequate antenatal care and predicted coverage. Findings Based on a population-weighted sample of 9 052 044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance. Conclusion While basic antenatal care coverage is high in Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care. PMID:27274597

  3. Comparing Dutch Case management care models for people with dementia and their caregivers: The design of the COMPAS study

    Directory of Open Access Journals (Sweden)

    MacNeil Vroomen Janet

    2012-05-01

    Full Text Available Abstract Background Dementia care in the Netherlands is shifting from fragmented, ad hoc care to more coordinated and personalised care. Case management contributes to this shift. The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in the Netherlands. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost. The objective of this article is to describe the design of a study comparing these two case management care models against usual care. Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered. Design Mixed methods include a prospective, observational, controlled, cohort study among persons with dementia and their primary informal caregiver in regions of the Netherlands with and without case management including a qualitative process evaluation. Inclusion criteria for the cohort study are: community-dwelling individuals with a dementia diagnosis who are not terminally-ill or anticipate admission to a nursing home within 6 months and with an informal caregiver who speaks fluent Dutch. Person with dementia-informal caregiver dyads are followed for two years. The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Questionnaire for their caregivers. Secondary outcomes include: quality of life and needs assessment in both persons with dementia and caregivers, activity of daily living, competence of care, and number of crises. Costs are measured from a societal perspective using cost diaries. Process indicators measure the quality of care from the participant’s perspective. The qualitative study uses purposive sampling methods to ensure a wide variation of

  4. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    OpenAIRE

    Alam Khurshid; Ahmed Shakil

    2010-01-01

    Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Give...

  5. The strength of primary care in Europe : an international comparative study

    OpenAIRE

    Kringos, D.S.; Boerma, W. G. W.; Bourgueil, Y.; Cartier, T.; Dedeu, T; Hasvold, T.; Groenewegen, P.P.; et al, [No Value

    2013-01-01

    Background A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Aim Evaluation of strength of primary care in Europe. Design and setting International comparative cross-sectional study performed in 2009–2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey. Method Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions ...

  6. Obstacles to continuity of care in young mental health service users' pathways - an explorative study

    OpenAIRE

    Ådnanes, Marian; Steihaug, Sissel

    2013-01-01

    Background: Users of mental health services often move between different primary and specialised health and care services, depending on their current condition, and this often leads to fragmentation of care. The aim of this study was to map care pathways in the case of young adult mental health service users and to identify key obstacles to continuity of care.Method: Quarterly semi-structured interviews were performed with nine young adults with mental health difficulties, following their pat...

  7. Maternity or catastrophe: a study of household expenditure on maternal health care in India

    OpenAIRE

    2013-01-01

    Using data from 60th round of the National Sample Survey, this study attempts to measure the incidence and intensity of ‘catastrophic’ maternal health care expenditure and examines its socio-economic correlates in urban and rural areas separately. Additionally, it measures the effect of maternal health care expenditure on poverty incidence and examines the factors associated with such impoverishment due to maternal health care payments. We found that maternal health care expenditure in urban ...

  8. Study of Access and Quality of Care in For-Profit PACE

    OpenAIRE

    David Jones; Nancy Duda; Bob Schmitz; Sandi Nelson; Chelsea Swete; Alex Bryce; Jared Coopersmith; Karen CyBulski

    2013-01-01

    This report summarizes a study to address quality of and access to care for participants of for-profit Programs of All-Inclusive Care for the Elderly (PACE) organizations. The PACE model allows people who otherwise need a nursing home-level of care to remain in the community by providing health care and related support services, such as social supports, meals and chore services, and transportation.

  9. Medical Mistrust and Discrimination in Health Care: A Qualitative Study of Hmong Women and Men

    OpenAIRE

    Thorburn, Sheryl; Kue, Jennifer; Keon, Karen Levy; Lo, Patela

    2012-01-01

    Low rates of breast and cervical cancer screening among Hmong women have been documented. Mistrust of Western medicine and the health care system, as well as experiences of discrimination in health care, may be barriers to seeking health care for this population. In this study, we explored medical mistrust among Hmong women and men, their experiences with discrimination in health care, and how these factors may influence Hmong women’s breast and cervical cancer screening behavior. We conducte...

  10. Adherence to self-care in patients with heart failure in the HeartCycle study

    Directory of Open Access Journals (Sweden)

    Stut W

    2015-08-01

    Full Text Available Wim Stut,1 Carolyn Deighan,2 John G Cleland,3 Tiny Jaarsma4 1Philips Research Europe, Eindhoven, the Netherlands; 2The Heart Manual Department, NHS Lothian, Edinburgh, UK; 3National Heart and Lung Institute, Royal Brompton and Harefield Hospitals Imperial College, London, UK; 4Department of Social and Welfare studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden Purpose: The purpose of this study was to evaluate a novel online education and coaching program to promote self-care among patients with heart failure. In this program, education and coaching content is automatically tailored to the knowledge and behavior of the patient. Patients and methods: The evaluation of the program took place within the scope of the HeartCycle study. This multi-center, observational study examined the ability of a third generation telehealth system to enhance the management of patients recently (<60 days admitted to the hospital for worsening heart failure or outpatients with persistent New York Heart Association (NYHA Functional Classification III/IV symptoms. Self-reported self-care behavior was assessed at baseline and study-end by means of the 9-item European Heart Failure Self-care Behavior scale. Adherence to daily weighing, blood pressure monitoring, and reporting of symptoms was determined by analyzing the system’s database. Results: Of 123 patients enrolled, the mean age was 66±12 years, 66% were in NYHA III and 79% were men. Self-reported self-care behavior scores (n=101 improved during the study for daily weighing, low-salt diet, physical activity (P<0.001, and fluid restriction (P<0.05. Average adherence (n=120 to measuring weight was 90%±16%, to measuring blood pressure was 89%±17% and to symptom reporting was 66%±32%. Conclusion: Self-reported self-care behavior scores improved significantly during the period of observation, and the objective evidence of adherence to daily weight and blood pressure measurements was

  11. Role of relatives of ethnic minority patients in patient safety in hospital care: a qualitative study

    OpenAIRE

    van Rosse, F.; Suurmond, J.; Wagner, C; de Bruijne, M.; M. L. Essink-Bot

    2016-01-01

    Objective Relatives of ethnic minority patients often play an important role in the care process during hospitalisation. Our objective was to analyse the role of these relatives in relation to the safety of patients during hospital care. Setting Four large urban hospitals with an ethnic diverse patient population. Participants On hospital admission of ethnic minority patients, 20 cases were purposively sampled in which relatives were observed to play a role in the care process. Outcome measur...

  12. Projected Image and Observed Behavior of Physicians in Terminal Cancer Care.

    Science.gov (United States)

    Family, Gilla

    1993-01-01

    Reports on abandoned study examining potential benefits of psychotherapy to terminal cancer patients. Preliminary feasibility study found physicians' attitudes toward their dying patients as reformed and progressive. Interest shown by physicians did not translate into tangible research effort in spite of active pursuit by investigator over period…

  13. In-Hospital Recruitment to Observational Studies of Stroke

    Science.gov (United States)

    Pickering, Ruth M.; Kunkel, Dorit; Fitton, Carolyn; Ashburn, Ann; Jenkinson, Damian

    2010-01-01

    The objective of this study was to examine recruitment in three observational follow-up studies of patients with stroke, focusing on reasons for nonparticipation and the role of potential factors in explaining recruitment rates. It comprised secondary analysis of the three studies. Recruitment rates varied between the studies. Between 10 and 50%…

  14. Oral and dental health in Huntington's disease - an observational study

    OpenAIRE

    Saft, Carsten; Andrich, Jürgen; Müller, Thomas; Becker, Julia; Jackowski, Jochen

    2013-01-01

    Background Only a few case reports and case series dealing with oral and dental health care are available in literature until now. The aim of the present pilot study was to determine the status of dental health in comparison to matched controls and to heighten the neurologists’ and dentists’ awareness of the oral aspects of the disease. Methods 42 Huntington’s disease (HD) participants were scored according to the Unified Huntington’s Disease Rating Scale. The dental status was assessed by us...

  15. Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients

    Directory of Open Access Journals (Sweden)

    Titis Kurniawan

    2011-01-01

    Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients

  16. Preadmission quality of life can predict mortality in intensive care unit—A prospective cohort study

    DEFF Research Database (Denmark)

    Bukan, Ramin I; Møller, Ann M; Henning, Mattias A S;

    2014-01-01

    quality of life, assessed by SF-36 and SF-12, is as good at predicting ICU, 30-, and 90-day mortality as APACHE II in patients admitted to the ICU for longer than 24 hours. This indicates that estimated preadmission quality of life, potentially available in the pre-ICU setting, could aid decision making......PURPOSE: We sought to investigate whether preadmission quality of life could act as a predictor of mortality among patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS: This is a prospective observational study of all patients above the age of 18 years admitted to the ICU with...

  17. How Safe Do Teenagers Behave on Facebook? An Observational Study

    OpenAIRE

    Vanderhoven, Ellen; Schellens, Tammy; Valcke, Martin; Raes, Annelies

    2014-01-01

    The substantial use of social network sites by teenagers has raised concerns about privacy and security. Previous research about behavior on social network sites was mostly based on surveys and interviews. Observational research overcomes problems inherent to this research method, for example social desirability. However, existing observational research mostly focuses on public profiles of young adults. Therefore, the current observation-study includes 1050 public and non-public Facebook-prof...

  18. Caval filters in intensive care: a retrospective study

    Directory of Open Access Journals (Sweden)

    Ferraro F

    2014-11-01

    Full Text Available F Ferraro,1 TL Di Gennaro,1 A Torino,1 J Petruzzi,1 A d’Elia,1 P Fusco,1 R Marfella,2 B Lettieri1 1Department of Anesthesiological, Surgical and Emergency Sciences, 2Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy Aim: To evaluate the effectiveness of a caval vein filter (CVF peri-implant monitoring protocol in order to reduce pulmonary embolism (PE mortality and CVF-related morbidity.Background: The reduction in mortality from PE associated with the use of CVF is affected by the risk of increase in morbidity. Therefore, CVF implant is a challenging prophylactic or therapeutic option. Nowadays, we have many different devices whose rational use, by applying a strict peri-implant monitoring protocol, could be safe and effective.Materials and methods: We retrospectively studied 62 patients of a general Intensive Care Unit (ICU scheduled for definitive, temporary, or optional bedside CVF implant. A peri-implant monitoring protocol including a phlebocavography, an echo-Doppler examination, and coagulation tests was adopted.Results: In our study, no thromboembolic recurrence was registered. We implanted 48 retrievable and only 20 definitive CVFs. Endothelial adhesion (18%, residual clot (5%, cranial or caudal migration (6%, microbial colonization of the filter in the absence of clinical signs of infection (1%, caval thrombosis (1%, and pneumothorax (1% were reported. Deep-vein thrombosis (DVT was reported (8% as early complication. All patients with DVT had a temporary or optional filter implanted. However, in our cohort, definitive CVFs were reserved only to 32% of patients and they were not associated with DVT as complication.Conclusion: CVF significantly reduces iatrogenic PE without affecting mortality. Generally, ICU patients have a transitory thromboembolic risk, and so the temporary CVF has been proved to be a first-line option to our cohort. A careful monitoring may contribute to a satisfactory

  19. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Peter Waiswa

    2015-03-01

    Full Text Available Background: Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. Objective: To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. Design: The Uganda Newborn Study (UNEST was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care. Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. Results: The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively. Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively. Half (49.6% of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in

  20. The EULAR Study Group for Registers and Observational Drug Studies

    DEFF Research Database (Denmark)

    Kearsley-Fleet, Lianne; Závada, Jakub; Hetland, Merete Lund;

    2015-01-01

    OBJECTIVE: Under the auspices of the European League Against Rheumatism (EULAR), a study group of investigators representing European biologic DMARD (bDMARD) registers was convened. The purpose of this initial assessment was to collect and compare a cross section of patient characteristics and...

  1. Characteristics of evolving models of care for arthritis: A key informant study

    Directory of Open Access Journals (Sweden)

    Veinot Paula

    2008-07-01

    Full Text Available Abstract Background The burden of arthritis is increasing in the face of diminishing health human resources to deliver care. In response, innovative models of care delivery are developing to facilitate access to quality care. Most models have developed in response to local needs with limited evaluation. The primary objective of this study is to a examine the range of models of care that deliver specialist services using a medical/surgical specialist and at least one other health care provider and b document the strengths and challenges of the identified models. A secondary objective is to identify key elements of best practice models of care for arthritis. Methods Semi-structured interviews were conducted with a sample of key informants with expertise in arthritis from jurisdictions with primarily publicly-funded health care systems. Qualitative data were analyzed using a constant comparative approach to identify common types of models of care, strengths and challenges of models, and key components of arthritis care. Results Seventy-four key informants were interviewed from six countries. Five main types of models of care emerged. 1 Specialized arthritis programs deliver comprehensive, multidisciplinary team care for arthritis. Two models were identified using health care providers (e.g. nurses or physiotherapists in expanded clinical roles: 2 triage of patients with musculoskeletal conditions to the appropriate services including specialists; and 3 ongoing management in collaboration with a specialist. Two models promoting rural access were 4 rural consultation support and 5 telemedicine. Key informants described important components of models of care including knowledgeable health professionals and patients. Conclusion A range of models of care for arthritis have been developed. This classification can be used as a framework for discussing care delivery. Areas for development include integration of care across the continuum, including primary

  2. Behavioral health referrals and treatment initiation rates in integrated primary care: a Collaborative Care Research Network study.

    Science.gov (United States)

    Auxier, Andrea; Runyan, Christine; Mullin, Daniel; Mendenhall, Tai; Young, Jessica; Kessler, Rodger

    2012-09-01

    Although the benefits of integrating behavioral health (BH) services into primary care are well established (World Health Organization and World Organization of Family Doctors, 2012; Chiles et al. in Clin Psychol-Sci Pr 6:204-220, 1999; Cummings 1997; O'Donohue et al. 2003; Olfson et al. in Health Aff 18:79-93, 1999; Katon et al. in Ann Intern Med 124:917-925, 2001; Simon et al. in Arch Gen Psychiatry 52:850-856, 1995; Anderson et al. in Diabetes Care 24:1069-1078, 2001; Ciechanowski et al. in Arch Intern Med 160:3278-3285, 2000; Egede et al. in Diabetes Care 25:464-470, 2002), research has focused primarily on describing the types of interventions behavioral health providers (BHPs) employ rather than on reasons for referral, treatment initiation rates, or the patient characteristics that may impact them. This study presents the results of a multisite card study organized by The Collaborative Care Research Network, a subnetwork of the American Academy of Family Physicians' National Research Network devoted to conducting practice-based research focused on the provision of BH and health behavior services within primary care practices. The goals of the study included: (1) identifying the characteristics of patients referred for BH services; (2) codifying reasons for referral and whether patients were treated for the referral; (3) exploring any differences between patients who initiated BH contact and those who did not; and (4) assessing the types and frequency of BH services provided to patients who attended at least one appointment. Of the 200 patients referred to a BHP, 81 % had an initial contact, 71 % of which occurred on the same day. Men and women were equally likely to engage with a BHP although the time between appointments varied by gender. Depression and anxiety were the primary reasons for referral. Practice-based research is a viable strategy for advancing the knowledge about integrated primary care. PMID:24073133

  3. Bacteriological study of urinary tract infection in antenatal care patients

    OpenAIRE

    Srivastava Ritu, Singh Brij N, Begum Rehana, Yadav Ramesh

    2014-01-01

    Aims & Objective: To isolate and diagnose the Uropathogens and its antibiotic sensitivity pattern in anti-natal care patient suffering from Urinary tract Infections. Material and Methods: 150 samples were collected by consent pregnant women between the age group of 18 to 40 years. A midstream clean catch is adequate, provided by all pregnant women’s through given careful instructions. For enumeration of bacteria we perform standard loop techniques method. The number of colonies counted or est...

  4. Global access to surgical care: a modelling study

    OpenAIRE

    Blake C Alkire, MD; Dr. Nakul P Raykar, MD; Mark G Shrime, MD; Thomas G Weiser, MD; Prof. Stephen W Bickler, MD; John A Rose, MD; Cameron T Nutt, BA; Sarah L M Greenberg, MD; Meera Kotagal, MD; Johanna N Riesel, MD; Micaela Esquivel, MD; Tarsicio Uribe-Leitz, MD; George Molina, MD; Prof. Nobhojit Roy, MD; John G Meara, MD

    2015-01-01

    Background: More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission's vision. Methods: We modelled access to surgical services in 196 countries with respect to four dimensions: timelines...

  5. Health Care Delivery Meets Hospitality: A Pilot Study in Radiology.

    Science.gov (United States)

    Steele, Joseph Rodgers; Jones, A Kyle; Clarke, Ryan K; Shoemaker, Stowe

    2015-06-01

    The patient experience has moved to the forefront of health care-delivery research. The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology began collaborating in 2011 with the University of Houston Conrad N. Hilton College of Hotel and Restaurant Management, and in 2013 with the University of Nevada, Las Vegas, William F. Harrah College of Hotel Administration, to explore the application of service science to improving the patient experience. A collaborative pilot study was undertaken by these 3 institutions to identify and rank the specific needs and expectations of patients undergoing imaging procedures in the MD Anderson Department of Diagnostic Radiology. We first conducted interviews with patients, providers, and staff to identify factors perceived to affect the patient experience. Next, to confirm these factors and determine their relative importance, we surveyed more than 6,000 patients by e-mail. All factors considered important in the interviews were confirmed as important in the surveys. The surveys showed that the most important factors were acknowledgment of the patient's concerns, being treated with respect, and being treated like a person, not a "number"; these factors were more important than privacy, short waiting times, being able to meet with a radiologist, and being approached by a staff member versus having one's name called out in the waiting room. Our work shows that it is possible to identify and rank factors affecting patient satisfaction using techniques employed by the hospitality industry. Such factors can be used to measure and improve the patient experience. PMID:25533732

  6. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning.

    Science.gov (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A

    2016-03-01

    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered. PMID:26694313

  7. Leadership in the clinical workplace: what residents report to observe and supervisors report to display: an exploratory questionnaire study

    OpenAIRE

    van der Wal, Martha A.; Scheele, Fedde; Schonrock-Adema, Johanna; Jaarsma, A. Debbie C.; Cohen-Schotanus, Janke

    2015-01-01

    Background: Within the current health care system, leadership is considered important for physicians. leadership is mostly self-taught, through observing and practicing. Does the practice environment offer residents enough opportunities to observe the supervisor leadership behaviours they have to learn? In the current study we investigate which leadership behaviours residents observe throughout their training, which behaviours supervisors report to display and whether residents and supervisor...

  8. Childhood Maltreatment and Prospectively Observed Quality of Early Care as Predictors of Antisocial Personality Disorder Features

    OpenAIRE

    Shi, Zhenyu; Bureau, Jean-Francois; EASTERBROOKS, M. ANN; Zhao, Xudong; Lyons-Ruth, Karlen

    2012-01-01

    Few studies have evaluated the separate contributions of maltreatment and ongoing quality of parent-child interaction to the etiology of antisocial personality features using a prospective longitudinal design. 120 low-income young adults (aged 18-23) were assessed for extent of ASPD features on the Structured Clinical Interview for Diagnosis-Axis II, for presence of maltreatment on the Conflict Tactics Scale, Traumatic Experiences Scale, and Adult Attachment Interview, and for referral in inf...

  9. Quality of Systematic Reviews of Observational Nontherapeutic Studies

    OpenAIRE

    Shamliyan, Tatyana; Kane, Robert L; Jansen, Stacy

    2010-01-01

    Introduction High-quality epidemiologic research is essential in reducing chronic diseases. We analyzed the quality of systematic reviews of observational nontherapeutic studies. Methods We searched several databases for systematic reviews of observational nontherapeutic studies that examined the prevalence of or risk factors for chronic diseases and were published in core clinical journals from 1966 through June 2008. We analyzed the quality of such reviews by using prespecified criteria and...

  10. Out of care and into care again: A Danish register‐based study of children placed in out-of‐home care before their third birthday

    DEFF Research Database (Denmark)

    Ubbesen, Mads Bonde; Petersen, Liselotte; Mortensen, Preben Bo;

    2012-01-01

    Objective: When children are reunited with their families of origin and the reasons for placing them in out-of-home care no longer exist, it is usually considered a good outcome. Unfortunately, some children are later returned to care. The objective of this register-based study is to describe in ...... histories. A psychiatric history is associated with re-entry only when the family structure consists of two parents. An immigration background is associatedwith a higher like- lihood of reunification and with a lower likelihood of re-entry. ©......Objective: When children are reunited with their families of origin and the reasons for placing them in out-of-home care no longer exist, it is usually considered a good outcome. Unfortunately, some children are later returned to care. The objective of this register-based study is to describe in...... terms of rates the processes of reunification and re-entry, involving children placed in out-of-homecare before their third birthday. Further- more, the objective is to study whether individual and parental characteristics predict reunifications and re-entries. Method: Data were obtained by using...

  11. Branding in senior care home services in China and Finland : Comparative case study in private sector

    OpenAIRE

    Kittilä, Petri

    2011-01-01

    ABSTRACT Kittilä, Petri 2011. Branding in senior care home services in China and Finland: Comparative case study in private sector. Bachelor’s Thesis. Kemi-Tornio University of Applied Sciences. Business and Culture. Pages 88. Appendix 1. The objective of this thesis was to study how the private sector senior care home services are branded and how significant the care homes see the brand building. In addition, my objective was to study differences in service branding between China and...

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

    OpenAIRE

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

    2014-01-01

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

  13. Midwives’ views on factors that contribute to health care inequalities among immigrants in Sweden: a qualitative study

    Directory of Open Access Journals (Sweden)

    Akhavan Sharareh

    2012-08-01

    Full Text Available Abstract Introduction Ethnic and socioeconomic inequalities in the Swedish health care system have increased. Most indicators suggest that immigrants have significantly poorer health than native Swedes. The purpose of this study was to explore the views of midwives on the factors that contribute to health care inequality among immigrants. Methods Data were collected via semi-structured interviews with ten midwives. These were transcribed and related categories identified through content analysis. Results The interview data were divided into three main categories and seven subcategories. The category “Communication” was divided into subcategories “The meeting”, “Cultural diversity and language barriers” and “Trust and confidence”. The category “Potential barriers to the use of health care services” contained two subcategories, “Seeking health care” and “Receiving equal treatment”. Finally, the category “Transcultural health care” had subcategories “Education on transcultural health care” and “The concept”. Conclusions This study suggests that midwives believe that health care inequality among immigrants can be the result of miscommunication which may arise due to a shortage of meeting time, language barriers, different systems of cultural beliefs and practices and limited patient-caregiver trust. Midwives emphasized that education level, country of origin and length of stay in Sweden play a role when an immigrant seeks health care. Immigrants face more difficulties when seeking health care and in receiving adequate levels of care. However, different views among the midwives were also observed. Some midwives were sensitive to individual and intra-group differences, while some others viewed immigrants as a group of “others”. Midwives’ beliefs about subgroup-specific health services vs. integrating immigrants’ health care into mainstream health care services should be investigated further. Patients

  14. INCIDENCE AND RISK FACTORS CONTRIBUTING TO ROP: STUDY FROM NEONATAL CARE UNIT- SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Karthiyaeni

    2016-01-01

    Full Text Available The study was conducted to identify the incidence of retinopathy of prematurity among the preterm neonates treated at neonatal unit and to evaluate the associated risk factors for ROP. DESIGN Prospective observational study. SETTING Neonatal Intensive Care Unit (NICU of Department of Paediatrics at Chengalpattu Medical College. During the study period, 159 babies were treated at the NICU and 111 babies were discharged from the unit. Among those babies who were discharged, 14 neonates were lost for followup for ROP screening. This lost to followup was 12.6% of the study population. In this study 97 infants were screened, out of which 18 infants had ROP. The rate of ROP is 18.6% in our institution and 2 out of 18 babies had threshold ROP (11.1%, who were treated with Laser therapy

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

    Directory of Open Access Journals (Sweden)

    Magnavita Nicola

    2012-05-01

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

  16. Seasonal variations of vivax and falciparum malaria: an observation at a tertiary care hospital

    International Nuclear Information System (INIS)

    Background: Malaria is a major public health problem in the malaria endemic zones of the world. Various factors influence the prevalence of malaria. This study was conducted to determine the variation in frequency of Plasmodium vivax and Plasmodium falciparum malaria in different seasons of the year in Khyber Teaching Hospital, Peshawar. Methods: A total of 411 patients were included in the study. All these febrile patients were reported to have trophozoites of either Plasmodium vivax or Plasmodium falciparum malaria on Giemsa stained thick and thin smears. The frequency of vivax and falciparum malaria was worked out and statistically analysed for different season of the year. The study was carried out from 2nd Jan 2004 till 31st December 2008. Results: Out of total 411 diagnosed malaria cases, total 134 (32.60%) presented in the autumn season (vivax=33.58%, and falciparum=66.42%), 37 (9%) in winter season (vivax=32.4%, and falciparum=67.6%), 76 (18.49%) in spring season (vivax=93.4% and falciparum 6.6%) and 164 (39.90%) in summer season (vivax=89.6, and falciparum=10.4%). The malaria showed a highly significant pattern in different seasons of the year (p=0.00) in a way that Plasmodium falciparum malaria reached its highest frequency in autumn and winter seasons while Plasmodium vivax malaria reached its peak frequency in spring and summer seasons. Conclusion: There was highly significant seasonal variation of vivax and falciparum malaria. There is arrival of Plasmodium falciparum in autumn which peaks in winter followed by arrival of Plasmodium vivax in spring till the end of summer. (author)

  17. Association between child-care and acute diarrhea: a study in Portuguese children

    Directory of Open Access Journals (Sweden)

    Barros Henrique

    2003-01-01

    Full Text Available OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR and their respective 95% confidence intervals (95% CI, crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]. CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.

  18. Self-Care Practices for Common Colds by Primary Care Patients: Study Protocol of a European Multicenter Survey-The COCO Study.

    Science.gov (United States)

    Weltermann, Birgitta M; Gerasimovska-Kitanovska, Biljana; Thielmann, Anika; Chambe, Juliette; Lingner, Heidrun; Pirrotta, Enzo; Buczkowski, Krzysztof; Tekiner, Selda; Czachowski, Slawomir; Edirne, Tamer; Zielinski, Andrzej; Yikilkan, Hülya; Koskela, Tuomas; Petrazzuoli, Ferdinando; Hoffman, Robert D; Petek Šter, Marija; Guede Fernández, Clara; Uludağ, Ayşegül; Hoffmann, Kathryn; Mevsim, Vildan; Kreitmayer Pestic, Sanda

    2015-01-01

    Background. Self-care for common colds is frequent, yet little is known about the spectrum, regional differences, and potential risks of self-care practices in patients from various European regions. Methods/Design. We describe the study protocol for a cross-sectional survey in 27 primary care centers from 14 European countries. At all sites, 120 consecutive adult patients, who visit their general practitioner for any reason, filled in a self-administered 27-item questionnaire. This addresses patients' self-care practices for common colds. Separately, the subjective level of discomfort when having a common cold, knowing about the diseases' self-limited nature, and medical and sociodemographic data are requested. Additionally, physicians are surveyed on their use of and recommendations for self-care practices. We are interested in investigating which self-care practices for common colds are used, whether the number of self-care practices used is influenced by knowledge about the self-limited nature of the disease, and the subjective level of discomfort when having a cold and to identify potential adverse interactions with chronic physician-prescribed medications. Further factors that will be considered are, for example, demographic characteristics, chronic conditions, and sources of information for self-care practices. All descriptive and analytical statistics will be performed on the pooled dataset and stratified by country and site. Discussion. To our knowledge, COCO is the first European survey on the use of self-care practices for common colds. The study will provide new insight into patients' and general practitioners' self-care measures for common colds across Europe. PMID:26421048

  19. Self-Care Practices for Common Colds by Primary Care Patients: Study Protocol of a European Multicenter Survey—The COCO Study

    Science.gov (United States)

    Weltermann, Birgitta M.; Gerasimovska-Kitanovska, Biljana; Thielmann, Anika; Chambe, Juliette; Lingner, Heidrun; Pirrotta, Enzo; Buczkowski, Krzysztof; Tekiner, Selda; Czachowski, Slawomir; Edirne, Tamer; Zielinski, Andrzej; Yikilkan, Hülya; Koskela, Tuomas; Petrazzuoli, Ferdinando; Hoffman, Robert D.; Petek Šter, Marija; Guede Fernández, Clara; Uludağ, Ayşegül; Hoffmann, Kathryn; Mevsim, Vildan; Kreitmayer Pestic, Sanda

    2015-01-01

    Background. Self-care for common colds is frequent, yet little is known about the spectrum, regional differences, and potential risks of self-care practices in patients from various European regions. Methods/Design. We describe the study protocol for a cross-sectional survey in 27 primary care centers from 14 European countries. At all sites, 120 consecutive adult patients, who visit their general practitioner for any reason, filled in a self-administered 27-item questionnaire. This addresses patients' self-care practices for common colds. Separately, the subjective level of discomfort when having a common cold, knowing about the diseases' self-limited nature, and medical and sociodemographic data are requested. Additionally, physicians are surveyed on their use of and recommendations for self-care practices. We are interested in investigating which self-care practices for common colds are used, whether the number of self-care practices used is influenced by knowledge about the self-limited nature of the disease, and the subjective level of discomfort when having a cold and to identify potential adverse interactions with chronic physician-prescribed medications. Further factors that will be considered are, for example, demographic characteristics, chronic conditions, and sources of information for self-care practices. All descriptive and analytical statistics will be performed on the pooled dataset and stratified by country and site. Discussion. To our knowledge, COCO is the first European survey on the use of self-care practices for common colds. The study will provide new insight into patients' and general practitioners' self-care measures for common colds across Europe. PMID:26421048

  20. Multiple medication use in older patients in post-acute transitional care: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Runganga M

    2014-09-01

    Full Text Available Maureen Runganga,1,2 Nancye M Peel,2 Ruth E Hubbard2,3 1The Prince Charles Hospital, Chermside, QLD, Australia; 2Centre for Research in Geriatric Medicine, The University of Queensland School of Medicine, QLD, Australia; 3Princess Alexandra Hospital, Woolloongabba, QLD, Australia Background: Older adults with a range of comorbidities are often prescribed multiple medications, which may impact on their function and cognition and increase the potential for drug interactions and adverse events. Aims: This study investigated the extent of polypharmacy and potentially inappropriate medications in patients receiving post-discharge transitional home care and explored the associations of polypharmacy with patient characteristics, functional outcomes, and frailty.Methods: A prospective observational study was conducted of 351 patients discharged home from hospital with support from six Transition Care Program (TCP sites in two states of Australia. A comprehensive geriatric assessment was conducted at TCP admission and discharge using the interRAI Home Care assessment tool, with frailty measured using an index of 57 accumulated deficits. Medications from hospital discharge summaries were coded using the World Health Organization Anatomical Therapeutic Chemical Classification System. Results: Polypharmacy (5–9 drugs was observed in 46.7% and hyperpolypharmacy (≥10 drugs in 39.2% of patients. Increasing numbers of medications were associated with greater number of comorbid conditions, a higher prevalence of diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease, dizziness, and dyspnea and increased frailty. At discharge from the program, the non-polypharmacy group (<5 drugs had improved outcomes in Activities of Daily Living, Instrumental Activities of Daily Living and fewer falls, which was mediated because of lower levels of frailty. The commonest drugs were analgesics (56.8% and antiulcer drugs (52.7%. The commonest

  1. A quality management model for integrated care : results of a Delphi and Concept Mapping study

    NARCIS (Netherlands)

    Minkman, Mirella; Ahaus, Kees; Fabbricotti, Isabelle; Nabitz, Udo; Huijsman, Robbert

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

  2. A quality management model for integrated care: results of a Delphi and Concept Mapping study

    NARCIS (Netherlands)

    M. Minkman; K. Ahaus; I. Fabbricotti; U. Nabitz; R. Huijsman

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

  3. Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study

    OpenAIRE

    Poortaghi; Salsali; Ebadi; Rahnavard; Maleki

    2015-01-01

    Background Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. Objectives This study aimed to audit nursing care based on a nursing process model. Patients and Methods This was a cross-sectional descriptive study in which a nursing audit checkl...

  4. A mixed methods observational simulation-based study of interprofessional team communication

    DEFF Research Database (Denmark)

    Paltved, Charlotte; Nielsen, Kurt; Musaeus, Peter

    2013-01-01

    Interprofessional team communication has been identified as an important focus for safety in medical emergency care. However, in-depth insight into the complexity of team communication is limited. Video observational studies might fill a gap in terms of understanding the meaning of specific...... communication interactions and link team performance to patient outcome. This study had two aims. First, to develop a theory-based evaluation instrument that measures and qualifies team communication. And second, to investigate the quality and content of summaries and re-evaluations evolving step wise and...

  5. Pityriasis versicolor: A clinicomycological and epidemiological study from a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Ghosh Sudip

    2008-01-01

    Full Text Available Background: Pityriasis versicolor is a mild, chronic, usually asymptomatic superficial fungal infection of the stratum corneum, caused by Malassezia yeasts. The purpose of the present study is to assess the clinical profile of a group of patients with pityriasis versicolor and to find out the epidemiological characteristics in this part of India as well as any association, if any, with other diseases. Materials and Methods: For this purpose, 110 consecutive patients of pityriasis versicolor were evaluated clinically and diagnosis was confirmed mycologically at a tertiary care hospital in Kolkata. All data were recorded in a predesigned, pretested semi-structured schedule. The total duration of study period was 12 months. Results: Majority of the patients were young adults. Most of the patients were asymptomatic. There is prominent seasonal variation of the patients with a peak in August and September months. Most of the lesions were hypopigmented scaly macules and were KOH positive. Most commonly involved sites were chest, face and back. Seborrheic dermatitis sometimes coexisted with pityriasis versicolor and a number of patients also had diabetes mellitus and immunosuppressive conditions. Conclusions: Overall, the clinicomycological and epidemiological profile of pityriasis versicolor infection as observed in a tertiary care setting in eastern India does not differ significantly from those observed by previous workers elsewhere.

  6. Study of Problems Arising during Perioperative Care of Postoperative Endophthalmitis

    Institute of Scientific and Technical Information of China (English)

    Jingyi Lin; Yue Cai; Jiehui Huang; Ronghua Ye

    2014-01-01

    Purpose:.To discuss the problems in perioperative nursing care for patients with postoperative infectious endophthalmitis. Methods: The medical records of 34 patients (35 eyes) pre-senting with infectious endophthalmitis at Zhongshan Oph-thalmic Center,.Sun Yat-sen University between April 2002 and December 2013 were collected to analyze preoperative and postoperative nursing care for endophthalmitis after ocular surgery. Results:Thirty-four patients (35 eyes) developed complications of infectious endophthalmitis after surgery..Thirty-three cases were successfully cured and only one patient (1 eye) was un-treated due to Pseudomonas aeruginosa infection. Conclusion: Perioperative nursing care plays a pivotal role in preventing and controlling the incidence and development of postoperative infectious endophthalmitis.

  7. The relationship between organizational culture of nursing staff and quality of care for residents with dementia: questionnaire surveys and systematic observations in nursing homes.

    NARCIS (Netherlands)

    Beek, A.P.A. van; Gerritsen, D.L.

    2010-01-01

    BACKGROUND: Since the 1990s, several studies have shown that organizational culture is an important characteristic in long-term care. However, at the moment little is known about organizational culture and its relationship with quality of care. OBJECTIVES: In this study, the relationship between org

  8. Profiling dizziness in older primary care patients: an empirical study.

    Directory of Open Access Journals (Sweden)

    Jacquelien Dros

    Full Text Available BACKGROUND: The diagnostic approach to dizzy, older patients is not straightforward as many organ systems can be involved and evidence for diagnostic strategies is lacking. A first differentiation in diagnostic subtypes or profiles may guide the diagnostic process of dizziness and can serve as a classification system in future research. In the literature this has been done, but based on pathophysiological reasoning only. OBJECTIVE: To establish a classification of diagnostic profiles of dizziness based on empirical data. DESIGN: Cross-sectional study. PARTICIPANTS AND SETTING: 417 consecutive patients of 65 years and older presenting with dizziness to 45 primary care physicians in the Netherlands from July 2006 to January 2008. METHODS: We performed tests, including patient history, and physical and additional examination, previously selected by an international expert panel and based on an earlier systematic review. We used the results of these tests in a principal component analysis for exploration, data-reduction and finally differentiation into diagnostic dizziness profiles. RESULTS: Demographic data and the results of the tests yielded 221 variables, of which 49 contributed to the classification of dizziness into six diagnostic profiles, that may be named as follows: "frailty", "psychological", "cardiovascular", "presyncope", "non-specific dizziness" and "ENT". These explained 32% of the variance. CONCLUSIONS: Empirically identified components classify dizziness into six profiles. This classification takes into account the heterogeneity and multicausality of dizziness and may serve as starting point for research on diagnostic strategies and can be a first step in an evidence based diagnostic approach of dizzy older patients.

  9. Evaluation of moral case deliberation at the Dutch Health Care Inspectorate: a pilot study

    OpenAIRE

    Seekles, Wike; Widdershoven, Guy; Robben, Paul; van Dalfsen, Gonny; Molewijk, Bert

    2016-01-01

    Background Moral case deliberation (MCD) as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate (IGZ). The objective of this pilot study is to investig...

  10. Methicillin-Resistant Staphylococcus aureus in Saarland, Germany: The Long-Term Care Facility Study

    OpenAIRE

    Nillius, Dorothea; von Müller, Lutz; Wagenpfeil, Stefan; Klein, Renate; Herrmann, Mathias

    2016-01-01

    Background Multiresistant organisms pose a threat for patients and care recipients. Control interventions need to be tailored to region, the type of institution considered, and risk factors. The German state of Saarland is ideally suited to study colonisation epidemiology throughout its various health and care institutions. After conclusion of a large admission prevalence study in acute care hospitals, we now performed a methicillin-resistant Staphylococcus aureus (MRSA) point prevalence stud...

  11. The relationship of primary health care use with persistence of insomnia: a prospective cohort study

    OpenAIRE

    Hayward Richard A; Jordan Kelvin P; Croft Peter

    2012-01-01

    Abstract Background Prevalence of insomnia symptoms in the general population is high. Insomnia is linked with high health care use and within primary care there are a number of treatment options available. The objective of this study was to determine the association of persistence and remission of insomnia with primary health care using a longitudinal study. Methods A postal survey of registered adult (over 18 years) populations of five UK general practices, repeated after 1 year, linked to ...

  12. Register studies of cancer in the Southern Health Care Region in Sweden

    OpenAIRE

    Attner, Bo

    2012-01-01

    The overall aim was to study different aspect of health care use and health care costs on a population based level for persons with cancer and their partners, and from an individual level to explore the impact of comorbidities in incidence and survival. In the beginning of the study all persons in the Southern Health Care Region in Sweden diagnosed with colon, rectal, breast, prostate and lung cancer during the period 2000 to 2005 were identified via the Swedish Cancer Register. Lately, inclu...

  13. Impact of the ‘Artful Moments’ Intervention on Persons with Dementia and Their Care Partners: a Pilot Study

    Science.gov (United States)

    Hazzan, Afeez Abiola; Humphrey, Janis; Kilgour-Walsh, Laurie; Moros, Katherine L.; Murray, Carmen; Stanners, Shannon; Montemuro, Maureen; Giangregorio, Aidan; Papaioannou, Alexandra

    2016-01-01

    Background Engaging with art can be valuable for persons living with dementia. ‘Artful Moments’ was a collaborative project undertaken by the Art Gallery of Hamilton and the Behavioural Health Program at Hamilton Health Sciences that sought to develop and implement a program of arts-based activities for persons in the middle-to-late stages of dementia who exhibit behavioural symptoms and for their accompanying care partners. Methods This pilot study employed a qualitative descriptive design. Eight participants were observed during multiple art sessions to evaluate their level of engagement in the program. Care partners also completed a questionnaire describing their experience. Qualitative content analysis was used to identify themes. Results For program participants, factors that promoted continued interest and engagement in art included: care partner involvement, group activities, opportunities to share opinions, validation of their personhood, and increased engagement over time. Care partners observed improvements in participants’ creativity, communication, relationship forming, and task accomplishment, and some reported reduced stress. Conclusions ‘Artful Moments’ promoted engagement and expression in persons in the middle-to-late stages of dementia, as well as having benefits for their care partners. Limitations of the study included a small convenience sample drawn from one hospital setting. PMID:27403209

  14. GP and nurses' perceptions of how after hours care for people receiving palliative care at home could be improved: a mixed methods study

    OpenAIRE

    Miles Gail; O'Connor Margaret M; Tan Heather M; Klein Britt; Schattner Peter

    2009-01-01

    Abstract Background Primary health care providers play a dominant role in the provision of palliative care (PC) in Australia but many gaps in after hours service remain. In some rural areas only 19% of people receiving palliative care achieve their goal of dying at home. This study, which builds on an earlier qualitative phase of the project, investigates the gaps in care from the perspective of general practitioners (GPs) and PC nurses. Methods Questionnaires, developed from the outcomes of ...

  15. Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care?—a cross-sectional study

    OpenAIRE

    van der Kop, Mia Liisa; Thabane, Lehana; Awiti, Patricia Opondo; Muhula, Samuel; Kyomuhangi, Lennie Bazira; Lester, Richard Todd; Ekström, Anna Mia

    2016-01-01

    Background Presenting to care with advanced HIV is common in sub-Saharan Africa and increases the risk of severe disease and death; however, it remains unclear whether this is a consequence of late diagnosis or a delay in seeking care after diagnosis. The objectives of this cross-sectional study were to determine factors associated with advanced HIV at presentation to care and whether this was due to late diagnosis or delays in accessing care. Methods Between 2013 and 2015, adults presenting ...

  16. On-scene time and outcome after penetrating trauma: an observational study

    DEFF Research Database (Denmark)

    Funder, Kamillia S.; Petersen, John Asger; Steinmetz, Jacob

    2011-01-01

    prehospital setting. Follow-up data were obtained from a national administrative database. The primary end point was 30-day survival. Results Of the 467 patients registered, 442 (94.6%) were identified at the 30-day follow-up, of whom 40 (9%) were dead. A higher mortality was found among patients treated on...... observational cohort study of penetrating trauma patients treated by the Mobile Emergency Care Unit in Copenhagen with a 30-day follow-up. Between January 2002 and September 2009, data were prospectively registered regarding the anatomical location of the trauma, time intervals and procedures performed in the...... On-scene time might be important in penetrating trauma, and ALS procedures should not delay transport to definite care at the hospital....

  17. Palliative care awareness among Indian undergraduate health care students: A needs-assessment study to determine incorporation of palliative care education in undergraduate medical, nursing and allied health education

    Directory of Open Access Journals (Sweden)

    Sakshi Sadhu

    2010-01-01

    Conclusion: The outcomes of the study showed that the basic knowledge of palliative care among students was inadequate, and students are unprepared and uncertain in their approach of delivering end-of-life care.

  18. Caring About Dostoyevsky: The Untapped Potential of Studying Literature.

    Science.gov (United States)

    Willems, Roel M; Jacobs, Arthur M

    2016-04-01

    Should cognitive scientists and neuroscientists care about Dostoyevsky? Engaging with fiction is a natural and rich behavior, providing a unique window onto the mind and brain, particularly for mental simulation, emotion, empathy, and immersion. With advances in analysis techniques, it is time that cognitive scientists and neuroscientists embrace literature and fiction. PMID:26809726

  19. Caring about Dostoyevsky: The untapped potential of studying literature

    OpenAIRE

    Willems, R.; Jacobs, A.

    2016-01-01

    Should cognitive scientists and neuroscientists care about Dostoyevsky? Engaging with fiction is a natural and rich behavior, providing a unique window onto the mind and brain, particularly for mental simulation, emotion, empathy, and immersion. With advances in analysis techniques, it is time that cognitive scientists and neuroscientists embrace literature and fiction.

  20. SPECTRUM OF POISONING IN CHILDREN: STUDY FROM TERTIARY CARE HOSPITAL IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Mallesh

    2015-08-01

    Full Text Available PURPOSE: To understand pattern of poisoning in different age group in tertiary child care center and quantify burden of poisoning in pediatric admissions and mortality. DESIGN: Retrospective observation study. SETTING: Tertiary care center for children. METHODS: All the children admitted with diagnosis of acute poisoning between January 2013 and June 2015 was studied. RESULTS: There were 332 admissions due to poisoning during the study period (5.4% of total admissions. Mortality due to poisoning was 7, i.e. , 1.97% of all - cause mortality. 2.1% of poisonings died during the study period where a s overall mortality from all causes was 5.71%. House hold Products topped the list with 112 cases, followed by agricultural products (88 cases, animal bites and stings (69 cases, drugs (48 cases and industrial compounds (7 cases. Majority of admissions were in summer seasons 31% of all poisoning followed by rainy season. CONCLUSIONS: Incidence of acute poisoning in childhood has not changed significantly over time. Organophosphorus compounds, phosphides and drugs poisoning peak during adolescence and is particularly alarming. Conditions such as free availability of these compounds, co morbid conditions of adolescents, adolescent stressors have to be addressed

  1. Bridging the Gap between Primary Care and Specialized Mental Health Care. A mixed method study of the quality of referral information and the referral letters’ potential impact on quality of care

    OpenAIRE

    Hartveit, Miriam

    2016-01-01

    Background. A major cause of adverse events in health care is insufficient information transference between health professionals. Despite the cardinal role of referral letters as the means of communication between primary care and specialized mental health care, earlier studies have shown that these letters often lack essential information. The impact of this lack of communication on patient care is unknown. The present study primarily aims to explore what information referral letters from pr...

  2. Exploring the Barriers of Home Care Services in Iran: A Qualitative Study

    OpenAIRE

    Heshmatolah Heydari; Hooman Shahsavari; Abdolrahim Hazini; Alireza Nikbakht Nasrabadi

    2016-01-01

    With increasing chronic diseases, the use of home care is rising in the world. Home care in Iran has many challenges and to improve that, we should identify the challenges and barriers of home care. The aim of this study was to identify and explore the barriers of home care in Iran. This is a qualitative study with content analysis approach that was conducted in Iran in 2015. Fourteen key informants comprising health policymakers, faculty members, nurses, and physicians as well as patients an...

  3. Impact of communication skills training on parents perceptions of care: intervention study

    DEFF Research Database (Denmark)

    Ammentorp, Jette; Kofoed, Poul-Erik; Laulund, Lone W

    2011-01-01

    This paper is a report of a study of the effects of communication-skills training for healthcare professionals on parents' perceptions of information, care and continuity.......This paper is a report of a study of the effects of communication-skills training for healthcare professionals on parents' perceptions of information, care and continuity....

  4. 77 FR 50548 - Agency Information Collection: (PACT Clinical Innovation Study: Engaging Caregivers in the Care...

    Science.gov (United States)

    2012-08-21

    ... AFFAIRS Agency Information Collection: (PACT Clinical Innovation Study: Engaging Caregivers in the Care of... No. 2900--New (VA Form 10-0537). SUPPLEMENTARY INFORMATION: Title: PACT Clinical Innovation Study... social services. The information will help VA develop and test a care management intervention that...

  5. Caregiver Involvement in the Education of Youth in Foster Care: An Exploratory Study

    Science.gov (United States)

    Beisse, Kay; Tyre, Ashli

    2013-01-01

    This study was an exploratory investigation of caregiver involvement in the education of youth in foster care. In this study, foster caregivers reported that they are involved in the education of children in their care and participate in at-home involvement activities more often than at-school involvement activities. Caregivers in this study…

  6. Establishing contact and gaining trust : an exploratory study of care avoidance

    NARCIS (Netherlands)

    Schout, Gert; de Jong, Gideon; Zeelen, Jacques

    2010-01-01

    Title. Establishing contact and gaining trust: an exploratory study of care avoidance. Aim. This paper is a report of a study conducted to explore the competencies especially deep-rooted personal qualities - of care providers who succeed in making contact and gaining trust with clients who are incli

  7. Cultural Adequecy of the Care Dependency Scale for Older Persons in Egypt : A Delphi Study

    NARCIS (Netherlands)

    Boggatz, Thomas; Farid, Tamer; Dijkstra, Ate; Lohrmann, Christa; Dassen, T.

    2009-01-01

    Purpose: The aim of this study is to determine the cultural adequateness of the Arabic version of the Care Dependency Scale (CDS), an internationally used instrument to measure care needs by either self-reports or external assessment. Method: A Delphi study in two rounds about the Arabic version was

  8. HEMATOLOGICAL MANIFESTATIONS IN DENGUE FEVER – AN OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Malathesha

    2014-02-01

    Full Text Available BACKGROUND: Dengue is a major preventable and treatable cause of morbidity and mortality among children and adults that occurs mainly in tropical and subtropical regions. Early diagnosis of dengue is important for provision of specific care which ensures marked reduction in the morbidity of the disease itself. OBJECTIVE: To evaluate hematological changes in serologically proven patients with clinical manifestations of Dengue in Bapuji & Chigateri Hospital, Davangere. METHODS: Clinical, hematological and serological information from Patients diagnosed with dengue infection in Bapuji & Chigateri hospital Davangere from April 2013 -June 2013. RESULTS: 221 cases of classic dengue predominated (90.2%, with mild clinical manifestations lacking complications. The main hematological findings were raised hematocrit (79.6%, lymphocytosis (66% monocytosis (84.6%, basophilia (52.9%, thrombocytopenia (100% and atypical lymphocytes (87%. In dengue hemorrhagic fever, thrombocytopenia was more prolonged and the number of atypical lymphocytes was higher, while the other hematological abnormalities presented daily evolution similar to those in classic dengue. The hematological changes observed in dengue presented according to the clinical course of the disease and its severity

  9. The Patients Assessment Chronic Illness Care (PACIC questionnaire in The Netherlands: a validation study in rural general practice

    Directory of Open Access Journals (Sweden)

    Hermsen Jan

    2008-09-01

    Full Text Available Abstract Background Many patients with chronic illness receive health care in primary care settings, so a challenge is to provide well-structured chronic care in these settings. Our aim was to develop and test a Dutch version of the PACIC questionnaire, a measure for patient reported structured chronic care. Methods Observational study in 165 patients with diabetes or COPD from four general practices (72% response rate. Patients completed a written questionnaire, which included instruments for assessing chronic illness care (PACIC, evaluations of general practice (Europep, enablement (PEI, and individual characteristics. Results The patients had a mean age of 68.0 years and 47% comprised of women. Twenty-two to 35% of responding patients did not provide answers to specific items in the PACIC. In 11 items the lowest answering category was used by 30% or more of the responders and in 6 items the highest answering category was used by this number of responders. Principal factor analysis identified the previously defined five domains reasonably well. Cronbach's alpha per domain varied from 0.71 to 0.83, and the intraclass coefficient from 0.66 to 0.91. Diabetes patients reported higher presence of structured chronic care for 14 out of the 20 PACIC items. The effect of patient evaluations of general practice on the PACIC score was positive (b = 0.72, p Conclusion A translated and validated Dutch version of the PACIC questionnaire is now available. Further research on its validity is recommended.

  10. Differences in COPD patient care by primary family caregivers: an age-based study.

    Directory of Open Access Journals (Sweden)

    Peng-Ching Hsiao

    Full Text Available BACKGROUND: Because Taiwan has the fastest aging rate among developed countries, care for the elderly is becoming more prominent in the country. Primary family caregivers play an important role in patient health and health promotion behavior. Chronic obstructive pulmonary disease (COPD, an age-related disease, is a major public health problem with high morbidity and mortality and can be a long-term burden for family members; however, little attention has been given to the differences in COPD care between elder caregivers and other caregivers. This study aimed to investigate the differences between elder family caregivers and non-elder family caregivers caring for COPD patients in Taiwan, including caring behavior, caregiver response, and caring knowledge. METHODS: This cross-sectional study was conducted between March 2007 and January 2008; 406 primary family caregivers of COPD patients from the thoracic outpatient departments of 6 hospitals in north-central Taiwan were recruited to answer questionnaires measuring COPD characteristics, care behavior, caregiver response, and COPD knowledge. All questionnaires, which addressed caregiver knowledge, care behaviors, and care reactions, were shown to have acceptable validity and reliability, and the data were analyzed using univariate and generalized linear model techniques. RESULTS: The elder caregivers group had 79 participants, and the non-elder caregivers comprised 327 participants. The COPD-related knowledge scale results were positively correlated with the family caregiver caring behavior scale, suggesting that better COPD-related knowledge among family caregivers may result in improved caring behavior. After adjusting for all possible confounding factors, the elder caregivers had significantly lower COPD-related knowledge than the non-elder caregivers (P<0.001. However, there were no significant differences in the family caregiver caring behavior scale or the caregiver reaction assessment scale

  11. Factors associated with anxiety in critically ill patients: A prospective observational cohort study

    OpenAIRE

    Castillo, M. I.; Cooke, M.; Macfarlane, B; Aitken, L. M.

    2016-01-01

    Background: Anxiety is an unpleasant emotion that most intensive care patients experience. This emotion is an important issue in intensive care settings because of its prevalence, adverse effects and severity. Little is known about the factors associated with state and trait anxiety during critical illness. Objectives: To describe the patterns of state anxiety reported by intensive care patients, and identify factors associated with state and trait anxiety. Design: Prospective observ...

  12. The communication of a secondary care diagnosis of autoimmune hepatitis to primary care practitioners:a population-based study

    OpenAIRE

    Varyani, Fumi; Card, Timothy; Kaye, Philip; Aithal, Guru P; West, Joe

    2013-01-01

    BACKGROUND: Autoimmune Hepatitis is a chronic liver disease which affects young people and can result in liver failure leading to death or transplantation yet there is a lack of information on the incidence and prevalence of this disease and its natural history in the UK. A means of obtaining this information is via the use of clinical databases formed of electronic primary care records. How reliably the diagnosis is coded in such records is however unknown. The aim of this study therefore wa...

  13. The communication of a secondary care diagnosis of autoimmune hepatitis to primary care practitioners: a population-based study

    OpenAIRE

    Varyani, Fumi; Card, Timothy; Kaye, Philip; Aithal, Guru P; West, Joe

    2013-01-01

    Background Autoimmune Hepatitis is a chronic liver disease which affects young people and can result in liver failure leading to death or transplantation yet there is a lack of information on the incidence and prevalence of this disease and its natural history in the UK. A means of obtaining this information is via the use of clinical databases formed of electronic primary care records. How reliably the diagnosis is coded in such records is however unknown. The aim of this study therefore ...

  14. The work of local healthcare innovation: a qualitative study of GP-led integrated diabetes care in primary health care

    OpenAIRE

    Foster, Michele; Burridge, Letitia; Donald, Maria; Zhang, Jianzhen; Jackson, Claire

    2016-01-01

    Background Service delivery innovation is at the heart of efforts to combat the growing burden of chronic disease and escalating healthcare expenditure. Small-scale, locally-led service delivery innovation is a valuable source of learning about the complexities of change and the actions of local change agents. This exploratory qualitative study captures the perspectives of clinicians and managers involved in a general practitioner-led integrated diabetes care innovation. Methods Data on these...

  15. A qualitative study of perceived social barriers to care for eating disorders: Perspectives from ethnically diverse health care consumers

    OpenAIRE

    Hadley Arrindell, Adrienne; Perloe, Alexandra; Fay, Kristen; Striegel-Moore, Ruth H; Becker, Anne Edith

    2009-01-01

    Objective: The study aim was to identify and describe health consumer perspectives on social barriers to care for eating disorders in an ethnically diverse sample. Method: We conducted an exploratory secondary analysis of qualitative data comprising transcripts from semi-structured interviews with past and prospective consumers of eating disorder treatment (n = 32). Transcripts were inputted into NVivo 8 for coding, sorting, and quantifying thematic content of interest within strata defined b...

  16. STUDY OF BACTERIAL FLORA OF HANDS OF HEALTH CARE GIVERS IN A TERTIARY CARE HOSPITAL IN EASTERN INDIA

    OpenAIRE

    Asim; Sayan; Mohammed Aftab Alam; Nitesh Kumar; Hema; Rohit; Shristi; Ripusudan; Shaan

    2015-01-01

    Bacterial contamination of palm of hand of health care givers like doctors and nurses can be an important source of nosocomial infections. Proper hand hygiene is hence key to prevent spread of such cross - infection. We studied the bacterial flora of palm of hand of 101 clinical staff ( D octors of clinical specialties and nurses) and compared it with bacterial flora of 99 non - clinical staff (Doctors of non - clinical specialties and lab technicians...

  17. Access to specialty care in autism spectrum disorders-a pilot study of referral source

    Directory of Open Access Journals (Sweden)

    West Therese

    2011-05-01

    Full Text Available Abstract Background In the United States, a medical home model has been shown to improve the outcomes for children with special health care needs. As part of this model, primary care physicians provide comprehensive medical care that includes identification of delayed and/or atypical development in children and coordination of care with specialists. However, it is not clear if families of children with Autism Spectrum Disorder (ASD rely on the medical home model for care of their child to the same extent as families of children with other special health care needs. This study aims to add to the understanding of medical care for children with ASD by examining the referral source for specialty care. Methods This retrospective study was accomplished by evaluating parent completed intake data for children with ASD compared to those with other neurological disorders in a single physician Pediatric Neurology Practice at a major urban medical center in Northern New Jersey. To account for referral bias, a similar comparison study was conducted using a multispecialty ASD practice at the same medical center. Parent reported "source of referral" and "reason for the referral" of 189 ASD children and 108 non-ASD neurological disordered children were analyzed. Results The specialty evaluations of ASD were predominantly parent initiated. There were significantly less referrals received from primary care physicians for children with ASD compared to children with other neurodevelopmental disorders. Requirement of an insurance referral was not associated with a primary care physician prompted specialty visit.We identified different patterns of referral to our specialty clinics for children with ASD vs. children with other neurolodevelopmental disorders. Conclusion The majority of the families of children with ASD evaluated at our autism center did not indicate that a primary care physician initiated the specialty referral. This study suggests that families of

  18. Program Implementation in the Prison System: An Organizational Study of the Chronic Care Model Program

    OpenAIRE

    Robinson, Greg

    2013-01-01

    This study provides evidence of a successful implementation of a not-for-profit operational model within a public setting. The federal government placed a receiver in charge of improving health care within the California Department of Corrections and Rehabilitation. To achieve the receivership's goals, a chronic care model from the not-for-profit sector was selected and implemented to improve the delivery of health care to inmates. The data suggest that operational programs developed outsi...

  19. A study on morbidity and mortality pattern of poisoning in tertiary care hospital

    OpenAIRE

    C. Paranthakan; P. K. Govindarajan

    2016-01-01

    Background: The poisoning due to various reasons commonly occurs among population. Normally tertiary care hospitals receive large numbers of referral. During treatment many die due to poisoning. Objectives of the study were to find out the magnitude of admissions due to poisoning and to find out various type of poisoning and related mortality. Methods: The secondary data was collected from records available in Intensive care unit of toxicology department of tertiary care hospital. The adm...

  20. Five year prognosis in patients with angina identified in primary care: incident cohort study

    OpenAIRE

    Buckley, B. S.; Simpson, C.R.; McLernon, D.J.; Murphy, A W; Hannaford, P.C.

    2009-01-01

    OBJECTIVE: To ascertain the risk of acute myocardial infarction, invasive cardiac procedures, and mortality among patients with newly diagnosed angina over five years. DESIGN: Incident cohort study of patients with primary care data linked to secondary care and mortality data. SETTING: 40 primary care practices in Scotland. PARTICIPANTS: 1785 patients with a diagnosis of angina as their first manifestation of ischaemic heart disease, 1 January 1998 to 31 December 2001. MAIN OUTCOME MEASURES: ...

  1. Increased utilization of health care services after psychotherapy: a register based study

    DEFF Research Database (Denmark)

    Fenger, Morten Munthe; Poulsen, Stig Bernt; Mortensen, Erik Lykke;

    2012-01-01

    Background Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care...... long-term period psychotherapy patients increased their utilization of health care services with a factor 3 compared to a control group....

  2. Consumer behaviour towards organic, natural and conventional skin care products: a pilot study

    OpenAIRE

    Alina-Aida Drăgan; Dacinia-Crina Petrescu

    2013-01-01

    The aim of this pilot study is to outline consumers’ profile in terms of their interest in organic, natural and conventional skin care, their knowledge about these products and the differences between them, their opinion regarding the performance and price of organic skin care in relation to conventional skin care. The survey used a self-administered questionnaire and was conducted on a sample of 86 customers from Cluj-Napoca, Romania. The results indicate that consumers who pu...

  3. Impact of a 2-Day Critical Care Ultrasound Course during Fellowship Training: A Pilot Study

    OpenAIRE

    Vi Am Dinh; Giri, Paresh C.; Inimai Rathinavel; Emilie Nguyen; David Hecht; Ihab Dorotta; H. Bryant Nguyen; Chrissian, Ara A.

    2015-01-01

    Objectives. Despite the increasing utilization of point-of-care critical care ultrasonography (CCUS), standards establishing competency for its use are lacking. The purpose of this study was to evaluate the effectiveness of a 2-day CCUS course implementation on ultrasound-naïve critical care medicine (CCM) fellows. Methods. Prospective evaluation of the impact of a two-day CCUS course on eight CCM fellows' attitudes, proficiency, and use of CCUS. Ultrasound competency on multiple organ system...

  4. The quality of childbirth care in China: women’s voices: a qualitative study

    OpenAIRE

    Raven, Joanna; van den Broek, Nynke; TAO, FANGBIAO; Kun, Huang; Tolhurst, Rachel

    2015-01-01

    Background In the context of improved utilisation of health care and outcomes, rapid socio-economic development and health system reform in China, it is timely to consider the quality of services. Data on quality of maternal health care as experienced by women is limited. This study explores women’s expectations and experiences of the quality of childbirth care in rural China. Methods Thirty five semi-structured interviews and five focus group discussions were conducted with 69 women who had ...

  5. Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study

    OpenAIRE

    Wiesman Floris J; Verheij Robert A; Zwaanswijk Marieke; Friele Roland D

    2011-01-01

    Abstract Background Various countries are currently implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs, their overall adoption remains low and meets resistance from health care providers. This study aims to increase our understanding of health care providers' attitude towards the n-EPR, by investigating their perceptions of the benefits and problems of electronic information exchange in health care and the n-EPR in particular. Methods The...

  6. The health and social consequences of an alcohol related admission to critical care: a qualitative study

    OpenAIRE

    McPeake, Joanne; Forrest, Ewan; Quasim, Tara; Kinsella, John; O'Neill, Anna

    2016-01-01

    Objective: To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design: In-depth, semistructured interviews with participants ( patients) 3–7 months post intensive care discharge. Setting: The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients ...

  7. Informal Caregivers' Experiences and Needs When Caring for a Relative With Heart Failure: An Interview Study

    OpenAIRE

    Gusdal, A. K.; Josefsson, K.; Adolfsson, E. T.; Martin, L

    2016-01-01

    Background: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden. Objective: The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home. Methods: The...

  8. Health and social consequences of an alcohol-related admission to critical care: a qualitative study

    OpenAIRE

    McPeake, Joanne; Forrest, Ewan; Quasim, Tara; Kinsella, John; O'Neill, Anna

    2016-01-01

    Objective To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design In-depth, semistructured interviews with participants (patients) 3–7 months post intensive care discharge. Setting The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocate...

  9. Role construction and boundaries in interprofessional primary health care teams: a qualitative study

    OpenAIRE

    MacNaughton, Kate; Chreim, Samia; Bourgeault, Ivy Lynn

    2013-01-01

    Background The move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients. Methods A comparative case...

  10. Functional prognosis of dizziness in older adults in primary care: a prospective cohort study.

    OpenAIRE

    Dros, J.; Maarsingh, O.R.; Beem, L.; van der Horst, H.E.; Riet, G. ter; Schellevis, F G; van Weert, H.C.P.M.

    2012-01-01

    Objectives: To investigate the 6-month functional prognosis of dizziness in older adults in primary care, to identify important predictors of dizziness-related impairment, and to construct a score to assist risk prediction. Design: Prospective cohort study with 6-month follow-up. Setting: Twenty-four primary care practices in the Netherlands. Participants: Four hundred seventeen older adults (mean age 78.5, range 65–95, 74% female) presenting consecutively to primary care with dizziness. Meas...

  11. Cross-Sectional Study of Periodontal Care and Glycosylated Hemoglobin in an Insured Population

    OpenAIRE

    Spangler, Leslie; Reid, Robert J.; Inge, Ronald; Newton, Katherine M.; Hujoel, Philippe; Chaudhari, Monica; Genco, Robert J.; Barlow, William E.

    2010-01-01

    OBJECTIVE Compare GHb among people with diabetes who have and have not received periodontal care. RESEARCH DESIGN AND METHODS This cross-sectional study linked 5 years of electronic medical record and dental insurance data for dually insured patients with diabetes, ages 40–70 years (n = 5,103). We assessed the association between annual mean GHb (%) and periodontal care (a proxy for periodontitis) defined using claim codes. Among patients who received periodontal care, we assessed the associa...

  12. Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

    OpenAIRE

    Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

    2015-01-01

    Objectives: To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design: Longitudinal study with three points of measurement. Setting: Primary care practices in Switzerland. Participants: In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes: The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed ...

  13. Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

    OpenAIRE

    Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

    2015-01-01

    Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quali...

  14. Community-based, interdisciplinary geriatric care team satisfaction with an electronic health record: a multimethod study.

    Science.gov (United States)

    Sockolow, Paulina S; Bowles, Kathryn H; Lehmann, Harold P; Abbott, Patricia A; Weiner, Jonathan P

    2012-06-01

    This multimethod study measured the impact of an electronic health record (EHR) on clinician satisfaction with clinical process. Subjects were 39 clinicians at a Program of All-inclusive Care for Elders (PACE) site in Philadelphia utilizing an EHR. Methods included the evidence-based evaluation framework, Health Information Technology Research-Based Evaluation Framework, which guided assessment of clinician satisfaction with surveys, observations, follow-up interviews, and actual EHR use at two points in time. Mixed-methods analysis of findings provided context for interpretation and improved validity. The study found that clinicians were satisfied with the EHR; however, satisfaction declined between time periods. Use of EHR was universal and wide and was differentiated by clinical role. Between time periods, EHR use increased in volume, with increased timeliness and decreased efficiency. As the first EHR evaluation at a PACE site from the perspective of clinicians who use the system, this study provides insights into EHR use in the care of older people in community-based healthcare settings. PMID:22411417

  15. Interstellar dust: interfacing laboratory, theoretical and observational studies

    Science.gov (United States)

    Jones, Anthony Peter

    2015-08-01

    In this talk I will consider how our understanding of interstellar dust can only be advanced through a combination of laboratory, theoretical and observational studies, which provide the critical framework for advancing our understanding. I will summarise what we currently know, or think we know, about the physical and compositional properties of dust and their evolution in interstellar media. Along the way I will question the utility of astronomical dust analogues and show, based on data from the laboratory, theoretical studies and from astronomical observations, that some of our prior interpretations need to be subjected to a critical re-evaluation. I will present interstellar dust modelling from a new vantage point and review ideas on the interpretation of observations within the framework of this model and its predictions for dust evolution within and between interstellar media. Finally, I will summarise some of the current outstanding issues and what we would like to learn in the future.

  16. Prepare and prevent rather than repair and repent: Study of maternal mortality in tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Anjali Mundkur

    2013-07-01

    Full Text Available Context: Maternal death signifies the quality of healthcare provided in the population. It is the young, relatively healthy women who die of various reasons. Audit of such mortality would prevent the recurrence by taking appropriate measures. Aims: To find the causes of maternal mortality. Settings and Design: Retrospective observational study. Materials and Methods : All maternal deaths in a tertiary care referral center from January 2007 to September 2012 were studied for their demographic profile and causes of death. Results: All 62 women were referred from other healthcare units. Twenty-nine patients died within 24 h of admission and 33 women died after 24 h of admission. Death of 34 patients was due to direct obstetric causes and of 26 patients due to indirect obstetric causes. There were 2 maternal deaths due to accidental causes. Conclusions: The corrective action to prevent the recurrence of such deaths should be taken. Sepsis was found to be the commonest cause for maternal mortality followed by hemorrhage. It important to note that, in the present study, all mothers received antenatal care, had hospital delivery (none had home delivery, no teenage pregnancy or grand multigravidas, and no obstructed labor or rupture uterus, and yet they died. There is a change in the trend of causes of maternal mortality. Strengthening of the first referral units with equipment, blood bank, and adequately competent staff should be of prime importance. Continued medical education of the medial personnel at the periphery is required. Maternal deaths occur in inspite of atenatal care and hospital delivery which is alarming. Contributing factors may be delay in referral or the travel which should be looked in to inorder to minimize such death of young women.

  17. Study of white-light flares observed by Hinode

    Institute of Scientific and Technical Information of China (English)

    Hai-Min Wang

    2009-01-01

    White-light flares are considered to be the most energetic flaring events that are observable in the optical broad-band continuum of the solar spectrum. They have not been commonly observed. Observations of white-light flares with sub-arcsecond resolution have been very rare. The continuous high resolution observations of Hinode provide a unique opportunity to systematically study the white-light flares with a spatial resolution around 0.2 arcsec. We surveyed all the flares above GOES magnitude C5.0 since the launch of Hinode in 2006 October. 13 of these kinds of flares were covered by the Hinode G-band observations. We analyzed the peak contrasts and equivalent areas (calculated via integrated excess emission contrast) of these flares as a function of the GOES X-ray flux, and found that the cut-off visibility is likely around M1 flares under the observing limit of Hinode. Many other observational and physical factors should affect the visibility of white-light flares; as the observing conditions are improved, smaller flares are likely to have detectable white-light emissions. We are cautious that this limiting visibility is an overestimate, because G-band observations contain emissions from the upper atmosphere.Among the 13 events analyzed, only the M8.7 flare of 2007 June 4 had near-simultaneous observations in both the G-band and the blue continuum. The blue continuum had a peak contrast of 94% vs. 175% in G-band for this event. The equivalent area in the blue continuum is an order of magnitude lower than that in the G-band. Very recently, Jess et al.studied a C2.0 flare with a peak contrast of 300% in the blue continuum. Compared to the events presented in this letter, that event is probably an unusual white-light flare: a very small kernel with a large contrast that can be detected in high resolution observations.

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

    Science.gov (United States)

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

    1993-06-01

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

  19. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

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

  20. Resource allocation in health care processes: A case study

    OpenAIRE

    Kauhanen, Antti; Kulvik, Martti; Kulvik, Silja; Maijanen, Sirpa; Martikainen, Olli; Ranta, Paula

    2013-01-01

    This paper utilizes queuing models to analyze health care processes. We extend previous queuing models to allow for i) heterogeneous resources, ii) resource allocation to various tasks, and iii) teams (complementary resources). We model a process of one clinical unit. We use the model to analyze how resource allocation affects both process performance and utilization of resources. This approach emphasizes how allocation of resources to tasks affects process performance. We illustrate how the ...

  1. Plastic Neuroscience: Studying What the Brain Cares About

    Directory of Open Access Journals (Sweden)

    Joseph eDumit

    2014-04-01

    Full Text Available Drawing on Allan Newell’s You can’t play 20 questions with nature and win, this article proposes that neuroscience needs to go beyond binary hypothesis testing and design experiments that follow what neurons care about. Examples from Lettvin et. al. are used to demonstrate that one can experimentally play with neurons and generate surprising results. In this manner, brains are not confused with persons, rather, persons are understood to do things with their brains.

  2. Scientific and Ethical Approaches for Observational Exposure Studies

    Science.gov (United States)

    Researchers conduct observational human exposure studies to understand how and the extent to which people come into contact with chemicals and environmental stressors in their everyday lives, through the air they breathe, the food and liquids they consume, and the things they tou...

  3. Observational Studies of Retarded Children with Multiple Stereotyped Movements.

    Science.gov (United States)

    Baumeister, Alfred A.; And Others

    1980-01-01

    Three relatively long-term observational studies, involving seven retarded preschool children, each of whom exhibited multiple stereotypes, were conducted to determine the extent to which the type of activity or setting had any effect upon the rates of stereotyped movements. (Author)

  4. Protopathic bias in observational studies on statin effectiveness

    OpenAIRE

    Korhonen, Maarit Jaana; Huupponen, Risto; Ruokoniemi, Päivi; Helin-Salmivaara, Arja

    2009-01-01

    Protopathic bias in observational studies on statin effectiveness phone: +350-40-3552901 (Korhonen, Maarit Jaana) (Korhonen, Maarit Jaana) Pharmacology, Drug Development and Therapeutics, University of Turku - 20014 - Turku - FINLAND (Korhonen, Maarit Jaana) School of Public Health and Clinical Nutrition, University of Kuopio - POB 1627 - 70211 - Kuopio - FINLAND (Korhonen, Maarit Jaana) Pharmacology, Drug Development and Therapeutics, University of T...

  5. The Chronic CARe for diAbeTes study (CARAT: a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Birnbaum Beatrice

    2010-06-01

    Full Text Available Abstract Background Diabetes is a major challenge for the health care system and especially for the primary care provider. The Chronic Care Model represents an evidence-based framework for the care for chronically ill. An increasing number of studies showed that implementing elements of the Chronic Care Model improves patient relevant outcomes and process parameters. However, most of these findings have been performed in settings different from the Swiss health care system which is dominated by single handed practices. Methods/Design CARAT is a cluster randomized controlled trial with general practitioners as the unit of randomization (trial registration: ISRCTN05947538. The study challenges the hypothesis that implementing several elements of the Chronic Care Model via a specially trained practice nurse improves the HbA1c level of diabetes type II patients significantly after one year (primary outcome. Furthermore, we assume that the intervention increases the proportion of patients who achieve the recommended targets regarding blood pressure ( Discussion This study challenges the hypothesis that the Chronic Care Model can be easily implemented by a practice nurse focused approach. If our results will confirm this hypothesis the suggestion arises whether this approach should be implemented in other chronic diseases and multimorbid patients and how to redesign care in Switzerland.

  6. Methodological issues in observational studies of obesity and mortality

    OpenAIRE

    W. Dana Flanders; Liv Berit Augestad

    2011-01-01

    Obesity has important health hazards, and the epidemic seems to be growing in developed countries. There is scientific evidence for higher risk of earlier death among the obese. However, most evidence of the effects of obesity on mortality comes from observational studies. The aim of this manuscript is to reviewsome of the most important issues in designing, analyzing and interpreting analytic studies of the effects of obesity on mortality. Key issues are clarity in the definition of the effe...

  7. Observational studies of transiting extrasolar planets (invited review)

    OpenAIRE

    Southworth, J.

    2014-01-01

    The study of transiting extrasolar planets is only 15 years old, but has matured into a rich area of research. I review the observational aspects of this work, concentrating on the discovery of transits, the characterisation of planets from photometry and spectroscopy, the Homogeneous Studies project, starspots, orbital obliquities, and the atmospheric properties of the known planets. I begin with historical context and conclude with a glance to a future of TESS, CHEOPS, Gaia and PLATO.

  8. The Amsterdam Studies of Acute Psychiatry - II (ASAP-II: a comparative study of psychiatric intensive care units in the Netherlands

    Directory of Open Access Journals (Sweden)

    van Venrooij Janine

    2009-09-01

    Full Text Available Abstract Background The number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU. From several studies and reports it has become evident that important dissimilarities exist between PICU's. The current study seeks to describe organisational as well as clinical and patient related factors across ten PICU's in and outside the Amsterdam region, adjusted for or stratified by level of urbanization. Method/Design This paper describes the design of the Amsterdam Studies of Acute Psychiatry II (ASAP-II. This study is a prospective observational cohort study comparing PICU's in and outside the Amsterdam region on various patient characteristics, treatment aspects and recovery related variables. Dissimilarities were measured by means of collecting standardized forms which were filled out in the framework of care as usual, by means of questionnaires filled out by mental health care professionals and by means of extracting data from patient files for every consecutive patient admitted at participating PICU's during a specific time period. Urbanization levels for every PICU were calculated conform procedures as proposed by the Dutch Central Bureau for Statistics (CBS. Discussion The current study may provide a deeper understanding of the differences between psychiatric intensive care units that can be used to promote best practice and benchmarking procedures, and thus improve the standard of care.

  9. Nurse′s perceptions of physiotherapists in critical care team: Report of a qualitative study

    Directory of Open Access Journals (Sweden)

    Pranati Gupte

    2016-01-01

    Full Text Available Background: Interprofessional relationship plays a major role in effective patient care. Specialized units such as critical care require multidisciplinary care where perception about every members role may affect the delivery of patient care. The objective of this study was to find out nurses′ perceptions of the role of physiotherapists in the critical care team. Methods: Qualitative study by using semi-structured interview was conducted among the qualified nurses working in the Intensive Care Unit of a tertiary care hospital. The interview consisted of 19 questions divided into 3 sections. Interviews were audio recorded and transcribed. In-depth content analysis was carried out to identify major themes in relation to the research question. Results: Analysis identified five major issues which included role and image of a physiotherapist, effectiveness of treatment, communications, teamwork, and interprofessional relations. Physiotherapists were perceived to be an important member of the critical team with the role of mobilizing the patients. The respondents admitted that there existed limitations in interprofessional relationship. Conclusion: Nurses perceived the role of physiotherapist in the critical care unit as an integral part and agreed on the need for inclusion of therapist multidisciplinary critical care team.

  10. Organization position statements and the stance of "studied neutrality" on euthanasia in palliative care.

    Science.gov (United States)

    Johnstone, Megan-Jane

    2012-12-01

    In recent years, palliative care and related organizations have increasingly adopted a stance of "studied neutrality" on the question of whether euthanasia should be legalized as a bona fide medical regimen in palliative care contexts. This stance, however, has attracted criticism from both opponents and proponents of euthanasia. Pro-euthanasia activists see the stance as an official position of indecision that is fundamentally disrespectful of a patient's right to "choose death" when life has become unbearable. Some palliative care constituents, in turn, are opposed to the stance, contending that it reflects an attitude of "going soft" on euthanasia and as weakening the political resistance that has hitherto been successful in preventing euthanasia from becoming more widely legalized. In this article, attention is given to examining critically the notion and possible unintended consequences of adopting a stance of studied neutrality on euthanasia in palliative care. It is argued that although palliative care and related organizations have an obvious stake in the outcome of the euthanasia debate, it is neither unreasonable nor inconsistent for such organizations to be unwilling to take a definitive stance on the issue. It is further contended that, given the long-standing tenets of palliative care, palliative care organizations have both a right and a responsibility to defend the integrity of the principles and practice of palliative care and to resist demands for euthanasia to be positioned either as an integral part or logical extension of palliative care. PMID:22771130

  11. Newly diagnosed incident dizziness of older patients: a follow-up study in primary care

    Directory of Open Access Journals (Sweden)

    Hummers-Pradier Eva

    2011-06-01

    Full Text Available Abstract Background Dizziness is a common complaint of older patients in primary care, yet not much is known about the course of incident dizziness. The aim of the study was to follow-up symptoms, subjective impairments and needs of older patients (≥65 with incident dizziness and to determine predictors of chronic dizziness. Furthermore, we analysed general practitioners' (GPs' initial diagnoses, referrals and revised diagnoses after six months. Methods An observational study was performed in 21 primary care practices in Germany, including a four-week and six-month follow-up. A questionnaire comprising characteristic matters of dizziness and a series of validated instruments was completed by 66 participants during enrolment and follow-up (after 1 month and 6 months. After six months, chart reviews and face-to-face interviews were also performed with the GPs. Results Mean scores of dizziness handicap, depression and quality of life were not or only slightly affected, and did not deteriorate during follow-up; however, 24 patients (34.8% showed a moderate or severe dizziness handicap, and 43 (62.3% showed a certain disability in terms of quality of life at the time of enrolment. In multivariate analysis, n = 44 patients suffering from chronic dizziness (dependent variable, i.e. relapsing or persistent at six months initially had a greater dizziness handicap (OR 1.42, 95%CI 1.05-1.47 than patients with transient dizziness. GPs referred 47.8% of the patients to specialists who detected two additional cases of benign paroxysmal positional vertigo (BPPV. Conclusions New-onset dizziness relapsed or persisted in a considerable number of patients within six months. This was difficult to predict due to the patients' heterogeneous complaints and characteristics. Symptom persistence does not seem to be associated with deterioration of the psychological status in older primary care patients. Management strategies should routinely consider BPPV as

  12. Staff perception on biomedical or health care waste management: a qualitative study in a rural tertiary care hospital in India.

    Directory of Open Access Journals (Sweden)

    Sudhir Chandra Joshi

    Full Text Available Health care or biomedical waste, if not managed properly, can be of high risk to the hospital staff, the patients, the community, public health and the environment, especially in low and middle income settings where proper disposal norms are often not followed. Our aim was to explore perceptions of staff of an Indian rural tertiary care teaching hospital on hospital waste management.A qualitative study was conducted using 10 focus group discussions (FGDs, with different professional groups, cleaning staff, nurses, medical students, doctors and administrators. The FGD guide included the following topics: (i role of Health Care Waste Management (HCWM in prevention of health care associated infections, (ii awareness of and views about HCWM-related guidelines/legislation, (iii current HCWM practices, (iv perception and preparedness related to improvements of the current practices, and (v proper implementation of the available guidelines/legislation. The FGDs were recorded, transcribed verbatim, translated to English (when conducted in Hindi and analysed using content analysis.Two themes were identified: Theme (A, 'Challenges in integration of HCWM in organizational practice,' with the categories (I Awareness and views about HCWM, (II Organizational practices regarding HCWM, and (III Challenges in Implementation of HCWM; and Theme (B, 'Interventions to improve HCWM,' with three categories, (I Educational and motivational interventions, (II Organizational culture change, and (III Policy-related interventions.A gap between knowledge and actual practice regarding HCWM was highlighted in the perception of the hospital staff. The participants suggested organizational changes, training and monitoring to address this. The information generated is relevant not merely to the microsystem studied but to other institutions in similar settings.

  13. Carbon Dioxide Observational Platform System (CO-OPS), feasibility study

    Science.gov (United States)

    Bouquet, D. L.; Hall, D. W.; Mcelveen, R. P.

    1987-01-01

    The Carbon Dioxide Observational Platform System (CO-OPS) is a near-space, geostationary, multi-user, unmanned microwave powered monitoring platform system. This systems engineering feasibility study addressed identified existing requirements such as: carbon dioxide observational data requirements, communications requirements, and eye-in-the-sky requirements of other groups like the Defense Department, the Forestry Service, and the Coast Guard. In addition, potential applications in: earth system science, space system sciences, and test and verification (satellite sensors and data management techniques) were considered. The eleven month effort is summarized. Past work and methods of gathering the required observational data were assessed and rough-order-of magnitude cost estimates have shown the CO-OPS system to be most cost effective (less than $30 million within a 10 year lifetime). It was also concluded that there are no technical, schedule, or obstacles that would prevent achieving the objectives of the total 5-year CO-OPS program.

  14. A conceptual framework for interprofessional shared decision making in home care: Protocol for a feasibility study

    Directory of Open Access Journals (Sweden)

    Murray Mary-Anne

    2011-01-01

    Full Text Available Abstract Background Shared decision making (SDM is fundamental to informed consent and client-centered care. So far, SDM frameworks have been limited to the client-physician dyad, even though care is increasingly delivered by interprofessional (IP teams. IP collaboration is especially essential in home care, one of health care's most rapidly growing areas. This study will assess whether it is possible to practice SDM in IP home care. Methods/Design We will use a qualitative case study and a quantitative survey to capture the macro, meso and micro levels of stakeholders in home care. The case study will follow the knowledge-to-action process framework to evaluate the work of an IP home care team at a Quebec City health center. Sources of data will include one-on-one interviews with patients, family caregivers or surrogates and significant others, and administrators; a focus group of home care health professionals; organizational documents; and government policies and standards. The interview guide for the interviews and the focus group will explore current practices and clinical problems addressed in home care; factors that could influence the implementation of the proposed IP approach to SDM; the face and content validity of the approach; and interventions to facilitate the implementation and evaluation of the approach. The survey will ask 300 health professionals working in home care at the health center to complete a questionnaire based on the Theory of Planned Behaviour that measures their intentions to engage in an IP approach to SDM. We will use our analysis of the individual interviews, the focus group and the survey to elaborate a toolkit for implementing an IP approach to SDM in home care. Finally, we will conduct a pilot study in Alberta to assess the transferability of our findings. Discussion We believe that developing tools to implement IP SDM in home care is essential to strengthening Canada's healthcare system and furthering

  15. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study.

    NARCIS (Netherlands)

    Graff, M.J.L.; Adang, E.M.M.; Vernooij-Dassen, M.J.F.J.; Dekker, J.; Jonsson, L.; Thijssen, M.; Hoefnagels, W.H.L.; Olde Rikkert, M.G.M.

    2008-01-01

    OBJECTIVE: To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint. DESIGN: Cost effectiveness study alongside a single blind randomised controlled trial. SETTING: Memory clinic,

  16. A criterion-related validity study of the nursing-care dependency (NCD) scale

    NARCIS (Netherlands)

    Dijkstra, A.; Buist, G.; Dassen, Th.W.N.

    1998-01-01

    The purpose of this study was to examine some aspects of the criterion-related validity of the Nursing-Care Dependency (NCD) scale. This 15-item counting scale has recently been developed for assessing the care dependency of demented or mentally handicapped in-patients. Its criterion-related validit

  17. The strength of primary care in Europe : an international comparative study

    NARCIS (Netherlands)

    Kringos, D.S.; Boerma, W.G.W.; Bourgueil, Y.; Cartier, T.; Dedeu, T.; Hasvold, T.; Groenewegen, P.P.; et al, [No Value

    2013-01-01

    Background A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Aim Evaluation of strength of primary care in Europe. Design and setting International comparative cross-sectional study performed in 2009–2010, in

  18. Home or hospital birth: a prospective study of midwifery care in the Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.

    1997-01-01

    A large scale study on maternity care in the Netherlands, describing many facets of midwifery care in relation to the preferred place of birth (at home or in hospital), the obstetric result, and the experiences of childbirth. In the Netherlands only women with low risk pregnancies are free to cho

  19. Benefits and problems of electronic information exchange as perceived by health care professionals: an interview study.

    NARCIS (Netherlands)

    Zwaanswijk, M.; Verheij, R.A.; Wiesman, F.J.; Friele, R.D.

    2011-01-01

    BACKGROUND: Various countries are currently implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs, their overall adoption remains low and meets resistance from health care providers. This study aims to increase our understanding of health care prov

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

    Science.gov (United States)

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

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

  1. Promoting Collaboration in Health Care Teams through Interprofessional Education: A Simulation Case Study

    Science.gov (United States)

    Ekmekci, Ozgur

    2013-01-01

    This simulation study explores how the integration of interprofessional components into health care curriculum may impact professional stereotyping and collaborative behavior in care delivery teams comprised of a physician, a registered nurse, a physician's assistant, a physical therapist, and a radiation therapist. As part of the agent-based…

  2. An Empirical Typology of Residential Care/Assisted Living Based on a Four-State Study

    Science.gov (United States)

    Park, Nan Sook; Zimmerman, Sheryl; Sloane, Philip D.; Gruber-Baldini, Ann L.; Eckert, J. Kevin

    2006-01-01

    Purpose: Residential care/assisted living describes diverse facilities providing non-nursing home care to a heterogeneous group of primarily elderly residents. This article derives typologies of assisted living based on theoretically and practically grounded evidence. Design and Methods: We obtained data from the Collaborative Studies of Long-Term…

  3. An Exploratory Study of the Impacts of an Employer-Supported Child Care Program

    Science.gov (United States)

    Morrissey, Taryn W.; Warner, Mildred E.

    2011-01-01

    Although employer-sponsored child care programs have become more common, there is little empirical research on whether these programs affect employees' satisfaction with child care or their work-life balance, and if effects vary across employee characteristics. In this exploratory study, we administered a survey to employees with children at one…

  4. Worthy Work, Unlivable Wages: The National Child Care Staffing Study, 1988-1997.

    Science.gov (United States)

    Whitebook, Marcy; Howes, Carollee; Phillips, Deborah

    In 1988, the National Child Care Staffing Study first gathered information on staffing and quality from a sample of child care centers in five metropolitan areas--Atlanta, Boston, Detroit, Phoenix, and Seattle--and returned for updated information in 1992. In 1997, directors of the original sample of centers still in operation were contacted again…

  5. Access Barriers to Dental Health Care in Children with Disability. A Questionnaire Study of Parents

    Science.gov (United States)

    Gerreth, Karolina; Borysewicz-Lewicka, Maria

    2016-01-01

    Background: A patient's with disability everyday life is rife with many limitations such as architectural, transport, information as well as medical, psychological, legal, economic and social barriers. The aim of this study was to evaluate access to dental health care of special-care schoolchildren with intellectual disability on the basis of…

  6. Outcomes for depression and anxiety in primary care and details of treatment : a naturalistic longitudinal study

    NARCIS (Netherlands)

    Prins, Marijn A.; Verhaak, Peter F. M.; Hilbink-Smolders, Mirrian; Spreeuwenberg, Peter; Laurant, Miranda G. H.; van der Meer, Klaas; van Marwijk, Harm W. J.; Penninx, Brenda W. J. H.; Bensing, Jozien M.

    2011-01-01

    Background: There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general pr

  7. Outcomes for depression and anxiety in primary care and details of treatment: a naturalistic longitudinal study.

    NARCIS (Netherlands)

    Prins, M.A.; Verhaak, P.F.M.; Hilbink-Smolders, M.; Spreeuwenberg, P.; Laurant, M.G.H.; Meer, K. van der; Marwijk, H.W.J. van; Penninx, B.W.J.H.; Bensing, J.M.

    2011-01-01

    Background: There is little evidence as to whether or not guideline concordant care in general practice results in better clinical outcomes for people with anxiety and depression. This study aims to determine possible associations between guideline concordant care and clinical outcomes in general pr

  8. Helicobacter pylori infection and dyspepsia in primary care : studies on diagnosis and guideline implementation

    NARCIS (Netherlands)

    Weijnen, Catherine Friderieke

    2002-01-01

    In this thesis various studies on the management of patients presenting with dyspepsia in primary care are described. Of all patients presenting with dyspepsia, only a minority has organic disease. Roughly 25% of the dyspeptic patients presenting in primary care is referred for endoscopy. At endosco

  9. Regulation-Exempt Family Child Care in the Context of Publicly Subsidized Child Care: An Exploratory Study.

    Science.gov (United States)

    Child Care Law Center, San Francisco, CA.

    Whether and how to regulate family child care has been a continuing policy dilemma facing child care advocates, policymakers, child care administrators, and child care regulators over the last 20 years. Insufficient attention has been given to what regulatory and/or non-regulatory methods might be used to ensure that all children, regardless of…

  10. Pharmacoepidemiological Study on Cerebrovascular Accident in Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Prathyusha GR

    2016-08-01

    Full Text Available Stroke is the third leading cause of death in the United States (US and a leading cause of serious, long-term disability. Incidence of ischemic stroke is higher than hemorrhagic stroke. The aim is to conduct pharmacoepidemiology study on cerebrovascular accident patient by evaluating the use and the effects of drugs, and quantification of adverse drug reactions, drug utilization studies to improve the quality and use of medicines. A prospective observational study was conducted in department of general medicine and ICU at Mallareddy hospital, data was collected from 130 patients and it was proposed to be conducted for 6 months. Among 130 patients 78(60% are males and 52(40% are females. Among all age groups major number of CVA patients was seen in 60-69 years (30%. Among them 92% of strokes are Ischemic majorly seen in both males and females and8% strokes are hemorrhagic. Ischemic stroke (94.87% is majorly seen in 60-69 yr age group. Among various risk factors Hypertension (36.43% is the major risk factor found in males (60% and females (40%.Antiplatelet drugs (25.75% are the highest number of drugs given in patients 71.27% in males and 28.72% in females. Highest numbers of drugs are given in 50-59yrs age group and are antiplatelets. As a clinical pharmacist 16 adverse drug reactions and 25 drug interactions are reported. Proper patient counselling is needed to reduce hypertension and to reduce the risk for cerebrovascular accident. Among all antiplatelet drugs are majorly given in males and lipid lowering drugs in females.

  11. Circuit life span in critically ill children on continuous renal replacement treatment: a prospective observational evaluation study

    OpenAIRE

    del Castillo, Jimena; López-Herce, Jesús; Cidoncha, Elena; Urbano, Javier; Mencía, Santiago; Santiago, Maria J; Bellón, Jose M

    2008-01-01

    Introduction One of the greatest problems with continuous renal replacement therapy (CRRT) is early coagulation of the filters. Few studies have monitored circuit function prospectively. The purpose of this study was to determine the variables associated with circuit life in critically ill children with CRRT. Methods A prospective observational study was performed in 122 children treated with CRRT in a pediatric intensive care unit from 1996 to 2006. Patient and filter characteristics were an...

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

    Directory of Open Access Journals (Sweden)

    Tieman Jennifer

    2007-06-01

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

  13. Quality standards for real-world research. Focus on observational database studies of comparative effectiveness.

    Science.gov (United States)

    Roche, Nicolas; Reddel, Helen; Martin, Richard; Brusselle, Guy; Papi, Alberto; Thomas, Mike; Postma, Dirjke; Thomas, Vicky; Rand, Cynthia; Chisholm, Alison; Price, David

    2014-02-01

    Real-world research can use observational or clinical trial designs, in both cases putting emphasis on high external validity, to complement the classical efficacy randomized controlled trials (RCTs) with high internal validity. Real-world research is made necessary by the variety of factors that can play an important a role in modulating effectiveness in real life but are often tightly controlled in RCTs, such as comorbidities and concomitant treatments, adherence, inhalation technique, access to care, strength of doctor-caregiver communication, and socio-economic and other organizational factors. Real-world studies belong to two main categories: pragmatic trials and observational studies, which can be prospective or retrospective. Focusing on comparative database observational studies, the process aimed at ensuring high-quality research can be divided into three parts: preparation of research, analyses and reporting, and discussion of results. Key points include a priori planning of data collection and analyses, identification of appropriate database(s), proper outcomes definition, study registration with commitment to publish, bias minimization through matching and adjustment processes accounting for potential confounders, and sensitivity analyses testing the robustness of results. When these conditions are met, observational database studies can reach a sufficient level of evidence to help create guidelines (i.e., clinical and regulatory decision-making). PMID:24559028

  14. Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care.

    OpenAIRE

    Kool Rudolf B; Winters Sjenny; Triemstra Mattanja; Wiegers Therese A

    2010-01-01

    Abstract Background This study aims to describe the development, testing and optimization of a new standard instrument, the Consumer Quality Index (CQ-index®) Long-term Care, for measuring client experiences with long-term care in the Netherlands. Methods Three versions of the CQ-index questionnaires and protocols for study sampling and data collection were developed, designed for interviews with residents of nursing or residential care homes and postal surveys among representatives of psycho...

  15. How to implement process-oriented care: a case study on the implementation of process-oriented in-hospital stroke care.

    OpenAIRE

    Vos, L; van Oostenbrugge, R.J.; Limburg, M.; Merode, G.G. van; Groothuis, S.

    2009-01-01

    Dutch hospitals are in the midst of a transition towards process-oriented organisation to realise optimal and undisturbed care processes. Between 2004 and 2007, the University Hospital of Maastricht conducted a case study implementing process-oriented in-hospital stroke unit care. The case study consisted of four steps: (1) process analysis; (2) identification of bottlenecks; (3) setting goals for process-oriented care, and selection of coordination measures; and (4) implementation and evalua...

  16. Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death.

    OpenAIRE

    Peter Hodkinson; Andrew Argent; Lee Wallis; Steve Reid; Rafael Perera; Sian Harrison; Matthew Thompson; Mike English; Ian Maconochie; Alison Ward

    2016-01-01

    Purpose Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided. Methods A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency dep...

  17. CHATURBEEJA IN PRIMARY DYSMENORRHOEA (KASHTARTAVA: AN OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Dhiman Kamini

    2012-06-01

    Full Text Available In folk medicines, Chaturbeeja(combination of seeds of four plants i.e Trigonella Foenum-graecum, Lepidium sativum , Nigella sativa, Trachyspermum ammi in equal quantity has been traditionally used for variety of applications including treatment of Dysmenorrhoea, the most common gynaecological symptom reported by women. To promote the proper use of such medicines and to determine their potential as sources for new drugs, it is essential to study medicinal plants, which have folklore reputation in a more intensified way. A Single blind, prospective observational clinical study was conducted to evaluate the efficacy of Chaturbeeja powder in Primary Dysmenorrhoea (Kashtartava. 25 patients were administered Chaturbeeja powder in a single dose of 3g with hot water at night, 7 days before starting of menstruation till 3rd day of the menstruation cycle. After assessing the results it was observed that12 patients were markedly improved, 8 moderately improved and 5 were improved.

  18. Exploring Real-time Patient Decision-making for Acute Care: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Adam L. Sharp

    2014-09-01

    Full Text Available Introduction: Research has described emergency department (ED use patterns in detail. However, evidence is lacking on how, at the time a decision is made, patients decide if healthcare is required or where to seek care. Methods: Using community-based participatory research methods, we conducted a mixed-methods descriptive pilot study. Due to the exploratory, hypothesis-generating nature of this research, we did not perform power calculations, and financial constraints only allowed for 20 participants. Hypothetical vignettes for the 10 most common low acuity primary care complaints (cough, sore throat, back pain, etc. were texted to patients twice daily over six weeks, none designed to influence the patient’s decision to seek care. We conducted focus groups to gain contextual information about participant decision-making. Descriptive statistics summarized responses to texts for each scenario. Qualitative analysis of open-ended text message responses and focus group discussions identified themes associated with decision-making for acute care needs. Results: We received text survey responses from 18/20 recruited participants who responded to 72% (1092/1512 of the texted vignettes. In 48% of the vignettes, participants reported they would do nothing, for 34% of the vignettes participants reported they would seek care with a primary care provider, and 18% of responses reported they would seek ED care. Participants were not more likely to visit an ED during “off-hours.” Our qualitative findings showed: 1 patients don’t understand when care is needed; 2 patients don’t understand where they should seek care. Conclusion: Participants were unclear when or where to seek care for common acute health problems, suggesting a need for patient education. Similar research is necessary in different populations and regarding the role of urgent care in acute care delivery. [West J Emerg Med. 2014;15(6:675-681

  19. Health care for irregular migrants: pragmatism across Europe. A qualitative study

    Directory of Open Access Journals (Sweden)

    Dauvrin Marie

    2012-02-01

    Full Text Available Abstract Background Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM. There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries. Results Semi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240. Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this. Conclusions The needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways.

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

    Science.gov (United States)

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

    2007-01-01

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

  1. Obstacles to continuity of care in young mental health service users’ pathways - an explorative study

    Directory of Open Access Journals (Sweden)

    Marian Ådnanes

    2013-08-01

    Full Text Available Background: Users of mental health services often move between different primary and specialised health and care services, depending on their current condition, and this often leads to fragmentation of care. The aim of this study was to map care pathways in the case of young adult mental health service users and to identify key obstacles to continuity of care.Method: Quarterly semi-structured interviews were performed with nine young adults with mental health difficulties, following their pathways in and out of different services in the course of a year.Results: Key obstacles to continuity of care included the mental health system's lack of access to treatment, lack of integration between different specialist services, lack of progress in care and inadequate coordination tools such as ‘Individual Plan’ and case conferences that did not prevent fragmented care pathways.Conclusions: Continuity of care should be more explicitly linked to aspirations for development and progress in the users' care pathways, and how service providers can cooperate with users to actually develop and make progress. Coordination tools such as case conferences and ‘individual plans’ should be upgraded to this end and utilised to the utmost. This may be the most effective way to counteract the system obstacles.

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

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

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

  3. Patient satisfaction concerning implant-supported prostheses: an observational study

    OpenAIRE

    Bruno César de Vasconcelos GURGEL; Ana Luísa de Barros PASCOAL; Bruno Luiz Menezes de SOUZA; Poliana Medeiros Cunha DANTAS; Sheyla Christinne Lira MONTENEGRO; Angelo Giuseppe Roncalli da Costa OLIVEIRA; Calderon, Patrícia dos Santos

    2015-01-01

    The aim of this observational study was to assess the degree of patient satisfaction toward implant-supported prostheses. A questionnaire was used with two scales (one consisting of detailed adjectival and the other of numerical responses) regarding chewing, esthetics, speaking, comfort and overall satisfaction. The scales were administered to a sample of 147 patients treated with implants and prostheses. The data were submitted to the Kappa statistic and the Chi-square test to analyze the as...

  4. The new worlds observer: The astrophysics strategic mission concept study

    Directory of Open Access Journals (Sweden)

    Cash W.

    2011-07-01

    Full Text Available We present some results of the Astrophysics Strategic Mission Concept Study for the New Worlds Observer (NWO. We show that the use of starshades is the most effective and affordable path to mapping and understanding our neighboring planetary systems, to opening the search for life outside our solar system, while serving the needs of the greater astronomy community. A starshade-based mission can be implemented immediately with a near term program of technology demonstration.

  5. The new worlds observer: The astrophysics strategic mission concept study

    Science.gov (United States)

    Cash, W.

    2011-07-01

    We present some results of the Astrophysics Strategic Mission Concept Study for the New Worlds Observer (NWO). We show that the use of starshades is the most effective and affordable path to mapping and understanding our neighboring planetary systems, to opening the search for life outside our solar system, while serving the needs of the greater astronomy community. A starshade-based mission can be implemented immediately with a near term program of technology demonstration.

  6. Comparative Studies of Different Imputation Methods for Recovering Streamflow Observation

    OpenAIRE

    Kim, Minjeong; Baek, Sangsoo; Ligaray, Mayzonee; Pyo, Jongcheol; Park, Minji; Cho, Kyung

    2015-01-01

    Faulty field sensors cause unreliability in the observed data that needed to calibrate and assess hydrology models. However, it is illogical to ignore abnormal or missing values if there are limited data available. This study addressed this problem by applying data imputation to replace incorrect values and recover missing streamflow information in the dataset of the Samho gauging station at Taehwa River (TR), Korea from 2004 to 2006. Soil and Water Assessment Tool (SWAT) and two machine lear...

  7. Observation Study of Aerosol Radiative Properities over China

    Institute of Scientific and Technical Information of China (English)

    MAO Jietai; LI Chengcai

    2006-01-01

    With a simplified radiation balance model, study is performed of aerosol direct radiation forcing in relation to its optical properties and surface reflectance, indicating that with the thickened aerosol layer the earth-atmosphere system may increase or weaken the solar radiation albedo, depending upon different combinations of aerosol single scattering albedo (SSA, ω0), asymmetry factor (g), and surface albedo (αg)rather than relying directly on the aerosol optical depth (δ), which has its value just in proportion to the changed range of albedo alone.As indicated by the model results, systematic observations of aerosol radiative properties are required to make quantitative study of aerosol direct radiative forcing. Observational research of the properties has been undertaken based on ground and space measurements over China, including ground-based sunphotometeraerosol optical depth (AOD), nephelometer-aerosol scattering coefficients, aethalometer-aerosol absorption coefficients, and MODIS products-retrieved AOD. The satellite retrieved AOD is validated against in situ sun photometer measured AOD, ind icating that for eastern China remote sensing given AODs are acceptable owing mainly to lower surface reflectance there whereas for poor vegetation in the north of China the surface reflectance may be underestimated in AOD retrieval. However, appropriate modification of the scheme of aerosol remote sensing is likely to improve the retrieval accuracy. The aerosol single scattering albedo in dry condition is around 0.80 from surface-measured scattering and absorption coefficients. It requires further studies based on more observations to improve our understanding of the issue.

  8. A study on prescribing pattern of antihypertensives in adult patients attending in a tertiary care hospital of Assam, India

    OpenAIRE

    Pavel Sikidar; Pinaki Chakravarty; Ayan Purkayastha; Rohit Tigga

    2016-01-01

    Background: Hypertension is one of the most common chronic medical problems prompting visits to health care providers. It has been estimated that hypertension accounts for 13% of deaths worldwide. The main objective of the present study was to assess the pattern of drug utilisation and to evaluate whether the prescribing patterns for anti-hypertensive in our institution is in adherence with JNC 8 guidelines for treatment of hypertension. Methods: A prospective, observational, non-intervent...

  9. Exploring the Utility of Ultra-Brief Delirium Assessments in a Nonintensive Care Geriatric Population: The GEM Study

    OpenAIRE

    Powers, James S.; Doering, Tracey; Gordon, Sharon; Svetlana K Eden; Shintani, Ayumi; Schnelle, John

    2012-01-01

    Objective: To determine how an ultra-brief structured tool that would require usually less than a minute for delirium assessment compares with a clinical assessment based on Diagnostic and Statistical Manual-IV (DSM-IV) in a geriatric postacute care (PAC) rehabilitation unit. Design: Prospective observational cohort study. Setting: Postacute geriatric hospital ward of a Veteran’s Affairs hospital. Participants: Consecutively admitted patients between 50 and 100 years old for inpatient postacu...

  10. Care Networking: A Study of Technical Mediations in a Home Telecare Service

    Directory of Open Access Journals (Sweden)

    Miquel Domènech

    2013-07-01

    Full Text Available This article examines the processes of technical mediation within familial care networks based on a study of home telecare targeted at older people. Supported by contributions from the actor—network theory as part of the social psychology of science and technology, these processes of technical mediation are analyzed using a qualitative approach. The data were gathered through six focus groups and four in-depth interviews; the participants in the study included users, relatives and formal carers. Thematic analysis techniques encompassing the information were used, revealing the effects on the patterns of caring relationships. The results show the interplay between presence-absence made possible by the devices; the two-way direction of care between the older people and the artifacts; and the process of sustaining care using the technology. We conclude that care should be seen as a socio-technical network where technology plays an active role in sustaining family relationships.

  11. Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study

    DEFF Research Database (Denmark)

    Peyrol, Mark; Rubin, Richard R.; Lauritzen, Torsten;

    2006-01-01

    respondent characteristics and outcomes varied by country. Conclusions/interpretation There is much need for improvement in applying the chronic-care model to the treatment and prevention of diabetes in all of the countries studied. Each country must develop its own priorities for improving diabetes care and......Aims/hypothesis We assessed country-level and individual-level patterns in patient and provider perceptions of diabetes care. Methods The study used a cross-sectional design with face-to-face or telephone interviews of diabetic patients and healthcare providers in 13 countries from Asia, Australia......, Europe and North America. Participants were randomly selected adults with type 1 or type 2 diabetes (n=5,104), and randomly selected diabetes-care providers, including primary-care physicians (n=2,070), diabetes specialist physicians (n=635) and nurses (n=1,122). Multivariate analysis was used to examine...

  12. Health Care Use by Patients with Somatoform Disorders A Register-Based Follow-Up Study*

    DEFF Research Database (Denmark)

    Andersen, Nadia Lyhne Trærup; Eplov, Lene Falgaard; Andersen, Jon Trærup;

    2012-01-01

    OBJECTIVE: Studies have shown a greater use of medical than mental health services in patients with somatoform disorders. However, not many studies are based on structured interviews and include the entire somatoform spectrum of diagnoses. We conducted a register-based case-control study to...... background population. Data from the Danish National Registers were used to assess health care use in both primary and secondary care. RESULTS: Somatoform patients incurred 2.11 (2.09-2.12) times the primary care visits of controls. They had 3.12 (3.08-3.16) times as many somatic bed-days than controls and 3...

  13. Study of some defects observed in the hexagonal liquid crystals

    International Nuclear Information System (INIS)

    A polarising microscopy study of the disclinations in an hexagonal discotic liquid crystal (hexa-pentoxy-triphenylene) allows us to confirm the theory of the developable domains and the existence of the disclinations as involute of the circle. The absence of the lines S = 1 leads us to propose a model of core in which the energetic instability of these lines is emphasized. The nature of the core is discussed: it is probably filled with hexagonal liquid crystal. Moreover the birefringence Δn is measured and a first estimate of the anchoring energies of the discotic both on the glass and in contact with the air is given. The Michelson interferometry study of the interaction between the disclinations and the free surface has allowed to observe a strong anisotropy of the interfacial tension. At last a study of the walls leads to a classification according to the matching angle and to a first estimate of the penetration distance λ. A similar study has been undertaken in an inverse middle liquid crystalline phase (Na dioctylsulfosuccinate). A strong dependence of the elastic constants with the water concentration is observed. The micellar → hexagonal transition is studied. (author)

  14. The effects of psychological treatment in primary care in Sweden—A practice-based study

    OpenAIRE

    Holmqvist, Rolf; Ström, Thomas; Foldemo, Anniqa

    2014-01-01

    Background: Practice-based studies have found substantial effects of psychological treatment in routine care, often equivalent between treatment methods. Factors that moderate treatment outcome may be important to assess. Aim: The purpose of this study was to evaluate treatment outcome in psychological treatment in primary care, and to compare outcome between the most frequently used methods. An additional aim was to study factors that might moderate outcome differences. Method: The Clinical ...

  15. Validation of the Prognosis in Palliative Care Study Predictor Models in Terminal Cancer Patients

    OpenAIRE

    Kim, Eun-Shin; Lee, Jung-Kwon; Kim, Mi-Hyun; Noh, Hye-Mi; Jin, Yeong-Hyeon

    2014-01-01

    Background Prognosis in Palliative Care Study (PiPS) predictor models were developed in 2011 to estimate the survival of terminal cancer patients in the United Kingdom. The aim of this study was to validate the PiPS model for terminal cancer patients in Korea, and evaluate its value in clinical practice. Methods This study included 202 advanced cancer patients who were admitted to the cancer hospital's palliative care ward from November 2011 to February 2013. On admission, physicians recorded...

  16. Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness (CEDAR: Study protocol

    Directory of Open Access Journals (Sweden)

    Nemes Zoltan

    2010-11-01

    Full Text Available Abstract Background A considerable amount of research has been conducted on clinical decision making (CDM in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness. Methods/Design The study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK. First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560. This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs by taking into account significant variables moderating the relationship between CDM and outcome. Discussion The results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe. Trial register ISRCTN75841675.

  17. Data analysis methods for assessing palliative care interventions in one-group pre–post studies

    Science.gov (United States)

    Ioroi, Takeshi; Kakuma, Tatsuyuki; Sakashita, Akihiro; Miki, Yuki; Ohtagaki, Kanako; Fujiwara, Yuka; Utsubo, Yuko; Nishimura, Yoshihiro; Hirai, Midori

    2015-01-01

    Objectives: Studies of palliative care are often performed using single-arm pre–post study designs that lack causal inference. Thus, in this study, we propose a novel data analysis approach that incorporates risk factors from single-arm studies instead of using paired t-tests to assess intervention effects. Methods: Physical, psychological and social evaluations of eligible cancer inpatients were conducted by a hospital-based palliative care team. Quality of life was assessed at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer QLQ-C15-PAL. Among 35 patients, 9 were discharged within 1 week and 26 were included in analyses. Structural equation models with observed measurements were applied to estimate direct and indirect intervention effects and simultaneously consider risk factors. Results: Parameters were estimated using full models that included associations among covariates and reduced models that excluded covariates with small effects. The total effect was calculated as the sum of intervention and covariate effects and was equal to the mean of the difference (0.513) between pre- and post-intervention quality of life (reduced model intervention effect, 14.749; 95% confidence intervals, −4.407 and 33.905; p = 0.131; covariate effect, −14.236; 95% confidence interval, −33.708 and 5.236; p = 0.152). Conclusion: Using the present analytical method for single-arm pre–post study designs, factors that modulate effects of interventions were modelled, and intervention and covariate effects were distinguished based on structural equation model. PMID:27092261

  18. Equivalência semântica, conceitual e de itens do Observable Indicators of Nursing Home Care Quality Instrument

    Directory of Open Access Journals (Sweden)

    Wagner Ivan Fonseca de Oliveira

    2016-07-01

    Full Text Available Resumo As Instituições de Longa Permanência para Idosos (ILPI são uma importante alternativa de cuidado no mundo, porém o Brasil ainda não dispõe de instrumento válido para monitorar a qualidade dessas instituições. Portanto, o objetivo do presente artigo é descrever as etapas iniciais da adaptação transcultural do Observable Indicators of Nursing Home Care Quality Instrument (IOQ usado para avaliar a qualidade do cuidado nas ILPI. Realizou-se a equivalência conceitual e de itens para avaliar a pertinência e a viabilidade do IOQ à realidade nacional através do Índice de Validade do Conteúdo (IVC. Em seguida, cumpriu-se a equivalência operacional, a idiomática e a semântica. Esta última tem 5 fases: (1 duas traduções e (2 duas respectivas retraduções; (3 apreciação formal; (4 revisão; e (5 aplicação do pré-teste em três ILPI. Modificações importantes foram realizadas para garantir a validade do IOQ. O IVC do instrumento referentes ao contexto brasileiro foi de 94,3% (viabilidade e 95,3% (relevância. O IOQ mostrou-se compreensível e de fácil aplicação no pré-teste. A adaptação transcultural do IOQ contribui para avaliação e melhoria da qualidade nas ILPI brasileiras, mas os resultados devem ser complementados mediante avaliação psicométrica.

  19. Linking Indigenous Knowledge and Observed Climate Change Studies

    Science.gov (United States)

    Alexander, Chief Clarence; Bynum, Nora; Johnson, Liz; King, Ursula; Mustonen, Tero; Neofotis, Peter; Oettle, Noel; Rosenzweig, Cynthia; Sakakibara, Chie; Shadrin, Chief Vyacheslav; Vicarelli, Marta; Waterhouse, Jon; Weeks, Brian

    2010-01-01

    We present indigenous knowledge narratives and explore their connections to documented temperature and other climate changes and observed climate change impact studies. We then propose a framework for enhancing integration of these indigenous narratives of observed climate change with global assessments. Our aim is to contribute to the thoughtful and respectful integration of indigenous knowledge with scientific data and analysis, so that this rich body of knowledge can inform science, and so that indigenous and traditional peoples can use the tools and methods of science for the benefit of their communities if they choose to do so. Enhancing ways of understanding such connections are critical as the Intergovernmental Panel on Climate Change Fifth Assessment process gets underway.

  20. Observations of radiographer communication: An exploratory study using Transactional Analysis

    International Nuclear Information System (INIS)

    Purpose: Communication in medical imaging is a neglected area of research, despite the necessity for good communication if optimum diagnostic images are to be achieved. Methods: The present study has investigated the styles of communication used in medical imaging, using an approach known as Transactional Analysis. This approach has been demonstrated previously as having reliability and validity, using observations and supporting interviews with medical imaging staff, along with inter-rater observations of radiographer-patient interactions. Results: The results indicate that Transactional Analysis can be used effectively for identifying and naming interaction events in diagnostic radiography, with diagnostic radiographers using five styles of communication. Conclusion: Radiographers tend to use Parental styles of communicating; these styles are commonly associated with a practitioner-centred approach to dealing with patients which often result in non-adherence