WorldWideScience

Sample records for care prothrombin time

  1. Prothrombin time (PT)

    Science.gov (United States)

    PT; Pro-time; Anticoagulant-prothrombin time; Clotting time: protime; INR; International normalized ratio ... PT is measured in seconds. Most of the time, results are given as what is called INR ( ...

  2. The progress of prothrombin time measurement

    Directory of Open Access Journals (Sweden)

    Juha Eero Horsti

    2009-12-01

    Full Text Available Warfarin is the most widely used medicine for oral anticoagulant therapy (OAT. It inhibits the synthesis of coagulation factors II, VII, IX, and X in the liver and results in the production of inactive or partially active versions of these factors. Inactive coagulation factors interfere with prothrombin time measurement (Quick and Owren PT measuring the sum of coagulation activity and inhibition. The narrow therapeutic range here involves a danger of serious complications and the risk of bleeding or thrombosis. The new-generation PT method can measure coagulation activity and inhibition separately. This new technique promotes patient care and anticoagulant medication (warfarin, dicoumarol based on coagulation activity in vivo. Both therapy and laboratory controls should be unquestionably accurate and based solely on in vivo coagulation activity. Inactive coagulation factors (inhibition render measurement, calibration, and harmonization. The use of the new-generation PT method based on measurement of coagulation activity in vivo could develop vitamin K antagonist (VKA therapy for the marked benefit of patients.

  3. The reliability of point-of-care prothrombin time testing. A comparison of CoaguChek S and XS INR measurements with hospital laboratory monitoring.

    LENUS (Irish Health Repository)

    Ryan, F

    2010-02-01

    The development of point-of-care (POC) testing devices enables patients to test their own international normalized ratio (INR) at home. However, previous studies have shown that when compared with clinical laboratory values, statistically significant differences may occur between the two methods of INR measurement. The aim of this study was to evaluate the accuracy of the CoaguChek S and XS POC meters relative to clinical laboratory measurements. As part of a randomized, crossover patient self-testing (PST) study at Cork University Hospital, patients were randomized to 6 months PST or 6 months routine care by the anticoagulation management service. During the PST arm of the study, patients measured their INR at home using the CoaguChek S or XS POC meter. External quality control was performed at enrollment, 2 months and 4 months by comparing the POC measured INR with the laboratory determined value. One hundred and fifty-one patients provided 673 paired samples. Good correlation was shown between the two methods of determination (r = 0.91), however, statistically significant differences did occur. A Bland-Altman plot illustrated good agreement of INR values between 2.0 and 3.5 INR units but there was increasing disagreement as the INR rose above 3.5. Eighty-seven per cent of all dual measurements were within the recommended 0.5 INR units of each other. This study adds to the growing evidence that POC testing is a reliable and safe alternative to hospital laboratory monitoring but highlights the importance of external quality control when these devices are used for monitoring oral anticoagulation.

  4. Comparison of Prothrombin Time and Aspartate Aminotransferase in Predicting Hepatotoxicity After Acetaminophen Overdose.

    Science.gov (United States)

    Levine, Michael; O'Connor, Ayrn D; Padilla-Jones, Angela; Gerkin, Richard D

    2016-03-01

    Despite decades of experience with acetaminophen (APAP) overdoses, it remains unclear whether elevated hepatic transaminases or coagulopathy develop first. Furthermore, comparison of the predictive value of these two variables in determining hepatic toxicity following APAP overdoses has been poorly elucidated. The primary objective of this study is to determine the test characteristics of the aspartate aminotransferase (AST) and the prothrombin time (PT) in patients with APAP toxicity. A retrospective chart review of APAP overdoses treated with IV N-acetylcysteine at a tertiary care referral center was performed. Of the 304 subjects included in the study, 246 with an initial AST less than 1000 were analyzed to determine predictors of hepatic injury, defined as an AST exceeding 1000 IU/L. The initial AST >50 was 79.5 % sensitive and 82.6 % specific for predicting hepatic injury. The corresponding negative and positive predictive values were 95.5 and 46.3 %, respectively. In contrast, an initial abnormal PT had a sensitivity of 82.1 % and a specificity of 63.6 %. The negative and positive predictive values for initial PT were 94.9 and 30.2 %, respectively. Although the two tests performed similarly for predicting a composite endpoint of death or liver transplant, neither was a useful predictor. Initial AST performed better than the initial PT for predicting hepatic injury in this series of patients with APAP overdose. PMID:26341088

  5. The effects of freeze drying and freeze drying additives on the prothrombin time and the international sensitivity index.

    OpenAIRE

    Poller, L; Keown, M; Shepherd, S A; Shiach, C R; Tabeart, S

    1999-01-01

    AIM: To determine whether freezing, freeze drying protective additives, or freeze drying of plasma samples from patients on coumarin treatment and from normal individuals affects prothrombin times or the international sensitivity index (ISI) calibration. METHODS: The effect of the addition of the protective additives singly and combined on the prothrombin time of coumarin samples and normal samples before and after freeze drying was observed using high and low ISI reference thromboplastins. I...

  6. Comparison of prothrombin time tests used in the monitoring of edoxaban and their evaluation as indicators of the reversal effect.

    Science.gov (United States)

    Iba, Toshiaki; Emmi, Mari; Hiki, Makoto; Nagayama, Masataka; Aihara, Koichiro; Tabe, Yoko; Yuri, Maiko; Ohsaka, Akimichi

    2016-06-01

    Clinical demand for the prompt assessment of the activity of direct-acting factor Xa inhibitors in the emergency care setting is increasing. In the present study, we examined whether prothrombin time (PT) tests can serve as a clinically useful indicator of anti-factor Xa activity. In the first series, the in vitro effect of edoxaban on PT was evaluated by spiking human plasma with edoxaban and measuring PT using three different commercial PT tests. In the second series, the reversal effect of prothrombin complex concentrates (PCC) and activated PCC (aPCC) in edoxaban-spiked plasma was evaluated. In the third series, PT of plasma samples from patients administered either 15 or 30 mg/day of edoxaban was assessed, and the results were compared with edoxaban concentrations determined by a calibrated anti-factor Xa activity assay. The spike test revealed that all PT reagents positively correlated with edoxaban. The sensitivity to edoxaban varied among the three reagents and Triniclot(®) Excel S showed the best performance. Prolonged PT by edoxaban was reversed by PCC and aPCC in a dose-dependent manner; however, complete reversal was not achieved. Positive correlation between anti-factor Xa activity and PT was shown in the clinical samples at the edoxaban range from 0 to >300 ng/mL. PMID:26984594

  7. Effectiveness of holographic optical element module sensor in measuring blood prothrombin time

    International Nuclear Information System (INIS)

    A small-form-factor holographic optical element (HOE) module, which was mounted on a dual-stage seesaw actuator, was utilized to evaluate blood coagulation in real time. The method involved assessing the decrease in transmitted light of the blood sample surface when the clotting is formed. The prothrombin time (PT) was measured by illumining and focusing a 635 nm laser beam onto the sample. As the fibrinogen turned into non-solute fibrin, the transmitted efficiency and total intensity of the reflected light from the reflector changed. A low-pass filter suppressed the noise in the coagulation-related transient response to yield accurate signals. Finally, the PT measurements were compared to those made classically using other optical sensors. (paper)

  8. Clinical factors influencing normalization of prothrombin time after stopping warfarin: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Zondag Michelle

    2008-10-01

    Full Text Available Abstract Background Anticoagulation with warfarin should be stopped 4–6 days before invasive procedures to avoid bleeding complications. Despite this routine, some patients still have high International Normalized Ratio (INR values on the day of surgery and the procedure may be cancelled. We sought to identify easily available clinical characteristics that may influence the rate of normalization of prothrombin time when warfarin is stopped before surgery or invasive procedures. Methods Clinical data were collected retrospectively from consecutive cases from two cohorts, who stopped warfarin 6 days before surgery. An INR value of 1.6 or higher on the day of surgery or requirement for reversal with vitamin K the day before surgery were criteria for slow return (S to normal INR. Results Of 202 patients, 14 (7% were classified as S. Eight of the S-patients required reversal with vitamin K one day before surgery and in another case surgery was cancelled due to high INR. Baseline INR was the only variable significantly associated with classification as S in stepwise logistic regression analysis (p = 0.003. The odds ratio for being in the normal group was 0.27 (95% confidence interval 0.12–0.62 for each unit baseline INR increased. The positive predictive value of baseline INR with a cut off at > 3.0 was only 15% and for INR > 3.5 it was 33%. Conclusion Baseline INR, but not the size of the maintenance dose, is associated with the rate of normalization of prothrombin time after stopping warfarin, but it has limited utility as predictor in clinical practice. Whenever normal hemostasis is considered crucial for the safety, the INR should be checked again before the invasive procedure.

  9. COMPARATIVE ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) AND PROTHROMBIN TIME (PT) PROFILE OF INDIAN SNAKES Naja naja, Echis carinatus, Vipera russelli HELPFUL IN ESTABLISHING THEIR SUPERIOR THERAPEUTIC PROCOAGULANT EFFICACY

    OpenAIRE

    Saroj C.L; More S.S; Umesh Hallikeri; Gadag J.R

    2010-01-01

    Comparative profile studies on the Activated Partial Thromboplastin Time (APTT) and the Prothrombin Time (PT) of Naja naja (Indian cobra), Vipera russelli (Indian Russell’s viper) Echis carinatus (Indian saw scaled viper) proving their superior Procoagulant efficacy than the normal platelet poor plasma.

  10. COMPARATIVE ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT AND PROTHROMBIN TIME (PT PROFILE OF INDIAN SNAKES Naja naja, Echis carinatus, Vipera russelli HELPFUL IN ESTABLISHING THEIR SUPERIOR THERAPEUTIC PROCOAGULANT EFFICACY

    Directory of Open Access Journals (Sweden)

    Saroj C.L

    2010-12-01

    Full Text Available Comparative profile studies on the Activated Partial Thromboplastin Time (APTT and the Prothrombin Time (PT of Naja naja (Indian cobra, Vipera russelli (Indian Russell’s viper Echis carinatus (Indian saw scaled viper proving their superior Procoagulant efficacy than the normal platelet poor plasma.

  11. Evaluation of prothrombin time and activated partial thromboplastin time mixing studies using an estimated factor correction method.

    Science.gov (United States)

    Chen, Jian; Phillips, Bonnie; Chandler, Wayne L

    2016-01-01

    Mixing studies for prolonged prothrombin time (PT)/activated partial thromboplastin time (aPTT) are used to estimate whether the prolongation is due to an inhibitor or factor deficiency. We propose a new method of mixing study interpretation based on estimation of average factor level changes. Factor level vs. PT/aPTT curves were prepared for single factor, vitamin K-dependent factor, and all factor deficiencies. These curves were used to predict the factor level in the sample and the correction needed to differentiate deficiencies from inhibitors. We compared this estimated factor correction (EFC) method to normal range, percentage correction, and Rosner index. For a given factor level, multiple factor deficiencies prolonged the PT/aPTT more than single factor deficiency, necessitating different thresholds for defining correction on mixing studies. The EFC method was superior to other the correction methods, correctly identifying 38 of 39 known inhibitors, single and multiple factor deficiencies, and correctly identifying inhibitor vs. deficiency in 50 of 59 patient samples. In 99 adult patient mixing studies over 18 months, 30% showed deficiency only, 30% inhibitor only, whereas 40% showed evidence of both. The EFC method for PT/aPTT mixing study interpretation was more accurate than the comparison methods at determining deficiency versus inhibitor. PMID:26397883

  12. Determining the effect of storage conditions on prothrombin time, activated partial thromboplastin time and fibrinogen concentration in rat plasma samples.

    Science.gov (United States)

    Goyal, Vinod Kumar; Kakade, Somesh; Pandey, Santosh Kumar; Gothi, Anil Kalidas; Nirogi, Ramakrishna

    2015-10-01

    Coagulation parameters are usually included in clinical and preclinical safety studies to evaluate the effect of xenobiotics on the extrinsic or intrinsic pathways of coagulation. The analysis is generally performed at the time of terminal sacrifice where many activities are scheduled. Chances of delay in analysis are likely particularly when blood is collected for coagulation via the abdominal vena cava. This experiment was planned to assess the variations in coagulation parameters caused by delay in analysis as well as by storage conditions. Blood was collected from the posterior vena cava under isoflurane anesthesia, and the plasma was separated immediately. Coagulation parameters were evaluated at 0, 6, 24 and 48 h from the plasma stored at room temperature, as well as plasma stored under refrigerated and freezing conditions. Stability of the analytes in blood was also evaluated under refrigerated conditions for 6 h. All parameters were analyzed using a semi-automated coagulometer. Prothrombin time (PT) was stable under all three storage conditions for up to 6 h. Although statistically significant differences were observed for activated partial thromboplastin time (APTT) at room and refrigeration temperatures for up to 6 h, the difference was clinically non-relevant. Fibrinogen was found to be the most stable parameter that showed consistency in results even up to 48 h under all three storage conditions. Plasma for PT can be stored and analyzed without any significant changes for up to 6 h from the actual blood collection, while fibrinogen level testing can be extended for up to 48 h after collection under any storage condition. For reliable APTT results, plasma samples should be run immediately after collection. PMID:26206586

  13. Prothrombin Time and Activated Partial Thromboplastin Time Testing: A Comparative Effectiveness Study in a Million-Patient Sample.

    Directory of Open Access Journals (Sweden)

    Manu N Capoor

    Full Text Available A substantial fraction of all American healthcare expenditures are potentially wasted, and practices that are not evidence-based could contribute to such waste. We sought to characterize whether Prothrombin Time (PT and activated Partial Thromboplastin Time (aPTT tests of preoperative patients are used in a way unsupported by evidence and potentially wasteful.We evaluated prospectively-collected patient data from 19 major teaching hospitals and 8 hospital-affiliated surgical centers in 7 states (Delaware, Florida, Maryland, Massachusetts, New Jersey, New York, Pennsylvania and the District of Columbia. A total of 1,053,472 consecutive patients represented every patient admitted for elective surgery from 2009 to 2012 at all 27 settings. A subset of 682,049 patients (64.7% had one or both tests done and history and physical (H&P records available for analysis. Unnecessary tests for bleeding risk were defined as: PT tests done on patients with no history of abnormal bleeding, warfarin therapy, vitamin K-dependent clotting factor deficiency, or liver disease; or aPTT tests done on patients with no history of heparin treatment, hemophilia, lupus anticoagulant antibodies, or von Willebrand disease. We assessed the proportion of patients who received PT or aPTT tests who lacked evidence-based reasons for testing.This study sought to bring the availability of big data together with applied comparative effectiveness research. Among preoperative patients, 26.2% received PT tests, and 94.3% of tests were unnecessary, given the absence of findings on H&P. Similarly, 23.3% of preoperative patients received aPTT tests, of which 99.9% were unnecessary. Among patients with no H&P findings suggestive of bleeding risk, 6.6% of PT tests and 7.1% of aPTT tests were either a false positive or a true positive (i.e. indicative of a previously-undiagnosed potential bleeding risk. Both PT and aPTT, designed as diagnostic tests, are apparently used as screening tests

  14. Saline obtaining and time standardization of prothrombin using thromboplastin of human placenta.

    Directory of Open Access Journals (Sweden)

    María de Jesús Sánchez Bouza

    2003-07-01

    Full Text Available Background: Determining prothombine ‘s time is an important lab test in the study of coagulation disorders. To develop this essay the main reactive was thromboplastin , a substance that is presented in tissue and that has been obtained habitually from the human brain or certain animals but its extraction in labs or its commercial acquisition is difficult at present. Objective: To obtain Thromboplastin throughout the extraction of human placenta and to standardise the determination of pro-time into the obtained reactive Method: Placenta from normal delivery was used from which thromboplastin was obtained using a saline extraction. The reactive was compared with thromboplastin from human brain from ¨Dr. Hermanos Ameijeiras¨ Hospital in Havana City in a group of patients with and without anticoagulant treatment . With the extracted thromplastin similar or compatible results were obtained than with the habitual reactives by using easier and cheaper process.

  15. Plasma lipids and prothrombin time in rats fed palm oil and other commonly used fats in Egypt

    Directory of Open Access Journals (Sweden)

    Hussein, Mona M.

    1993-02-01

    Full Text Available Sprague-Dawley rats were fed for a total period of 8 weeks on six diets that were different in the source of their fat content. The fat content was provided either, palm oil or palm olein or corn oil or hydrogenated fat, or frying palm oil and mixture of corn oil + hydrogenated fat in the ratio (1:1. The latter was given to the control group. Animals fed these various experimental diets showed statistically significant differences in serum cholesterol and serum triglycerides content among all group. Increased HDL-cholesterol content was evident in animals fed on palm-olein and palm oil. The frying oil fed group showed lowest HDL-cholesterol content. In these experiments palm olein fed animals showed highest ratio of HDL-cholesterol to total cholesterol while the lowest ratio was shown in rats fed on frying oil. Prothrombin (PT and activated partial thromboplastin time (PTT showed higher values In palm oil, palm olein and corn oil diets as compared to all groups with each other.

    Ratas Sprague-Dawley fueron alimentadas durante un periodo total de 8 semanas con seis dietas diferentes en su contenido graso. El contenido graso fue proporcionado por aceite de palma u oleína de palma o aceite de maíz o grasa hidrogenada o aceite de palma de fritura y mezcla de aceite de maíz + grasa hidrogenada en la relación (1:1. El último fue dado al grupo de control. Los animales alimentados con las diferentes dietas experimentales mostraron diferencias significativas estadísticamente en el contenido en colesterol y triglicéridos en suero entre todos los grupos. El aumento en contenido HDL-colesterol fue evidente en animales alimentados con oleína de palma y aceite de palma. El grupo alimentado con aceite de fritura mostró el más bajo contenido en HDL-colesterol. En estos experimentos, los animales alimentados con oleína de palma mostraron la mayor relación de HDL-colesterol a colesterol total, mientras que la relación más baja fue mostrada

  16. Effect of N-acetylcysteine on the accuracy of the prothrombin time assay of plasma coagulation factor II+VII+X activity in subjects infused with the drug. Influence of time and temperature

    DEFF Research Database (Denmark)

    Thorsen, Sixtus; Teisner, Ane; Jensen, Søren Astrup; Philips, Malou; Dalhoff, Kim; Bendtsen, Flemming

    2009-01-01

    OBJECTIVES: The prothrombin time (PT) assay of factor II+VII+X activity is an important predictor of liver damage in paracetamol poisoned patients. It complicates interpretation of results that the antidote, acetylcysteine (NAC) depresses this activity. The aim was to investigate if NAC influence...

  17. Recombinant snake venom prothrombin activators

    OpenAIRE

    Lövgren, Ann

    2012-01-01

    Three prothrombin activators; ecarin, which was originally isolated from the venom of the saw-scaled viper Echis carinatus, trocarin from the rough-scaled snake Tropidechis carinatus, and oscutarin from the Taipan snake Oxyuranus scutellatus, were expressed in mammalian cells with the purpose to obtain recombinant prothrombin activators that could be used to convert prothrombin to thrombin. We have previously reported that recombinant ecarin can efficiently generate thrombin without the need ...

  18. Timely and Effective Care - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - state data. This data set includes state-level data for measures of heart attack care, heart failure care, pneumonia care,...

  19. Recombinant snake venom prothrombin activators.

    Science.gov (United States)

    Lövgren, Ann

    2013-01-01

    Three prothrombin activators; ecarin, which was originally isolated from the venom of the saw-scaled viper Echis carinatus, trocarin from the rough-scaled snake Tropidechis carinatus, and oscutarin from the Taipan snake Oxyuranus scutellatus, were expressed in mammalian cells with the purpose to obtain recombinant prothrombin activators that could be used to convert prothrombin to thrombin. We have previously reported that recombinant ecarin can efficiently generate thrombin without the need for additional cofactors, but does not discriminate non-carboxylated prothrombin from biologically active γ-carboxylated prothrombin. Here we report that recombinant trocarin and oscutarin could not efficiently generate thrombin without additional protein co-factors. We confirm that both trocarin and oscutarin are similar to human coagulation Factor X (FX), explaining the need for additional cofactors. Sequencing of a genomic fragment containing 7 out of the 8 exons coding for oscutarin further confirmed the similarity to human FX. PMID:23111318

  20. Timely and Effective Care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - national data. This data set includes national-level data for measures of heart attack care, heart failure care, pneumonia...

  1. Timely and Effective Care - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of heart attack care, heart failure care, pneumonia...

  2. Taking Care of Time

    Directory of Open Access Journals (Sweden)

    Cortney Davis

    2007-01-01

    Full Text Available So take good care of time, therefore and how you spend it. -from " The Cloud of Unknowing"Yesterday it was a thousand small coinsringing in your pocket, your hand dipping in, scooping threeat a time, giving them away. Often you'd drop onein the lush grass, unaware it was lost.Spent, tarnished, it is irretrievable.Today time comes to you in a different disguise:a bold of fine silk, vermillion or blue, you measure itlike a woman preparing to sew.Tomorrow, watch out, it comes as something else-thunderstorm, slant rain, February blizzard that drives you inside.Insomniac, you pace and cursethe blue glow of television, computer screen, radio.Soon enough, time will come to you as you were once,newly born and difficult to recognize. You could mistake itfor an elderly coughing man or a woman overrun with disease.Do not stop your ears against its cry.It will ask you to return any small change.It will say, cherish every moment under the leaden sky.

  3. Dental care utilization over time.

    Science.gov (United States)

    Beazoglou, T; Brown, L J; Heffley, D

    1993-12-01

    Between 1950 and 1978, per capita real dental expenditures in the U.S. grew at an average annual rate of 3.33%. Between 1978 and 1989 there was virtually no net growth in this measure of dental care utilization. This sharp curtailment of utilization growth has promoted debate about the sources of this change. Possible explanations include, among others, a reduction in dental disease due to increased exposure to fluoridation, the substitution of noncaloric sweeteners for refined sugar, preventive dentistry, , improved oral health habits, an increase in the net price of dental services, and the cost-containment efforts of insurers and employers. Changes have occurred in all of these variables, but little has done to isolate and quantify the individual effects. This decomposition is difficult, in part, because of the lack of an established model for time-series analysis of dental care utilization. A model of dental care demand, incorporating economic factors (out-of-pocket or net dental prices, per capita income, and nondental prices) as well as dietary factors (refined sugar consumption, noncaloric sweeteners, and exposure to fluoridated water), is combined with a simple model of dental care supply within an equilibrium framework. A two-stage estimation procedure is applied, using U.S. aggregate time-series data for the period 1950-89. Results show that economic and dietary factors are significantly related to changes in utilization. Net price and income elasticities of demand exhibit the expected signs and are compatible with estimates from cross-sectional studies. Decreases in cane and beet sugar consumption, facilitated by the increase in the use of noncaloric sweeteners, are associated with reductions in utilization. Fluoridation appears to be weakly but positively related to utilization. There also appears to have been a significant structural shift in demand since 1978. Overall goodness-of-fit is strong and the model accurately tracks the 1978-89 flattening of

  4. Valores de referência do tempo de protrombina (TP e tempo de tromboplastina parcial ativada (TTPa em cães Reference ranges of prothrombin time (PT and activated partial thromboplastin time (aPTT in dogs

    Directory of Open Access Journals (Sweden)

    Sonia Terezinha dos Anjos Lopes

    2005-04-01

    Full Text Available Os fatores de coagulação são parte integrante da hemostasia normal, e tanto as coagulopatias hereditárias como adquiridas que envolvem este sistema são de grande importância veterinária, geralmente evidenciadas por manifestações clínicas, tais como, petéquias, equimoses, hematomas e sangramentos tardios. O presente trabalho teve por objetivo a determinação dos valores de referência do tempo de protrombina (TP e tempo de tromboplastina parcial ativada (TTPa, por métodos manuais. Para tanto, utilizou-se "kits" para dosagens humanas, devido à inexistência de produtos similares de uso específico veterinário. Foram utilizados 40 cães clinicamente sadios, sem raça definida, machos ou fêmeas, de diferentes idades. As amostras sanguíneas foram de 2,5ml cada, colhidas por venopunção cefálica e acondicionadas em tubos de centrífuga contendo 0,25ml de citrato de sódio a 3,8%. O plasma foi imediatamente separado por centrifugação e as determinações de TP e TTPa foram realizadas utilizando-se "kits" comerciais "HemoStat Thromboplastin-SIª" e "HemoStat aPTT-El b", respectivamente. Os resultados obtidos foram de 6,87 ± 1,4 segundos para o TP com valores mínimo e máximo de 4,07 e 9,67, respectivamente, e de 15,10 ± 1,6 segundos para TTPa com valores mínimo e máximo de 11,9 e 18,3, respectivamente. Conclui-se, que os valores obtidos neste trabalho podem ser utilizados como referência. Os reagentes utilizados para plasma humano podem ser empregados para o plasma de cães.The coagulation factors are part of normal hemostasis, and both hereditary and acquired coagulopathies that involve this system have an important role in veterinary medicine, generally evidenced by clinical signs such as: petechias, ecchymosis, hematomas and late hemorrhagies. The objective of this experiment was to determine reference range values of prothrombin time (PT and activated partial thromboplastin time (aPTT, for manual methods. Human commercial

  5. Avaliação da determinação do tempo de protrombina em amostras de sangue colhidas por duas diferentes técnicas Evaluation of determination of prothrombin time in blood samples using two different collection techniques

    Directory of Open Access Journals (Sweden)

    Paulo Roberto de Melo Reis

    2005-08-01

    Full Text Available O presente trabalho tem como objetivo avaliar a interferência de diferentes técnicas de coleta sanguínea na determinação do tempo de protrombina. Duas técnicas de coleta foram utilizadas: uma, realizada pelo sistema a vácuo; a outra, realizada mediante aspiração manual com seringa de plástico. Os valores obtidos na determinação do tempo de protrombina provenientes das duas técnicas de coleta foram comparados. Foram analisadas amostras de pacientes que apresentavam tempo de protrombina normais e anormais por estarem em tratamento oral com medicação anticoagulante. A conclusão foi que o processo de coleta utilizando tanto o sistema a vácuo como a aspiração manual com seringa de plástico não interfere no resultado do teste, e os valores obtidos, comparando-se os dois métodos de coleta, não apresentaram diferenças estatisticamente significativas.The objective of the present study is to evaluate the interference of different blood collection techniques in determining prothrombin time. Two collection techniques were used. One of them uses the vacuum system and the other, manual aspiration using plastic syringe. The obtained values of determination of prothrombin time from these two techniques were compared. We analyzed patients’ samples that presented normal and non-normal prothrombin time owing to oral treatment with anticoagulant medication. The conclusion was that the collection processes using either vacuum system or manual aspiration with plastic syringe to obtain samples destined to the prothrombin time analysis do not interfere in the test result and the obtained values. In comparing both collecting techniques we did not find any significant statistical differences.

  6. MASP-1 Induced Clotting--The First Model of Prothrombin Activation by MASP-1.

    Directory of Open Access Journals (Sweden)

    Lorenz Jenny

    Full Text Available Mannan-binding lectin-associated serine protease-1 (MASP-1, a protein of the complement lectin pathway, resembles thrombin in terms of structural features and substrate specificity. Due to its interplay with several coagulation factors, it has the ability to induce fibrin clot formation independent of the usual coagulation activation pathways. We have recently shown that MASP-1 activates prothrombin and identified arginine (R 155, R271, and R393 as potential cleavage sites. FXa cleaves R320 instead of R393, and thrombin cleaves R155 and R284 in prothrombin. Here we have used three arginine-to-glutamine mutants of prothrombin, R271Q, R320Q, R393Q and the serine-to-alanine active site mutant S525A to investigate in detail the mechanism of MASP-1 mediated prothrombin activation. Prothrombin wildtype and mutants were digested with MASP-1 and the cleavage products were analysed by SDS-PAGE and N-terminal sequencing. A functional clotting assay was performed by thrombelastography. We have found that MASP-1 activates prothrombin via two simultaneous pathways, either cleaving at R271 or R393 first. Both pathways result in the formation of several active alternative thrombin species. Functional studies confirmed that both R393 and R320 are required for prothrombin activation by MASP-1, whereas R155 is not considered to be an important cleavage site in this process. In conclusion, we have described for the first time a detailed model of prothrombin activation by MASP-1.

  7. Clinical effectiveness and safety outcomes associated with prothrombin complex concentrates.

    Science.gov (United States)

    Hedges, Ashley; Coons, James C; Saul, Melissa; Smith, Roy E

    2016-07-01

    Prothrombin complex concentrates (PCCs) are indicated for urgent reversal of warfarin and used for reversal of novel oral anticoagulants, in patients with acute major bleeding or need for an urgent procedure. The research goal was to evaluate effectiveness and safety outcomes with PCC usage at our institution. A retrospective review of electronic medical records identified patients that received a PCC commercially available in the United States (KCentra(®) or Profilnine(®)) at twelve hospitals in a tertiary care health system from July 1, 2013 to April 30, 2014. A total of 193 patients received PCC, of which 184 patients received four-factor PCC. The patient population was 48 % male and 75 % Caucasian, with a mean age of 73 years old. Clinical outcomes of interest included time to achieve a target INR ≤1.3, time to Hgb >7 g/dL, and incidence of thromboembolism. A total of 143 patients were on warfarin (74.1 %) at baseline, whereas 18 patients (9.3 %) were taking a novel anticoagulant. Target INR of ≤1.3 was achieved in 125 patients (65.8 %), within a median time of 8.03 h (IQR 3.38-34.07). Among patients with a baseline Hgb 7 g/dL was 8.48 h (IQR 6.95-13.00). Eight patients (4.1 %) developed an acute venous thromboembolism following PCC administration. INR reversal was achieved in approximately two-thirds of patients, with a low incidence of venous thromboembolism. Four-factor PCC is a viable alternative to plasma. PMID:26685667

  8. Emergency time: caring in Congo.

    Science.gov (United States)

    Reading, Claire

    2016-01-01

    Midwifery practice in rural central Africa is full of joys (an abundance of twins, births by candlelight and resilience and stoicism that would leave even the very experienced birth practitioner speechless), but also a lot of challenges (every obstetric emergency in your wildest nightmares and worse) that are compounded by a lack of access to a skilled birth attendant. Women here have a strong culture of traditional practices and remedies, and hospital is often not the first port of call. Caring for women who cannot, themselves, consent to emergency life-saving caesarean sections, is a cultural aspect that we accept and respect as medical professionals working in the Democratic Republic of Congo (DRC). In a busy maternity ward in a low-resource setting, in a hospital supported by emergency humanitarian medical organisation Médecins sans Frontières (MSF), just how are obstetric emergencies managed--and are the outcomes what you would expect? PMID:26975127

  9. Emergency reversal of anticoagulation with a three-factor prothrombin complex concentrate in patients with intracranial haemorrhage

    Science.gov (United States)

    Imberti, Davide; Barillari, Giovanni; Biasioli, Chiara; Bianchi, Marina; Contino, Laura; Duce, Rita; D’Incà, Marco; Gnani, Maria Cristina; Mari, Elisa; Ageno, Walter

    2011-01-01

    Background Intracranial haemorrhage is a serious and potentially fatal complication of oral anticoagulant therapy. Prothrombin complex concentrates can substantially shorten the time needed to reverse the effects of oral anticoagulants. The aim of this study was to determine the efficacy and safety of a prothrombin complex concentrate for rapid reversal of oral anticoagulant therapy in patients with intracranial haemorrhage. Methods Patients receiving oral anticoagulant therapy and suffering from acute intracranial haemorrhage were eligible for this prospective cohort study if their International Normalised Ratio (INR) was higher than or equal to 2.0. The prothrombin complex concentrate was infused at doses of 35–50 IU/kg, stratified according to the initial INR. Results Forty-six patients (25 males; mean age: 75 years; range 38–92 years) were enrolled. The median INR at presentation was 3.5 (range, 2–9). At 30 minutes after administration of the prothrombin complex concentrate, the median INR was 1.3 (range, 0.9–3), and the INR then declined to less than or equal to 1.5 in 75% of patients. The benefit of the prothrombin complex concentrate was maintained for a long time, since the median INR remained lower than or equal to 1.5 (median, 1.16; range, 0.9–2.2) at 96% of all post-infusion time-points up to 96 hours. No thrombotic complications or significant adverse events were observed during hospitalisation; six patients (13%) died, but none of these deaths was judged to be related to administration of the prothrombin complex concentrate. Conclusions Prothrombin complex concentrates are an effective, rapid and safe treatment for the urgent reversal of oral anticoagulation in patients with intracranial haemorrhage. Broader use of prothrombin complex concentrates in this clinical setting appears to be appropriate. PMID:21251465

  10. Synthesis and turnover of prothrombin during experimental inflammation in rats.

    OpenAIRE

    Koj, A; Regoeczi, E.; Chindemi, P A; Gauldie, J.

    1984-01-01

    The response of prothrombin to inflammatory reactions was investigated in rats. Inflammation was induced by the administration of either subcutaneous turpentine or intraperitoneal endotoxin, and its effects were studied 24 h and 48 h later. Albumin and alpha 1-acute-phase globulin served as the controls. There were only insignificant changes in plasma prothrombin concentration during inflammation which contrasts sharply with a decrease in circulating albumin by approximately 25% and an increa...

  11. Direct and indirect nursing care time in an Intensive Care Unit1

    OpenAIRE

    Luciana Emi Kakushi; Yolanda Dora Martinez Évora

    2014-01-01

    OBJECTIVE: to identify the direct and indirect nursing care time in an Intensive Care Unit. METHOD: a descriptive/exploratory study conducted at a private hospital. The Nursing Activities Score classification system was used to estimate the direct care time, and electronic health records were used to estimate the indirect care time. The data were collected from March to June 2011. RESULTS: the findings indicate that the average nursing care time was 29.5 hours, consisting of 27.4 hou...

  12. Impact of infusion speed on the safety and effectiveness of prothrombin complex concentrate

    OpenAIRE

    Pabinger, Ingrid; Tiede, Andreas; Kalina, Uwe; Knaub, Sigurd; Germann, Reinhard; Ostermann, Helmut

    2009-01-01

    Abstract Prothrombin complex concentrate (PCC) infusion is preferred for emergency reversal of coumarin therapy. Rapid infusion can potentially save crucial time; however, the possible impact of high infusion speed on PCC safety and effectiveness has not been delineated. In a prospective multinational clinical trial with 43 patients receiving PCC (Beriplex? P/N) for emergency reversal of coumarin therapy, infusion speeds were selected by the investigators. In a two-phase statistica...

  13. Efeito de alguns curares naturais e da d-Tubocurarina retardando o tempo de coagulação e o tempo de protombina do sangue humano Natural curares and d-Tubocuratine effects on human blood clothing time and prothrombine time

    Directory of Open Access Journals (Sweden)

    João Canali

    1967-01-01

    Full Text Available In this paper the author points out to a old question of about 200 years ago in wich two kinds of opinions were discussed. BANCROFT and FONTANA in one hand atributes for the Indian arrow poison (curare the propriety of uncoagulate the blood, and C. BEBNAHDJ, B. RODRIGUES and others made an contradictory opinion upon this subject. In our experiments, we utilized 4 curares samples from indians who lives near the Brazilian border at Colombia, the famous Ticunas poison, and the alkaloid d-Tubocurarine. These poisons were added in form of emulsion in saline to the blood and blood plasma in order to perform two kinds of experiments. In one serie of experiments we observed the effect of curare on human blood coagulation time according to LEE-WHITE technic puting 0.5 ml of the various poisons emulsions previously into the tube. By this method, we have found that the emulsion containing 0.1 g of the poison in 10 ml saline was the most effective (Table II, therefore we used this curare emulsion concentration in the other serie of experiments, in which we tested the action of these venoms on the human blood plasma prothrombins time, (Quick Technic adding 0.1 ml of the saline poison emulsion to each 0.1 ml of human blood plasma. Results from these experiments can be seen on Table II. These experiments we have tried on one sample of human blood plasma plus the differents curares samples; and in another opportunity four samples of human blood plasma were tried with the curare from Ticunas indians (the most effective in this respect. Results from these experiments may be seen on Table III. All the poison tried in our experiments was previously tested on toads legs (B. crucifer to verify his curares action. All times obtained with the experiments above, show highly significant results (P<001 when compared with the blood and blood plasma mixed with in the same volume of saline. Our results, point out that BANCROFT and FONTANA views upon the effect of curare on

  14. Time in Care for Older People Living in Nursing Homes

    OpenAIRE

    Sivberg, B. V.; L. Fagerström; B. M. Nordström; Thorsell, K. B. E.

    2010-01-01

    In order to measure actual care needs in relation to resources required to fulfill these needs, an instrument (Time in Care) with which to evaluate care needs and determine the time needed for various care activities has been developed with the aim of assessing nursing intensity in municipal care for older people. Interreliability (ICC = 0.854) of time measurements (n = 10'546) of 32 nursing activities in relation to evaluated care levels in two nursing homes (staff n = 81) has been determine...

  15. Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics

    OpenAIRE

    Fermo JD; Whitley HP; Thompson AM; Ragucci KR

    2009-01-01

    Until recently, Prothrombin Time/International Normalized Ratio (PT/INR) measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT) device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory. Objective: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed an...

  16. Blood Coagulation Induced by Iranian Saw-Scaled Viper (Echis Carinatus Venom: Identification, Purification and Characterization of a Prothrombin Activator

    Directory of Open Access Journals (Sweden)

    Mahdi Babaie

    2013-11-01

    Full Text Available   Objective(s: Echis carinatus is one of the venomous snakes in Iran. The venom of Iranian Echis carinatus is a rich source of protein with various factors affecting the plasma protein and blood coagulation factor. Some of these proteins exhibit types of enzymatic activities. However, other items are proteins with no enzymatic activity.   Materials and Methods: In order to study the mechanism and effect of the venom on human plasma proteins, the present study has evaluated the effect of crude venom and all fractions. A procoagulant factor (prothrombin activator was isolated from the venom of the Iranian snake Echis carinatus with a combination of gel filtration (Sephadex G-75, ion-exchange chromatography (DEAE- Sepharose and reverse phase HPLC. Furthermore, proteolytic activity of the crude venom and all fractions on blood coagulation factors such as prothrombin time (PT was studied. Results: In the present study, the PT test was reduced from 13.4 s to 8.6 s when human plasma was treated with crude venom (concentraion of venom was 1 mg/ml. The purified procoagulant factor revealed a single protein band in SDS polyacrylamide electrophoresis under reducing conditions and its molecular weight was estimated at about 65 kDa. A single-band protein showed fragment patterns similar to those generated by the group A prothrombin activators, which convert prothrombin into meizothrombin independent of the prothrombinase complex. Conclusion: This study showed that the fraction which separated from Iranian snake Echis carinatus venom can be a prothrombin activators. It can be concluded that this fraction is a procoagulant factor.

  17. Saline obtaining and time standardization of prothrombin using thromplastine of human placenta. Obtención salina y estandarización del tiempo de protrombina utilizando tromplastina de placenta humana.

    OpenAIRE

    Junior Jáuregui Solís; Deysi González Sarría; Miriam Soto González; Albert Vera Razumova; Pedro Sánchez Frenes; María de Jesús Sánchez Bouza

    2003-01-01

    Background: Determining prothombine ‘s time is an important lab test in the study of coagulation disorders. To develop this essay the main reactive was thrmboplastin , a substance that is presented in tissue and that has been obtained habitually from the human brain or certain animals but its extraction in labs or its commercial acquisition is difficult at present. Objective: To obtain Thromboplastin throughout the extraction of human ...

  18. Saline obtaining and time standardization of prothrombin using thromplastine of human placenta. Obtención salina y estandarización del tiempo de protrombina utilizando tromplastina de placenta humana.

    Directory of Open Access Journals (Sweden)

    Junior Jáuregui Solís

    2003-10-01

    Full Text Available Background: Determining prothombine ‘s time is an important lab test in the study of coagulation disorders. To develop this essay the main reactive was thrmboplastin , a substance that is presented in tissue and that has been obtained habitually from the human brain or certain animals but its extraction in labs or its commercial acquisition is difficult at present. Objective: To obtain Thromboplastin throughout the extraction of human placenta and to standardise the determination of pro-time into the obtained reactive Method: Placenta from normal delivery was used from which thromboplastin was obtained using a saline extraction. The reactive was compared with thromboplastin from human brain from ¨Dr. Hermanos Ameijeiras¨ Hospital in Havana City in a group of patients with and without anticoagulant treatment . With the extracted thromplastin similar or compatible results were obtained than with the habitual reactives by using easier and cheaper process.
    Fundamento: La determinación del tiempo de protrombina es un importante examen complementario en el estudio de los trastornos de la coagulación de la sangre. Para la realización del ensayo, se utiliza como reactivo principal tromboplastina, sustancia que se encuentra en varios tejidos y que habitualmente se ha obtenido de cerebro humano o de ciertos animales, pero su extracción en el laboratorio o su adquisición comercial en estos momentos se dificulta. Objetivos: Obtener tromboplastina a través de la extracción salina de placenta humana y estandarizar la determinación del tiempo de protrombina con el reactivo obtenido. Métodos : Se utilizó placenta de partos normales de la cual se obtuvo la tromboplastina utilizando extracción salina. Se comparó el reactivo con una tromboplastina de cerebro humano del Hospital ¨Hermanos Ameijeiras¨ de Ciudad de La Habana

  19. Time trend in diagnosing dementia in secondary care

    DEFF Research Database (Denmark)

    Phung, Thien Kieu Thi; Waltoft, Berit Lindum; Kessing, Lars Vedel;

    2010-01-01

    To study the trend of diagnosing dementia in the secondary health care sector over time, we conducted a nationwide longitudinal study of the incidence and prevalence of registered dementia diagnoses in the Danish national hospital registers.......To study the trend of diagnosing dementia in the secondary health care sector over time, we conducted a nationwide longitudinal study of the incidence and prevalence of registered dementia diagnoses in the Danish national hospital registers....

  20. Time based management in health care system: The chosen aspects

    OpenAIRE

    Joanna Kobza; Magdalena Syrkiewicz-Świtała

    2014-01-01

    Time-based management (TBM) is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms). Over the past two decades a systematic review of Polish literature (since 1990) and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011) have be...

  1. The linker connecting the two kringles plays a key role in prothrombin activation

    OpenAIRE

    Pozzi, Nicola; Chen, Zhiwei; Pelc, Leslie A.; Shropshire, Daniel B.; Di Cera, Enrico

    2014-01-01

    Deletion of the flexible linker connecting the two kringles of prothrombin reduces the drastic enhancement of thrombin generation by cofactor Va from >3,000-fold observed with wild-type prothrombin to only 60-fold. The change proves that deletion of the linker mimics the effect of cofactor Va on prothrombin activation. The crystal structure of the deletion mutant reveals a contorted conformation where the domains are not vertically stacked, kringle-1 comes close to the protease domain, and th...

  2. Reversibility of Apixaban Anticoagulation with a Four-Factor Prothrombin Complex Concentrate in Healthy Volunteers.

    Science.gov (United States)

    Nagalla, S; Thomson, L; Oppong, Y; Bachman, B; Chervoneva, I; Kraft, W K

    2016-06-01

    It was hypothesized that the four-factor prothrombin complex concentrate (4F-PCC) Kcentra 25 unit/kg would reverse impairment of thrombin generation in healthy volunteers dosed with apixaban to steady state. In this randomized, two-period crossover, assessor-blinded trial, 12 healthy subjects received 5 mg apixaban every 12 h. Three h after the fifth dose, four-factor prothrombin complex concentrate (4F-PCC) 25 unit/kg or saline were infused. Serial blood samples were assessed for thrombin generation using PPP-reagent and PPP-reagent low, anti-Xa, PT, and PTT assays. Geometric mean ratio was calculated at 30 min postinfusion, and at 24, 48, and 72 h. Peak thrombin generation was 76% higher at 30 min postinfusion with 4F-PCC (p = 0.025). The difference declined to 24% at 24 h and resolved by 48 h. Other thrombin generation parameters were also partially normalized. There was no difference between 4F-PCC and saline in anti-Xa assessment at 30 min or later time points. PMID:27170068

  3. Purification and characterization of multisquamase, the prothrombin activator present in Echis multisquamatus venom.

    Science.gov (United States)

    Petrovan, R J; Govers-Riemslag, J W; Nowak, G; Hemker, H C; Rosing, J; Tans, G

    1997-11-01

    The venom of Echis multisquamatus (Central Asian sand viper) contains a single prothrombin activator, designated multisquamase, which is structurally and functionally different from ecarin, the prothrombin activator from the venom of Echis carinatus (saw-scaled viper). Multisquamase is comprised of a 58000 Mr and a 23000 Mr subunit that consists of two disulfide-linked chains of 12000 Mr and 10000 Mr, respectively. In contrast to ecarin, which activates prothrombin and prethrombin 1 at comparable rates, and whose activity is hardly affected by Ca2+ or by changes in ionic strength, multisquamase hardly activates prethrombin 1; prothrombin activation requires Ca2+ and is strongly inhibited at high ionic strength. The most favourable kinetic parameters are observed at 1 mM Ca2+ and at low ionic strength (Km=0.085 microM and kcat=0.68 s(-1) at I approximately 0.04). An increase in ionic strength considerably reduces the rate of prothrombin activation, due to an increase of the Km (Km=0.8 microM and kcat=1.03 s(-1) at I approximately 0.2). Studies in plasmas from patients on oral anticoagulant therapy show that E. Multisquamatus venom only activates carboxylated prothrombin, whereas E. carinatus activates both prothrombin and descarboxyprothrombin. Thus, multisquamase-dependent prothrombin activation appears to require post-translational modification of the gla-domain. This venom prothrombin activator may, therefore, become a useful tool to quantitate prothrombin and descarboxyprothrombin in cases where vitamin K-dependent carboxylation of prothrombin is impaired. PMID:9526951

  4. Productivity in dental care for children. Factors influencing the time spent delivering dental care.

    Science.gov (United States)

    Wang, N J

    1994-12-01

    The cost of dental services is related to their productivity. The purpose of the study was to identify factors influencing productivity, measured as time spent providing dental care per child under care, per year, in public dental clinics. The time was expected to vary with characteristics of the patients, the personnel and the clinics. Time spent by dentists and dental hygienists delivering dental care for children aged three to 18 years was obtained from 137 public dental clinics. The data showed substantial variation in productivity between clinics. Multiple regression analysis revealed that the time spent per child was associated with interval between examinations, proportion of male dentists, ratio of dental assistants to dentists, proportion of child treatment time given by dental hygienists and proportion of all treatment time spent on child patients. These variables explained 43 per cent of the variance in the total time spent by dentists and hygienists and 41 per cent of the variance in dentists' time. Individual dentists and hygienists may reduce the mean time spent per child by extending recall intervals. On an administrative level, dentists' time per child may be reduced by employing more dental assistants or dental hygienists and allowing dentists to treat patient groups other than children. It is concluded that productivity in dental care for children in the public dental services may be influenced in several ways, both by clinical and administrative decisions. PMID:7850642

  5. Waiting Time Policies in the Health Care Sector. What Works?

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Bech, Mickael

    2013-01-01

    times. In addition, a range of other measures may indirectly have affected waiting times, such as a general increase in spending on health care, the general practitioners’ role as gate-keepers, increased use of activity-based hospital reimbursement, increasing use of private heath insurance and private......Waiting times for hospital treatment have been on the political agenda in Denmark for a long time, and various measures have been taken since the 1990s to deal with the problem directly, such as systematic monitoring and reporting, introduction of maximum waiting time guarantee coupled with free...... choice of hospital for somatic and psychiatric patients, short maximum waiting time guarantee for life-threatening diseases coupled with care packages for cancer and heart diseases and extra-activity targeted hospital grants. There are good reasons to believe that these policies have reduced waiting...

  6. Time based management in health care system: The chosen aspects

    Directory of Open Access Journals (Sweden)

    Joanna Kobza

    2014-08-01

    Full Text Available Time-based management (TBM is the key element of the whole management process. For many years in health care systems of highly developed countries modern and effective methods of time-based management have been implemented in both primary health care and hospitals (emergency departments and operating rooms. Over the past two decades a systematic review of Polish literature (since 1990 and peer reviewed articles published in international journals based on PubMed/Medline (2001–2011 have been carried out. The collected results indicate that the demographic and health changes in the populations are one of the main challenges facing general practitioners in the nearest future. Time-based management needs new and effective tools and skills, i.e., identification of priorities, well designed planning, delegation of the tasks, proper coordination, and creation of primary care teams that include additional members and human resources management. Proper reimbursement of health services, development of IT in health care system, better collection, storage, processing, analysis and exchange of information and research findings will also be needed. The use of innovative technologies, like telemedicine consultations, provides the possibility of reducing waiting time for diagnosis and treatment and in some cases could be applied in terms of secondary care. To improve the efficiency of operating rooms it is necessary to introduce different solutions, such as operating room coordinator involvement, application of automation to guide decision-making or use of robotic tools to assist surgical procedures. Overcrowded emergency departments have a major detrimental effect on the quality of hospital functions, therefore, efforts should be made to reduce them. Time-based management training among physicians and health care management in Poland, as well as the implementation of practice-based solutions still applied in highly developed countries seem to be necessary

  7. One-time physical therapist consultation in primary health care.

    NARCIS (Netherlands)

    Hendriks, E.J.M.; Kerssens, J.J.; Dekker, J.; Nelson, R.M.; Oostendorp, R.A.B.; Zee, J. van der

    2003-01-01

    BACKGROUND AND PURPOSE: One-time physical therapist consultation, prior to possible referral for physical therapy intervention, may enhance the quality of patient care, particularly if the referring physician is uncertain as to whether intervention by a physical therapist will be beneficial. The pur

  8. Improving health care means spending more time with patients and less time with inventory.

    Science.gov (United States)

    Nathan, J; Trinkaus, J

    1996-11-01

    In most hospitals and medical establishments, about 35 percent of their budgets are spent on supplies and labor to manage the inventories, material, and information flows; typically, these are managed as multiechelon systems. The importance of reducing inventory costs, among others, has become relevant in today's health care management. This research applies just-in-time concepts to health care inventories. PMID:10162366

  9. Carbohydrate-linked asparagine-101 of prothrombin contains a metal ion protected acetylation site. Acetylation of this site causes loss of metal ion induced protein fluorescence change

    International Nuclear Information System (INIS)

    Prothrombin fragment 1 (prothrombin residues 1-156) contains two acetylation sites that are protected from derivatization by calcium. The first site was protected by only calcium while the second site was protected by magnesium as well. To identify this second acetylation site, fragment 1 was first acetylated with unlabeled reagent in the presence of magnesium. Metal ions were removed, and the protein was acetylated with radiolabeled reagent. The incorporated radiolabel was stable over long periods of time and at acidic or basic pH as long as elevated temperatures were avoided. The radiolabel was removed by treatment of the protein at pH 10 and 50 0C or with 0.2 M hydroxylamine at 50 0C for at least 30 min. Proteolytic degradation of the protein showed that the radioactivity appeared in a tryptic peptide corresponding to residues 94-111 of prothrombin. Amino acid sequence analysis revealed that the radiolabel was associated with an unextracted sequence product. The major radiolabeled product contained Asn101-Ser102 along with the expected chitobiose attached to Asn-101. NMR analysis revealed the presence of three acetate groups which would correspond to two from the chitobiose plus the incorporated acetate residue. Mass spectral analysis showed the correct mass for this glycopeptide plus a single added acetyl group. Amide 1H NMR analysis showed only three amide protons rather than the anticipated four. On the basis of these several observations, it is postulated that the site of acetylation is the β-amide nitrogen of Asn-101. Consequently, these studies showed an unusual chemical reactivity in prothrombin fragment 1. They further show that metal ion binding to prothrombin fragment 1 and subsequent protein fluorescence quenching involve sites ion the kringle region of the protein

  10. Lack of association between the prothrombin rs1799963 polymorphism and juvenile myoclonic epilepsy

    Directory of Open Access Journals (Sweden)

    João Paulo Lopes Born

    2015-04-01

    Full Text Available Juvenile myoclonic epilepsy (JME accounts for 26% of generalized idiopathic epileptic syndromes. The highest levels of thrombin activity are closely involved in the development of neurological diseases, including epilepsy. The prothrombin c.20210G>A (rs1799963 variation, which alters prothrombin mRNA stability, is associated with high plasma prothrombin levels. Objective : The present study was designed to investigate whether the SNP rs1799963 is a risk factor for JME in the northeastern Brazilian population. Results : The polymorphism was genotyped in 207 controls and 123 patients using polymerase chain reaction-restriction fragment length polymorphism method. No significant differences were observed in the genotype and allele frequencies of this polymorphism between cases and controls. Conclusion : These results present no evidence for an association of rs1799963 with JME. Further studies including other types of epilepsy are required to investigate the involvement of prothrombin gene in the genetic susceptibility to chronic seizure.

  11. Impact of collaborative care on survival time for dogs with congestive heart failure and revenue for attending primary care veterinarians.

    Science.gov (United States)

    Lefbom, Bonnie K; Peckens, Neal K

    2016-07-01

    OBJECTIVE To assess the effects of in-person collaborative care by primary care veterinarians (pcDVMs) and board-certified veterinary cardiologists (BCVCs) on survival time of dogs after onset of congestive heart failure (CHF) and on associated revenue for the attending pcDVMs. DESIGN Retrospective cohort study. ANIMALS 26 small-breed dogs treated for naturally occurring CHF secondary to myxomatous mitral valve disease at a multilocation primary care veterinary hospital between 2008 and 2013. PROCEDURES Electronic medical records were reviewed to identify dogs with confirmed CHF secondary to myxomatous mitral valve disease and collect information on patient care, survival time, and pcDVM revenue. Data were compared between dogs that received collaborative care from the pcDVM and a BCVC and dogs that received care from the pcDVM alone. RESULTS Dogs that received collaborative care had a longer median survival time (254 days) than did dogs that received care from the pcDVM alone (146 days). A significant positive correlation was identified between pcDVM revenue and survival time for dogs that received collaborative care (ie, the longer the dog survived, the greater the pcDVM revenue generated from caring for that patient). CONCLUSIONS AND CLINICAL RELEVANCE Findings suggested that collaborative care provided to small-breed dogs with CHF by a BCVC and pcDVM could result in survival benefits for affected dogs and increased revenue for pcDVMs, compared with care provided by a pcDVM alone. PMID:27308884

  12. Prevalence of factor Ⅴ Leiden and prothrombin G20210A in patients with gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Sandra Battistelli; Massimo Stefanoni; Alberto Genovese; Aurelio Vittoria; Roberto Cappelli; Franco Roviello

    2006-01-01

    AIM: To analyze the prevalence of the two commonest thrombophilic mutations, factor Ⅴ Leiden and prothrombin G20210A, in patients with gastric cancer.METHODS: One hundred and twenty-one patients with primary gastric carcinoma and 130 healthy subjects,comparable for age and sex, were investigated. Factor Ⅴ Leiden was detected by using polymerase chain reaction and restriction enzyme digestion, and prothrombin G20210A gene mutation by allele-specific PCR.RESULTS: Among the 121 cancer patients, factor Ⅴ Leiden was found in 4 cases (GA genotype: 3.3%) and prothrombin G20210A in 10 cases (GA genotype: 8.3%).Of the 130 control subjects, factor Ⅴ Leiden was detected in 6 cases (GA genotype: 4.6%) and prothrombin G20210A in 8 cases (GA genotype: 6.1%). No double heterozygous carriers of both mutations were found in either group. The prevalence of both factor Ⅴ Leiden and prothrombin G20210A variant was not statistically different between the cancer patients and the healthy subjects.CONCLUSION: Our study suggests that, in gastric cancer, the risk factors of thrombophilic cancer state are on acquired rather than on a genetic basis and that prothrombin G20210A does not seem to be a cofactor in gastric cancer pathogenesis.

  13. Is There Time Enough? Temporal Resources and Service Performance in the Danish Home Care Sector

    DEFF Research Database (Denmark)

    Tufte, Pernille

    2013-01-01

    scarcity in the daily work performance, care workers relate the issue of time to a more fundamental discussion of what the performance of care does and should entail. The purpose of the article is to examine care workers’ perceptions of the temporal conditions of care work, investigating how time pressure...... performance of care work. Care workers do, however, not accept this notion. Relying on their experience of work, they perceive additional services as an ambiguous concept, which recognizes the multiple character of care work. Conclusions are that time scarcity constitutes a pressure on work performance as a...

  14. 4-Factor Prothrombin Complex Concentrate (PCC4, Kcentra®) Protocol Reduces Blood Requirements for Heart Transplantation: A Novel Protocol.

    Science.gov (United States)

    Pratt Cleary, Jacqueline; Hodge, Laura; Palmer, Brittany; Barreiro, Christopher J; Ingemi, Amanda

    2016-01-01

    BACKGROUND All patients with a ventricular assist device (VAD) awaiting heart transplantation are anticoagulated with warfarin to prevent thromboembolism. The use of 4 factor prothrombin complex concentrate (PCC4, Kcentra®) for anticoagulation reversal prior to surgery may include benefits such as quicker reversal, longer duration of action, and a reduction in total volume of blood products used compared to other reversal practices. The study objective is to evaluate benefits of using an anticoagulation reversal protocol featuring PCC4, over standard of care in heart transplant patients requiring anticoagulation. MATERIAL AND METHODS This is a single center, combined retrospective and prospective, time-matched cohort study compared 12 patients transplanted pre-protocol and 11 patients transplanted post-protocol. The primary outcome was the total volume of blood and blood products used. Secondary outcomes included length of hospital and ICU stay, safety and adverse events, primary chest closure, and a cost comparison. RESULTS The PCC4 reversal protocol showed a significant reduction in total blood volume received with an overall decrease of 1.76L (4.20L pre-protocol, 2.45L post-protocol, P=0.037), total units of blood products infused (20 units pre, 12 units post, P=0.033), and units of packed red blood cells (7 units pre, 3 units post, P=0.033). All heart transplant recipients were listed Status 1A with the primary indication being infection (n=12; 52%). Baseline characteristics, survival, and cost were not different between the two groups. There were no thrombotic events or patient that experienced serious reactions to PCC4. Secondary outcomes were only significant to time to INR reversal. CONCLUSIONS Patients treated with the PCC4 protocol demonstrated a significant decrease in volume of blood and units of blood products required prior to chest closure for heart transplant patients. PCC4 was found to be a safe and beneficial agent in anticoagulation reversal for

  15. eHealth and quality in health care: implementation time.

    Science.gov (United States)

    Ossebaard, Hans C; Van Gemert-Pijnen, Lisette

    2016-06-01

    The use of information and communication technologies in health and health care could improve healthcare quality in many ways. Today's evidence base demonstrates the (cost-)effectiveness of online education, self-management support and tele-monitoring in several domains of health and care. While new results gradually provide more evidence for eHealth's impact on quality issues, now is the time to come to grips with implementation issues. Documented drawbacks such as low acceptance, low adoption or low adherence need our attention today to make the most of eHealth' potential. Improvement science is beginning to deliver the tools to address these persistent behavioural and cultural issues. The ceHRes Roadmap, for instance, is a plural and pragmatic approach that includes users' needs. It is now imperative to improve our implementation strategies in order to scale up eHealth technologies. This will accelerate the much needed transformation of our healthcare systems and sustain access, affordability and quality for all in the near future. PMID:27029590

  16. Prothrombin Gene G20210A Mutation in Acute Deep Venous Thrombosis Patients with Poor Response to Warfarin Therapy

    OpenAIRE

    Attia, F.M; Mikhailidis, D. P.; Reffat, S.A

    2009-01-01

    Aim: The pathogenesis of deep venous thrombosis (DVT) involves an interaction between hereditary and acquired factors. Prothrombin gene mutation is one of the hereditary risk factors. We evaluated the frequency of the prothrombin gene mutation in patients with DVT and its relation to oral warfarin anticoagulant therapy response. Methods: Prothrombin gene mutation was looked for in 40 DVT patients with poor response to warfarin. The results were compared with 40 DVT patients with a normal resp...

  17. Antibodies Against Annexin V and Prothrombin, Their Correlation with Other Anti-phospholipid Antibodies in Recurrent Pregnancy Loss

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Objective To study the findings of serum antibodies against annexin V, prothrombin,ph-inositol, ph-acid, ph-ethanolamine, ph-serine, ph-glycerol, cardiolipin, and beta2-glycoprotein I and analyze the trophoblast annexin V receptorsMethods Sera from 156 patients aged 26-41 years with recurrent pregnancy loss (3-7 times) were investigated. Eighty-four fertile healthy women aged 24-38 years were included in a control group. ELISA methods were used for detecting a panel of sera anti-phospholipid antibodies. Immunolocalization of annexin Vreceptors in 143trophoblast specimens of 156patients was investigated by the immunofluorescence technique using Annexin V-FITC, Apoptosis and Annexin V-CY3 commercial kits.Results Positivity for anti-phospholipid antibodies mainly against ph-serine, phethanolamine, and ph-inositol was found together in 80. 8% (126 out of 156 patients),anti-prothrombin antibodies in 12% (18), and anti-annexin Vantibodies in 13. 5%(21) women. No significant levels of anti-phospholipid antibodies were found in 6controls. Placenta immunohistopathology also exhibited some changes manifested by the presence of apoptotic and necrotic cells in trophoblast, and very few microthrombotization in some intervillous spaces.Conclusion Our detailed study demonstrated the prevalence of majority of antiphospholipid antibodies as a high risk factor for repeated reproductive failure. Very low microthrombosis in placentas could be explained by the changes of haemocoagulation properties out of uterus.

  18. Nursing and en route care: history in time of war.

    Science.gov (United States)

    Davis, R Scott; Connelly, Linda K

    2011-01-01

    The mission of the en route caregiver is to provide critical care in military helicopters for wounded Warriors. This care minimizes the effects of the wounds and injuries, and improves morbidity and mortality. This article will focus on the history of Army Nursing en route care. From World War II through Vietnam, and continuing through the War on Terrorism in Iraq and Afghanistan, Army nurses served in providing en route care in military airplanes and helicopters for patients being transported to higher echelons of care. From aid stations on the battlefield to forward surgical teams which provide life, limb, and eyesight saving care, to the next higher level of care in combat support hospitals, these missions require specialized nursing skills to safely care for the high acuity patients. Before the en route care concept existed, there was not a program to train nurses in these critical skills. There was also a void of information about patient outcomes associated with the nursing assessment and care provided during helicopter medical evacuation (MEDEVAC) of such unstable patients, and the consequent impact on the patient's condition after transport. The role of critical care nurses has proven to be essential and irreplaceable in providing full-spectrum care to casualties of war, in particular, the postsurgical patients transferred from one surgical facility to another in theatre. However, we have only recently developed the concepts over the required skill set, training, equipment, functionality, evidenced-based care, and sustainability of nursing in the en route care role. Much of the work to quantify and qualify nursing care has been done by individuals and individual units whose lessons-learned have only recently been captured. PMID:22124872

  19. Increased fibrosis progression rates in hepatitis C patients carrying the prothrombin G20210A mutation

    Institute of Scientific and Technical Information of China (English)

    Nitsan Maharshak; Ran Oren; Philippe Halfon; Varda Deutsch; Hava Peretz; Shlomo Berliner; Sigal Fishman; Shira Zelber-Sagi; Uri Rozovski; Moshe Leshno

    2011-01-01

    AIM: To examine whether hepatitis C virus (HCV)-infected patients who carry hypercoagulable mutations suffer from increased rates of liver fibrosis. METHODS: We analyzed DNA samples of 168 HCV patients for three common hypercoagulable gene mutations: prothrombin 20210 (PT20210), factor V Leiden (FV Leiden) and methylene tetrahydrofolate reductase (MTHFR). The patients were consecutively recruited as part of the prospective "Fibroscore Study" in France. The effect of the various mutations on the rate of fibrosis was analyzed statistically and was correlated with epidemiological, clinical and biochemical data such as grade and stage of liver biopsies, patients' risk factors for liver cirrhosis, and timing of infection.RESULTS: Fifty two of the patients were categorized as "fast fibrosers" and 116 as "slow fibrosers"; 13% of the "fast fibrosers" carried the PT20210 mutation as compared with 5.5% of the "slow fibrosers", with an odds ratio of 4.76 (P = 0.033; 95% CI: 1.13-19.99) for "fast" liver fibrosis. Carriage of MTHFR or FV Leiden mutations was not associated with enhanced liver fibrosis. CONCLUSION: Carriage of the PT20210 mutation is related to an increased rate of liver fibrosis in HCV patients.

  20. Time Spent in Face-to-Face Patient Care and Work Outside the Examination Room

    OpenAIRE

    Gottschalk, Andrew; Flocke, Susan A.

    2005-01-01

    PURPOSE Contrary to physicians’ concerns that face-to-face patient time is decreasing, data from the National Ambulatory Medical Care Survey (NAMCS) indicate that between 1988 and 1998, durations of primary care outpatient visits have increased. This study documented how physicians spend time during the workday, including time outside the examination room, and compared observed face-to-face patient care time with that reported in NAMCS.

  1. Is This Time Different? The Slowdown in Health Care Spending

    OpenAIRE

    Chandra, Amitabh; Holmes, Jonathan; Skinner, Jonathan

    2013-01-01

    Why have health care costs moderated in the last decade? Some have suggested that the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) take credit, since the slowdown began prior to its implementation. Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, an...

  2. Regulated Cleavage of Prothrombin by Prothrombinase: REPOSITIONING A CLEAVAGE SITE REVEALS THE UNIQUE KINETIC BEHAVIOR OF THE ACTION OF PROTHROMBINASE ON ITS COMPOUND SUBSTRATE*♦

    OpenAIRE

    Bradford, Harlan N.; Micucci, Joseph A.; Krishnaswamy, Sriram

    2009-01-01

    Prothrombinase converts prothrombin to thrombin via cleavage at Arg320 followed by cleavage at Arg271. Exosite-dependent binding of prothrombin to prothrombinase facilitates active site docking by Arg320 and initial cleavage at this site. Precise positioning of the Arg320 site for cleavage is implied by essentially normal cleavage at Arg320 in recombinant prothrombin variants...

  3. Is This Time Different? The Slowdown in Health Care Spending.

    Science.gov (United States)

    Chandra, Amitabh; Holmes, Jonathan; Skinner, Jonathan

    2013-01-01

    Why have health care costs moderated in the last decade? Some have suggested that the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) take credit, since the slowdown began prior to its implementation. Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly for use by the Medicare population. A more difficult question is: Will this slowdown continue? On this question we are pessimistic, and not entirely because a similar (and temporary) slowdown occurred in the early 1990s. The primary determinant of long-term growth is the continued development of expensive technology, and there is little evidence of a permanent slowdown in that pipeline. Proton beam accelerators are on target to double between 2010 and 2014, while the market for heart-assist devices (costing more than $300,000 each) is projected to grow rapidly. Accountable care organizations (ACOs) and emboldened insurance companies may yet stifle health care cost growth, but our best estimate over the next two decades is that health care costs will grow at GDP plus 1.2 percent, a rate lower than previous estimates but still on track to cause serious fiscal pain for taxpayers and workers who bear the costs of higher premiums. PMID:25418992

  4. Wait Times for Sleep Apnea Care in Ontario: A Multidisciplinary Assessment

    OpenAIRE

    Rotenberg, Brian W; George, Charles F.; Sullivan, Kevin M; Eric Wong

    2010-01-01

    BACKGROUND: Obstructive sleep apnea (OSA) is a highly prevalent disorder that is associated with significant patient morbidity and societal burden. In general, wait times for health care in Ontario are believed to be lengthy; however, many diseases lack specific corroborative wait time data.OBJECTIVE: To characterize wait times for OSA care in Ontario.METHODS: Cross-sectional survey. A survey tool was designed and validated to question physicians involved in OSA care about the length of the w...

  5. A simple method to discriminate between beta(2)-glycoprotein I- and prothrombin-dependent lupus anticoagulants

    NARCIS (Netherlands)

    Simmelink, MJA; Derksen, RHWM; Arnout, J; De Groot, PG

    2003-01-01

    Lupus anticoagulants (LAC) are a heterogeneous group of autoantibodies that prolong phospholipid-dependent clotting assays. The autoantibodies that cause LAC activity are predominantly directed against beta(2)-glycoprotein I (beta(2)GPI) or prothrombin. In the present study, we describe a method to

  6. Providing care to children in times of war.

    Science.gov (United States)

    Cole, Will; Edwards, Mary J; Burnett, Mark W

    2015-06-01

    The Geneva Conventions stipulate that an occupying power must ensure adequate health care delivery to noncombatants. Special emphasis is given to children, who are among the most vulnerable in a conflict zone. Whether short-term pediatric care should be provided by Military Treatment Facilities to local nationals for conditions other than combat-related injury is controversial. A review of 1,197 children without traumatic injury cared for during 10 years in Iraq and Afghanistan was conducted. Mortality rates were less than 1% among patients with surgical conditions and resource utilization was not excessive. In view of international humanitarian law and these outcomes, children with nontraumatic conditions can and should be considered for treatment at Military Treatment Facilities. The ability to correct the condition and availability of resources necessary to do so should be taken into account. PMID:26032375

  7. Is Part-Time Child Care Surrogate Parenting? Parents' Perceptions.

    Science.gov (United States)

    Rana, Avis

    The purpose of this survey and report is to gain information about parental planning for child-rearing when the mother is employed. This study is intended to explore mothers' perceptions of possible delegation of some basic child-rearing functions during the mothers' absence for employment. Comparison of the child care arrangements which the…

  8. Limiting prothrombin activation to meizothrombin is compatible with survival but significantly alters hemostasis in mice.

    Science.gov (United States)

    Shaw, Maureen A; Kombrinck, Keith W; McElhinney, Kathryn E; Sweet, David R; Flick, Matthew J; Palumbo, Joseph S; Cheng, Mei; Esmon, Naomi L; Esmon, Charles T; Brill, Alexander; Wagner, Denisa D; Degen, Jay L; Mullins, Eric S

    2016-08-01

    Thrombin-mediated proteolysis is central to hemostatic function but also plays a prominent role in multiple disease processes. The proteolytic conversion of fII to α-thrombin (fIIa) by the prothrombinase complex occurs through 2 parallel pathways: (1) the inactive intermediate, prethrombin; or (2) the proteolytically active intermediate, meizothrombin (fIIa(MZ)). FIIa(MZ) has distinct catalytic properties relative to fIIa, including diminished fibrinogen cleavage and increased protein C activation. Thus, fII activation may differentially influence hemostasis and disease depending on the pathway of activation. To determine the in vivo physiologic and pathologic consequences of restricting thrombin generation to fIIa(MZ), mutations were introduced into the endogenous fII gene, resulting in expression of prothrombin carrying 3 amino acid substitutions (R157A, R268A, and K281A) to limit activation events to yield only fIIa(MZ) Homozygous fII(MZ) mice are viable, express fII levels comparable with fII(WT) mice, and have reproductive success. Although in vitro studies revealed delayed generation of fIIa(MZ) enzyme activity, platelet aggregation by fII(MZ) is similar to fII(WT) Consistent with prior analyses of human fIIa(MZ), significant prolongation of clotting times was observed for fII(MZ) plasma. Adult fII(MZ) animals displayed significantly compromised hemostasis in tail bleeding assays, but did not demonstrate overt bleeding. More notably, fII(MZ) mice had 2 significant phenotypic advantages over fII(WT) animals: protection from occlusive thrombosis after arterial injury and markedly diminished metastatic potential in a setting of experimental tumor metastasis to the lung. Thus, these novel animals will provide a valuable tool to assess the role of both fIIa and fIIa(MZ) in vivo. PMID:27252233

  9. Avaliação de fibrinogênio, tempo de tromboplastina parcial e tempo de protrombina em pacientes com infarto agudo do miocárdio Evaluation of fibrinogen, activated partial thromboplastin time and prothrombin time in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Marinês Lavall Dias

    2007-04-01

    during the acute phase of AMI were related to cardiovascular death or a new AMI event. This incidence was higher in the age range of 44 to 75 years in men, and 56 to 90 in women. Approximately 73% of patients presented family history of coronary heart disease (CHD, 66% were smokers, 63% presented hypertension and most of them were sedentary. Increased incidence of AMI in extreme temperatures was also observed. For fibrinogen concentrations (Fbr, results demonstrated significant difference (p < 0.05 between control and AMI patients. Considering troponin (TROP, creatine kinase (CK, the MB fraction of creatine kinase (CK-MB and leukocytes count, results showed statistically significant differences. However, partial thromboplastin time activated (PTAT, total cholesterol (TC, high-density lipoprotein (HDL, low-density lipoprotein (LDL, and triglyceride levels presented no significant difference between the studied groups. In conclusion, this work demonstrated a trend towards increasing fibrinogen concentration in patients with AMI, revealing that it may be considered one of the cardiac markers for AMI.

  10. How much time is available for antenatal care consultations? Assessment of the quality of care in rural Tanzania

    Directory of Open Access Journals (Sweden)

    Cousens Simon

    2011-09-01

    Full Text Available Abstract Background Many women in Sub-Saharan African countries do not receive key recommended interventions during routine antenatal care (ANC including information on pregnancy, related complications, and importance of skilled delivery attendance. We undertook a process evaluation of a successful cluster randomized trial testing the effectiveness of birth plans in increasing utilization of skilled delivery and postnatal care in Ngorongoro district, rural Tanzania, to document the time spent by health care providers on providing the recommended components of ANC. Methods The study was conducted in 16 health units (eight units in each arm of the trial. We observed, timed, and audio-recorded ANC consultations to assess the total time providers spent with each woman and the time spent for the delivery of each component of care. T-test statistics were used to compare the total time and time spent for the various components of ANC in the two arms of the trial. We also identified the topics discussed during the counselling and health education sessions, and examined the quality of the provider-woman interaction. Results The mean total duration for initial ANC consultations was 40.1 minutes (range 33-47 in the intervention arm versus 19.9 (range 12-32 in the control arm p Conclusion Although the implementation of birth plans in the intervention health units improved provider-women dialogue on skilled delivery attendance, most recommended topics critical to improving maternal and newborn survival were rarely covered.

  11. Rivaroxaban and Hemostasis in Emergency Care

    Directory of Open Access Journals (Sweden)

    Jürgen Koscielny

    2014-01-01

    Full Text Available Rivaroxaban is an oral, direct Factor Xa inhibitor, approved for the prevention and treatment of several thromboembolic disorders. Rivaroxaban does not require routine coagulation monitoring and has a short half-life. However, confirmation of rivaroxaban levels may be required in circumstances such as life-threatening bleeding or perioperative management. Here, we explore the management strategies in patients receiving rivaroxaban who have a bleeding emergency or require emergency surgery. Rivaroxaban plasma concentrations can be assessed quantitatively using anti-Factor Xa chromogenic assays, or qualitatively using prothrombin time assays (using rivaroxaban-sensitive reagents. In patients receiving long-term rivaroxaban therapy who require elective surgery, discontinuation of rivaroxaban 20–30 hours beforehand is normally sufficient to minimize bleeding risk. For emergency surgery, we advise against prophylactic use of hemostatic blood products, even with high rivaroxaban concentrations. Temporary rivaroxaban discontinuation is recommended if minor bleeding occurs; for severe bleeding, rivaroxaban withdrawal may be necessary, along with compression or appropriate surgical treatment. Supportive measures such as blood product administration might be beneficial. Life-threatening bleeding demands comprehensive hemostasis management, including potential use of agents such as prothrombin complex concentrate. Patients taking rivaroxaban who require emergency care for bleeding or surgery can be managed using established protocols and individualized assessment.

  12. The Effects of Alcohol Policies in Reducing Entry Rates and Time Spent in Foster Care

    OpenAIRE

    Sara Markowitz; Alison Evans Cuellar; Conrad, Ryan M.; Michael Grossman

    2011-01-01

    The purpose of this paper is to empirically estimate the propensity for alcohol-related policies to influence rates of entry into foster care and the length of time spent in foster care. Alcohol consumption is believed to be major contributing factor to child maltreatment, associated with an increased likelihood of abuse and longer durations once in foster care. We analyze a panel of state-level foster care entry rates over time, followed by a duration analysis of individual-level cases. The ...

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

    Directory of Open Access Journals (Sweden)

    Tara Sampalli

    2015-07-01

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

  14. Ratcheting of the substrate from the zymogen to proteinase conformations directs the sequential cleavage of prothrombin by prothrombinase

    OpenAIRE

    Bianchini, Elsa P.; Orcutt, Steven J.; Panizzi, Peter; Bock, Paul E.; Krishnaswamy, Sriram

    2005-01-01

    Prothrombinase catalyzes thrombin formation by the ordered cleavage of two peptide bonds in prothrombin. Although these bonds are likely ≈36 Å apart, sequential cleavage of prothrombin at Arg-320 to produce meizothrombin, followed by its cleavage at Arg-271, are both accomplished by equivalent exosite interactions that tether each substrate to the enzyme and facilitate presentation of the scissile bond to the active site of the catalyst. We show that impairing the conformational transition fr...

  15. Restricted Active Site Docking by Enzyme-bound Substrate Enforces the Ordered Cleavage of Prothrombin by Prothrombinase*

    OpenAIRE

    Hacisalihoglu, Ayse; Panizzi, Peter; Bock, Paul E.; Camire, Rodney M.; Krishnaswamy, Sriram

    2007-01-01

    The preferred pathway for prothrombin activation by prothrombinase involves initial cleavage at Arg320 to produce meizothrombin, which is then cleaved at Arg271 to liberate thrombin. Exosite binding drives substrate affinity and is independent of the bond being cleaved. The pathway for cleavage is determined by large differences in Vmax for cleavage at the two sites within intact prothrombin. By fluorescence binding studies in the absence of catalysis, we have assessed the ability of the indi...

  16. Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding

    OpenAIRE

    Schick, Kerstin S.; Fertmann, Jan M; Jauch, Karl-Walter; Hoffmann, Johannes N

    2009-01-01

    Introduction Prothrombin complex concentrates are recommended for rapid reversal of vitamin K anticoagulants. As they normalize levels of vitamin K dependent clotting factors and re-establish hemostasis, they may also be used as adjunctive therapy in patients with major bleeding. The aim of this study was to retrospectively evaluate the efficacy of prothrombin complex concentrates in the surgical setting. Methods The case notes of 50 patients requiring urgent oral anticoagulation reversal (n ...

  17. Purification and characterization of a prothrombin-activating protease from Nephila clavata.

    Science.gov (United States)

    Joo, Han-Seung; Park, Gun-Chun; Cho, Woo Ri; Tak, Eunsik; Paik, Seung R; Chang, Chung-Soon

    2002-03-01

    We report upon the purification and characterization of a novel prothrombin-activating enzyme from the body fluid (total homogenates of isolated digestive tract without eggs, spinnerets and silk glands) of the spider, Nephila clavata by a combination of acetone fractionation, ion exchange, and Soybean trypsin inhibitor-Sepharose chromatography. Analysis of the purified enzyme with SDS-PAGE and gel filtration revealed a single polypeptide chain with an apparent molecular weight of 24kDa. The proteolytic activity of the enzyme was stable up to 50 degrees C, however, it became unstable over 55 degrees C. The enzyme had an optimum pH of 8, and Ca(2+) was not required for the enzyme activity. According to inhibition profiles obtained with several serine protease inhibitors such as PMSF and benzamidine, the purified protease is a member of the serine proteases. Bz-Ile-Glu(gamma-OR)- Gly-Arg-pNA and Z-Arg-Gly-Arg-pNA which are known as substrates for factor Xa, were hydrolyzed favorably by the enzyme. And the Nephila protease could produce thrombin from prothrombin at nM range, and form the turbid ring using fibrinogen-agarose plate. The results obtained confirmed that the purified protease is a potent prothrombin-activating activity belonging to the family of serine protease. PMID:11711126

  18. Increased prothrombin, apolipoprotein A-IV, and haptoglobin in the cerebrospinal fluid of patients with Huntington's disease.

    Directory of Open Access Journals (Sweden)

    Yen-Chu Huang

    Full Text Available Huntington's disease (HD is a progressive neurodegenerative disease caused by an unstable CAG trinucleotide repeat expansion. The need for biomarkers of onset and progression in HD is imperative, since currently reliable outcome measures are lacking. We used two-dimensional electrophoresis and mass spectrometry to analyze the proteome profiles in cerebrospinal fluid (CSF of 6 pairs of HD patients and controls. Prothrombin, apolipoprotein A-IV (Apo A-IV and haptoglobin were elevated in CSF of the HD patients in comparison with the controls. We used western blot as a semi-quantified measurement for prothrombin and Apo A-IV, as well as enzyme linked immunosorbent assay (ELISA for measurement of haptoglobin, in 9 HD patients and 9 controls. The albumin quotient (Qalb, a marker of blood-brain barrier (BBB function, was not different between the HD patients and the controls. The ratios of CSF prothrombin/albumin (prothrombin/Alb and Apo A-IV/albumin (Apo A-IV/Alb, and haptoglobin level were significantly elevated in HD. The ratio of CSF prothrombin/Alb significantly correlated with the disease severity assessed by Unified Huntington's Disease Rating Scale (UHDRS. The results implicate that increased CSF prothrombin, Apo A-IV, and haptoglobin may be involved in pathogenesis of HD and may serve as potential biomarkers for HD.

  19. Time telling devices used in Danish health care are not synchronized

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Hosbond, Susanne; Petersen, Dan Brun;

    2012-01-01

    Many patients begin their encounter with the health-care services in an ambulance. In some critical patients, it is pivotal that the timing of treatment and events is registered correctly. When patients are transferred from one health care provider to another, there is a risk that the time tellin...... devices used are not synchronized. It has never been examined if this is a problem in Denmark. We performed the present study to examine if time telling devices used in the pre-hospital setting were synchronized with devices used in emergency departments.......Many patients begin their encounter with the health-care services in an ambulance. In some critical patients, it is pivotal that the timing of treatment and events is registered correctly. When patients are transferred from one health care provider to another, there is a risk that the time telling...

  20. Across-province standardization and comparative analysis of time-to-care intervals for cancer

    Directory of Open Access Journals (Sweden)

    Nugent Zoann

    2007-10-01

    Full Text Available Abstract Background A set of consistent, standardized definitions of intervals and populations on which to report across provinces is needed to inform the Provincial/Territorial Deputy Ministries of Health on progress of the Ten-Year Plan to Strengthen Health Care. The objectives of this project were to: 1 identify a set of criteria and variables needed to create comparable measures of important time-to-cancer-care intervals that could be applied across provinces and 2 use the measures to compare time-to-care across participating provinces for lung and colorectal cancer patients diagnosed in 2004. Methods A broad-based group of stakeholders from each of the three participating cancer agencies was assembled to identify criteria for time-to-care intervals to standardize, evaluate possible intervals and their corresponding start and end time points, and finalize the selection of intervals to pursue. Inclusion/exclusion criteria were identified for the patient population and the selected time points to reduce potential selection bias. The provincial 2004 colorectal and lung cancer data were used to illustrate across-province comparisons for the selected time-to-care intervals. Results Criteria identified as critical for time-to-care intervals and corresponding start and end points were: 1 relevant to patients, 2 relevant to clinical care, 3 unequivocally defined, and 4 currently captured consistently across cancer agencies. Time from diagnosis to first radiation or chemotherapy treatment and the smaller components, time from diagnosis to first consult with an oncologist and time from first consult to first radiation or chemotherapy treatment, were the only intervals that met all four criteria. Timeliness of care for the intervals evaluated was similar between the provinces for lung cancer patients but significant differences were found for colorectal cancer patients. Conclusion We identified criteria important for selecting time-to-care intervals

  1. 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

  2. Care package for anxiety disorders: no-show and dropout of standardised, time restricted treatment

    DEFF Research Database (Denmark)

    Tranberg, Hanne; Mortensen, Erik Lykke; Lau, Marianne Engelbrecht

    Background: Psychotherapy has shown to be efficacious but therapy effectiveness in mental health services is compromised by patients who fail to show up for assessment, treatment start and stay in treatment. Predictors for patient non-attendance (no-show and dropout) have been identified as patient...... or therapist characteristics. Organisational variables are sparsely studied although waiting time may affect no-show and dropout. In order to reduce waiting time the Mental Health Services in Denmark have introduced care packages in the treatment of non-psychotic disorders. Care packages are courses...... of treatment characterised by standardisation, time restriction and pre-coordination. Currently, the impact of care packages on patient non-attendance remains unknown. Objectives: The aim was to study the influence of care packages treatment organisation on non-attendance for treatment for anxiety disorders...

  3. A Study of Anti Beta-2 Glycoprotein I and Anti-Prothrombin Antibodies in Patients with Unexplained Recurrent Pregnancy Losses.

    Science.gov (United States)

    Singh, Angad; Nangia, Anita; Sharma, Sunita; Puri, Manju

    2016-06-01

    To compare the levels of IgG and IgM anti beta-2 glycoprotein I antibodies and IgG and IgM anti prothrombin antibodies among women with unexplained recurrent pregnancy losses and women with at least 2 live issues. To compare the prevalence of newer anti beta-2 glycoprotein I & anti prothrombin antibodies with conventional Lupus anticoagulant & anticardiolipin antibodies. 50 women with recurrent pregnancy losses & 50 matched controls were evaluated for the presence of: Lupus anticoagulant-screened by LA sensitive aPTT& DRVV and confirmatory Staclot Assay. ELISA kits were used for detecting IgG & IgM anticardiolipin, anti beta-2 glycoprotein I & anti prothrombin antibodies. 11/50 (22 %) women in study group and none in control group had circulating antiphospholipid antibodies. 2 cases (4 %) had lupus anticoagulant. 1 case (2 %) had anticardiolipin antibody & 6 cases (12 %) were positive for anti beta-2 Glycoprotein I antibody (p value = 0.027). 3 cases (6 %) had anti prothrombin antibody. All were mutually exclusive except for one. Women with recurrent pregnancy losses should be tested for anti beta-2 Glycoprotein I antibodies & anti prothrombin antibodies in addition to conventional lupus anticoagulant and anticardiolipin antibodies. This approach can decrease the incidence of SNAP (seronegative antiphospholipid syndrome) cases while establishing the true prevalence of antiphospholipid syndrome. PMID:27065583

  4. Prothrombin kringle-2 domain has a growth inhibitory activity against basic fibroblast growth factor-stimulated capillary endothelial cells.

    Science.gov (United States)

    Lee, T H; Rhim, T; Kim, S S

    1998-10-30

    Recently, O'Reilly et al. (O'Reilly, M. S., Holmgren, L., Shing, Y., Chen, C., Rosenthal, R. A., Moses, M., Lane, W. S., Cao, Y., Sage, E. H., and Folkman, J. (1994) Cell 79, 315-328; O'Reilly, M. S., Boehm, T., Shing, Y., Fukai, N., Vasios, G., Lane, W. S., Flynn, E., Birkhead, J. R., Olsen, B. R., and Folkman, J. (1997) Cell 88, 277-285) developed a simple in vitro angiogenesis assay system using bovine capillary endothelial cell proliferation and purified potent angiogenic inhibitors, including angiostatin and endostatin. Using a simple in vitro assay for angiogenesis, we purified a protein molecule that showed anti-endothelial cell proliferative activity from the serum of New Zealand White rabbits, which was stimulated by lipopolysaccharide. The purified protein showed only bovine capillary endothelial cell growth inhibition and not any cytotoxicity. This molecule was identified as a prothrombin kringle-2 domain (fragment-2) using Edman degradation and the amino acid sequence deduced from the cloned cDNA. Both the prothrombin kringle-2 domain released from prothrombin by factor Xa cleavage and the angiogenic inhibitor purified from rabbit sera exhibited anti-endothelial cell proliferative activity. The recombinant rabbit prothrombin kringle-2 domain showed potent inhibitory activity with half-maximal concentrations (ED50) of 2 microg/ml media. As in angiostatin, the recombinant rabbit prothrombin kringle-2 domain also inhibited angiogenesis in the chorioallantoic membrane of chick embryos. PMID:9786880

  5. Novel wireless electroencephalography system with a minimal preparation time for use in emergencies and prehospital care

    OpenAIRE

    Jakab, Andrei; Kulkas, Antti; Salpavaara, Timo; Kauppinen, Pasi; Verho, Jarmo; Heikkilä, Hannu; Jäntti, Ville

    2014-01-01

    Background Although clinical applications such as emergency medicine and prehospital care could benefit from a fast-mounting electroencephalography (EEG) recording system, the lack of specifically designed equipment restricts the use of EEG in these environments. Methods This paper describes the design and testing of a six-channel emergency EEG (emEEG) system with a rapid preparation time intended for use in emergency medicine and prehospital care. The novel system comprises a quick-applicati...

  6. Pregnancy wantedness, frequency and timing of antenatal care visit among women of childbearing age in Kenya

    OpenAIRE

    Ochako, Rhoune; Gichuhi, Wanjiru

    2016-01-01

    Background A woman’s health seeking behaviour during pregnancy has been found to have significant repercussions on her wellbeing and that of her unborn child. For example, the risk of poor pregnancy outcomes and maternal death is higher among women who do not receive antenatal care. Methods The study described the characteristics of women who reported wanted, unwanted and mistimed pregnancies from their last birth at the time of the survey; the linkage between frequency of antenatal care visi...

  7. Implementing large-scale quality improvement – lessons from the productive ward: Releasing time to care

    OpenAIRE

    Morrow, Elizabeth; Robert, Glenn; Maben, Jill; Griffiths, Peter

    2011-01-01

    Purpose: This paper is concerned with facilitating large-scale quality improvement in health care, and specifically understanding more about the known challenges associated with implementation of Lean innovations: receptivity, the complexity of adoption processes, evidence of the innovation, and embedding change. Lessons are drawn from the implementation of The Productive Ward: Releasing Time to CareTM programme in English hospitals. Design/participants: The study which the paper draws up...

  8. A study of the training and development needs of Support Time Recovery & Health Care Support Workers

    OpenAIRE

    James, Liz; Wintrup, Julie

    2009-01-01

    The purpose of this study is to explore the development needs of Support Time Recovery (STR) and health / social care Support Workers (SW), given the growing importance of their work across the spectrum of direct mental health care and treatment. Remarkably little is known about this significant proportion of the workforce, although the absence of a recognised framework of training for STRs was commented upon by Huxley (2006). A research team including education leads from two NHS Trusts and ...

  9. On the reporting of dental health, time for dental care, and the treatment panorama.

    Science.gov (United States)

    Swedberg, Y

    1999-01-01

    The thesis included five methodological studies and one caries epidemiological investigation, the general aim being to study how to measure and report dental health, time for dental care, treatment panorama, and dental care outcomes, within a Public Dental Service organization. The specific aims were to monitor dental clinic activities using a time study method, to apply time study results of a dental health-related patient group system for the 3-19 year age groups, and to compare time study results with corresponding results from computerized systems used for reporting dental care. Other specific aims were to compare longitudinal caries index data results between cohort and cross-sectional samples, to analyse caries index for extreme caries groups among adolescents leaving organized dental care, and--using time series methods--to analyse dental health development of the 15-19 year age groups. Results from the time studies portrayed the dental clinic as a working unit, showed that reported values can represent dental care only for intervention procedures, and indicated that clinic patterns were not adapted to the health situation of the patient groups. Longitudinal cohort attempts gave different values from those of the cross-sectional year classes, which should be the primary focus when presenting caries index mean values in dental health reviews. Caries-free groups from 15 to 19 years of age seem to be stable in their caries development in about 60%-80% of cases; while the 20% groups with the highest index values accounted for about 80% of all approximal lesions. In times of major economic adjustment, dental health for adolescents in Göteborg was an example of sustainable dental health development. A model system for monitoring, analysing, and reporting dental health and dental care outcomes within a dental care-giving organization calls for several conditions, for example, a dental health-related patient group system, and a rationale for the choice of dental

  10. Autosomal-dominant inheritance of the prothrombin gene mutation in a Puerto Rican family: A case study.

    Science.gov (United States)

    Morales-Borges, Raúl H

    2012-12-01

    Splenic infarction is rare and the prothrombin gene mutation (PGM) is not commonly observed in Puerto Rico. PGM is present in 1% of the general population, and in 7% of the people with deep venous thrombosis (DVT); it is found in up to 40% of patients with splenic-portal-mesenteric thrombosis. Our study has identified a Puerto Rican family of four generations whose members all have inherited PGM in an autosomal dominant manner. The eldest member of the family, an 82-year-old male, presented with DVT of the lower extremity. The man's 62-year-old daughter had suffered a splenic infarction; his 37-year-old grandson presented with superficial and deep vein thrombosis (SDVT), and his great-grandson of 8 years was asymptomatic at the time of the report. This is the second report of PGM as the cause of a hypercoagulable state and the first reported PGM-related splenic infarction in Puerto Rico. We need to test for genetic hypercoagulable states in the members of Puerto Rican families with thromboembolism. Once testing has revealed the existence of such states in a given family, it is important that the family members receive genetic counseling. PMID:23844473

  11. Health care providers under pressure: making the most of challenging times.

    Science.gov (United States)

    Davis, Scott B; Robinson, Phillip J

    2010-01-01

    Whether the slowing economic recovery, tight credit markets, increasing costs, or the uncertainty surrounding health care reform, the health care industry faces some sizeable challenges. These factors have put considerable strain on the industry's traditional financing options that the industry has relied on in the past--bonds, banks, finance companies, private equity, venture capital, real estate investment trusts, private philanthropy, and grants. At the same time, providers are dealing with rising costs, lower reimbursement rates, shrinking demand for elective procedures, higher levels of charitable care and bad debt, and increased scrutiny of tax-exempt hospitals. Providers face these challenges against a back ground of uncertainty created by health care reform. PMID:21294438

  12. Impact of Barcode Medication Administration Technology on How Nurses Spend Their Time On Clinical Care

    OpenAIRE

    Poon, Eric G; Keohane, Carol; Featherstone, Erica; Hays, Brandon; Dervan, Andrew; Woolf, Seth; Hayes, Judy; Bane, Anne; Newmark, Lisa; Gandhi, Tejal K.

    2006-01-01

    In a time-motion study conducted in a hospital that recently implemented barcode medication administration (BCMA) technology, we found that the BCMA system did not increase the amount of time nurses spend on medication administration activities, and did not compromise the amount of time nurses spent on direct care of patients. Our results should allay concerns regarding the impact of BCMA on nursing workflow.

  13. Improving recovery time following heart transplantation: the role of the multidisciplinary health care team

    Directory of Open Access Journals (Sweden)

    Roussel MG

    2013-08-01

    Full Text Available Maureen G Roussel,1 Noreen Gorham,2 Lynn Wilson,2 Abeel A Mangi2 1Heart and Vascular Center, Yale-New Haven Hospital, New Haven, CT, USA; 2Center for Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation, Yale New Haven Heart and Vascular Institute, Yale-New Haven Hospital, New Haven, CT, USA Background: The care of cardiac transplant patients is complex requiring a finely orchestrated endeavor to save a patient’s life. Given the chronic and complex nature of these patients, multiple disciplines are involved in their care. Recognizing difficulties with communication among team members and striving for improved efficiencies in our pretransplant listing process and in our inpatient care, our team was prompted to change the existing approach to patient care related to heart transplantation. Methods: Daily multidisciplinary rounds were instituted and the format of the weekly Multidisciplinary Review Committee (MDRC meetings was modified with the list of attendees broadened to include a larger interdisciplinary team. Additionally, the approach to patient care was analyzed for process improvement. Results: The quality improvements are improved communication and throughput, quantified in an 85% decrease in time to complete transplant evaluation, a 37% decrease in median length of stay posttransplantation, and a 33% reduction in the 30 day readmission rate. In addition, pre- and posttransplant caregivers now participate in MDRC in person or via an electronic meeting platform to support the continuum of care. Quality metrics were chosen and tracked via a transparent electronic platform allowing all involved to assess progress toward agreed upon goals. These were achieved in an 18 month time period following the recruitment of new leadership and invested team members working together as a multidisciplinary team to improve the quality of cardiac transplant care. Discussion: Implementation of daily multidisciplinary rounds and

  14. Introducing waiting times for health care in a labor supply model for sickness absence

    Directory of Open Access Journals (Sweden)

    Daniela Andrén

    2014-08-01

    Full Text Available This paper studies the association between waiting times for different health care services and the duration of sick leave, using a Swedish register database supplemented with information from questionnaires for 3,653 employees. The duration of sick leave is positively associated with waiting two weeks or more for primary care, technical investigations and specialists, compared to waiting one week or less. Except for waiting for a specialist, there is no indication that waiting four weeks or more is associated with longer durations of sick leave than waiting two to three weeks. Long waiting times for surgery is negatively associated with the duration of sick leave, which might be explained by prioritizing where patients with longer waiting times are those with less severe conditions. Including these waiting time variables did not induce substantial changes on the impact of traditional labor supply variables, which suggests that the parameter estimates of traditional variables are relatively robust.

  15. Time pressured deprioritization of COPD in primary care: a qualitative study

    Science.gov (United States)

    Sandelowsky, Hanna; Hylander, Ingrid; Krakau, Ingvar; Modin, Sonja; Ställberg, Björn; Nager, Anna

    2016-01-01

    Objective To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden. Setting Primary health care centres (PHCCs) in Stockholm, Sweden. Subjects A total of 59 PCPs. Design Semi-structured individual and focus-group interviews between 2012 and 2014. Data were analysed inspired by grounded theory methods (GTM). Results Time-pressured patient–doctor consultations lead to deprioritization of COPD. During unscheduled visits, deprioritization resulted from focusing only on acute health concerns, while during routine care visits, COPD was deprioritized in multi-morbid patients. The reasons PCPs gave for deprioritizing COPD are: “Not becoming aware of COPD”, “Not becoming concerned due to clinical features”, “Insufficient local routines for COPD care”, “Negative personal attitudes and views about COPD”, “Managing diagnoses one at a time”, and “Perceiving a patient’s motivation as low’’. Conclusions De-prioritization of COPD was discovered during PCP consultations and several factors were identified associated with time constraints and multi-morbidity. A holistic consultation approach is suggested, plus extended consultation time for multi-morbid patients, and better documentation and local routines. Key pointsUnder-diagnosis and insufficient management of chronic obstructive pulmonary disease (COPD) are common in primary health care. A patient–doctor consultation offers a key opportunity to identify and provide COPD care. Time pressure, due to either high number of patients or multi-morbidity, leads to omission or deprioritization of COPD during consultation.Deprioritization occurs due to lack of awareness, concern, and local routines, negative personal views, non-holistic consultation approach, and low patient motivation.Better local routines, extended consultation time, and a holistic approach are needed when managing multi

  16. A queueing network model to analyze the impact of parallelization of care on patient cycle time.

    Science.gov (United States)

    Jiang, Lixiang; Giachetti, Ronald E

    2008-09-01

    The total time a patient spends in an outpatient facility, called the patient cycle time, is a major contributor to overall patient satisfaction. A frequently recommended strategy to reduce the total time is to perform some activities in parallel thereby shortening patient cycle time. To analyze patient cycle time this paper extends and improves upon existing multi-class open queueing network model (MOQN) so that the patient flow in an urgent care center can be modeled. Results of the model are analyzed using data from an urgent care center contemplating greater parallelization of patient care activities. The results indicate that parallelization can reduce the cycle time for those patient classes which require more than one diagnostic and/ or treatment intervention. However, for many patient classes there would be little if any improvement, indicating the importance of tools to analyze business process reengineering rules. The paper makes contributions by implementing an approximation for fork/join queues in the network and by improving the approximation for multiple server queues in both low traffic and high traffic conditions. We demonstrate the accuracy of the MOQN results through comparisons to simulation results. PMID:18826003

  17. Risk of venous thromboembolism and myocardial infarction associated with factor V Leiden and prothrombin mutations and blood type

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Allin, Kristine H; Dahl, Morten;

    2013-01-01

    ABO blood type locus has been reported to be an important genetic determinant of venous and arterial thrombosis in genome-wide association studies. We tested the hypothesis that ABO blood type alone and in combination with mutations in factor V Leiden R506Q and prothrombin G20210A is associated...

  18. Differences in urinary prothrombin fragment 1 + 2 levels after total hip replacement in relation to venous thromboembolism and bleeding events

    DEFF Research Database (Denmark)

    Borris, L C; Breindahl, M; Lassen, M R;

    2008-01-01

    BACKGROUND: Prothrombin fragment 1 + 2 is excreted in urine (uF1 + 2) as a result of thrombin generation and, therefore, may be a useful marker of coagulation status. OBJECTIVES: To assess uF1 + 2 levels after total hip replacement (THR) in patients with venous thromboembolism (VTE) and bleeding ...

  19. Des-γ-carboxy prothrombin (DCP) as a potential autologous growth factor for the development of hepatocellular carcinoma.

    Science.gov (United States)

    Zhang, Yu-Sheng; Chu, Jia-Hui; Cui, Shu-Xiang; Song, Zhi-Yu; Qu, Xian-Jun

    2014-01-01

    Des-γ-carboxy prothrombin (DCP) is a prothrombin precursor produced in hepatocellular carcinoma (HCC). Because of deficiency of vitamin K or γ-glutamyl carboxylase in HCC cells, the 10 glutamic acid (Glu) residues in prothrombin precursor did not completely carboxylate to γ-carboxylated glutamic acid (Gla) residues, leaving some Glu residues remained in N-terminal domain. These prothrombin precursors with Glu residues are called DCPs. DCP displays insufficient coagulation activity. Since Liebman reported an elevated plasma DCP in patients with HCC, DCP has been used in the diagnosis of HCC. Recently, its biological malignant potential has been specified to describe DCP as an autologous growth factor to stimulate HCC growth and a paracrine factor to integrate HCC with vascular endothelial cells. DCP was found to stimulate HCC growth through activation of the DCP-Met-JAK1-STAT3 signaling pathway. DCP might increase HCC invasion and metastasis through activation of matrix metalloproteinase (MMPs) and the ERK1/2 MAPK signaling pathway. DCP has also been found to play a crucial role in the formation of angiogenesis. DCP could increase the angiogenic factors released from HCC and vascular endothelial cells. These effects of DCP in angiogenesis might be related to activation of the DCP-KDR-PLC-γ-MAPK signaling pathway. In this article, we summarized recent studies on DCP in biological roles related to cancer progression and angiogenesis in HCC. PMID:25200250

  20. TIME (Training in a Manila Envelope): A Child Care Plus+ Outreach Project To Expand Care and Education Options for Young Children with Disabilities. Final Report.

    Science.gov (United States)

    Morris, Sandra L.

    This final report summarizes the activities of TIME (Training in a Manila Envelope), a federally funded project designed to replicate the Child Care plus+ model of inservice training by providing: (1) a course on inclusion directly for child care providers and other early childhood professionals in rural areas across the nation; and (2) training…

  1. Measurement of informal care: an empirical study into the valid measurement of time spent on informal caregiving.

    NARCIS (Netherlands)

    Berg, Bernard van den; Spauwen, Pol

    2006-01-01

    The incorporation of informal care into economic evaluations of health care is troublesome. The debate focuses on the valuation of time spent on informal caregiving, while time measurement, a related and may be even a more important issue, tends to be neglected. Valid time measurement is a necessary

  2. Portal Vein Thrombosis due to Prothrombin Gene Mutation following Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Murad Baba

    2015-01-01

    Full Text Available Introduction. Portomesenteric thrombosis is increasingly recognized as a complication of laparoscopic sleeve gastrectomy (LSG. It often presents with abdominal pain. We present a mother and her son who both developed portal vein thrombosis (PVT after LSG. Case Description. A 43-year-old woman presented complaining of sudden severe abdominal pain, two weeks after she had uncomplicated laparoscopic sleeve gastrectomy. CT scan of the abdomen and pelvis with IV contrast showed portal vein thrombosis and SMV thrombosis. Two weeks later her son had the same LSG for morbid obesity and presented with the same clinical picture. Thrombophilia workup showed heterozygous prothrombin gene mutation. Conclusions. A high index of suspicion is necessary to diagnose PVT; although rare, it can be potentially lethal. Anticoagulation therapy should be initiated immediately to limit the morbidities and improve the outcome. Patients with family history of thrombophilia should be investigated prior to any bariatric surgery and nonsurgical alternative treatments for morbid obesity should be strongly encouraged.

  3. SO MUCH TO DO, SO LITTLE TIME: CARE FOR THE SOCIALLY DISADVANTAGED AND THE 15-MINUTE VISIT

    OpenAIRE

    Fiscella, Kevin; Epstein, Ronald M

    2008-01-01

    There is much to do in primary care and little time to do it. Currently, primary care delivery is organized around visits, often 15 minutes or less, during which much is expected of clinicians. This includes establishing partnerships with patient and families; addressing acute and chronic biomedical and psychosocial problems; prevention, care coordination; and ensuring informed decision-making that respects patients’ needs and preferences. Visit-based care discriminates against socially disad...

  4. Emergency department physicians spend only 25% of their working time on direct patient care

    DEFF Research Database (Denmark)

    Füchtbauer, Laila Maria; Nørgaard, Birgitte; Mogensen, Christian Backer

    2013-01-01

    physicians spend on these tasks and it is therefore difficult to assess how changes in the system might affect workflow and thus time efficacy. The aim of this study was to investigate how physicians in the emergency department (ED) of a public hospital in Denmark spend their time. Results were stratified......In modern hospital medicine, there is a growing awareness of the need for efficient and secure -patient care. Authorities seek to improve this by adding requirements for documentation, administrative tasks and standardized patient programmes. However, it is rarely investigated how much time...

  5. TIMING OF REGISTRATION FOR ANTENATAL CARE AMONG PREGNANT WOMEN DELIVERING IN A TERTIARY CARE HOSPITAL IN AN URBAN AREA

    Directory of Open Access Journals (Sweden)

    Pankaj

    2014-05-01

    Full Text Available INTRODUCTION: Antenatal care (ANC services has the potential to affect maternal and foetal outcome positively. The ideal gestational age for booking is within the first ten weeks of pregnancy. METHODOLOGY: An Institution based cross-sectional study amongst puerperal women was conducted at B.J. Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India. Variables studied were socio-demographic factors, parity, complications in previous pregnancy etc. Analysis was done with the Fishers exact test. RESULTS: Out of the total 370 women, 38% reported late/no ANC registration. The husband and wife’s education, husband’s alcoholism, history of complication in previous pregnancy were significantly associated with the time of ANC registration. Early registered women revealed a positive impact on the number of ANC visits; number of ferrous sulphate (FS & Folic acid (FA consumed and birth weight. Strongest driving force to seek ANC was ‘to know the fetal condition’. Women were referred for Ultrasonography without ANC registration and very few had been advised timely anomaly scan. CONCLUSION: There is scope to improve early ANC registration if special efforts are taken to enroll the women at risk of late/no registration, focus on the benefits of early registration and tap the missed opportunities.

  6. Clever mothers balance time and effort in parental care: a study on free-ranging dogs

    OpenAIRE

    Paul, Manabi; Sau, Shubhra; Nandi, Anjan K.; Bhadra, Anindita

    2016-01-01

    Mammalian offspring require parental care, at least in the form of suckling during their early development. While mothers need to invest considerable time and energy in ensuring the survival of their current offspring, they also need to optimize their investment in one batch of offspring in order to ensure future reproduction and hence lifetime reproductive success. Free-ranging dogs live in small social groups, mate promiscuously, and lack the cooperative breeding biology of other group livi...

  7. Time to manage: patient strategies for coping with an absence of care coordination and continuity.

    Science.gov (United States)

    Jowsey, Tanisha; Dennis, Simone; Yen, Laurann; Mofizul Islam, M; Parkinson, Anne; Dawda, Paresh

    2016-07-01

    This paper examines how people with chronic illnesses respond to absences of continuity and coordination of care. Little work has been done on how the ill person might mitigate flaws in a less than optimal system. Our qualitative research, carried out among 91 participants in Australia, reveals that people with chronic illnesses create strategies to facilitate the management of their care. These strategies included efforts to improve communication between themselves and their health care practitioners; keeping personal up-to-date medication lists; and generating their own specific management plans. While we do not submit that it is patients' responsibility to attend to gaps in the health system, our data suggests that chronically ill people can, in and through such strategies, exert a measure of agency over their own care; making it effectively more continuous and coordinated. Participants crafted strategies according to the particular social and bodily rhythms that their ongoing illnesses had lent to their lives. Our analysis advances the view that the ill body itself is capable of enfolding the health system into the rhythms of illness - rather than the ill body always fitting into the overarching structural tempo. This entails an agent-centric view of time in illness experience. A Virtual Abstract of this paper can be found at: https://youtu.be/UwbxlEJOTx8. PMID:26871716

  8. Just-in-time information improved decision-making in primary care: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Jessie McGowan

    Full Text Available BACKGROUND: The "Just-in-time Information" (JIT librarian consultation service was designed to provide rapid information to answer primary care clinical questions during patient hours. This study evaluated whether information provided by librarians to answer clinical questions positively impacted time, decision-making, cost savings and satisfaction. METHODS AND FINDING: A randomized controlled trial (RCT was conducted between October 2005 and April 2006. A total of 1,889 questions were sent to the service by 88 participants. The object of the randomization was a clinical question. Each participant had clinical questions randomly allocated to both intervention (librarian information and control (no librarian information groups. Participants were trained to send clinical questions via a hand-held device. The impact of the information provided by the service (or not provided by the service, additional resources and time required for both groups was assessed using a survey sent 24 hours after a question was submitted. The average time for JIT librarians to respond to all questions was 13.68 minutes/question (95% CI, 13.38 to 13.98. The average time for participants to respond their control questions was 20.29 minutes/question (95% CI, 18.72 to 21.86. Using an impact assessment scale rating cognitive impact, participants rated 62.9% of information provided to intervention group questions as having a highly positive cognitive impact. They rated 14.8% of their own answers to control question as having a highly positive cognitive impact, 44.9% has having a negative cognitive impact, and 24.8% with no cognitive impact at all. In an exit survey measuring satisfaction, 86% (62/72 responses of participants scored the service as having a positive impact on care and 72% (52/72 indicated that they would use the service frequently if it were continued. CONCLUSIONS: In this study, providing timely information to clinical questions had a highly positive impact on

  9. Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context.

    Science.gov (United States)

    Luginaah, Isaac N; Kangmennaang, Joseph; Fallah, Mosoka; Dahn, Bernice; Kateh, Francis; Nyenswah, Tolbert

    2016-07-01

    In Liberia, 75% of those who died from 2014 Ebola epidemic were women and the effects of this gruelling epidemic were more severely felt by pregnant women. This immediately raised fears about the long-term impacts of the epidemic on maternal and child health. As part of a larger study, this paper uses Andersen's behavioural model of health care utilization and Goffman's stigma theory to explain the timing and utilization of maternal health services before the outbreak of the Ebola epidemic as a background to the potential long-term effects on maternal health. We conducted survival and multiple regression analysis using the 2007 (N = 3524) and 2013 (N = 5127) Liberia's Demographic and Health Survey (LDHS) data. Our sample consisted of women of reproductive age (15-49 years) that had given birth in the last five years preceding the survey year. The findings show that from 2007 to 2013, there was an overall improvement in the timing of first antenatal care (ANC) visits (TR = 0.92, p Ebola epidemic likely eroded many of the previous gains in maternal health care, and may have left a lingering negative effect on the access and utilization of maternal health services in the long-term. The study makes relevant policy recommendations. PMID:27214711

  10. CORELATION BETWEEN TIME COMPETENCE OF THE CHILD CARE STAFF AND THEIR PROFESSIONAL BURNOUT

    Directory of Open Access Journals (Sweden)

    Olga Viktorovna Kuzmin

    2013-08-01

    Full Text Available The article presents the results of the empirical research into correlation between the time competence indices of child care staff and their professional burnout; the article also addresses the notion of time competence and gives its characteristics. We have also confirmed the hypothesis that the reduction of professional and personal achievements contribute to recognition of the fact that it is vital to organize your time, to prioritize and to schedule, it is also crucial to increase self-organization that manifests itself in the in the desire to set goals on the basis of situation analysis, to establish self-control and performance correction.    The research results will help psychologists prevent professional burnout by means of time consciousness awareness. DOI: http://dx.doi.org/10.12731/2218-7405-2013-7-4

  11. Optimization of time distribution for studying the course modules on advanced training of health care administrators

    Directory of Open Access Journals (Sweden)

    Dorovskaya A.l.

    2015-06-01

    Full Text Available The research objective is rational (optimal time management in studying the course modules on Advanced Training of Health Care Administrators. Materials and methods. We conducted expert survey of 73 healthcare administrators from medical organizations of Saratov region. Branch-and-bound method was used for rescheduling the educational program. Results. Both direct and inverse problems have been solved. The direct one refers to time distribution for each module of the advanced Training of Healthcare Administrators course so that the total score is maximum and each module is marked not lower than "satisfactory". The inverse one resulted in achieving minimal time characteristics for varieties of average score. Conclusion. The offered approach allows to solve problems of managing time given for education.

  12. Sleep time and pattern of adult individuals in primary care in an Asian urbanized community

    Science.gov (United States)

    Tan, Ngiap Chuan; Tan, Mui Suan; Hwang, Siew Wai; Teo, Chia Chia; Lee, Zhi Kang Niccol; Soh, Jing Yao Jonathan; Koh, Yi Ling Eileen; How, Choon How

    2016-01-01

    Abstract Sleep norms vary between individuals, being affected by personal, communal, and socioeconomic factors. Individuals with sleep time which deviate from the population norm are at risks of adverse mental, cardiovascular, and metabolic health. Sleep-related issues are common agenda for consultation in primary care. This study aimed to determine the sleep time, pattern, and behavior of multiethnic Asian individuals who attended public primary care clinics in an urban metropolitan city-state. Standardized questionnaires were assistant-administered to adult Asian individuals who visited 2 local public primary care clinics in north-eastern and southern regions of Singapore. The questionnaire included questions on demographic characteristics, self-reported sleep time, patterns, and behavior and those originated from the American National Sleep Foundation Sleep Diary. The data were collated, audited, rectified, and anonymized before being analyzed by the biostatistician. Individuals with 7 h sleep time or longer were deemed getting adequate sleep. Chi-squared or Fisher exact test was used to test the association between the demographic and behavioral variables and sleep time. Next, regression analysis was performed to identify key factors associated with their sleep time. A total of 350 individuals were recruited, with higher proportion of those of Chinese ethnicity reporting adequate sleep. Almost half (48.1%) of those who slept sleep ≥7 h on weekends. More individuals who reported no difficulty falling asleep, had regular sleep hours and awakening time, tended to sleep adequately. Those who slept with children, studied, read leisurely, used computer or laptops in their bedrooms, drank caffeinated beverages or smoked had inadequate sleep. Those who perceived sufficient sleep and considered 8 h as adequate sleep time had weekday and weekend sleep adequacy. Sleep time varied according to ethnicity, employment status, personal behavior, and perception of sleep

  13. Implementation and evaluation of Google Glass for visualizing real-time image and patient data in the primary care office

    Science.gov (United States)

    Monroy, Guillermo L.; Shemonski, Nathan D.; Shelton, Ryan L.; Nolan, Ryan M.; Boppart, Stephen A.

    2014-02-01

    Primary care physicians must conduct a staggering number of comprehensive physical exams and medical record reviews, resulting in demanding daily schedules. Few commercial technologies have been marketed towards the primary care market, which has stifled improvements in disease screening and detection, work flow, and records management, taking time away from interactions with patients. In efforts to improve the quality of care in primary care medicine, we integrated our handheld primary care optical imaging system with Google Glass©, a commercial heads-up display (HUD). The integration of a HUD allows the physician to focus on the patient during the medical history review and during the patient exam, resulting in potential improvements to the quality of care and efficient access to real-time data for display and analysis.

  14. Prevalence of factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations in 200 healthy Jordanians.

    Science.gov (United States)

    Eid, Suhair S; Rihani, Ghada

    2004-01-01

    Thrombophilia is now considered a multi-causal condition, with interplay of acquired genetic risk factors. In order to estimate the frequency of the factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations in the Jordanian population, we screened 200 healthy Jordanian individuals. 40% were females. Mean age was 32.1 years for males and 30.0 years for female participants. A PCR method detected 15.0% factor V Leiden (87% heterozygous, 13% homozygous), 2% prothrombin G20210A (100% heterozygous), and 24% MTHFR C677T (67% heterozygous, 33% homozygous). We conclude that the prevalence of factor V Leiden and MTHFR C677T is elevated in this population of Jordanians. However the incidence of G20210A is relatively low. Quantification of these genetic thrombosis risk factors in various populations will contribute to a better understanding of the interaction of genetic and environmental risk factors. PMID:15559724

  15. Prothrombin fragment 1+2 is associated with carotid intima-media thickness in subjects free of clinical cardiovascular disease

    OpenAIRE

    Paramo, J. A.; Orbe, J.; Beloqui, O. (Óscar); Benito, A.; Colina, I. (Inmaculada); Martinez-Vila, E; Diez, J.

    2004-01-01

    BACKGROUND AND PURPOSE: Thrombin, a central enzyme in the clotting cascade, plays a role not only in thrombosis but also in the progression of atherosclerosis. We studied the relationship between prothrombin fragment 1+2 (F1+2), a specific marker of thrombin generation in vivo, and carotid intima-media thickness (IMT), an index of subclinical atherosclerosis. METHODS: We examined 181 asymptomatic middle-aged subjects (mean age 55.6 years, 76.7% men) free of overt clinical atherosclerotic ...

  16. Reimagining care for adolescent and young adult cancer programs: Moving with the times.

    Science.gov (United States)

    Gupta, Abha A; Papadakos, Janet K; Jones, Jennifer M; Amin, Leila; Chang, Eugene K; Korenblum, Chana; Mina, Daniel Santa; McCabe, Lianne; Mitchell, Laura; Giuliani, Meredith E

    2016-04-01

    Literature regarding the development of adolescent and young adult (AYA) cancer programs has been dominantly informed by pediatric centers and practitioners. However, the majority of young adults are seen and treated at adult cancer centers, in which cancer volumes afford the development of innovative supportive care services. Although the supportive care services in adult cancer centers are helpful to AYAs, some of the most prominent and distinct issues faced by AYAs are not adequately addressed through these services alone. This article describes how the AYA Program at Princess Margaret Cancer Centre has collaborated with existing supportive care services in addition to supplying its own unique services to meet the comprehensive needs of AYAs in the domains of: symptom management (sexuality and fatigue), behavior modification (return to work and exercise), and health services (advanced cancer and survivorship). These collaborations are augmented by patient education interventions and timely referrals. The objective of this article was to assist other centers in expanding existing services to address the needs of AYA patients with cancer. Cancer 2016;122:1038-1046. © 2016 American Cancer Society. PMID:26848554

  17. Travel time to maternity care and its effect on utilization in rural Ghana: a multilevel analysis.

    Science.gov (United States)

    Masters, Samuel H; Burstein, Roy; Amofah, George; Abaogye, Patrick; Kumar, Santosh; Hanlon, Michael

    2013-09-01

    Rates of neonatal and maternal mortality are high in Ghana. In-facility delivery and other maternal services could reduce this burden, yet utilization rates of key maternal services are relatively low, especially in rural areas. We tested a theoretical implication that travel time negatively affects the use of in-facility delivery and other maternal services. Empirically, we used geospatial techniques to estimate travel times between populations and health facilities. To account for uncertainty in Ghana Demographic and Health Survey cluster locations, we adopted a novel approach of treating the location selection as an imputation problem. We estimated a multilevel random-intercept logistic regression model. For rural households, we found that travel time had a significant effect on the likelihood of in-facility delivery and antenatal care visits, holding constant education, wealth, maternal age, facility capacity, female autonomy, and the season of birth. In contrast, a facility's capacity to provide sophisticated maternity care had no detectable effect on utilization. As the Ghanaian health network expands, our results suggest that increasing the availability of basic obstetric services and improving transport infrastructure may be important interventions. PMID:23906132

  18. Time to diagnosis and mortality in colorectal cancer: a cohort study in primary care

    DEFF Research Database (Denmark)

    Tørring, Marie Louise; Frydenberg, Morten; Hansen, Rikke Pilegaard; Olesen, Frede; Hamilton, William; Vedsted, Peter

    2011-01-01

    CRC were included in a prospective, population-based study in a Danish county. The diagnostic interval was defined as the time from first presentation of symptoms until diagnosis. We analysed patients separately according to the general practitioner’s interpretation of symptoms. Logistic regression...... 3 years decreased with diagnostic intervals up to 5 weeks and then increased (P=0.002). In patients presenting with vague symptoms, the association was reverse, although not statistically significant. CONCLUSION: Detecting cancer in primary care is two sided: aimed at expediting ill patients while...

  19. The Effect of Kangaroo Mother Care on Fuss and Crying Time in Colicky Infants

    Directory of Open Access Journals (Sweden)

    Zahra Akbarian Rad

    2015-03-01

    Full Text Available AbstractBackground: Infantile colic is a common complaint in the first few weeks of life. On the other hand, because of its unknown etiology, there is not a specific therapy for this complaint, but various therapeutic options for reducing pain and restlessness of these infants are recommended. Skin to skin contact by Kangaroo Mother Care (KMC increases in pain threshold and it seems to be a suitable method for the care of these infants. This study was designed to evaluate the effect of KMC on infantile colic.Methods: This case- control study was performed between March 2012 and March 2013. Subjects were 55 infants with exclusive breast fed infant, aged 15-60 days with excessive fuss and crying, referred to Infant and Child Clinic in Ayatollah Rohani Hospital in Babol, north of Iran. Babies whose weights were less than 2500 Grams and with inheritance and clinical diseases excluded from the study. Infants were subjected to KMC at least 2 hours a day. Standard questionnaire and Barr Scale were filled by interview. Data was analyzed by SPSS v.11.5 and T-test, a P- value less than 0.05 considered being significant.Results:The fuss and crying time before the KMC was 2.21±1.54 hours per day and decreased to 1.16±1.3 hours per day after the implementation of KMC. (p=0.001Conclusions:Kangaroo mother care at home can be used as a simple and safe method for decreasing of cry and fussiness in colicky infants. Keywords: Kangaroo Mother Care (KMC, fussiness, Colicky Infants, colic

  20. The Effect of Kangaroo Mother Care on Fuss and Crying Time in Colicky Infants

    Directory of Open Access Journals (Sweden)

    Zahra Akbarian Rad

    2015-03-01

    Full Text Available Background: Infantile colic is a common complaint in the first few weeks of life. On the other hand, because of its unknown etiology, there is not a specific therapy for this complaint, but various therapeutic options for reducing pain and restlessness of these infants are recommended. Skin to skin contact by Kangaroo Mother Care (KMC increases in pain threshold and it seems to be a suitable method for the care of these infants. This study was designed to evaluate the effect of KMC on infantile colic. Methods: This case- control study was performed between March 2012 and March 2013. Subjects were 55 infants with exclusive breast fed infant, aged 15-60 days with excessive fuss and crying, referred to Infant and Child Clinic in Ayatollah Rohani Hospital in Babol, north of Iran. Babies whose weights were less than 2500 Grams and with inheritance and clinical diseases excluded from the study. Infants were subjected to KMC at least 2 hours a day. Standard questionnaire and Barr Scale were filled by interview. Data was analyzed by SPSS v.11.5 and T-test, a P- value less than 0.05 considered being significant. Results: The fuss and crying time before the KMC was 2.21±1.54 hours per day and decreased to 1.16±1.3 hours per day after the implementation of KMC. (p=0.001 Conclusions: Kangaroo mother care at home can be used as a simple and safe method for decreasing of cry and fussiness in colicky infants. Keywords: Kangaroo Mother Care (KMC, fussiness, Colicky Infants, colic

  1. Takayasu Arteritis With Antiphosphatidylserine/Prothrombin Antibody-Positive Antiphospholipid Syndrome: Case Report and Literature Review.

    Science.gov (United States)

    Fukui, Shoichi; Hirota, Shogo; Iwamoto, Naoki; Karata, Hiroki; Kawakami, Atsushi

    2015-12-01

    A relationship between Takayasu arteritis (TA) and positive antiphospholipid antibody states has been pointed out, but patients with TA complicated with antiphospholipid antibody syndrome (APS) are rare. Here we report the case of a 17-year-old Japanese man diagnosed with TA based on pulselessness of the left brachial artery, discrepancy of blood pressure between the upper extremities, and arterial wall thickening and narrowing of artery in contrast computed tomography. He was also diagnosed with provisional APS based on a pulmonary infarction without narrowing of the pulmonary artery and positive antiphosphatidylserine/prothrombin antibody. The patient also had concurrent Crohn's disease (CD) based on histopathological findings, which may have been associated with TA. We started high-dose corticosteroid therapy and anticoagulation therapy, and his symptoms including fever, dizziness, chest pain, and lower-right uncomfortable abdomen improved.We reviewed 9 cases of TA with APS including our patient by conducting a PubMed search. Based on past reports, we considered the relationship among TA, APS, and CD.Clinicians should bear in mind that many etiologies can exist in 1 patient, and differential diagnoses are essential. PMID:26705229

  2. Antibodies to Phosphatidylserine/Prothrombin Complex in Antiphospholipid Syndrome: Analytical and Clinical Perspectives.

    Science.gov (United States)

    Peterson, Lisa K; Willis, Rohan; Harris, E Nigel; Branch, Ware D; Tebo, Anne E

    2016-01-01

    Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thrombosis and/or pregnancy-related morbidity accompanied by persistently positive antiphospholipid antibodies (aPL). Current laboratory criteria for APS classification recommend testing for lupus anticoagulant as well as IgG and IgM anticardiolipin, and beta-2 glycoprotein I (anti-β2GPI) antibodies. However, there appears to be a subset of patients with classical APS manifestations who test negative for the recommended criteria aPL tests. While acknowledging that such patients may have clinical features that are not of an autoimmune etiology, experts also speculate that these "seronegative" patients may test negative for relevant autoantibodies as a result of a lack of harmonization and/or standardization. Alternatively, they may have aPL that target other antigens involved in the pathogenesis of APS. In the latter, autoantibodies that recognize a phosphatidylserine/prothrombin (PS/PT) complex have been reported to be associated with APS and may have diagnostic relevance. This review highlights analytical and clinical attributes associated with PS/PT antibodies, taking into consideration the performance characteristics of criteria aPL tests in APS with specific recommendations for harmonization and standardization efforts. PMID:26975968

  3. The effect of the development of an emergency transfer system on the travel time to tertiary care centres in Japan

    Directory of Open Access Journals (Sweden)

    Arima Hideaki

    2006-06-01

    Full Text Available Abstract Background In Japan, the emergency medical system is categorized into three levels: primary, secondary, and tertiary, depending on the severity of the condition of the patient. Tertiary care centres accept patients who require 24-h monitoring. In this research, the average travel times (minutes from the centroids of all municipalities in Japan to the nearest tertiary care centre were estimated, using the geographic information system. The systems affecting travel time to tertiary care centres were also examined. Regression analysis was performed to determine the factors affecting the travel time to tertiary care centres, using selected variables representing road conditions and the emergency transfer system. Linear regression analysis was performed to identify specific benchmarks that would be effective in reducing the average travel time to tertiary care centres in prefectures with travel times longer than the average 57 min. Results The mean travel time was 57 min, the range was 83 min, and the standard deviation was 20.4. As a result of multiple regression analysis, average coverage area per tertiary care centre, kilometres of highway road per square kilometre, and population were selected as variables with impact on the average travel time. Based on results from linear regression analysis, benchmarks for the emergency transfer system that would effectively reduce travel time to the mean value of 57 min were identified: 26% pavement ratio of roads (percentage of paved road to general roads, and three tertiary care centres and 108 ambulances. Conclusion Regional gaps in the travel time to tertiary care centres were identified in Japan. The systems we should focus on to reducing travel time were identified. Further reduction of travel time to tertiary care centres can be effectively achieved by improving these specific systems. Linear regression analysis showed that a 26% pavement ratio and three tertiary care centres are beneficial to

  4. A method to reduce response times in prehospital care: the motorcycle experience.

    Science.gov (United States)

    Lin, C S; Chang, H; Shyu, K G; Liu, C Y; Lin, C C; Hung, C R; Chen, P H

    1998-11-01

    This study compared the response times of a motorcycle and a standard ambulance in a congested urban emergency medical services (EMS) setting. The study was performed in Taipei, Taiwan, a densely populated urban area. A basic life support (BLS) motorcycle (without defibrillation capability) and an advanced life support (ALS) ambulance were based at three study hospitals and simultaneously dispatched when there was a perceived need for ALS ambulance transport. Over a 3-month period, prehospital personnel evaluated 307 medical and trauma emergencies. Time data were insufficient for analysis in 33 cases, leaving a study population of 274. Response times of the motorcycle and the ambulance were prospectively assessed and compared. During rush hours, the response times of the motorcycle and ambulance were 4.9+/-3.0 minutes and 6.3+/-3.4 minutes (P motorcycles to transport EMTs to the emergency scene significantly reduced response time compared with a standard ambulance in a congested urban setting. Large prospective studies are required to determine the impact on patient outcome of shorter EMS response times using motorcycles. EMS motorcycles appear feasible and deserve consideration to help expedite prehospital care in other systems in densely populated cities. PMID:9827757

  5. Des-gamma-carboxy prothrombin as an important prognostic indicator in patients with small hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Kenichi Hakamada; Norihisa Kimura; Takuya Miura; Hajime Morohashi; Keinosuke Ishido; Masaki Nara; Yoshikazu Toyoki; Shunji Narumi; Mutsuo Sasaki

    2008-01-01

    AIM:To clarify the effect of a high des-gamma-carboxy prothrombin (DCP) level on the invasiveness and prognosis of small hepatocellular carcinoma.METHODS:Among 142 consecutive patients with known DCP levels,who underwent hepatectomy because of hepatocellular carcinoma,85 patients met the criteria for small hepatocellular carcinoma,i.e.one≤5 cm sized single tumor or no more than three≤3 cm sized tumors.RESULTS:The overall survival rate of the 142 patients was 92.1% for 1 year,69.6% for 3 years,and 56.9% for 5 years.Multivariate analysis showed that microscopic vascular invasion (P = 0.03) and serum DCP≥400mAU/mL (P = 0.02) were independent prognostic factors.In the group of patients who met the criteria for small hepatocellular carcinoma,DCP≥400 mAU/mL was found to be an independent prognostic factor for recurrence-free (P = 0.02) and overall survival (P = 0.0005).In patients who did not meet the criteria,the presence of vascular invasion was an independent factor for recurrence-free (P = 0.02) and overall survivals (P = 0.01).In 75% of patients with small hepatocellular carcinoma and high DCP levels,recurrence occurred extrahepatically.CONCLUSION:For small hepatocellular carcinoma,a high preoperative DCP level appears indicative for tumor recurrence.Because many patients with a high preoperative DCP level develop extrahepatic recurrence,it is necessary to screen the whole body.

  6. A Systematic Review of Des-γ-Carboxy Prothrombin for the Diagnosis of Primary Hepatocellular Carcinoma.

    Science.gov (United States)

    De, Ji; Shen, Yi; Qin, Jinyu; Feng, Li; Wang, Yiping; Yang, Li

    2016-04-01

    Determining the serum des-γ-carboxy-prothrombin (DCP) level is of great importance for the diagnosis of primary hepatocellular carcinoma (PHC). Although several studies have investigated the accuracy of diagnostic DCP tests for PHC, the results have been inconsistent.The aim of this study was to systematically evaluate DCP as a diagnostic standard for PHC.Several databases, including PubMed, EMBASE, MEDLINE (Ovid), the Chinese National Knowledge Infrastructure (CNKI), the VIP Database for Chinese Technical Periodicals (VIP), WanFang Data, and the China Biological Medicine Database (CBM), were searched from the date of database inception until July 1, 2015 to collect published international and domestic studies of DCP in the diagnosis of PHC. Two investigators screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies.A total of 38 studies involving 11,124 cases were included (5298 cases in the PHC group and 5826 cases in the control group). A meta-analysis was then performed using Meta-Disc 1.4 and RevMan 5.2 software. The overall sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR) of DCP for the detection of PHC were 0.66 (95% confidence interval [CI]: 0.65-0.68), 0.88 (95% CI: 0.87-0.90), 7.13 (95% CI: 5.73-8.87), and 0.33 (95% CI: 0.29-0.38), respectively. The area under the curve (AUC) of the summary receiver-operating characteristic curve (SROC) was 0.9002. In conclusion, DCP has moderate diagnostic utility for PHC. Owing to the heterogeneity and limitations of the included studies, the above conclusion requires further support from additional high-quality studies. PMID:27124038

  7. Impact of ethanol, dry care and human milk on the time for umbilical cord separation

    International Nuclear Information System (INIS)

    Objective: To compare the extraction time and infection rate of umbilical cord by applying ethanol, human milk or dry care. Method: The parallel single-blinded randomised clinical trial was performed on 300 neonates at Shahid Sadougi University of Medical Sciences and Health Service, Yazd, Iran, between March and September 2010. The neonates were divided into three random but numerically equal groups. Each group was assigned the application of ethanol or mother's milk or to keep the stump dry. The neonates were visited on the 3rd and the 7th day after birth and follow-up was maintained telephonically until umbilical separation. Umbilical separation time and umbilical local infection frequency were considered as the study outcome, which was compared among the three groups according to age, gender and delivery type of the neonates. Results: Umbilical separation time in neonates of the human milk group had significant difference with the ethanol group (p=0.0001) and drying groups (p=0.003). Frequency of omphalitis had no significant difference among the three groups. Conclusion: Topical usage of human milk on umbilical cord stamp decreased separation time and incidence rate of omphalitis. (author)

  8. Effect of primary care physicians' use of estimated glomerular filtration rate on the timing of their subspecialty referral decisions

    Directory of Open Access Journals (Sweden)

    Jaar Bernard G

    2011-01-01

    Full Text Available Abstract Background Primary care providers' suboptimal recognition of the severity of chronic kidney disease (CKD may contribute to untimely referrals of patients with CKD to subspecialty care. It is unknown whether U.S. primary care physicians' use of estimated glomerular filtration rate (eGFR rather than serum creatinine to estimate CKD severity could improve the timeliness of their subspecialty referral decisions. Methods We conducted a cross-sectional study of 154 United States primary care physicians to assess the effect of use of eGFR (versus creatinine on the timing of their subspecialty referrals. Primary care physicians completed a questionnaire featuring questions regarding a hypothetical White or African American patient with progressing CKD. We asked primary care physicians to identify the serum creatinine and eGFR levels at which they would recommend patients like the hypothetical patient be referred for subspecialty evaluation. We assessed significant improvement in the timing [from eGFR 2 of their recommended referrals based on their use of creatinine versus eGFR. Results Primary care physicians recommended subspecialty referrals later (CKD more advanced when using creatinine versus eGFR to assess kidney function [median eGFR 32 versus 55 mL/min/1.73m2, p Conclusions Primary care physicians recommended subspecialty referrals earlier when using eGFR (versus creatinine to assess kidney function. Enhanced use of eGFR by primary care physicians' could lead to more timely subspecialty care and improved clinical outcomes for patients with CKD.

  9. All Danish first-time COPD hospitalisations 2002-2008: Incidence, outcome, patients, and care

    DEFF Research Database (Denmark)

    Lykkegaard, Jesper; Søndergaard, Jens; Kragstrup, Jakob;

    2012-01-01

    , and patients. METHODS: Using health administrative data from national registers, all first-time hospitalisations with COPD in Denmark (population 5.4 million) were identified. Data based on the individual hospitalisations and patients were retrieved and analysed. RESULTS: During the period 2002 to.......01-1.34) and the one-year mortality increased OR 1.12 (95% CI1.03-1.21). Concurrently, significant age- and sex-adjusted increases were found in use of intensive care, comorbidity, patient travel distance, bed occupancy rate of the receiving department, prior use of oral and inhaled corticosteroids, use of...... exacerbations has been gradually restricted. This may be causally related to both the centralisation into overcrowded departments and the improved outside hospital treatment of COPD, also demonstrated in this study....

  10. Time from first presentation of symptoms in primary care until diagnosis of cancer: Association with mortality

    DEFF Research Database (Denmark)

    Tørring, Marie Louise

    association was reverse, although not statistically significant. The thesis demonstrates how confounding by indication hampers the epidemiological study design by masking the actual effect of delay. For obvious clinical reasons, doctors respond faster to patients who are clinically very sick and have clear...... than other patients. Some studies illustrating this paradox take the results to show no association and find them reassuring. The aim of this thesis was to validly identify an underlying relation between delayed diagnosis and mortality by exploring the association between time from first presentation...... of symptoms in primary care to diagnosis (the diagnostic interval) and mortality after diagnosis of cancer. The empirical part of the thesis consists of three papers based on data from two Danish and one British population-based study. In Paper I, we analyse the association between the length of...

  11. Variable time-delay estimation for anesthesia control during intensive care.

    Science.gov (United States)

    Ionescu, Clara M; Hodrea, Ramona; De Keyser, Robin

    2011-02-01

    The presence of artifacts plays a crucial role in automatic sedation systems and may introduce variable time delays (TDs) in the closed-loop-control structures. This paper presents a successful procedure to estimate the varying TD of the bispectral index (BIS) monitor used in closed-loop control during intensive care. The TD estimation (TDE) is based on the cross-correlation analysis technique and the method is validated with real measured signals of propofol and BIS. Extended prediction self-adaptive control is used in combination with a Smith predictor to reduce the computational burden imposed by the variable TD. The conclusion is that an online TDE of the BIS monitor improves the performance of the closed-loop system for reference tracking, disturbance rejection, and overall stability. PMID:20959260

  12. Parent adjustment over time in gay, lesbian, and heterosexual parent families adopting from foster care.

    Science.gov (United States)

    Lavner, Justin A; Waterman, Jill; Peplau, Letitia Anne

    2014-01-01

    Although increasing numbers of gay and lesbian individuals and couples are adopting children, gay men and lesbian women continue to face increased scrutiny and legal obstacles from the child welfare system. To date, little research has compared the experiences of gay or lesbian and heterosexual adoptive parents over time, limiting conceptual understandings of the similarities they share and the unique challenges that gay and lesbian adoptive parents may face. This study compared the adoption satisfaction, depressive symptoms, parenting stress, and social support at 2, 12, and 24 months postplacement of 82 parents (60 heterosexual, 15 gay, 7 lesbian) adopting children from foster care in Los Angeles County. Few differences were found between heterosexual and gay or lesbian parents at any of the assessments or in their patterns of change over time. On average, parents in both household types reported significant increases in adoption satisfaction and maintained low, nonclinical levels of depressive symptoms and parenting stress over time. Across all family types, greater parenting stress was associated with more depressive symptoms and lower adoption satisfaction. Results indicated many similarities between gay or lesbian and heterosexual adoptive parents, and highlight a need for services to support adoptive parents throughout the transition to parenthood to promote their well-being. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24826826

  13. A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

    Science.gov (United States)

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

    2013-01-01

    There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics. PMID:23903937

  14. [The significance of early evaluation of outpatient integrated care in psychiatry taking patients' waiting time as an example].

    Science.gov (United States)

    Hausen, Anita; Glaeske, Gerd

    2014-03-01

    Quality indicators are widely used instruments of quality assurance measures to illustrate/document/take on record output variables. We here want to review and discuss the significance of quality indicators in outpatient integrated psychiatric care. Taking patient waiting time as an example, we want to discuss the challenges and difficulties to make clear statements about achievements in outpatient psychiatric care, and what parameters determine (or temper) these results and statements. As a conclusion, we strongly suggest early evaluation in the implementation of new ways and structures of patient care to prevent adverse outcomes by deficient or erroneous use of quality indicators. PMID:24089314

  15. Prothrombin fragment 1+2 in urine as an indicator of sustained coagulation activation after total hip arthroplasty

    DEFF Research Database (Denmark)

    Borris, L.C.; Breindahl, M.; Ryge, C.;

    2007-01-01

    Purpose: Prothrombin fragment 1 + 2 measured in spot urine (uF1 + 2) is an indicator of thrombin generation. We examined whether measured levels of uF1 + 2 can be used to differentiate between patients who do and do not acquire sustained coagulation activation after total hip arthroplasty (THA). ...... patients (8.8%) in the second study suffered VTC or death, assumed to be caused by a coagulation problem. Analysis of variance revealed the following statistically significant associations: pre- vs. postoperative tog uF1 + 2 Levels (P...

  16. Chromogenic assay for the prothrombin activator ecarin from the venom of the saw-scaled viper (Echis carinatus).

    Science.gov (United States)

    Stocker, K; Fischer, H; Brogli, M

    1986-01-01

    Ecarin, by limited proteolysis and subsequent autocatalytic reactions, causes the conversion of prothrombin into three products with amidolytic activity: meizothrombin, meizothrombin 1 and lpha-thrombin. Ecarin action may be abolished by ethylenediaminetetraacetic acid and the activity of alpha-thrombin can, with a high degree of selectivity, be inhibited by heparin. Thus, ecarin potency may be assayed by measuring the meizothrombin activity generated by ecarin action on human plasma in the presence of heparin. The chromogenic substrate Tosyl-glycyl-L-prolyl-L-arginine-p-nitroanilide (Chromozym TH) is used in this assay. PMID:3082039

  17. Retirement timing of women and the role of care responsibilities for grandchildren.

    Science.gov (United States)

    Lumsdaine, Robin L; Vermeer, Stephanie J C

    2015-04-01

    This article considers the potential relationship between providing care for grandchildren and retirement, among women nearing retirement age. Using 47,444 person-wave observations from the Health and Retirement Study (HRS), we find that the arrival of a new grandchild is associated with more than an 8 % increase in the retirement hazard despite little overall evidence of a care/retirement interaction. We document that although family characteristics seem to be the most important factors driving the care decision, they are also important determinants of retirement. In contrast, although financial incentives such as pensions and retiree health insurance have the largest influence on retirement, the opportunity cost associated with outside income seems to have little effect on whether a grandmother provides care. There is little evidence of substitution between caring for grandchildren versus providing care for elderly parents or engaging in volunteer activities; grandchild care is instead taken on as an additional responsibility. Our findings suggest that policies aimed at prolonging work life may need to consider grandchild care responsibilities as a countervailing factor, while those policies focused on grandchild care may also affect elderly labor force participation. PMID:25828723

  18. Inhibition of prothrombin kringle-2-induced inflammation by minocycline protects dopaminergic neurons in the substantia nigra in vivo.

    Science.gov (United States)

    Nam, Jin Han; Leem, Eunju; Jeon, Min-Tae; Kim, Young-Je; Jung, Un Ju; Choi, Myung-Sook; Maeng, Sungho; Jin, Byung Kwan; Kim, Sang Ryong

    2014-05-01

    Prothrombin kringle-2 (pKr-2), a domain of prothrombin, can cause the degeneration of mesencephalic dopaminergic neurons through microglial activation. However, the chemical products that inhibit pKr-2-induced inflammatory activities in the brain are still not well known. The present study investigated whether minocycline, a semisynthetic tetracycline derivative, could inhibit pKr-2-induced microglial activation and prevent the loss of nigral dopaminergic (DA) neurons in vivo. To address this question, rats were administered a unilateral injection of pKr-2 in the substantia nigra in the presence or absence of minocycline. Our results show that pKr-2 induces the production of proinflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), and inducible nitric oxide synthase from the activated microglia. In parallel, 7 days after pKr-2 injection, tyrosine hydroxylase immunocytochemical analysis and western blot analysis showed a significant loss of nigral DA neurons. This neurotoxicity was antagonized by minocycline and the observed neuroprotective effects were associated with the ability of minocycline to suppress the expression of tumor necrosis factor-α, interleukin-1β, and nitric oxide synthase. These results suggest that minocycline may be promising as a potential therapeutic agent for the prevention of DA neuronal degeneration associated with pKr-2-induced microglial activation. PMID:24488033

  19. "I Have to Rest All the Time Because You Are Not Allowed to Play": Exploring Children's Perceptions of Autonomy during Sleep-Time in Long Day Care Services

    Science.gov (United States)

    Nothard, Michaela; Irvine, Susan; Theobald, Maryanne; Staton, Sally; Pattinson, Cassandra; Thorpe, Karen

    2015-01-01

    Daytime sleep is a significant part of the daily routine for children attending early childhood education and care (ECEC) services in Australia and many other countries. The practice of sleep-time can account for a substantial portion of the day in ECEC and often involves a mandated sleep/rest period for all children, including older…

  20. A Time and Place: The Role of Social Workers in Improving End-of-Life Care.

    Science.gov (United States)

    Peres, Judith

    2016-01-01

    Americans are living longer, but dying after a prolonged period of management of multiple chronic illnesses and functional disabilities. Despite waves of public and professional activity targeted toward improving care for the dying and supporting the families, gaps in care and challenges in end-of-life care persist. Contentious issues such as the so-called "death panels" or physician payment for discussion of advance directives and care wishes at the end of life; aid in dying; and regarding individuals who actively choose death (case of Brittney Maynard) are continually debated in the public media. Progress toward improvement in the experience of dying remains incremental and change has been slow. With the release of a second Institute of Medicine ( 2014 ) report devoted to what it means to die in America in the 21st century, momentum and opportunity for change may increase. If this is to happen, social workers will need to deliver the range of biopsychosocial care that patients and families so desperately need. However, holistic care of the individual will only improve, if the nation also addresses ongoing systemic problems in financing, policy, and service delivery in end-of-life care. PMID:27462948

  1. The health-care manager's guide to managing change in challenging times.

    Science.gov (United States)

    Lombardi, D N

    1996-01-01

    Fifteen years ago, Bill Gates was a college dropout working for a four-member, fledgling company in New Mexico. Today, he is the richest man in America and the head of perhaps the most powerful company in recent corporate history. Ten years ago, managed health care was merely a concept discussed in academic and industry observer circles. Now it is a norm in almost every health-care organization nationally. Five years ago, health-care professionals in every discipline believed the maxim that, ¿as long as people get sick, health-care professionals will have jobs.¿ In 1995, health-care executives have alternately referred to the widescale process of laying off employees as reengineering, rightsizing, downsizing, or RIF (reduction in force). With this massive amount of change, both societally and professionally, health-care managers have been contending with the change management process. Although a breadth of concepts borrowed from other industries and a plethora of conceptual practicums have entered the health-care educational realm, a straightforward, immediately useful approach to managing change is probably more beneficial, as the need to manage change quickly and effectively becomes the paramount criterion for health-care management success in the second half of this decade of change. In this article we will explore the four areas where mistakes are made most frequently by leaders in the change process, and we will provide specific strategies to not only avoid these mistakes but moreover reduce resistance to change, activate positive action, and ultimately improve performance through optimum staff contribution. The four critical areas we will explore are the reasons for resistance to change, the management of the proactive phase of change, creating staff interdependence, and key leadership roles for change management. PMID:10154378

  2. Intravenous artesunate reduces parasite clearance time, duration of intensive care, and hospital treatment in patients with severe malaria in Europe

    DEFF Research Database (Denmark)

    Kurth, Florian; Develoux, Michel; Mechain, Matthieu; Clerinx, Jan; Antinori, Spinello; Gjørup, Ida E; Gascon, Joaquím; Mørch, Kristine; Nicastri, Emanuele; Ramharter, Michael; Bartoloni, Alessandro; Visser, Leo; Rolling, Thierry; Zanger, Philipp; Calleri, Guido; Salas-Coronas, Joaquín; Nielsen, Henrik Ib; Just-Nübling, Gudrun; Neumayr, Andreas; Hachfeld, Anna; Schmid, Matthias L; Antonini, Pietro; Pongratz, Peter; Kern, Peter; Saraiva da Cunha, José; Soriano-Arandes, Antoni; Schunk, Mirjam; Suttorp, Norbert; Hatz, Christoph; Zoller, Thomas

    2015-01-01

    Intravenous artesunate improves survival in severe malaria, but clinical trial data from nonendemic countries are scarce. The TropNet severe malaria database was analyzed to compare outcomes of artesunate vs quinine treatment. Artesunate reduced parasite clearance time and duration of intensive...... care unit and hospital treatment in European patients with imported severe malaria....

  3. Parental self-feeding effects on parental care levels and time allocation in Palestine sunbirds.

    Directory of Open Access Journals (Sweden)

    Shai Markman

    Full Text Available The trade-off between parents feeding themselves and their young is an important life history problem that can be considered in terms of optimal behavioral strategies. Recent studies on birds have tested how parents allocate the food between themselves and their young. Until now the effect of food consumption by parent birds on their food delivery to their young as well as other parental activities has rarely been studied. I have previously shown that parent Palestine sunbirds (Nectarinia osea will consume nectar and liquidized arthropods from artificial feeders. However, they will only feed their young with whole arthropods. This provided a unique opportunity to experimentally manipulate the food eaten by parents independent of that fed to their offspring. Here, I hypothesized that parents invest in their current young according to the quality of food that they themselves consume. Breeding pairs with two or three nestlings were provided with feeders containing water (control, sucrose solution (0.75 mol or liquidized mealworms mixed with sucrose solution (0.75 mol. As food quality in feeders increased (from water up to liquidized mealworms mixed with sucrose solution: 1 Parents (especially females increased their food delivery of whole arthropod prey to their young. 2 Only males increased their nest guarding effort. Nestling food intake and growth rate increased with increasing food quality of parents and decreasing brood size. These results imply that increasing the nutrient content of foods consumed by parent sunbirds allow them to increase the rate at which other foods are delivered to their young and to increase the time spent on other parental care activities.

  4. The role of triage to reduce long waiting times in primary health care clinics / Anna-Therese Swart

    OpenAIRE

    Swart, Anna-Therese

    2014-01-01

    Worldwide, patients who visit health-care facilities generally have to wait very long to be attended by physicians and professional nurses. In South Africa, the Cape Triage Score system was implemented with great success in Emergency departments in the Cape Metropole. In primary health-care clinics the concern is that patients have to wait too long for service delivery, even if they are very ill and need hospitalisation. In this research study the role of triage in reducing waiting times in p...

  5. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T

    DEFF Research Database (Denmark)

    Simone, Benedetto; De Stefano, Valerio; Leoncini, Emanuele;

    2013-01-01

    Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes ha...

  6. Urinary Prothrombin Fragment 1+2 in relation to Development of Non-Symptomatic and Symptomatic Venous Thromboembolic Events following Total Knee Replacement

    DEFF Research Database (Denmark)

    Borris, Lars Carl; Breindahl, Morten; Rud-Lassen, Michael;

    2011-01-01

    Prothrombin fragment 1+2 is excreted in urine (uF1+2) as a result of in vivo thrombin generation and can be a marker of coagulation status after an operative procedure. This study compared uF1+2 levels in patients with symptomatic and non-symptomatic venous thromboembolism (VTE) after total knee ...

  7. Evaluation design of New York City's regulations on nutrition, physical activity, and screen time in early child care centers.

    Science.gov (United States)

    Breck, Andrew; Goodman, Ken; Dunn, Lillian; Stephens, Robert L; Dawkins, Nicola; Dixon, Beth; Jernigan, Jan; Kakietek, Jakub; Lesesne, Catherine; Lessard, Laura; Nonas, Cathy; O'Dell, Sarah Abood; Osuji, Thearis A; Bronson, Bernice; Xu, Ye; Kettel Khan, Laura

    2014-01-01

    This article describes the multi-method cross-sectional design used to evaluate New York City Department of Health and Mental Hygiene's regulations of nutrition, physical activity, and screen time for children aged 3 years or older in licensed group child care centers. The Center Evaluation Component collected data from a stratified random sample of 176 licensed group child care centers in New York City. Compliance with the regulations was measured through a review of center records, a facility inventory, and interviews of center directors, lead teachers, and food service staff. The Classroom Evaluation Component included an observational and biometric study of a sample of approximately 1,400 children aged 3 or 4 years attending 110 child care centers and was designed to complement the center component at the classroom and child level. The study methodology detailed in this paper may aid researchers in designing policy evaluation studies that can inform other jurisdictions considering similar policies. PMID:25321635

  8. Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV

    Science.gov (United States)

    Momplaisir, Florence M.; Brady, Kathleen A.; Fekete, Thomas; Thompson, Dana R.; Diez Roux, Ana; Yehia, Baligh R.

    2015-01-01

    Background HIV suppression at parturition is beneficial for maternal, fetal and public health. To eliminate mother-to-child transmission of HIV, an understanding of missed opportunities for antiretroviral therapy (ART) use during pregnancy and HIV suppression at delivery is required. Methodology We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013. Multivariable regression examined associations between patient (age, race/ethnicity, insurance status, drug use) and clinical factors such as adequacy of prenatal care measured by the Kessner index which classifies prenatal care as inadequate, intermediate, or adequate prenatal care; timing of HIV diagnosis; and the outcomes: receipt of ART during pregnancy and viral suppression at delivery. Results Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care. Eight-five percent of mother-to-child pairs received ART during pregnancy but only 52% achieved suppression at delivery. Adjusting for patient factors, pairs diagnosed with HIV during pregnancy were less likely to receive ART (AOR 0.39, 95% CI 0.25-0.61) and achieve viral suppression (AOR 0.70, 95% CI 0.49-1.00) than those diagnosed before pregnancy. Similarly, women with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03-0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20-0.47) than those with adequate prenatal care. Conclusions Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period. PMID:26132142

  9. Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics

    Directory of Open Access Journals (Sweden)

    Fermo JD

    2009-12-01

    Full Text Available Until recently, Prothrombin Time/International Normalized Ratio (PT/INR measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory. Objective: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT device versus venipuncture within ambulatory care clinics at our institution. Methods: All patients currently treated with warfarin therapy who were managed by clinical pharmacists for anticoagulation monitoring at the Medical University of South Carolina (MUSC Family Medicine Center and University Diagnostic Center, were enrolled. Patients were asked to complete a satisfaction survey regarding their anticoagulation monitoring. In addition, data related to emergency department (ED visits, hospitalizations and percent of time in the INR therapeutic range for 6 months pre- and post-implementation of POCT device was collected. This information was obtained through an electronic patient information database, Oacis. Results: A total of 145 patients were included in the data collection from the two clinics. The majority (41% of these patients were taking warfarin for atrial fibrillation. Satisfaction surveys were completed by 86 (59 % of patients. The surveys revealed that POCT device was preferred over venipuncture in 95% of patients. Reasons for the preference included more face-to-face interaction, less wait time, less pain, less blood needed, and quicker results. Of the 145 patients who were included in the objective data analysis, no significant differences were found in the number of hospitalizations, ED visits, or percent of time in the INR therapeutic range pre- and post- implementation of POCT device

  10. Cloning of a prothrombin activator-like metalloproteinase from the West African saw-scaled viper, Echis ocellatus.

    Science.gov (United States)

    Hasson, S S; Theakston, R D G; Harrison, R A

    2003-11-01

    Systemic envenoming by the saw-scaled viper, Echis ocellatus, is responsible for more deaths than any other snake in West Africa. Despite its medical importance, there have been few investigations into the toxin composition of the venom of this viper. Here we describe the isolation of E. ocellatus venom gland cDNAs encoding a protein of 514 amino acids that showed 91% sequence similarity to Ecarin, a prothrombin-activating metalloproteinase from the venom of the East African viper, E. pyramidum leakeyi, that induces severe consumption coagulopathy. Structural similarities between the E. ocellatus metalloproteinase and analogues in venoms of related vipers suggest that antibodies raised to phylogenetically conserved E. ocellatus metalloproteinase domains may have potential for cross-specific and cross-generic neutralisation of analogous venom toxins. PMID:14602118

  11. Prothrombin complex concentrate for reversal of vitamin K antagonist treatment in bleeding and non-bleeding patients

    DEFF Research Database (Denmark)

    Johansen, Mathias; Wikkelsø, Anne; Lunde, Jens;

    2015-01-01

    well as patients at high risk of bleeding. Evidence is lacking regarding indication, dosing, efficacy and safety. OBJECTIVES: We assessed the benefits and harms of PCC compared with fresh frozen plasma in the acute medical and surgical setting involving vitamin K antagonist-treated bleeding and non......BACKGROUND: Treatment with vitamin K antagonists is associated with increased morbidity and mortality. Reversal therapy with prothrombin complex concentrate (PCC) is used increasingly and is recommended in the treatment of patients with bleeding complications undertaking surgical interventions, as......-bleeding patients. We investigated various outcomes and predefined subgroups and performed sensitivity analysis. We examined risks of bias and applied trial sequential analyses (TSA) to examine the level of evidence, and we prepared a 'Risk of bias' table to test the quality of the evidence. SEARCH METHODS: We...

  12. Phenotypic presentation of thrombophilia in double heterozygote for factor v leiden and prothrombin 20210 G>A mutations: Case report

    Directory of Open Access Journals (Sweden)

    Nagorni-Obradović Ljudmila

    2014-01-01

    Full Text Available Physicians usually do not suspect pulmonary thromboembolism in younger patients except in those who have thrombophilia. In those latter patients some special conditions such as trauma or surgery may provoke the disease. In some adult persons, thrombophilia may still remain unrecognized, until appearance of additional conditions influence development of thrombosis. A 55-year-old Caucasian female, non-smoker, experienced sudden chest pain and hemoptysis without chest trauma. History taking revealed type 2 diabetes mellitus and hypothyroidism. She was overweight with body mass index 29.0. The review of the family history revealed that her father and mother died of brain infarction, while her 22-year-old son and 24-year-old daughter were healthy. Due to suspicion for thrombosis, multi-slice computerized tomography thorax scan was done and pulmonary embolism was diagnosed. Although without clear risk factor for thrombosis in our patient, we performed laboratory investigation for congenital thrombophilia. Genetic analysis showed double heterozygous for factor V Leiden and prothrombin 20210 G>A mutations. Congenital thrombophilia was risk factor for thrombosis in our patient but haemostatic imbalance was not previously clinically recognized. She had two pregnancies without complications. Appearance of other associative factors such as endocrine disorders - hypothyroidism and metabolic syndrome with diabetes type 2, and overweigh were additional potential triggers for clinical manifestation of pulmonary thromboembolism in her adult age. Her children underwent genetic analysis, too. The son was also double heterozygous for factor V Leiden and prothrombin 20210 G>A mutations, while daughter was heterozygous for factor V Leiden, and none had clinical signs of thrombosis. [Projekat Ministarstva nauke Republike Srbije, br. ON175081 i br. ON 175091

  13. Time trends in the incidence of eating disorders : A primary care study in the Netherlands

    NARCIS (Netherlands)

    van Son, Gabrielle E.; van Hoeken, Daphne; Bartelds, Aad I. M.; van Furth, Eric F.; Hoek, Hans W.

    2006-01-01

    Objective: This Dutch epidemiological study used primary care-based data to examine changes in the incidence of eating disorders in the 1990s compared to the 1980s. Method: A nationwide network of general practitioners, serving a representative sample of the total Dutch population, recorded newly di

  14. Interruption Management in the Intensive Care Unit: Predicting Resumption Times and Assessing Distributed Support

    Science.gov (United States)

    Grundgeiger, Tobias; Sanderson, Penelope; MacDougall, Hamish G.; Venkatesh, Balasubramanian

    2010-01-01

    Interruptions are frequent in many work domains. Researchers in health care have started to study interruptions extensively, but their studies usually do not use a theoretically guided approach. Conversely, researchers conducting theoretically rich laboratory studies on interruptions have not usually investigated how effectively their findings…

  15. Do we care about sustainability? An analysis of time sensitivity of social preferences under environmental time-persistent effects.

    Science.gov (United States)

    Faccioli, Michela; Hanley, Nick; Torres, Cati; Font, Antoni Riera

    2016-07-15

    Environmental cost-benefit analysis has traditionally assumed that the value of benefits is sensitive to their timing and that outcomes are valued higher, the sooner in time they occur following implementation of a project or policy. Though, this assumption might have important implications especially for the social desirability of interventions aiming at counteracting time-persistent environmental problems, whose impacts occur in the long- and very long-term, respectively involving the present and future generations. This study analyzes the time sensitivity of social preferences for preservation policies of adaptation to climate change stresses. Results show that stated preferences are time insensitive, due to sustainability issues: individuals show insignificant differences in benefits they can experience within their own lifetimes compared to those which occur in the longer term, and which will instead be enjoyed by future generations. Whilst these results may be specific to the experimental design employed here, they do raise interesting questions regarding choices over time-persistent environmental problems, particularly in terms of the desirability of interventions which produce longer-term benefits. PMID:27123670

  16. How much time do health services spend on antenatal care? Implications for the introduction of the focused antenatal care model in Tanzania

    Directory of Open Access Journals (Sweden)

    Mpembeni Rose

    2006-06-01

    Full Text Available Abstract Background Antenatal care (ANC is a widely used strategy to improve the health of pregnant women and to encourage skilled care during childbirth. In 2002, the Ministry of Health of the United Republic of Tanzania developed a national adaptation plan based on the new model of the World Health Organisation (WHO. In this study we assess the time health workers currently spent on providing ANC services and compare it to the requirements anticipated for the new ANC model in order to identify the implications of Focused ANC on health care providers' workload. Methods Health workers in four dispensaries in Mtwara Urban District, Southern Tanzania, were observed while providing routine ANC. The time used for the overall activity as well as for the different, specific components of 71 ANC service provisions was measured in detail; 28 of these were first visits and 43 revisits. Standard time requirements for the provision of focused ANC were assessed through simulated consultations based on the new guidelines. Results The average time health workers currently spend for providing ANC service to a first visit client was found to be 15 minutes; the provision of ANC according to the focused ANC model was assessed to be 46 minutes. For a revisiting client the difference between current practise and the anticipated standard of the new model was 27 minutes (9 vs. 36 min.. The major discrepancy between the two procedures was related to counselling. On average a first visit client was counselled for 1:30 minutes, while counselling in revisiting clients did hardly take place at all. The simulation of focused ANC revealed that proper counselling would take about 15 minutes per visit. Conclusion While the introduction of focused ANC has the potential to improve the health of pregnant women and to raise the number of births attended by skilled staff in Tanzania, it may need additional investment in human resources. The generally anticipated saving effect of

  17. Stop the hunting: using a wound care-specific EMR for 'just-in-time" supply ordering.

    Science.gov (United States)

    Turner, Toni; Walker, David

    2007-01-01

    Ensuring adequate stocks of wound care supplies at wound care to be tied up, and too little can cause problems for patients. Most facilities maintain a "par" level for each item, which requires that supplies be ordered even if the "par" is numerically short by one item. In addition, due to the current just-in-time environment, if attention is not paid to the par level, unexpected shortages of supplies can develop. By using Inventory Trak software developed by Intellicure, facility managers will always know how much stock is presentfor each item, as individual item barcodes are registered in the system each time an item is used through software-linking scanners. The result is increased efficiency, reduced cost to the facility, and an assurance that the facility will not run out of critical items. PMID:18225821

  18. Treatment outcome and factors affecting time to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program

    OpenAIRE

    Mengesha, Melkamu Merid; Deyessa, Negussie; Tegegne, Balewgizie Sileshi; Dessie, Yadeta

    2016-01-01

    Background: The outpatient therapeutic care program (OTP) of children with severe acute malnutrition (SAM) has been decentralized to health post level in Ethiopia since 2008–2009. However, there is a lack of evidence regarding treatment outcomes and factors related to the duration of stay on treatment after its decentralization to health post level.Objective: This study was aimed to assess treatment outcome and factors affecting time to recovery in children with SAM treated at OTP.Design: Hea...

  19. Factors affecting attendance at and timing of formal antenatal care: results from a qualitative study in Madang, Papua New Guinea.

    Directory of Open Access Journals (Sweden)

    Erin V W Andrew

    Full Text Available BACKGROUND: Appropriate antenatal care (ANC is key for the health of mother and child. However, in Papua New Guinea (PNG, only a third of women receive any ANC during pregnancy. Drawing on qualitative research, this paper explores the influences on ANC attendance and timing of first visit in the Madang region of Papua New Guinea. METHODS: Data were collected in three sites utilizing several qualitative methods: free-listing and sorting of terms and definitions, focus group discussions, in-depth interviews, observation in health care facilities and case studies of pregnant women. Respondents included pregnant women, their relatives, biomedical and traditional health providers, opinion leaders and community members. RESULTS: Although generally reported to be important, respondents' understanding of the procedures involved in ANC was limited. Factors influencing attendance fell into three main categories: accessibility, attitudes to ANC, and interpersonal issues. Although women saw accessibility (distance and cost as a barrier, those who lived close to health facilities and could easily afford ANC also demonstrated poor attendance. Attitudes were shaped by previous experiences of ANC, such as waiting times, quality of care, and perceptions of preventative care and medical interventions during pregnancy. Interpersonal factors included relationships with healthcare providers, pregnancy disclosure, and family conflict. A desire to avoid repeat clinic visits, ideas about the strength of the fetus and parity were particularly relevant to the timing of first ANC visit. CONCLUSIONS: This long-term in-depth study (the first of its kind in Madang, PNG shows how socio-cultural and economic factors influence ANC attendance. These factors must be addressed to encourage timely ANC visits: interventions could focus on ANC delivery in health facilities, for example, by addressing healthcare staff's attitudes towards pregnant women.

  20. Timing of antenatal care and ART initiation in HIV-infected pregnant women before and after introduction of NIMART

    Directory of Open Access Journals (Sweden)

    Coceka Nandipha Mnyani

    2014-05-01

    Full Text Available In this review of routinely collected data from five community health centres in the Johannesburg Health District, we assess timing of antenatal care and antiretroviral therapy (ART initiation in HIV-infected pregnant women before and after the introduction of nurse-initiated management of ART in antenatal clinics. There are important lessons to be learnt as we reflect on the South African prevention of mother-to-child transmission of HIV programme.

  1. Is it time to use checklists in mental health care auditing?

    Directory of Open Access Journals (Sweden)

    Jacob Polackiewicz

    2011-02-01

    Full Text Available A key strategy for improving the quality of mental health care is the design and implementation of a mechanism for on-site inspection and clinical auditing. We discuss the use of checklists in auditing providing an objective, comprehensive system for recording and analyzing multi-disciplinary, clinical auditing in mental health services. We believe such an approach can identify potential risks and allow for better decision making.

  2. Is it time to use checklists in mental health care auditing?

    Science.gov (United States)

    Abramowitz, Moshe Z.; Polackiewicz, Jacob; Grinshpoon, Alexander

    2011-01-01

    A key strategy for improving the quality of mental health care is the design and implementation of a mechanism for on-site inspection and clinical auditing. We discuss the use of checklists in auditing providing an objective, comprehensive system for recording and analyzing multi-disciplinary, clinical auditing in mental health services. We believe such an approach can identify potential risks and allow for better decision making. PMID:25478101

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

    Directory of Open Access Journals (Sweden)

    Green T

    2014-01-01

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

  4. Patient-Reported Experiences with First-Time Naturopathic Care for Type 2 Diabetes

    OpenAIRE

    Oberg, Erica B.; Ryan Bradley; Clarissa Hsu; Sherman, Karen J.; Sheryl Catz; Carlo Calabrese; Cherkin, Daniel C.

    2012-01-01

    Differences in the effectiveness of diverse healthcare providers to promote health behavior change and successful diabetes self-care have received little attention. Because training in naturopathic medicine (NM) emphasizes a patient-centered approach, health promotion, and routine use of clinical counseling on wellness and prevention, naturopathic physicians (NDs) may be particularly well-prepared for promoting behavior change. However, patients' experiences with NM have not been well studied...

  5. Do Time in Child Care and Peer Group Exposure Predict Poor Socioemotional Adjustment in Norway?

    Science.gov (United States)

    Solheim, Elisabet; Wichstrøm, Lars; Belsky, Jay; Berg-Nielsen, Turid Suzanne

    2013-01-01

    Extensive exposure to nonparental child care during the first 4.5 years of life has been demonstrated in some American studies to negatively affect children's socioemotional functioning. Data from 935 preschool children who averaged 54.9 (SD = 3.0) months of age, from Trondheim, Norway were used to examine whether such negative effects, would…

  6. Reporting time of ischemic stroke patients within the time window for thrombolysis in a tertiary care hospital at rawalpindi

    International Nuclear Information System (INIS)

    To determine the reporting time of ischemic stroke patients within the time window for thrombolysis at Military Hospital (MH) Rawalpindi. Design: A descriptive study. Place and duration of Study: Military Hospital Rawalpindi over a period of four months from Dec 2013 to Mar 2014. Patients and Methods: Patients admitted to MH Rawalpindi with symptoms suggestive of stroke and having objective focal neurologic deficits consistent with stroke were included in the study. A CT scan of brain was carried out immediately to rule out intracranial bleed. The CT scan of brain was either normal or revealed radiological findings suggestive of an infarct. Results: A total of 86 patients met the inclusion criteria of the study. Only 19 (22%) patients with ischemic stroke presented to the hospital within 4.5 hours after onset of their symptoms. Conclusion: Only a small number of ischemic stroke patients report to the hospital within the therapeutic window for thrombolytic therapy. (author)

  7. Arrival time pattern and waiting time distribution of patients in the emergency outpatient department of a tertiary level health care institution of North India

    Directory of Open Access Journals (Sweden)

    Yogesh Tiwari

    2014-01-01

    Full Text Available Background: Emergency Department (ED of tertiary health care institute in India is mostly overcrowded, over utilized and inappropriately staffed. The challenges of overcrowded EDs and ill-managed patient flow and admission processes result in excessively long waits for patients. Aim: The objective of the present study was to analyze the patient flow system by assessing the arrival and waiting time distribution of patients in an Emergency out Patient Department (EOPD. Materials and Methods: This short cross-sectional descriptive study was conducted in the EOPD of a Tertiary level health care Institution in North India in the month of May, 2011. The data was obtained from 591 patients, who were present in the EOPD during the month of May, 2011. The waiting time, inter arrival time between two consecutive patients were calculated in addition to the daily census data (discharge rate, admission rate and transfer out rates etc. of the emergency. Results: Arrival time pattern of patients in the EOPD was highly stochastic with the peak arrival hours to be "9.00-12.00 h" in which around 26.3% patients arrived in the EOPD. The primary waiting areas of patients included patients "under observation" (29.6%; "waiting for routine diagnostic tests" (16.4% and "waiting for discharge" (14.6%. Around 71% patients were waiting due to reasons within emergency complex. Conclusion: The patient flow of the ED could only be addressed by multifaceted, multidisciplinary and hospital wide approach.

  8. Standard guidelines of care for vitiligo surgery

    Directory of Open Access Journals (Sweden)

    Parsad Davinder

    2008-03-01

    , about the possible future progression of disease and whether more procedures will be needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures and one-to-one discussions. The need for concomitant medical therapy should be emphasized and the patient should understand that proper results take time (a few months to a year. Preoperative laboratory studies include hemogram including platelet counts, bleeding and clotting time (or prothrombin and activated partial thromboplastin time, and blood chemistry profile. Screening for antibodies for hepatitis B surface antigen and HIV is recommended depending on individual requirements. Anesthesia: Lignocaine (2% with or without adrenaline is generally used for anesthesia; infiltration and nerve block anesthesia are adequate in most cases. General anesthesia may be needed in patients with extensive lesions. Postoperative care: Proper postoperative immobilization and care are very important to obtain satisfactory results.

  9. Plasma lipids and prothrombin time in rats fed palm oil and other commonly used fats in Egypt

    OpenAIRE

    Hussein, Mona M.; Salama, Fawzy M.; Ebada, Karina M.

    1993-01-01

    Sprague-Dawley rats were fed for a total period of 8 weeks on six diets that were different in the source of their fat content. The fat content was provided either, palm oil or palm olein or corn oil or hydrogenated fat, or frying palm oil and mixture of corn oil + hydrogenated fat in the ratio (1:1). The latter was given to the control group. Animals fed these various experimental diets showed statistically significant differences in serum cholesterol and serum triglycerides content amo...

  10. Measuring Quality Improvement in Acute Ischemic Stroke Care: Interrupted Time Series Analysis of Door-to-Needle Time

    Directory of Open Access Journals (Sweden)

    Anne Margreet van Dishoeck

    2014-06-01

    Full Text Available Background: In patients with acute ischemic stroke, early treatment with recombinant tissue plasminogen activator (rtPA improves functional outcome by effectively reducing disability and dependency. Timely thrombolysis, within 1 h, is a vital aspect of acute stroke treatment, and is reflected in the widely used performance indicator ‘door-to-needle time' (DNT. DNT measures the time from the moment the patient enters the emergency department until he/she receives intravenous rtPA. The purpose of the study was to measure quality improvement from the first implementation of thrombolysis in stroke patients in a university hospital in the Netherlands. We further aimed to identify specific interventions that affect DNT. Methods: We included all patients with acute ischemic stroke consecutively admitted to a large university hospital in the Netherlands between January 2006 and December 2012, and focused on those treated with thrombolytic therapy on admission. Data were collected routinely for research purposes and internal quality measurement (the Erasmus Stroke Study. We used a retrospective interrupted time series design to study the trend in DNT, analyzed by means of segmented regression. Results: Between January 2006 and December 2012, 1,703 patients with ischemic stroke were admitted and 262 (17% were treated with rtPA. Patients treated with thrombolysis were on average 63 years old at the time of the stroke and 52% were male. Mean age (p = 0.58 and sex distribution (p = 0.98 did not change over the years. The proportion treated with thrombolysis increased from 5% in 2006 to 22% in 2012. In 2006, none of the patients were treated within 1 h. In 2012, this had increased to 81%. In a logistic regression analysis, this trend was significant (OR 1.6 per year, CI 1.4-1.8. The median DNT was reduced from 75 min in 2006 to 45 min in 2012 (p Conclusion and Implications: The DNT steadily improved from the first implementation of thrombolysis. Specific

  11. Parental child care in single parent, cohabiting, and married couple families: time diary evidence from the United States and the United Kingdom

    OpenAIRE

    Kalenkoski, Charlene Marie; Ribar, David C.; Stratton, Leslie Sundt

    2006-01-01

    This study uses time diary data from the 2003 American Time Use Survey and the United Kingdom Time Use Survey 2000 to examine the time that single, cohabiting, and married parents devote to caring for their children. Time spent in market work, in child care as a primary activity, and in child care as a passive activity are jointly modeled using a correlated, censored regression model. Separate estimates are provided by gender, by country, and by weekend/weekday day. We find no evidence that t...

  12. The impact of case mix on timely access to appointments in a primary care group practice.

    Science.gov (United States)

    Ozen, Asli; Balasubramanian, Hari

    2013-06-01

    At the heart of the practice of primary care is the concept of a physician panel. A panel refers to the set of patients for whose long term, holistic care the physician is responsible. A physician's appointment burden is determined by the size and composition of the panel. Size refers to the number of patients in the panel while composition refers to the case-mix, or the type of patients (older versus younger, healthy versus chronic patients), in the panel. In this paper, we quantify the impact of the size and case-mix on the ability of a multi-provider practice to provide adequate access to its empanelled patients. We use overflow frequency, or the probability that the demand exceeds the capacity, as a measure of access. We formulate problem of minimizing the maximum overflow for a multi-physician practice as a non-linear integer programming problem and establish structural insights that enable us to create simple yet near optimal heuristic strategies to change panels. This optimization framework helps a practice: (1) quantify the imbalances across physicians due to the variation in case mix and panel size, and the resulting effect on access; and (2) determine how panels can be altered in the least disruptive way to improve access. We illustrate our methodology using four test practices created using patient level data from the primary care practice at Mayo Clinic, Rochester, Minnesota. An important advantage of our approach is that it can be implemented in an Excel Spreadsheet and used for aggregate level planning and panel management decisions. PMID:23076360

  13. Frozen in time: life in the face of chronic care cutbacks.

    Science.gov (United States)

    Cook, K

    1999-04-01

    Kathy Cook won the $750 first prize in CMAJ's 7th Annual Amy Chouinard Memorial Essay Contest. The deadline for entries to the contest, which is designed to stimulate interest in medical writing among journalism students, is June 1. Entries should be forwarded to the news and features editor. In her winning essay, Cook explores the frustrations and quality-of-life issues that arise in a chronic care institution that is trying to operate in the midst of serious funding cuts. PMID:10207348

  14. Sleep time and pattern of adult individuals in primary care in an Asian urbanized community: A cross-sectional study.

    Science.gov (United States)

    Tan, Ngiap Chuan; Tan, Mui Suan; Hwang, Siew Wai; Teo, Chia Chia; Lee, Zhi Kang Niccol; Soh, Jing Yao Jonathan; Koh, Yi Ling Eileen; How, Choon How

    2016-08-01

    Sleep norms vary between individuals, being affected by personal, communal, and socioeconomic factors. Individuals with sleep time which deviate from the population norm are at risks of adverse mental, cardiovascular, and metabolic health. Sleep-related issues are common agenda for consultation in primary care. This study aimed to determine the sleep time, pattern, and behavior of multiethnic Asian individuals who attended public primary care clinics in an urban metropolitan city-state.Standardized questionnaires were assistant-administered to adult Asian individuals who visited 2 local public primary care clinics in north-eastern and southern regions of Singapore. The questionnaire included questions on demographic characteristics, self-reported sleep time, patterns, and behavior and those originated from the American National Sleep Foundation Sleep Diary. The data were collated, audited, rectified, and anonymized before being analyzed by the biostatistician. Individuals with 7 h sleep time or longer were deemed getting adequate sleep. Chi-squared or Fisher exact test was used to test the association between the demographic and behavioral variables and sleep time. Next, regression analysis was performed to identify key factors associated with their sleep time.A total of 350 individuals were recruited, with higher proportion of those of Chinese ethnicity reporting adequate sleep. Almost half (48.1%) of those who slept <7 h on weekdays tended to sleep ≥7 h on weekends. More individuals who reported no difficulty falling asleep, had regular sleep hours and awakening time, tended to sleep adequately. Those who slept with children, studied, read leisurely, used computer or laptops in their bedrooms, drank caffeinated beverages or smoked had inadequate sleep. Those who perceived sufficient sleep and considered 8 h as adequate sleep time had weekday and weekend sleep adequacy.Sleep time varied according to ethnicity, employment status, personal behavior, and

  15. Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Bigdeli Maryam

    2010-07-01

    Full Text Available Abstract Background Road traffic injuries (RTIs are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. Timely arrival of the Emergency Medical Service (EMS at the crash scene followed by speedy victim transportation by trained personnel may reduce the RTIs' consequences. The first 60 minutes after injury occurrence - referred to as the "golden hour"- are vital for the saving of lives. The present study was designed to estimate the average of various time intervals occurring during the pre-hospital care process and to examine the differences between these time intervals as regards RTIs on urban and interurban roads. Method A retrospective cross-sectional study was designed and various time intervals in relation to pre-hospital care of RTIs identified in the ambulance dispatch centre in Urmia, Iran from 20 March 2005 to 20 March 2007. All cases which resulted in ambulance dispatches were reviewed and those that had complete data on time intervals were analyzed. Results In total, the cases of 2027 RTI victims were analysed. Of these, 61.5 % of the subjects were injured in city areas. The mean response time for city locations was 5.0 minutes, compared with 10.6 minutes for interurban road locations. The mean on-scene time on the interurban roads was longer than on city roads (9.2 vs. 6.1 minutes, p Conclusion The response, transport and total time intervals among EMS responding to RTI incidents were longer for interurban roads, compared to the city areas. More research should take place on needs-to and access-for EMS on city and interurban roads. The notification interval seems to be a hidden part of the post-crash events and indirectly affects the "golden hour" for victim management and it needs to be measured through the establishment of the surveillance systems.

  16. Time your strategies carefully: when to communicate strategic intentions during M&A

    OpenAIRE

    Angwin, Duncan; Meadows, Maureen; Yakis-Douglas, Basak

    2013-01-01

    In competitive strategy, timing advantages are often discussed in relation to first mover and fast follower advantages, innovation cycles, imitation speed, time-based competition and hyper-competition. There is also research on the value of signalling strategic commitment in gaining strategic advantage. However, there has been little discussion about the timing, and relevance, of strategic communications in different institutional contexts. When should strategy be communicated to the wider ma...

  17. Emergency Management of Major Bleeding in a Case of Maxillofacial Trauma and Anticoagulation: Utility of Prothrombin Complex Concentrates in the Shock Room

    OpenAIRE

    Alessandro Morotti; Mauro Felice Frascisco

    2015-01-01

    Life-threatening bleeding in anticoagulation with Warfarin is an emergency challenging issue. Several approaches are available to treat bleeding in either over-anticoagulation or proper-anticoagulation, including vitamin K, fresh frozen plasma and prothrombin complex concentrates (PCC) administration. In coexisting trauma-induced bleeding and anticoagulation, reversal of anticoagulation must be a rapid and highly effective procedure. Furthermore the appropriate treatment must be directly avai...

  18. Assessing Program Efficiency: A Time and Motion Study of the Mental Health Emergency Care — Rural Access Program in NSW Australia

    OpenAIRE

    Emily Saurman; David Lyle; Sue Kirby; Russell Roberts

    2014-01-01

    The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telehealth solution providing specialist emergency mental health care to rural and remote communities across western NSW, Australia. This is the first time and motion (T&M) study to examine program efficiency and capacity for a telepsychiatry program. Clinical services are an integral aspect of the program accounting for 6% of all activities and 50% of the time spent conducting program activities, but half of this time ...

  19. Successful Use of Four Factor-Prothrombin Complex Concentrate for Congenital Factor X Deficiency in the Setting of Neurosurgery.

    Science.gov (United States)

    Siddon, Alexa J; Tormey, Christopher A

    2016-08-01

    Congenital factor X deficiency is an extremely rare coagulation disorder that can place patients at risk for spontaneous hemorrhage or excessive bleeding in the setting of trauma or invasive procedures. Given the rarity of this disorder, there is little published guidance on how best to prevent or treat bleeding. Herein, we report a case of a 56-year-old white man with congenital factor X deficiency who was scheduled for major neurosurgery and who was treated perioperatively with 4-factor prothrombin complex concentrate (4F-PCC). Doses of 4F-PCC at 15 U per kg, administered immediately preoperatively and once at 24 hours postoperatively, allowed for successful completion of an anterior cervical discectomy and fusion without excessive bleeding. Moreover, no thromboembolic complications were observed. As such, given the wide availability of 4F-PCC, it may be considered as a first-line therapy and an alternative to fresh frozen plasma for factor X deficiencies, particularly in high-risk operative cases. PMID:27378481

  20. 异常凝血酶原和肝细胞癌%Des-gamma-carboxy-prothrombin and Hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    袁联文; 唐伟; 幕内·雅敏

    2002-01-01

    目前肝细胞癌(hepatocellular carcinoma,HCC)的诊断主要有影像学诊断和血清肿瘤标志物的检测.异常凝血酶原(des-gamma-carboxy-prothrombin,DCP)又被称为PIVKA-Ⅱ(protein induced by vita-min K absence or antagonist-Ⅱ),与AFP(alpha-fetoprotein)和AFP-L3(alpha-fetoprotein L3 fraction)一样被认为是一种很有价值的肝细胞癌血清肿瘤标志物.在HCC的检测诊断上,它们之间无明显相关关系,而表现为一定的互补性,结合影像学诊断,动态观测HCC高危(肝炎、肝硬化)人群,这些血清肿瘤标志物有助于HCC的早期发现,同时对HCC的手术疗效的评价、预后的估评有着一定的指导意义.

  1. Diagnostic performance of des-γ-carboxy prothrombin (DCP) for hepatocellular carcinoma: a bivariate meta-analysis.

    Science.gov (United States)

    Gao, P; Li, M; Tian, Q B; Liu, Dian-Wu

    2012-01-01

    Serum markers are needed to be developed to specifically diagnose Hepatocellular carcinoma (HCC). Des-γ-carboxy prothrombin (DCP) is a promising tool with limited expense and widely accessibility, but the reported results have been controversial. In order to review the performance of DCP for the diagnosis of HCC, the meta-analysis was performed. After a systematic review of relevant studies, the sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR, respectively) were pooled using a bivariate meta-analysis. Potential between-study heterogeneity was explored by meta-regression model. The post-test probability and the likelihood ratio scattergram to evaluate clinical usefulness were calculated. Based on literature review of 20 publications, the overall sensitivity, specificity, PLR and NLR of DCP for the detection of HCC were 67% (95%CI, 58%-74%), 92% (95%CI, 88%-94%), 7.9 (95%CI, 5.6-11.2) and 0.36 (95%CI, 0.29-0.46), respectively. The area under the bivariate summary receiving operating characteristics curve was 0.89 (95%CI, 0.85-0.92). Significant heterogeneity was present. In conclusion, the major role of DCP is the moderate confirmation of HCC. More prospective studies of DCP are needed in future. PMID:22248272

  2. Anti-inflammatory effect of a human prothrombin fragment-2-derived peptide, NSA9, in EOC2 microglia

    International Nuclear Information System (INIS)

    Pro-inflammatory mediators, such as nitric oxide (NO), prostaglandin E2 (PGE2), and several cytokines (tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6) are responsible for central nervous system (CNS) injuries that include ischemia, Alzheimer's disease, and neural death. Inhibition of these pro-inflammatory mediators would be an effective therapy to reduce the progression of neurodegenerative diseases. In this study, we examined the anti-inflammatory effects of a human prothrombin fragment-2-derived peptide, NSA9 (NSAVQLVEN), on the production of pro-inflammatory mediators in lipopolysaccharide (LPS)-activated brain microglia. NSA9 significantly inhibited the release of NO, PGE2, and pro-inflammatory cytokines in a dose-dependent manner. Furthermore, NSA9 reduced the expression of inducible NO synthase (iNOS) and cyclooxygenase (COX)-2 mRNA and protein, which control the production of NO and PGE2, respectively. Moreover, NSA9 suppressed the LPS-induced nuclear translocation and activation of nuclear factor-κB (NF-κB). These results suggest that NSA9 strongly inhibits the pro-inflammatory responses of microglia through the modulation of NF-κB activity

  3. Communication between Health Care Professionals and Chronic Pain Patients Time to change the "Pain Game".

    Science.gov (United States)

    Lavand'Homme, Patricia

    2015-12-01

    Patient satisfaction is currently used as a comparative measure to evaluate the quality of health care programs. This seems the best way to evaluate results although an important discordance might exist between patient's perception and doctor's opinion regarding satisfactory outcome after surgery, including that after joint replacement. Pain remains a major cause of dissatisfaction for many patients. To understand the meaning of pain, i.e. "why does pain hurt" in some patients but not in other ones, and to decipher patient's pain expression is a key feature of patient-doctor communication. Questionnaires based on patient's personality traits (integrated and comprehensive reflection of psychological traits) are still underused but might help the doctors to get closer to their patients and understand them better. Besides the source of the relationship, dysfunction should not be attributed only to the person with pain, as the lack of doctors' training to capture and understand the psycho-social dimensions of pain can be pointed out too. Failure to address the psycho-social dimensions of patient's pain and suffering, a skill which relies on patients-doctor communication, represents a major socio-economic problem as it may negatively impact postoperative outcome both in terms of poor management of treatment failure and in term of poor prediction of surgical outcome. PMID:26790800

  4. Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care

    Directory of Open Access Journals (Sweden)

    Assaad Sayah

    2014-01-01

    Full Text Available We conducted a pre- and postintervention analysis to assess the impact of a process improvement project at the Cambridge Hospital ED. Through a comprehensive and collaborative process, we reengineered the emergency patient experience from arrival to departure. The ED operational changes have had a significant positive impact on all measured metrics. Ambulance diversion decreased from a mean of 148 hours per quarter before changes in July 2006 to 0 hours since April 2007. ED total length of stay decreased from a mean of 204 minutes before the changes to 132 minutes. Press Ganey patient satisfaction scores rose from the 12th percentile to the 59th percentile. ED patient volume grew by 11%, from a mean of 7,221 patients per quarter to 8,044 patients per quarter. Compliance with ED specific quality core measures improved from a mean of 71% to 97%. The mean rate of ED patients that left without being seen (LWBS dropped from 4.1% to 0.9%. Improving ED operational efficiency allowed us to accommodate increasing volume while improving the quality of care and satisfaction of the ED patients with minimal additional resources, space, or staffing.

  5. Books and reading: evidence-based standard of care whose time has come.

    Science.gov (United States)

    Zuckerman, Barry; Augustyn, Marilyn

    2011-01-01

    Reach Out and Read (ROR) is the only systematically evaluated clinical activity to promote child development in primary care used throughout the United States. The ROR intervention is straightforward: clinicians provide advice about the benefits of reading aloud, as well as directly giving books to high-risk children and parents to take home at each pediatric visit of children aged 6 months to 5 years. ROR builds upon a significant evidence base of the value of reading aloud to young children. The studies evaluating ROR from different sites from subjects from different racial backgrounds and numerous outcome measures are consistently positive. From its initial single site at Boston City Hospital in 1989, to over 4600 clinical sites in 2010, over 30 000 clinicians distributed over 6.2 million books a year to 3.9 million children across the United States. The future efforts for ROR include integrating mental health competencies found in American Academy of Pediatrics guidelines as part of residency and clinician training into the ROR paradigm, quality improvement to ensure fidelity to the intervention, and expanded pediatric clinician involvement in local early childhood/school readiness community efforts. Finally, the most important future goal is the adoption of giving advice about reading aloud and giving developmentally appropriate books to high-risk families as best practice by official bodies. PMID:21272819

  6. Right Pedagogy/Wrong Language and Caring in Times of Fear? Issues in the Schooling of Ethnic Kurdish Children in Denmark

    Science.gov (United States)

    Taylor, Shelley K.

    2009-01-01

    Cummins calls on educators to promote critical dialog during micro-interactions with students, times when students acquire knowledge and negotiate their identities. For critical dialog to flourish, educators must create caring environments. The purpose of this paper is to examine whether a discourse of caring was transmitted to ethnic Kurdish…

  7. Relationships between Young Children in Full-Time Day Care and Their Caregivers: A Qualitative Study of Parental and Caregiver Perspectives

    Science.gov (United States)

    Drugli, May Britt; Mari Undheim, Anne

    2012-01-01

    We studied the quality of caregiver-child relationships from the perspectives of parents and caregivers of young children in full-time day care. The sample consisted of 41 parents of children aged two years or younger (22 boys and 19 girls) in day care, and 35 of their caregivers. Parents and caregivers were interviewed. Parents and caregivers…

  8. 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

  9. 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.

  10. Antibody Responses against Pneumocystis jirovecii in Health Care Workers Over Time

    OpenAIRE

    Fong, Serena; Daly, Kieran R.; Tipirneni, Renuka; Leah G Jarlsberg; Djawe, Kpandja; Koch, Judy V.; Swartzman, Alexandra; Roth, Brenna; Walzer, Peter D.; Huang, Laurence

    2013-01-01

    In a previous cross-sectional study, we showed that clinical staff working in a hospital had significantly higher antibody levels than nonclinical staff to Pneumocystis jirovecii. We conducted a longitudinal study, described here, to determine whether occupation and self-reported exposure to a patient with P. jirovecii pneumonia were associated with antibody levels to P. jirovecii over time. Baseline and quarterly serum specimens were collected and analyzed by using an ELISA that targeted dif...

  11. Self-reported leisure time physical activity: a useful assessment tool in everyday health care

    Directory of Open Access Journals (Sweden)

    Rödjer Lars

    2012-08-01

    .94-4.35 and for reporting stress (men OR 3.59, 95 % CI: 2.34-5.49; women OR 1.25, 95% CI: 0.79-1.98, compared to the most active individuals, but also showed increased OR for most other risk factors analyzed above. Conclusion The self-reported PA-level according to the modernized Saltin-Grimby Physical Activity Level Scale, SGPALS, is associated with the presence of many cardiovascular risk factors, with the most inactive individuals having the highest risk factor profile, including self-reported stress. We propose that the present SGPALS may be used as an additional, simple tool in a routine risk assessment in e.g. primary care, to identify inactive individuals, with a higher risk profile.

  12. Real-time monitoring of ubiquitous wireless ECG sensor node for medical care using ZigBee

    Science.gov (United States)

    Vijayalakshmi, S. R.; Muruganand, S.

    2012-01-01

    Sensor networks have the potential to impact many aspects of medical care greatly. By outfitting patients with wireless, wearable vital sign sensors, collecting detailed real-time data on physiological status can be greatly simplified. In this article, we propose the system architecture for smart sensor platform based on advanced wireless sensor networks. An emerging application for wireless sensor networks involves their use in medical care. In hospitals or clinics, outfitting every patient with tiny, wearable wireless vital sign sensors would allow doctors, nurses and other caregivers to continuously monitor the status of their patients. In an emergency or disaster scenario, the same technology would enable medics to more effectively care for a large number of casualties. First responders could receive immediate notifications on any changes in patient status, such as respiratory failure or cardiac arrest. Wireless sensor network is a set of small, autonomous devices, working together to solve different problems. It is a relatively new technology, experiencing true expansion in the past decade. People have realised that integration of small and cheap microcontrollers with sensors can result in the production of extremely useful devices, which can be used as an integral part of the sensor nets. These devices are called sensor nodes. Today, sensor nets are used in agriculture, ecology and tourism, but medicine is the area where they certainly meet the greatest potential. This article presents a medical smart sensor node platform. This article proposes a wireless two-lead EKG. These devices collect heart rate and EKG data and relay it over a short-range (300 m) wireless network to any number of receiving devices, including PDAs, laptops or ambulance-based terminals.

  13. Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme

    OpenAIRE

    Thoonsen, Bregje; Groot, Marieke; Verhagen, Stans; van Weel, Chris; Vissers, Kris; Engels, Yvonne

    2016-01-01

    Background Palliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients’ needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient’s future, and consulted a palliative care consultant to fine-tune the care plan. We...

  14. Real-Time Processing of Continuous Physiological Signals in a Neurocritical Care Unit on a Stream Data Analytics Platform.

    Science.gov (United States)

    Bai, Yong; Sow, Daby; Vespa, Paul; Hu, Xiao

    2016-01-01

    Continuous high-volume and high-frequency brain signals such as intracranial pressure (ICP) and electroencephalographic (EEG) waveforms are commonly collected by bedside monitors in neurocritical care. While such signals often carry early signs of neurological deterioration, detecting these signs in real time with conventional data processing methods mainly designed for retrospective analysis has been extremely challenging. Such methods are not designed to handle the large volumes of waveform data produced by bedside monitors. In this pilot study, we address this challenge by building a prototype system using the IBM InfoSphere Streams platform, a scalable stream computing platform, to detect unstable ICP dynamics in real time. The system continuously receives electrocardiographic and ICP signals and analyzes ICP pulse morphology looking for deviations from a steady state. We also designed a Web interface to display in real time the result of this analysis in a Web browser. With this interface, physicians are able to ubiquitously check on the status of their patients and gain direct insight into and interpretation of the patient's state in real time. The prototype system has been successfully tested prospectively on live hospitalized patients. PMID:27165881

  15. Patients' experiences of the quality of long-term care among the elderly: comparing scores over time

    Directory of Open Access Journals (Sweden)

    Zuidgeest Marloes

    2012-01-01

    by representatives of psychogeriatric patients and by assisted-living clients. For representatives of psychogeriatric patients, the performance groups 1 and 2 ([much] below average improved significantly more than the other three groups (ω2 = 0.05. Conclusions Both hypotheses were confirmed: almost all indicator scores improved over time and long-term care organizations for the elderly with substandard performance improved more than those with a performance which was already relatively good.

  16. Timely detection of localized excess influenza activity in Northern California across patient care, prescription, and laboratory data.

    Science.gov (United States)

    Greene, Sharon K; Kulldorff, Martin; Huang, Jie; Brand, Richard J; Kleinman, Kenneth P; Hsu, John; Platt, Richard

    2011-02-28

    Timely detection of clusters of localized influenza activity in excess of background seasonal levels could improve situational awareness for public health officials and health systems. However, no single data type may capture influenza activity with optimal sensitivity, specificity, and timeliness, and it is unknown which data types could be most useful for surveillance. We compared the performance of 10 types of electronic clinical data for timely detection of influenza clusters throughout the 2007/08 influenza season in northern California. Kaiser Permanente Northern California generated zip code-specific daily episode counts for: influenza-like illness (ILI) diagnoses in ambulatory care (AC) and emergency departments (ED), both with and without regard to fever; hospital admissions and discharges for pneumonia and influenza; antiviral drugs dispensed (Rx); influenza laboratory tests ordered (Tests); and tests positive for influenza type A (FluA) and type B (FluB). Four credible events of localized excess illness were identified. Prospective surveillance was mimicked within each data stream using a space-time permutation scan statistic, analyzing only data available as of each day, to evaluate the ability and timeliness to detect the credible events. AC without fever and Tests signaled during all four events and, along with Rx, had the most timely signals. FluA had less timely signals. ED, hospitalizations, and FluB did not signal reliably. When fever was included in the ILI definition, signals were either delayed or missed. Although limited to one health plan, location, and year, these results can inform the choice of data streams for public health surveillance of influenza. PMID:21312219

  17. Prediction of Unmet Primary Care Needs for the Medically Vulnerable Post-Disaster: An Interrupted Time-Series Analysis of Health System Responses

    Directory of Open Access Journals (Sweden)

    Amy B. Martin

    2012-09-01

    Full Text Available Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.

  18. Emergency management of major bleeding in a case of maxillofacial trauma and anticoagulation: utility of prothrombin complex concentrates in the shock room

    Directory of Open Access Journals (Sweden)

    Alessandro Morotti

    2015-03-01

    Full Text Available Life-threatening bleeding in anticoagulation with Warfarin is an emergency challenging issue. Several approaches are available to treat bleeding in either over-anticoagulation or propeanticoagulation, including vitamin K, fresh frozen plasma and prothrombin complex concentrates (PCC administration. In coexisting trauma-induced bleeding and anticoagulation, reversal of anticoagulation must be a rapid and highly effective procedure. Furthermore the appropriate treatment must be directly available in each shock rooms to guarantee the rapid management of the emergency. PCC require a simple storage, rapid accessibility, fast administration procedures and high effectiveness. Here we report the utility of PCC in management of a craniofacial trauma in proper-anticoagulation.

  19. Temps professionnel et temps personnel des travailleuses du care : perméabilité ou clivage ? Care Workers’ professional time and personal time: permeability or disconnection? The hazard of the “right distance”

    Directory of Open Access Journals (Sweden)

    Pascale Molinier

    2009-09-01

    Full Text Available Les recherches en ergonomie ont montré de longue date l’existence d’une perméabilité psychologique entre les temps professionnels et personnels. Toutefois la situation des travailleuses du care a peu été étudiée sous cet angle. Les femmes qui ont à faire avec les mêmes sortes d’activités, au travail et à domicile, seraient-elles plus vulnérables que d’autres et plus susceptibles de connaître un surmenage ? L’article traite de cette question à partir d’enquêtes de psychodynamique du travail réalisées auprès d’infirmières. Pour les infirmières ayant elles-mêmes des enfants, la confrontation professionnelle avec la maladie et la mort d’enfants est particulièrement anxiogène. Différentes conduites défensives sont décrites et analysées : les stratégies de distanciation affective, de cloisonnement temporel, l’activisme et l’intolérance à la plainte de ses propres enfants. Ces stratégies protectrices visent à instaurer un clivage entre vies professionnelle et privée. Ce clivage est en partie inévitable, mais il augmente en importance, au prix d’une perte du sens du travail, quand les conditions qui autorisent le libre jeu du collectif comme instance d’élaboration de la souffrance dans le travail sont dégradées.Ergonomic research has long shown that professional and personal times are permeable. Yet, the situation of care workers has seldom been studied from that point of view. Are women who have to cope with the same activities both at work and at home more vulnerable than others? more likely to experience burnout? The author tackles the question, beginning with psychodynamic investigations on nurses. For nurses who are mothers themselves, coping with the illness and death of children is particularly anxiety-ridden. Various defensive behaviours are described and analyzed: remaining emotionally aloof, separating time periods, being militant, finding one’s own children’s complaints

  20. Time to choose. Consumers who make a snap decision about long-term care use different criteria from those who can afford to deliberate.

    Science.gov (United States)

    Tudor, R K; Carley, S S

    1995-01-01

    When consumers face an immediate vs. future need for a long-term health care facility, their decision process is rushed. The authors investigate the possible effects of time on the use of and emphasis on specific evaluative criteria consumers employ in making their choice. Findings suggest that marketers of long-term care facilities should adopt a temporal-based approach to market segmentation. PMID:10144667

  1. Time and Money: The True Costs of Health Care Utilization for Patients Receiving "Free" HIV/Tuberculosis Care and Treatment in Rural KwaZulu-Natal

    NARCIS (Netherlands)

    Chimbindi, N.; Bor, J.; Newell, M.L.; Tanser, F.; Baltussen, R.M.P.M.; Hontelez, J.; Vlas, S.J. de; Lurie, M.; Pillay, D.; Barnighausen, T.

    2015-01-01

    BACKGROUND: HIV and tuberculosis (TB) services are provided free of charge in many sub-Saharan African countries, but patients still incur costs. METHODS: Patient-exit interviews were conducted in primary health care clinics in rural South Africa with representative samples of 200 HIV-infected patie

  2. Factors influencing modes of transport and travel time for obstetric care: a mixed methods study in Zambia and Uganda.

    Science.gov (United States)

    Sacks, Emma; Vail, Daniel; Austin-Evelyn, Katherine; Greeson, Dana; Atuyambe, Lynn M; Macwan'gi, Mubiana; Kruk, Margaret E; Grépin, Karen A

    2016-04-01

    Transportation is an important barrier to accessing obstetric care for many pregnant and postpartum women in low-resource settings, particularly in rural areas. However, little is known about how pregnant women travel to health facilities in these settings. We conducted 1633 exit surveys with women who had a recent facility delivery and 48 focus group discussions with women who had either a home or a facility birth in the past year in eight districts in Uganda and Zambia. Quantitative data were analysed using univariate statistics, and qualitative data were analysed using thematic content analysis techniques. On average, women spent 62-68 min travelling to a clinic for delivery. Very different patterns in modes of transport were observed in the two countries: 91% of Ugandan women employed motorized forms of transportation, while only 57% of women in Zambia did. Motorcycle taxis were the most commonly used in Uganda, while cars, trucks and taxis were the most commonly used mode of transportation in Zambia. Lower-income women were less likely to use motorized modes of transportation: in Zambia, women in the poorest quintile took 94 min to travel to a health facility, compared with 34 for the wealthiest quintile; this difference between quintiles was ∼50 min in Uganda. Focus group discussions confirmed that transport is a major challenge due to a number of factors we categorized as the 'three A's:' affordability, accessibility and adequacy of transport options. Women reported that all of these factors had influenced their decision not to deliver in a health facility. The two countries had markedly different patterns of transportation for obstetric care, and modes of transport and travel times varied dramatically by wealth quintile, which policymakers need to take into account when designing obstetric transport interventions. PMID:26135364

  3. Treatment outcome and factors affecting time to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program

    Directory of Open Access Journals (Sweden)

    Melkamu Merid Mengesha

    2016-07-01

    Full Text Available Background: The outpatient therapeutic care program (OTP of children with severe acute malnutrition (SAM has been decentralized to health post level in Ethiopia since 2008–2009. However, there is a lack of evidence regarding treatment outcomes and factors related to the duration of stay on treatment after its decentralization to health post level. Objective: This study was aimed to assess treatment outcome and factors affecting time to recovery in children with SAM treated at OTP. Design: Health facility–based retrospective cohort study was conducted using data from 348 patient cards. The outcome variable was time to recovery. Descriptive analysis was done using percentages for categorical data and mean/median for continuous variables. A robust method of analyzing time to event data, the Cox proportional-hazard regression, was used. All statistical tests in this study are declared significant at p<0.05. Result: 89.1% of children with kwashiorkor and 69.4% of children with marasmus were recovered. Of the total children studied, 22% were readmitted cases. The median time of recovery was 35 days for children with kwashiorkor and 49 days for children with marasmus. Children older than 3 years were 33% less likely to achieve nutritional recovery [adjusted hazard ratio, AHR=0.67, 95% confidence interval, CI (0.46, 0.97]. Similarly, marasmic children stayed longer on treatment [AHR=0.42, 95% CI (0.32, 0.56]. However, children who gained Mid-Upper Arm Circumference (MUAC ≥ 0.24 mm/day were 59% more likely to recover faster [AHR=1.59, 95% CI (1.23, 2.06]. Conclusions: Close monitoring of weight and MUAC gain to assess nutritional improvement with due emphasis given to children with lower admission weight, children of age 3 years and above and marasmic children will have a positive effect on treatment duration and outcome.

  4. The influence of orphan care and other household shocks on health status over time: a longitudinal study of children's caregivers in rural Malawi.

    Science.gov (United States)

    Littrell, Megan; Boris, Neil W; Brown, Lisanne; Hill, Michael; Macintyre, Kate

    2011-12-01

    In the context of rising rates of orphanhood in AIDS-affected settings, very little is understood about implications for caregiver well-being given increasing and intensifying responsibilities for the care of orphaned children. Emotional distress and self-reported health status as well as shifts in household orphan care, wealth, food security and recent illness and death among household members were measured among a panel of 1219 caregivers in rural Malawi between 2007 and 2009. Logistic regression was used to identify predictors of improved and diminished caregiver health and emotional distress. Results suggest that becoming an orphan caregiver is associated with a shift from good to poor health status (adjusted odds ratio [AOR]=2.29, 95% confidence interval [CI]=1.16-4.54), and that elevated levels of distress and poor health both persist over time in comparison with care for non-orphans only. Once engaged in orphan care, taking on additional orphans is associated with increased emotional distress in relation to not caring for orphans (AOR=3.16, 95% CI=1.30-7.73) as well as in relation to maintaining the same number of orphans in care over time (AOR=2.84, 95% CI=1.04-7.70). In addition, findings illustrate the strong influence of household wealth and food security on caregiver well-being. Food insecurity and poverty that persist or develop over time are associated with increasing distress. Conversely, maintenance or improvement in food security and household wealth are associated with decreases in distress. Providing all aspects of household maintenance and care for children, primary caregivers are key to the extended family solution for orphaned and vulnerable children. Bolstering the foundation of rural African families to ensure care and protection of these children involves targeting support to orphan caregivers but must also include addressing the issues of poverty and food insecurity that pose a wider threat to caregiving capacity. PMID:21711171

  5. The Nordic Maintenance Care Program - Time intervals between treatments of patients with low back pain: how close and who decides?

    Directory of Open Access Journals (Sweden)

    Leboeuf-Yde Charlotte

    2010-03-01

    Full Text Available Abstract Background The management of chiropractic patients with acute and chronic/persistent conditions probably differs. However, little is known on this subject. There is, for example, a dearth of information on maintenance care (MC. Thus it is not known if patients on MC are coerced to partake in a program of frequent treatments over a long period of time, or if they are actively involved in designing their own individualized treatment program. Objectives It was the purpose of this study to investigate how chiropractic patients with low back pain were scheduled for treatment, with special emphasis on MC. The specific research questions were: 1. How many patients are on maintenance care? 2 Are there specific patterns of intervals between treatments for patients and, if so, do they differ between MC patients and non-MC patients? 3. Who decides on the next treatment, the patient, the chiropractor or both, and are there any differences between MC patients and non-MC patients? Methods Chiropractic students, who during their summer holidays were observers in chiropractic clinics in Norway and Denmark, recorded whether patients were classified by the treating chiropractor as a MC-patient or not, dates for last and subsequent visits, and made a judgement on whether the patient or the chiropractor decided on the next appointment. Results Observers in the study were 16 out of 30 available students. They collected data on 868 patients from 15 Danish and 13 Norwegian chiropractors. Twenty-two percent and 26%, respectively, were classified as MC patients. Non-MC patients were most frequently seen within 1 week. For MC patients, the previous visit was most often 2-4 weeks prior to the actual visit, and the next appointment between 1 and 3 months. This indicates a gradual increase in intervals. The decision of the next visit was mainly made by the chiropractor, also for MC patients. However, the study samples of chiropractors appear not to be

  6. Wound Botulism in Injection Drug Users: Time to Antitoxin Correlates with Intensive Care Unit Length of Stay

    Directory of Open Access Journals (Sweden)

    Offerman, Steven R

    2009-11-01

    Full Text Available Objectives: We sought to identify factors associated with need for mechanical ventilation (MV, length of intensive care unit (ICU stay, length of hospital stay, and poor outcome in injection drug users (IDUs with wound botulism (WB.Methods: This is a retrospective review of WB patients admitted between 1991-2005. IDUs were included if they had symptoms of WB and diagnostic confirmation. Primary outcome variables were the need for MV, length of ICU stay, length of hospital stay, hospital-related complications, and death.Results: Twenty-nine patients met inclusion criteria. Twenty-two (76% admitted to heroin use only and seven (24% admitted to heroin and methamphetamine use. Chief complaints on initial presentation included visual changes, 13 (45%; weakness, nine (31%; and difficulty swallowing, seven (24%. Skin wounds were documented in 22 (76%. Twenty-one (72% patients underwent mechanical ventilation (MV. Antitoxin (AT was administered to 26 (90% patients but only two received antitoxin in the emergency department (ED. The time from ED presentation to AT administration was associated with increased length of ICU stay (Regression coefficient = 2.5; 95% CI 0.45, 4.5. The time from ED presentation to wound drainage was also associated with increased length of ICU stay (Regression coefficient = 13.7; 95% CI = 2.3, 25.2. There was no relationship between time to antibiotic administration and length of ICU stay.Conclusion: MV and prolonged ICU stays are common in patients identified with WB. Early AT administration and wound drainage are recommended as these measures may decrease ICU length of stay.[West J Emerg Med. 2009;10(4:251-256.

  7. Perspective of Parents and Caregivers on the Influence of Full-Time Day-Care Attendance on Young Children

    Science.gov (United States)

    Undheim, Anne Mari; Drugli, May Britt

    2012-01-01

    The aim of this study was to explore the experience of parents and caregivers regarding young children in day care. The tiredness of children after day-care attendance was explored. In the autumn of 2009, 41 parents and 35 caregivers of children aged 1.5 years or younger living in the city of Trondheim and nearby communities were assessed using a…

  8. Cozy landscapes in a time of subtleties: Resonance of dance in a body treatment clinic in mental health care

    Directory of Open Access Journals (Sweden)

    Ingrid Bergma da Silva Oliveira

    2013-12-01

    Full Text Available The quest to build cozy landscapes in times of subtleties in mental health care is based on an ethical and poetic choice to build a clinic. This study deals with research aimed at the cartography of a body treatment clinic in mental health that has used various practices in this perspective of coziness and subtleties within a Psychosocial Attendance Center (PSAC - type II in Belém, Para state, Brazil. In the methodological path we have traveled in these practices, we would like to highlight the work with Sacred Circle Dances (SCD in the experience of a Body Work Group involving 14 service users between 2010 and 2012. We resorted to participant observation and records in field notebook to find highlights in the intensity of meetings, especially regarding the experiments with dance. The results showed that, in Sacred Circle Dances, service users battled for their spaces, shared their stories, gave in and demanded, pulling away from any stereotype of passivity, and possible lack of motivation, or victimization In conclusion, SCD subscribe the emancipation of dancers of “expected” acting to the dance, in a territory that comprises dance together and do with others, which enriches experience and sustains differences. SCD in the daily routine of PSACs reaffirm that those centers are not a place of mental illness, but of mental health, where the relief is life and the disorder is only a part of existence. SCD are configured as a potential place of exchange.

  9. Geo-mapping of time trends in childhood caries risk a method for assessment of preventive care

    Directory of Open Access Journals (Sweden)

    Strömberg Ulf

    2012-06-01

    Full Text Available Abstract Background Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time. The aim of this study was to develop the geo-map concept, addressing time trends in caries risk, and demonstrate the novel approach by analyzing epidemiological data from preschool residents in the region of Halland, Sweden. Methods The study population consisted of 9,973 (2006 and 10,927 (2010 children between 3 to 6years of age (~77% of the eligible population from whom caries data were obtained. Reported dmfs>0 for a child was considered as the primary caries outcome. Each study individual was geo-coded with respect to his/her residence parish (66 parishes in the region. Smoothed caries risk geo-maps, along with corresponding statistical certainty geo-maps, were produced by using the free software Rapid Inquiry Facility and the ESRI ArcGIS system. Parish-level socioeconomic data were available. Results The overall proportion of caries-free (dmfs=0 children improved from 84.0% in 2006 to 88.6% in 2010. The ratio of maximum and minimum (parish-level smoothed relative risks (SmRRs increased from 1.76/0.44=4.0 in 2006 to 2.37/0.33=7.2 in 2010, which indicated an increased geographical polarization of early childhood caries in the population. Eight parishes showed evidential, positional changes in caries risk between 2006 and 2010; their corresponding SmRRs and statistical certainty ranks changed markedly. No considerable parallel changes in parish-level socioeconomic characteristics were seen during the same time period. Conclusion Geo-maps based on caries risk can be used to monitor changes in caries risk over time. Thus, geo-mapping offers a convenient tool for evaluating the effectiveness of tailored health promotion and preventive

  10. Time for new guidelines in advanced diabetes care: Paradigm change from delayed interventional approach to predictive, preventive & personalized medicine

    OpenAIRE

    Golubnitschaja, Olga

    2010-01-01

    Global burden of diabetes mellitus clearly demonstrate inadequacy of current diabetes care measures: the costs of caring for patients with diabetes mellitus are the highest compared to other frequent pathologies. Nonetheless, for every 10 s one patient dies of diabetes-related consequences. Thus, there is urgent need for highly effective measures that would lead to reduced prevalence, better long-term outcomes and improved quality of life for diabetic patients reducing associated economic bur...

  11. Blood sample tube transporting system versus point of care technology in an emergency department; effect on time from collection to reporting?

    DEFF Research Database (Denmark)

    Nørgaard, Birgitte; Mogensen, Christian Backer

    technologies (POCT) are used in emergency departments. This study assesses the hypothesis, that using Point of Care Technology in analysing blood samples versus tube transporting blood samples for laboratory analyses results in shorter time from the blood sample is collected to the result is reported in an...

  12. A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units.

    Science.gov (United States)

    Dicks, Kristen V; Lofgren, Eric; Lewis, Sarah S; Moehring, Rebekah W; Sexton, Daniel J; Anderson, Deverick J

    2016-07-01

    OBJECTIVE To determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). DESIGN Interrupted time series analysis. SETTING The study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013. PARTICIPANTS All ICU patients at study hospitals during the study period. METHODS Of the 33 hospitals, 17 hospitals implemented CHG bathing during the study period, and 16 hospitals that did not perform CHG bathing served as controls. Primary pre-specified outcomes included ICU central-line-associated bloodstream infections (CLABSIs), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs). MRSA and VRE HAIs were also evaluated. RESULTS Chlorhexidine gluconate (CHG) bathing was associated with a significant downward trend in incidence rates of ICU CLABSI (incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.93-0.99), ICU primary BSI (IRR, 0.96; 95% CI, 0.94-0.99), VRE CLABSIs (IRR, 0.97; 95% CI, 0.97-0.98), and all combined VRE infections (IRR, 0.96; 95% CI, 0.93-1.00). No significant trend in MRSA infection incidence rates was identified prior to or following the implementation of CHG bathing. CONCLUSIONS In this multicenter, real-world analysis of the impact of CHG bathing, hospitals that implemented CHG bathing attained a decrease in ICU CLABSIs, ICU primary BSIs, and VRE CLABSIs. CHG bathing did not affect rates of specific or overall infections due to MRSA. Our findings support daily CHG bathing of ICU patients. Infect Control Hosp Epidemiol 2016;37:791-797. PMID:26861417

  13. Comparing the Effect of Topical Application of Maternal Milk, 96% Ethyl Alcohol, and Dry Cord Care on Umbilical Cord Separation Time in Healthy Full-Term Neonates

    Directory of Open Access Journals (Sweden)

    F. Eghbalian

    2015-04-01

    Full Text Available Introduction & Objective: Umbilical cord infections are of main causes for neonatal morbidities and mortalities. Different methods are used for umbilical cord care with multifarious efficien-cies. The aim of this study was to compare three methods of local use of maternal milk, local use of 96% ethyl alcohol, and dry cord care. Materials & Methods: In this prospective, randomized, clinical trial, 207 healthy full-term neo-nates were randomly assigned to three groups. In the first and second groups, mothers rubbed her milk and 96% ethyl alcohol on umbilical cord until two days after its separation, respec-tively. In the third group, they only kept the cord clean and dry. The length of umbilical cord separation was compared among the groups with ANOVA and Tukey HSD tests. Results: The difference among lengths of umbilical cord separation in three groups was statis-tically significant. For alcohol users group, this time was significantly longer than that for the other two groups. The difference between cord separation time in maternal milk users and dry cord care groups was not statistically significant. Conclusion: Usage of maternal milk on umbilical cord and keeping the cord dry are acceptable methods but alcohol is not recommended for cord care in healthy term neonates with home care and in normal state. (Sci J Hamadan Univ Med Sci 2015; 22 (1:5-10

  14. "Can Child-care Subsidies Reduce Poverty? Assessing the Korean Experience Using the Levy Institute Measure of Time and Income Poverty"

    OpenAIRE

    Zacharias, Ajit; Masterson, Thomas; Kim, Kijong

    2014-01-01

    In partnership with the Korea Employment Information Service, Senior Scholar Ajit Zacharias and Research Scholars Thomas Masterson and Kijong Kim investigate the complex issues of gender, changing labor market conditions, and the public provisioning of child care in Korea using the Levy Institute Measure of Time and Income Poverty (LIMTIP), an alternative measure that factors in both time and income deficits in the assessment of poverty. Since the 1997 Asian financial crisis, lifetime employm...

  15. Correlation between timing of tracheostomy and duration of mechanical ventilation in patients with potentially normal lungs admitted to intensive care unit

    OpenAIRE

    Mehrdad Masoudifar; Omid Aghadavoudi; Lida Nasrollahi

    2012-01-01

    Background: There is insufficient evidence to conclude that the timing of tracheostomy alters the duration of mechanical ventilation, hence this study was designed to investigate the correlation between timing of tracheostomy and duration of mechanical ventilation for patients admitted to intensive care unit (ICU) with potentially normal lungs. Materials and Methods: In a retrospective study for a period of 2 years, all adult patients admitted to the medical ICU of Al-Zahra Hospital in Is...

  16. D-dimer testing for safe exclusion and risk stratification in patients with acute pulmonary embolism in primary care

    Directory of Open Access Journals (Sweden)

    Zhou Yin

    2015-01-01

    Full Text Available Background: Safe exclusion and risk stratification are currently recommended for the initial management of patients with acute pulmonary embolism (APE. The aim of this study was to assess the safe exclusion and risk stratification value of D-dimer (DD for APE when tested at the beginning of admission. Materials and Methods: All consecutive Chinese APE patients and controls were recruited from January 2010 to December 2012. All measurements of serum indexes were made in duplicate and blinded to the patients′ status. All the 40 patients with the first episode of APE were confirmed by multi-detector computed tomographic pulmonary angiography. The plasma prothrombin time (PT, activated partial thromboplastin time, thrombin time, fibrinogen, and DD levels were measured within 24 h of admission. We used the Mann-Whitney U-test to determine the differences between groups and drew receiver operator characteristic curve to evaluate the indexes′ value in the APE screening. Results: The PT and DD in the APE group were significantly higher than those in the disease control group (P 1820 μg/L as cut-off value, the sensitivity, specificity, positive and negative predictive value was 82.5%, 75.2%, 56.9%, and 91.6%, respectively. Conclusion: The patients with APE showed significant higher DD levels compared with disease controls, suggesting a negative qualitative DD test result can safely and efficiently exclude APE in primary care.

  17. The clinical study of prothrombin precursor protein in monitoring anticoagulation%凝血酶原前体蛋白在抗凝监测中的临床研究

    Institute of Scientific and Technical Information of China (English)

    朱平; 刘菁; 黄劲松; 舒峻; 周志凌; 庄建; 吴若彬; 肖学钧; 郑少忆; 陈寄梅; 卢聪; 范瑞新; 郭惠明

    2009-01-01

    目的 探讨凝血酶原前体蛋白(PIVKA-Ⅱ)在华法林抗凝治疗监测中的意义.方法 动态监测60例心脏机械瓣膜置换术后行抗凝治疗病人(实验组)的血浆PIVKA-Ⅱ浓度、凝血酶原时间(prothrombin time,PT)、国际标准化比率(international normalized ratio,INR),比较3者出现明显异常的最早时间,分析PIVKA-Ⅱ与PI'及INR之间的相关性.结果 实验组首次服华法林后6h,血浆PIVKA-Ⅱ浓度即出现明显异常,并随时间增加而增高;实验组首次服华法林后60 h,PT出现明显异常,并随时间增加而增高;实验组首次服华法林后24 h,INR出现明显异常,并随时间增加而增高;线性相关分析,结果显示PIVKA-Ⅱ浓度与PT呈正相关(r=0.786,P<0.01);PIVKA-Ⅱ浓度与INR呈正相关(r=0.737,P<0.01).结论 在抗凝治疗的患者中,通过监测患者的血浆PIVKA-Ⅱ浓度可以有效地监测其抗凝程度,联合监测患者的血浆PIVKA-Ⅱ浓度、PT、INR则更能早期、有效的监测患者抗凝程度.

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

    OpenAIRE

    Bramley, Louise

    2016-01-01

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

  19. Admission time to hospital: a varying standard for a critical definition for admissions to an intensive care unit from the emergency department.

    Science.gov (United States)

    Nanayakkara, Shane; Weiss, Heike; Bailey, Michael; van Lint, Allison; Cameron, Peter; Pilcher, David

    2014-11-01

    Objective Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of 'time of admission' for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Methods Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Results Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83-5.35) to 5.1h (2.82-8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Conclusions Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. What is known about the topic? There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely

  20. Effects of storage time and temperature on coagulation tests and factors in fresh plasma

    OpenAIRE

    Limin Feng; Ying Zhao; Hongcan Zhao; Zhexin Shao

    2014-01-01

    Coagulation tests and factors measurements have been widely applied in clinical practice. Pre-analytical conditions are very important in laboratory assessment.Here,we aim to determine the effects of storage time and temperature on activated partial thromboplastin time (APTT), fibrinogen (Fbg), prothrombin time (PT), the international normalized ratio (INR), thrombin time (TT), factor VIII activity (FVIII:C), and factor IX activity (FIX:C) in fresh plasma. Seventy-two blood samples were teste...

  1. Is It Time to Redesign Hospice? End-of-Life Care at the User Interface. Syracuse Seminar on Aging.

    OpenAIRE

    Casarett, David J.

    2007-01-01

    Hospice is a system of end-of-life care that’s not used to its full potential. That is, hospice is not used in the way that would benefit patients and families as much as it could. My argument is that this is an issue of usability, or ergonomics—the science of design. I illustrate how to take what we have learned from the science of usability to make hospice more accessible and approachable, and to increase hospice use among those who would benefit from it. Underneath this discussion, though,...

  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

    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.

  3. Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps in a Medicaid managed care plan: study protocol

    Directory of Open Access Journals (Sweden)

    Ratanawongsa Neda

    2012-01-01

    Full Text Available Abstract Background Health information technology can enhance self-management and quality of life for patients with chronic disease and overcome healthcare barriers for patients with limited English proficiency. After a randomized controlled trial of a multilingual automated telephone self-management support program (ATSM improved patient-centered dimensions of diabetes care in safety net clinics, we collaborated with a nonprofit Medicaid managed care plan to translate research into practice, offering ATSM as a covered benefit and augmenting ATSM to promote medication activation. This paper describes the protocol of the Self-Management Automated and Real-Time Telephonic Support Project (SMARTSteps. Methods/Design This controlled quasi-experimental trial used a wait-list variant of a stepped wedge design to enroll 362 adult health plan members with diabetes who speak English, Cantonese, or Spanish and receive care at 4 publicly-funded clinics. Through language-stratified randomization, participants were assigned to four intervention statuses: SMARTSteps-ONLY, SMARTSteps-PLUS, or wait-list for either intervention. In addition to usual primary care, intervention participants received 27 weekly calls in their preferred language with rotating queries and response-triggered education about self-care, medication adherence, safety concerns, psychological issues, and preventive services. Health coaches from the health plan called patients with out-of-range responses for collaborative goal setting and action planning. SMARTSteps-PLUS also included health coach calls to promote medication activation, adherence and intensification, if triggered by ATSM-reported non-adherence, refill non-adherence from pharmacy claims, or suboptimal cardiometabolic indicators. Wait-list patients crossed-over to SMARTSteps-ONLY or -PLUS at 6 months. For participants who agreed to structured telephone interviews at baseline and 6 months (n = 252, primary outcomes will be

  4. Assessing Program Efficiency: A Time and Motion Study of the Mental Health Emergency Care — Rural Access Program in NSW Australia

    Directory of Open Access Journals (Sweden)

    Emily Saurman

    2014-07-01

    Full Text Available The Mental Health Emergency Care-Rural Access Program (MHEC-RAP is a telehealth solution providing specialist emergency mental health care to rural and remote communities across western NSW, Australia. This is the first time and motion (T&M study to examine program efficiency and capacity for a telepsychiatry program. Clinical services are an integral aspect of the program accounting for 6% of all activities and 50% of the time spent conducting program activities, but half of this time is spent completing clinical paperwork. This finding emphasizes the importance of these services to program efficiency and the need to address variability of service provision to impact capacity. Currently, there is no efficiency benchmark for emergency telepsychiatry programs. Findings suggest that MHEC-RAP could increase its activity without affecting program responsiveness. T&M studies not only determine activity and time expenditure, but have a wider application assessing program efficiency by understanding, defining, and calculating capacity. T&M studies can inform future program development of MHEC-RAP and similar telehealth programs, both in Australia and overseas.

  5. Use of Flumazenil to Provide Adequate Recovery Time Post-Midazolom Infusion in a General Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    MOJTABA MOJTAHEDZADEH

    1999-08-01

    Full Text Available Sedation permits patients to tolerate the various treatment modalities to which they are subjected. However it may sometimes cause prolonged sedation in critically ill patients. Flumazenil, a benzo¬diazepine antagonist, reverses midazolam-induced sedation and amnesia. We prospectively designed a double-blind randomized study to evaluate the effects of flumazenil on thirty (30 Iranian General Intensive Care Unit (ICU patients. They were requiring mechanical ventilation for more than 12 hours and they were sedated by midazolam infusions. Sedation levels were measured hourly during the infusion, at the end of the infusion, and at 5, 15, 30, 60, and 120 min after cessation of the mida¬zolam infusion. Reversal of sedation was observed in all patients who received flumazenil, and re-sedation occurred in seven of these patients. Reversal was not seen in any of the patients who receiv-ed placebo.

  6. Are health care systems insensitive to needs of suicidal patients in times of conflict? The Kashmir experience

    Directory of Open Access Journals (Sweden)

    Shiekh Shoib

    2011-02-01

    Full Text Available Suicide and attempted suicide is an important health issue and the number of people who die of suicide exceeds that of conflicts. Kashmir has been suffering from a low intensity war since last 20 years in which thousands have been killed or injured. There has been phenomenal increase in cases of psychological disorders along with suicide and and suicide attempters. Suicide in a conflict zone is viewed with indifference due to focus on the physical part of trauma. Difficulties faced by the suicidal patient and his attendants are seldom highlighted. 1408 patients who reported to emergency room for suicide attempt from 2000 to 2008 were taken for the study. All the patients underwent the hospital protocol for poisoning management. Patients were subjected to detailed psychiatric evaluation and questions were specifically asked about the difficulties encountered during management. Most of the cases were females with 92.11% belonging to the Muslim religion. 76.20% cases were from a rural background. 32.5% had been referred because of the lack of specific antidotes. Forty-three percent required arrangement of transportation by their own family members. Fifty-seven percent had been stopped for security checks along the way. Seventy-three percent felt that the attitude of the staff hostile. Twenty-three percent of patients had to share a bed. Almost all patients were questioned by security agencies within the hospital. More than 68% patient reported hostility amongst their neighbors. Suicidal poisoning is a significant health problem in Kashmir and management of these cases is fraught with difficulties across the spectrum of health care. Educating the doctors at primary care about first aid, improvement in community services followed by long term resolution of the conflict would go some way in alleviating the difficulties faced by a suicidal patient and his family in a conflict zone.

  7. Comparing Prothrombin induced by vitamin K absence-II (PIVKA-II) with the oncofetal proteins Glypican-3, Alpha feto protein and Carcinoembryonic antigen in diagnosing hepatocellular carcinoma among Egyptian patients

    OpenAIRE

    Iman A. Abd El Gawad; Mossallam, Ghada I.; Noha H. Radwan; Elzawahry, Heba M; Niveen M. Elhifnawy

    2014-01-01

    Background: Hepatocellular carcinoma (HCC) is usually asymptomatic in the early stage and does not show elevated alpha-feto protein (AFP). AFP shows 60–80% sensitivity in diagnosing HCC. Glypican3 (GPC-3) is an oncofetal protein that is only detected in HCC cells but not in benign liver tissues, while Carcinoembryonic antigen (CEA) is expressed in various neoplasms including HCC. Although, it is not specific for HCC. Prothrombin induced by vitamin K absence-II (PIVKA-II) is an abnormal ...

  8. Evaluation of patients' attitudes to their care during oral and maxillofacial surgical outpatient consultations: the importance of waiting times and quality of interaction between patient and doctor.

    Science.gov (United States)

    Dimovska, E O F; Sharma, S; Trebble, T M

    2016-06-01

    Knowing what patients think about their care is fundamental to the provision of an effective, quality service, and it can help to direct change and reduce costs. Much of the work in oral and maxillofacial departments concerns the treatment of outpatients, but as little is known about what they think about their care, we aimed to find out which aspects were associated with satisfaction. Consecutive patients (n=244) who attended the oral and maxillofacial outpatient department at Southampton University Hospital NHS Foundation Trust over a 7-day period were given a questionnaire to complete before and after their consultation. It included questions with Likert scale responses on environmental, procedural, and interactive aspects of the visit, and a 16-point scale to rank their priorities. A total of 187 patients (77%) completed the questionnaires. No association was found between expected (p=0.93) or actual (p=0.41) waiting times, and 90% of patients were satisfied with their visit. Seeing the doctor, having confidence in the treatment plan, being listened to, and the ability of the doctor to recognise their personal needs, were ranked as important. Environmental and procedural aspects were considered the least important. These findings may be of value in the development of services to improve patient-centred care. PMID:26994564

  9. Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya.

    Science.gov (United States)

    Mmeje, Okeoma; van der Poel, Sheryl; Workneh, Meklit; Njoroge, Betty; Bukusi, Elizabeth; Cohen, Craig R

    2015-01-01

    In female-positive HIV-serodiscordant couples desiring children, home timed vaginal insemination (TVI) of semen during the fertile period along with consistent condom use may reduce the risk of HIV transmission when the man is HIV-uninfected. In sub-Saharan Africa, up to 45% of HIV-infected women desire to have more children. HIV viral load assessment is not routinely available in low-resource countries for monitoring adherence and response to antiretroviral therapy. Therefore, in these settings, timed unprotected intercourse without assurance of HIV viral suppression may pose unnecessary risks. TVI, a simple and affordable intervention, can be considered an adjunct method and option of safer conception for HIV prevention with treatment of the HIV-infected partner and/or pre-exposure prophylaxis. We conducted five mixed and single-sex focus group discussions comprised of 33 HIV-serodiscordant couples and health-care providers in the Nyanza region of Kenya to assess the acceptability and feasibility of TVI as a safer method of conception. The transcribed data were analyzed using a grounded theory approach. We found that educating and counseling HIV-serodiscordant couples on TVI could make it an acceptable and feasible safer conception method when associated with frequent communication and home visits by health-care providers. The findings of this study indicate that implementation studies that integrate training and counseling of HIV-serodiscordant couples and health-care providers on TVI combined with consistent condom use are needed. Acknowledging and supporting the reproductive choice and needs of female positive, male negative HIV-serodiscordant couples who desire children should also include the use of assisted reproductive services at the same time as pharmaceutical options that prevent sexual HIV transmission. PMID:25105422

  10. Association between the thrombophilic polymorphisms MTHFR C677T, Factor V Leiden, and prothrombin G20210A and recurrent miscarriage in Brazilian women.

    Science.gov (United States)

    Gonçalves, R O; Fraga, L R; Santos, W V B; Carvalho, A F L; Veloso Cerqueira, B A V; Sarno, M; Toralles, M B P; Vieira, M J; Dutra, C G; Schüler-Faccini, L; Sanseverino, M T V; Gonçalves, M S; Vianna, F S L; Costa, O L N

    2016-01-01

    Some cases of recurrent first trimester miscarriage have a thrombotic etiology. The aim of this study was to investigate the prevalence of the most common thrombophilic mutations - factor V (FV) Leiden G1691A (FVL), prothrombin (FII) G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T - in women with recurrent miscarriages. In this case-control study, we included 137 women with two or more consecutive first-trimester miscarriages (£12 weeks of gestation) and 100 healthy women with no history of pregnancy loss, and with at least one living child. DNA was extracted from the patient samples, and the relevant genes (FVL, FII, and MTHFR) were amplified by PCR, followed by restriction fragment length polymorphism, to assess the polymorphisms in these genes. The allelic frequencies of polymorphisms were not significantly different between the case and control groups. Polymorphisms in the MTHFR, FVL, and FII genes were not associated with recurrent miscarriage during the first trimester of pregnancy in Brazilian women (P = 0.479; P = 0.491 and P = 0.107, respectively). However, the etiologic identification of genetic factors is important for genetic counseling. PMID:27525841

  11. The Predictive Power of Serum α-Fetoprotein and Des-γ-Carboxy Prothrombin for Survival Varies by Tumor Size in Hepatocellular Carcinoma.

    Science.gov (United States)

    Tsugawa, Daisuke; Fukumoto, Takumi; Kido, Masahiro; Takebe, Atsushi; Tanaka, Motofumi; Kuramitsu, Kaori; Matsumoto, Ippei; Ajiki, Tetsuo; Koyama, Tatsuki; Ku, Yonson

    2016-01-01

    Alpha-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) are frequently used as tumor markers in hepatocellular carcinoma (HCC). The authors hypothesized different patient populations with varying tumor sizes would influence the predictive power of tumor markers for survival in HCC patients. The authors investigated the influence of tumor size on predictive powers of AFP and DCP. 181 patients underwent hepatectomy for HCC from 2003 to 2008 at Kobe University Hospital. Tumor markers were measured before and at 1 month post-hepatectomy. The Cox proportional-hazards model revealed that preoperative serum AFP was associated with survival; its effects depended on tumor size. Hazard ratios (HRs) for preoperative AFP were maximum for medium-sized HCC, and for DCP, HRs were maximum in small-sized tumors. Post-hepatectomy, both tumor markers were associated with survival, revealing significant interactions with tumor size. HRs for postoperative AFP were greater than 1 for relatively wide range tumors (3-11 cm). HRs for postoperative DCP increased with tumor size, with a strong prognostic predictive power for tumors >5 cm. The predictive power of serum tumor markers varied by tumor size in HCC patients. By selecting the appropriate tumor marker, its predictive power can be improved. PMID:27363395

  12. 3-Factor Versus 4-Factor Prothrombin Complex Concentrate for Warfarin Reversal in Severe Bleeding: A Multicenter, Retrospective, Propensity-Matched Pilot Study.

    Science.gov (United States)

    Jones, G Morgan; Erdman, Michael J; Smetana, Keaton S; Mohrien, Kerry M; Vandigo, Joseph E; Elijovich, Lucas

    2016-07-01

    Current guidelines recommend 4-factor prothrombin complex concentrate (4PCC) for emergent reversal of bleeding secondary to warfarin. While current research has demonstrated superiority of 4PCC over plasma, direct comparisons with 3-factor PCC (3PCC) are lacking. The purpose of this study is to compare the efficacy and safety of 3PCC and 4PCC. We conducted a retrospective analysis of patients who received PCC at one of four medical centers. All patients in the 3PCC group were treated at one center that utilizes a fixed, weight-based dosing protocol. After evaluation of all patients meeting inclusion criteria, propensity-score matching was used to adjust for differences in treatment characteristics. There was no difference in the primary outcome of INR ≤ 1.4 between 3PCC and 4PCC in both the unmatched (85.7 vs. 90.6 %; p = 0.37) and matched (84.2 vs. 92.1 %; p = 0.48) analyses. There was a significant difference in goal INR achieved favoring 4PCC (56.3 vs 90.0 %; p  4.0. A total of three thrombotic events were documented, all in the 4PCC group. We found no difference in the rate of INR reversal in those treated with 3PCC and 4PCC. However, those with a baseline INR > 4.0 may experience more successful INR reversal with 4PCC. PMID:26721625

  13. Timely detection of localized excess influenza activity in northern California across patient care, prescription, and laboratory data

    OpenAIRE

    Greene, Sharon K.; Kulldorff, Martin; Huang, Jie; Brand, Richard J; Kleinman, Kenneth P.; Hsu, John; Platt, Richard

    2011-01-01

    Timely detection of clusters of localized influenza activity in excess of background seasonal levels could improve situational awareness for public health officials and health systems. However, no single data type may capture influenza activity with optimal sensitivity, specificity, and timeliness, and it is unknown which data types could be most useful for surveillance. We compared the performance of ten types of electronic clinical data for timely detection of influenza clusters throughout ...

  14. The use of segmented regression in analysing interrupted time series studies: an example in pre-hospital ambulance care

    OpenAIRE

    Taljaard, Monica; McKenzie, Joanne E; Ramsay, Craig R; Grimshaw, Jeremy M

    2014-01-01

    Background An interrupted time series design is a powerful quasi-experimental approach for evaluating effects of interventions introduced at a specific point in time. To utilize the strength of this design, a modification to standard regression analysis, such as segmented regression, is required. In segmented regression analysis, the change in intercept and/or slope from pre- to post-intervention is estimated and used to test causal hypotheses about the intervention. We illustrate segmented r...

  15. Geo-mapping of time trends in childhood caries risk - a method for assessment of preventive care

    OpenAIRE

    Strömberg Ulf; Holmn Anders; Magnusson Kerstin; Twetman Svante

    2012-01-01

    Abstract Background Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time. The aim of this study was to develop the geo-map concept, addressing time trends in caries risk, and demonstrate the novel approach by analyzing epidemiological data from preschool re...

  16. Caring for the Caregiver

    Science.gov (United States)

    ... But during this time, it’s important that caregivers take care of themselves too. PDF Kindle ePub This booklet ... cancer This booklet is not about how to take care of a patient. Instead, it mainly provides ways ...

  17. Elevated prothrombin time on routine preoperative laboratory results in a healthy infant undergoing craniosynostosis repair: Diagnosis and perioperative management of congenital factor VII deficiency

    Directory of Open Access Journals (Sweden)

    Kareen L. Jones

    2016-01-01

    Conclusion: A thorough history and physical examination with a high clinical suspicion are vital in preventing hemorrhage during surgeries in children with coagulopathies. Abnormal preoperative lab values should always be confirmed and addressed before proceeding with high-risk surgery. A multidisciplinary discussion is essential to optimize the risk-benefit ratio during the perioperative period.

  18. Access to Care for Multiple Sclerosis in Times of Economic Crisis in Greece – the HOPE II Study

    Directory of Open Access Journals (Sweden)

    Kyriakos Souliotis

    2016-02-01

    Full Text Available Background While there is currently no cure for multiple sclerosis (MS, treatment with biologic diseasemodifying drugs (bDMDs can reduce the impact of the condition on the lives of patients. In Greece, the regulatory change in the distribution system of bDMDs, limited their administration through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY or the National Health System (ESY hospitals, thus potentially impacting access to MS treatment. In this context, the aim of this paper was to assess the barriers to bDMDs, by recording MS patients’ experiences. Methods A survey research was conducted between January and February 2014 in Athens and 5 other major Greek cities with the methods of personal and telephone interview. A structured questionnaire was used to elicit socio-economic and medical information, information related to obstacles in accessing bDMDs and medical treatment, from MS patients that visited EOPYY pharmacies during the study period. Results During the last year 69% of 179 participants reported that the distribution system of bDMDs has improved. Thirteen percent of participants encountered problems in accessing their medication, and 16.9% of participants in accessing their physician, with the obstacles being more pronounced for non-Athens residents. Frequent obstacles to bDMDs were the distance from EOPYY pharmacies and difficulties in obtaining a diagnosis from an EOPYY/ESY physician, while obstacles to medical care were delays in appointment booking and travel difficulties. Conclusion Even though the major weaknesses of the distribution system of bDMDs have improved, further amelioration of the system could be achieved through the home delivery of medicines to patients living in remote areas, and through the development of a national MS registry.

  19. Geo-mapping of time trends in childhood caries risk--a method for assessment of preventive care

    DEFF Research Database (Denmark)

    Strömberg, Ulf; Holmn, Anders; Magnusson, Kerstin; Twetman, Svante

    2012-01-01

    Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time. The...... aim of this study was to develop the geo-map concept, addressing time trends in caries risk, and demonstrate the novel approach by analyzing epidemiological data from preschool residents in the region of Halland, Sweden....

  20. Implementing Role-Changing Versus Time-Changing Innovations in Health Care: Differences in Helpfulness of Staff Improvement Teams, Management, and Network for Learning.

    Science.gov (United States)

    Nembhard, Ingrid M; Morrow, Christopher T; Bradley, Elizabeth H

    2015-12-01

    Health care organizations often fail in their effort to implement care-improving innovations. This article differentiates role-changing innovations, altering what workers do, from time-changing innovations, altering when tasks are performed or for how long. We examine our hypothesis that the degree to which access to groups that can alter organizational learning--staff, management, and external network--facilitates implementation depends on innovation type. Our longitudinal study using ordinal logistic regression and survey data on 517 hospitals' implementation of evidence-based practices for treating heart attack confirmed our thesis for factors granting access to each group: improvement team's representativeness (of affected staff), senior management engagement, and network membership. Although team representativeness and network membership were positively associated with implementing role-changing practices, senior management engagement was not. In contrast, senior management engagement was positively associated with implementing time-changing practices, whereas team representativeness was not, and network membership was not unless there was limited management engagement. These findings advance implementation science by explaining mixed results across past studies: Nature of change for workers alters potential facilitators' effects on implementation. PMID:26116611

  1. Social Impairment in the "Care in the Community" Cohort: The Effect of Deinstitutionalization and Changes over Time in the Community.

    Science.gov (United States)

    Beadle-Brown, Julie; Forrester-Jones, Rachel

    2003-01-01

    A longitudinal study involving 250 adults who had been institutionalized found that once they moved into the community, social impairment did not change over time, although there was a significant decrease in conversation and social mixing, non-verbal communication, and initiation of conversation and social interaction. (Contains references.) (CR)

  2. Impact of computer-assisted data collection, evaluation and management on the cancer genetic counselor's time providing patient care.

    Science.gov (United States)

    Cohen, Stephanie A; McIlvried, Dawn E

    2011-06-01

    Cancer genetic counseling sessions traditionally encompass collecting medical and family history information, evaluating that information for the likelihood of a genetic predisposition for a hereditary cancer syndrome, conveying that information to the patient, offering genetic testing when appropriate, obtaining consent and subsequently documenting the encounter with a clinic note and pedigree. Software programs exist to collect family and medical history information electronically, intending to improve efficiency and simplicity of collecting, managing and storing this data. This study compares the genetic counselor's time spent in cancer genetic counseling tasks in a traditional model and one using computer-assisted data collection, which is then used to generate a pedigree, risk assessment and consult note. Genetic counselor time spent collecting family and medical history and providing face-to-face counseling for a new patient session decreased from an average of 85-69 min when using the computer-assisted data collection. However, there was no statistically significant change in overall genetic counselor time on all aspects of the genetic counseling process, due to an increased amount of time spent generating an electronic pedigree and consult note. Improvements in the computer program's technical design would potentially minimize data manipulation. Certain aspects of this program, such as electronic collection of family history and risk assessment, appear effective in improving cancer genetic counseling efficiency while others, such as generating an electronic pedigree and consult note, do not. PMID:21240560

  3. Daylight saving time (summer 2001) for a culture of energy care; Horario de verano 2001 por una cultura del cuidado de la energia

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-09-01

    As in other headings, such as the care of water and the environment, in what corresponds to energy care, we must take a foresighted attitude so that in a near future we not only can continue covering our energy needs, but also that we do not lack of it, because it is an indispensable service for modern life, practically in any field of the human activity. In this article it is mentioned how the daylight saving time works, the impact in the consumption and demand of electrical energy, resulting from the daylight saving time program 1996-2000. Energy impact, certification of the energy impact due to the application of the program in Mexico, the environmental impact, how the organism adapts harmonically to the summer schedule, the daylight saving program in the world, the daylight saving time program in Mexico, the adjustment in the period of application, and the accumulated results 1996-2000 by the establishment of the daylight saving time program. [Spanish] Al igual que en otros rubros, tales como el cuidado del agua y del medio ambiente, en lo que corresponde al cuidado de la energia, debemos tomar una actitud previsora para que en un futuro cercano no solo podamos continuar cubriendo nuestras necesidades de energia, sino para que esta no nos falte, porque se trata de un servicio indispensable para la vida moderna, practicamente en cualquier campo de la actividad humana. Este articulo se habla sobre como funciona el horario de verano, el impacto en el consumo y la demanda de energia electrica, resultados del horario de verano 1996-2000, Impacto energetico, certificacion del impacto energetico debido a la aplicacion del horario de verano en Mexico, el impacto ambiental, el organismo se adapta armonicamente al horario de verano, el horario de verano en el mundo, el horario de verano en Mexico, el ajuste en el periodo de aplicacion, y resultados acumulados 1996-2000 por el establecimiento del horario de verano.

  4. Rationale for New York City’s Regulations on Nutrition, Physical Activity, and Screen Time in Early Child Care Centers

    OpenAIRE

    Nonas, Cathy; Silver, Lynn D; Kettel Khan, Laura; Leviton, Laura

    2014-01-01

    Childhood obesity is associated with health risks in childhood, and it increases the risk of adult obesity, which is associated with many chronic diseases. Therefore, implementing policies that may prevent obesity at young ages is important. In 2007, the New York City Department of Health and Mental Hygiene implemented new regulations for early childhood centers to increase physical activity, limit screen time, and provide healthful beverage offerings (ie, restrict sugar-sweetened beverages f...

  5. Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study

    OpenAIRE

    Bigdeli Maryam; Khorasani-Zavareh Davoud; Mohammadi Reza

    2010-01-01

    Abstract Background Road traffic injuries (RTIs) are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. Timely arrival of the Emergency Medical Service (EMS) at the crash scene followed by speedy victim transportation by trained personnel may reduce the RTIs' consequences. The first 60 minutes after injury occurrence - referred to as the "golden hour"- are vital for the saving of lives. The present study was designed to ...

  6. Impact of critically ill patients in regards to the boarding time from the emergency department to the intensive care unit

    Directory of Open Access Journals (Sweden)

    George Fildissis

    2011-07-01

    Full Text Available Objective: To determine the association between ED overcrowding and outcomes for critically ill patients Design and Setting: We included medical and surgical pts that all of them were intubated promptly to ED of 2 general hospitals of Athens GR, for 12 months. Pts survived > 24hours were divided into 2 groups: ED boarding 61 yrs, female gender and direct admission to ICU were associated with lower hospital survival (odds ratio 0.815; 95% 0.612-0.976. Conclusions: Boarding time of critically ill from ED to ICUs is very important because it is strongly related to the hospital LOS and mortality rate.

  7. The transmission of nosocomial pathogens in an intensive care unit: a space-time clustering and structural equation modelling approach.

    Science.gov (United States)

    Rushton, S P; Shirley, M D F; Sheridan, E A; Lanyon, C V; O'Donnell, A G

    2010-06-01

    We investigated the incidence of cases of nosocomial pathogens and risk factors in an intensive treatment unit ward to determine if the number of cases is dependent on location of patients and the colonization/infection history of the ward. A clustering approach method was developed to investigate the patterns of spread of cases through time for five microorganisms [methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter spp., Klebsiella spp., Candida spp., and Pseudomonas aeruginosa] using hospital microbiological monitoring data and ward records of patient-bed use. Cases of colonization/infection by MRSA, Candida and Pseudomonas were clustered in beds and through time while cases of Klebsiella and Acinetobacter were not. We used structural equation modelling to analyse interacting risk factors and the potential pathways of transmission in the ward. Prior nurse contact with colonized/infected patients, mediated by the number of patient-bed movements, were important predictors for all cases, except for those of Pseudomonas. General health and invasive surgery were significant predictors of cases of Candida and Klebsiella. We suggest that isolation and bed movement as a strategy to manage MRSA infections is likely to impact upon the incidence of cases of other opportunist pathogens. PMID:19814850

  8. Prognostic value of α-fetoprotein and des-γ-carboxy prothrombin responses in patients with hepatocellular carcinoma treated with transarterial chemoembolization

    International Nuclear Information System (INIS)

    Alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) have been used as diagnostic tools for hepatocellular carcinoma (HCC). However, prediction of outcome using AFP and DCP has not been elucidated. We investigated the clinical role of AFP and DCP as predictors of treatment outcome in patients with HCC undergoing trans-arterial chemoembolization (TACE). Between January 2003 and December 2005, we enrolled 115 treatment-naïve patients who received TACE as an initial treatment modality. An AFP or DCP response was defined as a reduction of more than 50% from the baseline level 1 month after TACE. Patients with AFP < 20 ng/mL or DCP < 20 mAU/mL were excluded. The median age was 59 years and the male gender predominated (n = 81, 70.4%). AFP and DCP response was identified in 91 (79.1%) and 77 (66.9%) patients after TACE. Although progression-free survival (PFS) did not differ according to AFP response (P = 0.150), AFP responders showed significantly better overall survival (OS) than non-responders (34.9 vs. 13.2 months; P = 0.002). In contrast, DCP response did not influence either PFS or OS (all P > 0.05). Multivariate analyses showed that gamma-glutamyltranspeptidase and baseline AFP were predictors of PFS (all P < 0.05) and that male gender, the presence of liver cirrhosis, baseline DCP, number of measurable tumors and AFP response were independent predictors of OS (all P < 0.05). AFP response and higher baseline DCP level are significant predictors of OS in treatment-naïve patients with HCC receiving TACE who showed pretreatment elevation of both AFP and DCP

  9. Universal method to determine acidic licit and illicit drugs and personal care products in water by liquid chromatography quadrupole time-of-flight

    Science.gov (United States)

    Andrés-Costa, María Jesús; Carmona, Eric; Picó, Yolanda

    2016-01-01

    Pharmaceuticals, illicit drugs and personal care products are emerging contaminants widely distributed in water. Currently, a number of solid-phase extraction (SPE) procedures followed by liquid chromatography tandem mass spectrometry (LC–MS/MS) have been reported. However, target analysis of selected compounds is commonly used whereas other related contaminants present in the sample remain invisible. Carmona et al. [1] described a method for determining 21 emerging contaminants by LC–MS/MS with improved mobile phases. We tested this protocol in combination with high resolution mass spectrometry using a quadrupole time-of-flight (QqTOF) instrument to get a wide non-target screening approach in order to have a broader scope and more practical method for detecting licit and illicit drugs and personal care products than traditional target methods. The essential points in the method are: • The screening capabilities of QqTOF (ABSciex Triple TOF™) are used for detecting and identifying non-target pharmaceuticals and a large number of other emerging contaminants in water. • The quantitative features of the instrument, the Achilles heel of the QqTOF mass spectrometers, are established for few selected compounds. • The method may be applied to identify a large number of emerging contaminants in water. However, pre-validation will be needed to quantify them. PMID:27144129

  10. Universal method to determine acidic licit and illicit drugs and personal care products in water by liquid chromatography quadrupole time-of-flight.

    Science.gov (United States)

    Andrés-Costa, María Jesús; Carmona, Eric; Picó, Yolanda

    2016-01-01

    Pharmaceuticals, illicit drugs and personal care products are emerging contaminants widely distributed in water. Currently, a number of solid-phase extraction (SPE) procedures followed by liquid chromatography tandem mass spectrometry (LC-MS/MS) have been reported. However, target analysis of selected compounds is commonly used whereas other related contaminants present in the sample remain invisible. Carmona et al. [1] described a method for determining 21 emerging contaminants by LC-MS/MS with improved mobile phases. We tested this protocol in combination with high resolution mass spectrometry using a quadrupole time-of-flight (QqTOF) instrument to get a wide non-target screening approach in order to have a broader scope and more practical method for detecting licit and illicit drugs and personal care products than traditional target methods. The essential points in the method are: •The screening capabilities of QqTOF (ABSciex Triple TOF™) are used for detecting and identifying non-target pharmaceuticals and a large number of other emerging contaminants in water.•The quantitative features of the instrument, the Achilles heel of the QqTOF mass spectrometers, are established for few selected compounds.•The method may be applied to identify a large number of emerging contaminants in water. However, pre-validation will be needed to quantify them. PMID:27144129

  11. Real-Time Transmission and Storage of Video, Audio, and Health Data in Emergency and Home Care Situations

    Directory of Open Access Journals (Sweden)

    Barbieri Ivano

    2007-01-01

    Full Text Available The increase in the availability of bandwidth for wireless links, network integration, and the computational power on fixed and mobile platforms at affordable costs allows nowadays for the handling of audio and video data, their quality making them suitable for medical application. These information streams can support both continuous monitoring and emergency situations. According to this scenario, the authors have developed and implemented the mobile communication system which is described in this paper. The system is based on ITU-T H.323 multimedia terminal recommendation, suitable for real-time data/video/audio and telemedical applications. The audio and video codecs, respectively, H.264 and G723.1, were implemented and optimized in order to obtain high performance on the system target processors. Offline media streaming storage and retrieval functionalities were supported by integrating a relational database in the hospital central system. The system is based on low-cost consumer technologies such as general packet radio service (GPRS and wireless local area network (WLAN or WiFi for lowband data/video transmission. Implementation and testing were carried out for medical emergency and telemedicine application. In this paper, the emergency case study is described.

  12. Quantification of Staphylococcus aureus and Staphylococcus epidermidis on the hands of health-care workers using a real-time polymerase chain reaction method

    DEFF Research Database (Denmark)

    Horn, P; Schouenborg, P Øland; Brandslund, I

    2007-01-01

    OBJECTIVE: The objective of this study was to test a polymerase chain reaction (PCR) assay intended as a tool for monitoring hand hygiene in hospital wards. METHODS: The hands of 20 health-care workers were sampled for 10 days using real-time PCR for quantification of Staphylococcus aureus and S....... aureus and 211% for S. epidermidis. In an intervention study aimed at better hand hygiene in a ward with n participants, the difference before and after intervention is significant at CDI/sqrt[n] per cent. CONCLUSIONS: The PCR assay can be used to detect change in a group mean of S. aureus and S....... epidermidis in a hospital ward, i.e. before and after an intervention to improve hand hygiene. For the individual, the change in bacteria levels needed for significance is compromised by high intra-individual variation....

  13. Análise da mutação G20210A no gene da protrombina (fator II em pacientes com suspeita de trombofilia no sul do Brasil Analysis of prothrombin G20210A mutation (factor II in patients with suspected trombophilia in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Marcos Edgar Herkenhoff

    2012-04-01

    Full Text Available INTRODUÇÃO: A protrombina (fator II é uma proteína sanguínea sintetizada no fígado com a presença de vitamina K. É a precursora da trombina, que induz a formação de fibrina. Foi descrita uma mutação no gene da protrombina G20210A, associada diretamente a altos níveis de protrombina no sangue e, consequentemente, à trombofilia. Essa variante alélica consiste em mutação pontual, também chamada de polimorfismo de nucleotídeo simples (SNP, ocasionando a troca de uma guanina por uma adenina no nucleotídeo 20210, localizado em um sítio de clivagem do precursor do ácido ribonucleico mensageiro (mRNA. Essa troca caracteriza o alelo A e a ausência da mutação do alelo G. OBJETIVO: Quantificar o número de indivíduos homozigotos para alelo G, homozigotos para alelo A e heterozigotos, cujas amostras foram enviadas para o laboratório Genolab Análises Genéticas, abrangendo os estados do Paraná e Santa Catarina, no período de 1º de janeiro de 2009 a 10 de outubro de 2010. MÉTODOS: Análise de mutação pontual por reação em cadeia da polimerase em tempo real (RT-PCR. RESULTADOS: Obtivemos o número de 243 indivíduos e desse total 51,03% eram oriundos do estado do Paraná, enquanto 48,97%, oriundos do estado de Santa Catarina. Do total analisado, 88,89% possuíam o genótipo para homozigoto G, e nenhum indivíduo foi encontrado com mutação para homozigoto A. Apenas 11,11% possuíam genótipo heterozigoto. O estado de Santa Catarina apresentou frequência superior para genótipo heterozigoto em relação ao Paraná. CONCLUSÃO: Este estudo mostrou que é recomendável a identificação do genótipo para esse gene em pacientes com suspeita de trombofilia nos dois estados.INTRODUCTION: Prothrombin (factor II is a blood protein synthesized in the liver in the presence of vitamin K. It is a thrombin precursor, which induces fibrin formation. Prothrombin G20210A mutation and high prothrombin levels have been closely associated

  14. 血液透析室护理工作的时间管理研究%Time management of nursing care in blood dialysis room

    Institute of Scientific and Technical Information of China (English)

    颜艳芳

    2013-01-01

    目的 探讨时间管理在血液透析室护理工作中的应用效果.方法 将实施血液透析护理常规管理的7 530例次透析作为对照组,将实施时间管理的8 030例次透析作为观察组,比较两组护理不良事件发生率、护理投诉率和患者对护理工作满意度.结果 观察组护理不良事件发生率、护理投诉发生率显著下降,患者对护理工作满意度得到大幅度提升,与对照组比较,差异有统计学意义(均P<0.01).结论 时间管理能提高护士的管理能力和工作效率,帮助护士达成高质量工作目标,有利于提高患者满意度.%Objective To explore the effect of time management of nursing care in blood dialysis room. Methods A total of 7 530 times of hcmodialysis were seen as the control group, receiving routine care,and another 8 030 times of hcmodialysis as the observation group, receiving time management during the therapy. The incidence rates of nursing adverse events,patient complaint rates and patient satisfaction with nursing work,between the 2 groups were compared. Results The incidence rates of nursing adverse events,patient complaint rates in the observation group were significantly lower than in the control group, patient satisfaction in the observation group were significantly higher than in the control group (P<0. 01 for all). Conclusion Time management could improve nurses management ability and work efficiency, and help nurses fulfill their job with high quality, which is beneficial to improving patient satisfaction.

  15. Barriers and Incentives to Orphan Care in a Time of AIDS and Economic Crisis: A Cross-Sectional Survey of Caregivers in Rural Zimbabwe

    Science.gov (United States)

    Howard, Brian H.; Phillips, Carl V.; Matinhure, Nelia; Goodman, Karen J.; McCurdy, Sheryl A; Johnson, Cary A.

    2007-01-01

    Background: Africa is in an orphan-care crisis. In Zimbabwe, where one-fourth of adults are HIV-positive and one-fifth of children are orphans, AIDS and economic decline are straining society's ability to care for orphans within their extended families. Lack of stable care is putting thousands of children at heightened risk of malnourishment,…

  16. Ideal timing to transfer from an acute care hospital to an interdisciplinary inpatient rehabilitation program following a stroke: an exploratory study

    Directory of Open Access Journals (Sweden)

    Nadeau Sylvie

    2006-11-01

    Full Text Available Abstract Background Timely accessibility to organized inpatient stroke rehabilitation services may become compromised since the demand for rehabilitation services following stroke is rapidly growing with no promise of additional resources. This often leads to prolonged lengths of stays in acute care facilities for individuals surviving a stroke. It is believed that this delay spent in acute care facilities may inhibit the crucial motor recovery process taking place shortly after a stroke. It is important to document the ideal timing to initiate intensive inpatient stroke rehabilitation after the neurological event. Therefore, the objective of this study was to examine the specific influence of short, moderate and long onset-admission intervals (OAI on rehabilitation outcomes across homogeneous subgroups of patients who were admitted to a standardized interdisciplinary inpatient stroke rehabilitation program. Methods A total of 418 patients discharged from the inpatient neurological rehabilitation program at the Montreal Rehabilitation Hospital Network after a first stroke (79% of all cases reviewed were included in this retrospective study. After conducting a matching procedure across these patients based on the degree of disability, gender, and age, a total of 40 homogeneous triads (n = 120 were formed according to the three OAI subgroups: short (less than 20 days, moderate (between 20 and 40 days or long (over 40 days; maximum of 70 days OAI subgroups. The rehabilitation outcomes (admission and discharge Functional Independence Measure scores (FIM, absolute and relative FIM gain scores, rehabilitation length of stay, efficiency scores were evaluated to test for differences between the three OAI subgroups. Results Analysis revealed that the three OAI subgroups were comparable for all rehabilitation outcomes studied. No statistical difference was found for admission (P = 0.305–0.972 and discharge (P = 0.083–0.367 FIM scores, absolute (P = 0

  17. Integrating palliative care into comprehensive cancer care.

    Science.gov (United States)

    Abrahm, Janet L

    2012-10-01

    While there are operational, financial, and workforce barriers to integrating oncology with palliative care, part of the problem lies in ourselves, not in our systems. First, there is oncologists' "learned helplessness" from years of practice without effective medications to manage symptoms or training in how to handle the tough communication challenges every oncologist faces. Unless they and the fellows they train have had the opportunity to work with a palliative care team, they are unlikely to be fully aware of what palliative care has to offer to their patients at the time of diagnosis, during active therapy, or after developing advanced disease, or may believe that, "I already do that." The second barrier to better integration is the compassion fatigue many oncologists develop from caring for so many years for patients who, despite the oncologists' best efforts, suffer and die. The cumulative grief oncologists experience may go unnamed and unacknowledged, contributing to this compassion fatigue and burnout, both of which inhibit the integration of oncology and palliative care. Solutions include training fellows and practicing oncologists in palliative care skills (eg, in symptom management, psychological disorders, communication), preventing and treating compassion fatigue, and enhancing collaboration with palliative care specialists in caring for patients with refractory distress at any stage of disease. As more oncologists develop these skills, process their grief, and recognize the breadth of additional expertise offered by their palliative care colleagues, palliative care will become integrated into comprehensive cancer care. PMID:23054873

  18. Comparing Prothrombin induced by vitamin K absence-II (PIVKA-II) with the oncofetal proteins Glypican-3, Alpha feto protein and Carcinoembryonic antigen in diagnosing hepatocellular carcinoma among Egyptian patients

    International Nuclear Information System (INIS)

    Background: Hepatocellular carcinoma (HCC) is usually asymptomatic in the early stage and does not show elevated alpha-feto protein (AFP). AFP shows 60-80% sensitivity in diagnosing HCC. Glypican3 (GPC-3) is an oncofetal protein that is only detected in HCC cells but not in benign liver tissues, while Carcinoembryonic antigen (CEA) is expressed in various neoplasms including HCC. Although, it is not specific for HCC. Prothrombin induced by vitamin K absence-II (PIVKA-II) is an abnormal prothrombin protein that is increased in the serum of HCC patients. It has higher sensitivity and specificity compared to AFP. The aim of this study is to compare the clinical utility of PIVKA-II with GPC-3, AFP and CEA in diagnosing HCC. Prothrombin induced by vitamin K absence-II Patients and methods: This study included 40 patients with HCC, 10 patients with cirrhosis as a benign control group, and 10 apparently healthy volunteers as normal controls. Serum samples were subjected to routine laboratory investigations, measurement of CEA, AFP using MEIA technique (Axsym), glypican3, and PIVKA-II using ELISA technique in the sera of all patients and controls. Results: All markers showed the highest results in the HCC group. Higher concentrations of PIVKA- II were detected in patients with splenomegaly, and in tumors with size (>3 cm). Combination of Glypican-3 and PIVKA-II showed the highest sensitivity, while GPC-3 alone and combination of GPC-3 and AFP showed the highest specificity to differentiate HCC from liver cirrhosis and normal controls. GPC-3, PIVKAII, and combination of both showed the highest sensitivity, while GPC-3 alone showed the highest specificity to differentiate HCC from liver cirrhosis. Conclusion: Glypican-3 is the only oncofetal antigen that showed comparable high diagnostic accuracy as PIVKA-II in diagnosing HCC among Egyptian patients.

  19. Sociodemographic and Clinical Determinants of Time to Care-Seeking Among Febrile Children Under-Five in North-Central Nigeria

    Directory of Open Access Journals (Sweden)

    Mohammed B. Abdulkadir

    2015-09-01

    Full Text Available Objectives: Our study sought to determine the time parents of febrile children under the age of five took to seek competent medical care. We also looked at the possible sociodemographic/ clinical factors that influenced this presentation. Methods: Four hundred and nine under-fives presenting at the emergency unit with a history of fever in the last 48 hours along with their mothers were recruited over four months. Relevant sociodemographic information as well as symptoms and duration of illness were obtained. Multinomial regression analysis was performed to determine the predictors of early and late presentation. Results: Over half (57% of patients presented within 24 hours of onset of fever. The mean age of the children and mothers were 22±15 months and 30±5 years, respectively. High social class (odds ratio (OR 6.5, 95% CI 1.6–26.4, Hausa ethnic group (OR 19.3, 95% CI 5.7–65.6, convulsions (OR 3.2, 95% CI 1.6–6.5 and appearance of other symptoms (OR 6.0, 95% CI 3.0–12.0 were significant predictors of early presentation. Secondary school education, belonging to another ethnic group, and non-resolution of fever were significant predictors of late presentation. Conclusion: The majority of febrile under-fives came to the hospital to seek competent medical care within the first 24 hours of illness. However, there is a need for more parental education on early hospital presentation for parents of low socioeconomic status and educational background.

  20. Does Care Matter?

    DEFF Research Database (Denmark)

    Loft, Lisbeth Trille Gylling; Hogan, Dennis P.

    2014-01-01

    The aim of this study is to introduce the concept of care capital and provide an example of its application in the context of child care and maternal employment using the currently most suitable American data. We define care capital as the nexus of available, accessible, and experienced resources...... for care. The American setting is an ideal context to investigate the linkages between child care capital and maternal employment as the patterns of child care use tend to be more diverse compared to other national context. In the presented application of care capital, we examine mothers’ entry to paid...... employment during the first 36 weeks following a birth, and its association with experienced non-parental child care use before labor force entry. Using data from the Early Childhood Longitudinal Survey – Birth Cohort (N = 10,400 mothers), results from discrete-time hazard models show that use of non...

  1. Laboratory evaluation of anti-phospholipid syndrome: a preliminary prospective study of phosphatidylserine/prothrombin antibodies in an at-risk patient cohort.

    Science.gov (United States)

    Heikal, N M; Jaskowski, T D; Malmberg, E; Lakos, G; Branch, D W; Tebo, A E

    2015-05-01

    Immunoglobulin (Ig)G/IgM autoantibodies to phosphatidylserine/prothrombin (aPS/PT) were evaluated individually and in combination with criteria anti-phospholipid (aPL) tests in a prospectively ascertained cohort of patients at risk for anti-phospholipid syndrome (APS). One hundred and sixty (160) consecutive requests for lupus anti-coagulant (LAC) from the University of Utah Health Sciences Center were identified during 8 weeks. Of these, 104 unique patients had additional requests for cardiolipin (aCL) and/or beta2 glycoprotein I (aβ2 GPI) IgG and/or IgM; samples were retained and analysed for aPS/PT, aCL and/or aβ2 GPI IgG and IgM antibodies. Following testing, a comprehensive chart review was performed and patients categorized according to their clinical diagnosis. Individual and combined sensitivities, specificities, odd ratios (OR), diagnostic accuracy for specific tests or combinations by receiver operating characteristic (ROC), area under the curve (AUC) analyses and correlations between test results were determined. The sensitivities of aPS/PT IgG/IgM (54·6/45·5%) were lower than LAC (81·8%) but higher relative to aCL IgG/IgM (27·3/0%) or aβ2 GPI IgG/IgM (27·3/0%). The best correlation between LAC and any aPL test was observed with aPS/PT (P = 0·002). There was no significant difference in the diagnostic accuracies for any panel with LAC: LAC/aβ2 GPI IgG/aCL IgG [AUC 0·979, OR 475·4, 95% confidence interval (CI) 23·1-9056·5, P = 0·0001 and LAC/aβ2 GPI IgG/aPS/PT IgG or LAC/aPS/PT IgG/aCL IgG (AUC 0·962, OR 265·3, 14·2-4958·2, P = 0·0001). The high correlation between LAC and aPS/PT IgG/IgM in this preliminary study suggest that this marker may be useful in the evaluation of APS. More studies to determine the optimal aPL antibody tests combination are needed. PMID:25522978

  2. Low mechanical ventilation times and reintubation rates associated with a specific weaning protocol in an intensive care unit setting: a retrospective study

    Directory of Open Access Journals (Sweden)

    Cilene Saghabi de Medeiros Silva

    2012-09-01

    Full Text Available OBJECTIVES: A number of complications exist with invasive mechanical ventilation and with the use of and withdrawal from prolonged ventilator support. The use of protocols that enable the systematic identification of patients eligible for an interruption in mechanical ventilation can significantly reduce the number of complications. This study describes the application of a weaning protocol and its results. METHODS: Patients who required invasive mechanical ventilation for more than 24 hours were included and assessed daily to identify individuals who were ready to begin the weaning process. RESULTS: We studied 252 patients with a median mechanical ventilation time of 3.7 days (interquartile range of 1 to 23 days, a rapid shallow breathing index value of 48 (median, a maximum inspiratory pressure of 40 cmH(20, and a maximum expiratory pressure of 40 cm H(20 (median. Of these 252 patients, 32 (12.7% had to be reintubated, which represented weaning failure. Noninvasive ventilation was used postextubation in 170 (73% patients, and 15% of these patients were reintubated, which also represented weaning failure. The mortality rate of the 252 patients studied was 8.73% (22, and there was no significant difference in the age, gender, mechanical ventilation time, and maximum inspiratory pressure between the survivors and nonsurvivors. CONCLUSIONS: The use of a specific weaning protocol resulted in a lower mechanical ventilation time and an acceptable reintubation rate. This protocol can be used as a comparative index in hospitals to improve the weaning system, its monitoring and the informative reporting of patient outcomes and may represent a future tool and source of quality markers for patient care.

  3. A Librarian Consultation Service Improves Decision-Making and Saves Time for Primary Care Practitioners. A Review of: McGowan, Jessie, William Hogg, Craig Campbell, and Margo Rowan. “Just-in-Time Information Improved Decision-Making in Primary Care: A Randomized Controlled Trial.” PLoS ONE 3.11 (2008: e3785. 10 Mar 2009

    Directory of Open Access Journals (Sweden)

    Heather Ganshorn

    2009-06-01

    Full Text Available Objectives – To determine whether a point-of-care librarian consultation service for primary care practitioners (PCPs improves the quality of PCPs’ decision-making; saves PCPs time; reduces the number of point-of-care questions that go unanswered due to time constraints; and is cost-effective. Overall PCP satisfaction with the service was also assessed.Design – Randomized controlled trial.Setting – Four Family Health Networks (FHNs and 14 Family Health Groups (FHGs in Ontario, Canada. These represent new models for primary care service delivery in Ontario.Subjects – PCPs working within the selected FHNs and FHGs. The majority of these were physicians, but the sample also contained one resident, one nurse, and four nurse-practitioners.Methods – Subjects were trained in the use of a Web-based query form or mobile device to submit their point-of-care questions electronically. They were also trained in query formulation using PICO (patient, intervention, comparison, and outcome. Allocation was concealed by an independent company hired to manage data for the project. Participants were not randomized; rather the questions were randomized using a random-number generator. To ensure blinding of the librarians, all questions submitted were answered by a librarian. Answers to questions in the intervention group were relayed by a third party to the practitioner within minutes. Answers to the questions in the control group were not communicated to the physician. Blinding of the PCP subjects was not possible, as they either received or did not receive an answer. Subjects were asked to respond to a questionnaire 24 hours after submitting their question. If the question was in the control group, subjects were asked to indicate whether they had let the question remain unanswered or pursued an answer on their own. In order to assess cognitive impact of both librarian-provided information and self-sought information, respondents were asked to rate

  4. Fragmento 1+2 da protrombina em indivíduos submetidos à angiografia coronariana Prothrombin fragment 1+2 in subjects undergoing coronary angiography

    Directory of Open Access Journals (Sweden)

    Luciana M. Lima

    2005-09-01

    transforms the prothrombin into thrombin and breaks up prothrombin fragment 1+2 (F1+2. F1+2 plasma levels reflect the thrombin generation and can be used as in vivo markers of hypercoagulability since the thrombin is an unstable and easily degraded substance that cannot be directly measured in the plasma. The present study aims at determining the F1+2 plasma levels of a group of subjects undergoing coronary angiography, attempting to establish a possible correlation between this parameter and the severity of the coronary artery disease. F1+2 plasma levels were determined in blood samples of 17 subjects with absence of atheromatosis in coronary arteries (controls, 12 subjects presenting mild/moderate atheromatosis and 28 subjects presenting severe atheromatosis, using the Enzignost F1+2 (Behring® Diagnostics GmbH, Marburg, Germany diagnostic Kit. Significant differences between the averages for the three groups in respect to the evaluated parameters were not found. Therefore, F1+2 plasma level averages for the three groups did not point to a state of hypercoagulability in the studied population. However, 73.7% of the individuals were taking acetylsalicylic acid, which may have influenced the F1+2 plasma levels, considering that this medicine promotes the inhibition of the enzyme cyclo-oxygenase, diminishing the release of thromboxane A2 and the platelet aggregation. Therefore, it is presumed that platelet activation reduction could be contributing to a lower formation of thrombin and, consequently, diminishing the hypercoagulability potential.

  5. Prenatal Care

    Science.gov (United States)

    ... am thinking about getting pregnant. How can I take care of myself? You should start taking care of ... What should I do — or not do — to take care of myself and my unborn baby? Follow these ...

  6. Self Care

    Science.gov (United States)

    ... Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic ... help you cope can make a real difference. Self-care techniques are things you can do for ...

  7. Hair transplantation: Standard guidelines of care

    Directory of Open Access Journals (Sweden)

    Patwardhan Narendra

    2008-03-01

    that proper hair growth can be expected after about 9 months after transplantation. Preoperative laboratory studies to be performed include Hb%, blood counts including platelet count, bleeding and clotting time (or prothrombin time and activated partial thromboplastin time, blood chemistry profile including sugar. Methods : Follicular unit hair transplantation is the gold standard method of hair transplantation; it preserves the natural architecture of the hair units and gives natural results. Mini-micro-grafting is a method hair transplantation involving randomly assorted groups of hairs, with out consideration of their natural configuration of follicular units, under loupe or naked eye examination. Mini-grafts consist of 4-5-6 hairs while micro-grafts consist of 1-3 hairs. Punch gives ugly cosmetically unacceptable results and should no longer be used. Patient Selection : Hair transplantation can be performed in any person with pattern hair loss, with good donor area, in good general health and reasonable expectations. Caution should be exercised in, very young patients whose early alopecia is still evolving, patients with Norwood grade VI or VII with poor density, patients with unrealistic expectations, and patients with significant systemic health problems. Medical therapy: Most patients will need concurrent medical treatment since the process of pattern hair loss is progressive and may affect the remaining hairs. Manpower : Hair transplantation is a team effort. Particularly, performing large sessions, needs a well trained team of trained assistants. Anesthesia: 2% lignocaine with adrenaline is generally used for anesthesia; tumescent technique is preferred. Bupivacaine has been used by some authors in view of its prolonged duration of action. Donor dissection : Strip dissection by single blade is recommended for donor area. Steromicroscopic dissection is recommended for dissection of hair units in follicular unit transplantation; mini-micro-grafting does not need

  8. "Beating osteoARThritis": Development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis

    NARCIS (Netherlands)

    Smink, A.J.; Ende, C.H.M. van den; Vliet Vlieland, T.P.M.; Swierstra, B.A.; Kortland, J.H.; Bijlsma, J.W.J.; Voorn, T.B.; Schers, H.J.; Bierma-Zeinstra, S.M.; Dekker, J.

    2011-01-01

    Inadequacies in health care practices have been reported despite existing guidelines to manage hip or knee osteoarthritis. To facilitate guideline implementation and improve utilization of non-surgical treatment options a care strategy should be developed. This study describes the development of an

  9. "Beating osteoARThritis" : Development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis

    NARCIS (Netherlands)

    Smink, Agnes J.; van den Ende, Cornelia H. M.; Vlieland, Thea P. M. Vliet; Swierstra, Bart A.; Kortland, Joke H.; Bijlsma, Johannes W. J.; Voorn, Theo B.; Schers, Henk J.; Bierma-Zeinstra, Sita M. A.; Dekker, Joost

    2011-01-01

    Inadequacies in health care practices have been reported despite existing guidelines to manage hip or knee osteoarthritis. To facilitate guideline implementation and improve utilization of non-surgical treatment options a care strategy should be developed. This study describes the development of an

  10. Protrombina mutante em indivíduos sob investigação de trombofilia Mutant prothrombin in individuals under thrombophilia investigation

    Directory of Open Access Journals (Sweden)

    Catarina Paula da Silva Ramos

    2008-04-01

    coagulation factor II, prothrombin G20210A (PTCR, constitutes the second most prevalent genetic defect associated with the predisposition to thrombosis or thrombophilia. In Brazil, the study of this risk factor is relatively recent and there is little available data in medical literature. OBJECTIVE: The aim of this study was to determine the frequency of PTCR in 285 individuals being investigated for thrombophilia at Fundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE/PE. MATERIAL AND METHOD: The molecular biology technique used was restriction enzyme/polymerase chain reaction (RE/PCR, using specific primers and the Hind III enzyme. RESULTS: The frequency of PTCR was 6% in heterozygosis. The presence of the mutation was similar among individuals under and over 45 years old. DISCUSSION: The presence of PTCR may have been a relevant factor for the episodes of thrombosis, and the low median age of the group suggests that other genetic causes of thrombophilia must be investigated inasmuch as most publications associate the presence of genetic risk factor with thrombotic events in individuals under 45 years old. CONCLUSIONS: Our findings showed that the frequency of PTCR in the studied population is similar to the results published in medical literature for selected patients with thromboembolism and they confirm the importance of molecular testing at different age groups.

  11. Differential Diagnosis of Malaria on Truelab Uno®, a Portable, Real-Time, MicroPCR Device for Point-Of-Care Applications

    Science.gov (United States)

    Nair, Chandrasekhar Bhaskaran; Manjula, Jagannath; Subramani, Pradeep Annamalai; Nagendrappa, Prakash B.; Manoj, Mulakkapurath Narayanan; Malpani, Sukriti; Pullela, Phani Kumar; Subbarao, Pillarisetti Venkata; Ramamoorthy, Siva; Ghosh, Susanta K.

    2016-01-01

    Background Sensitive and specific detection of malarial parasites is crucial in controlling the significant malaria burden in the developing world. Also important is being able to identify life threatening Plasmodium falciparum malaria quickly and accurately to reduce malaria related mortality. Existing methods such as microscopy and rapid diagnostic tests (RDTs) have major shortcomings. Here, we describe a new real-time PCR-based diagnostic test device at point-of-care service for resource-limited settings. Methods Truenat® Malaria, a chip-based microPCR test, was developed by bigtec Labs, Bangalore, India, for differential identification of Plasmodium falciparum and Plasmodium vivax parasites. The Truenat Malaria tests runs on bigtec’s Truelab Uno® microPCR device, a handheld, battery operated, and easy-to-use real-time microPCR device. The performance of Truenat® Malaria was evaluated versus the WHO nested PCR protocol. The Truenat® Malaria was further evaluated in a triple-blinded study design using a sample panel of 281 specimens created from the clinical samples characterized by expert microscopy and a rapid diagnostic test kit by the National Institute of Malaria Research (NIMR). A comparative evaluation was done on the Truelab Uno® and a commercial real-time PCR system. Results The limit of detection of the Truenat Malaria assay was found to be <5 parasites/μl for both P. falciparum and P. vivax. The Truenat® Malaria test was found to have sensitivity and specificity of 100% each, compared to the WHO nested PCR protocol based on the evaluation of 100 samples. The sensitivity using expert microscopy as the reference standard was determined to be around 99.3% (95% CI: 95.5–99.9) at the species level. Mixed infections were identified more accurately by Truenat Malaria (32 samples identified as mixed) versus expert microscopy and RDTs which detected 4 and 5 mixed samples, respectively. Conclusion The Truenat® Malaria microPCR test is a valuable

  12. Health care delivery systems.

    OpenAIRE

    Stevens, F; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective, meaningful, and socially accepted. From a sociological point of view, the analysis of health care delivery systems implies recognition of their distinct history over time, their specific values an...

  13. Point-of-care detection and real-time monitoring of intravenously delivered drugs via tubing with an integrated SERS sensor

    Science.gov (United States)

    Wu, Hsin-Yu; Cunningham, Brian T.

    2014-04-01

    We demonstrate an approach for detection, identification, and kinetic monitoring of drugs flowing within tubing, through the use of a plasmonic nanodome array (PNA) surface. The PNA structures are fabricated using a low-cost nanoreplica molding process upon a flexible plastic substrate that is subsequently integrated with a flow cell that connects in series with ordinary intravenous (IV) drug delivery tubing. To investigate the potential clinical applications for point-of-care detection and real-time monitoring, we perform SERS detection of ten pharmaceutical compounds (hydrocodone, levorphanol, morphine, oxycodone, methadone, phenobarbital, dopamine, diltiazem, promethazine, and mitoxantrone). We demonstrate dose-dependent SERS signal magnitude, resulting in detection limits (ng ml-1) well below typical administered dosages (mg ml-1). Further, we show that the detected drugs are not permanently attached to the PNA surface, and thus our approach is capable of performing continuous monitoring of drug delivery as materials flow through IV tubing that is connected in series with the sensor. Finally, we demonstrate the potential co-detection of multiple drugs when they are mixed together, and show excellent reproducibility and stability of SERS measurements for periods extending at least five days. The capabilities reported here demonstrate the potential to use PNA SERS surfaces for enhancing the safety of IV drug delivery.We demonstrate an approach for detection, identification, and kinetic monitoring of drugs flowing within tubing, through the use of a plasmonic nanodome array (PNA) surface. The PNA structures are fabricated using a low-cost nanoreplica molding process upon a flexible plastic substrate that is subsequently integrated with a flow cell that connects in series with ordinary intravenous (IV) drug delivery tubing. To investigate the potential clinical applications for point-of-care detection and real-time monitoring, we perform SERS detection of ten

  14. Comparing the Effect of Topical Application of Maternal Milk, 96% Ethyl Alcohol, and Dry Cord Care on Umbilical Cord Separation Time in Healthy Full-Term Neonates

    OpenAIRE

    F. Eghbalian; M. Shokohi; . Ghoreyshi

    2015-01-01

    Introduction & Objective: Umbilical cord infections are of main causes for neonatal morbidities and mortalities. Different methods are used for umbilical cord care with multifarious efficien-cies. The aim of this study was to compare three methods of local use of maternal milk, local use of 96% ethyl alcohol, and dry cord care. Materials & Methods: In this prospective, randomized, clinical trial, 207 healthy full-term neo-nates were randomly assigned to three groups. In the first and second g...

  15. Measurement of Compliance With New York City’s Regulations on Beverages, Physical Activity, and Screen Time in Early Child Care Centers

    OpenAIRE

    Lessard, Laura; Lesesne, Catherine; Kakietek, Jakub; Breck, Andrew; Jernigan, Jan; Dunn, Lillian; Nonas, Cathy; O’Dell, Sarah Abood; Stephens, Robert L; Xu, Ye; Kettel Khan, Laura

    2014-01-01

    Introduction Policy interventions designed to change the nutrition environment and increase physical activity in child care centers are becoming more common, but an understanding of the implementation of these interventions is yet to be developed. The objective of this study was to explore the extent and consistency of compliance with a policy intervention designed to promote nutrition and physical activity among licensed child care centers in New York City. Methods We used a multimethod cros...

  16. Prealbumina, precalicreína e protrombina na forma hepatesplênica da esquistossomose: catabolismo aumentado de proteínas da coagulação? Prealbumin, prekallikrein and prothrombin in hepatosplenic schistosomiasis: increased turnover of the clotting proteins?

    Directory of Open Access Journals (Sweden)

    Nora Manoukian

    1984-10-01

    Full Text Available No plasma de 20 doentes portadores da forma hepatesplênica da esquistossomose mansônica, assim como no de 18 indivíduos normais, foram avaliados pré-albumina, precalicreína (atividade amidolítica e protrombina-antígeno. Os valores da concentração plasmática de pré-albumina obtidos no grupo controle permitiram que se estabelecesse um intervalo de referência (0,5 — 99,5% de 97 — 389 mg/I. Valores anormalmente diminuídos de pré-albumina encontrados em 2 dos doentes indicaram nestes uma disfunção hepatocítica de síntese protêica. Nos 18 doentes restantes a média da pré-albumina (232 ± 13 mg/l não diferiu (p > 0,05 da do grupo controle (243 ± 11 mg/l enquanto as médias da atividade de pró-calicreina (34 ± 1 μKat/l e protrombina (81 ± 3,0 mg/l estavam significativamente diminuídos no grupo de esquistossomóticos (p Prealbumin, prekallikrein and prothrombin were evaluated in 20 patients with the hepatosplenic form of schistosomiasis and in 18 subjects of a control group. With the prealbumin concentration values obtained in the latter group a reference interval (0.5 — 99.5% of 97 to 389 mg/L was calculated and plasma levels below 97 mg/L assessed in 2 patients a deficiency in hepatic synthetic capacity. Mean (± SEM prealbumin concentration in the 18 remaining patients (232 ± 13 mg/L did not differ (p > 0.05 from that of the control group (243 ± 11 mg/L. Otherwise these 18 patients had both mean plasma prekallikrein (34 ± 1.3 /μKat/L and prothrombin-antigen (81 ± 3 mg/L concentrations lower (p < 0.01 than those of the control group (40 ± 1.4 μKat/L and 100 ± 3 mg/L, respectively. The present findings do not necessarily rule out the possibility that prekallikrein and prothrombin may asses a minimal hepatocellular damage earlier than prealbumin; but, since the latter protein have a shorter half-life than the formers and is a reliable index of hepatic synthetic capacity, the present report supports the hypothesis

  17. Tumescent liposuction: Standard guidelines of care

    Directory of Open Access Journals (Sweden)

    Mysore Venkataram

    2008-03-01

    procedures. Liposuction is contraindicated in patients with severe cardiovascular disease, severe coagulation disorders including thrombophilia, and during pregnancy. Physical evaluation should be detailed and should include assessment of general physical health to determine the fitness of the patient for surgery, as well as the examination of specific sites that need liposuction to check for potential problems. Preoperative Informed consent : The patient should sign a detailed consent form listing details about the procedure and possible complications. The consent form should specifically state the limitations of the procedure and should mention whether more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, computer presentations, and personal discussions. Preoperative laboratory studies to be performed include Hb%, blood counts including platelet counts, bleeding and clotting time (or prothrombin and activated partial thromboplastin time and blood chemistry profile; ECG is advisable. Liver function tests, and pregnancy test for women of childbearing age are performed as mandated by the individual patient′s requirements. Ultrasound examination is recommended in cases of gynecomastia. Preoperative medication : Preoperative antibiotics and non-sedative analgesics such as paracetamol are recommended. The choice of antibiotic and analgesic agents depends on the individual physician′s preference and the prevailing local conditions. Type of anesthetic employed : Lidocaine is the preferred local anesthetic; its recommended dose is 35-45 mg/kg and doses should not exceed 55 mg/kg wt. The recommended concentration of epinephrine in tumescent solutions is 0.25-1.5 mg/L. The total dosage of epinephrine should be minimized and should not exceed 50 µg/kg. Surgical technique/procedure It is always advisable not to combine liposuction with other procedures to avoid exceeding the recommended dosage

  18. Caring for the caregiver.

    Science.gov (United States)

    2008-01-01

    Caring for the Caregiver is information for persons helping to care for people with cancer. The emphasis is on what caregivers can do to help themselves at this stressful time. Topics included are: Who Is a Caregiver, Your Feelings, Asking For Help, Caring for Yourself, Going With Your Loved One to Medical Visits, Talking With Others, Remember, Other Resources for Caregivers. The information is written on a basic level and it is very suitable for health professionals to share with persons helping to care for family members or friends who have cancer. The National Cancer Institute posted this information on its website last June 29. PMID:19062356

  19. Has the time come to use near-infrared spectroscopy as a routine clinical tool in preterm infants undergoing intensive care?

    DEFF Research Database (Denmark)

    Greisen, Gorm; Leung, Terence; Wolf, Martin

    2011-01-01

    the neonatal period. It is likely that an important part of the burden of this handicap is due to brain injury induced by hypoxia-ischaemia during intensive care. In particular, this is true for infants born extremely preterm. Thus, monitoring of cerebral oxygenation has considerable potential benefit......Several instruments implementing spatially resolved near-infrared spectroscopy (NIRS) to monitor tissue oxygenation are now approved for clinical use. The neonatal brain is readily assessible by NIRS and neurodevelopmental impairment is common in children who were in need of intensive care during...... in this group. The benefit, however, should be weighed against the disturbance to the infant, against the limitations imposed on clinical care and against costs. The ultimate way of demonstrating the 'added value' is by a randomized controlled trial. Cerebral oximetry must reduce the risk of a...

  20. Daily Care

    Science.gov (United States)

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

  1. Hair Care

    Science.gov (United States)

    ... Body Looking and feeling your best Hair care Hair care Short, long, curly, straight, up, down. Hair options can seem endless! Not all of what makes your hair look good comes from the outside, though. Good ...

  2. Continuing Care

    Science.gov (United States)

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

  3. Tracheostomy care

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000076.htm Tracheostomy care To use the sharing features on this ... through your nose and mouth. Caring for Your Tracheostomy Once the hole in your neck is not ...

  4. Antimicrobial stewardship for carbapenem use at a Japanese tertiary care center: An interrupted time series analysis on the impact of infectious disease consultation, prospective audit, and feedback.

    Science.gov (United States)

    Tagashira, Yasuaki; Horiuchi, Mikihiro; Tokuda, Yasuharu; Heist, Brian S; Higuchi, Masanori; Honda, Hitoshi

    2016-06-01

    Given the concerns surrounding the overuse of carbapenem antibiotics in Japan, we evaluated the impact of infectious disease consultation and a prospective carbapenem audit at a tertiary care center in Tokyo, Japan. Overall, carbapenem use was safely and effectively reduced after implementation of these interventions. The leadership of the infectious diseases physicians also proved critically important to implementing effective stewardship. PMID:26831278

  5. The impact of family policy and career interruptions on women's perceptions of negative occupational consequences of full-time home care

    DEFF Research Database (Denmark)

    Ejrnæs, Anders

    2011-01-01

    This article examines the role of family policy in shaping mothers' choice between work and care and the perceived occupational consequences of that choice. A central question concerns how parental/maternal leave and childcare policies affect the occupational consequences for mothers who spend ti...

  6. Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol

    NARCIS (Netherlands)

    Archambault, P.M.; Turgeon, A.F.; Witteman, H.O.; Lauzier, F.; Moore, L.; Lamontagne, F.; Horsley, T.; Gagnon, M.P.; Droit, A.; Weiss, M.; Tremblay, S.; Lachaine, J.; Sage, N. Le; Emond, M.; Berthelot, S.; Plaisance, A.; Lapointe, J.; Razek, T.; Belt, T.H. van de; Brand, K; Berube, M.; Clement, J.; Iii, F.J. Grajales; Eysenbach, G.; Kuziemsky, C.; Friedman, D.; Lang, E.; Muscedere, J.; Rizoli, S.; Roberts, D.J.; Scales, D.C.; Sinuff, T.; Stelfox, H.T.; Gagnon, I.; Chabot, C.; Grenier, R.; Legare, F.

    2015-01-01

    BACKGROUND: Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the qu

  7. The Nordic maintenance care program--time intervals between treatments of patients with low back pain: how close and who decides?

    DEFF Research Database (Denmark)

    Sandnes, Kjerstin F; Bjørnstad, Charlotte; Leboeuf-Yde, Charlotte;

    2010-01-01

    The management of chiropractic patients with acute and chronic/persistent conditions probably differs. However, little is known on this subject. There is, for example, a dearth of information on maintenance care (MC). Thus it is not known if patients on MC are coerced to partake in a program of f...

  8. The Diagnostic Accuracy of Dementia-Screening Instruments With an Administration Time of 10 to 45 Minutes for Use in Secondary Care : A Systematic Review

    NARCIS (Netherlands)

    Appels, Bregje A.; Scherder, Erik

    2010-01-01

    Early screening for dementia is crucial for identifying reversible causes as well as managing, counseling, and other therapeutic interventions. Many reviews have compared the suitability of very brief screening instruments for use in primary care, but reviews on more extensive instruments in seconda

  9. Controle do tempo de protrombina em sangue capilar e venoso em pacientes com anticoagulação oral: correlação e concordância Comparative study of a portable system for prothrombin monitoring using capillary blood against venous blood measurements in patients using oral anticoagulants: correlation and concordance

    Directory of Open Access Journals (Sweden)

    Tiago Luiz Luz Leiria

    2007-07-01

    Full Text Available FUNDAMENTO: O uso de anticoagulantes orais (ACO é comum na prática cardiológica, tendo como principais indicações a fibrilação atrial e próteses valvares. Os pacientes em uso de ACO necessitam de controle freqüente do tempo de protrombina (TP. Novos sistemas portáteis de monitorização, para medida do tempo de protrombina, sem necessidade da coleta de sangue por venopunção, facilitam a rotina desses pacientes. OBJETIVO: Comparar as medidas do TP realizadas pelo sistema Coaguchek S®, em sangue capilar, com o método padrão em sangue venoso. MÉTODOS: Cento e vinte e sete pacientes em acompanhamento no ambulatório de anticoagulação do Instituto de Cardiologia foram submetidos ao método convencional e coleta de sangue capilar da polpa digital para medida com o sistema Coaguchek S®. RESULTADOS: A idade foi de 58±14 anos, 90% eram brancos. As indicações de ACO foram fibrilação atrial 49,6% e próteses valvares 37,0%. O coeficiente de correlação r s foi 0,90 (p 3,5 foi de Kappa 73,5%. O sistema Coaguchek S® superestimou o INR em 0,15±0,85 unidades. Valores acima de 3,5 unidades de INR mostram discrepância importante entre as duas técnicas. CONCLUSÕES: O sistema Coaguchek S® mostrou boa correlação e bom grau de concordância quando comparado com o controle, com resultados menores que 4. Porém, valores de INR acima de 3,5 ainda necessitam de confirmação com o método padrão.BACKGROUND: Oral anticoagulants (OAC are widely used in cardiology and are mainly indicated in cases of atrial fibrillation and prosthetic heart valves. Regular prothrombin time (PT control is required for patients using OAC. New portable monitoring systems for measuring prothrombin time, eliminate the need to collect blood by venous puncture and facilitate daily life for these patients. OBJECTIVE: To compare PT measurements using the Coaguchek S™ system with capillary blood and the standard method in venous blood. METHODS: One hundred and

  10. A season of snakebite envenomation: presentation patterns, timing of care, anti-venom use, and case fatality rates from a hospital of southcentral Nepal.

    Science.gov (United States)

    Pandey, Deb P; Vohra, Rais; Stalcup, Philip; Shrestha, Bhola R

    2016-01-01

    Snakebite envenomation affects thousands of people annually in Nepal. Published hospital-based studies of snakebite treatment in Nepal are scarce. Here we present the results of the first prospective, cross-sectional study of hospitalized envenomed snakebite cases in southcentral Nepal, a region characterized by poor pre-hospital care of snakebites, limited supply and excessive use of antivenom, and a high case/fatality ratio. We seek to identify clinical management problems and suggest potential interventions to improve treatment of snakebites. Out of the 342 patients presented with snakebites to an urban emergency department in the Terai region of Nepal between April and September of 2007, 39 patients were enrolled based on development of ptosis or swelling of bitten body parts. We collected patient demographic information and documented circumstances of snakebite, prehospital care, hospital care, and development of complications. Among 39 envenomated patients admitted to Bharatpur Hospital enrolled in the study 34 (92%) exhibited features of clinically significant neurotoxicity and were treated with antivenom. Antivenom use ranged from 4 to 98 vials of Polyspecific Indian Antivenom per patient. Each of victims (n=34) received antivenom an average of 4.3 (median) ±0.73 (standard error of mean) hours after receiving the snakebite. The overall case fatality rate was 21%. Neurotoxicity developed up to 25.8hr after suspected elapid snakebites. This was not observed for viperid snake bites. No enrolled patients received any of the currently recommended first aid for snake bite. The prevalence of nocturnal elapid snake bites, the practice of inappropriate first aid measures and highly variable administration of antivenom were identified as major challenges to appropriate care in this study. To address these issues we suggest development of a comprehensive checklist for identification of snake species, management of envenomation, and an educational program which

  11. Time well spent

    DEFF Research Database (Denmark)

    Fallesen, Peter

    2013-01-01

    Individuals who spent time in foster care as children fare on average worse than non-placed peers in early adult life. Recent research on the effect of foster care placement on early adult life outcomes provides mixed evidence. Some studies suggest negative effects of foster care placement on early...... care on income and labor market participation....

  12. Information Sharing for Care Coordination

    OpenAIRE

    Amir, Ofra; Grosz, Barbara J.; Stern, Roni; Sanders, Lee M.

    2013-01-01

    Teamwork and care coordination are of increasing importance to health care delivery and patient safety and health. This paper describes our initial work on developing agents that are able to make intelligent information sharing decisions to support a diverse, evolving team of care providers in constructing and maintaining a shared plan that operates in uncertain environments and over a long time horizon.

  13. Patient-centered Care.

    Science.gov (United States)

    Reynolds, April

    2009-01-01

    Patient-centered care focuses on the patient and the individual's particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. This requires that physicians, radiologic technologists and other health care providers develop good communication skills and address patient needs effectively. Patient-centered care also requires that the health care provider become a patient advocate and strive to provide care that not only is effective but also safe. For radiologic technologists, patient-centered care encompasses principles such as the as low as reasonably achievable (ALARA) concept and contrast media safety. Patient-centered care is associated with a higher rate of patient satisfaction, adherence to suggested lifestyle changes and prescribed treatment, better outcomes and more cost-effective care. This article is a Directed Reading. Your access to Directed Reading quizzes for continuing education credit is determined by your area of interest. For access to other quizzes, go to www.asrt.org/store. According to one theory, most patients judge the quality of their healthcare much like they rate an airplane flight. They assume that the airplane is technically viable and is being piloted by competent people. Criteria for judging a particular airline are personal and include aspects like comfort, friendly service and on-time schedules. Similarly, patients judge the standard of their healthcare on nontechnical aspects, such as a healthcare practitioner's communication and "soft skills." Most are unable to evaluate a practitioner's level of technical skill or training, so the qualities they can assess become of the utmost importance in satisfying patients and providing patient-centered care.(1). PMID:19901351

  14. C-reactive protein prolongs blood coagulation time in phospholipids-dependent coagulation tests

    Directory of Open Access Journals (Sweden)

    L D Kozmin

    2003-01-01

    Full Text Available C-refctive protein prolongs blood coagulation time in phospholipids-dependent coagulation tests. O.P. Bliznukov, L.D. Kostin, A.J. Martinov, T.A. Lisitsina, T.M. Reshetnyak, V.J. Lauga Objective. To study influence of different CRP forms on blood clotting time in standard phospholipid clotting tests. Material and methods. Purified native CRP. monomeric CRP (0-1.6 M, immune complexes of native CRP and rabbit polyclonal anti-CRP antibodies (1.6 M were added to blood plasma of healthy donors. Blood clotting time was registered using optical coagulometer. Phospholipid dependent prothrombin time (PT, activated partial tromboplastin time (APTT, kaolin clotting time (KCT with kaolin and ellagic acid, dilute Russel viper venom time (dRVVT were determined. Results. Native CRP was able to increase blood clotting time in all mentioned clotting tests, excluding prothrombin time. CRP influence on blood clotting time showed a concentration dependence. Polyclonal rabbit anti-CRP antibodies had no inhibitory effect on CRP prolonged blood clotting time. Monomeric CRP (0-1.6 M had no influence on blood clotting time in all phospholipid-dependent clotting tests.

  15. Time trends in the prescription of statins for the primary prevention of cardiovascular disease in the United Kingdom: a cohort study using The Health Improvement Network primary care data

    OpenAIRE

    O'Keeffe, Aidan

    2016-01-01

    Aidan G O’Keeffe,1 Irwin Nazareth,2 Irene Petersen2 1Department of Statistical Science, 2Department of Primary Care and Population Health, University College London, London, UK Background: Statins are widely prescribed for the primary prevention of cardiovascular disease. Guidelines exist for statin prescriptions, but there is little recent analysis concerning prescription trends over time and how these vary with respect to demographic variables.Methods and results: Using The Health...

  16. Time trends in the prescription of statins for the primary prevention of cardiovascular disease in the United Kingdom: a cohort study using The Health Improvement Network primary care data

    OpenAIRE

    O’Keeffe AG; Nazareth I; Petersen I.

    2016-01-01

    Aidan G O’Keeffe,1 Irwin Nazareth,2 Irene Petersen2 1Department of Statistical Science, 2Department of Primary Care and Population Health, University College London, London, UK Background: Statins are widely prescribed for the primary prevention of cardiovascular disease. Guidelines exist for statin prescriptions, but there is little recent analysis concerning prescription trends over time and how these vary with respect to demographic variables.Methods and results: Using The Health Imp...

  17. Childbearing in a Time of ART: Birth Rates, Childbearing Desires and Family Planning in a Rural HIV Treatment and Care Programme in South Africa

    OpenAIRE

    Benton, L. M.

    2015-01-01

    Mixed methods investigate the association between HIV, ART and fertility following scale-up of HIV treatment and care in South Africa. Two longitudinal analyses of surveillance data from the Africa Centre for Health and Population Studies compare factors associated with live birth by HIV and ART exposure. Semi-structured interviews with women enrolled on ART and healthcare providers explore perceptions of childbearing and contraceptive use. A quantitative study reports on one open cohort anal...

  18. 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...

  19. Nurse leaders' Attitudes, Self-Efficacy and training Needs for Implementing Evidence-Based Practice: Is It Time for a Change toward Safe Care?

    OpenAIRE

    Farokhzadian, Jamileh; Nayeri, Nahid Dehghan; Borhani, Fariba; Zare, Mohmmad Reza

    2015-01-01

    Introduction Evidence-based practice (EBP) has been recognized as the gold standard for safe and high quality care. Nurse leaders have a strategic position in terms of initiating changes in clinical settings for successfully implementing EBP. Therefore, the factors that influence implementing EBP must be measured. Aims To examine nurse leaders' attitudes, self-efficacy, and training needs for implementing evidence-based practice. Place and Duration of Study Four teaching hospitals affiliated ...

  20. Universal method to determine acidic licit and illicit drugs and personal care products in water by liquid chromatography quadrupole time-of-flight

    OpenAIRE

    Andrés-Costa, María Jesús; Carmona, Eric; Picó, Yolanda

    2016-01-01

    Pharmaceuticals, illicit drugs and personal care products are emerging contaminants widely distributed in water. Currently, a number of solid-phase extraction (SPE) procedures followed by liquid chromatography tandem mass spectrometry (LC–MS/MS) have been reported. However, target analysis of selected compounds is commonly used whereas other related contaminants present in the sample remain invisible. Carmona et al. [1] described a method for determining 21 emerging contaminants by LC–MS/MS w...

  1. Valores de referência do tempo de protrombina (TP) e tempo de tromboplastina parcial ativada (TTPa) em cães Reference ranges of prothrombin time (PT) and activated partial thromboplastin time (aPTT) in dogs

    OpenAIRE

    Sonia Terezinha dos Anjos Lopes; Mauren Picada Emanuelli; Claudete Schmidt; Alceu Gaspar Raiser; Alexandre Mazzanti; Aline Souza Alves

    2005-01-01

    Os fatores de coagulação são parte integrante da hemostasia normal, e tanto as coagulopatias hereditárias como adquiridas que envolvem este sistema são de grande importância veterinária, geralmente evidenciadas por manifestações clínicas, tais como, petéquias, equimoses, hematomas e sangramentos tardios. O presente trabalho teve por objetivo a determinação dos valores de referência do tempo de protrombina (TP) e tempo de tromboplastina parcial ativada (TTPa), por métodos manuais. Para tanto, ...

  2. The value of combined detection of AFP, plasma prothrombin activity and serum ferritin in the prognostic of severe chronic hepatitis B%甲胎蛋白、血浆凝血酶原活动度与血清铁蛋白联合检测对慢性重型乙型肝炎预后的价值

    Institute of Scientific and Technical Information of China (English)

    李四海; 袁明娟

    2011-01-01

    Objective To analyze the joint determination of alpha - fetoprotein, plasma prothrombin activity and serum ferritin in patients with chronic severe hepatitis B for the significance prognosis.Methods Eighty chronic severe hepatitis B patients, who were divided into improved group and death group according to clinical outcomes, were observed and compared in alpha - fetoprotein (AFP), prothrombin activity (PTA) and serum ferritin (SF) with retrospective analysis.Results The AFP of the improved group at admission were higher than that of death group, and prothrombin activity and serum ferritin showed no difference between the two groups.AFP and serum ferritin showed a downward trend in the improved group while the prothrombin activity showed an upward trend; death group has been at a low level of AFP, and serum ferritin and prothrombin activity rose.Conclusion Dynamic joint detection of AFP, prothrombin activity and serum ferritin can be better used in clinical prognosis of severe hepatitis.%目的 分析慢性重型乙型肝炎患者,联合测定甲胎蛋白(AFP)、血浆凝血酶原活动度(PTA)与血清铁蛋白(SF)对于其预后的意义.方法 回顾性分析80例慢性重型乙型肝炎,并根据临床转归分为好转组、死亡组,观察并比较AFP、PTA与SF的变化情况.结果 好转组入院时AFP明显高于死亡组,而PTA和SF 2组无区别,治疗后好转组AFP、SF显著下降,而PTA显著上升;死亡组中AFP一直处于低水平,而PTA和SF显著上升.结论 动态联合检测AFP、PTA与SF临床上能更好地用于慢性乙型重症肝炎预后的判断.

  3. Why do care workers withdraw from elderly care?

    DEFF Research Database (Denmark)

    Liveng, Anne

    2012-01-01

    the same time it illustrates the care workers' commitment to the elderly. A paradoxical "empathy at a distance" is characteristic of the scene. When analyzing my written observations in an interpretation group, my use of language was a point of discussion. What did it mean when I described the...... interactions between care workers and elderly residents in words commonly used to describe mother-child interactions? My use of language became a "hermeneutical key" which enabled a psychoanalytically inspired interpretation. This focuses on the care relationship as activating our earliest memories of our own...... care relations, independently of whether we are in the role of care providers or care receivers. Through collusion theory, the interpretation accepts both the anxiety which the helpless elderly people arouse in the care workers and their motivation for care work as two sides of a subjectively important...

  4. Has the time come to use near-infrared spectroscopy as a routine clinical tool in preterm infants undergoing intensive care?

    DEFF Research Database (Denmark)

    Greisen, Gorm; Leung, Terence; Wolf, Martin

    2011-01-01

    Several instruments implementing spatially resolved near-infrared spectroscopy (NIRS) to monitor tissue oxygenation are now approved for clinical use. The neonatal brain is readily assessible by NIRS and neurodevelopmental impairment is common in children who were in need of intensive care during...... clinically relevant endpoint, such as death or neurodevelopmental handicap. We estimate that such a trial should recruit about 4000 infants to have the power to detect a reduction in brain injury by one-fifth. This illustrates the formidable task of providing first-grade evidence for the clinical value of...

  5. Optimization of health-care organization and perceived improvement of patient comfort by switching from intra-venous BU four-times-daily infusions to a once-daily administration scheme in adult hematopoietic stem cell recipients.

    Science.gov (United States)

    Xhaard, A; Rzepecki, P; Valcarcel, D; Santarone, S; Fürst, S; Serrano, D; De Angelis, G; Krüger, W; Scheid, C

    2014-04-01

    Previous studies have shown an equivalent pharmacokinetic profile between four-times-daily (4QD) and once-daily (QD) administration of intra-venous (IV) BU, without increased toxicity. We assess the impact of a switch in IV BU from a 4QD to a QD schedule, in terms of health-care organization, staff working conditions, quality of care dispensed and perceived patient comfort. Clinicians, nurses and pharmacists from nine allogeneic transplantation units in five European countries were interviewed face to face. Overall perception of QD versus 4QD BU was very positive. Both administration schemes were evaluated to be equally efficaciousZ. QD BU was perceived to be safer and more convenient. Clinicians and nurses perceived that patient comfort was improved, due to fewer complications associated with repeated infusions, and avoiding night infusions associated with stress, anxiety and decreased quality of sleep. Switching from 4QD to QD BU had a significant impact on health-care organization, with a better integration in the overall management and usual timelines in the pharmacies and transplantation units. Time spent to prepare and administer BU was significantly reduced, leading to potential financial savings that merit further assessment and would be of particular interest in the current economic climate. PMID:24419513

  6. Mercury and health care

    OpenAIRE

    Rustagi Neeti; Singh Ritesh

    2010-01-01

    Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world ha...

  7. An out break of more than 1300 cases of acute viral hepatitis in a tertiary care hospital in Rawalpindi in summer of 2009

    International Nuclear Information System (INIS)

    To find out the short-term clinical course including common clinical features, laboratory parameters, treatment provided and outcome of cases of acute viral hepatitis hospitalized in a tertiary care hospital. Study Design: Descriptive observational study. Place and Duration of Study: Military Hospital in Rawalpindi from May to July 2009. Patients and Methods: Patients hospitalized with acute viral hepatitis, both male and female, older than 12 years of age were included in the study. A detailed proforma including patients' particulars, clinical features; laboratory parameters, treatment provided, disposal/ outcome was designed and filled for each patient. Results: During the study period a total 1334 patients were hospitalized, 1279 (95.87%) were male while only 55 (4.13%) were female. Majority of patients were young adults. Mean age was 26 years with a range of 12 to 85 years. Maximum serum bilirubin levels of 559 micromoles and serum alanine aminotransferas (ALT) levels of 7750 IU/L were observed. Maximum prothrombin time (PT) ranged from 105 seconds to failed to clot, against a control of 13 seconds. Thrombocytopenia was observed in some patients especially those with coagulopathy and encephalopathy but recovered with improvement in LFTs. Anti HEV serology was sent in a third of all admitted patients and was positive for IgM in patients tested. Five patients were pregnant ladies. Two patients also had laboratory proven malaria along with acute viral hepatitis. Majority of patients had uneventful recovery. A total of 13 patients went in to hepatic encephalopathy while three unfortunate patients died. Conclusion: HEV has been an important cause of acute viral hepatitis in Pakistan, particularly in adults from lower socioeconomic groups. The problem is more serious for those living in military camps, residential institutions and in segregated areas who consume untreated water from a common source. Outbreaks like the one described have significant morbidity and not

  8. Supportive Care.

    Science.gov (United States)

    Olsen, Pia Riis; Lorenzo, Rosalía

    2016-01-01

    This chapter takes its point of departure in psychosocial aspects of supportive care in adolescent and young adult cancer care. The purpose is to describe some of the challenges that these young people face following a cancer diagnosis and guide healthcare professionals in how to provide care that improves the quality of life. In most hospitals and healthcare systems, adolescents and young adults are cared for and treated in settings for children or adults. Accordingly, healthcare professionals may lack attention to and knowledge about what characterize young peoples' life situation, their special needs and how to meet them. The topics we include in the chapter are the following: the youth friendly environment, social support and social network, parents, information during a psychosocial crisis event, the use of HEADSS, peer support, fertility, body image and self-esteem, after treatment and future challenges and palliative and end of life care. PMID:27595353

  9. Lack of effect of influenza vaccine on warfarin anticoagulation in the elderly.

    OpenAIRE

    Gomolin, I. H.

    1986-01-01

    Influenza vaccine may inhibit hepatic metabolism of drugs and has been reported to prolong the prothrombin time in patients receiving warfarin by affecting the coagulation pathway. In a group of seven elderly residents of a long-term care facility who were receiving warfarin, prolongation of the prothrombin and partial thromboplastin times could not be shown up to 5 weeks after vaccination against influenza. The results were similar in nine elderly subjects who were not receiving warfarin.

  10. Careful science?

    DEFF Research Database (Denmark)

    Jespersen, Astrid P; Bønnelycke, Julie; Eriksen, Hanne Hellerup

    2014-01-01

    into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday...... lives. Care practices are an inherent part of producing scientific facts but they are removed from the recognised results of scientific practice and thus from common public health recommendations. However, knowledge about the strategic use of care practices in lifestyle interventions is important for...

  11. Primary care patient and provider preferences for diabetes care managers

    Directory of Open Access Journals (Sweden)

    Ramona S DeJesus

    2010-06-01

    Full Text Available Ramona S DeJesus1, Kristin S Vickers2, Robert J Stroebel1, Stephen S Cha31Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, MN, USA; 3Department of Biostatistics, Mayo Clinic, Rochester, MN, USAPurpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferences for chronic disease care, hence, we conducted a study aimed at identifying these.Methods: A 20-item questionnaire, asking for patients’ and providers’ preferences and perceptions, was mailed out to 1000 randomly selected patients in Olmsted County, Minnesota, identified through a diabetes registry to have type 2 diabetes mellitus, a prototypical prevalent chronic disease. Surveys were also sent to 42 primary care providers.Results: There were 254 (25.4% patient responders and 28 (66% provider responders. The majority of patients (>70% and providers (89% expressed willingness to have various aspects of diabetes care managed by a care manager. Although 75% of providers would be comfortable expanding the care manager role to other chronic diseases, only 39.5% of patient responders would be willing to see a care manager for other chronic problems. Longer length of time from initial diagnosis of diabetes was associated with decreased patient likelihood to work with a care manager.Conclusion: Despite study limitations, such as the lack of validated measures to assess perceptions related to care management, our results suggest that patients and providers are willing to collaborate with a care manager and that both groups have similar role expectations of a care manager.Keywords: care manager, collaborative care, patient preference, diabetes care

  12. 凝血酶原前体蛋白在华法林抗凝效果监测中的应用%Application of Precursor of Prothrombin in Monitoring of Anticoagulation Effect for Warfarin

    Institute of Scientific and Technical Information of China (English)

    李伟皓; 李彦会; 李伟; 张会丰; M.J.Shearer; 刘永春

    2003-01-01

    @@ 华法林是一种常用口服抗凝剂,具有服用方便、疗效确切等优点,被广泛用于临床.目前,临床多以凝血酶原时间(PT)、国际标准化比率(INR)、凝血酶原片段1+2(F1+2)等指标对华法林抗凝效果进行评价.凝血酶原前体蛋白(Prescursor of Prothrombin.Proteins Induced by Vitamin K Abense of Antagonism,PIVKA-Ⅱ)作为反映机体维生素K营养状况最敏感的指标[1],其作用已被医学界公认,但其对评价华法林抗凝效果是否具有应用价值,目前国内尚未见报道.为此我们进行了试验研究,报道如下.

  13. Early Decreases in α-Fetoprotein and Des-γ-carboxy Prothrombin Predict the Antitumor Effects of Hepatic Transarterial Infusion Chemotherapy with Cisplatin (CDDP) Powder in Patients with Advanced Hepatocellular Carcinoma.

    Science.gov (United States)

    Hatanaka, Takeshi; Kakizaki, Satoru; Shimada, Yasushi; Takizawa, Daichi; Katakai, Kenji; Yamazaki, Yuichi; Sato, Ken; Kusano, Motoyasu; Yamada, Masanobu

    2016-01-01

    Objective We retrospectively investigated the relationship between the tumor response and serial changes in α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP) during hepatic arterial infusion of a cisplatin powder formulation (CDDP powder) in patients with advanced hepatocellular carcinoma (HCC). Methods Seventy-six advanced HCC patients were analyzed. All HCC patients received high-concentration cisplatin (1.43 mg/mL) via the haptic artery at a dose of 65 mg/m(2). AFP and DCP were measured at baseline and four to eight weeks after treatment, and the antitumor responses were evaluated according to the response evaluation criteria in solid tumours (RECIST) criteria after one or two courses of treatment. The patients were classified into two groups, a decreased group and a non-decreased group, according to the change in the serum levels of AFP and DCP at four to eight weeks compared to baseline. Results The response to treatment of the decreased group (n=16) and non-decreased group (n=60) was complete response/partial response/stable disease/progressive disease (CR/PR/SD/PD) in 4/4/5/3 and 1/11/8/40 patients, respectively. The response rate and disease control rate of the decreased group were significantly higher than those of the non-decreased group (p=0.016 and pAFP and DCP after the first treatment with CDDP powder is a good predictor for the antitumor effect and the prognosis. PMID:27522991

  14. Endothelial Nitric Oxide Synthase T-786C Mutation, Prothrombin Gene Mutation (G-20210-A and Protein S Deficiency Could Lead to Myocardial Infarction in a Very Young Male Adult

    Directory of Open Access Journals (Sweden)

    Milka Klincheva

    2016-01-01

    Full Text Available INTRODUCTION: Myocardial infarction is a rare medical event in young people. The main reasons include congenital coronary abnormalities, coronary artery spasm, and coronary thrombosis due to hypercoagulable states (hereditary and acquired. AIM: We present a case of a young male adult with myocardial infarction caused by a combination of gene mutations and anticoagulation protein deficiency. CASE PRESENTATION: A 19 years old young man was admitted to our hospital complaining of chest pain during the last two weeks. The patient did not have any known cardiovascular risk factors, except a positive family anamnesis. Subacute inferior nonST segment myocardial infarction was diagnosed according to the patient’s history, electrocardiographic and laboratory findings. Coronary angiography revealed suboclusive thrombus in the proximal, medial and distal part of the right coronary artery (TIMI 2. Percutaneous coronary intervention was performed. Anticoagulant and antiagregant therapy (heparin, acetilsalicilic acid and clopidogrel according to protocol was started. The hospital stay was uneventful. Homozygous endothelial nitric oxid synthase (eNOS T-786-C mutation, heterozygote prothrombin gene mutation (G-20210-A, and protein S deficiency were verified from the thrombophilia testing. Other trombophilic tests were normal. Three months after discharge from hospital another coronary angiography was performed. It revealed normal coronary arteries. Four years after the attack, the patient is free of symptoms and another cardiovascular event. CONCLUSION: Combination of genetic mutations and anticoagulation protein deficiency could be a reasonable cause for myocardial infarction in a very young male adult without any other cardiovascular risk factors.

  15. Comprehensive Care

    Science.gov (United States)

    ... Providing emotional support Comprehensive care includes attention to emotional health as well as physical health. Mental health professionals provide support and education, as well as diagnose and treat the depression, ...

  16. Palliative Care

    Science.gov (United States)

    ... Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & Safety Doctors & Hospitals Q&A ... assess the complex needs of the patient and family, facilitate communication with the care team and within the family, ...

  17. Hospice Care

    Science.gov (United States)

    ... your care. Other team members may include a music therapist, physical therapist, speech therapist or occupational therapist. ... to the Terms and Conditions and Privacy Policy Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium ...

  18. Multidisciplinary Care.

    Science.gov (United States)

    Daly, Megan E; Riess, Jonathan W

    2016-01-01

    Optimal multidisciplinary care of the lung cancer patient at all stages should encompass integration of the key relevant medical specialties, including not only medical, surgical, and radiation oncology, but also pulmonology, interventional and diagnostic radiology, pathology, palliative care, and supportive services such as physical therapy, case management, smoking cessation, and nutrition. Multidisciplinary management starts at staging and tissue diagnosis with pathologic and molecular phenotyping, extends through selection of a treatment modality or modalities, management of treatment and cancer-related symptoms, and to survivorship and end-of-life care. Well-integrated multidisciplinary care may reduce treatment delays, improve cancer-specific outcomes, and enhance quality of life. We address key topics and areas of ongoing investigation in multidisciplinary decision making at each stage of the lung cancer treatment course for early-stage, locally advanced, and metastatic lung cancer patients. PMID:27535399

  19. Use of palivizumab and infection control measures to control an outbreak of respiratory syncytial virus in a neonatal intensive care unit confirmed by real-time polymerase chain reaction.

    LENUS (Irish Health Repository)

    O'Connell, K

    2011-04-01

    Respiratory syncytial virus (RSV) is a potentially life-threatening infection in premature infants. We report an outbreak involving four infants in the neonatal intensive care unit (NICU) of our hospital that occurred in February 2010. RSV A infection was confirmed by real-time polymerase chain reaction. Palivizumab was administered to all infants in the NICU. There were no additional symptomatic cases and repeat RSV surveillance confirmed that there was no further cross-transmission within the unit. The outbreak highlighted the infection control challenge of very high bed occupancy in the unit and the usefulness of molecular methods in facilitating detection and management.

  20. Impact of a pilot pharmacy health-care professional out-of-school time physical activity and nutrition education program with exercise on fourth and fifth graders in a rural Texas community

    OpenAIRE

    Robles, Janie; Gutierrez, Ashley; Seifert, Charles F.

    2014-01-01

    Objectives: Childhood obesity continues to be a problem. Children in rural populations are more likely to be overweight or obese and a lack of resources in those areas may contribute to this problem. We aimed to assess the impact of a pilot pharmacy health-care professional out-of-school time vigorous physical activity and nutrition education program on fourth and fifth graders in a rural Texas community. Methods: We conducted a prospective 12-week cohort study from August to November 2012. T...

  1. Nursing care of diabetic mellitus patients treated by the real-time dynamic insulin pump system%实时动态胰岛素泵系统强化治疗糖尿病患者的护理

    Institute of Scientific and Technical Information of China (English)

    王素玲; 程千鹏; 张星光; 武晋晓; 许秀萍; 吕肖锋

    2012-01-01

    Objective To investigate the nursing care for the diabetic patients receiving real-time dynamic insulin pump system treating.Methods In addition to psychological care and diet instruction,the nurses actively communicated with the diabetic patients,introduced the principle and advantages of the real-time dynamic insulin pump system to promote the diabetic patients to cooperate with the medical staff.Results The blood glucose control of the diabetic patients treated with the real-time dynamic insulin pump system was well after 2.7 days.Among 7 cases,there were twice cal error alarm,4 times lost sensor,3 times weak signal,twice sensor error,1 time high blood glucose alarm,1 time low blood glucose alarm.Conclusions Development and implementation of system nursing care can achieve a satisfactory treatment effect.%目的 探讨应用实时动态胰岛素泵系统强化治疗糖尿病患者的护理方法.方法 除了监测中的心理治疗与饮食干预护理以外,还要积极主动地与糖尿病患者沟通,介绍实时动态胰岛素泵系统的原理与优点,使患者与医生更好地配合.做好实时动态胰岛素泵系统植入前、植入时、植入后的护理.结果 使用实时动态胰岛素泵系统治疗糖尿病2.7d可使患者血糖控制好.7例中校准错误报警2次,丢失探头报警4次,弱信号报警3次,探头错误2次,低血糖报警1次,高血糖报警1次.结论 系统的护理方法的制定与执行可以使实时动态胰岛素泵系统强化治疗糖尿病患者血糖取得良好控制.

  2. Caring Encounters

    Science.gov (United States)

    Gunn, Alyson

    2012-01-01

    Children with autism may seem to not care about things or have the same range of emotions as those of us who see them and care for them. But they do have empathy and they can be taught how to communicate it, says the author, a teacher of children with autism. We simply need to listen to them, watch them, and be with them in their moment.

  3. Correlation between timing of tracheostomy and duration of mechanical ventilation in patients with potentially normal lungs admitted to intensive care unit

    Directory of Open Access Journals (Sweden)

    Mehrdad Masoudifar

    2012-01-01

    Conclusion: Our study with mentioned sample size could not show any relationship between timing of tracheostomy and duration of mechanical ventilation in patients under mechanical ventilation with good pulmonary function in ICU.

  4. Access and care issues in urban urgent care clinic patients

    Directory of Open Access Journals (Sweden)

    Adams Jill C

    2009-12-01

    Full Text Available Abstract Background Although primary care should be the cornerstone of medical practice, inappropriate use of urgent care for non-urgent patients is a growing problem that has significant economic and healthcare consequences. The characteristics of patients who choose the urgent care setting, as well as the reasoning behind their decisions, is not well established. The purpose of this study was to determine the motivation behind, and characteristics of, adult patients who choose to access health care in our urgent care clinic. The relevance of understanding the motivation driving this patient population is especially pertinent given recent trends towards universal healthcare and the unclear impact it may have on the demands of urgent care. Methods We conducted a cross-sectional survey of patients seeking care at an urgent care clinic (UCC within a large acute care safety-net urban hospital over a six-week period. Survey data included demographics, social and economic information, reasons that patients chose a UCC, previous primary care exposure, reasons for delaying care, and preventive care needs. Results A total of 1, 006 patients were randomly surveyed. Twenty-five percent of patients identified Spanish as their preferred language. Fifty-four percent of patients reported choosing the UCC due to not having to make an appointment, 51.2% because it was convenient, 43.9% because of same day test results, 42.7% because of ability to get same-day medications and 15.1% because co-payment was not mandatory. Lack of a regular physician was reported by 67.9% of patients and 57.2% lacked a regular source of care. Patients reported delaying access to care for a variety of reasons. Conclusion Despite a common belief that patients seek care in the urgent care setting primarily for economic reasons, this study suggests that patients choose the urgent care setting based largely on convenience and more timely care. This information is especially applicable to

  5. Wound Care in Primary Health Care

    OpenAIRE

    Nail Ersoz; Ismail Hakki Ozerhan; Fatih Zor

    2008-01-01

    Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull 2008; 7(1.000): 71-74

  6. Wound Care in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Nail Ersoz

    2008-02-01

    Full Text Available Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull. 2008; 7(1: 71-74

  7. Wound Care in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Nail Ersoz

    2008-02-01

    Full Text Available Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull 2008; 7(1.000: 71-74

  8. The theoretical accuracy of Runge-Kutta time discretizations for the initial boundary value problem: A careful study of the boundary error

    Science.gov (United States)

    Carpenter, Mark H.; Gottlieb, David; Abarbanel, Saul; Don, Wai-Sun

    1993-01-01

    The conventional method of imposing time dependent boundary conditions for Runge-Kutta (RK) time advancement reduces the formal accuracy of the space-time method to first order locally, and second order globally, independently of the spatial operator. This counter intuitive result is analyzed in this paper. Two methods of eliminating this problem are proposed for the linear constant coefficient case: (1) impose the exact boundary condition only at the end of the complete RK cycle, (2) impose consistent intermediate boundary conditions derived from the physical boundary condition and its derivatives. The first method, while retaining the RK accuracy in all cases, results in a scheme with much reduced CFL condition, rendering the RK scheme less attractive. The second method retains the same allowable time step as the periodic problem. However it is a general remedy only for the linear case. For non-linear hyperbolic equations the second method is effective only for for RK schemes of third order accuracy or less. Numerical studies are presented to verify the efficacy of each approach.

  9. Relationship of glucose values to sliding scale insulin (correctional insulin) dose delivery and meal time in acute care patients with diabetes mellitus.

    Science.gov (United States)

    Trotter, Barbara; Conaway, Mark R; Burns, Suzanne M

    2013-01-01

    Findings of this study suggest the traditional sliding scale insulin (SSI) method does not improve target glucose values among adult medical inpatients. Timing of blood glucose (BC) measurement does affect the required SSI dose. BC measurement and insulin dose administration should be accomplished immediately prior to mealtime. PMID:23802496

  10. Continuity of care in community midwifery

    OpenAIRE

    Bowers, John; Cheyne, Helen; Mould, Gillian; Page, Miranda

    2014-01-01

    Continuity of care is often critical in delivering high quality health care. However, it is difficult to achieve in community health care where shift patterns and a need to minimise travelling time can reduce the scope for allocating staff to patients. Community midwifery is one example of such a challenge in the National Health Service where postnatal care typically involves a series of home visits. Ideally mothers would receive all of their antenatal and postnatal care from the same midwife...

  11. Collaborative Health Care Plan Support

    OpenAIRE

    Amir, Ofra; Grosz, Barbara J.; Law, Edith Lok Man; Stern, Roni

    2013-01-01

    This paper envisions a multi-agent system that assists patients and their health care providers. This system would support a diverse, evolving team in formulating, monitoring and revising a shared "care plan" that operates on multiple time scales in uncertain environments. It would also enhance communication of health information within this planning framework. The coordination of care for children with complex conditions (CCC), which is a compelling societal need, is presented as a model env...

  12. Comparison of nested-multiplex, Taqman & SYBR Green real-time PCR in diagnosis of amoebic liver abscess in a tertiary health care institute in India

    OpenAIRE

    K P Dinoop; Subhash Chandra Parija; Jharna Mandal; R P Swaminathan; Narayanan, P.

    2016-01-01

    Background & objectives: Amoebiasis is a common parasitic infection caused by Entamoeba histolytica and amoebic liver abscess (ALA) is the most common extraintestinal manifestation of amoebiasis. The aim of this study was to standardise real-time PCR assays (Taqman and SYBR Green) to detect E. histolytica from liver abscess pus and stool samples and compare its results with nested-multiplex PCR. Methods: Liver abscess pus specimens were subjected to DNA extraction. The extracted DNA samp...

  13. Wound Care.

    Science.gov (United States)

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve. PMID:26022525

  14. Funding Rural Health Care.

    Science.gov (United States)

    Moore, Kim

    This paper provides first-time grant writers with suggestions on how to approach a private funding source. While intended for rural health care advocates, the remarks are equally applicable for educators and others. The rural crisis has produced many heart-rending stories about medically indigent people, but there is a lack of reliable statistics…

  15. Accountability in Health Care

    DEFF Research Database (Denmark)

    Vrangbæk, Karsten; Byrkjeflot, Haldor

    2016-01-01

    adjustment of such frameworks. In this article we present a framework for analyzing accountability within health care. The paper makes use of the concept of "accountability regime" to signify the combination of different accountability forms, directions and functions at any given point in time. We show...

  16. Child Care and Child Nutrition

    Science.gov (United States)

    Karolak, Eric

    2009-01-01

    The weak economy is challenging the child care program budget. Fluctuations in enrollment come up against rising costs making every penny count. So for many reasons a federal program that helps defray the costs of snacks and meals in child care programs is particularly important and timely. In this article, the author pushes for the…

  17. Comparison of PCR/Electron spray Ionization-Time-of-Flight-Mass Spectrometry versus Traditional Clinical Microbiology for active surveillance of organisms contaminating high-use surfaces in a burn intensive care unit, an orthopedic ward and healthcare workers

    Directory of Open Access Journals (Sweden)

    Yun Heather C

    2012-10-01

    Full Text Available Abstract Background Understanding nosocomial pathogen transmission is restricted by culture limitations. Novel platforms, such as PCR-based electron spray ionization-time-of-flight-mass spectrometry (ESI-TOF-MS, may be useful as investigational tools. Methods Traditional clinical microbiology (TCM and PCR/ESI-TOF-MS were used to recover and detect microorganisms from the hands and personal protective equipment of 10 burn intensive care unit (ICU healthcare workers providing clinical care at a tertiary care military referral hospital. High-use environmental surfaces were assessed in 9 burn ICU and 10 orthopedic patient rooms. Clinical cultures during the study period were reviewed for pathogen comparison with investigational molecular diagnostic methods. Results From 158 samples, 142 organisms were identified by TCM and 718 by PCR/ESI-TOF-MS. The molecular diagnostic method detected more organisms (4.5 ± 2.1 vs. 0.9 ± 0.8, p S. aureus in 13 samples vs. 21 by PCR/ESI-TOF-MS. Gram-negative organisms were less commonly identified than gram-positive by both methods; especially by TCM. Among all detected bacterial species, similar percentages were typical nosocomial pathogens (18-19% for TCM vs. PCR/ESI-TOF-MS. PCR/ESI-TOF-MS also detected mecA in 112 samples, vanA in 13, and KPC-3 in 2. MecA was associated (p S. aureus. No vanA was codetected with enterococci; one KPC-3 was detected without Klebsiella spp. Conclusions In this pilot study, PCR/ESI-TOF-MS detected more organisms, especially gram-negatives, compared to TCM, but the current assay format is limited by the number of antibiotic resistance determinants it covers. Further large-scale assessments of PCR/ESI-TOF-MS for hospital surveillance are warranted.

  18. Home Care

    Science.gov (United States)

    ... care is especially useful for persons who need nursing, therapy, or aide services. You may need help if you are dealing with one or more of the following: You have trouble getting around (for example, after a hospital stay or an accident) You have wounds that need to be cleaned, ...

  19. Enacting Care

    Czech Academy of Sciences Publication Activity Database

    Urban, Petr

    2015-01-01

    Roč. 9, č. 2 (2015), s. 216-222. ISSN 1749-6535 R&D Projects: GA ČR(CZ) GPP401/12/P544 Institutional support: RVO:67985955 Keywords : ethics of care * enactivism * autonomy * social institutions * autism * exclusion Subject RIV: AA - Philosophy ; Religion http://dx.doi.org/10.1080/17496535.2015.1022356

  20. Who cares?

    DEFF Research Database (Denmark)

    Petersen, Morten Krogh

    practices. If that is the case, the great challenge is to “come up with ingenious solutions to the problem of how to become interesting enough for practices to care about” (ibid: 72). Through ethnographic fieldwork encounters with Radicand Design Collaboratory, a collaborative product development...

  1. Team networking in palliative care.

    Science.gov (United States)

    Spruyt, Odette

    2011-01-01

    "If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members. PMID:21811361

  2. Team networking in palliative care

    Directory of Open Access Journals (Sweden)

    Odette Spruyt

    2011-01-01

    Full Text Available "If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges for providers of palliative care. Teams are organic and can be life giving or life sapping for their members.

  3. Time4: Time for SDN

    OpenAIRE

    Mizrahi, Tal; Moses, Yoram

    2015-01-01

    With the rise of Software Defined Networks (SDN), there is growing interest in dynamic and centralized traffic engineering, where decisions about forwarding paths are taken dynamically from a network-wide perspective. Frequent path reconfiguration can significantly improve the network performance, but should be handled with care, so as to minimize disruptions that may occur during network updates. In this paper we introduce Time4, an approach that uses accurate time to coordinate network upda...

  4. Polymeric LabChip real-time PCR as a point-of-care-potential diagnostic tool for rapid detection of influenza A/H1N1 virus in human clinical specimens.

    Directory of Open Access Journals (Sweden)

    Hyun-Ok Song

    Full Text Available It is clinically important to be able to detect influenza A/H1N1 virus using a fast, portable, and accurate system that has high specificity and sensitivity. To achieve this goal, it is necessary to develop a highly specific primer set that recognizes only influenza A viral genes and a rapid real-time PCR system that can detect even a single copy of the viral gene. In this study, we developed and validated a novel fluidic chip-type real-time PCR (LabChip real-time PCR system that is sensitive and specific for the detection of influenza A/H1N1, including the pandemic influenza strain A/H1N1 of 2009. This LabChip real-time PCR system has several remarkable features: (1 It allows rapid quantitative analysis, requiring only 15 min to perform 30 cycles of real-time PCR. (2 It is portable, with a weight of only 5.5 kg. (3 The reaction cost is low, since it uses disposable plastic chips. (4 Its high efficiency is equivalent to that of commercially available tube-type real-time PCR systems. The developed disposable LabChip is an economic, heat-transferable, light-transparent, and easy-to-fabricate polymeric chip compared to conventional silicon- or glass-based labchip. In addition, our LabChip has large surface-to-volume ratios in micro channels that are required for overcoming time consumed for temperature control during real-time PCR. The efficiency of the LabChip real-time PCR system was confirmed using novel primer sets specifically targeted to the hemagglutinin (HA gene of influenza A/H1N1 and clinical specimens. Eighty-five human clinical swab samples were tested using the LabChip real-time PCR. The results demonstrated 100% sensitivity and specificity, showing 72 positive and 13 negative cases. These results were identical to those from a tube-type real-time PCR system. This indicates that the novel LabChip real-time PCR may be an ultra-fast, quantitative, point-of-care-potential diagnostic tool for influenza A/H1N1 with a high sensitivity and

  5. Influence of airway management strategy on "no-flow-time" during an "Advanced life support course" for intensive care nurses – A single rescuer resuscitation manikin study

    Directory of Open Access Journals (Sweden)

    Bahr Jan

    2008-04-01

    Full Text Available Abstract Background In 1999, the laryngeal tube (VBM Medizintechnik, Sulz, Germany was introduced as a new supraglottic airway. It was designed to allow either spontaneous breathing or controlled ventilation during anaesthesia; additionally it may serve as an alternative to endotracheal intubation, or bag-mask ventilation during resuscitation. Several variations of this supraglottic airway exist. In our study, we compared ventilation with the laryngeal tube suction for single use (LTS-D and a bag-mask device. One of the main points of the revised ERC 2005 guidelines is a low no-flow-time (NFT. The NFT is defined as the time during which no chest compression occurs. Traditionally during the first few minutes of resuscitation NFT is very high. We evaluated the hypothesis that utilization of the LTS-D could reduce the NFT compared to bag-mask ventilation (BMV during simulated cardiac arrest in a single rescuer manikin study. Methods Participants were studied during a one day advanced life support (ALS course. Two scenarios of arrhythmias requiring defibrillation were simulated in a manikin. One scenario required subjects to establish the airway with a LTS-D; alternatively, the second scenario required them to use BMV. The scenario duration was 430 seconds for the LTS-D scenario, and 420 seconds for the BMV scenario, respectively. Experienced ICU nurses were recruited as study subjects. Participants were randomly assigned to one of the two groups first (LTS-D and BMV to establish the airway. Endpoints were the total NFT during the scenario, the successful airway management using the respective device, and participants' preference of one of the two strategies for airway management. Results Utilization of the LTS-D reduced NFT significantly (p Conclusion In our manikin study, NFT was reduced significantly when using LTS-D compared to BMV. During cardiac arrest, the LTS-D might be a good alternative to BMV for providing and maintaining a patent airway

  6. Are disparities of waiting times for breast cancer care related to socio-economic factors? A regional population-based study (France).

    Science.gov (United States)

    Ayrault-Piault, Stéphanie; Grosclaude, Pascale; Daubisse-Marliac, Laetitia; Pascal, Jean; Leux, Christophe; Fournier, Evelyne; Tagri, Anne-Delphine; Métais, Magali; Lombrail, Pierre; Woronoff, Anne-Sophie; Molinié, Florence

    2016-11-01

    The increasing number of breast cancer cases may induce longer waiting times (WT), which can be a source of anxiety for patients and may play a role in survival. The aim of this study was to examine the factors, in particular socio-economic factors, related to treatment delays. Using French Cancer Registry databases and self-administered questionnaires, we included 1,152 women with invasive non-metastatic breast cancer diagnosed in 2007. Poisson regression analysis was used to identify WTs' influencing factors. For 973 women who had a malignant tissue sampling, the median of overall WT between the first imaging procedure and the first treatment was 44 days (9 days for pathological diagnostic WT and 31 days for treatment WT). The medical factors mostly explained inequalities in WTs. Socio-economic and behavioral factors had a limited impact on WTs except for social support which appeared to be a key point. Better identifying the factors associated with increase in WTs will make it possible to develop further interventional or prospective studies to confirm their causal role in delay and at last reduce disparities in breast cancer management. PMID:27405647

  7. The Mediatization of Care

    DEFF Research Database (Denmark)

    Dindler, Camilla; Ahlmark, Nanna

    This paper will explore the implications for peer-to-peer health interventions of two developments in modern Western societies; the increasing status of the media as a site for gaining governmental legitimacy (Schillemanns, 2012) and a neoliberal “logic of choice” in health care, focusing on...... citizens’ individual risk and responsibilities in pursuing “factual” health (Mol, 2008). The practice of peer-to-peer health intervention may, as opposed to the logic of choice, be guided by a “logic of care” (Mol, 2008) , defined as a professional way of doing that attunes into the everyday life of the...... in health care defined partly by a democratization of health expertise and the abovementioned logic of care, when – at the same time - there is an experienced need of gaining public legitimacy and status via linking to the agendas of the media and broader culture that promote an individualized, risk...

  8. Palliative care and spirituality

    Directory of Open Access Journals (Sweden)

    Narayanasamy Aru

    2007-01-01

    Full Text Available Critical junctures in patients′ lives such as chronic illnesses and advanced diseases may leave the persons in a state of imbalance or disharmony of body, mind and spirit. With regard to spirituality and healing, there is a consensus in literature about the influence of spirituality on recovery and the ability to cope with and adjust to the varying and demanding states of health and illness. Empirical evidence suggests that spiritual support may act as an adjunct to the palliative care of those facing advanced diseases and end of life. In this article, the author draws from his empirical work on spirituality and culture to develop a discourse on palliative care and spirituality in both secular and non-secular settings. In doing so, this paper offers some understanding into the concept of spirituality, spiritual needs and spiritual care interventions in palliative care in terms of empirical evidence. Responding to spiritual needs could be challenging, but at the same time it could be rewarding to both healthcare practitioner (HCP and patient in that they may experience spiritual growth and development. Patients may derive great health benefits with improvements in their quality of life, resolutions and meaning and purpose in life. It is hoped that the strategies for spiritual support outlined in this paper serve as practical guidelines to HCPs for development of palliative care in South Asia.

  9. Care for nutrition and development.

    Science.gov (United States)

    Engle, P L; Pelto, G; Bentley, P

    2000-09-01

    Optimal growth and development depend not only on food quality and availability, on access to health care services and a healthy environment but also on the care provided to the child especially during the first few years of life. Care refers to the actions and practices of caregivers on a day to day basis that translate food, heakh care, and water and sanitation supplies into good growth and development of children. It includes behaviours such as feeding, sanitation and hygiene, home health practices, preparing food for children, and providing psychosocial support for development. Families also are responsible for providing care for girls in the family and women. Care requires resources--both skills and capabilities, as well as economic resources. Some resources are easily recognised, such as education of the caregiver, but others are less often seen, including time of the caregiver, motivation of caregiver and male family members, organisational resources such as child care centres, and the caregiver's ability to influence decisions about child care. It must be noted that the poorer the family, the more risks for children in the environment. Therefore, the poorer the environment, the more important a role care has in children's survival, growth and development. Implications for health care providers include assessing the care practices in the home, and resources for care when making recommendations; supporting positive practices already being performed in order to empower the caregiver; checking the understanding and recall of the caregiver; and finally, recognising that all children, regardless of gender, ethnicity, case, economic level, etc, have a right to good nutrition and health care in order to develop to their fullest potential under the Convention for the Rights of the Child, acceded to by India in 1992. PMID:11291785

  10. Maternal care

    OpenAIRE

    2001-01-01

    In June 2000 a distinguished group of obstetricians, midwives, general practitioners, and medical statisticians came together to discuss maternal care. Chaired by Professor James Drife from Leeds, discussion ranged over many topics, including: the changing role of the obstetrician, general practitioners, and the increasing status and responsibility of midwives. Other subjects include the induction of labour, obstetric analgesia and anaesthesia, and debates about the place and kind of delivery...

  11. Liquid vs Solid Culture Medium to Evaluate Proportion and Time to Change in Management of Suspects of Tuberculosis-A Pragmatic Randomized Trial in Secondary and Tertiary Health Care Units in Brazil.

    Directory of Open Access Journals (Sweden)

    Adriana da Silva Rezende Moreira

    Full Text Available The use of liquid medium (MGIT960 for tuberculosis (TB diagnosis was recommended by WHO in 2007. However, there has been no evaluation of its effectiveness on clinically important outcomes.A pragmatic trial was carried out in a tertiary hospital and a secondary health care unit in Rio de Janeiro City, Brazil. Participants were 16 years or older, suspected of having TB. They were excluded if only cerebral spinal fluid or blood specimens were available for analysis. MGIT960 technique was compared with the Lowenstein-Jensen (LJ method for laboratory diagnosis of active TB. Primary outcome was the proportion of patients who had their initial medical management changed within 2 months after randomisation. Secondary outcomes were: mean time for changing the procedure, patient satisfaction with the overall treatment and adverse events. Data were analysed by intention-to-treat. Between April 2008 and September 2011, 693 patients were enrolled (348 to MGIT, 345 to LJ. Smear and culture results were positive for 10% and 15.7% of participants, respectively. Patients in the MGIT arm had their initial medical management changed more frequently than those in the LJ group (10.1% MGIT vs 3.8% LJ, RR 2.67 95% CI 1.44-.96, p = 0.002, NNT 16, 95% CI 10-39. Mean time for changing the initial procedure was greater in LJ group at both sites: 20.0 and 29.6 days in MGIT group and 52.2 and 64.3 in LJ group (MD 33.5, 95% CI 30.6-36.4, p = 0.0001. No other important differences were observed.This study suggests that opting for the MGIT960 system for TB diagnosis provides a promising case management model for improving the quality of care and control of TB.Controlled-Trials.com ISRCTN79888843.

  12. Depressive co-morbidity in medical in-patients at the time of hospital discharge and outcome in a Primary Care follow-up: I. Rational and design of the project

    Directory of Open Access Journals (Sweden)

    Antonio Lobo

    2005-09-01

    Full Text Available Objectives: In a context of a "continuity of care" model in Psychosomatic and Liaison Psychiatry, this study is intended to test, in patients to be discharged from Medicine wards, hypotheses related to a high prevalence of depression and, in particular, its negative outcome at six-months follow-up in Primary Care (PC, specially among the elderly. Methods:Sample. Consecutive patients aged 18 years or more, hospitalized in Medicine wards were randomly selected for screening at the time of admission. On the bases of a previous study and the expected sampling errors, sample size was estimated in 700 patients (approximately 60% in geriatric age for the initial screening, to recruit 75 or more cases of depression and enough number of control, non-cases without psychiatric morbidity.. Instruments. Standardized, Spanish versions of screening/case-finding instruments COMPRI/INTERMED, Mini-Mental, CAGE and drug screening, Hospital Anxiety and Depression Scale (HADS, Standardized Polyvalent Psychiatric Interview (SPPI. Diagnostic criteria ICD-10 research, medical patients version and DSM-IV-TR (psychiatric; and ICD-9-M; ICHPPC, WONCA (medical. Cumulative Illness Rating Scale (CIRS (severity of physical condition; SF36 and EuroQol (quality of life; Client Service Receipt Interview (CSRI (costs. Procedure. Part I, hospital study: Two-phase screening (lay interviewers: COMPRI/INTERMED at admission; Mini-Mental, CAGE, HADS at the time of discharge; and standardized clinicians: SPPI. CIRS was used to control severity of physical conditions. Part II, follow-up study in PC (six months: Standardized clinicians, blind to the previous phases (HADS and SPPI to both cases and controls. Outcome study: EuroQuol, SF36, CSRI and data on morbidity and mortality, were collected. Conclusions. To our knowledge, this is the first study using modern epidemiological methods in medical patients to be discharged with co-morbid depression and followed in PC with a "continuity of

  13. Intergenerational pathways leading to foster care placement of foster care alumni’s children

    OpenAIRE

    Jackson Foster, Lovie J.; Beadnell, Blair; Pecora, Peter J.

    2013-01-01

    This study examined a path model that postulated intergenerational relationships between biological parent psychosocial functioning and foster care alumni mental health, economic status, and social support; and from these to the likelihood of children of foster care alumni being placed in foster care. The sample included 742 adults who spent time in foster care as children with a private foster care agency and who reported having at least one biological child. A full pathway was found between...

  14. Determining level of care appropriateness in the patient journey from acute care to rehabilitation

    OpenAIRE

    Bashford Guy; Magee Christopher; Poulos Christopher J; Eagar Kathy

    2011-01-01

    Abstract Background The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care an...

  15. Taking care of your back at home

    Science.gov (United States)

    Back strain treatment; Back pain - home care; Low back pain - home care; Lumbar pain - home care ... A common myth about back pain is that you need to rest and avoid activity for a long time. In fact, doctors do not recommend bed ...

  16. Effect of Organizational Culture on Patient Access, Care Continuity, and Experience of Primary Care.

    Science.gov (United States)

    Hung, Dorothy; Chung, Sukyung; Martinez, Meghan; Tai-Seale, Ming

    2016-01-01

    This study examined relationships between organizational culture and patient-centered outcomes in primary care. Generalized least squares regression was used to analyze patient access, care continuity, and reported experiences of care among 357 physicians in 41 primary care departments. Compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care. Understanding the unique effects of organizational culture can enhance the delivery of more patient-centered care. PMID:27232685

  17. Caring for Multiples

    Science.gov (United States)

    ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Tools & ... Home > Complications & Loss > The newborn intensive care unit (NICU) > Caring for multiples Caring for multiples E-mail ...

  18. Care management: agreement between nursing prescriptions and patients' care needs

    Science.gov (United States)

    Faeda, Marília Silveira; Perroca, Márcia Galan

    2016-01-01

    ABSTRACT Objectives: analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions. Method: descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed. Results: 75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found. Conclusion: the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended. PMID:27508902

  19. Day care schemes and cash for-care at home

    DEFF Research Database (Denmark)

    Eydal, Gudny; Rostgaard, Tine

    2012-01-01

    The purpose of this chapter is to analyse and compare Nordic day-care policies, i.e. ECEC services as well as cash-for-care for children under school age. The chapter examines the legislative purpose behind the provision of the services and the cash benefits as well as the take-up rates. The review...... of day-care will also look at how the programmes are organised and funded, and at the quality indicators of the care provided. In this context, the Nordic countries will be compared with the EU average. The review of cash-for-care will assess the key elements of the programmes: the length of time...

  20. Who cares!

    Institute of Scientific and Technical Information of China (English)

    老晃

    2013-01-01

    1有人再三怂恿,希望我能吐槽《富春山居图》,务求鞭辟入里,揭露丑恶真相。我舍不得,舍不得浪费纸。好吧,小吐一下。传说,在《富春山居图》开拍之前有心人提醒导演孙健君,剧本有硬伤,得改,例举一三三四……话没说完,孙勃然大怒,"Who cares!"这位目空一切的君王,他什么都不care,所以他花钱砸的那堆玩意儿,根本也不是电影。这就是真相。值得一说的,是此刻红得发紫,摸都摸不得的《小时代》。

  1. Factors influencing nursing care in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Raj John

    2006-01-01

    Full Text Available Context: The total time spent in nursing care depends on the type of patient and the patient′s condition. We analysed factors that influenced the time spent in nursing a patient. Aims : To analyse the factors in a patient′s condition that influenced time spent in nursing a patient. Materials and Methods: This study was performed in the Surgical Intensive Care Unit of a tertiary referral centre, over a period of one month. The total time spent on a patient in nursing care for the first 24 hours of admission, was recorded. This time was divided into time for routine nursing care, time for interventions, time for monitoring and time for administering medications. Statistical analysis used: A backward stepwise linear regression analysis using the age, sex, diagnosis, type of admission and ventilatory status as variables, was done. Results: Patients admitted after elective surgery required less time (852.4 ± 234.1 minutes, than those admitted after either emergency surgery (1069.5 ± 187.3 minutes, or directly from the ward or the emergency room (1253.7 ± 42.1 minutes. Patients who were ventilated required more time (1111.5 ± 132.5 minutes, than those brought on a T-piece (732.2 ± 134.8 minutes or extubated (639.5 ± 155.6 minutes. The regression analysis showed that only the type of admission and the ventilatory status significantly affected the time. Conclusions : This study showed that the type of admission and ventilatory status significantly influenced the time spent in nursing care. This will help optimal utilization of nursing resources.

  2. Committee Opinion No. 666: Optimizing Postpartum Care.

    Science.gov (United States)

    2016-06-01

    In the weeks after birth, postpartum care often is fragmented among maternal and pediatric health care providers, and communication between inpatient and outpatient settings is inconsistent. To optimize postpartum care, anticipatory guidance should begin during pregnancy. During antenatal care, it is recommended that the patient and her obstetrician-gynecologist or other obstetric care provider formulate a postpartum care plan and identify the health care professionals who will comprise the postpartum care team for the woman and her infant. Ideally, during the postpartum period, a single health care practice assumes responsibility for coordinating the woman's care. At discharge from maternity care, the woman should receive contact information for her postpartum care team and written instructions regarding the timing of follow-up postpartum care. It is recommended that all women undergo a comprehensive postpartum visit within the first 6 weeks after birth. This visit should include a full assessment of physical, social, and psychological well-being. Systems should be implemented to ensure each woman can receive her desired form of contraception during the comprehensive postpartum visit, if not done earlier. At the conclusion of the postpartum visit, the woman and her obstetrician-gynecologist or other obstetric care provider should determine who will assume primary responsibility for her ongoing care. If responsibility is transferred to another primary care provider, the obstetrician-gynecologist or other obstetric care provider is responsible for ensuring that there is communication with the primary care provider so that he or she can understand the implications of any pregnancy complications for the woman's future health and maintain continuity of care. PMID:27214194

  3. Oral care.

    Science.gov (United States)

    Hitz Lindenmüller, Irène; Lambrecht, J Thomas

    2011-01-01

    Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing/recovering from chemo-/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable. PMID:21325845

  4. Team Networking in Palliative Care

    OpenAIRE

    Odette Spruyt

    2011-01-01

    "If you want to travel quickly, go alone. But if you want to travel far, you must go together". African proverb. The delivery of palliative care is often complex and always involves a group of people, the team, gathered around the patient and those who are close to them. Effective communication and functional responsive systems of care are essential if palliative care is to be delivered in a timely and competent way. Creating and fostering an effective team is one of the greatest challenges f...

  5. Health-care market robust.

    Science.gov (United States)

    Merkel, Jayne

    2004-01-01

    Construction of health care facilities hit an all-time high in 2002 totalling about $16 billion of work. As baby boomers age health care construction will soar, because seniors are the largest consumers of health care The top five firms--Perkins & Will, HDR, HKS, NBBJ, and Ellerbe Becket--monopolize about 20 percent of the work. H.R. 1 increases Medicare payments to rural hospitals by $25 billion over 10 years--so help is on the way for facilities that are languishing. PMID:15077503

  6. Displacements in Care Technology Design

    OpenAIRE

    2013-01-01

    As has been remarked by other researchers, the elderly population in Norway is growing with increasing speed, while at the same time, the number of health- and care workers needed to accommodate this growth is decreasing accordingly. The change in demographics resulting from this ”tidal-wave of elderly”, has consequently called for a reconfiguring of the national health– and care sector. Part of this provident rearrangement, is to move technologies into the homes of the elderly - with the goa...

  7. Low prevalence of Factor V Leiden and the prothrombin G20210A mutation in a healthy population from the central-south region of Chile Baixa prevalência do Fator V Leiden e da mutação da protrombina G20210A em uma população sã da região centro-sul do Chile

    OpenAIRE

    Iván Palomo; Fabian Segovia; Daniela Parra; Marcelo Alarcón; Edgardo Rojas

    2009-01-01

    Thrombosis is a result of the interaction between predisposing genetic polymorphisms and acquired risk factors. The two prothrombotic polymorphisms which are most frequently associated with thrombosis are factor V (FV) Leiden and the prothrombin (PT) G20210A mutation. The objective of this work was to investigate the prevalence of both factors in the central-south region of Chile. Determination of the frequency was carried out by means of a genetic analysis of 1200 healthy, non-native individ...

  8. [The application of n-acetylcysteine as an antioxidant and mucolytic in mechanical ventilation in intensive care patients. A prospective, randomized, placebo-controlled, double-blind study].

    Science.gov (United States)

    Konrad, F; Schoenberg, M H; Wiedmann, H; Kilian, J; Georgieff, M

    1995-09-01

    the BAL (Figs. 1, 2). Plasma concentrations of malondialdehyde were similar (Fig. 3). Only the levels of conjugated dienes were significantly higher on the 5th treatment day in the placebo group (Fig. 4). The organ function of the lung (FiO2, PEEP, PaO2), liver (SGOT, bilirubin), and kidney (creatinine) and coagulation parameters (PTT, prothrombin time, platelet count) were similar in the two groups during the time of investigation. We observed no clinically relevant differences in the tracheobronchial mucus (Table 2). CONCLUSION. The present data do not support routine use of NAC in ventilated patients, either as an antioxidant or as a mucolytic agent. Intravenous administration of 3 g NAC/day had no clinically relevant effect on glutathione levels, lipid peroxidation products, tracheobronchial mucus, and clinical condition. PMID:7485927

  9. The Effect of Lactate, Albumin, C-reactive Protein, PaO2/FiO2 and Glucose Levels of Trauma Patients at the Time of Administration to Intensive Care

    Directory of Open Access Journals (Sweden)

    Eren Yılmaz

    2014-12-01

    Full Text Available Objective: Blood analyses are preferred in the observation of cases requiring intensive care unit (ICU following a trauma. The purpose of this study was to examine the relationship of albumin, C-reactive protein (CRP, PaO2/FiO2 and glucose levels of trauma patients at time of admission with mortality. Material and Method: The patients who were admitted into ICU following a trauma between the years of 2010 and 2012 were retrospectively evaluated. 200 trauma cases were included in the study. Their demographic data, APACHE II scores, Glasgow Coma Scales (GCS, and arterial blood gas in the lactate and PaO2/FiO2 ratio, CRP, glucose and albumin levels in the first collected arterial blood gas, as well as, the presence of thoracic, cardiac, renal, abdominal and head trauma, length of ICU stay and mortality were recorded. Results: Of the patients included in the study 84% were male, with an average age of 38.3 and an average APACHE II score of 16.6. 64% suffered from head trauma and the average GCS was calculated to be 11.2. The patients were observed in the ICU for an average of 18.7 days and the rate of mortality was 33.5%. GCS, PaO2/FiO2, age and elevated lactate levels increased mortality as independent risk factors. Conclusion: It has been concluded that parameters like age and the first GCS, lactate, glucose, albumin and PaO2/FiO2 at time of acceptance into the ICU were found to be related with mortality.

  10. Health care operations management

    OpenAIRE

    Carter, M W; Hans, E.W.; Kolisch, R.

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully selected papers dealing with optimization and decision analysis problems in the field of health care operations management.

  11. Dental Care Every Day: A Caregiver's Guide. Practical Oral Care for People with Developmental Disabilities

    Science.gov (United States)

    National Institute of Dental and Craniofacial Research (NIDCR), 2009

    2009-01-01

    Taking care of someone with a developmental disability requires patience and skill. As a caregiver, you know this as well as anyone does. You also know how challenging it is to help that person with dental care. It takes planning, time, and the ability to manage physical, mental, and behavioral problems. Dental care isn't always easy, but you can…

  12. Do Child Care Regulations Affect the Child Care and Labor Markets?

    Science.gov (United States)

    Blau, David M.

    2003-01-01

    The effect of child care regulations on outcomes in the child care market and the labor market for mothers of young children is examined. The analysis uses a time series of cross sections and examines the robustness of previous cross-section findings to controls for state-level heterogeneity. Child care regulations as a group have statistically…

  13. Nursing care time and quality indicators for adult intensive care: correlation analysis Tiempo de atención de enfermería en la unidad de cuidados intensivos de adultos y los indicadores de atención de calidad: análisis de correlación Tempo de assistência de enfermagem em unidade de terapia intensiva adulto e indicadores de qualidade assistencial: análise correlacional

    Directory of Open Access Journals (Sweden)

    Paulo Carlos Garcia

    2012-08-01

    Full Text Available The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with quality care indicators. The average length of time spent on care and the quality care indicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies' indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome of care delivery.Un estudio de enfoque cuantitativo, de correlación y descriptiva, elaborado con objetivo de analizar el tiempo empleado por equipo de enfermería para asistir pacientes hospitalizados en Unidad de Cuidados Intensivos de Adultos y verificar su correlación con indicadores de calidad de la atención. La identificación del promedio de tiempo de cuidados y de indicadores de calidad asistencial fue realizada por medio de consulta a las herramientas de gestión utilizadas por el jefe de enfermería de la Unidad. El promedio de tiempo de cuidado ministrado a los pacientes se mantuvo equilibrado, pero inferior a los indicados por organismos oficiales en Brasil. La correlación entre tiempo de cuidados de enfermería e indicador de incidencia extubación accidental indicó que esta disminuye con aumento de tiempo de atención de enfermería utilizado por enfermeras. Los resultados de esta investigación demuestran la influencia del tiempo de atención de enfermería por las enfermeras, en los resultados de la atención prestada.Trata-se de studo de abordagem quantitativa, correlacional e descritivo, elaborado com o objetivo de

  14. Time trend and predictors of lab positivity among suspected cases in the post pandemic phase of H1N1: An observation from a tertiary care hospital, South India

    Directory of Open Access Journals (Sweden)

    Sitanshu Sekhar Kar

    2016-06-01

    Full Text Available Background WHO declared Influenza A H1N1 to have entered the post pandemic phase on August 10, 2010. Continued surveillance activities are recommended in the post pandemic phase to watch over the trend, severity and impact of Influenza like illnesses (ILI. Aims This study aimed to document the epidemiological profile of lab positive H1N1 cases in post pandemic period from August 2010-December 2014 in nodal H1N1 surveillance centre of Puducherry. Methods The study analysed secondary data collected during the period August 10, 2010 to Dec 2014 from ILI suspects attending a tertiary care hospital, for the Integrated Disease Surveillance Project (IDSP. Demographic details, lab positivity based on Real-time PCR technique for H1N1, clinical symptoms and outcomes were extracted. Data were analysed using STATA version 11.0. Independent predictors of lab positivity rate were identified using logistic regression analysis. Time trend of frequency of suspected cases and lab positivity rate were performed using time series plots. Results A total of 2065 suspected cases were reported, of whom 197 cases were positive for H1N1 (lab positivity rate 9.5 per cent. Being an adult (OR: 1.6; 95 per cent CI: 1.1-2.3; p=0.02, management in in-patient settings (OR: 2.5; 95 per cent CI: 1.3-4.7; p=0.001, history of contact (OR: 2.7; 95 per cent CI: 1.5-4.5; p=0.0001 and history of travel (OR: 2.3; 95 per cent CI: 1.2-4.3; p=0.01 were the independent predictors for lab positivity. Death rate among lab confirmed cases was found to be 9.6 per cent. After 2012, the trend of laboratory confirmed H1N1 cases became a plateau. One needs to screen 35 suspected cases to capture one lab confirmed case of H1N1 in 2014. Conclusion Lab positivity was seen among 9.5 per cent of cases and the independent predictors were severe cases, adult patients, positive history of contact and travel. The number needed to screen to get one lab positive H1N1 case is 35 suspected cases.

  15. Adoption & Foster Care

    Science.gov (United States)

    ... Children > Family Life > Family Dynamics > Adoption & Foster Care Adoption & Foster Care Article Body ​Each year, many children join families through adoption and foster care. These families may face unique ...

  16. Home Care Services

    Science.gov (United States)

    ... ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with bathing, ... your home. Some types of care and community services are free or donated. Many other types you ...

  17. Skin Care and Aging

    Science.gov (United States)

    ... Home » Skin Care and Aging Heath and Aging Skin Care and Aging Dry Skin and Itching Bruises Wrinkles Age Spots ... doctor. For More Information About Skin Care and Aging American Academy of Dermatology 1-866-503-7546 ( ...

  18. About Critical Care Nursing

    Science.gov (United States)

    ... requiring intense and vigilant nursing care. Number of Critical Care Nurses in the United States According to "The Registered ... nurses who work in a hospital setting. Where Critical Care Nurses Work According to "The Registered Nurse Population" study, ...

  19. Enlarged prostate - after care

    Science.gov (United States)

    BPH - self-care; Benign prostatic hypertrophy - self-care; Benign prostatic hyperplasia - self-care ... exercises ( Kegel exercises ) that strengthen the pelvic floor muscles. Doing these exercise may help with leaking or ...

  20. Organizational Fragmentation and Care Quality in the U.S. Health Care System

    OpenAIRE

    Randall D. Cebul; James B. Rebitzer; Taylor, Lowell J.; Mark Votruba

    2008-01-01

    Many goods and services can be readily provided through a series of unconnected transactions, but in health care close coordination over time and within care episodes improves both health outcomes and efficiency. Close coordination is problematic in the US health care system because the financing and delivery of care is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations and capabilities. These fragmented organizational structures l...

  1. Oncology and palliative care

    OpenAIRE

    Bausewein, Claudia; Hartenstein, R.

    2000-01-01

    Oncology developed as a discipline over the last decades. Treatment is concentrated on cure or palliation of the illness with the help of chemotherapy, radiotherapy or surgery. Palliative care has its origin in the hospice movement that started around 1960 in the UK. Centre of care is the patient and his family. Focus of care has moved from quantity to quality of life. Symptom control, communication, rehabilitation and care for the dying are main areas of palliative care. Palliative care and ...

  2. Critical care during epidemics

    OpenAIRE

    Rubinson, Lewis; O'Toole, Tara

    2005-01-01

    We recommend several actions that could improve hospitals' abilities to deliver critical care during epidemics involving large numbers of victims. In the absence of careful pre-event planning, demand for critical care services may quickly exceed available intensive care unit (ICU) staff, beds and equipment, leaving the bulk of the infected populace without benefit of potentially lifesaving critical care. The toll of death may be inversely proportional to the ability to augment critical care c...

  3. Can a Healthcare “Lean Sweep” Deliver on What Matters to Patients?; Comment on “Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping”

    Directory of Open Access Journals (Sweden)

    Jennifer Y. Verma

    2015-11-01

    Full Text Available Disconnects and defects in care – such as duplication, poor integration between services or avoidable adverse events – are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects and containing costs (eg, improving integration of services as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim; and involve patients and families in co-designing new models of care that better address complex, longer-term health needs.

  4. Intensive care of conjoined twins.

    Science.gov (United States)

    Kobylarz, Krzysztof

    2014-01-01

    Conjoined twinning is one of the most uncommon congenital anomalies. Maintenance in an intensive care setting during this time allows for close monitoring, stabilisation, and nutritional supplementation of the infants as necessary to optimise preoperative growth and development. The birth of conjoined twins is a very difficult and dramatic moment for parents. It is also a very difficult situation for the team of physicians, nurses and other required hospital staff to carry out treatment and care of these specific developmental anomalies. The diagnostics and treatment in this extraordinary situation requires close cooperation of the multidisciplinary medical team, which includes their personal experience and medical knowledge, with a team of intensive care unit nurses. This report presents the rules in cease of conjoined twins during their intensive care unit stay with special reference to the proceedings before and after complete separation. PMID:24858974

  5. Pediatric palliative care.

    Science.gov (United States)

    Moody, Karen; Siegel, Linda; Scharbach, Kathryn; Cunningham, Leslie; Cantor, Rabbi Mollie

    2011-06-01

    Progress in pediatric palliative care has gained momentum, but there remain significant barriers to the appropriate provision of palliative care to ill and dying children, including the lack of properly trained health care professionals, resources to finance such care, and scientific research, as well as a continued cultural denial of death in children. This article reviews the epidemiology of pediatric palliative care, special communication concerns, decision making, ethical and legal considerations, symptom assessment and management, psychosocial issues, provision of care across settings, end-of-life care, and bereavement. Educational and supportive resources for health care practitioners and families, respectively, are included. PMID:21628042

  6. Social Public Care Ahead

    Institute of Scientific and Technical Information of China (English)

    Guo Liqin

    2008-01-01

    @@ China faces toughest after-quake reconstruction since 1976. In contrast with neighbouring Myanmar's lethargic and secre-tive handling of its cyclone ten days earlier, China responded to the earthquake rapidly and with uncharacteristic openness. Within hours Premier Wen Jiabao was on a plane, and appeared in almost all the strategic plac-es in the earthquake-hit areas in the follow-ing days; President Hu Jintao was chairing an emergency meeting of Standing Com-mittee and thousands of soldiers and police were being dispatched. China is moved and moves. For the most impressive time, we read the social care from all works of lives.

  7. Improving Palliative Care Team Meetings: Structure, Inclusion, and "Team Care".

    Science.gov (United States)

    Brennan, Caitlin W; Kelly, Brittany; Skarf, Lara Michal; Tellem, Rotem; Dunn, Kathleen M; Poswolsky, Sheila

    2016-07-01

    Increasing demands on palliative care teams point to the need for continuous improvement to ensure teams are working collaboratively and efficiently. This quality improvement initiative focused on improving interprofessional team meeting efficiency and subsequently patient care. Meeting start and end times improved from a mean of approximately 9 and 6 minutes late in the baseline period, respectively, to a mean of 4.4 minutes late (start time) and ending early in our sustainability phase. Mean team satisfaction improved from 2.4 to 4.5 on a 5-point Likert-type scale. The improvement initiative clarified communication about patients' plans of care, thus positively impacting team members' ability to articulate goals to other professionals, patients, and families. We propose several recommendations in the form of a team meeting "toolkit." PMID:25794871

  8. Assuring quality care: measuring and monitoring the caring process.

    Science.gov (United States)

    Ammentorp, W; Bock, W; Irrgang, S; Gossett, K

    1988-01-01

    Everyone interested in the quality of the human services agrees that it should be largely determined by the interaction between the client and their caregivers. Unfortunately, this exchange has proven to be very difficult to measure in an accurate and timely manner. The resulting uncertainty has prevented smooth adaptation of the caring process to client needs; it has also made it virtually impossible for managers to devise workable quality control systems. This paper describes the use of miniaturized barcode technology for collection of real-time data at the point of care. With the addition of laptop computers, this technology provides for immediate feedback of information to address quality issues in care planning and management. The data bases produced by this system are sources of documentation for quality assurance as well as a dynamic foundation for quality control. PMID:10291607

  9. What is Good Quality of Health Care?

    Directory of Open Access Journals (Sweden)

    Magne Nylenna

    2015-03-01

    Full Text Available A diversity of definitions of quality exists, that frequently contain aspects of complexity, relativity and subjectivity. This paper provides an overview of key components in the quality debate within health care, including different perspectives and dimensions of the quality of care. Definitions of the quality of health care reflect the characteristics of health services, and are useful for measurements and quality improvement. Over time the patient perspective of quality has gotten increasing weight, and in quality improvement there has been a shift from individual responsibility for doctors and health care personnel to systems thinking. We argue that the quality approach in health care should be more standardized and that health care-specific definitions of quality should be used when the relationship between physician professionalism and quality is investigated.Keywords: quality, health care, systems thinking, patient perspective, outcome, indicator, measurement, improvement.

  10. cura, care, C A R E, Care: Dimensions and Qualities of Care (re)forming an Ecology of Care

    DEFF Research Database (Denmark)

    Coxon, Ian Robert; Bremner, Craig; Jensen, Jesper;

    a convincing and interesting story on it" (Glanville, 2014). In doing this we also recognise and appreciate that some readers may find the text less than accessible at times because of what might be viewed as philosophical or esoteric language. Using this language and writing style is not intentionally done...... to make the reading and understanding process heavy going. It is quite the opposite, in fact. At times it has been necessary to delve sufficiently deeply into some of the topics discussed using the language of the thinkers who have paved the way. This may be off-putting to some who are not familiar...... of the acknowledged complexity of such a holistic notion such as Care. Its role is to simplify Care, as we formulate it, to a point where its complexity can begin to be understood in ways that might be practically useful. After all, Care derives much of its meaning through the actions taken in its name, but more...

  11. Time, Cost, Information Seeking Skills and Format of Resources Present Barriers to Information Seeking by Primary Care Practitioners in a Research Environment. A review of: Andrews James E., Kevin A. Pearce, Carol Ireson, and Margaret M. Love. “Information‐Seeking Behaviors of Practitioners in a Primary Care Practice‐Based Research Network (PBRN.” Journal of the Medical Library Association 93.2 (Apr. 2005: 206‐12.

    Directory of Open Access Journals (Sweden)

    Martha Ingrid Preddie

    2007-09-01

    Full Text Available Objective – To determine the information seeking behaviors of primary care practitioners in order to inform future efforts towards the design of information services that would support quality inprimary care.Design – A cross‐sectional survey.Setting – A primary care practice based research network (PBRN of caregivers who serve a broad population while simultaneously studying and disseminating innovations aimed at improvements in quality, efficiency and/or safety of primaryhealth care in the United States.Subjects – All primary care practitioners in the PBRN including family practitioners, general practitioners, nurse practitioners and physician assistants.Methods – A questionnaire comprising twenty‐six questions was distributed to 116 practitioners. Practitioners attached to academic centres (who were also members of the PBRN were excluded in order “to achieve a sample of practices more representative of the primary care practising population” (208. Descriptive data were collected and analyzed. SPSS v11.5 was used for statistical analyses.Main results – There was a response rate of 51% (59 of 116. Fifty‐eight percent of the respondents stated that they sought information (excluding drug dosing or drug interactions information to support patient care several times a week. Sixty‐eight per cent sought this information while the patient waited. Almost half of therespondents had access to a small medical library (48% or a hospital library (46%, while 21% used a university medical library.Approximately 14% had no immediate access to a medical library. Almost 60% of practitioners stated that they had an e‐mail account. Thirty‐four percent agreed that the use of e‐mail to communicate with patients enhanced medical practice, while 24% disagreed. There was frequent prescribing of Internet‐based consumer health information to patients by only 16% of the practitioners, while Internet support groups were frequently recommended

  12. Health care retail clinics: current perspectives

    OpenAIRE

    Kaissi, Amer

    2016-01-01

    Amer Kaissi Department of Health Care Administration, Trinity University, San Antonio, TX, USA Abstract: Retail clinics represent a major innovation with a radical value proposition in American health care: convenient locations and hours, walk-in care, short waiting times, and transparent pricing. Many organizations, groups, associations, and individual providers affect and are affected by retail clinics. The main winners from the retail clinic trend are insurance companies and third-party p...

  13. Care of patients with permanent tracheostomy.

    Science.gov (United States)

    Everitt, Erica

    The third article in our series on tracheostomy care discusses the care of patients with a permanent tracheostomy. While these patients make up a small proportion of all patients who have a tracheostomy inserted, they have complex needs. This means they require practitioners in both acute and community settings, who have time, support and competent tracheostomy-care skills, to achieve a successful discharge and ongoing management of their tracheostomy. PMID:27396099

  14. Access to flexible working and informal care

    OpenAIRE

    Bryan, Mark L.

    2011-01-01

    We use matched employer-employee data to explore the relationship between employees' access to flexible working arrangements and the amount of informal care they provide to sick or elderly friends and relatives. Flexitime and the ability to reduce working hours are each associated with about 10% more hours of informal care, with effects concentrated among full-time workers providing small amounts of care. The wider workplace environment beyond formal flexible work also appears to facilitate c...

  15. Defining Remoteness from Health Care: Integrated Research on Accessing Emergency Maternal Care in Indonesia

    OpenAIRE

    Myers, Bronwyn A; Rohan P Fisher; Nelson Nelson; Suzanne Belton

    2015-01-01

    The causes of maternal death are well known, and are largely preventable if skilled health care is received promptly. Complex interactions between geographic and socio-cultural factors affect access to, and remoteness from, health care but research on this topic rarely integrates spatial and social sciences. In this study, modeling of travel time was integrated with social science research to refine our understanding of remoteness from health care. Travel time to health facilities offering em...

  16. The ecology of medical care in Beijing.

    Directory of Open Access Journals (Sweden)

    Shuang Shao

    Full Text Available BACKGROUND: We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. METHODS: A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics. RESULTS: On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing. CONCLUSIONS: This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.

  17. Pediatric Palliative Care

    OpenAIRE

    Johnston, Donna L.; Hentz, Tracy A.; Friedman, Debra L.

    2005-01-01

    Pediatric palliative care provides benefit to children living with life-threatening or terminal conditions. Palliative care should be available to all seriously ill children. Palliative care includes the treatment of symptoms such as pain, nausea, dyspnea, constipation, anorexia, and sialorrhea. This care can occur in a variety of settings, from home to hospice to hospital, and must include bereavement care and follow up after the death of a child. There are many challenges in pediatric palli...

  18. Palliative and end of life care for people living with dementia in care homes: part 1.

    Science.gov (United States)

    Mitchell, Gary; Agnelli, Joanne; McGreevy, Jessie; Diamond, Monica; Roble, Herlindina; McShane, Elaine; Strain, Joanne

    2016-06-22

    The terms palliative and end of life care are often used interchangeably and healthcare practitioners may perceive that palliative care is only appropriate during the terminal stages of an illness. This article, the first of two parts, provides healthcare practitioners with an overview of the concept of palliative care. It explains how this can be differentiated from end of life care and how it should be commenced in a timely manner, so that people who are living with dementia can contribute to the planning of their future care and death. The policies and tools used in the provision of palliative and end of life care are discussed, including advance care planning and The Gold Standards Framework. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. The second part of this article will discuss end of life care and the best practices for providing end of life care, including nutrition and hydration, oral hygiene, pain management and spiritual care. PMID:27332611

  19. Why Do Care Workers Withdraw From Elderly Care? Researcher’s Language as a Hermeneutical Key

    Directory of Open Access Journals (Sweden)

    Anne Liveng

    2012-11-01

    Full Text Available Care workers frequently withdraw from elderly people in their care; this has resulted in a number of scandals in the media. Here I analyze an empirical scene observed at an old people’s home in Denmark, which contains behavioral patterns among the care workers which could be seen as withdrawal. At the same time it illustrates the care workers’ commitment to the elderly. A paradoxical “empathy at a distance” is characteristic of the scene. When analyzing my written observations in an interpretation group, my use of language was a point of discussion. What did it mean when I described the interactions between care workers and elderly residents in words commonly used to describe mother-child interactions? My use of language became a “hermeneutical key” which enabled a psychoanalytically inspired interpretation. This focuses on the care relationship as activating our earliest memories of our own care relations, independently of whether we are in the role of care providers or care receivers. Through collusion theory, the interpretation accepts both the anxiety which the helpless elderly people arouse in the care workers and their motivation for care work as two sides of a subjectively important theme. The article illustrates how working consciously with the researcher’s subjectivity makes it possible to understand apparently irrational patterns. The insights thus gained may be used to prevent withdrawals in care work as an argument for care workers’ need for emotional supervision.

  20. From Perspectives of the Elderly: Quality of care in Germany

    Directory of Open Access Journals (Sweden)

    Dorian R. Woods

    2014-06-01

    Full Text Available This article reviews state-of-the-art findings on care and quality from published research from 2003-2014 in Germany, specifically from the perspective of the elderly. It is based on a larger project on care and quality in Germany that was funded by the Hans Böckler Foundation. The study provides a much needed overview of current issues on quality and care in light of increased pressure to address care and changes in German social policy. Although quality also encompasses conditions for professional care work and informal carers, this article focuses on the elderly as recipients of care, their perspectives and the ways in which they are involved in their care. Research on care quality from the perspective of the elderly is highlighted in the following themes: 1 the rights of the elderly to quality care 2 elderly perception of satisfaction and quality of outcomes of care, 3 documentation of care as quality control and time, 4 active aging and 5 equality of access. Results show that long-term care rights are more clearly defined and expanded, but enforcement problems are present. Satisfaction with care is traced to good communication with carers, but time for care is scarce. Active aging has become a central focus of care and more research on equal access is needed. The article outlines strengths and weaknesses in German quality care provision as well as learning effects for other countries.

  1. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

    DEFF Research Database (Denmark)

    Vester-Andersen, M; Waldau, T; Wetterslev, J; Møller, M H; Rosenberg, J; Jørgensen, L N; Jakobsen, J C; Møller, Ann

    2015-01-01

    BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care in...

  2. 血清异常凝血酶原检测在原发性肝癌临床诊断中的应用%Application of serum abnormal prothrombin in clinical diagnosis of primary hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    濮珏彪; 王学锋; 彭奕冰

    2014-01-01

    Objective To investigate the significance of serum abnormal prothrombin [protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)]in clinical diagnosis of primary hepatocellular carcinoma.Methods There were 365 samples from inpatients in Ruijin Hospital,including 100 patients with primary hepatocellular carcinoma and the other 265 patients with no primary hepatocellular carcinoma (59 cases of chronic liver disease,50 cases of gastrointestinal cancer,50 cases of secondary liver cancer,56 cases of other hepatopathy and 50 cases of healthy controls).Serum alpha fetoprotein (AFP)and PIVKA-Ⅱlevels were detected by Roche Cobas e601 automatic immunity analyzer and LUMIPULSE G1200 automatic immunity analyzer,respectively.Data were analyzed statistically by SPSS 16.0 software.Results Serum AFP and PIVKA-Ⅱlevels were significantly higher in primary hepatocellular carcinoma group than those in other disease group and healthy controls.Serum AFP had a sensitivity of 63.00%and a specificity of 84.91% in the diagnosis of primary hepatocellular carcinoma,while PIVKA-Ⅱhad a sensitivity of 74.00% and a specificity of 89.81%.The results of receiver operating characteristic (ROC)curve showed that the areas under the curve of AFP and PIVKA-Ⅱwere 0.789 and 0.873,respectively.The diagnosis sensitivity and specificity of the combination determination of AFP and PIVKA-Ⅱreached to 81.00% and 98.49%.Conclusions Serum PIVKA-Ⅱhas a better diagnosis significance than AFP,and can be a tumor marker in the diagnosis of primary hepatocellular carcinoma.Moreover,the combination determination of AFP and PIVKA-Ⅱcan improve the diagnosis efficiency for clinical primary hepatocellular carcinoma.%目的:研究血清异常凝血酶原[又称维生素K缺乏或拮抗剂Ⅱ诱导的蛋白质(PIVKA-Ⅱ)]检测在临床原发性肝癌诊断中的价值及意义。方法收集瑞金医院住院365例患者的血清,其中100例为原发性肝癌患者血清,265例为非原发

  3. A FAIR way to reduce uncompensated care.

    Science.gov (United States)

    Zimmerli, Bert; Craghead, Todd; Gupta, Neera

    2010-05-01

    Intermountain Healthcare's leadership committed the organization to a systematic redesign of the initial patient encounter process. The redesigned process ensured clear and timely application of the organization's charity care policies. Results included an 11 percent decrease in bad-debt expense and a 40 percent increase in charity care approved. PMID:20446429

  4. Care and Commitment: Foster Parent Adoption Decisions.

    Science.gov (United States)

    Meezan, William; Shireman, Joan F.

    Foster homes have traditionally been considered transitional homes, where children receive good care for a limited time period. However, in recent years, many children have been drifting in foster care. Child welfare agencies are using new criteria for evaluating services, including the 1970s permanency planning idea--asserting the importance of…

  5. Handling during neonatal intensive care.

    OpenAIRE

    Murdoch, D R; Darlow, B A

    1984-01-01

    The handling received by very low birthweight newborns undergoing intensive care in the first few days of life and the effects of this were studied. Infants were handled an average of 4.3 hours (18%) of the total 24 hour observation time and received a mean 234 handling procedures. Parental handling contributed 35% of the total time but was usually benign except in that it could interfere with the infant's rest. Many procedures were associated with undesirable consequences. Endotracheal sucti...

  6. Self-care in heart failure patients

    Directory of Open Access Journals (Sweden)

    Ana Paula da Conceição

    2015-08-01

    Full Text Available AbstractObjective: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients.Method: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care. Association tests were applied, considering a descriptive level of 0.05.Results: the mean age of participants was 57.7 (SD =11.3 years; 54.3% were male; the mean schooling was 5.5 (SD = 4.0 years; and 74.1% had functional class II-III. The mean scores on the subscales of the Self-Care of Heart Failure Index indicated inappropriate self-care (self-care maintenance: 53.2 (SD =14.3, selfcare management: 50.0 (SD = 20.3 and self-care confidence: 52.6 (SD=22.7 and it was found low frequencies of participants with appropriate self-care (self-care maintenance, 6.9%, self-care management (14.7% and self-care confidence (19%. Higher scores of the Self-Care of Heart Failure Index were associated with: reduced left ventricular ejection fraction (p=0.001, longer time of experience with the disease (p=0.05 and joint monitoring by physician and nurse (p=0.007.Conclusion: investments are needed to improve the self-care behavior and the nursing can play a relevant role in this improvement.

  7. Care for elderly : A challenge in the anaesthesia context

    OpenAIRE

    Larsson Mauleon, Annika

    2005-01-01

    Anaesthesia care involves bioscience and technical knowledge. Provision of anaesthesia care for elderly surgical patients can be a significant challenge when promoting patient comfort, safety, and satisfaction in a high-tech context with time constraints. Many patients in anaesthesia care are old and frail and have multiple illnesses and other problems, such as delicate skin, malnutrition, and pain. All this must be accounted for when caring for the elderly. Extra time in an...

  8. Time to Talk about CAM

    Science.gov (United States)

    ... Home Current Issue Past Issues Special Section CAM Time to Talk Past Issues / Winter 2009 Table of ... helps to ensure your coordinated, safe care. NCCAM's Time to Talk program is just right for talking ...

  9. Measuring Nursing Care Value.

    Science.gov (United States)

    Welton, John M; Harper, Ellen M

    2016-01-01

    The value of nursing care as well as the contribution of individual nurses to clinical outcomes has been difficult to measure and evaluate. Existing health care financial models hide the contribution of nurses; therefore, the link between the cost and quality o nursing care is unknown. New data and methods are needed to articulate the added value of nurses to patient care. The final results and recommendations of an expert workgroup tasked with defining and measuring nursing care value, including a data model to allow extraction of key information from electronic health records to measure nursing care value, are described. A set of new analytic metrics are proposed. PMID:27055306

  10. Research in cardiovascular care

    DEFF Research Database (Denmark)

    Jaarsma, Tiny; Deaton, Christi; Fitzsimmons, Donna;

    2014-01-01

    To deliver optimal patient care, evidence-based care is advocated and research is needed to support health care staff of all disciplines in deciding which options to use in their daily practice. Due to the increasing complexity of cardiac care across the life span of patients combined...... of the body of knowledge that is needed to further improve cardiovascular care. In this paper, knowledge gaps in current research related to cardiovascular patient care are identified, upcoming challenges are explored and recommendations for future research are given....

  11. Use of Plasma for Acquired Coagulation Factor Deficiencies in Critical Care.

    Science.gov (United States)

    Shah, Akshay; McKechnie, Stuart; Stanworth, Simon

    2016-03-01

    Coagulopathy in critically ill patients is common and often multifactorial. Fresh frozen plasma (FFP) is commonly used to correct this either prophylactically or therapeutically. FFP usage is mainly guided by laboratory tests of coagulation, which have been shown to have poor predictive values for bleeding. Viscoelastic tests are an attractive option to guide hemostatic therapy, but require rigorous evaluation. The past few years have seen a gradual reduction in national use of FFP potentially due to an increased awareness of risks such as transfusion-related acute lung injury, patient blood management strategies to reduce transfusion in general, and increased awareness of the lack of high-quality evidence available to support FFP use. Within critical care, FFP is administered before invasive procedures/surgery, to treat major traumatic and nontraumatic hemorrhage, disseminated intravascular coagulation, and for urgent warfarin reversal if first-line agents, such as prothrombin complex concentrate (PCC) are not available. Alternative agents such as fibrinogen concentrate and PCC need further evaluation through large-scale clinical trials. PMID:26716502

  12. care about还是care for?

    Institute of Scientific and Technical Information of China (English)

    曾克辉

    2015-01-01

    1问care about和care for可以相互替换使用吗?答:有时可以。但在不同情况下,它们在较确切的含义上还是有区别的。1在表示"喜欢,关心,担心"时,意思一样,常可以互换使用。如:I care about/for your integrity and honesty.我喜欢你的正直和诚实。She doesn’t care about/for politics.她不关心政治。You needn't care about/for his safety.你不必为他的安全担心。2在表示"介意,计较,在乎"等意思时,

  13. Wholistic Health Care: Evolutionary Conceptual Analysis.

    Science.gov (United States)

    Ziebarth, Deborah Jean

    2016-10-01

    While performing a data search to define "wholistic health care", it was evident that a definite gap existed in published literature. In addition, there are different definitions and several similar terms (whole person care, wholistic health, whole person health, wholism, etc.), which may cause confusion. The purpose of this paper was to present the analysis of "wholistic health care" using Rodgers' Evolutionary Method. The method allows for the historical and social nature of "wholistic health care" and how it changes over time. Attributes, antecedents, and consequences of wholistic health care were reduced using a descriptive matrix. In addition, attributes that consistently occurred in wholistic health care were presented as essential attributes. Definitions of Wholistic Health Care Provider(s), Wholistic Health, Wholistic Illness, Wholistic Healing, and Patient were created from the analysis of the literature review of attributes, antecedents, and consequences of wholistic health care. Wholistic Health Care is defined as the assessment, diagnosis, treatment and prevention of wholistic illness in human beings to maintain wholistic health or enhance wholistic healing. Identified wholistic health needs are addressed simultaneously by one or a team of allied health professionals in the provision of primary care, secondary care, and tertiary care. Wholistic health care is patient centered and considers the totality of the person (e.g., human development at a given age, genetic endowments, disease processes, environment, culture, experiences, relationships, communication, assets, attitudes, beliefs, and lifestyle behaviors). Patient centered refers to the patient as active participant in deciding the course of care. Essential attributes of wholistic health care are faith (spiritual) integrating, health promoting, disease managing, coordinating, empowering, and accessing health care. Wholistic health care may occur in collaboration with a faith-based organization to

  14. Determinants of the use of prenatal care in rural China: the role of care content.

    Science.gov (United States)

    Nwaru, Bright I; Wu, Zhuochun; Hemminki, Elina

    2012-01-01

    Several maternal demographic factors have been identified to influence the timing of starting prenatal care and its adequate use. However, how the content of prenatal care modifies these factors has not been studied previously. Using a representative sample collected for other purposes in rural China, we examined the factors predicting the uptake of prenatal care by taking into account the content of care (advice: on nutrition during pregnancy, diseases and pregnancy-related problems, and on child care after birth; and routine tests: blood pressure, blood tests, and ultrasound). We studied 1,479 women who answered a house-hold KAP (knowledge, attitude, and practice) survey (97% response rate) collected after a prenatal care intervention from 2001 to 2003 in 20 townships located in a county in Anhui Province. A multinomial logistic regression was used for the analysis. The most prominent factors that predicted late start of prenatal care and inadequate care were younger age, low maternal income, and having more than one child. When we adjusted for the content of care, the influence of these factors on the use of prenatal care attenuated to varying degrees: in some cases there was up to 20% reduction in the values of the risk estimates, while in other cases the statistical significance of the estimates were lost. It is important to take into account the content of prenatal care when assessing the factors predicting women's use of prenatal care. PMID:21184157

  15. Technology for Eye Care: Training in the Care of Equipment and Instruments

    OpenAIRE

    S Shree Vidhya BE; V Srinivasan MA MS (USA)

    2002-01-01

    Modern health care, eye care especially, is very much dependent on the use of technical equipment and instruments. These are expensive, more so in developing countries. Much of the quality equipment and instruments are made in developed countries and, even with normal and careful use, are subject to wear and tear. It is important to take good care of them and employ preventive maintenance to keep them working at all times. The 'down time', if any, during which an instrument or equipment is no...

  16. Supportive care in radiation oncology

    International Nuclear Information System (INIS)

    The radiation therapist, concerned with the disease process and all the technical intricacies of treatment, has usually not been involved in managing the supportive aspects of caring for the patient. Yet, of the team of medical specialists and allied health personnel required in oncology, the radiation therapist is the one most responsible for overseeing the total care of the cancer patient. At times this might include emotional support, prevention and correction of tissue dysfunction, augmentation of nutrition, metabolic and electrolyte regulation, rehabilitation, and vocational support. This chapter is a brief overview of a considerable volume of literature that has occupied the interest of a rather small group of physicians, nutritionists, and psychologists. The discussion highlights the special management problems of the normal-tissue effects of radiation, the related nutritional aspects of cancer care, and certain emotional and pathologic considerations

  17. Critical care nursing: Embedded complex systems.

    Science.gov (United States)

    Trinier, Ruth; Liske, Lori; Nenadovic, Vera

    2016-01-01

    Variability in parameters such as heart rate, respiratory rate and blood pressure defines healthy physiology and the ability of the person to adequately respond to stressors. Critically ill patients have lost this variability and require highly specialized nursing care to support life and monitor changes in condition. The critical care environment is a dynamic system through which information flows. The critical care unit is typically designed as a tree structure with generally one attending physician and multiple nurses and allied health care professionals. Information flow through the system allows for identification of deteriorating patient status and timely interventionfor rescue from further deleterious effects. Nurses provide the majority of direct patient care in the critical care setting in 2:1, 1:1 or 1:2 nurse-to-patient ratios. The bedside nurse-critically ill patient relationship represents the primary, real-time feedback loop of information exchange, monitoring and treatment. Variables that enhance information flow through this loop and support timely nursing intervention can improve patient outcomes, while barriers can lead to errors and adverse events. Examining patient information flow in the critical care environment from a dynamic systems perspective provides insights into how nurses deliver effective patient care and prevent adverse events. PMID:27047997

  18. National Health Care Survey

    Science.gov (United States)

    This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.

  19. Wound Care: Preventing Infection

    Science.gov (United States)

    ... happening, the better you’ll be prepared to take care of yourself once you leave the hospital. You ... skin. If you catch a problem early and take care, you will often be able to continue to ...

  20. Day Care Centers

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of day care centers for 50 states and Washington D.C. and Puerto Rico. The dataset only includes center based day care locations...

  1. US EPA CARE Grants

    Data.gov (United States)

    U.S. Environmental Protection Agency — This is a provisional dataset that contains point locations for the subset of Community Action for a Renewed Environment (CARE) grants given out by the US EPA. CARE...

  2. Palliative Care in Cancer

    Science.gov (United States)

    ... care that is given to a person when cancer therapies are no longer controlling the disease. It focuses on caring, not curing. When a person has a terminal diagnosis (usually defined as having a life expectancy ...

  3. Critical Care Team

    Science.gov (United States)

    ... of these areas: Surgery Internal medicine Pediatrics Anesthesiology Critical care nurse: A highly skilled nurse who provides all aspects ... and can often uphold the patient's wishes. The critical care nurse becomes an important part of decision-making with ...

  4. Surgical Critical Care Initiative

    Data.gov (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  5. Preeclampsia - self-care

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000606.htm Preeclampsia - self-care To use the sharing features on this ... have frequent checkups and tests. Bed Rest and Self-care at Home When you are at home, ...

  6. Pet Care: MRSA FAQ

    Science.gov (United States)

    ... AVMA Meeting Dates Meetings & CE Calendar Symposiums & Summits Pet Health Awareness Events About AVMA Who We Are ... 12 Educators You are here: Home | Public Resources | Pet Care Print Share This! Your Veterinarian Pet Care ...

  7. CareCoor

    DEFF Research Database (Denmark)

    Bossen, Claus; Christensen, Lars Rune; Grönvall, Erik;

    2013-01-01

    Objectives The present study aims to augment the network of home care around elderly. We investigate the nature of cooperative work between relatives and home care workers around elderly persons; present the CareCoor system developed to support that work; and report experiences from two pilot tests...... persons. The design implications led to the development of a prototype, called CareCoor, which is accessible via a tablet PC and on the Internet. CareCoor was subsequently evaluated in two pilot tests. The first lasted a week and included three elderly, their next of kin and the affiliated home care...... workers, while the second test lasted for six weeks and involved five elderly people, their next of kin and relevant home care workers. Results In the paper we make three major points, namely, (1) home care work is highly cooperative in nature and involves substantial coordinative efforts on the part...

  8. Diabetes - eye care

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000078.htm Diabetes - eye care To use the sharing features on this ... enable JavaScript. Diabetic retinopathy - care Diabetes and your eyes Diabetes can harm your eyes. It can damage ...

  9. The PACT study protocol: a time series study investigating the impact, acceptability and cost of an integrated model for psychosocial screening, care and treatment of patients with urological and head and neck cancers

    OpenAIRE

    Girgis, Afaf; Kelly, Brian; Boyes, Allison; Haas, Marion; Viney, Rosalie; Descallar, Joseph; Candler, Hayley; Bellamy, Douglas; Proietto, Anthony

    2014-01-01

    Introduction While there is good evidence of the effectiveness of a variety of interventions and services to prevent and/or relieve distress experienced by people affected by cancer, much of this psychosocial morbidity is undetected and untreated, with consequent exacerbated suffering, decreased satisfaction with care, impaired adherence to treatment regimens and poorer morbidity and mortality outcomes. The objective of this study is to develop, implement and assess the impact, acceptability ...

  10. Searching for the evidence in pre-hospital care: a review of randomised controlled trials. On behalf of the Ambulance Response Time Sub-Group of the National Ambulance Advisory Committee.

    OpenAIRE

    Brazier, H; Murphy, A W; Lynch, C; Bury, G

    1999-01-01

    OBJECTIVES: To identify randomised controlled trials (RCTs) which evaluate aspects of pre-hospital care; to perform categorisation by theme; to compare the sensitivity and precision of the search databases. DATA SOURCES: August 1997 updates of MEDLINE and EMBASE databases, using the Datastar online system. Papers published in 1987 or later were included, with no language restrictions. STUDY SELECTION: A trial was eligible for inclusion if it was judged, by two independent and blinded assessor...

  11. Caring for Wrestlers.

    Science.gov (United States)

    Kiningham, Robert; Monseau, Aaron

    2015-01-01

    Wrestling is a popular high school and college sport with an injury and illness rate second only to football. It is important that the physician providing medical care for wrestlers be familiar with the unique characteristics of wrestling and the associated common injuries and medical problems. Common orthopedic injuries include shoulder, elbow, and finger dislocation; prepatellar bursitis; knee medial collateral ligament sprains; and cervical strains. Skin infections are the most common cause of missed mat time for wrestlers. Physicians need to be able to identify and treat these infections, and know the rules regarding return to wrestling once an infection has been identified. Other conditions that are common include auricular hematomas, epistaxis, and brow lacerations. Physicians also need to be familiar with the medical issues involved with rapid weight loss and weight cycling, and understand the high school and college weight certification rules. PMID:26359843

  12. Parental Care and Investment

    OpenAIRE

    González-Voyer, Alejandro; Kolm, N.

    2010-01-01

    Parental care is common throughout the animal kingdom and among caring species there is a bewildering variation in how parents care for offspring, as well as in the amount of resources parents invest in care. For instance, there is considerable variation in the relative parental investment by the sexes – in some species females invest more, in others males invest more, and in some investment is more or less equally shared. Different hypotheses have been proposed to explain patterns of parenta...

  13. Creonization of health care.

    Science.gov (United States)

    Bulger, R J

    1990-01-01

    As prefigured in the Greek tragedy Antigone, one of the primary conflicts in contemporary health care is that between humane concern for the individual and concern for society at large and administrative rules. The computerization of the health care system and development of large data bases will create new forms of this conflict that will challenge the self-definition of health care and health care professionals. PMID:2394563

  14. Caring for Yourself

    Science.gov (United States)

    Alzheimer ’s Caregiving Tips Caring forYourself Taking care of yourself is one of the most important things you ... are some ways you can take care of yourself: • Ask for help when you need it. • Join ...

  15. Education in palliative care.

    Science.gov (United States)

    Weissman, David E; Blust, Linda

    2005-02-01

    Palliative care education includes the domains of pain and nonpain symptom management, communications skills, ethics and law, psychosocial care, and health systems. Defining key attitudes, knowledge, and skill objectives, and matching these to appropriate learning formats, is essential in educational planning. Abundant educational resource material is available to support classroom and experiential palliative care training. PMID:15639043

  16. Value of care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Value of care displays – national data. This data set includes national-level data for the value of care displays associated with a 30-day episode of care for...

  17. Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition)

    OpenAIRE

    Muntinga Maaike E; Hoogendijk Emiel O; van Leeuwen Karen M; van Hout Hein PJ; Twisk Jos WR; van der Horst Henriette E; Nijpels Giel; Jansen Aaltje PD

    2012-01-01

    Abstract Background Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling...

  18. Are care workers appropriate mentors for nursing students in residential aged care?

    OpenAIRE

    Annear, Michael; Lea, Emma; Robinson, Andrew

    2014-01-01

    Background The aged care sector is increasingly dominated by a less-qualified workforce at a time of increasing prevalence of complex health concerns, such as dementia. An Australian program to develop teaching aged care facilities is being undertaken to build the sector’s capacity and provide nursing students with positive experiences of engaging with vulnerable clients. This research aimed to examine care staff potential to facilitate nursing student engagement with clinically relevant know...

  19. Speak Up: Help Prevent Errors in Your Care: Ambulatory Care

    Science.gov (United States)

    ... role in making health care safe. That includes doctors, nurses and other health care professionals. Health care organizations ... embarrassed if you don't understand what your doctor, nurse or other health care professional tells you. • Don’ ...

  20. Benchmarking HIV health care

    DEFF Research Database (Denmark)

    Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda;

    2012-01-01

    ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care were...... to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East and Argentina (adjusted OR 0.16[95%CI 0.11-0.23, p care utilization...

  1. Space-Time--Time

    OpenAIRE

    Ellis, Homer G.

    2002-01-01

    Space-time--time is a natural hybrid of Kaluza's five-dimensional geometry and Weyl's conformal space-time geometry. Translations along the secondary time dimension produce the electromagnetic gauge transformations of Kaluza--Klein theory and the metric gauge transformations of Weyl theory, related as Weyl postulated. Geometrically, this phenomenon resides in an exponential-expansion producing ``conformality constraint'', which replaces Kaluza's ``cylinder condition''. The curvature tensors e...

  2. Neuroeconomics and Integrated Care

    DEFF Research Database (Denmark)

    Larsen, Torben

    2012-01-01

    Background: Fragmented specialized care for the frail elderly as claimed by WHO needs horizontal integration across settings. The home of the patient seems to be a promising place to integrate hospital care, primary care and social services for high-risk discharges where the quality...... of rehabilitation makes a difference. Objective: The study aims to reveal how integrated home care may be organised to improve quality of care as compared to usual hospital care. Method: A qualitative case study of the use of a neuroeconomic model in relation to multidisciplianry collaboration on a RCT...... of integrated home care for stroke patients. Results: (1) The classical understanding of CNS is that of a dual system of ANS and Cortex. The new neuroeconomic understanding is that of a reciprocal balance of Limbic System (LS) and Neocortex (NC). This applies directly in favour of integrated homecare compared...

  3. Shin splints - self-care

    Science.gov (United States)

    ... care; Anterior tibial pain - self-care; Medial tibial stress syndrome - self-care; MTSS - self-care; Exercise-induced ... these medicines have side effects and can cause ulcers and bleeding. Talk to your doctor about how ...

  4. Telemedicine in Neonatal Home Care

    DEFF Research Database (Denmark)

    Garne, Kristina; Brødsgaard, Anne; Zachariassen, Gitte;

    2016-01-01

    visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. OBJECTIVE: To identify parental needs when wanting to provide neonatal home care supported by telemedicine. METHODS: The study used...... telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. RESULTS: Three overall themes were identified: being a family......, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a "bell cord" to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the...

  5. Trends in Time

    OpenAIRE

    Andries van den Broek; Koen Breedveld; Jos de Haan; Joep de Hart; Frank Huysmans

    2004-01-01

    How do the Dutch spend their time? How much time for example do they devote to remunerated work, care, reading or voluntary work? And: how is time structured in Dutch society? To what extent is Sunday still a special day? The Social and Cultural Planning Office has been participating in a survey since 1975 that seeks to answer these questions. The most recent time use survey was conducted in October 2000. This book sets out the most important trends in time use and the structuring of time. Th...

  6. 38 CFR 59.40 - Maximum number of nursing home care and domiciliary care beds for veterans by State.

    Science.gov (United States)

    2010-07-01

    ... ACQUISITION OF STATE HOMES § 59.40 Maximum number of nursing home care and domiciliary care beds for veterans... projection of demand for nursing home and domiciliary care by veterans who at such time are 65 years of age... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Maximum number of...

  7. Health care social media: engagement and health care in the digital era.

    Science.gov (United States)

    Aase, Lee; Timimi, Farris K

    2013-09-01

    Health care as an industry continues in reluctant participation with consumers through social networks. Factors behind health care's laggard position range from providers' concerns about patient privacy and lack of personal psychic bandwidth to organizational anxiety about employee time management and liability for online behavior. Despite these concerns, our patients are spending increasing amounts of their time online, often looking for information regarding their diagnosis, treatment, care providers, and hospitals, with much of that time spent in social networks. Our real opportunity for meaningful engagement in the future may depend on our capacity to meet our patients where they are, online, utilizing the tools that they use, that is, social media. PMID:23787711

  8. Handle with care

    International Nuclear Information System (INIS)

    Full text: A film dealing with transport of radioactive materials by everyday means - rail, road, sea and air transport - has been made for IAEA. It illustrates in broad terms some of the simple precautions which should be followed by persons dealing with such materials during shipment. Throughout, the picture stresses the transport regulations drawn up and recommended by the Agency, and in particular the need to carry out carefully the instructions based on these regulations in order to ensure that there is no hazard to the public nor to those who handle radioactive materials in transit and storage. In straightforward language, the film addresses the porter of a goods wagon, an airline cargo clerk, a dockside crane operator, a truck driver and others who load and ship freight. It shows the various types of package used to contain different categories of radioactive substances according to the intensity of the radiation emitted. It also illustrates their robustness by a series of tests involving drops, fires, impact, crushing, etc. Clear instructions are conveyed on what to do in the event of an unlikely accident with any type of package. The film is entitled, 'The Safe Transport of Radioactive Materials', and is No. 3 in the series entitled, 'Handle with Care'. It was made for IAEA through the United Kingdom Atomic Energy Authority by the Film Producers' Guild in the United Kingdom. It is in 16 mm colour, optical sound, with a running time of 20 minutes. It is available for order at $50 either direct from IAEA or through any of its Member Governments. Prints can be supplied in English, French, Russian or Spanish. Copies are also available for adaptation for commentaries in other languages. (author)

  9. Changing the focus of care: from curative to palliative care

    Directory of Open Access Journals (Sweden)

    Silvia Soffritti

    2014-06-01

    Full Text Available The improvements in the obstetrical and neonatal diagnosis and therapies have resulted into an increase in the survival rate of infants previously considered as non-viable. Debate is focusing on professionals’ behaviour about withdrawal or withholding of life sustaining treatment (LST and administration of palliative care for newborns whose conditions are incompatible with a prolonged life. Decisions about treatment should be made jointly by the professionals’ team and the family, placing the interest of the baby at the very heart of the decision process. It is very important that the environment in which the family has to make the decision is characterized by openness, dialogue and frankness. A proper and effective communication with parents is always necessary and can resolve any conflict caused by disagreement. Furthermore, parents need time in the decision making process. Other supports, which could help the family in the final decision are the possibility to ask for a specialist’s second opinion and the involvement of religious leaders and of an indipendent clinical ethics committee. Withholding or withdrawal of LST does not mean cessation of care for the baby, it means to change the focus of care from curative to palliative care. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou 

  10. The shape of digital engagement: health care and social media.

    Science.gov (United States)

    Timimi, Farris K

    2013-01-01

    Health care lags behind other industries in engaging with customers via social networking. In part, this reflects concerns regarding health information privacy concerns, organizational fears regarding employee time mismanagement, and the real challenge that health care providers face with multiple and competing demands on time. Despite these fears and concerns, our patients are spending more and more of their time online seeking health care information, more often in social networks. Our greatest capacity for health care change management at present may well center on our strategic capacity to meet our patients where they spend the majority of their time online. PMID:23748265

  11. Navigating the field of temporally framed care in the Danish home care sector

    DEFF Research Database (Denmark)

    Tufte, Pernille Juul; Dahl, Hanne Marlene

    2016-01-01

    framing: how care workers approach the services specified in their rotas, and navigate between needs, demands and opportunities in the daily performance of their duties. Applying feminist theory on time and anthropological theory on social navigation, it examines the practice of home care work in two...

  12. Workload of primary care midwives.

    OpenAIRE

    Wiegers, T.A.

    2007-01-01

    OBJECTIVE: to assess the actual workload of primary-care midwives in the Netherlands. BACKGROUND: In 2000, a strike and large demonstration before parliament convinced everyone of the shortage of midwives and their excessive workload. The government reacted by increasing the capacity of the midwifery schools and lowering the 'standard caseload' for a full-time working midwife. To assess whether this would lead to sufficient improvement of the situation, more insight was needed of the actual w...

  13. The health care information directive

    OpenAIRE

    Goel Vivek; Upshur Ross EG

    2001-01-01

    Abstract Background Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on techn...

  14. Mild Hypertransaminasemia in Primary Care

    OpenAIRE

    Al-Busafi, Said A; Hilzenrat, Nir

    2013-01-01

    The liver enzymes, alanine transaminase (ALT) or aspartate transaminase (AST), are commonly used in clinical practice as screening as well as diagnostic tests for liver diseases. ALT is more specific for liver injury than AST and has been shown to be a good predictor of liver related and all-cause mortality. Asymptomatic mild hypertransaminasemia (i.e., less than five times normal) is a common finding in primary care and this could be attributed to serious underlying condition or has transien...

  15. Aging Risk and Health Care Expenditure in Korea

    OpenAIRE

    Sang-Ho Nam; Byongho Tchoe

    2010-01-01

    This paper analyzes the impact of population aging on health care expenditures in Korea. Examination of the age-expenditure profile reveals that health care resources are allocated more for the older cohort of population over time, suggesting significant growth of health care expenditures due to population aging. We contend, however, that population aging is considered as a parameter rather than an independent variable to explain rising health care expenditures. This paper shows that populati...

  16. Equitable long term care for the elderly immigrants

    OpenAIRE

    2012-01-01

    Background: The recent studies conducted among the health professionals representing long term care have shown that working with the elderly immigrants involves a range of challenges. One of the typical challenges is to adjust care service to the individual needs so that it maintains the patient’s integrity and dignity. The Norwegian health care system is built on the principles of equal access, equal quality and equal health outcomes. At the same time, it requires that health care takes into...

  17. Space-Time--Time

    CERN Document Server

    Ellis, H G

    2002-01-01

    Space-time--time is a natural hybrid of Kaluza's five-dimensional geometry and Weyl's conformal space-time geometry. Translations along the secondary time dimension produce the electromagnetic gauge transformations of Kaluza--Klein theory and the metric gauge transformations of Weyl theory, related as Weyl postulated. Geometrically, this phenomenon resides in an exponential-expansion producing ``conformality constraint'', which replaces Kaluza's ``cylinder condition''. The curvature tensors exhibit a wealth of ``interactions'' among geometrical entities with physical interpretations. Unique to the conformally constrained geometry is a sectionally isotropic, ultralocally determined ``residual curvature'', useful in construction of an action density for field equations. A space-time--time geodesic describes a test particle whose rest mass m and electric charge q evolve according to definite laws. The particls's motion is governed by four apparent forces: the Einstein gravitational force, the Lorentz electromagn...

  18. Time over time

    OpenAIRE

    Vicente Navarro, Eduardo

    2006-01-01

    The present essay is designed to be a general introduction to the philosophical problem of time from its very different forms and ways of approaching. In this sense, the article covers the problem from different perspectives and gives a brief account of the plurality and diversity of the time found in the different philosophical definitions, in the different layers of knowledge, in different periods and cultures and also in the different instruments used to measure time itself

  19. Translating technology into patient care: Smartphone applications in pediatric health care.

    Science.gov (United States)

    Sondhi, Vishal; Devgan, Amit

    2013-04-01

    The latest generations of smartphones are increasingly viewed as handheld computers rather than as phones and the applications on these phones are becoming increasingly popular among the medical professionals. A large number of health care applications are available across various smartphone platforms. At times it may be difficult to identify most appropriate and reliable application for use at the point of care. In this review, we have tried to identify the applications relevant to Pediatrics and Childcare which when used at the point of care might be helpful in improving patient care. PMID:24600090

  20. Committee Opinion No. 666 Summary: Optimizing Postpartum Care.

    Science.gov (United States)

    2016-06-01

    In the weeks after birth, postpartum care often is fragmented among maternal and pediatric health care providers, and communication between inpatient and outpatient settings is inconsistent. To optimize postpartum care, anticipatory guidance should begin during pregnancy. During antenatal care, it is recommended that the patient and her obstetrician-gynecologist or other obstetric care provider formulate a postpartum care plan and identify the health care professionals who will comprise the postpartum care team for the woman and her infant. Ideally, during the postpartum period, a single health care practice assumes responsibility for coordinating the woman's care. At discharge from maternity care, the woman should receive contact information for her postpartum care team and written instructions regarding the timing of follow-up postpartum care. It is recommended that all women undergo a comprehensive postpartum visit within the first 6 weeks after birth. This visit should include a full assessment of physical, social, and psychological well-being. Systems should be implemented to ensure each woman can receive her desired form of contraception during the comprehensive postpartum visit, if not done earlier. At the conclusion of the postpartum visit, the woman and her obstetrician-gynecologist or other obstetric care provider should determine who will assume primary responsibility for her ongoing care. If responsibility is transferred to another primary care provider, the obstetrician-gynecologist or other obstetric care provider is responsible for ensuring that there is communication with the primary care provider so that he or she can understand the implications of any pregnancy complications for the woman's future health and maintain continuity of care. PMID:27214188

  1. Teamwork in pediatric heart care

    Directory of Open Access Journals (Sweden)

    Kumar R

    2009-01-01

    Full Text Available Pediatric cardiac specialties, pediatric cardiology (pediatric cardiac surgery and pediatric cardiac anesthesiology and intensive care are only now being recognized as distinct specialties in most parts of the world. There has been a tremendous growth in knowledge in these specialties in the last 30-40 years with dramatic improvements in outcome. Pediatric cardiac care thrives on team work. The cohesiveness of the team of caregivers has a direct impact on the patient outcomes and efficiency of the system. The development of hybrid heart procedures in pediatric heart care represents an important benchmark in a team-based approach to patient care where a group of specialists with specific skills work closely together for ensuring the best possible patient outcome. Establishment of a cohesive team requires organization of group of team members with diverse skills to come together through good mutual understanding, under a leadership that actively promotes team harmony. Excellent communication among team members is a core requirement. The barriers for development and sustenance of a successful team must be recognized and overcome. They include egos of key team members as a source of conflict, time for interactions, disproportionate rewards and recognition for members of the team and traditional hierarchical arrangements. Special attention must be paid to motivating non-physician staff.

  2. The health care information directive

    Directory of Open Access Journals (Sweden)

    Goel Vivek

    2001-04-01

    Full Text Available Abstract Background Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on technical solutions to protect the privacy of personal health information, there is very little research on ways to improve individuals power over their health information. This paper proposes a health care information directive, analogous to an advance directive, to facilitate choices regarding health information disclosure. Results and Discussion A health care information directive is described which creates a decision matrix that combines the ethical appropriateness of the use of personal health information with the sensitivity of the data. It creates a range of possibilities with in which individuals can choose to contribute health information with or without consent, or not to contribute information at all. Conclusion The health care information directive may increase individuals understanding of the uses of health information and increase their willingness to contribute certain kinds of health information. Further refinement and evaluation of the directive is required.

  3. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Letsch, Suzanne W.

    1993-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  4. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Cowan, Cathy A.

    1992-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  5. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Sensenig, Arthur L.

    1994-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  6. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Maple, Brenda T.; Sivarajan, Lekha

    1993-01-01

    This regular feature of the journal includes a discussion of each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avail...

  7. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Sensenig, Arthur L.; Heffler, Stephen K.

    1995-01-01

    This regular feature of the journal includes a discussion of each of the following four topics community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avail...

  8. Health Care Indicators

    OpenAIRE

    Maple, Brenda T.; Cowan, Cathy A.; Donham, Carolyn S.; Letsch, Suzanne W.

    1991-01-01

    This regular feature of the journal includes a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of...

  9. Health Care Indicators

    OpenAIRE

    Donham, Carolyn S.; Sensenig, Arthur L.; Heffler, Stephen K.

    1995-01-01

    This regular feature of the journal includes a discussion of each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they allow us to anticipate the direction and magnitude of health care cost changes prior to the avai...

  10. Health Care Indicators

    OpenAIRE

    Cowan, Cathy A.; Donham, Carolyn S.; Letsch, Suzanne W.; Maple, Brenda T.; Lazenby, Helen C.

    1992-01-01

    This regular feature of the journal includes a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of...

  11. Italian health care reform

    OpenAIRE

    Livio Garattini

    1992-01-01

    It is remarkable how health care systems, created over decades and influenced by very different cultures exhibit similar problems. Most health care systems are compartmentalised with managers at margins responding to perverse incentives and seeking to shift patients and costs onto rival organisations. Decision makers behave selfishly, considering the welfare of their own organisations rather than those of the health care system as a whole, and in the absence if evidence about the cost-effecti...

  12. [Nursing care in prison].

    Science.gov (United States)

    Aujard, Ségolène; de Brisoult, Béatrice; Broussard, Daniel; Petitclerc-Roche, Solenne; Lefort, Hugues

    2016-03-01

    In France, nurses practising in the prison environment work in a health care unit, for somatic care, or in a regional medical-psychological unit for large facilities and psychological care. These units belong to the regional hospitals. Located at the heart of the prison, they cater for prisoner-patients. On the frontline, the nurse has specific autonomy and responsibility in this unique context. PMID:26975674

  13. Lesbian health care needs.

    OpenAIRE

    Moran, N

    1996-01-01

    OBJECTIVE: To define the special health care needs of Canadian lesbians. DESIGN: A questionnaire containing 61 yes-or-no and multiple-choice questions sought information on six areas: demographics; health care use; habits, diet, and exercise; preventive care; mental health; and physical health. SETTING: The organizational meeting of a lesbian softball league in Toronto. PARTICIPANTS: Of 360 women eligible for the meeting, 205 attended and 195 completed the survey. Questionnaires used for anal...

  14. Improving Palliative Cancer Care

    OpenAIRE

    Del Ferraro, Catherine; Ferrell, Betty; Van Zyl, Carin; Freeman, Bonnie; Klein, Linda

    2014-01-01

    Over a decade ago, the Institute of Medicine (IOM) presented Ensuring Quality Cancer Care in the United States, with recommendations for change (IOM, 1999). However, barriers to integrating palliative care (PC) to achieve high-quality care in cancer still remain. As novel therapeutic agents evolve, patients are living longer, and advanced cancer is now considered a chronic illness. In addition to complex symptom concerns, patients and family caregivers are burdened with psychological, social,...

  15. Pediatric palliative care

    OpenAIRE

    Trapanotto Manuela; Spizzichino Marco; Benini Franca; Ferrante Anna

    2008-01-01

    Abstract The WHO defines pediatric palliative care as the active total care of the child's body, mind and spirit, which also involves giving support to the family. Its purpose is to improve the quality of life of young patients and their families, and in the vast majority of cases the home is the best place to provide such care, but for cultural, affective, educational and organizational reasons, pediatric patients rarely benefit from such an approach. In daily practice, it is clear that pedi...

  16. Music in child care

    OpenAIRE

    Maria Polikandrioti; Ioannis Koutelekos

    2007-01-01

    Music has been used therapeutically for many centuries, and numerous studies have researched the curative and preventative powers of music in several diseases. Music, as a therapy was shown to have positive effects in child care, such as in premature infants, children in emergency care, children receiving surgery, children in oncology departments and handicapped children. The aim of this review was to study the therapeutic effects of music in child care at hospital. The method οf this study i...

  17. [Primary care in France].

    Science.gov (United States)

    Sánchez-Sagrado, T

    2016-01-01

    The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain. PMID:26304179

  18. 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

  19. Is it racism? Skepticism and resistance towards ethnic minority care workers among older care recipients.

    Science.gov (United States)

    Jönson, Håkan

    2007-01-01

    The study investigates the occurrence and character of skepticism and resistance towards ethnic minority care workers among older care recipients in a municipality in Sweden. Twelve representatives of caregiver organizations were interviewed about their experience of this phenomenon. Three additional interviews were conducted with ethnic minority care workers. Representatives described the problem as rare and mostly occurring as language difficulties or as a temporary problem characterized as a fear of the unknown among some care recipients. They tended to apply a pragmatic or pathologizing approach when talking about causes of and solutions to the problem. These approaches enabled care providers to comply with "potential racism" without challenging an official ideology of anti-racism. In contrast, staff of foreign descent described the problem as more frequent and severe, particularly for short-term employees who experience many first-time encounters with care recipients. PMID:17953063

  20. Dare to Care, Care to Perform

    DEFF Research Database (Denmark)

    Giangreco, Antonio; Sebastiano, Antnio; Carugati, Andrea

    2010-01-01

    -driven modernization process of an Italian nursing home. Based on qualitative research methods, our aim is to identify what are the elements of a designing approach of an IT-tool meant to enhance a process of modernization in a health care organization. Our results show that a patient-centered, user-friendly, bottomup...... designed and results-driven tool is more likely to be beneficial for the patients and the users and therefore, for the organization at large. This study contributes to the extant literature on health care management providing the alternative view that, if the tool is designed around and for the individuals...... (patients and users), then it will produce positive results for the organization. In other words, who dares to care, will perform....

  1. Penis care (uncircumcised)

    Science.gov (United States)

    Uncircumcised penis - bathing; Cleaning an uncircumcised penis ... An uncircumcised penis has its foreskin intact. An infant boy with an uncircumcised penis does not need special care. Normal bathing ...

  2. Democracy, caring and competence

    DEFF Research Database (Denmark)

    Broström, Stig; Johannesson, Eva Marianne; Purola, Anna-Maija;

    2015-01-01

    The aim of the study is to explore how Nordic Early Childhood Education and Care policies frame values education in preschools with a special focus on the values of democracy, caring and competence. The study is part of a larger Nordic project, Valueseducation in Nordic preschools: Basis of...... the study. Keywords related with democratic, caring and competence values were selected. The findings reveal different dimensions and meanings of the three value fields, such as democracy as being and/or becoming; care as fulfilment of basic needs and an ethical relationship; and competence values as...

  3. Nursing Care after Death

    OpenAIRE

    Gong, Xi

    2012-01-01

    Nurses care, help and support patients before they are born, when they are alive and after they die. The starting points of this study were how nurses provide physical care for the dead patients and psychological care for the bereaved families. The purpose of this study was to describe the role of a nurse when patients die. The aims of this study were that the results of the study could help the nurses’ clinical work and could be used as part of teaching material in post-mortem care or nu...

  4. Progressive Care of Obese Patients.

    Science.gov (United States)

    Dambaugh, Lori A; Ecklund, Margaret M

    2016-08-01

    Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36[4]:58-63). PMID:27481802

  5. Initiation of prenatal care by low-income Hispanic women in Houston.

    OpenAIRE

    Byrd, T L; Mullen, P D; Selwyn, B. J.; Lorimor, R

    1996-01-01

    OBJECTIVE: To understand why many Hispanic women begin prenatal care in the later stages of pregnancy. METHODS: The authors compared the demographic profile, insurance status, and health beliefs--including the perceived benefits of and barriers to initiating prenatal care--of low-income Hispanic women who initiated prenatal care at different times during pregnancy or received no prenatal care. RESULTS: A perception of many barriers to care was associated with later initiation of care and non-...

  6. Information and care: A relational approach.

    Science.gov (United States)

    Barnes, Marian; Henwood, Flis; Smith, Naomi

    2016-07-01

    This article explores how the provision of information about dementia impacts on carers and the caring relationships in which they are involved. Narrative interviews were undertaken with 25 carers who had undertaken the Alzheimer's Society - run Carer Information and Support Programme in one of seven sites across London and the South East. Thematic analysis identified two major themes relating to the impact of information on carer and caring relationships ('understanding and care' and 'emotional impact of information'), and another theme relating to the context within which the information was provided and shared ('relational practices in information-giving and receiving'). Findings suggest that while information, particularly in the form of new knowledge about how dementia progresses, helps to improve understanding and increase confidence, competence and a sense of security and achievement in caring practices, it can also confound and complicate caring practices in ways that reflect and reinforce previously difficult relationships. Providing information in the context of carers' support was important for most participants but others were less able to benefit from this, especially where they felt unrecognised or where the timing of information felt inappropriate to their needs. Our analysis complements and extends previous scholarship emphasising the relational nature of care by showing how information can both enhance and complicate care relationships, depending on both specific care contexts and on how carers experience the context of information provision. PMID:24662501

  7. Organizing Safe Transitions from Intensive Care

    Directory of Open Access Journals (Sweden)

    Marie Häggström

    2014-01-01

    Full Text Available Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients’ transfers from high technological intensive care units (ICU to general wards. Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient’s care before, during, and after transfer from intensive care. Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using qualitative content analysis. Results. The results showed that the categories secure, encourage, and collaborate are strategies used in the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated how all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction was described: between staff and patient/families, between team members and involved units, and between patient/family and environment. Discussion/Conclusions. The findings highlight that ICU transitional care implies critical care rehabilitation. Discharge procedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, early mobilization, and a multidiscipline approach.

  8. Allomaternal Care among the Hadza of Tanzania.

    Science.gov (United States)

    Crittenden, Alyssa N; Marlowe, Frank W

    2008-09-01

    Cooperative child care among humans, where individuals other than the biological mother (allomothers) provide care, may increase a mother's fertility and the survivorship of her children. Although the potential benefits to the mother are clear, the motivations for allomothers to provide care are less clear. Here, we evaluate the kin selection allomothering hypothesis using observations on Hadza hunter-gatherers collected in ten camps over 17 months. Our results indicate that related allomothers spend the largest percentage of time holding children. The higher the degree of relatedness among kin, the more time they spend holding, supporting the hypothesis of nepotism as the strongest motivation for providing allomaternal care. Unrelated helpers of all ages also provide a substantial amount of investment, which may be motivated by learning to mother, reciprocity, or coercion. PMID:26181616

  9. Dementia Care: Intersecting Informal Family Care and Formal Care Systems

    OpenAIRE

    Prabhjot Singh; Rafat Hussain; Adeel Khan; Lyn Irwin; Roslyn Foskey

    2014-01-01

    Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions rel...

  10. The association between care co-ordination and emergency department use in older managed care enrollees

    Directory of Open Access Journals (Sweden)

    Eric A. Coleman

    2002-10-01

    Full Text Available Objective: To investigate the association between care co-ordination and use of the Emergency Department (ED in older managed care enrollees. Design: Nested case-control with 103 cases (used the ED and 194 controls (did not use the ED. Patients and methods: Older patients with multiple chronic illnesses enrolled in a care management programme of a large group-model health maintenance organisation with more than 50,000 members over the age of 64. Better care co-ordination was defined as timely follow-up after a change in treatment; fewer decision-makers involved with the care plan; and a higher patient-perceived rating of overall care co-ordination. Logistic regression was used to assess the relationship between ED use (the outcome variable and measures of care co-ordination (the predictor variables. Results: Self-reported care co-ordination was not significantly different between cases and controls for any of the four classifications of inappropriate ED use. Similarly, no differences were found in the number of different physicians or medication prescribers involved in the patients' care. Four-week follow-up after potentially high-risk events for subsequent ED use, including changes in chronic disease medications, missed encounters, and same day encounters, did not differ between subjects with inappropriate ED use and controls. Conclusion: Existing measures of care co-ordination were not associated with inappropriate ED use in this study of older adults with complex care needs. The absence of an association may, in part, be attributable to the paucity of validated measures to assess care co-ordination, as well as the methodological complexity inherent in studying this topic. Future research should focus on the development of new measures and on approaches that better isolate the role of care co-ordination from other potential variables that influence utilisation.

  11. Improving care for children with cerebral palsy.

    Science.gov (United States)

    Newey, Colin

    2008-09-01

    A report about the health care of people with learning disability published by a UK charity concluded that this group was discriminated against and that healthcare professionals had a poor understanding of their needs. A case report of a young person with cerebral palsy is used here to demonstrate good practice in the care of children with learning disabilities. The careful development over time of individualised solutions makes a difference to the quality of life for children and families. Improved understanding through education as well as collaborative working and family participation will help ensure that children and young people receive the range of services they require. PMID:18808052

  12. User handbook for the program CARE

    International Nuclear Information System (INIS)

    The program CARE calculates the annual environmental exposure of complex nuclear installations. In the calculation, the real weather conditions and the measured release rates of the nuclides are taken into account. According to their location in the plant, the contributions of the time integrated pollutant concentrations of the individual emitters are superimposed at predefinable receiving points. In the conception of the model for calculating the resultant dose care was taken to ensure that the program is capable of treating both individual emissions and quasi-continuous emissions. The program CARE can therefore be used in the event of accidents. (orig.)

  13. Long-term home care scheduling

    DEFF Research Database (Denmark)

    Gamst, Mette; Jensen, Thomas Sejr

    In several countries, home care is provided for certain citizens living at home. The long-term home care scheduling problem is to generate work plans spanning several days such that a high quality of service is maintained and the overall cost is kept as low as possible. A solution to the problem...... provides detailed information on visits and visit times for each employee on each of the covered days. We propose a branch-and-price algorithm for the long-term home care scheduling problem. The pricing problem generates one-day plans for an employee, and the master problem merges the plans with respect...

  14. Contraception-related deep venous thrombosis and pulmonary embolism in a 17-Year-old girl heterozygous for factor V leiden, prothrombin G20210A mutation, MTHFR C677T and homozygous for PAI-1 mutation: report of a family with multiple genetic risk factors and review of the literature.

    Science.gov (United States)

    Lenicek Krleza, Jasna; Jakovljevic, Gordana; Bronic, Ana; Coen Herak, Désirée; Bonevski, Aleksandra; Stepan-Giljevic, Jasminka; Roic, Goran

    2010-01-01

    We present the case of a 17-year-old girl who suddenly woke up with localized pain in the left groin and the inability to twist her leg. After comprehensive physician and laboratory examinations, deep venous thrombosis with consequent pulmonary embolism was ascertained. She had not experienced any recent trauma, but she had started to take oral contraceptives 6 months prior to the onset of the symptoms. Her parents and sisters had been asymptomatic throughout their lives, but the family history revealed a few thromboembolic accidents. Using DNA analysis, heterozygosity for factor V Leiden, prothrombin gene mutation G20210A and methylenetetrahydrofolate reductase C677T, as well as the homozygous 4G/4G genotype in the plasminogen activator inhibitor 1 were identified in our patient. Subsequently, DNA analysis was performed in all living family members, and multiple factors associated with thrombophilia were discovered. Our case confirms the multifactorial cause of thromboembolic events and emphasizes the importance of oral contraceptive use in the onset of venous thrombosis, especially in teenage females. In addition, this case indicates that teenage females with a family history of thrombosis who are making choices about contraception could most likely benefit from advanced thrombophilia testing. PMID:20664190

  15. Pastoral Care and Counseling with Military Families.

    Science.gov (United States)

    Moon, Zachary

    2016-06-01

    The complex human experience of military service and the stress suffered by millions of military families each time a loved one deploys present unique challenges and opportunities in providing pastoral care and counseling. War and military service impact many facets of our society, as well as generational and interpersonal relationships. This article speaks to both academic and practitioner communities, and provides a vision for effective pastoral care and counseling with military families drawing on resources from family systems theory. PMID:27281760

  16. Equity in health care utilization in Chile

    OpenAIRE

    Núñez, Alicia; Chi, Chunhuei

    2013-01-01

    One of the most extensive Chilean health care reforms occurred in July 2005, when the Regime of Explicit Health Guarantees (AUGE) became effective. This reform guarantees coverage for a specific set of health conditions. Thus, the purpose of this study is to provide timely evidence for policy makers to understand the current distribution and equity of health care utilization in Chile. The authors analyzed secondary data from the National Socioeconomic Survey (CASEN) for the years 1992–2009 an...

  17. The effects of patient care in health care work: The effects of patient care on job stress, emotional exhaustion, and job satifaction among health care workers in Norway

    OpenAIRE

    Granbo, Sanna Mari Dyrkorn

    2013-01-01

    Previous research has indicated that patient care is a source of job stress and emotional exhaustion, but at the same time a source of job satisfaction. The present study examined the effects of hours spent in patient care on job stress, emotional exhaustion, and job satisfaction, and investigated the relationship between hardiness, job control and work-related support and the three dependent variables. A questionnaire survey, consisting of Cooper’s Job Stress Questionnaire, the Emotional Exh...

  18. Influence of nursing intervention in early time on self-care of diabetic foot patients%早期护理干预对糖尿病足患者自我护理的影响

    Institute of Scientific and Technical Information of China (English)

    郝广英; 韩彦菊

    2011-01-01

    Objective To evaluate the influence of nursing intervention on the self-care of patients with high risks of diabetic foot. Methods Among 60 diabetic patients who have risks of indeed getting diabetic foot. Those risks include peripheral vascular disease and neuropathy, we gave them self-care ability education and nursing intervention. Each patient was given personal self-nursing education. Those patients were followed for 6 months, and were instructed with everyday foot nursing, and self-monitoring management, etc. A year later, we investigated the self-management capability of those patients, and came out with the statistical data of those who go hospital again or catch diabetic foot. Results Before the education, only 16.6% patients can recognize the risks of diabetic foot, 15% patients nurse the feet by themselves daily, 13.3% patients grasp the methods to discern and process the normal foot problems in all 60 patients. After nursing intervention, 84.3% patients can recognize the risks of diabetic foot, 85% patients nurse the feet by themselves daily, 86.6% patients grasp the methods to discern and process the normal foot problems. Diabetic patients with high risks got more nursing knowledge and self-nursing ability after nursing intervention. (t =22. 71,-19.90;P <0. 05). 0nly one sample caught diabetic foot. Conclusions Nursing invention can promote the serf-care ability d patients. It has an important role in controlling the diabetic foot risk factors and preventing disease.%目的 评价系统健康教育对糖尿病足高危因素患者自我护理的影响。方法 对60例有糖尿病足危险因素的2型糖尿病患者,进行早期护理干预,开展个体化的足部自我护理,在随访6个月,1年之后对患者自我管理能力进行调查,并统计1年内发生糖尿病足的情况。结果 60例患者中,教育前仅有16.6%患者能识别糖尿病足的危险因素,15%的患者对足部进行日常护理,13.3

  19. Adoption in ancient times

    OpenAIRE

    Bisha Eugena

    2015-01-01

    Since in ancient times, in all human cultures, children transfered from biological parents to parents that want them to create family, for political alliances, for inheritance, for a future marriage, or to care for elderly parents. The practice of adoption was fairly common in different places and periods. Adoption is mention on Bible and Quran. Greeks, Romans, Egyptians and Babylonians had adoption systems.

  20. Effect of Primary Health Care Orientation on Chronic Care Management

    OpenAIRE

    Schmittdiel, Julie A.; Shortell, Stephen M.; Rundall, Thomas G; Bodenheimer, Thomas; SELBY, Joe V.

    2006-01-01

    PURPOSE It has been suggested that the best way to improve chronic illness care is through a redesign of primary care emphasizing comprehensive, coordinated care as espoused by the Chronic Care Model (CCM). This study examined the relationship between primary care orientation and the implementation of the CCM in physician organizations.