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Sample records for care surgery model

  1. A comparative analysis of predictive models of morbidity in intensive care unit after cardiac surgery – Part I: model planning

    Directory of Open Access Journals (Sweden)

    Biagioli Bonizella

    2007-11-01

    Full Text Available Abstract Background Different methods have recently been proposed for predicting morbidity in intensive care units (ICU. The aim of the present study was to critically review a number of approaches for developing models capable of estimating the probability of morbidity in ICU after heart surgery. The study is divided into two parts. In this first part, popular models used to estimate the probability of class membership are grouped into distinct categories according to their underlying mathematical principles. Modelling techniques and intrinsic strengths and weaknesses of each model are analysed and discussed from a theoretical point of view, in consideration of clinical applications. Methods Models based on Bayes rule, k-nearest neighbour algorithm, logistic regression, scoring systems and artificial neural networks are investigated. Key issues for model design are described. The mathematical treatment of some aspects of model structure is also included for readers interested in developing models, though a full understanding of mathematical relationships is not necessary if the reader is only interested in perceiving the practical meaning of model assumptions, weaknesses and strengths from a user point of view. Results Scoring systems are very attractive due to their simplicity of use, although this may undermine their predictive capacity. Logistic regression models are trustworthy tools, although they suffer from the principal limitations of most regression procedures. Bayesian models seem to be a good compromise between complexity and predictive performance, but model recalibration is generally necessary. k-nearest neighbour may be a valid non parametric technique, though computational cost and the need for large data storage are major weaknesses of this approach. Artificial neural networks have intrinsic advantages with respect to common statistical models, though the training process may be problematical. Conclusion Knowledge of model

  2. From 'solution shop' model to 'focused factory' in hospital surgery: increasing care value and predictability.

    Science.gov (United States)

    Cook, David; Thompson, Jeffrey E; Habermann, Elizabeth B; Visscher, Sue L; Dearani, Joseph A; Roger, Veronique L; Borah, Bijan J

    2014-05-01

    The full-service US hospital has been described organizationally as a "solution shop," in which medical problems are assumed to be unstructured and to require expert physicians to determine each course of care. If universally applied, this model contributes to unwarranted variation in care, which leads to lower quality and higher costs. We purposely disrupted the adult cardiac surgical practice that we led at Mayo Clinic, in Rochester, Minnesota, by creating a "focused factory" model (characterized by a uniform approach to delivering a limited set of high-quality products) within the practice's solution shop. Key elements of implementing the new model were mapping the care process, segmenting the patient population, using information technology to communicate clearly defined expectations, and empowering nonphysician providers at the bedside. Using a set of criteria, we determined that the focused-factory model was appropriate for 67 percent of cardiac surgical patients. We found that implementation of the model reduced resource use, length-of-stay, and cost. Variation was markedly reduced, and outcomes were improved. Assigning patients to different care models increases care value and the predictability of care process, outcomes, and costs while preserving (in a lesser clinical footprint) the strengths of the solution shop. We conclude that creating a focused-factory model within a solution shop, by applying industrial engineering principles and health information technology tools and changing the model of work, is very effective in both improving quality and reducing costs.

  3. The perioperative dialogue--a model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia.

    Science.gov (United States)

    Pulkkinen, Maria; Junttila, Kristiina; Lindwall, Lillemor

    2016-03-01

    The aim of the study was to describe how patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia experienced to be a part of the perioperative dialogue as an ideal model of caring. A qualitative approach was chosen as a method. Nineteen patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia participated. These patients and their nurse anaesthetists had three perioperative dialogues in the pre-, intra- and postoperative phase of care. Data were collected by means of conversational interviews by four voluntary nurse anaesthetists who wrote the dialogues from each perioperative phase. The text from the collected data was analysed by qualitative, latent content analysis. The findings of the analysis show three identified themes: Suffering while waiting for surgery (preoperative dialogue), Continuity creates togetherness (intraoperative dialogue) and Uniqueness - the patient has been seen (postoperative dialogue). The findings show evidence that the perioperative dialogue is an ideal model of caring and serves the patients' desires of individual and dignified care. The patients have a deep appreciation when there is time to develop a caring encounter with his or her own nurse. When a caring encounter has been established, the patient is involved in his or her own care. This model of caring offers the perioperative nurses a new way of caring and arouses reflections about their main task caring for the suffering patient. The continuity created by the perioperative dialogue probably has an influence on both patient satisfaction and patient safety.

  4. Development of the 24/7 Nurse Practitioner Model on the Inpatient Pediatric General Surgery Service at a Large Tertiary Care Children's Hospital and Associated Outcomes.

    Science.gov (United States)

    Rejtar, Marketa; Ranstrom, Lee; Allcox, Christina

    Nurse practitioners (NPs) have been providing high-quality and safe patient care for a few decades, and evidence showing the extent of their impact is emerging. This article describes the implementation of a 24/7 NP patient care model on an inpatient pediatric general surgery service in a tertiary free-standing Children's Hospital in the Northeastern United States. The literature shows that there is limited evidence regarding NP models of care and their effect on patient outcomes. In response to policy changes leading to reduction of resident work hours and a more acute and complex inpatient pediatric general surgery patient population, our existing NP model evolved into a 24/7 NP Model in June 2011. The results from two quality improvement projects showed positive registered nurse and attending surgeon staff satisfaction with the 24/7 NP Model of care and a decreased trend of unplanned intensive care unit patient transfers after the 24/7 NP Model implementation. These findings further support the evidence in the literature that NPs provide safe and quality patient care.

  5. Monitoring and improving care in thoracic surgery

    OpenAIRE

    Numan, R.C.

    2016-01-01

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

  6. Postoperative care in trichiasis surgery

    Directory of Open Access Journals (Sweden)

    Esmael Ali

    2016-10-01

    Full Text Available Postoperative care is an important aspect of trachomatous trichiasis (TT surgical services. Follow-up visits should ideally take place on the first postoperative day (to remove the eye patch, after 8–14 days (to remove sutures; optional if absorbable sutures are used, at 3 months (to re-examine the operated lid for intermediate surgical outcomes, and then at or after six months.

  7. Standard guidelines of care for vitiligo surgery

    Directory of Open Access Journals (Sweden)

    Parsad Davinder

    2008-03-01

    Full Text Available Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. Physician′s qualifications: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. Facility: Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. Indications for vitiligo surgery : Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. Preoperative counseling and Informed consent: A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure

  8. Nursing care for patients undergoing transoral robotic surgery.

    Science.gov (United States)

    Murray, Shannon

    2009-01-01

    Otorhinolaryngologists began developing new operative techniques to minimize open surgical resections of the head and neck. While striving to reduce the morbidity and mortality associated with head and neck surgery and decrease the many psychosocial issues facing these patients, a new procedure defined as Transoral Robotic Surgery (TORS) was developed. With the development of new surgical techniques, nursing care must also change to meet the needs of the patient. As the TORS procedure becomes fully defined, so is nursing's role in the care of the patient. This paper aims to define TORS and discuss the nursing care of the patient undergoing this new surgical procedure.

  9. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Carlene Johnson Stoklossa

    2013-01-01

    Full Text Available Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.

  10. Standard guidelines of care for acne surgery

    Directory of Open Access Journals (Sweden)

    Khunger Niti

    2008-03-01

    Full Text Available Acne surgery is the use of various surgical procedures for the treatment of postacne scarring and also, as adjuvant treatment for active acne. Surgery is indicated both in active acne and post-acne scars. Physicians′ qualifications: Any Dermatologist can perform most acne surgery techniques as these are usually taught during postgraduation. However, certain techniques such as dermabrasion, laser resurfacing, scar revisions need specific "hands-on" training in appropriate training centers. Facility: Most acne surgery procedures can be performed in a physician′s minor procedure room. However, full-face dermabrasion and laser resurfacing need an operation theatre in a hospital setting. Active acne: Surgical treatment is only an adjunct to medical therapy, which remains the mainstay of treatment. Comedone extraction is a process of applying simple mechanical pressure with a comedone extractor, to extract the contents of the blocked pilosebaceous follicle. Superficial chemical peel is a process of applying a chemical agent to the skin, so as to cause controlled destruction of the epidermis leading to exfoliation. Glycolic acid, salicylic acid and trichloroacetic acid are commonly used peeling agents for the treatment of active acne and superficial acne scars. Cryotherapy: Cryoslush and cryopeel are used for the treatment of nodulocystic acne. Intralesional corticosteroids are indicated for the treatment of nodules, cysts and keloidal acne scars. Nonablative lasers and light therapy using Blue light, non ablative radiofrequency, Nd:YAG laser, IPL (Intense Pulsed Light, PDT (Photodynamic Therapy, pulse dye laser and light and heat energy machines have been used in recent years for the treatment of active inflammatory acne and superficial acne scars. Proper counseling is very important in the treatment of acne scars. Treatment depends on the type of acne scars; a patient may need more than one type of treatment. Subcision is a treatment to break the

  11. Postoperative care for the robotic surgery bowel resection patient.

    Science.gov (United States)

    Brenner, Zara R; Salathiel, Mary; Macey, Barbara A; Krenzer, Maureen

    2011-01-01

    A new surgical method is available for colon and rectal surgery. Robotic surgery, using the daVinci Si HD Surgical System, offers surgical advances compared with the traditional open or laparoscopic surgical methods. The potential advantages of robotic technology continue to be explored and its most appropriate functions are yet to be determined. In clinical experience, the use of this surgical method has resulted in changes to postoperative nursing care management. This article describes changes in the management of postoperative patient care including fluid and electrolyte balance, and patient and staff education. Modifications were instituted in the clinical pathway to facilitate an accelerated standard of care. New discharge strategies were implemented to ensure ongoing fluid and electrolyte balance by the patient. A true team effort from a multitude of disciplines was required for the changes in patient care routine to be effective. Outcomes including length of stay and patient satisfaction are presented.

  12. The Plastic Surgery Compass: Navigating the Reconstructive Ladder in the Personalized Health Care Era.

    Science.gov (United States)

    Sandberg, Lars Johan M

    2016-09-01

    The reconstructive ladder and the reconstructive elevator have withstood the test of time as didactic tools for resident education. Over time, many alternative models have been suggested to incorporate the technological advances in plastic surgery, but none of them have focused on the patient. Changes in practice and the trend toward personalized health care demand a 360-degree evaluation and solution of surgical problems incorporating patient-specific characteristics. We, therefore, suggest the concept of the plastic surgery compass to navigate the ladder.

  13. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating...... postoperative intermediate care after emergency abdominal surgery, the InCare trial. DESIGN: A qualitative study with individual semi-structured interviews. METHODS: We analysed interviews using Systematic Text Condensation. RESULTS: Eighteen patients (nine intervention/nine controls) were strategically sampled...

  14. Take Care of Yourself After an Amputation or Other Surgery

    Centers for Disease Control (CDC) Podcasts

    2010-02-18

    This podcast provides health information for amputees on how to take care of yourself after an amputation or other surgery.  Created: 2/18/2010 by National Center on Birth Defects and Developmental Disability, Disability and Health Program.   Date Released: 2/18/2010.

  15. Monitored Anaesthesia Care (MAC in antalgic surgery

    Directory of Open Access Journals (Sweden)

    Giovanni Maria Pisanu

    2011-09-01

    Full Text Available The use of surgical techniques for pain relief in the treatment of chronic-persistent pain unresponsive to drug therapy is experiencing a growing spread application in algology. These techniques have set themselves the goal of removing the pain after treatment. Therefore, not always, percutaneous or open procedures are carried out with due precaution necessary to alleviate the patient discomfort and suffering during the surgical intervention. We present our personal experience in the use of this technique Monitored Anaesthesia Care (MAC for patients undergoing surgical treatment of pain management at our Regional Center of Pain Management.

  16. The Epital Care Model

    DEFF Research Database (Denmark)

    Phanareth, Klaus; Vingtoft, Søren; Christensen, Anders Skovbo

    2017-01-01

    and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports...... the intentions of the World Health Organization (WHO) to have integrated people-centered care. OBJECTIVE: To design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care...... and face-to-face support for COPD management. In step five the initial model was extended with elements that support continuity of care. Beginning in the autumn of 2013, 1102 frail elderly individuals were included and offered two additional services: an outgoing acute medical team and a local subacute bed...

  17. Surgery

    Science.gov (United States)

    ... the hospital, sometimes in an intensive care unit (ICU). Direct discharge home A person being sent home ... from surgery should occur gradually. Some people need rehabilitation , which involves special exercises and activities, to improve ...

  18. Need for Intensive Nutrition Care After Bariatric Surgery.

    Science.gov (United States)

    Bétry, Cécile; Disse, Emmanuel; Chambrier, Cécile; Barnoud, Didier; Gelas, Patrick; Baubet, Sandrine; Laville, Martine; Pelascini, Elise; Robert, Maud

    2017-02-01

    Severe nutrition complications after bariatric surgery remain poorly described. The aim of this case series was to identify specific factors associated with nutrition complications after bariatric surgery and to characterize their nutrition disorders. We retrospectively reviewed all people referred to the clinical nutrition intensive care unit of our university hospital after bariatric surgery from January 2013 to June 2015. Twelve persons who required artificial nutrition supplies (ie, enteral nutrition or parenteral nutrition) were identified. Seven persons underwent a "one-anastomosis gastric bypass" (OAGB) or "mini gastric bypass," 2 underwent a Roux-en-Y gastric bypass, 2 had a sleeve gastrectomy, and 1 had an adjustable gastric band. This case series suggests that OAGB could overexpose subjects to severe nutrition complications requiring intensive nutrition care and therefore cannot be considered a "mini" bariatric surgery. Even if OAGB is often considered a simplified surgical technique, it obviously requires as the other standard bariatric procedures a close follow-up by experimented teams aware of its specific complications.

  19. [Evaluation of quality of care in a general surgery department].

    Science.gov (United States)

    Visset, J; Paineau, J; Letessier, E; Hamelin, E; Hamy, A; Courant, O

    A permanent evaluation of a department's activity and the quality of health care it provides is needed to avoid inappropriate use resulting from a wide range of causes. The activity of a general surgery department treating and average of 1,500 patients per year and performing 1,200 operations was analyzed over the period 1986 to 1992. Post-operative hospital follow-up was noted for each patient and any complications were analyzed on discharge day by the surgeons, the anaesthesiologists and the nursing staff. A year-end sum up was conducted each year by homogeneous groups. Examples are presented: surgery for cancer of the oesophagus (122 cases), surgery for gastro-oesophageal reflux (120 cases), thyroid surgery (1,314 cases from 1988 to 1992). Complications, hospital stay and former pathologies were evaluated in order to determine the indications, prevent complications and evaluate more rapidly the advantages of modifications in techniques. The results were compared between surgeons. This daily evaluation allowed a better analysis than a retrospective study compared with data in the literature. Permanent personal reevaluation was one of the practical consequences of the study considered to be and enriching experience.

  20. The Plastic Surgery Compass: Navigating the Reconstructive Ladder in the Personalized Health Care Era

    Science.gov (United States)

    2016-01-01

    Summary: The reconstructive ladder and the reconstructive elevator have withstood the test of time as didactic tools for resident education. Over time, many alternative models have been suggested to incorporate the technological advances in plastic surgery, but none of them have focused on the patient. Changes in practice and the trend toward personalized health care demand a 360-degree evaluation and solution of surgical problems incorporating patient-specific characteristics. We, therefore, suggest the concept of the plastic surgery compass to navigate the ladder. PMID:27757348

  1. [Nursing care in patients undergoing radiological surgery. A case report].

    Science.gov (United States)

    Armero-Barranco, David; Ruiz-Mateos, María; Alcaraz-Baños, Miguel; Bernal-Páez, Fernando Luis

    2007-01-01

    We report the case of a 73-year-old man with medical diagnoses of long-standing diabetes mellitus, chronic ischemia of the lower limbs and intermittent claudication, for which the patient had been treated with minimally invasive radiological surgery. On arrival at the radiology unit, the patient had nursing diagnoses of anxiety and fear. Intraoperatively, the client had nursing diagnoses of pain, urine retention and infection risk. At discharge, a collaboration problem was detected and hemorrhagic risk. The patient received individualized nursing care. Interventions were planned following the nursing intervention classification (NIC) and the expected results for these interventions followed the Nursing Outcomes Classification (NOC) taxonomy. The application of an appropriate nursing care plan contributes to making the patient's hospital stay easier, more comfortable and less traumatic.

  2. Decision support systems for robotic surgery and acute care

    Science.gov (United States)

    Kazanzides, Peter

    2012-06-01

    Doctors must frequently make decisions during medical treatment, whether in an acute care facility, such as an Intensive Care Unit (ICU), or in an operating room. These decisions rely on a various information sources, such as the patient's medical history, preoperative images, and general medical knowledge. Decision support systems can assist by facilitating access to this information when and where it is needed. This paper presents some research eorts that address the integration of information with clinical practice. The example systems include a clinical decision support system (CDSS) for pediatric traumatic brain injury, an augmented reality head- mounted display for neurosurgery, and an augmented reality telerobotic system for minimally-invasive surgery. While these are dierent systems and applications, they share the common theme of providing information to support clinical decisions and actions, whether the actions are performed with the surgeon's own hands or with robotic assistance.

  3. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial

    DEFF Research Database (Denmark)

    Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn

    2013-01-01

    . The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency...... influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care.Trial registration: Clinicaltrials.gov identifier: NCT01209663....

  4. Ibuprofen timing for hand surgery in ambulatory care

    Science.gov (United States)

    Giuliani, Enrico; Bianchi, Anna; Marcuzzi, Augusto; Landi, Antonio; Barbieri, Alberto

    2015-01-01

    OBJECTIVE: To evaluate the effect of pre-operative administration of ibuprofen on post-operative pain control vs. early post-operative administration for hand surgery procedures performed under local anaesthesia in ambulatory care. METHODS: Candidates to trigger finger release by De Quervain tenosynovitis and carpal tunnel operation under local anesthesia were enrolled in the study. Group A received 400 mg ibuprofen before the operation and placebo after the procedure; group B received placebo before the operation and ibuprofen 400 mg at the end of the procedure; both groups received ibuprofen 400 mg every 6h thereafter. Visual analogue scale (VAS) was measured at fixed times before and every 6h after surgery, for a total follow-up of 18h. RESULTS: Groups were similar according to age, gender and type of surgery. Median VAS values did not produce any statistical significance, while there was a statistically significant difference on pre-operative and early post-operative VAS values between groups (A -8.53 mm vs. B 3.36 mm, p=0.0085). CONCLUSION: Average pain levels were well controlled by local anesthesia and post-operative ibuprofen analgesia. Pre-operative ibuprofen administration can contribute to improve early pain management. Level of Evidence II, Therapeutic Studies. PMID:26327799

  5. 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;

    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...... no statistically significant effect on 30-day mortality after emergency abdominal surgery, nor any effect on secondary outcomes. The trial was stopped prematurely owing to slow recruitment and a much lower than expected mortality rate among the enrolled patients. REGISTRATION NUMBER: NCT01209663 (http://www.clinicaltrials.gov)....

  6. Nursing Care of the Laryngeal Mask Airway in Pediatric Cataract Surgery

    Institute of Scientific and Technical Information of China (English)

    Aihuan Chen; Ronghua Ye; Yanchan Liu; Weici Liu; Jingyi Lin

    2014-01-01

    Purpose:To investigate the important experience of nursing care of the laryngeal mask airway (LMA) in children under-going cataract surgery. Methods: Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and re-ceived perioperative nursing care. The safety of perioperative nursing for these children was also evaluated. Results:Through perioperative nursing care and psychological counseling for children with LMA,.all patients were anes-thetized without complications and underwent successful surgeries..No severe postoperative complications were ob-served. Conclusion: Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.

  7. Multiscale mechanobiology modeling for surgery assessment

    Institute of Scientific and Technical Information of China (English)

    M. Garbey; B. L. Bass; S. Berceli

    2012-01-01

    This paper discusses some of the concept of modeling surgery outcome.It is also an attempt to offer a road map for progress.This paper may serve as a common ground of discussion for both communities i.e surgeons and computational scientist in its broadest sense.Predicting surgery outcome is a very difficult task.All patients are different,and multiple factors such as genetic,or environment conditions plays a role.The difficulty is to construct models that are complex enough to address some of these significant multiscale elements and simple enough to be used in clinical conditions and calibrated on patient data.We will provide a multilevel progressive approach inspired by two applications in surgery that we have been working on.One is about vein graft adaptation after a transplantation,the other is the recovery of cosmesis outcome after a breast lumpectomy.This work,that is still very much in progress,may teach us some lessons.We are convinced that the digital revolution that is transforming the working environment of the surgeon makes closer collaboration between surgeons and computational scientist unavoidable.We believe that "computational surgery" will allow the community to develop predictive model of the surgery outcome and greatprogresses in surgery procedures that goes far beyond the operating room procedural aspect.

  8. 78 FR 62506 - TRICARE; Coverage of Care Related to Non-Covered Initial Surgery or Treatment

    Science.gov (United States)

    2013-10-22

    ... a non-covered incident of treatment (such as nonadjunctive dental care or cosmetic surgery) but only... Initial Surgery or Treatment AGENCY: Office of the Secretary, Department of Defense. ACTION: Proposed rule... on a determination that a waiver authorizing the original non-covered surgery or treatment...

  9. Optimizing cardiothoracic surgery information for a managed care environment.

    Science.gov (United States)

    Denton, T A; Matloff, J M

    1995-11-01

    The rapid change occurring in American healthcare is a direct response to rising costs. Managed care is the fastest growing model that attempts to control escalating costs through limitations in patient choice, the active use of guidelines, and placing providers at risk. Managed care is an information intensive system, and those providers who use information effectively will be at an advantage in the competitive healthcare marketplace. There are five classes of information that providers must collect to be competitive in a managed care environment: patient satisfaction, medical outcomes, continuous quality improvement, quality of the decision, and financial data. Each of these should be actively used in marketing, assuring the quality of patient care, and maintaining financial stability. Although changes in our healthcare system are occurring rapidly, we need to respond to the marketplace to maintain our viability, but as physicians, we have the singular obligation to maintain the supremacy of the individual patient and the physician-patient relationship.

  10. Orem自理模式在手术孤儿照顾者依赖性照顾能力评估中的应用%Application of Orem self-care model in assessing dependency care ability of caregivers for surgery orphans

    Institute of Scientific and Technical Information of China (English)

    唐浪娟; 程淑华; 谌秘; 王亚宁; 邓淑红

    2010-01-01

    目的 运用Orem自理模式评估手术孤儿照顾者的依赖性照顾能力,分析其依赖性照顾缺陷程度,提出相应的护理对策.方法 用自制调查表对16名手术孤儿照顾者进行调查,调查表包括了照顾者的一般情况、为孤儿提供的护理情况及照顾者依赖性照顾能力需求.结果 发放的调查表全部有效回收.照顾者为孤儿提供的基础护理正确比例较高,为62.50%~93.75%,康复锻炼正确比例较低,<43.75%,96%照顾者希望培训获得护理相关知识,提高依赖性照顾能力.结论 照顾者依赖性照顾能力能满足孤儿的基本依赖性照顾需要,但仍然存在照顾缺陷,护士应针对不同的孤儿和不同的照顾缺陷采取不同的护理补偿.%Objective To adopt Orem self-care model to assestt the dependency care ability of care-givers for surgery orphans and analyze its defective level of dependency case,then propose corresponding nursing policy. Methods 16 caregivers for surgery orphans were surveyed with self-made questionnaire which included the general condition of the caregivers,the nursing situation for orphans and the require-ment for dependency care ability of the caregivers.Results All questionnaires were withdrew.The pro-portion of providing correct primary care for orphans was up to 62.50%~93.75%.But the proportion of pro-viding correct rehabilitation exercises was lower than 43.75%.96% caregivers wished to obtain the relative nursing knowledge by training and improve their dependency care ability.Conclmions The caregivers' dependency care ability can meet the needs of orphans' basic dependency care.But the defect still exists,the nurses should adopt different nursing compensation for different orphans and different care defects.

  11. Day care surgery in a metropolitan government hospital setting--Indian scenario.

    Science.gov (United States)

    Dorairajan, Natarajan; Andappan, Anandi; Arun, B; Siddharth, Dorairajan; Meena, M

    2010-01-01

    Day care surgery has generated a lot of interest, among both surgeons and the common people. This study aims to explore the management and advantages, including the cost benefits and cost effectiveness, of day care surgery in a government hospital setting. A prospective, single-center, single-unit study was carried out over 1 year from August 2006 to January 2008. The total number of patients studied was 327. Surgeries for hernia, hydrocele, fibroadenoma, fissure in ano, and phimosis were included. Patients were admitted on the day of surgery and were discharged the same day or evening. Patients were analyzed with respect to failure to discharge, wound infection, duration of stay in the ward, cost benefits, cost effectiveness, and postoperative pain. A total of 157 patients were treated for hernia, 61 for hydrocele, 52 for fibroadenoma, 34 for fissure in ano, and 23 for phimosis. Day care surgery is a fast growing and well accepted way of providing care to patients. Most of the patients studied had a favorable impression of the day care surgical procedure compared with inpatient care. In a country like India, in spite of problems of financial constraints and insufficient grants for health care, we are able to enjoy all the advantages of day care surgery, even in a government hospital setting.

  12. MDT协作护理模式在白内障手术患者中的应用效果%Application of MDT collaborative care model in surgery of cataract patients

    Institute of Scientific and Technical Information of China (English)

    陈俊娥; 王志学; 陈俊荣

    2015-01-01

    Objective To study the clinical value of Multi-disciplinary Team ( MDT) collaborative care model in cataract surgery patients. Methods A total of 112 cases of cataract patients with surgery from March 2013 to March 2014 in our hospital were divided into control group and experimental group, with 56 cases in each. In the control group, the traditional treatment methods were used, while multidisciplinary teamwork approach was applied to the experimental group. The time of hospital stay, postoperative recovery, postoperative complication, the knowledge of disease and the Symptom Checklist 90 ( SCL-90 ) were compared between the two groups. Results In the experimental group, the length of stay and the postoperative vision were (3. 8 ± 1. 0) days and (0. 55 ± 0. 12), which were significantly better than those of the control group (t =2. 471,2.019, respectively;P <0. 05). The incidence of complication of corneal endothelial injury, glaucoma and amotio retinae were 3(5. 4%), 7(12. 5%) and 4(71. 4%),which were significantly lower than those of the control group (χ2 =17. 638,11. 241,13. 492, respectively;P<0. 05). The knowledge of disease and the score of SCL-90 were significantly improved in the experimental group (P<0. 05). Conclusions MDT collaborative care model can shorten the hospital stay of patients, promote the recovery of visual acuity, increase patients′ control of health knowledge, reduce the incidence of complications, improve patient′s psychological and emotional condition in cataract surgery patients. The care model in the clinical treatment of cataract surgery patients are significantly effective, and worthy of generalizing.%目的:研究多学科团队( MDT)协作护理模式在白内障手术患者中的临床应用价值。方法选择2013年3月—2014年3月沧州市中心医院收治的白内障手术患者112例,根据对患者护理方式的不同分为对照组和研究组各56例。对照组采取传统治疗护理方式,研究组采取

  13. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

    Directory of Open Access Journals (Sweden)

    Michael Mazzeffi

    2015-01-01

    Full Text Available Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.

  14. Level of Perception of Individualized Care and Satisfaction With Nursing in Orthopaedic Surgery Patients.

    Science.gov (United States)

    Tekin, Fatma; Findik, Ummu Yildiz

    2015-01-01

    Lately, individualized nursing care and patient satisfaction are important and current issues being discussed. But there is not enough information for patients undergoing orthopaedic surgery. The aim of this study was to determine the individualized care perception and satisfaction in nursing care levels in orthopaedic surgery patients. This descriptive cross-sectional study was conducted with 156 patients who underwent orthopaedic surgery. Data were collected using the personal information form, the Individualized Care Scale, and the Newcastle Satisfaction With Nursing Scale. The Spearman correlation analysis and descriptive statistics were performed. The mean individualized care and satisfaction with nursing care scores were found to be close to the preset maximum value, and it was determined that an increase in the level of awareness about nursing interventions and the level of perceived individualized care caused an increase in satisfaction levels regarding nursing care. Nurses should recognize the importance of performing individualized care in order to increase the level of satisfaction with nursing care in orthopaedic surgery patients.

  15. Postoperative delirium and factors related in a cardiac surgery unit care

    Directory of Open Access Journals (Sweden)

    Julia de las Pozas Abril

    2011-07-01

    Full Text Available Objective: Describe the incidence of postoperative delirium and related risk factors associated with this complication in patients undergoing cardiac surgery. Method: Cohort study conducted for 3 months in a sample of 105 patients undergoing cardiac surgery in a hospital in Madrid. The emergence of delirium with scale ICDSC (Intensive Care Delirium Screening Checklist was measured during the first five days of postoperative and collected data on preoperative, intra-operative and post-operative factors to relate to the emergence of delirium. Results: 95 Patients studied, 15 of them developed delirium, which means an incidence of 15.7%. We found that there was a significant relationship between delirium appearance and age of the patients, the presence of atrial fibrillation, intubation orotraqueal time and the administration of adrenaline during the immediate post-operative management. The multivariable model showed the duration of orotraqueal intubation to be independently associated with delirium. Conclusions: The incidence of delirium found in this study as well as the identification of the time of orotraqueal intubation as independent risk factor supposes a new contribution to the knowledge of this postoperative complication and allow us to begin to evaluate its importance in the unit of cardiac surgery.

  16. Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

    Full Text Available Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23 service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01, those undergoing wide local excision (P<0.01 and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01, were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

  17. Recovery at the post anaesthetic care unit after breast cancer surgery

    DEFF Research Database (Denmark)

    Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl

    2010-01-01

    Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine...

  18. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2014-01-01

    Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good...... outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining...... this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach...

  19. Developing integrated care. Towards a development model for integrated care

    OpenAIRE

    Minkman, Mirella M.N

    2012-01-01

    textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated care. Based on a systematic approach in which a literature study, a delphi study, a concept mapping study and questionnaire research are combined, a development model for integrated care is created....

  20. Colonic surgery with accelerated rehabilitation or conventional care

    DEFF Research Database (Denmark)

    Basse, Linda; Thorbøl, Jens Erik; Løssl, Kristine;

    2004-01-01

    after colonic resection with conventional care compared with fast-track multimodal rehabilitation. METHODS: One hundred thirty consecutive patients receiving conventional care (group 1) in one hospital were compared with 130 consecutive patients receiving multimodal, fast-track rehabilitation (group 2...... ( P complication rate (35 patients) was lower in group 2 ( P...... complications (5 patients; P 0.05). CONCLUSIONS: Time to first defecation, hospital stay, and morbidity may be reduced after colonic resection with fast...

  1. The Affordable Care Act: implications for cardiothoracic surgery.

    Science.gov (United States)

    Ferguson, T Bruce; Babb, Joseph A

    2013-01-01

    The Affordable Care Act legislation that was passed by the US Congress and signed into law by President Obama on March 23, 2010 is having a substantial effect throughout all of health care in the United States. Cardiothoracic surgeons, as hospital-based procedural specialists, bring unique assets and certain important liabilities into this massive restructuring of our health care delivery system. This article highlights how each of the 10 titles in the Obamacare legislation might affect our specialty; its collaborative relationship with our cardiovascular, medical specialty, and primary care colleagues; and our clinical practice roles and responsibilities in accountable care organizations and primary care medical homes. This article also addresses the unique assets in clinical data in medicine and quality improvement demonstrated by our specialty that have been used to help shape the current and future landscape. Finally, key resources are identified to allow the cardiothoracic community to monitor the ongoing progress of Obamacare as implementation begins. Keeping abreast of these rapidly changing developments will be an important role for our specialty societies and for practitioners alike going forward.

  2. Achieving Value in Primary Care: The Primary Care Value Model.

    Science.gov (United States)

    Rollow, William; Cucchiara, Peter

    2016-03-01

    The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM). We advocate for use of patient-centered value when measuring the impact of primary care transformation, recognition, and performance-based payment; for financial support and research and development to better define primary care value-creating activities and their implementation; and for use of the model to support primary care organizations in transformation.

  3. A service model for delivering care closer to home.

    Science.gov (United States)

    Dodd, Joanna; Taylor, Charlotte Elizabeth; Bunyan, Paul; White, Philippa Mary; Thomas, Siân Myra; Upton, Dominic

    2011-04-01

    Upton Surgery (Worcestershire) has developed a flexible and responsive service model that facilitates multi-agency support for adult patients with complex care needs experiencing an acute health crisis. The purpose of this service is to provide appropriate interventions that avoid unnecessary hospital admissions or, alternatively, provide support to facilitate early discharge from secondary care. Key aspects of this service are the collaborative and proactive identification of patients at risk, rapid creation and deployment of a reactive multi-agency team and follow-up of patients with an appropriate long-term care plan. A small team of dedicated staff (the Complex Care Team) are pivotal to coordinating and delivering this service. Key skills are sophisticated leadership and project management skills, and these have been used sensitively to challenge some traditional roles and boundaries in the interests of providing effective, holistic care for the patient.This is a practical example of early implementation of the principles underlying the Department of Health's (DH) recent Best Practice Guidance, 'Delivering Care Closer to Home' (DH, July 2008) and may provide useful learning points for other general practice surgeries considering implementing similar models. This integrated case management approach has had enthusiastic endorsement from patients and carers. In addition to the enhanced quality of care and experience for the patient, this approach has delivered value for money. Secondary care costs have been reduced by preventing admissions and also by reducing excess bed-days. The savings achieved have justified the ongoing commitment to the service and the staff employed in the Complex Care Team. The success of this service model has been endorsed recently by the 'Customer Care' award by 'Management in Practice'. The Surgery was also awarded the 'Practice of the Year' award for this and a number of other customer-focussed projects.

  4. Robotic surgery in urological oncology: patient care or market share?

    Science.gov (United States)

    Kaye, Deborah R; Mullins, Jeffrey K; Carter, H Ballentine; Bivalacqua, Trinity J

    2015-01-01

    Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered.

  5. Perioperative complications of cardiac surgery and postoperative care.

    Science.gov (United States)

    Nearman, Howard; Klick, John C; Eisenberg, Paul; Pesa, Nicholas

    2014-07-01

    The care of the cardiac surgical patient postoperatively is fraught with several complications because of the nature of the surgical procedure itself and the common comorbidities of this patient population. Most complications occurring in the immediate postoperative period are categorized by organ system, and their pathophysiology is presented. Current diagnostic approaches and treatment options are offered. Preventive measures, where appropriate, are also included in the discussion.

  6. Choosing a Hospital for Surgery: The Importance of Information on Quality of Care

    NARCIS (Netherlands)

    Dijs-Elsinga, J.; Otten, W.; Versluijs, M.; Smeets, H.J.; Kievit, J.; Vree, R.; Made, W.J. van der; Marang-Van De Mheen, P.J.

    2010-01-01

    OBJECTIVE: To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. METHODS: In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical

  7. Developing Integrated Care: Towards a development model for integrated care

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella)

    2012-01-01

    textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated c

  8. Intercultural caring-an abductive model.

    Science.gov (United States)

    Wikberg, Anita; Eriksson, Katie

    2008-09-01

    The aim of this study was to increase the understanding of caring from a transcultural perspective and to develop the first outline of a theory. The theoretical perspective includes Eriksson's theory of caritative caring. Texts on caring by the transcultural theorists, including Campinha-Bacote, Kim-Godwin, Leininger and Ray, are analysed using content analysis. The overall theme that resulted from this analysis was that caring is a complex whole. Three main categories of caring emerged: inner caring, outer caring and the goal of caring. Inner caring consists of caring is a relationship, and caring and culture are seen in different dimensions. Outer caring refers to caring affected by educational, administrative and social and other structures. The goal of caring consists of caring leading to change towards health and well-being. The main categories include categories and subcategories that are compared with Eriksson's theory of caritative caring. A model for intercultural caring is generated abductively. Caring and culture appear in three dimensions: caring as ontology independent of context; caring as a phenomenon emphasised differently in different cultures; caring as nursing care activities is unique. Caring alleviates suffering and leads to health and well-being. This model describes caring from an intercultural perspective as a mutual but asymmetric relationship between the nurse and the patient, including the patient's family and community. The patient's cultural background and acculturation influence caring. The cultural background, cultural competence and organisation of the nurse also influence caring. Caring is seen as a complex whole. This study integrates Campinha-Bacote's, Kim-Godwin's, Leininger's and Ray's views of caring with Eriksson's caritative caring and presents caring from a transcultural perspective in a new way as a model for intercultural caring, which can benefit nursing care, education, research and administration.

  9. Mortality and postoperative care pathways after emergency gastrointestinal surgery in 2904 patients

    DEFF Research Database (Denmark)

    Vester-Andersen, M; Lundstrøm, Lars Hyldborg; Møller, M H

    2014-01-01

    operation in the standard ward, with a 30 day mortality of 14.3%, and 4.8% were admitted to the intensive care unit (ICU) after a median stay of 2 days (inter-quartile range: 1-6). When compared with 'admission to standard ward', 'admission to standard ward before ICU admission' and 'ICU admission after......BACKGROUND: Emergency major gastrointestinal (GI) surgery carries a considerable risk of mortality and postoperative complications. Effective management of complications and appropriate organization of postoperative care may improve outcome. The importance of the latter is poorly described...... in emergency GI surgical patients. We aimed to present mortality data and evaluate the postoperative care pathways used after emergency GI surgery. METHODS: A population-based cohort study with prospectively collected data from six Capital Region hospitals in Denmark. We included 2904 patients undergoing major...

  10. Improving outcomes from high-risk surgery: a multimethod evaluation of a patient-centred advanced care planning intervention

    Science.gov (United States)

    Senthuran, Siva; Blakely, Brette; Lane, Paul; North, John; Clay-Williams, Robyn

    2017-01-01

    Introduction Patients who are frail, have multiple comorbidities or have a terminal illness often have poor outcomes from surgery. However, sole specialists may recommend surgery in these patients without consultation with other treating clinicians or allowing for patient goals. The Patient-Centred Advanced Care Planning (PC-ACP) model of care provides a framework in which a multidisciplinary advanced care plan is devised to incorporate high-risk patients' values and goals. Decision-making is performed collaboratively by patients, their family, surgeons, anaesthetists, intensivists and surgical case managers. This study aims to evaluate the feasibility of this new model of care, and to determine potential benefits to patients and clinicians. Methods and analysis After being assessed for frailty, patients will complete a patient–clinician information engagement survey pretreatment and at 6 months follow-up. Patients (and/or family members) will be interviewed about their experience of care pretreatment and at 3 and 6 months follow-ups. Clinicians will complete a survey on workplace attitudes and engagement both preimplementation and postimplementation of PC-ACP and be interviewed, following each survey, on the implementation of PC-ACP. We will use process mapping to map the patient journey through the surgical care pathway to determine areas of improvement and to identify variations in patient experience. Ethics and dissemination This study has received ethical approval from Townsville Hospital and Health Service HREC (HREC/16/QTHS/100). Results will be communicated to the participating hospital, presented at conferences and submitted for publication in a peer-reviewed MEDLINE-indexed journal. PMID:28242771

  11. Enhanced recovery after elective colorectal surgery: now the standard of care.

    LENUS (Irish Health Repository)

    Andrews, E J

    2011-09-01

    Enhanced recovery programmes have been studied in randomised trials with evidence of quicker recovery of gut function, reduced morbidity, mortality and hospital stay and improved physiological and nutritional outcomes. They aim to reduce the physiological and psychological stress of surgery and consequently the uncontrolled stress response. The key elements, reduced pre-operative fasting, intravenous fluid restriction and early feeding after surgery, are in conflict with traditional management plans but are supported by strong clinical evidence. Given the strength of the current data enhanced recovery should now be the standard of care.

  12. Day-care hypospadias surgery: Single surgeon experience

    Directory of Open Access Journals (Sweden)

    Chandrasekharam V.V.S.S

    2007-01-01

    Full Text Available Aim: To report the results of the early discharge of children after hypospadias repair with an indwelling catheter. Materials and Methods: To facilitate early the discharge of children after hypospadias repair, the author adopted the technique of draining the indwelling urinary catheter into diapers in children undergoing this operation. Home catheter care was taught to the mother; the dressings and catheters were subsequently managed in the outpatient clinic. Results: Over a 2-year period, 43 children were managed by this technique and were sent home within 24-48 h after the operation with an indwelling catheter. Minor problems requiring outpatient visits to the surgeon occurred in nine (20% children after discharge from the hospital. All the nine children were successfully managed as outpatients and no child required rehospitalisation. The catheter remained in position for 5 days in all the children. The overall results were satisfactory with an acceptable (7% fistula rate. Conclusions: It is possible to reduce the duration of the hospital stay of children after hypospadias repair without compromising on the final results.

  13. Designing a Care Pathway Model – A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway

    Directory of Open Access Journals (Sweden)

    Robin I. Oosterholt

    2017-03-01

    Full Text Available Introduction: Although the clinical attributes of total hip arthroplasty (THA care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. Theory: The outpatient THA care pathway enables patients to be discharged on the day of surgery, short- ening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. Methods: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi- structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. Results: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1 and mobilisation & discharge (4. The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. Conclusion: The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1, radiologist (1, anaesthetist (1, nurse specialist (1, pharmacist (1, orthopaedic surgeon (1,4, physiotherapist (1,4, nurse (4, doctor (4 and patient applica- tion (1,4. The critical value exchanges include patient preparation (mental and practical, patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

  14. Palliative Care Doula: an innovative model.

    Science.gov (United States)

    Lentz, Judy C

    2014-01-01

    Walking the journey of serious illness is very difficult and stressful for patients and families. A universal principle of palliative care is caring for the patient/ family unit. This article introduces a model for the Palliative Care Doula for experienced and advanced practice palliative care nurses to support patients and families during the traumatic and vulnerable period of end-of-life care.

  15. Improving Intensive Care Unit and Ward Utilization by Adapting Master Surgery Schedules.

    Science.gov (United States)

    Fügener, Andreas; Edenharter, Guenther Michael; Kiefer, Paskal; Mayr, Ulrike; Schiele, Julian; Steiner, Fabian; Kolisch, Rainer; Blobner, Manfred

    2016-03-15

    With increasing organizational and financial pressure on hospitals, each individual surgical treatment has to be reviewed and planned thoroughly. Apart from the expensive operating room facilities, proper staffing and planning of downstream units, like the wards or the intensive care units (ICUs), should be considered as well. In this article, we outline the relationship between a master surgery schedule (MSS), i.e., the assignment of surgical blocks to medical specialties, and the bed demand in the downstream units using an analytical model. By using historical data retrieved from the clinical information system and a patient flow model, we applied a recently developed algorithm for predicting bed demand based on the MSSs for patients of 3 surgical subspecialties of a hospital. Simulations with 3 different MSSs were performed. The impact on the required amount of beds in the downstream units was analyzed. We show the potential improvements of the current MSS considering 2 main goals: leveling workload among days and reduction of weekend utilization. We discuss 2 different MSSs, one decreasing the weekend ICU utilization by 20% and the other one reducing maximum ward bed demand by 7%. A test with 12 months of real-life data validates the results. The application of the algorithm provides detailed insights for the hospital into the impact of MSS designs on the bed demand in downstream units. It allowed creating MSSs that avoid peaks in bed demand and high weekend occupancy levels in the ICU and the ward.

  16. The potential impact of a cataract surgery programme on the care of orphans and vulnerable children in Swaziland.

    Science.gov (United States)

    Pons, J; Mapham, W E; Newsome, B; Myer, L; Anderson, R; Courtright, P; Cook, C

    2012-02-23

    We aimed to evaluate the potential impact of a cataract surgery programme at the Good Shepherd Hospital, Siteki, Swaziland, on the care of orphans and vulnerable children in Swaziland. We studied consecutive patients aged 50 years and older undergoing surgery for age-related cataract who reported having children living in their household. Of 131 subjects recruited, 65 (49.6%) were the primary caregivers for the child(ren) in their household. Visual acuities measured 2 weeks after surgery significantly improved. Four weeks after surgery, there was a sizable increase in the proportions of subjects who were able to undertake self-care activities, attend to activities of daily living, undertake income-generating activities and care for children. Cataract surgery on elderly visually impaired patients has the potential to impact positively on the care of orphans and vulnerable children.

  17. 左半肝切除术的护理%Left liver resection careSurgery

    Institute of Scientific and Technical Information of China (English)

    唐成毅

    2015-01-01

    Objective To investigate the left liver resection patient care, summarize nursing experience, reduce complications. Methods Our department in January 2013 --2015 January pancreas left hepatectomy in patients after surgery care cases 32 cases, from lessons learned.Results Our department 32 cases left hepatectomy patient had complications, and achieved satisfactory results. Conclusion Strengthening careful observation of the disease after surgery and intensive care to improve the success rate of surgery, reduce complications and mortality is extremely important.%目的:探讨左半肝切除术后病人的护理,总结护理经验,减少并发症的发生.方法:总结我科2013年1月~2015年1月,32例胰左半肝切除病人手术后的护理情况,从中总结经验.结果:我科32例左半肝切除术病人均未发生并发症,取得了较满意的效果.结论:加强手术前后病情的细致观察和精心护理对提高手术成功率、减少并发症和死亡率极为重要.

  18. [Nursing Care of Lumbar Spine Fusion Surgery Using a Semi-Rigid Device (ISOBAR)].

    Science.gov (United States)

    Wu, Meng-Shan; Su, Shu-Fen

    2016-04-01

    Aging frequently induces degenerative changes in the spine. Patients who suffer from lumbar degenerative disease tend to have lower back pain, neurological claudication, and neuropathy. Furthermore, incontinence may be an increasing issue as symptoms become severe. Lumbar spine fusion surgery is necessary if clinical symptoms continue to worsen or if the patient fails to respond to medication, physical therapy, or alternative treatments. However, this surgical procedure frequently induces adjacent segment disease (ASD), which is evidenced by the appearance of pathological changes in the upper and lower sections of the spinal surgical sites. In 1997, ISOBAR TTL dynamic rod stabilization was developed for application in spinal fusion surgery to prevent ASD-related complications. The device has proven effective in reducing pain in the lower back and legs, decreasing functional disability, improving quality of life, and retarding disc degeneration. However, the effectiveness of this intervention in decreasing the incidence of ASD requires further research investigation, and relevant literature and research in Taiwan is still lacking. This article discusses lumbar degenerative disease, its indications, the contraindications of lumbar spine fusion surgery using ISOBAR, and related postoperative nursing care. We hope this article provides proper and new knowledge to clinical nurses for the care of patients undergoing lumbar spine fusion surgery with ISOBAR.

  19. Physical and rehabilitation medicine (PRM) care pathways: "patients after knee ligament surgery".

    Science.gov (United States)

    Calmels, P; Ribinik, P; Barrois, B; Le Moine, F; Yelnik, A-P

    2011-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (Sofmer) and the French Federation of PRM (Fedmer). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after knee ligament surgery are classified into four care sequences and two clinical categories, taking into account personal and environmental factors that could influence patients' needs, in accordance with the International Classification of Functioning (WHO).

  20. Physical and rehabilitation medicine (PRM) care pathways: "patients after rotator cuff tear surgery".

    Science.gov (United States)

    Ribinik, P; Calmels, P; Barrois, B; Le Moine, F; Yelnik, A P

    2011-11-01

    This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (Sofmer) and the French Federation of PRM (Fedmer). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. "Care pathways in PRM" is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. Patients after rotator cuff tear surgery are classified into four care sequences and two clinical categories, taking into account personal and environmental factors that could influence patients' needs, in accordance with the International Classification of Functioning (ICF) (WHO).

  1. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology

    OpenAIRE

    French, Daniel G.; Dilena, Michael; LaPlante, Simon; Shamji, Farid; Sundaresan, Sudhir; Villeneuve, James; Seely, Andrew; Maziak, Donna; Gilbert, Sebastien

    2016-01-01

    Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be appl...

  2. DayAND#8211;Care Surgery for Pilonidal Sinus Using Sinotomy Technique and Fibrin Glue Injection

    Directory of Open Access Journals (Sweden)

    Selim Sozen

    2012-06-01

    Conclusion: An ideal surgical procedure for a pilonidal sinus should be one aiming at reducing hospital stay, minimizing tissue assault, promoting early work resumption, and preventing recurrence. The method described in this paper was found to be simple, safe, and feasible as day-care surgery. The technique of sinotomy with a good wound and surrounding skin care is an ideal approach with a high chance of cure. The patients returned to their routine within a short duration of time. [Arch Clin Exp Surg 2012; 1(3.000: 138-141

  3. Postoperative hypoxia and length of intensive care unit stay after cardiac surgery: the underweight paradox?

    Directory of Open Access Journals (Sweden)

    Marco Ranucci

    Full Text Available OBJECTIVE: Cardiac operations with cardiopulmonary bypass can be associated with postoperative lung dysfunction. The present study investigates the incidence of postoperative hypoxia after cardiac surgery, its relationship with the length of intensive care unit stay, and the role of body mass index in determining postoperative hypoxia and intensive care unit length of stay. DESIGN: Single-center, retrospective study. SETTING: University Hospital. Patients. Adult patients (N = 5,023 who underwent cardiac surgery with CPB. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: According to the body mass index, patients were attributed to six classes, and obesity was defined as a body mass index >30. POH was defined as a PaO2/FiO2 ratio <200 at the arrival in the intensive care unit. Postoperative hypoxia was detected in 1,536 patients (30.6%. Obesity was an independent risk factor for postoperative hypoxia (odds ratio 2.4, 95% confidence interval 2.05-2.78, P = 0.001 and postoperative hypoxia was a determinant of intensive care unit length of stay. There is a significant inverse correlation between body mass index and PaO2/FiO2 ratio, with the risk of postoperative hypoxia increasing by 1.7 folds per each incremental body mass index class. The relationship between body mass index and intensive care unit length of stay is U-shaped, with longer intensive care unit stay in underweight patients and moderate-morbid obese patients. CONCLUSIONS: Obese patients are at higher risk for postoperative hypoxia, but this leads to a prolonged intensive care unit stay only for moderate-morbid obese patients. Obese patients are partially protected against the deleterious effects of hemodilution and transfusions. Underweight patients present the "paradox" of a better lung gas exchange but a longer intensive care unit stay. This is probably due to a higher severity of their cardiac disease.

  4. The Evaluation of Nursing Care Satisfaction and Patient Learning Needs in day Case Surgery.

    Science.gov (United States)

    Goktas, Sonay B; Yildiz, Tülin; Nargiz, Sibel Kosucu

    2015-12-01

    Patients in surgical service units have higher expectations for treatment and care. The aims of this study were to determine nursing care satisfaction and information requirements at the time of discharge of patients from a day surgery unit and to assess the effects of demographics. The study was conducted on 291 patients undergoing day case surgery. Patient perception scale for nursing care (PPSN) and the patient learning needs scale (PLNS) were used and total and sub-dimension points averages were calculated and then compared with demographic data using the Kruskal-Wallis test. The results were evaluated at the p patients, 58.8 % (n = 171) were females and the average age was 49.5 ± 15.3 years. PPSN and PLNS total point averages were 68.16 ± 10.17 and 178.53 ± 27.59, respectively. A significant difference was determined in PPSN total point average with regard to previous hospitalisations; the PPSN total point average was higher for patients with prior hospitalisations (p patient satisfaction and patient information requirements could change according to demographic features of the patients at a day case surgery unit. In this respect, healthcare providers should offer healthcare services by evaluating the personal characteristics of patients because this is important for their satisfaction.

  5. Modeling the consequences of tongue surgery on tongue mobility

    CERN Document Server

    Buchaillard, Stéphanie; Perrier, Pascal; Payan, Yohan

    2007-01-01

    This paper presents the current achievements of a long term project aiming at predicting and assessing the impact of tongue and mouth floor surgery on tongue mobility. The ultimate objective of this project is the design of a software with which surgeons should be able (1) to design a 3D biomechanical model of the tongue and of the mouth floor that matches the anatomical characteristics of each patient specific oral cavity, (2) to simulate the anatomical changes induced by the surgery and the possible reconstruction, and (3) to quantitatively predict and assess the consequences of these anatomical changes on tongue mobility and speech production after surgery.

  6. 以家庭为中心的护理模式在小儿外科护理中的实施效果%The effect of family-centered care model in the pediatric surgery nursing

    Institute of Scientific and Technical Information of China (English)

    陈慧

    2015-01-01

    目的:研究以家庭为中心的护理模式在小儿外科护理中的实施效果。方法选取2014年3~12月我科收治的外科手术患儿230例,按照护理方法不同分为对照组和观察组,每组115例。对照组采用常规护理方式,观察组采用以家庭为中心的护理模式,比较两组的焦虑情况及护理满意度。结果实施护理后,两组的焦虑情况均明显缓解,观察组的焦虑评分低于对照组(P<0.05);观察组的各项护理满意度高于对照组(P<0.05)。结论以家庭为中心的护理模式可带来优质的护理服务,显著缓解患儿及家属的紧张、焦虑情况,促进护患关系和谐,有利于患儿的康复。%Objective To analyze the family-centered care model in the pediatric surgical nursing. Methods 230 cases of pediatric patients with surgical operation admitted in our department from March to December 2014 were selected and divided into control group and observation group according to the different nursing method,with 115 cases in each group.Control group was treated conventional care,observation group was treated the family-centered care method.The anxiety and nursing satisfaction was compared between two groups. Results The anxiety in two groups were significant-ly alleviated,the anxiety score in observation group was lower than that of control group (P<0.05).All the nursing satis-faction in observation group was higher than that of control group (P<0.05). Conclusion Family-centered care model can bring high quality nursing service and alleviate the anxiety in children and their families,and promote the harmo-nious relationship between nurses and patients significantly,which is helpful for children health recovery.

  7. Which patients need critical care intervention after total joint arthroplasty? : a prospective study of factors associated with the need for intensive care following surgery.

    Science.gov (United States)

    Courtney, P M; Melnic, C M; Gutsche, J; Hume, E L; Lee, G-C

    2015-11-01

    Older patients with multiple medical co-morbidities are increasingly being offered and undergoing total joint arthroplasty (TJA). These patients are more likely to require intensive care support, following surgery. We prospectively evaluated the need for intensive care admission and intervention in a consecutive series of 738 patients undergoing elective hip and knee arthroplasty procedures. The mean age was 60.6 years (18 to 91; 440 women, 298 men. Risk factors, correlating with the need for critical care intervention, according to published guidelines, were analysed to identify high-risk patients who would benefit from post-operative critical care monitoring. A total of 50 patients (6.7%) in our series required critical care level interventions during their hospital stay. Six independent multivariate clinical predictors were identified (p 1000 mL (OR 17.36, 95% CI 5.36 to 56.19), chronic obstructive pulmonary disease (13.90, 95% CI 4.78 to 40.36), intra-operative use of vasopressors (OR 8.10, 95% CI 3.23 to 20.27), revision hip arthroplasty (OR 2.71, 95% CI 1.04 to 7.04) and body mass index > 35 kg/m(2) (OR 2.70, 95% CI 123 to 5.94). The model was then validated against an independent, previously published data set of 1594 consecutive patients. The use of this risk stratification model can be helpful in predicting which high-risk patients would benefit from a higher level of monitoring and care after elective TJA and aid hospitals in allocating precious critical care resources.

  8. Models for Planning and Simulation in Computer Assisted Orthognatic Surgery

    CERN Document Server

    Chabanas, M; Payan, Y; Boutault, F; Chabanas, Matthieu; Marecaux, Christophe; Payan, Yohan; Boutault, Franck

    2002-01-01

    Two aspects required to establish a planning in orthognatic surgery are addressed in this paper. First, a 3D cephalometric analysis, which is clini-cally essential for the therapeutic decision. Then, an original method to build a biomechanical model of patient face soft tissue, which provides evaluation of the aesthetic outcomes of an intervention. Both points are developed within a clinical application context for computer aided maxillofacial surgery.

  9. Orthognathic model surgery with LEGO key-spacer.

    Science.gov (United States)

    Tsang, Alfred Chee-Ching; Lee, Alfred Siu Hong; Li, Wai Keung

    2013-12-01

    A new technique of model surgery using LEGO plates as key-spacers is described. This technique requires less time to set up compared with the conventional plaster model method. It also retains the preoperative setup with the same set of models. Movement of the segments can be measured and examined in detail with LEGO key-spacers.

  10. [Potentials of 3D-modeling in reconstructive orbital surgery].

    Science.gov (United States)

    Butsan, S B; Khokhlachev, S B; Ĭigitaliev, Sh N; Zaiakin, Ia A

    2012-01-01

    A technique of bone reconstructive surgery of orbitofrontonasomalar region using 3D-modeling based on multispiral computer tomography data is presented. The efficacy of intraoperative templates created using 3D-modeling was showed for harvesting and modeling of bone calvarial autografts. The steps of reconstructive procedure are explained in details for repair of medial and inferior orbital fractures.

  11. The therapeutic use of music as experienced by cardiac surgery patients of an intensive care unit

    Directory of Open Access Journals (Sweden)

    Varshika M. Bhana

    2014-04-01

    Full Text Available Patients perceive the intensive care unit (ICU as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants.

  12. Putting a face and context on pediatric surgery cancelations: The development of parent personas to guide equitable surgical care.

    Science.gov (United States)

    Vaughn, Lisa M; DeJonckheere, Melissa; Pratap, Jayant Nick

    2016-06-09

    Last-minute cancelation of planned surgery can have substantial psychological, social, and economic effects for patients/families and also leads to wastage of expensive health-care resources. In order to have a deeper understanding of the contextual, psychological, practical, and behavioral factors that potentially impact pediatric surgery cancelation, we conducted a qualitative study to create 'personas' or fictional portraits of parents who are likely to cancel surgery. We conducted in-depth qualitative interviews with 21 parents of children who were considered 'at risk' for surgical cancelation and whose scheduled surgery was canceled at late notice. From the themes, patterns, and associated descriptive phrases in the data, we developed and validated five different personas of typical scenarios reflecting parent experiences with surgery and surgery cancelations. The personas are being employed to guide contextualized development of interventions tailored to prototypical families as they prepare and attend for surgery.

  13. Clinical profile, nursing diagnoses and nursing care for postoperative bariatric surgery patients.

    Science.gov (United States)

    Steyer, Nathalia Helene; Oliveira, Magáli Costa; Gouvêa, Mara Regina Ferreira; Echer, Isabel Cristina; Lucena, Amália de Fátima

    2016-03-01

    Objective To analyze the clinical profile, nursing diagnoses, and nursing care established for postoperative bariatric surgery patients. Method Cross-sectional study carried out in a hospital in southern Brazil with a sample of 143 patients. Data were collected retrospectively from electronic medical records between 2011 and 2012 and analyzed statistically. Results We found a predominance of adult female patients (84%) with class III obesity (59.4%) and hypertension (72%). Thirty-five nursing diagnoses were reported, among which the most frequent were: Acute Pain (99.3%), Risk for perioperative positioning injury (98.6%), and Impaired tissue integrity (93%). The most frequently prescribed nursing care were: to use protection mechanisms in the surgical patient positioning, to record pain as 5th vital sign, and to take vital signs. There was an association between age and comorbidities. Conclusion The nursing diagnoses supported the nursing care prescription, which enables the qualification of nursing assistance.

  14. Evidence-based surgical care and the evolution of fast-track surgery

    DEFF Research Database (Denmark)

    Kehlet, H.; Wilmore, D.W.

    2008-01-01

    , randomized studies, and meta-analyses, the concept of the "fast-track methodology" has uniformly provided a major enhancement in recovery leading to decreased hospital stay and with an apparent reduction in medical morbidity but unaltered "surgery-specific" morbidity in a variety of procedures. However......BACKGROUND: Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. OBJECTIVE: To assess, synthesize, and discuss implementation of "fast-track" recovery programs. DATA SOURCES: Medline MBASE...... (January 1966-May 2007) and the Cochrane library (January 1966-May 2007) were searched using the following keywords: fast-track, enhanced recovery, accelerated rehabilitation, and multimodal and perioperative care. In addition, the synthesis on the many specific interventions and organizational...

  15. POST ANAESTHETIC RECOVERY FOLLOWING DAY-CARE SURGERY: COMPARISON OF TWO ANAESTHETIC TECHNIQUES

    Directory of Open Access Journals (Sweden)

    Dhrubajyoti

    2016-04-01

    Full Text Available BACKGROUND The growing demand for early discharge from hospital, consequent early return to work has resulted in the evolution of concept of “day care surgery.” This has led to development of precise safe anaesthetic techniques and agents as well as a battery of tests of recovery. Day care surgery presents unique challenges for the anaesthetists to produce a ‘street fit’ patient as soon as possible after the surgery with least complications, which can be achieved by both intravenous and inhalational techniques. Thus, an endeavour was made to carry out the present study with the aims and objectives to assess the progress of recovery in patients undergoing day care surgery with two groups of intravenous anaesthetic agents and also to determine the optimum time taken to achieve “home readiness.” METHODS The study included patients of average intelligence of both sexes aged between 15 and 45 yrs. belonging to physical status ASA I and II, undergoing operative procedures less than 30 minutes in our institute over a period of two years. A randomized double blind study was done amongst 80 patients scheduled for day care surgery, where two techniques were compared. Amongst 2 groups [Group I: Propofol (1% and Group II: Thiopentone (2.5% as the intravenous anaesthetic agent]. Recovery was assessed using standard scoring systems. The different variables were evaluated by mean and standard deviation. For comparing two groups, paired ‘t’ test was applied and a p value of ˂0.05 was considered significant. RESULTS The mean total dose requirement in Group-II patients were more than that in Group-I patients (p0.05, but the quality of anaesthesia was excellent in 57.5% in Group-I as compared to 45% in Group-II. After 5 minutes of cessation of anaesthesia, patients in Group-I attained much higher score as compared to Group-II (p<0.001 as assessed by the “Steward scoring system.” More number of patients were “Home ready” in Group-I than in

  16. Information available on the internet about pain after orthognathic surgery: A careful review

    Directory of Open Access Journals (Sweden)

    Matheus Melo Pithon

    2014-12-01

    Full Text Available OBJECTIVE: Investigate the quality of data available on the internet with respect to pain after orthognathic surgery.METHODS: A careful search was conducted on the Internet in December, 2012. The most accessed websites browsers were employed for research using the terms: "pain" and "orthognathic surgery" together. The first 30 results of each portal were examined, and after applying the exclusion criteria, 29 sites remained. All remaining websites went through an evaluation process with online tools that investigated the quality, level of reading, accessibility, usability and reliability.RESULTS: Assessment criteria outcomes were considered unfavorable. Texts were considered difficult to read with inappropriate language for the general public. The mean global validation for the 29 websites of the LIDA instrument was 65.10, thereby indicating a structure of medium quality.CONCLUSION: Information about post-orthognathic surgery pain available on the internet is poorly written and unreliable. Therefore, candidates for orthognathic surgery must seek information from specialists who, in turn, should indicate reliable sources.

  17. Zoning for Day Care (from Models for Day Care Licensing).

    Science.gov (United States)

    Day Care and Child Development Council of America, Inc., Washington, DC.

    Recommendations and regulations regarding the zoning of child development day care programs are discussed. Zoning in general is discussed, as is the treatment of child development day care in zoning ordinance, the background of program planning, modular housing, the impelmentation of zoning, and model provisions regarding characteristics of…

  18. Medicare Care Choices Model Enables Concurrent Palliative and Curative Care.

    Science.gov (United States)

    2015-01-01

    On July 20, 2015, the federal Centers for Medicare & Medicaid Services (CMS) announced hospices that have been selected to participate in the Medicare Care Choices Model. Fewer than half of the Medicare beneficiaries use hospice care for which they are eligible. Current Medicare regulations preclude concurrent palliative and curative care. Under the Medicare Choices Model, dually eligible Medicare beneficiaries may elect to receive supportive care services typically provided by hospice while continuing to receive curative services. This report describes how CMS has expanded the model from an originally anticipated 30 Medicare-certified hospices to over 140 Medicare-certified hospices and extended the duration of the model from 3 to 5 years. Medicare-certified hospice programs that will participate in the model are listed.

  19. Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals with Developmental Disabilities

    Science.gov (United States)

    Kastner, Theodore A.; Walsh, Kevin K.

    2006-01-01

    Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an…

  20. Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery.

    Directory of Open Access Journals (Sweden)

    Jasper van der Slegt

    Full Text Available BACKGROUND: Surgical site infections (SSI's are associated with severe morbidity, mortality and increased health care costs in vascular surgery. OBJECTIVE: To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. DESIGN: Prospective, quasi-experimental, cohort study. METHODS: A prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP was introduced in 2009. The elements of the bundle were (1 perioperative normothermia, (2 hair removal before surgery, (3 the use of perioperative antibiotic prophylaxis and (4 discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback. RESULTS: Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4% SSI were observed. Deep SSI occurred in 25 (3.5% patients. Patients with SSI's (28,5±29.3 vs 10.8±11.3, p<0.001 and deep-SSI's (48.3±39.4 vs 11.4±11.8, p<0.001 had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32-6.63. Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009. CONCLUSION: The implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI's in patients undergoing

  1. Biomechanical models to simulate consequences of maxillofacial surgery

    CERN Document Server

    Payan, Y; Pelorson, X; Vilain, C; Levy, P; Luboz, V; Perrier, P; Payan, Yohan; Chabanas, Matthieu; Pelorson, Xavier; Vilain, Coriandre; Levy, Patrick; Luboz, Vincent; Perrier, Pascal

    2002-01-01

    This paper presents the biomechanical finite element models that have been developed in the framework of the computer-assisted maxillofacial surgery. After a brief overview of the continuous elastic modelling method, two models are introduced and their use for computer-assisted applications discussed. The first model deals with orthognathic surgery and aims at predicting the facial consequences of maxillary and mandibular osteotomies. For this, a generic three-dimensional model of the face is automatically adapted to the morphology of the patient by the mean of elastic registration. Qualitative simulations of the consequences of an osteotomy of the mandible can thus be provided. The second model addresses the Sleep Apnoea Syndrome. Its aim is to develop a complete modelling of the interaction between airflow and upper airways walls during respiration. Dynamical simulations of the interaction during a respiratory cycle are computed and compared with observed phenomena.

  2. Simulation Modeling for Process Improvement in a General Surgery Service

    Directory of Open Access Journals (Sweden)

    Kidak Levent B.

    2011-03-01

    Full Text Available The aim of the study is to improve the General Surgery patients' treatment duration in order to eliminate the bottlenecks by speeding up the process. For this purpose, some model proposals were carried out to allow reorganizing the processes to serve more patients by improving the productivity of the clinic. The study has been carried out in the general surgery clinic at the well known, training and research hospital. First of all, the simulation model of the existing system was demonstrated. The simulation model has been developed via PROMODEL software program. In the simulation model installed, four scenarios have been established in order to determine the critical factors which effect patients’ waiting durations. Thus, the goal of the study was to reduce the waiting times by considering what-if analysis using simulation. The model has been worked on for six months and ten times repetitively, so to get some statistics. It has been determined that an improvement of 17% efficiency of operations in clinic may be considerable in case of reviewing and redesigning the processes of the General Surgery clinic. It was found that a decrease of 76, 57 and 52% in the duration patients’ being in the system for Medical Treatment (MTP, Operation (OP, and Urgent Operations (UOP, respectively. All outcomes of study showed that an improvement in the efficiency could be acquired without any financial burden for the hospital budget by enhancing the processes in General Surgery clinic via using simulation modeling.

  3. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system.

    Science.gov (United States)

    Carl, M; Alms, A; Braun, J; Dongas, A; Erb, J; Goetz, A; Goepfert, M; Gogarten, W; Grosse, J; Heller, A R; Heringlake, M; Kastrup, M; Kroener, A; Loer, S A; Marggraf, G; Markewitz, A; Reuter, D; Schmitt, D V; Schirmer, U; Wiesenack, C; Zwissler, B; Spies, C

    2010-06-15

    Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefässchirurgie, DGTHG) and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI) made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical

  4. S3 guidelines for intensive care in cardiac surgery patients: hemodynamic monitoring and cardiocirculary system

    Directory of Open Access Journals (Sweden)

    Schmitt, D. V.

    2010-01-01

    Full Text Available Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF. The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the

  5. Soft Tissue Biomechanical Modeling for Computer Assisted Surgery

    CERN Document Server

    2012-01-01

      This volume focuses on the biomechanical modeling of biological tissues in the context of Computer Assisted Surgery (CAS). More specifically, deformable soft tissues are addressed since they are the subject of the most recent developments in this field. The pioneering works on this CAS topic date from the 1980's, with applications in orthopaedics and biomechanical models of bones. More recently, however, biomechanical models of soft tissues have been proposed since most of the human body is made of soft organs that can be deformed by the surgical gesture. Such models are much more complicated to handle since the tissues can be subject to large deformations (non-linear geometrical framework) as well as complex stress/strain relationships (non-linear mechanical framework). Part 1 of the volume presents biomechanical models that have been developed in a CAS context and used during surgery. This is particularly new since most of the soft tissues models already proposed concern Computer Assisted Planning, with ...

  6. Developing Models of Caring in the Professions.

    Science.gov (United States)

    Noddings, Nel

    Much theoretical work is being done in relational ethics, particularly the ethics of care. Models of human caring are also arising within the professions. This paper discusses feminist contributions to theories of caring, focusing on the shared premises, conflicts, and paradoxes faced by four professions (law, nursing, theology, and education),…

  7. Virtual Models of Long-Term Care

    Science.gov (United States)

    Phenice, Lillian A.; Griffore, Robert J.

    2012-01-01

    Nursing homes, assisted living facilities and home-care organizations, use web sites to describe their services to potential consumers. This virtual ethnographic study developed models representing how potential consumers may understand this information using data from web sites of 69 long-term-care providers. The content of long-term-care web…

  8. Modeling and analysis of multistate access to elective surgery.

    Science.gov (United States)

    Sobolev, B; Brown, P; Zelt, D

    2001-06-01

    In this paper, we attempt to determine whether delays in scheduling operation affect waiting time in a queue for elective surgery. We analyze the waiting-list management system in a Canadian hospital. We estimate the impact of scheduling delays by modeling access to treatment as a multistate process. We found that patients with any delay in scheduling surgery had longer waiting times than patients without delays. For certain sources of delays, the admission rate was 50-60% lower compared with the rate for admissions without a delay independent of urgency of surgical intervention. Our findings support a concern that waiting time for elective surgery is not simply determined by how many patients are on the waiting list, or by how urgently they need treatment, but also by the waiting list management practice.

  9. Validation of four different risk stratification models in patients undergoing heart valve surgery in a single center in China

    Institute of Scientific and Technical Information of China (English)

    ZHANG Chun-xiao; XU Jian-ping; GE Yi-peng; WEI Yu; YANG Yan; LIU Feng; SHI Yi

    2011-01-01

    Background Several risk stratification models have been developed for cardiac surgery. This study aimed to evaluate the accuracy of four existing risk stratification models, the Fuwai System for Cardiac Operative Risk Evaluation (FuwaiSCORE), the Society of Thoracic Surgeons 2008 cardiac surgery risk model for isolated valve surgery (the STS model), the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the initial Parsonnet's score (the Parsonnet model) in predicting prolonged intensive care unit (ICU) stay in Chinese patients undergoing heart valve surgery. Methods Data were collected retrospectively from records of 1333 consecutive patients who received heart valve surgery in a single center between November 2006 and December 2007. Prolonged ICU stay was defined as not less than 124 hours. Calibration was assessed using the Hosmer-Lemeshow (H-L) goodness of fit test. Discrimination was assessed using the receiver-operating-characteristic (ROC) curve area. Results The FuwaiSCORE showed good calibration and discrimination compared with other risk models. According to the H-L statistics, the value of the FuwaiSCORE was 12.82, P>0.1. The area under ROC curve of the FuwaiSCORE was 0.81 (95%C/0.78-0.84). Conclusions Our study suggests that the FuwaiSCORE is superior to the other three risk models in predicting prolonged length of ICU stay in Chinese patients with heart valve surgery. Having fewer variables, the system is much easier for bedside use than other systems.

  10. Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial: study protocol, rationale and feasibility of a randomised multicentre trial

    Directory of Open Access Journals (Sweden)

    Vester-Andersen Morten

    2013-02-01

    Full Text Available Abstract Background Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients. Methods and design The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. Discussion This trial evaluates the benefits and possible harm of intermediate care. The results may potentially influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care. Trial registration Clinicaltrials.gov identifier: NCT01209663

  11. COMPARISON OF DEXMEDETOMIDINE WITH FENTANYL FOR SEDATION IN TYMPANOPLASTY (ENT SURGERIES DONE UNDER MONITORED ANAESTHESIA CARE

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    Illendula

    2016-02-01

    Full Text Available INTRODUCTION Monitored anaesthesia care involves administering a combination of drugs for anxiolytic, hypnotic, amnestic and analgesic effect. Ideally it should result in less physiological disturbance and allow for more rapid recovery than general anaesthesia. It typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and analgesic drugs which is a common practice during various ENT surgical procedures. AIM OF STUDY Is to “Compare Dexmedetomidine with Fentanyl for sedation in tympanoplasty (ENT Surgeries”. The objective of the study is to evaluate the efficacy of dexmedetomidine and fentanyl as an appropriate sedative drug for Monitored Anaesthesia Care in Tympanoplasty (ENT surgeries METHODS & MATERIALS A total of 60 patients are being recruited into this study with regards to assess, Pain, Discomfort, Sedation, Peripheral Oxygen Saturation (SPO2 & Systolic Blood Pressure (SBP, Diastolic blood pressure (DBP, Mean arterial blood pressure(MAP & Heart rate This study was undertaken at Govt. ENT Hospital Hyderabad. Sixty (60 patients undergoing Tympanoplasty surgery were taken for study. Thus the study contains 30 patients in Dexmedetomidine group-(Group D and 30 patients in Fentanyl group (Group F RESULT Dexmedetomidine provides less discomfort, better sedation, and analgesia when compared with fentanyl under monitored anaesthesia care (Conscious sedation. However, the risk of adverse effects requires monitoring for ready intervention. It provides a unique type of sedation, “conscious sedation” in which patients appear to be sleepy but are easily arousable, cooperative and communicative when stimulated. It is sedative and analgesic agent, with opioid-sparing properties and minimal respiratory depression.

  12. Viral contamination during sequential phacoemulsification surgeries in an experimental model

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    Roberto Pinto Coelho

    2012-06-01

    Full Text Available PURPOSE: To determine the incidence of Piry virus contamination among surgical instruments used with disposable accessories for phacoemulsification during sequential surgeries. METHODS: An experimental model was created with 4 pigs' eyes that were contaminated with Piry virus and 4 pigs' eyes that were not contaminated. Phacoemulsification was performed on the eyes, alternating between the contaminated and non-contaminated eyes. From one surgery to another, the operating fields, gloves, scalpel, tweezers, needles, syringes, tips and bag collector from the phacoemulsification machine were exchanged; only the hand piece and the irrigation and aspiration systems were maintained. RESULTS: In the collector bag, three samples from the contaminated eyes (3/4 were positive, and two samples from the non-contaminated (2/4 eyes were also positive; at the tip, one sample from the contaminated eyes (1/4 and two samples of the non-contaminated eyes (2/4 yielded positive results. In the irrigation system, one sample from a non-contaminated eye (1/4 was positive, and in the aspiration system, two samples from contaminated eyes (2/4 and two samples from non-contaminated eyes (2/4 were positive. In the gloves, the samples were positive in two samples from the non-contaminated eyes (2/4 and in two samples from the contaminated eyes (2/4. In the scalpel samples, three contaminated eyes (3/4 and none of the non-contaminated eyes (0/4 were positive; finally, two samples from the anterior chambers of the non-contaminated eyes gathered after surgery were positive. CONCLUSIONS: In two non-contaminated eyes, the presence of genetic material was detected after phacoemulsification surgery, demonstrating that the transmission of the genetic material of the Piry virus occurred at some point during the surgery on these non-contaminated eyes when the hand piece and irrigation and aspiration systems were reused between surgeries.

  13. Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics.

    Science.gov (United States)

    Gandedkar, Narayan H; Chng, Chai Kiat; Yeow, Vincent Kok Leng

    2016-01-01

    Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.

  14. Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics

    Directory of Open Access Journals (Sweden)

    Narayan H Gandedkar

    2016-01-01

    Full Text Available Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.

  15. Orthognathic Surgery Patients (Maxillary Impaction and Setback Plus Mandibular Advancement Plus Genioplasty Need More Intensive Care Unit (ICU Admission after Surgery

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    Hamidreza Eftekharian

    2015-03-01

    Full Text Available Statement of the Problem: Due to shortage of ICU beds in hospitals, knowing what kind of orthognathic surgery patients more need ICU care after surgery would be important for surgeons and hospitals to prevent unnecessary ICU bed reservation. Purpose: The aim of the present study was to determine what kinds of orthognathic surgery patients would benefit more from ICU care after surgery. Materials and Method: 210 patients who were admitted to Chamran Hospital, Shiraz, for bimaxillary orthognathic surgery (2008-2013 were reviewed based on whether they had been admitted to ICU or maxillofacial surgery ward. Operation time, sex, intraoperative Estimated Blood Loss (EBL, postoperative complications, ICU admission, and unwanted complications resulting from staying in ICU were assessed. Results: Of 210 patients undergoing bimaxillary orthognathic surgery, 59 patients (28.1% were postoperatively admitted to the ICU and 151 in the maxillofacial ward (71.9%. There was not statistically significant difference in age and sex between the two groups (p> 0.05. The groups were significantly different in terms of operation time (p< 0.001. Blood loss For ICU admitted patients was 600.00±293.621mL and for those who were hospitalized in the ward was 350.00±298.397 mL. Statistically significant differences were found between the two groups (p< 0.001. Moreover, there was a direct linear correlation between operation time and intraoperative estimated blood loss and this relationship was statistically significant (r=0.42, p< 0.001. Patients with maxillary impaction and setback plus mandibular advancement plus genioplasty were among the most ICU admitted patients (44%, while these patients were only 20% of all patients who were admitted to the ward. As a final point, the result illustrated that patients who were admitted to the ICU experienced more complication such as bleeding, postoperative nausea, and pain (p< 0.001. Conclusion: Orthognathic surgery patients

  16. [Structured teaching of surgery the LMU model in Munich].

    Science.gov (United States)

    Chiapponi, C; Bruns, C J; Pilz, F; Kanz, K-G; Mutschler, W; Jauch, K-W; Siebeck, M

    2014-12-01

    The medical curriculum (MeCuM) of the Ludwig Maximilian University (LMU) in Munich is a dynamic curriculum aimed to support the learning process of all students with their different learning styles. It is based on interactive, activating teaching methods in order to increase students' interest, and on repetitive evaluation of teaching units to modify the teaching in order to meet students' needs and wishes. In this context the teaching of surgery at our faculty takes place. Besides interdisciplinary lessons where diseases are taught in cooperation with our colleagues from internal medicine, indications for surgery, complications and consequences of surgery for the patients are analysed in PBL tutorials, online cases, bedside teachings and practical teaching on the ward. Surgical skills like suturing are demonstrated in videos, practiced on models or during practical teaching on the ward and they are tested in OSCEs. During the "praktisches Jahr", the students in the last year of their medical studies are supposed to apply their practical skills besides repeating theoretical knowledge in order to pass the final examination. For this purpose they are taught in a revision course called "LMU-StaR" (revision course for the Staatsexamen). In this paper we describe in detail the teaching of surgery at our faculty.

  17. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

    DEFF Research Database (Denmark)

    Hansen, Tina Birgitte; Zwisler, Ann Dorthe; Berg, Selina Kikkenborg

    2017-01-01

    and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs...... and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality......Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following...

  18. Optimal delivery of follow-up care after surgery for Crohn’s disease: current perspectives

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    Campbell JP

    2016-08-01

    Full Text Available James P Campbell, Byron P Vaughn Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA Abstract: Despite improvements in medical therapies for Crohn’s disease (CD, up to 70% of patients require surgery within 10 years of diagnosis. Surgery is not curative, and almost all patients will experience endoscopic recurrence, and many will go on to clinical recurrence. Identifying patients at high-risk of endoscopic recurrence and standardizing postoperative assessments are essential in preventing clinical recurrence of CD. In this review, we discuss the assessment, monitoring, and treatment of postoperative CD patients. We address the various individual risk factors as well as composite risk factors. Medications used for primary CD treatment can be used in the postoperative setting to prevent endoscopic or clinical recurrence with varying efficacy, although the cost-effectiveness of these approaches are not fully understood. Future directions for postoperative CD management include evaluation of newer biologic agents such as anti-integrin therapy and fecal microbiota transplant for prevention of recurrence. Development of a standard preoperative risk assessment tool to clearly stratify those at high-risk of recurrence is necessary to guide empiric therapy. Lastly, the incorporation of noninvasive testing into disease monitoring will likely lead to early detection of endoscopic recurrence that will allow for tailored treatment to prevent clinical recurrence. Keywords: Crohn’s disease, postoperative care, postoperative recurrence

  19. Intensive Care Unit Admission after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Is It Necessary?

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    Horacio N. López-Basave

    2014-01-01

    Full Text Available Introduction. Cytoreductive surgery (CS with hyperthermic intraperitoneal chemotherapy (HIPEC is a new approach for peritoneal carcinomatosis. However, high rates of complications are associated with CS and HIPEC due to treatment complexity; that is why some patients need stabilization and surveillance for complications in the intensive care unit. Objective. This study analyzed that ICU stay is necessary after HIPEC. Methods. 39 patients with peritoneal carcinomatosis were treated according to strict selection criteria with CS and HIPEC, with closed technique, and the chemotherapy administered were cisplatin 25 mg/m2/L and mitomycin C 3.3 mg/m2/L for 90-minutes at 40.5°C. Results. 26 (67% of the 39 patients were transferred to the ICU. Major postoperative complications were seen in 14/26 patients (53%. The mean time on surgical procedures was 7.06 hours (range 5−9 hours. The mean blood loss was 939 ml (range 100–3700 ml. The mean time stay in the ICU was 2.7 days. Conclusion. CS with HIPEC for the treatment of PC results in low mortality and high morbidity. Therefore, ICU stay directly following HIPEC should not be standardized, but should preferably be based on the extent or resections performed and individual patient characteristics and risk factors. Late complications were comparable to those reported after large abdominal surgery without HIPEC.

  20. Pro patria et spes gentis: military medicine, paediatric surgery and those who care for children.

    Science.gov (United States)

    Pearn, John

    2011-12-01

    Children and military medicine have many links. On humanitarian and disaster deployments, the surgery of war has increasingly seen children as the focus of clinical salvage. When Romans spoke of children, they used the phrase 'spes gentis'-'the hope of the race'. In modern times, there developed a synergy, in the context of defensive war, that its prosecution depended not only on the defence of territory but also on its hopes for continuation of people and culture, into the future. In the 19th century, in Australia, several regiments had the motto 'Pro Aris et Focis'-'For the Defence of Hearth and Home'. Hearth implies the family and that implies children. From the point of view of an attending military clinician, the centrum of all medical care is the patient himself, and that centrality is reflected equally in the helplessness of a bomb-blast or gunshot victim as it is in the vulnerability of a sick or injured infant or child. The life and service of Major General Rupert Downes (1885-1945), whom the Downes Memorial Lecture commemorates, reflected this nexus. His career was that of a national leader in military medicine and that of paediatric surgery. The 2011 Rupert Downes Lecture explores and documents the extraordinary corpus of service of Australian paediatric surgeons and their contributions to military medicine from the 19th to the 21st centuries.

  1. ORGANIZATION AND PROCEDURES GUIDE FOR PERFORMING MAJOR AMBULATORY AND SHORT-STAY SURGERY IN COORDINATION WITH THE PRIMARY HEALTH CARE TEAM

    Directory of Open Access Journals (Sweden)

    Javier Cruz Rodríguez

    2015-11-01

    Full Text Available Currently, there are constraints on coordination between the primary and secondary levels of care, and we lack a regulatory document for surgical activity in major ambulatory and short-stay surgery, which affects the quality of this modality of care. Such reasons led to the design of the “Organization and Procedures Guide for Performing Major Ambulatory and Short-stay Surgery in Coordination with the Primary Health Care Team". The guide was assessed by 90 experts with experience in the primary and secondary levels of care, who endorsed the quality and relevance of the proposal. It contains recommendations to help primary and secondary care professionals involved in surgical care to select the most appropriate approach to conditions treated by means of ambulatory or short-stay surgery. The recommendations are based on the latest available scientific evidence supporting the use of ambulatory surgery, short-stay surgery and home hospitalization.

  2. The real-world outcomes of off-pump coronary artery bypass surgery in a public health care system

    Science.gov (United States)

    Guru, Veena; Glasgow, Kevin W; Fremes, Stephen E; Austin, Peter C; Teoh, Kevin; Tu, Jack V

    2007-01-01

    BACKGROUND: The population-based results of off-pump coronary artery bypass surgery (OPCAB) in a public health care system have not been reported. OBJECTIVE: The study objective was to compare the one-year outcomes of OPCAB with those of the standard on-pump coronary artery bypass surgery (ONCAB) in the province of Ontario. METHODS: The present study was a retrospective, population-based study (n=15,172, with 1660 OPCAB patients) undertaken in fiscal years 2000 and 2001 using clinical and administrative data. Multivariate regression modelling for risk adjustment and propensity matching were used to compare OPCAB with ONCAB for one-year outcomes, including death, repeat revascularization and cardiac readmission. RESULTS: The rate of OPCAB was 11%, with institutional rates ranging from 3% to 51%. OPCAB patients were more likely to be female and older than 79 years of age, with peripheral vascular disease and higher socioeconomic status. OPCAB patients were less likely to have surgically significant coronary disease, poor left ventricular function, an urgent status, congestive heart failure and diabetes. The risk-adjusted one-year composite outcome was higher for OPCAB (11.8%, 95% CI 10.40% to 13.29%) than ONCAB (10.8%, 95% CI 10.23% to 11.27%); however, this difference was eliminated with propensity matching. OPCAB patients had shorter hospital lengths of stay and lower blood product transfusion rates than ONCAB patients. CONCLUSIONS: Despite the minimal use of OPCAB in Canada’s public health care system, outcome rates are similar to those of ONCAB. The benefits of OPCAB observed in randomized trials, including shorter hospital lengths of stay and lower transfusion rates, remained true in the investigators’ real-world experience. The results OPCAB were at least equivalent to those of ONCAB. PMID:17380221

  3. Many diseases, one model of care?

    Directory of Open Access Journals (Sweden)

    Tit Albreht

    2016-02-01

    Full Text Available Abstract This article has been corrected. See J Comorbidity 2016;6(1:33. http://dx.doi.org/joc.2016.6.78. Patients with multiple chronic conditions (multimorbidity have complex and extensive health and social care needs that are not well served by current silo-based models of care. A lack of integration between care providers often leads to fragmented, incomplete, and ineffective care, leaving many patients overwhelmed and unable to navigate their way towards better health outcomes. In planning for the future, healthcare policies and models of care are required that cater for the complex needs of patients with multimorbidity and that deliver coordinated care that is patient-centred and focused on disease prevention, multidisciplinary teamwork and shared decision-making, and on empowering patients to self-manage. Salient lessons can be learnt from the work undertaken at a European and national level to develop care models in cancer and diabetes – two complex and often co-occurring conditions requiring coordinated long-term care. Innovative work is also underway in many European countries aimed at improving the integration of care for people with multimorbidity, resulting in more efficient and cost-effective health outcomes. This article reviews some of the most innovative programmes that have been initiated across and within Europe with the aim of improving the way care is delivered to people with complex and multiple long-term conditions. This work provides a foundation upon which to build better, more effective models of care for people with multimorbidity. Journal of Comorbidity 2016;6(1:12–20

  4. Modeling Surgery: A New Way Toward Understanding Earth Climate Variability

    Institute of Scientific and Technical Information of China (English)

    WU Lixin; LIU Zhengyu; Robert Gallimore; Michael Notaro; Robert Jacob

    2005-01-01

    A new modeling concept, referred to as Modeling Surgery, has been recently developed at University of Wisconsin-Madison. It is specifically designed to diagnose coupled feedbacks between different climate components as well as climatic teleconnections within a specific component through systematically modifying the coupling configurations and teleconnective pathways. It thus provides a powerful means for identifying the causes and mechanisms of low-frequency variability in the Earth's climate system. In this paper, we will give a short review of our recent progress in this new area.

  5. Music benefits on postoperative distress and pain in pediatric day care surgery.

    Science.gov (United States)

    Calcaterra, Valeria; Ostuni, Selene; Bonomelli, Irene; Mencherini, Simonetta; Brunero, Marco; Zambaiti, Elisa; Mannarino, Savina; Larizza, Daniela; Albertini, Riccardo; Tinelli, Carmine; Pelizzo, Gloria

    2014-08-12

    Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (PMusic improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age.

  6. Music benefits on postoperative distress and pain in pediatric day care surgery

    Directory of Open Access Journals (Sweden)

    Valeria Calcaterra

    2014-09-01

    Full Text Available Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period or the non-music group (standard postoperative care. Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001. Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age.

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  8. Understanding Business Models in Health Care.

    Science.gov (United States)

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

    2016-05-01

    The increasing focus on the costs of care is forcing health care organizations to critically look at their basic set of processes and activities, to determine what type of value they can deliver. A business model describes the resources, processes, and cost assumptions that an organization makes that will lead to the delivery of a unique value proposition to a customer. As health care organizations are beginning to transform their structure in preparation for a value-based delivery system, understanding business model theory can help in the redesign process.

  9. COMPARATIVE EVALUATION OF PROPOFOL KETAMINE AND PROPOFOL FENTANYL IN DAY CARE SURGERIES

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    Brajesh

    2014-09-01

    Full Text Available To find the ideal drug combinations which can be used during day care surgeries and procedures. AIMS: This study was conducted. To evaluate and compare the efficacy, and haemodynamic stability of ketamine and fentanyl combination with propofol. To compare the incidence of side effects. To compare the time of awakening and recovery time. To compare the discharge criteria in both groups. METHODS: The study was conducted in 50 patients of age group 18-50 years of either gender belonging to ASA grade I and II, were divided into two groups of 25 each. They underwent elective surgery of approximately 1 hour duration. Group I received Propofol-ketamine while group II received Propofol-fentanyl for induction and maintenance of anaesthesia. Postoperatively, time for awakening, recovery time ‘(by modified Aldrete scoring system and discharge status (by modified post anaesthetic discharge scoring system were recorded and compared in two groups. RESULTS: Profol-fentanyl combination produced a significantly greater fall in pulse rate and in both systolic and diastolic blood pressure as compared to Propofol-ketamine during induction and maintenance of anaesthesia. Fall in respiratory rate was greater in Propofol-fentanyl group as compared to Propofol-ketamine group. The recovery time in group I was longer than group II. Discharge criteria is significantly earlier in group II. CONCLUSION: Both Profol-ketamine and Propofol-fentanyl combination reduce rapid, pleasant and safe anesthesia with only a few untoward side effects and propofol-ketamine produces better haemodynamic statistic, during anaesthesia.

  10. Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Beishuizen Albertus

    2011-05-01

    Full Text Available Abstract Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU. Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52% of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index 2 and a positive fluid balance (> 4,683 mL were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery.

  11. Decentralization of care for adults with congenital heart disease in the United States: a geographic analysis of outpatient surgery.

    Directory of Open Access Journals (Sweden)

    Bryan G Maxwell

    Full Text Available BACKGROUND: Guidelines recommend that adults with congenital heart disease (CHD undergo noncardiac surgery in regionalized centers of expertise, but no studies have assessed whether this occurs in the United States. We hypothesized that adults with CHD are less likely than children to receive care at specialized CHD centers. METHODS: Using a comprehensive state ambulatory surgical registry (California Ambulatory Surgery Database, 2005-2011, we calculated the proportion of adult and pediatric patients with CHD who had surgery at a CHD center, distance to the nearest CHD center, and distance to the facility where surgery was performed. RESULTS: Patients with CHD accounted for a larger proportion of the pediatric population (n = 11,254, 1.0% than the adult population (n = 10,547, 0.07%. Only 2,741 (26.0% adults with CHD had surgery in a CHD center compared to 6,403 (56.9% children (p<0.0001. Adult CHD patients who had surgery at a non-specialty center (11.9 ± 15.4 miles away lived farther from the nearest CHD center (37.9 ± 43.0 miles than adult CHD patients who had surgery at a CHD center (23.2 ± 28.4 miles; p<0.0001. Pediatric CHD patients who had surgery at a non-specialty center (18.0 ± 20.7 miles away lived farther from the nearest CHD center (35.7 ± 45.2 miles than pediatric CHD patients who had surgery at a CHD center (22.4 ± 26.0 miles; p<0.0001. CONCLUSIONS: Unlike children with CHD, most adults with CHD (74% do not have outpatient surgery at a CHD center. For both adults and children with CHD, greater distance from a CHD center is associated with having surgery at a non-specialty center. These results have significant public health implications in that they suggest a failing to achieve adequate regional access to specialized ACHD care. Further studies will be required to evaluate potential strategies to more reliably direct this vulnerable population to centers of expertise.

  12. Animal Surgery and Resources Core

    Data.gov (United States)

    Federal Laboratory Consortium — The ASR services for NHLBI research animals include: animal model development, surgery, surgical support, post-operative care as well as technical services such as...

  13. Case Control Analyses of Acute Endophthalmitis after Cataract Surgery in South India Associated with Technique, Patient Care, and Socioeconomic Status

    Directory of Open Access Journals (Sweden)

    Taraprasad Das

    2012-01-01

    Full Text Available Purpose. We investigated acute endophthalmitis incidence following cataract surgery vis-a-vis the current technological and postoperative care changes in higher and lower socioeconomic categories of patients in South India. Methods. In a retrospective case control study, we analyzed 62 cases of acute endophthalmitis and 5 controls for each endophthalmitis case from 46,095 cataract surgeries done between years 1993 and 1998. The time period covered the transition of surgical technique and after care. In addition, we analyzed systemic diseases, surgeon factor, habitat, and socioeconomic status. Results. Clinical and culture positive endophthalmitis incidence were 0.13% and 0.07%, respectively. Differential incidence of 0.10% and 0.17% for in- and ambulatory care surgeries, respectively, was close to statistical significance (=0.054. Lower economy category ambulatory patients had higher risk of infection. Conclusion. Ambulatory cataract surgery carried additional risk for post-operative infection in lower socioeconomic group. Improved health education could ensure greater safety.

  14. Tele-surgery simulation with a patient organ model for robotic surgery training.

    Science.gov (United States)

    Suzuki, S; Suzuki, N; Hattori, A; Hayashibe, M; Konishi, K; Kakeji, Y; Hashizume, M

    2005-12-01

    Robotic systems are increasingly being incorporated into general laparoscopic and thoracoscopic surgery to perform procedures such as cholecystectomy and prostatectomy. Robotic assisted surgery allows the surgeon to conduct minimally invasive surgery with increased accuracy and with potential benefits for patients. However, current robotic systems have their limitations. These include the narrow operative field of view, which can make instrument manipulation difficult. Current robotic applications are also tailored to specific surgical procedures. For these reasons, there is an increasing demand on surgeons to master the skills of instrument manipulation and their surgical application within a controlled environment. This study describes the development of a surgical simulator for training and mastering procedures performed with the da Vinci surgical system. The development of a tele-surgery simulator and the construction of a training center are also described, which will enable surgeons to simulate surgery from or in remote places, to collaborate over long distances, and for off-site expert assistance.

  15. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology

    Science.gov (United States)

    French, Daniel G.; Dilena, Michael; LaPlante, Simon; Shamji, Farid; Sundaresan, Sudhir; Villeneuve, James; Seely, Andrew; Maziak, Donna

    2016-01-01

    Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be applied to chest tubes; (IV) and selecting the safest method for chest tube removal. There is evidence that routine use of chest X-rays does not influence the management of chest tubes. There is a lack of consensus on the highest fluid output threshold below which chest tubes can be safely removed. The optimal use of negative intra-pleural pressure has not yet been established despite multiple randomized controlled trials and meta-analyses. When attempting to improve efficiency in the management of chest tubes, evidence in support of drain removal without a trial of water seal should be considered. Inconsistencies in the interpretation of air leaks and in chest tube management are likely contributors to the conflicting results found in the literature. New digital pleural drainage systems, which provide a more objective air leak assessment and can record air leak trend over time, will likely contribute to the development of new evidence-based guidelines. Technology should be combined with continued efforts to standardize care, create clinical pathways, and analyze their impact on postoperative outcomes. PMID:26941968

  16. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology.

    Science.gov (United States)

    French, Daniel G; Dilena, Michael; LaPlante, Simon; Shamji, Farid; Sundaresan, Sudhir; Villeneuve, James; Seely, Andrew; Maziak, Donna; Gilbert, Sebastien

    2016-02-01

    Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be applied to chest tubes; (IV) and selecting the safest method for chest tube removal. There is evidence that routine use of chest X-rays does not influence the management of chest tubes. There is a lack of consensus on the highest fluid output threshold below which chest tubes can be safely removed. The optimal use of negative intra-pleural pressure has not yet been established despite multiple randomized controlled trials and meta-analyses. When attempting to improve efficiency in the management of chest tubes, evidence in support of drain removal without a trial of water seal should be considered. Inconsistencies in the interpretation of air leaks and in chest tube management are likely contributors to the conflicting results found in the literature. New digital pleural drainage systems, which provide a more objective air leak assessment and can record air leak trend over time, will likely contribute to the development of new evidence-based guidelines. Technology should be combined with continued efforts to standardize care, create clinical pathways, and analyze their impact on postoperative outcomes.

  17. Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital.

    Directory of Open Access Journals (Sweden)

    Judith Rodríguez-García

    Full Text Available Controversy exists as to whether obesity constitutes a risk-factor or a protective-factor for the development of nosocomial Infection (NI. According to the obesity-paradox, there is evidence that moderate obesity is a protective-factor. In Mexico few studies have focused on the nutritional status (NS distribution in the hospital setting.The aim of this study was to estimate the distribution of NS and the prevalence of nosocomial infection NI among adult elective surgery (ES patients and to compare the clinical and anthropometric characteristics and length of stays (LOS between obese and non-obese patients and between patients with and without NI.We conducted a cross-sectional study with a sample (n = 82 adult ES patients (21-59 years old who were recruited from a tertiary-care hospital. The prevalences of each NS category and NI were estimated, the assessments were compared between groups (Mann-Whitney, Chi-squared or the Fisher's-exact-test, and the association between preoperative risk-factors and NI was evaluated using odds ratios.The distribution of subjects by NS category was: underweight (3.66%, normal-weight (28.05%, overweight (35.36%, and obese (32.93%. The prevalence of NI was 14.63%. The LOS was longer (p<0.001 for the patients who developed NI. The percentages of NI were: 33.3% in underweight, 18.52% in obese, 17.39% in normal-weight, and 6.90% in overweight patients.The prevalence of overweight and obesity in adult ES patients is high. The highest prevalence of NI occurred in the underweight and obese patients. The presence of NI considerably increased the LOS, resulting in higher medical care costs.

  18. ACO model should encourage efficient care delivery.

    Science.gov (United States)

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

    2015-09-01

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

  19. Anesthesia and Intensive care implications for pituitary surgery: Recent trends and advancements

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful surgical outcome. The focus of pre-anesthetic checkup is mainly directed at the endocrinological manifestations of pituitary hypo or hyper-secretion as it secretes a variety of essential hormones, and also any pathological state that can cause imbalance of pituitary secretions. The pathophysiological aspects associated with pituitary tumors mandate a thorough airway, cardiovascular, neurologic and endocrinological assessment. A meticulous preoperative preparation and definite plans for the intra-operative period are the important clinical components of the anesthetic strategy. Various anesthetic modalities and drugs can be useful to provide a smooth intra-operative period by countering any complication and thus providing an uneventful recovery period.

  20. 新生儿术后监护%Intensive Care for Newborns After Surgery

    Institute of Scientific and Technical Information of China (English)

    伍连康; 余家康; 潘韶芳; 曾其毅

    1993-01-01

    1989年1月~1992年1月,对77例新生儿进行术后监护处理.低温、呼吸功能不全、循环障碍和酸碱平衡失调为术后主要的病理生理改变.本组17例患儿(22%)分别死于感染、吸入性肺炎和呼吸功能不全.我们认为术后广泛使用呼吸机,加强抗感染治疗以及营养支持是提高新生儿外科疗效的关键环节.%From Jan. 1989 to Jan. 1992, 77 newborns were monitored in neonatal intensive care unit following surgical procedures. The main pathophysiologic changes were as follows: low body temperature, respiratory and circulation insufficiency, and electrolyte imbalance. Seventeen of them (22%) died of infection, aspiration pneumonia or respiratory failure. The authors emphasize thatmechanical ventilation, antibiotics and nutritional support would play an important role in decreasing mortality and morbility of newborns after surgery.

  1. Outcomes of surgical site infections in orthopedic trauma surgeries in a tertiary care centre in India

    Directory of Open Access Journals (Sweden)

    N Rajkumari

    2014-01-01

    Full Text Available Background: Surgical site infections (SSIs still cause significant morbidity and mortality despite advances in trauma care. We have studied in this paper the rate of SSIs, their outcomes in patients undergoing interventions for trauma and SSI trends in developing countries. Materials and Methods: A 16-month study (May, 2011- August, 2012 was carried out. Patients undergoing interventions for orthopedic trauma were followed and assessed for SSIs and their outcomes and antimicrobial sensitivity patterns of the micro-organisms isolated were noted and correlated. Results: A total of 40 (4.4% confirmed cases of SSIs were identified among 852 patients of orthopedic trauma. Based on the new CDC criteria, after ruling out cellulitis, only 24 (2.6% were found to have SSIs. A total of 12.5% of the SSIs were detected during follow-up. Acinetobacter baumannii was the predominant organism as also Staphylococcus aureus. Outcomes observed included changes in antibiotic regime, revision surgery, readmission to hospital and deaths. Conclusion: SSI is prevalent in orthopaedic trauma patients and an active surveillance program will help in early management and prevention.

  2. Implementing Outcome Measures Within an Enhanced Palliative Care Day Care Model.

    LENUS (Irish Health Repository)

    Kilonzo, Isae

    2015-04-23

    Specialist palliative care day care (SPDC) units provide an array of services to patients and their families and can increase continuity of care between inpatient and homecare settings. A multidisciplinary teamwork approach is emphasized, and different models of day care exist. Depending on the emphasis of care, the models can be social, medical, therapeutic, or mixed. We describe our experience of introducing an enhanced therapeutic specialist day care model and using both patient- and carer-rated tools to monitor patient outcomes.

  3. Porcine Model In The Laparoscopic Liver Surgery Training

    Directory of Open Access Journals (Sweden)

    Komorowski Andrzej L.

    2015-08-01

    Full Text Available The aim of the study was to evaluate the possibility to use live anesthetized pigs as a model for laparoscopic liver resection. During two days laparoscopy course two trainees were operating on two live animals performing exposure of the liver, Pringle manoeuver, division of liver ligaments, dissecting of the structures inside the hepatoduodenal ligament, dissection of the hepatic veins and left lateral liver sectionectomy. Exposure of the liver and Pringle manoeuver were performed correctly within 50 and 35 minutes. Left lateral sectionectomy has been performed correctly within 2 hours. The full dissection of the hepatoduodenal ligament and exposure of the hepatic veins were judged as insufficient by experienced laparoscopic tutors. There was one injury to the suprahepatic vena cava that was managed laparoscopically. The porcine model can be used as an advanced training for laparoscopic liver surgery.

  4. [Research on direct forming of comminuted fracture surgery orienting model by selective laser melting].

    Science.gov (United States)

    He, Xingrong; Yang, Yongqiang; Wu, Weihui; Wang, Di; Ding, Huanwen; Huang, Weihong

    2010-06-01

    In order to simplify the distal femoral comminuted fracture surgery and improve the accuracy of the parts to be reset, a kind of surgery orienting model for the surgery operation was designed according to the scanning data of computer tomography and the three-dimensional reconstruction image. With the use of DiMetal-280 selective laser melting rapid prototyping system, the surgery orienting model of 316L stainless steel was made through orthogonal experiment for processing parameter optimization. The technology of direct manufacturing of surgery orienting model by selective laser melting was noted to have obvious superiority with high speed, precise profile and good accuracy in size when compared with the conventional one. The model was applied in a real surgical operation for thighbone replacement; it worked well. The successful development of the model provides a new method for the automatic manufacture of customized surgery model, thus building a foundation for more clinical applications in the future.

  5. INGUINAL HERNIA SURGERY UNDER LOCAL ANAESTHESIA, AS DAY CARE SURGERY AND COMPARISON AMONG THREE GROUP OF PATIENTS CLASSIFIED ACCORDING TO TYPE OF MESH USED

    Directory of Open Access Journals (Sweden)

    Arvind

    2015-06-01

    Full Text Available BACKGROUND: Inguinal hernia repair is one of the most commonly performed operations worldwide . This study was done to evaluate , local anesthesia as choice of procedure for inguinal hernia as day care surgery including both regular & comorbidity associated patients , to know which mesh is suitable smallpore ( H eavy weight or largepore ( L igh t weight and to know if use of absorbable suture is better than non - absorbable suture for fixation of mesh. METHODS: We prospectively studied 69 patients with a primary unilateral inguinal hernia. The study group was randomized to Lichtenstein repair afte r taking full informed consent. Pain was assessed by visual analogue scale , Quality of life was assessed by responses to a health questionnaire administered to post - operative patients . RESULTS: The highest contraction rate was found in polypropylene small pore mesh (28.76% , followed by polypropylene large pore mesh (23.9% and the least contraction seen in knitted composite mesh (17.2%. Quality of life was assessed at 1 month and 3 month have shown significant difference among three groups. CONCLUSION: Mos t of the inguinal hernia surgery can be carried out smoothly in local anesthesia , as day care procedure. It is choice of procedure also in patients with comorbidity. Use of absorbable suture for Lichtenstein hernia repair did not affect recurrence rate. Qu ality of life is better with knitted composite group , than pp large pore group , than Polypropylene small pore mesh.

  6. Subject-specific models for image-guided cardiac surgery

    Science.gov (United States)

    Wierzbicki, Marcin; Moore, John; Drangova, Maria; Peters, Terry

    2008-10-01

    Three-dimensional visualization for planning and guidance is still not routinely available for minimally invasive cardiac surgery (MICS). This can be addressed by providing the surgeon with subject-specific geometric models derived from 3D preoperative images for planning of port locations or to rehearse the procedure. For guidance purposes, these models can also be registered to the subject using intraoperative images. In this paper, we present a method for extracting subject-specific heart geometry from preoperative MR images. The main obstacle we face is the low quality of clinical data in terms of resolution, signal-to-noise ratio, and presence of artefacts. Instead of using these images directly, we approach the problem in three steps: (1) generate a high quality template model, (2) register the template with the preoperative data, and (3) animate the result over the cardiac cycle. Validation of this approach showed that dynamic subject-specific models can be generated with a mean error of 3.6 ± 1.1 mm from low resolution target images (6 mm slices). Thus, the models are sufficiently accurate for MICS training and procedure planning. In terms of guidance, we also demonstrate how the resulting models may be adapted to the operating room using intraoperative ultrasound imaging.

  7. Cytoreductive surgery for peritoneal malignancies--development of standards of care for the community.

    Science.gov (United States)

    Esquivel, Jesus

    2007-07-01

    Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) continue to play an increasing role in the management of peritoneal surface malignancies of gastrointestinal origin. The prognosis of patients and the responses to cytoreductive surgery and HIPEC depend on the histology, the degree of malignant transformation, the adequacy of the cytoreductive surgery, and the response to systemic therapy. Continuous interaction between medical and surgical oncologists is needed to identify the most appropriate patients for and the most efficient sequence of the available therapeutic modalities.

  8. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial

    OpenAIRE

    Peul, Wilco; Hout, Wilbert; Brand, René; Thomeer, Raph; Koes, Bart

    2008-01-01

    Objectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. Interventions: Early surgery or an intended six months of continued conservative treatment, with delayed surgery if needed. Main outcome measures: Scores from Roland disability questionnaire for sciatica, visua...

  9. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation : cost utility analysis alongside a randomised controlled trial

    NARCIS (Netherlands)

    Hout, van den W.B.; Peul, W.C.; Koes, B.W.; Brand, R.; Kievit, J.; Thomeer, R.T.W.M.

    2008-01-01

    Objective: To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs. Design: Cost utility analysis alongside a randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with sciati

  10. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial.

    NARCIS (Netherlands)

    Hout, W.B. van den; Peul, W.C.; Koes, B.W.; Brand, R.; Kievit, J.; Thomeer, R.T.

    2008-01-01

    OBJECTIVE: To determine whether the faster recovery after early surgery for sciatica compared with prolonged conservative care is attained at reasonable costs. DESIGN: Cost utility analysis alongside a randomised controlled trial. SETTING: Nine Dutch hospitals. PARTICIPANTS: 283 patients with sciati

  11. Otologic surgeries in National Ear Care Centre, Kaduna, Nigeria: A 5 years review

    Directory of Open Access Journals (Sweden)

    Grema Umar Sambo

    2015-01-01

    Full Text Available Background: Otologic surgeries that endure are based on a detailed knowledge of anatomy, physiology, and pathology of the temporal bone. Ear surgeries are challenging to most otolaryngologists practicing in Nigeria. The aim was to present a 5 years review of indications, types, complications, success, and limitations of the ear surgeries at the study center. Materials and Methods: A 5 years retrospective review of all the otologic surgeries are done under general and local anesthesia from July, 2009 to July, 2014. Results: There were 1067 patients who had ear, nose, and throat surgeries within the period under review, out of which 68 were ear surgeries. Prevalence was 6.37%, there were 25 (37% males and 43 (63% females, male: female 1:1.7. Age ranged from 1 to 58 years, mean age 21 ± 6 years. Chronic suppurative otitis media was the most common diagnosis 39 (57.4% and indication for tympanoplasty 31 (46.6%. Meatocanaloplasty was the least with 2 (2.9%, mastoidectomy 7 (10.3%, myringotomy and grommet insertion 11 (16.2%, excisional biopsy 7 (10.3%, foreign body removal 4 (5.90%, tympanomastoidectomy 3 (4.40%, and pinnaplasty 3 (4.40%. Forty-one (60.3% achieved resolution of symptoms while 8 (11.8% had persistence of symptoms. One (1.5% had revision surgery. The success rate is about 60.3% within the period under review. Postoperative complications (facial nerve paralysis, persistence discharge from the mastoid cavity, worsened deafness, postauricular fistula were seen in 14 (20.6%. While 4 (5.9% were lost to follow-up. Conclusion: Ear surgeries are still underdeveloped when compared to nose and throat surgeries in our center. Complication (chronic suppurative otitis media was the most common indication for ear surgery. Provision of adequate training facilities, especially in the field of otology and review of the training curriculum for otorhinolaryngology residency in Nigeria is indispensable.

  12. Impact of different sedation protocols and perioperative procedures on patients admitted to the intensive care unit after maxillofacial tumor surgery of the lower jaw: A retrospective study.

    Science.gov (United States)

    Lebherz-Eichinger, Diana; Tudor, Bianca; Krenn, Claus G; Roth, Georg A; Seemann, Rudolf

    2016-04-01

    Maxillofacial tumor surgery often necessitates prolonged invasive ventilation to prevent blockage of the respiratory tract. To tolerate ventilation, continuously administered sedatives are recommended. Half-time of sedative or analgesic medication is an important characteristic by which narcotic drugs are chosen, due to the fact that weaning period increases with half-time. The aim of our study was to investigate whether a change in sedation regimen would affect the length of invasive ventilation or intensive care unit stay and medical costs. Additionally, the impact of various surgical procedures was analyzed. Data of 157 patients after mandibular surgery were retrospectively analyzed over 5 years in count regression models. Of those patients, 84 received a sedation regimen with sufentanil and midazolam and 73 with remifentanil and propofol. The impact of the surgical procedures (tracheostomy, tumor resection, neck dissection and length of operation) and the patient age and sex were analyzed with respect to length of ventilation and ICU days. Cost savings were calculated. Our data show that patients receiving remifentanil/propofol had fewer ventilation days (2.5 ± 2.5 versus 6.1 ± 4.6 days, P < 0.001) and were discharged earlier from the intensive care unit than patients receiving sufentanil/midazolam (5.1 ± 3.8 versus 9.2 ± 6.2 days, P < 0.001), leading to calculated cost savings of about 8000 Euro per patient. Length of operation negatively influenced length of ICU stay (P < 0.001). In conclusion, short-acting drugs such as remifentanil/propofol, as well as tracheostoma and shortened surgery duration may reduce the postoperative need for invasive ventilation and length of intensive care unit stay.

  13. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care.

    Directory of Open Access Journals (Sweden)

    Ian J Douglas

    2015-12-01

    2.65-11.99. No association was detected between bariatric surgery and fractures, cancer, or stroke. Effect estimates for mortality found no protective association with bariatric surgery overall, with a HR of 0.97 (95% CI 0.66-1.43. The data used were recorded for the management of patients in primary care and may be subject to inaccuracy, which would tend to lead to underestimates of true relative effect sizes.Bariatric surgery as delivered in the UK healthcare system is associated with dramatic weight loss, sustained at least 4 y after surgery. This weight loss is accompanied by substantial improvements in pre-existing T2DM and hypertension, as well as a reduced risk of incident T2DM, hypertension, angina, MI, and obstructive sleep apnoea. Widening the availability of bariatric surgery could lead to substantial health benefits for many people who are morbidly obese.

  14. The University Münster model surgery system for Orthognathic surgery. Part I – The idea behind

    Directory of Open Access Journals (Sweden)

    Ehmer Ulrike

    2012-05-01

    Full Text Available Abstract Background We describe a procedure for diagnosis and planning for orthognatic surgery based on international standards. A special 2D planning based on lateral cephalograms (Axis Orbital Marker Lines System realize a transmission to the SAM 2P articulator (3D by means of the Axis Orbital Plane. Methods Former intraoperative measurement of the average height of the LeFort I osteotomy plane relative to the molar occlusal plane allow to construct a virtual osteotomy plane in the lateral cephalogram. This is the basis for the development of the Axis Orbital Marker Lines System (AO-MLS. Results The AO-MLS is presented graphically, and in detail, with construction guidelines. The system could be integrated into various lateral cephalometric analysis- and surgical prediction schemes. It forms the basis for a standardized transfer of the 2D planning to the 3D planning in the articulator, and vice versa. This procedure makes it possible to generate surgical planning protocols based on the model surgery, which represent the dislocations in the proximity of the real osteotomy planes. Conclusions The Axis Orbital Marker Lines System (software component in conjunction with the University Münster Model Surgery System (hardware system increases the predictability of model operations in orthognathic surgery.

  15. Development of a preoperative predictive model for major complications following adult spinal deformity surgery.

    Science.gov (United States)

    Scheer, Justin K; Smith, Justin S; Schwab, Frank; Lafage, Virginie; Shaffrey, Christopher I; Bess, Shay; Daniels, Alan H; Hart, Robert A; Protopsaltis, Themistocles S; Mundis, Gregory M; Sciubba, Daniel M; Ailon, Tamir; Burton, Douglas C; Klineberg, Eric; Ames, Christopher P

    2017-03-24

    interbody fusion levels, Physical Component Summary of the SF-36, Scoliosis Research Society (SRS)-Schwab coronal curve type, Charlson Comorbidity Index, SRS activity, T-1 pelvic angle, American Society of Anesthesiologists grade, presence of osteoporosis, pelvic tilt, sagittal vertical axis, primary versus revision surgery, SRS pain, SRS total, use of bone morphogenetic protein, use of iliac crest graft, and pelvic incidence-lumbar lordosis mismatch. CONCLUSIONS A successful model (87% accuracy, 0.89 AUROC curve) was built predicting major intraoperative or perioperative complications following ASD surgery. This model can provide the foundation toward improved education and point-of-care decision making for patients undergoing ASD surgery.

  16. The university münster model surgery system for orthognathic surgery. Part II – KD-MMS

    Directory of Open Access Journals (Sweden)

    Ehmer Ulrike

    2013-01-01

    Full Text Available Abstract Background Model surgery is an integral part of the planning procedure in orthognathic surgery. Most concepts comprise cutting the dental cast off its socket. The standardized spacer plates of the KD-MMS provide for a non-destructive, reversible and reproducible means of maxillary and/or mandibular plaster cast separation. Methods In the course of development of the system various articulator types were evaluated with regard to their capability to provide a means of realizing the concepts comprised of the KD-MMS. Special attention was dedicated to the ability to perform three-dimensional displacements without cutting of plaster casts. Various utilities were developed to facilitate maxillary displacement in accordance to the planning. Objectives of this development comprised the ability to implement the values established in the course of two-dimensional ceph planning. Results The system - KD-MMS comprises a set of hardware components as well as a defined procedure. Essential hardware components are red spacer and blue mounting plates. The blue mounting plates replace the standard yellow SAM mounting elements. The red spacers provide for a defined leeway of 8 mm for three-dimensional movements. The non-destructive approach of the KD-MMS makes it possible to conduct different model surgeries with the same plaster casts as well as to restore the initial, pre-surgical situation at any time. Thereby, surgical protocol generation and gnathologic splint construction are facilitated. Conclusions The KD-MMS hardware components in conjunction with the defined procedures are capable of increasing efficiency and accuracy of model surgery and splint construction. In cases where different surgical approaches need to be evaluated in the course of model surgery, a significant reduction of chair time may be achieved.

  17. The economics of pancreas surgery.

    Science.gov (United States)

    Vollmer, Charles M

    2013-06-01

    Pancreas surgery is a paradigm for high-acuity surgical specialization. Given the current intrigue over containing health care expenditures, pancreas surgery provides an ideal model to investigate the cost of care. This article explores the economics of this field from literature accrued over the last 2 decades. The cost of performing a pancreatic resection is established and then embellished with a discussion of the effects of clinical care paths. Then the influence of complications on costs is explored. Next, cost is investigated as an emerging outcome metric regarding variations in pancreatic surgical care. Finally, the societal-level fiscal impact is considered.

  18. Cavus Foot Surgery

    Science.gov (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A ... problems. What are the goals of cavus foot surgery? The main goal of surgery is to reduce ...

  19. Measuring the quality of melanoma surgery - Highlighting issues with standardization and quality assurance of care in surgical oncology.

    Science.gov (United States)

    Pasquali, S; Sommariva, A; Spillane, A J; Bilimoria, K Y; Rossi, C R

    2017-03-01

    In an attempt to ensure high standards of cancer care, there is increasing interest in determining and monitoring the quality of interventions in surgical oncology. In recent years, this has been particularly the case for melanoma surgery. The vast majority of patients with melanoma undergo surgery. Usually, this is with combinations of wide excision, sentinel lymph node biopsy and lymphadenectomy. The indications for these procedures evolved during a time when no effective systemic adjuvant therapy was available, and whilst the rationale has been sound, the justification for differences in extent and thoroughness has generally been supported by inadequate or low-level evidence. This has led to a substantial variation among melanoma centres or even among surgeons within a centre in how these procedures are done. With recent rapid progress in the efficacy of systemic treatments that are impacting on overall survival, the prospect of long-term survival in these previously high risk patients means that more than ever long-term locoregional control of melanoma is imperative. Furthermore, the understanding of effects of systemic therapy on locoregional disease will only be interpretable if surgeons use standardized, high quality techniques. This article focuses on standardization and evolution of quality indicators for melanoma surgery and how these might have a positive impact on patient care.

  20. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review.

    Science.gov (United States)

    Meyer, Zainna C; Schreinemakers, Jennifer M J; de Waal, Ruud A L; van der Laan, Lijckle

    2015-09-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in PubMed from inception to July 2013 that met the following inclusion criteria: evaluation of the above parameters, describing their diagnostic accuracy and the risk stratification for surgical complications in surgical patients admitted to an intensive care unit. No difference in the Sequential Organ Failure Assessment scores was seen between patients with or without complications. The D-lactate levels were significantly higher in those who developed colonic ischemic complications after a ruptured abdominal aortic aneurysm. After gastro-intestinal surgery, contradictory data were reported, with both positive and negative use of C-reactive protein and procalcitonin in the diagnosis of septic complications. However, in trauma patients, the C-reactive protein levels may help to discriminate between those with and without infectious causes. We conclude that the Sequential Organ Failure Assessment score, lactate concentration and C-reactive protein level have no significant predictive value for early postoperative complications in critically ill post-surgery patients. However, procalcitonin seems to be a useful parameter for diagnosing complications in specific patient populations after surgery and/or after trauma.

  1. [Guidelines for intensive care in cardiac surgery patients: haemodynamic monitoring and cardio-circulatory treatment guidelines of the German Society for Thoracic and Cardiovascular Surgery and the German Society of Anaesthesiology and Intensive Care Medicine].

    Science.gov (United States)

    Carl, M; Alms, A; Braun, J; Dongas, A; Erb, J; Goetz, A; Göpfert, M; Gogarten, W; Grosse, J; Heller, A; Heringlake, M; Kastrup, M; Kröner, A; Loer, S; Marggraf, G; Markewitz, A; Reuter, M; Schmitt, D V; Schirmer, U; Wiesenack, C; Zwissler, B; Spies, C

    2007-03-01

    Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors, are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery and the German Society for Anaesthesiology and Intensive Care Medicine made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess available monitoring methods and their risks as well as the differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilators, inodilators and calcium-sensitizers and the use of intra-aortic balloon pumps. The guideline has been developed according to the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).

  2. Development of an online information and support resource for adolescent idiopathic scoliosis patients considering surgery: perspectives of health care providers

    Directory of Open Access Journals (Sweden)

    Nicholas David

    2010-06-01

    Full Text Available Abstract Background Adolescents with idiopathic scoliosis who are considering spinal surgery face a major decision that requires access to in-depth information and support. Unfortunately, most online resources provide incomplete and inconsistent information and minimal social support. The aim of this study was to develop an online information and support resource for adolescent idiopathic scoliosis (AIS patients considering spinal surgery. Prior to website development, a user-based needs assessment was conducted. The needs assessment involved a total of six focus groups with three stakeholder groups: (1 post-operative AIS patients or surgical candidates (10-18 years (n = 11, (2 their parents (n = 6 and (3 health care providers (n = 11. This paper reports on the findings from focus groups with health care providers. Methods Focus group methodology was used to invite a range of perspectives and stimulate discussion. During audio-recorded focus groups, an emergent table of website content was presented to participants for assessment of relevance, viability and comprehensiveness in targeting global domains of need. Specifically, effective presentation of content, desired aspects of information and support, and discussions about the value of peer support and the role of health professionals were addressed. Focus group transcripts were then subject to content analysis through a constant comparative review and analysis. Results Two focus groups were held with health care providers, consisting of 5 and 6 members respectively. Clinicians provided their perceptions of the information and support needs of surgical patients and their families and how this information and support should be delivered using internet technology. Health care providers proposed four key suggestions to consider in the development of this online resource: (1 create the website with the target audience in mind; (2 clearly state the purpose of the website and organize website content

  3. Effects of Clown Doctors on Child and Caregiver Anxiety at the Entrance to the Surgery Care Unit and Separation from Caregivers

    Science.gov (United States)

    Arriaga, Patrícia; Pacheco, Catarina

    2016-01-01

    This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care).…

  4. Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value.

    Science.gov (United States)

    Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R

    2015-10-01

    : The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients.

  5. Comprehensive care of amyotrophic lateral sclerosis patients: a care model.

    Science.gov (United States)

    Güell, Maria Rosa; Antón, Antonio; Rojas-García, Ricardo; Puy, Carmen; Pradas, Jesus

    2013-12-01

    Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease that presents with muscle weakness, causing progressive difficulty in movement, communication, eating and ultimately, breathing, creating a growing dependence on family members and other carers. The ideal way to address the problems associated with the disease, and the decisions that must be taken, is through multidisciplinary teams. The key objectives of these teams are to optimise medical care, facilitate communication between team members, and thus to improve the quality of care. In our centre, we have extensive experience in the care of patients with ALS through an interdisciplinary team whose aim is to ensure proper patient care from the hospital to the home setting. In this article, we describe the components of the team, their roles and our way of working.

  6. Circuito Quirúrgico Informatizado: Una herramienta para la mejora de la atención al paciente quirúrgico Improving the Care level on a surgery-needed patient through a Computer-Aided Surgery Cares Program

    Directory of Open Access Journals (Sweden)

    Luis Fuentes Cebada

    2007-11-01

    Full Text Available El Programa de Atención al Paciente Quirúrgico en el Hospital Puerta del Mar (Cádiz surge con el objetivo de personalizar la atención y garantizar la continuidad de cuidados y la seguridad de nuestros pacientes en cada una de las unidades por las que va desarrollándose la actividad quirúrgica. Este programa se soporta en una herramienta informática que es el circuito quirúrgico, la cual ha sido diseñada siguiendo la metodología de mejora continua y la participación desde el inicio de los profesionales enfermeros como actores de su desarrollo e implantación. En sólo ocho meses se ha conseguido que más del 55 % de los pacientes intervenidos quirúrgicamente disponga de un registro informatizado en el que se valoran, diagnostican, planifican y abordan los aspectos relacionados con la propia intervención quirúrgica como una parte añadida a las respuestas humanas que la misma ocasiona tanto a él como a su familia. Todo ello haciendo uso de las taxonomías enfermeras NANDA, NOC y NIC, con un enfoque holístico, centrado en la persona como agente y receptor de cuidados. Acompaña a este registro un sistema de información desde el que se explotan aspectos tales como la prevalencia diagnóstica enfermera, intervenciones realizadas, alergias, profilaxis antibiótica administrada, etc.The Surgery-needed Care Program, currently under test at the Puerta del Mar Hospital in Cadiz, has been conceived with the aim of both tuning the care level to each individual patient and, at the same time, to secure a continuous assistance through all the units involved in the surgery process. It is based on a computer tool so called Surgery Program. This computer application has been designed on the basis of continually-improving approach while counting with the enrolment, from the very first phases, of nurses in the affected units both in development and set-up steps. After just eight months running this Program, we have been able to create a digital

  7. Leadership models in health care - a case for servant leadership.

    Science.gov (United States)

    Trastek, Victor F; Hamilton, Neil W; Niles, Emily E

    2014-03-01

    Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients.

  8. Providing surgical care in Somalia: A model of task shifting

    Directory of Open Access Journals (Sweden)

    Ford Nathan P

    2011-07-01

    Full Text Available Abstract Background Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. Methods In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Results Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65% were male and the median age was 22 (interquartile range, 17-30. 1460 (70% of interventions were emergent. Trauma accounted for 76% (1585 of all surgical pathology; gunshot wounds accounted for 89% (584 of violent injuries. Operative mortality (0.5% of all surgical interventions was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. Conclusions The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully

  9. Evidence-based models of care for people with epilepsy.

    LENUS (Irish Health Repository)

    Fitzsimons, Mary

    2012-02-01

    Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

  10. Developing a service model that integrates palliative care throughout cancer care: the time is now.

    Science.gov (United States)

    Partridge, Ann H; Seah, Davinia S E; King, Tari; Leighl, Natasha B; Hauke, Ralph; Wollins, Dana S; Von Roenn, Jamie Hayden

    2014-10-10

    Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care; coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships; prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings; and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal.

  11. Expanded Medical Home Model Works for Children in Foster Care

    Science.gov (United States)

    Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.

    2012-01-01

    The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…

  12. A randomized study of telephonic care support in populations at risk for musculoskeletal preference-sensitive surgeries

    Directory of Open Access Journals (Sweden)

    Veroff David R

    2013-02-01

    Full Text Available Abstract Background The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. Methods We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog®, was compared to a control (mailed outreach or

  13. Fast-track surgery-an update on physiological care principles to enhance recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik

    2011-01-01

    INTRODUCTION: The concept of fast-track surgery (enhanced recovery programs) has been evolved and been documented to be successful by decreasing length of stay, morbidity and convalescence across procedures. FUTURE STRATEGIES: However, there are several possibilities for further improvement of mo...

  14. Urologic complications following obstetrics and gynecologicai surgery: Our experience in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Dilip Kumar Pal

    2016-01-01

    Conclusion: Although obstetrical causes are still important in developing countries, gynecological procedures especially laparoscopic surgeries are on the rise. In these procedures the suspicion of urological injuries should be kept in mind and intra-operative detection and early repair should be attempted. Delayed diagnosis and improper treatment leads to severe complications.

  15. Evaluation of The Products of Ambulatory Care and Products of Ambulatory Surgery Classification System For the Military Health Care System.

    Science.gov (United States)

    1992-09-14

    98.97 IV Problem 13 24 Diagnostic Investigation with 21 .27 99.24 Nuclear or Computerized Axial Tomgrpy Imaging 14 2 Annual Well Care Examination, Child...720 7209 Spondylitis , Inflammatory, Unspec 72101 7210 Spondylosis, Cervical W/O Myelopathy 72131 7213 Spondylosis, Lumbosacral 7219 72190 Spondylosis

  16. Mathematical Modeling of the Consumption of Low Invasive Plastic Surgery Practices: The Case of Spain

    Directory of Open Access Journals (Sweden)

    E. De la Poza

    2013-01-01

    Full Text Available Plastic surgery practice grows continuously among the women in Western countries due to their body image dissatisfaction, aging anxiety, and an ideal body image propagated by the media. The consumption growth is so important that plastic surgery is becoming a normal practice among women, like any other cosmetic product, with the risk of suffering psychopathology disorders in the sense that plastic surgery could be employed as an instrument to recover personal self-esteem or even happiness. Plastic surgery practice depends on economic, demographic, and social contagion factors. In this paper, a mathematical epidemiological model to forecast female plastic surgery consumption in Spain is fully constructed. Overconsumer subpopulation is predicted and simulated. Robustness of the model versus uncertain parameters is studied throughout a sensitivity analysis.

  17. Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery.

    Science.gov (United States)

    Starmer, Heather M; Riley, Lee H; Hillel, Alexander T; Akst, Lee M; Best, Simon R A; Gourin, Christine G

    2014-02-01

    Dysphonia and dysphagia are common complications of anterior cervical discectomy (ACD). We sought to determine the relationship between dysphagia and in-hospital mortality, complications, speech therapy/dysphagia training, length of hospitalization, and costs associated with ACD. Discharge data from the Nationwide Inpatient Sample for 1,649,871 patients who underwent ACD of fewer than four vertebrae for benign acquired disease between 2001 and 2010 were analyzed using cross-tabulations and multivariate regression modeling. Dysphagia was reported in 32,922 cases (2.0 %). Speech therapy/dysphagia training was reported in less than 0.1 % of all cases and in only 0.2 % of patients with dysphagia. Dysphagia was significantly associated with age ≥65 years (OR = 1.5 [95 % CI 1.4-1.7], P < 0.001), advanced comorbidity (OR = 2.3 [2.0-2.6], P < 0.001), revision surgery (OR = 2.7 [2.3-3.1], P < 0.001), disc prosthesis placement (OR = 1.5 [1.0-2.0], P = 0.029), and vocal cord paralysis (OR = 11.6 [8.3-16.1], P < 0.001). Dysphagia was a significant predictor of aspiration pneumonia (OR = 8.6 [6.7-10.9], P < 0.001), tracheostomy (OR = 2.3 [1.6-3.3], P < 0.001), gastrostomy (OR = 30.9 [25.3-37.8], P < 0.001), and speech therapy/dysphagia training (OR = 32.0 [15.4-66.4], P < 0.001). Aspiration pneumonia was significantly associated with in-hospital mortality (OR = 15.9 [11.0-23.1], P < 0.001). Dysphagia, vocal cord paralysis, and aspiration pneumonia were significant predictors of increased length of hospitalization and hospital-related costs, with aspiration pneumonia having the single largest impact on length of hospitalization and costs. Dysphagia is significantly associated with increased morbidity, length of hospitalization, and hospital-related costs in ACD patients. Despite the known risk of dysphagia in ACD patients and an established role for the speech-language pathologist in dysphagia management, speech-language pathology

  18. Supportive nursing care around breast cancer surgery : An evaluation of the 1997 status in The Netherlands

    NARCIS (Netherlands)

    Thijs-Boer, FM; de Kruif, ATC; van de Wiel, HBM

    1999-01-01

    This study aimed to assess nurses' involvement in the supportive care of patients with recently diagnosed breast cancer in Dutch hospitals. A questionnaire used to evaluate various aspects of nursing care for breast cancer patients was sent to the surgical nursing teams in all 120 Dutch hospitals th

  19. Certificate-of-Need regulation in outpatient surgery and specialty care: implications for plastic surgeons.

    Science.gov (United States)

    Pacella, Salvatore J; Comstock, Matthew; Kuzon, William M

    2005-09-15

    For plastic surgeons, independent development of outpatient surgical centers and specialty facilities is becoming increasingly common. These facilities serve as important avenues not only for increasing access and efficiency but in maintaining a sustainable, competitive specialty advantage. Certificate of Need regulation represents a major hurdle to plastic surgeons who attempt to create autonomy in this fashion. At the state level, Certificate of Need programs were initially established in an effort to reduce health care costs by preventing unnecessary capital outlays for facility expansion (i.e., managing supply of health care resources) in addition to assisting with patient safety and access to care. The purpose of this study was to examine the effect of Certificate of Need regulations on health care costs, patient safety, and access to care and to discuss specific implications of these regulations for plastic surgeons. Within Certificate of Need states, these regulations have done little, if anything, to control health care costs or affect patient safety. Presently, Certificate of Need effects coupled with recent provisions in the Medicare Modernization Act banning development of specialty hospitals may restrict patient access to ambulatory surgical and specialty care. For the plastic surgeon, these effects not only act as an economic barrier to entry but can threaten the efficiencies gained from providing surgical care in an ambulatory setting. An appreciation of these effects is critical to maintaining specialty autonomy and access to fiscal policy.

  20. Postoperative nutrition practices in abdominal surgery patients in a tertiary referral hospital Intensive Care Unit: A prospective analysis

    Directory of Open Access Journals (Sweden)

    Tejaswini Arunachala Murthy

    2016-01-01

    Full Text Available Background: Benefit of early enteral feeds in surgical patients admitted to Intensive Care Units (ICUs has been emphasized by several studies. Apprehensions about anastomotic leaks in gastrointestinal surgical patients prevent initiation of early enteral nutrition (EN. The impact of these practices on outcome in Indian scenario is less studied. Aims: This study compares the impact of early EN (within 48 h after surgery with late EN (48 h postsurgery on outcomes in abdominal surgical ICU patients. Settings and Design: Postabdominal surgery patients admitted to a tertiary referral hospital ICU over a 2-year period were analyzed. Methods: Only patients directly admitted to ICU after abdominal surgery were included in this study. ICU stay>3 days was considered as prolonged; with average ICU length of stay (LOS for this ICU being 3 days. The primary outcome was in-patient mortality. ICU LOS, hospital LOS, infection rates, and ventilator days were secondary outcome measures. Acute Physiology and Chronic Health Evaluation II scores were calculated. SPSS and Microsoft Excel were used for analysis. Results: Of 91 ICU patients included, 58 received early EN and 33 late EN. Hospital LOS and infection rates were less in early EN group. Use of parenteral nutrition (odds ratio [OR] 5.25, 95% confidence interval (CI; P = 0.003 and number of nil-per-oral days (OR 8.25, 95% CI; P ≤ 0.001 were other predictors of prolonged LOS. Conclusions: Early EN in postabdominal surgery ICU patients was associated with reduced hospital LOS and infection rates. ICU LOS, duration of mechanical ventilation and mortality rates did not vary.

  1. Radiology as the Point of Cancer Patient and Care Team Engagement: Applying the 4R Model at a Patient's Breast Cancer Care Initiation.

    Science.gov (United States)

    Weldon, Christine B; Friedewald, Sarah M; Kulkarni, Swati A; Simon, Melissa A; Carlos, Ruth C; Strauss, Jonathan B; Bunce, Mikele M; Small, Art; Trosman, Julia R

    2016-12-01

    Radiologists aspire to improve patient experience and engagement, as part of the Triple Aim of health reform. Patient engagement requires active partnerships among health providers and patients, and rigorous teamwork provides a mechanism for this. Patient and care team engagement are crucial at the time of cancer diagnosis and care initiation but are complicated by the necessity to orchestrate many interdependent consultations and care events in a short time. Radiology often serves as the patient entry point into the cancer care system, especially for breast cancer. It is uniquely positioned to play the value-adding role of facilitating patient and team engagement during cancer care initiation. The 4R approach (Right Information and Right Care to the Right Patient at the Right Time), previously proposed for optimizing teamwork and care delivery during cancer treatment, could be applied at the time of diagnosis. The 4R approach considers care for every patient with cancer as a project, using project management to plan and manage care interdependencies, assign clear responsibilities, and designate a quarterback function. The authors propose that radiology assume the quarterback function during breast cancer care initiation, developing the care initiation sequence, as a project care plan for newly diagnosed patients, and engaging patients and their care teams in timely, coordinated activities. After initial consultations and treatment plan development, the quarterback function is transitioned to surgery or medical oncology. This model provides radiologists with opportunities to offer value-added services and solidifies radiology's relevance in the evolving health care environment. To implement 4R at cancer care initiation, it will be necessary to change the radiology practice model to incorporate patient interaction and teamwork, develop 4R content and local adaption approaches, and enrich radiology training with relevant clinical knowledge, patient interaction

  2. Sustaining hope and life courage in patients undergoing ovarian cancer surgery - the impact of care

    DEFF Research Database (Denmark)

    Seibaek, L; Delmar, C; Hounsgaard, L

    2017-01-01

    Ovarian cancer is the leading cause of death from a gynaecological malignancy in the Western World. To explore if experiences of physical comfort influenced hope and life courage during final diagnosis and early treatment, qualitative research interviews were performed with women undergoing surgery......, and it was a main finding that sufficient symptom management combined with sensitive attention of the patient sustained her hope, life courage and action competences. Surgery constitutes an essential part of sufficient cancer treatment. However, the diagnostic and pre-operative phase represents an insufficiently...... for ovarian cancer. By applying a phenomenological-hermeneutic methodology, the findings were systematically identified, put into meaning-structures, interpreted and critically discussed. The empirical material constituted a main theme concerning "Hope and life courage are created in the interplay between...

  3. Information technology implementing globalization on strategies for quality care provided to children submitted to cardiac surgery: International Quality Improvement Collaborative Program - IQIC

    Directory of Open Access Journals (Sweden)

    Adilia Maria Pires Sciarra

    2014-03-01

    Full Text Available Introduction: Congenital heart diseases are the world's most common major birth defect, affecting one in every 120 children. Ninety percent of these children are born in areas where appropriate medical care is inadequate or unavailable. Objective: To share knowledge and experience between an international center of excellence in pediatric cardiac surgery and a related program in Brazil. Methods: The strategy used by the program was based on long-term technological and educational support models used in that center, contributing to the creation and implementation of new programs. The Telemedicine platform was used for real-time monthly broadcast of themes. A chat software was used for interaction between participating members and the group from the center of excellence. Results: Professionals specialized in care provided to the mentioned population had the opportunity to share to the knowledge conveyed. Conclusion: It was possible to observe that the technological resources that implement the globalization of human knowledge were effective in the dissemination and improvement of the team regarding the care provided to children with congenital heart diseases.

  4. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Aliya Ahmed

    2013-01-01

    Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

  5. Different models of training and certification in plastic surgery

    NARCIS (Netherlands)

    Fodor, L.; Ciuce, C.; Fodor, M.; Shrank, C.; Lapid, O.; Kon, M.; Ramon, Y.; Ullmann, Y.

    2009-01-01

    A varying period of training followed by examinations is the usual way to become a specialist in one of the many fields of Medicine. Plastic Surgery is one of the surgical fields that require good technical and cognitive skills. The best way to train and evaluate a candidate is hard to judge. The mo

  6. [Primary care practices in Germany: a model for the future].

    Science.gov (United States)

    Beyer, Martin; Gerlach, Ferdinand M; Erler, Antje

    2011-01-01

    In its 2009 report the Federal Advisory Council on the Assessment of Developments in the Health Care System developed a model of Primary Care Practices for future general practice-based primary care. This article presents the theoretical background of the model. Primary care practices are seen as developed organisations requiring changes at all system levels (interaction, organisation, and health system) to ensure sustainability of primary care functions in the future. Developments of the elements comprising the health care system may be compared to the developments and proposals observed in other countries. In Germany, however, the pace of these developments is relatively slow.

  7. Reciprocal learning and chronic care model implementation in primary care: results from a new scale of learning in primary care

    Directory of Open Access Journals (Sweden)

    Noël Polly H

    2011-02-01

    Full Text Available Abstract Background Efforts to improve the care of patients with chronic disease in primary care settings have been mixed. Application of a complex adaptive systems framework suggests that this may be because implementation efforts often focus on education or decision support of individual providers, and not on the dynamic system as a whole. We believe that learning among clinic group members is a particularly important attribute of a primary care clinic that has not yet been well-studied in the health care literature, but may be related to the ability of primary care practices to improve the care they deliver. To better understand learning in primary care settings by developing a scale of learning in primary care clinics based on the literature related to learning across disciplines, and to examine the association between scale responses and chronic care model implementation as measured by the Assessment of Chronic Illness Care (ACIC scale. Methods Development of a scale of learning in primary care setting and administration of the learning and ACIC scales to primary care clinic members as part of the baseline assessment in the ABC Intervention Study. All clinic clinicians and staff in forty small primary care clinics in South Texas participated in the survey. Results We developed a twenty-two item learning scale, and identified a five-item subscale measuring the construct of reciprocal learning (Cronbach alpha 0.79. Reciprocal learning was significantly associated with ACIC total and sub-scale scores, even after adjustment for clustering effects. Conclusions Reciprocal learning appears to be an important attribute of learning in primary care clinics, and its presence relates to the degree of chronic care model implementation. Interventions to improve reciprocal learning among clinic members may lead to improved care of patients with chronic disease and may be relevant to improving overall clinic performance.

  8. Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

    Directory of Open Access Journals (Sweden)

    Mathoulin-Pélissier Simone

    2012-07-01

    Full Text Available Abstract Background Colorectal cancer (CRC care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. Methods CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery, and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN, non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. Results We included 1,206 patients, 825 (68% with colon and 381 (32% with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location; whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Conclusions Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care

  9. Evaluation of a Pilot Project to Introduce Simulation-Based Team Training to Pediatric Surgery Trauma Room Care

    Directory of Open Access Journals (Sweden)

    Markus Lehner

    2017-01-01

    Full Text Available Introduction. Several studies in pediatric trauma care have demonstrated substantial deficits in both prehospital and emergency department management. Methods. In February 2015 the PAEDSIM collaborative conducted a one and a half day interdisciplinary, simulation based team-training course in a simulated pediatric emergency department. 14 physicians from the medical fields of pediatric surgery, pediatric intensive care and emergency medicine, and anesthesia participated, as well as four pediatric nurses. After a theoretical introduction and familiarization with the simulator, course attendees alternately participated in six simulation scenarios and debriefings. Each scenario incorporated elements of pediatric trauma management as well as Crew Resource Management (CRM educational objectives. Participants completed anonymous pre- and postcourse questionnaires and rated the course itself as well as their own medical qualification and knowledge of CRM. Results. Participants found the course very realistic and selected scenarios highly relevant to their daily work. They reported a feeling of improved medical and nontechnical skills as well as no uncomfortable feeling during scenarios or debriefings. Conclusion. To our knowledge this pilot-project represents the first successful implementation of a simulation-based team-training course focused on pediatric trauma care in German-speaking countries with good acceptance.

  10. A survey of financial planning models for health care organizations.

    Science.gov (United States)

    Coleman, J R; Kaminsky, F C; McGee, F

    1978-01-01

    This paper describes "what if?" financial planning models developed for health care administrators and financial managers to study and evaluate the economic impact of changes in a health care organization's charge structure, operating policies, reimbursement plans, and services and resources. Models for inpatient and outpatient care systems are presented. The models are described in terms of input, output, and application. An assessment of the state of the art of financial planning and prospects for the future of what if?models are given.

  11. Two rare cases of Acremonium acute endophthalmitis after cataract surgery in a tertiary care hospital.

    Science.gov (United States)

    Calderaro, Adriana; Motta, Federica; Larini, Sandra; Gorrini, Chiara; Martinelli, Monica; Piscopo, Giovanni; Benecchi, Magda; Arcangeletti, Maria Cristina; Medici, Maria Cristina; De Conto, Flora; Montecchini, Sara; Neri, Alberto; Scaroni, Patrizia; Gandolfi, Stefano; Chezzi, Carlo

    2013-10-01

    This report describes two cases of Acremonium sp. endophthalmitis, occurring in two patients who underwent cataract surgery on the same day in the same operating room of our hospital ophthalmology clinic. Diagnosis of fungal endophthalmitis was established by the repeated isolation of the same fungal agent from vitreous washing, acqueous fluid and intraocular lens samples and by its identification on the basis of morphological and molecular features. The cases reported in this study emphasize the need for clinical microbiology laboratories to be prepared to face the diagnosis of uncommon infectious diseases such as exogenous fungal endophthalmitis by Acremonium, and to enhance the awareness of surgeons and clinicians of this occurrence.

  12. [Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units].

    Science.gov (United States)

    Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura

    2014-01-01

    Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.

  13. Profile of acute kidney injury after open heart surgeries in a tertiary care hospital.

    Science.gov (United States)

    Rather, Fayaz A; Najar, Saleem M; Malla, Hilal A; Ahangar, A G; Bhat, Hilal M; Wani, Imtiyaz A

    2015-11-01

    Our objective is to determine the incidence, etiology, risk factors and outcome of acute kidney injury (AKI) after open heart surgery. A prospective study was conducted on 62 patients who underwent open heart surgery and were followed-up for the development of AKI and to determine its incidence, etiology and outcome. Post-operative AKI was considered when the post-operative serum creatinine was >1.5 mg/dL or there was doubling of serum creatinine above the baseline (pre-operative) with a prior normal renal function. The incidence of AKI in the post-operative period in our study was 17.7%. The common etiological factors for AKI in our study were sepsis, hypotension, prolonged need for ventilator and inotropic support and drugs given in the post-operative period. The important risk factors for the development of AKI in the post-operative period were hypertension, diabetes mellitus, gout, prolonged total bypass time and prolonged aortic cross-clamp time. The overall mortality in our study subjects was 11.3% (seven of 62 died) and the mortality in the patients who developed post-operative AKI was 71.4%.

  14. Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

    Directory of Open Access Journals (Sweden)

    Anis Dizdarevic

    2016-01-01

    Full Text Available Objective. Primary lateral sclerosis (PLS is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS. Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use.

  15. Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

    Science.gov (United States)

    Fernandes, Anthony

    2016-01-01

    Objective. Primary lateral sclerosis (PLS) is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS). Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use. PMID:27200193

  16. Patients' satisfaction and spectacle independence after cataract surgery with multifocal intraocular lens implantation in a tertiary care hospital.

    Science.gov (United States)

    Baig, Rashid; A Chaudhry, Tanveer; Kukreja, Saajan; Shakil, Sidra; Ahmad, Khabir

    2016-06-01

    This single group cohort study, undertaken at Aga Khan University Hospital, Karachi, from Jan 2012 to September 2013, assessed patients' satisfaction, spectacle independence and visual disturbance after implantation of multifocal IOLs. A total of 39 patients who underwent bilateral cataract surgery with multifocal IOL implantation were included for telephonic interviews. The mean age of participants was 55.5 ± 8.1 years. The mean follow up time was 9.60 ± 3.19 months. The overall satisfaction rate after surgery was found to be 84.6% and there was no statistically significant association of satisfaction with gender, age or education. In all 84.6%, 94.9% and 84.6% people had spectacle independence for far, intermediate and near, respectively. More than half of participants (59%) had some degree of visual disturbance. In this study, multifocal IOL implantation provided high levels of satisfaction and spectacle independence despite notable risk of halo or glare symptoms at night. Therefore, careful patient selection and preoperative counselling regarding possible risks and benefits is recommended.

  17. Anesthesia and critical-care delivery in weightlessness: A challenge for research in parabolic flight analogue space surgery studies

    Science.gov (United States)

    Ball, Chad G.; Keaney, Marilyn A.; Chun, Rosaleen; Groleau, Michelle; Tyssen, Michelle; Keyte, Jennifer; Broderick, Timothy J.; Kirkpatrick, Andrew W.

    2010-03-01

    BackgroundMultiple nations are actively pursuing manned exploration of space beyond low-earth orbit. The responsibility to improve surgical care for spaceflight is substantial. Although the use of parabolic flight as a terrestrial analogue to study surgery in weightlessness (0 g) is well described, minimal data is available to guide the appropriate delivery of anesthesia. After studying anesthetized pigs in a 0 g parabolic flight environment, our group developed a comprehensive protocol describing prolonged anesthesia in a parabolic flight analogue space surgery study (PFASSS). Novel challenges included a physically remote vivarium, prolonged (>10 h) anesthetic requirements, and the provision of veterinary operating room/intensive care unit (ICU) equivalency on-board an aircraft with physical dimensions of ethical approval, multiple ground laboratory sessions were conducted with combinations of anesthetic, pre-medication, and induction protocols on Yorkshire-cross specific pathogen-free (SPF) pigs. Several constant rate infusion (CRI) intravenous anesthetic combinations were tested. In each regimen, opioids were administered to ensure analgesia. Ventilation was supported mechanically with blended gradients of oxygen. The best performing terrestrial 1 g regime was flight tested in parabolic flight for its effectiveness in sustaining optimal and prolonged anesthesia, analgesia, and maintaining hemodynamic stability. Each flight day, a fully anesthetized, ventilated, and surgically instrumented pig was transported to the Flight Research Laboratory (FRL) in a temperature-controlled animal ambulance. A modular on-board surgical/ICU suite with appropriate anesthesia/ICU and surgical support capabilities was employed. ResultsThe mean duration of anesthesia (per flight day) was 10.28 h over four consecutive days. A barbiturate and ketamine-based CRI anesthetic regimen supplemented with narcotic analgesia by bolus administration offered the greatest prolonged hemodynamic

  18. The perioperative surgical home: An innovative, patient-centred and cost-effective perioperative care model.

    Science.gov (United States)

    Desebbe, Olivier; Lanz, Thomas; Kain, Zeev; Cannesson, Maxime

    2016-02-01

    Contrary to the intraoperative period, the current perioperative environment is known to be fragmented and expensive. One of the potential solutions to this problem is the newly proposed perioperative surgical home (PSH) model of care. The PSH is a patient-centred micro healthcare system, which begins at the time the decision for surgery is made, is continuous through the perioperative period and concludes 30 days after discharge from the hospital. The model is based on multidisciplinary involvement: coordination of care, consistent application of best evidence/best practice protocols, full transparency with continuous monitoring and reporting of safety, quality, and cost data to optimize and decrease variation in care practices. To reduce said variation in care, the entire continuum of the perioperative process must evolve into a unique care environment handled by one perioperative team and coordinated by a leader. Anaesthesiologists are ideally positioned to lead this new model and thus significantly contribute to the highest standards in transitional medicine. The unique characteristics that place Anaesthesiologists in this framework include their systematic role in hospitals (as coordinators between patients/medical staff and institutions), the culture of safety and health care metrics innate to the specialty, and a significant role in the preoperative evaluation and counselling process, making them ideal leaders in perioperative medicine.

  19. Effects of Clown Doctors on child and caregiver anxiety at the entrance to the surgery care unit and separation from caregivers

    OpenAIRE

    Patrícia Arriaga; Catarina Pacheco

    2016-01-01

    This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care). Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children’s anxiety, while the State-Trait Anxiet...

  20. Interaction model for 3D cutting in maxillofacial surgery planning

    Science.gov (United States)

    Neumann, Patrick; Siebert, Dirk; Schulz, Armin; Faulkner, Gabriele; Krauss, Manfred; Tolxdorff, Thomas

    1999-05-01

    Our main research work is the realization of a completely computer-based maxillofacial surgery planning system. An important step toward this goal is the availability of virtual tools for the surgeon to interactively define bone segments from skull and jaw bones. The easy-to-handle user interface employs visual and force-feedback devices to define subvolumes of a patient's volume dataset. The defined subvolumes together with their spatial arrangements lead to an operation plan. We have evaluated modern low-cost, force- feedback devices with regard to their ability to emulate the surgeon's working procedure.

  1. [Evaluation of flipped classroom teaching model in undergraduates education of oral and maxillofacial surgery].

    Science.gov (United States)

    Cai, Ming; Cao, Xia; Fang, Xiao; Wang, Xu-dong; Zhang, Li-li; Zheng, Jia-wei; Shen, Guo-fang

    2015-12-01

    Flipped classroom is a new teaching model which is different from the traditional teaching method. The history and characteristics of flipped classroom teaching model were introduced in this paper. A discussion on how to establish flipped classroom teaching protocol in oral and maxillofacial surgery education was carried out. Curriculum transformation, construction of education model and possible challenges were analyzed and discussed.

  2. Serving transgender people: clinical care considerations and service delivery models in transgender health.

    Science.gov (United States)

    Wylie, Kevan; Knudson, Gail; Khan, Sharful Islam; Bonierbale, Mireille; Watanyusakul, Suporn; Baral, Stefan

    2016-07-23

    The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in transgender health, although the best evidence supports introducing modules on transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in transgender health-care decisions, effective models of health service provision, and available surgical interventions for transgender people.

  3. Gender-affirming Surgeries in the Era of Insurance Coverage: Developing a Framework for Psychosocial Support and Care Navigation in the Perioperative Period.

    Science.gov (United States)

    Deutsch, Madeline B

    2016-01-01

    Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs.

  4. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation : two year results of a randomised controlled trial

    NARCIS (Netherlands)

    Peul, W.C.; Hout, van den W.B.; Brand, R.; Thomeer, R.T.W.M.; Koes, B.W.

    2008-01-01

    Objectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. Interventions

  5. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: Two year results of a randomised controlled trial

    NARCIS (Netherlands)

    W.C. Peul (Wilco); W.B. van den Hout (Wilbert); R. Brand (René); R.T.W.M. Thomeer (Raph); B.W. Koes (Bart)

    2008-01-01

    textabstractObjectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. I

  6. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial.

    NARCIS (Netherlands)

    Peul, W.C.; Hout, W.B. van den; Brand, R.; Thomeer, R.T.; Koes, B.W.; Eekhof, J.A.H.; Tans, J.T.; Houwelingen, H.C. van; Nuyten, M.; Bergman, P.; Holtkamp, G.; Dukker, S.; Mast, A.; Smakman, L.; Waanders, C.; Polak, P.; Nieborg, A.; Walchenbach, R.; Rossum, J. van; Schutte, P.J.; Verheul, G.A.; Dalman, J.A.; Wurzer, J.A.; Sven, J.W.; Kloet, A.; Merkies, I.S.; Dulken, H. van; Lambrechts, P.C.; Keunen, R.W.; Hoffmann, C.; Haan, J.; Groen, R.; Kuiters, R.R.; Roos, R.A.C.; Voormolen, J.H.

    2008-01-01

    OBJECTIVES: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. DESIGN: Randomised controlled trial. SETTING: Nine Dutch hospitals. PARTICIPANTS: 283 patients with 6-12 weeks of sciatica. INTERVENTIONS

  7. A Conceptual Model for Episodes of Acute, Unscheduled Care.

    Science.gov (United States)

    Pines, Jesse M; Lotrecchiano, Gaetano R; Zocchi, Mark S; Lazar, Danielle; Leedekerken, Jacob B; Margolis, Gregg S; Carr, Brendan G

    2016-10-01

    We engaged in a 1-year process to develop a conceptual model representing an episode of acute, unscheduled care. Acute, unscheduled care includes acute illnesses (eg, nausea and vomiting), injuries, or exacerbations of chronic conditions (eg, worsening dyspnea in congestive heart failure) and is delivered in emergency departments, urgent care centers, and physicians' offices, as well as through telemedicine. We began with a literature search to define an acute episode of care and to identify existing conceptual models used in health care. In accordance with this information, we then drafted a preliminary conceptual model and collected stakeholder feedback, using online focus groups and concept mapping. Two technical expert panels reviewed the draft model, examined the stakeholder feedback, and discussed ways the model could be improved. After integrating the experts' comments, we solicited public comment on the model and made final revisions. The final conceptual model includes social and individual determinants of health that influence the incidence of acute illness and injury, factors that affect care-seeking decisions, specific delivery settings where acute care is provided, and outcomes and costs associated with the acute care system. We end with recommendations for how researchers, policymakers, payers, patients, and providers can use the model to identify and prioritize ways to improve acute care delivery.

  8. Adapting chronic care models for diabetes care delivery inlow-and-middle-income countries: A review

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    A contextual review of models for chronic care was doneto develop a context-adapted chronic care model-basedservice delivery model for chronic conditions includingdiabetes. The Philippines was used as the setting ofa low-to-middle-income country. A context-basednarrative review of existing models for chronic carewas conducted. A situational analysis was done at thegrassroots level, involving the leaders and members ofthe community, the patients, the local health system andthe healthcare providers. A second analysis making useof certain organizational theories was done to explore onimproving feasibility and acceptability of organizing carefor chronic conditions. The analyses indicated that carefor chronic conditions may be introduced, consideringthe needs of people with diabetes in particular andthe community in general as recipients of care, andthe issues and factors that may affect the healthcareworkers and the health system as providers of thiscare. The context-adapted chronic care model-basedservice delivery model was constructed accordingly.Key features are incorporation of chronic care in thehealth system's services; assimilation of chronic caredelivery with the other responsibilities of the healthcareworkers but with redistribution of certain tasks; andensuring that the recipients of care experience thewhole spectrum of basic chronic care that includes educationand promotion in the general population, riskidentification, screening, counseling including self-caredevelopment, and clinical management of the chroniccondition and any co-morbidities, regardless of level ofcontrol of the condition. This way, low-to-middle incomecountries can introduce and improve care for chronicconditions without entailing much additional demand ontheir limited resources.

  9. Methodology of the Access to Care and Timing Simulation Model for Traumatic Spinal Cord Injury Care.

    Science.gov (United States)

    Santos, Argelio; Fallah, Nader; Lewis, Rachel; Dvorak, Marcel F; Fehlings, Michael G; Burns, Anthony Scott; Noonan, Vanessa K; Cheng, Christiana L; Chan, Elaine; Singh, Anoushka; Belanger, Lise M; Atkins, Derek

    2017-03-12

    Despite the relatively low incidence, the management and care of persons with traumatic spinal cord injury (tSCI) can be resource intensive and complex, spanning multiple phases of care and disciplines. Using a simulation model built with a system level view of the healthcare system allows for prediction of the impact of interventions on patient and system outcomes from injury through to community reintegration after tSCI. The Access to Care and Timing (ACT) project developed a simulation model for tSCI care using techniques from operations research and its development has been described previously. The objective of this article is to briefly describe the methodology and the application of the ACT Model as it was used in several of the articles in this focus issue. The approaches employed in this model provide a framework to look into the complexity of interactions both within and among the different SCI programs, sites and phases of care.

  10. Organizational effectiveness. Primary care and the congruence model.

    Science.gov (United States)

    Eiser, A R; Eiser, B J

    1996-10-01

    The congruence model is a framework used to analyze organizational strengths and weaknesses and pinpoint specific areas for improving effectiveness. This article provides an overview of organizations as open systems, with examples in the primary care arena. It explains and applies the congruence model in the context of primary care issues and functions, including methods by which the model can be used to diagnose organizational problems and generate solutions. Changes needed in primary care due to the managed care environment, and areas of potential problems and sensitivities requiring organizational changes to meet market and regulatory demands now placed on PCOs are examined.

  11. ANALYSIS OF METHODS OF AIRWAY MANAGEMENT IN MAXILLOFACIAL SURGERIES IN A TERTIARY CARE CENTRE AT PUDUCHERRY

    Directory of Open Access Journals (Sweden)

    Joseph Raajesh

    2016-02-01

    Full Text Available BACKGROUND Anaesthetic management of patients with oromaxillofacial surgeries poses quite a few challenges to both anaesthesiologist and operating surgeons. This is because the corrective procedure demands fixation of fractures, repair of soft tissue injuries and maintaining occlusion all without compromising the cosmetic aspect. Though securing the airway takes the precedence, it is of paramount importance that it should not interfere with the surgical techniques. METHODS Seventy one patients of maxillofacial injuries, operated over a period of five years between February 2011 and December 2015 in Indira Gandhi Medical College Hospital at Puducherry were reviewed. All patients were reviewed in relation to age, type of injury, etiology, bones involved and method of airway management. RESULTS The major etiology of injuries were road traffic accidents (79%. Majority of patients were young in the age group of 21-40 years (55%. Fracture mandible (46% was the most common injury. Airway secured by nasotracheal route with direct visualization of vocal cords was the most common (90%, followed by submental route (10%. CONCLUSION This analysis showed in maxillofacial procedures, trauma is the leading cause in this part of India also. Male preponderance, maximum injuries are seen in third and fourth decade of life and other findings that are correlating well with other studies. Nasotracheal intubation is the method of choice in securing the airway during the maxillofacial procedures. Submental intubation can be considered as a viable option when nasotracheal intubation is not possible due to the involvement of base of the skull or midfacial fractures.

  12. Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care

    Directory of Open Access Journals (Sweden)

    Vincent Q. Trinh

    2016-01-01

    Full Text Available Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS. Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS, a Healthcare Cost and Utilization Project (HCUP subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P<0.001; the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P=0.01. Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.

  13. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by ... Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic ...

  14. A patient-centered care ethics analysis model for rehabilitation.

    Science.gov (United States)

    Hunt, Matthew R; Ells, Carolyn

    2013-09-01

    There exists a paucity of ethics resources tailored to rehabilitation. To help fill this ethics resource gap, the authors developed an ethics analysis model specifically for use in rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a process model to guide careful moral reasoning for particularly complex or challenging matters in rehabilitation. The Patient-Centered Care Ethics Analysis Model for Rehabilitation was developed over several iterations, with feedback at different stages from rehabilitation professionals and bioethics experts. Development of the model was explicitly informed by the theoretical grounding of patient-centered care and the context of rehabilitation, including the International Classification of Functioning, Disability and Health. Being patient centered, the model encourages (1) shared control of consultations, decisions about interventions, and management of the health problems with the patient and (2) understanding the patient as a whole person who has individual preferences situated within social contexts. Although the major process headings of the Patient-Centered Care Ethics Analysis Model for Rehabilitation resemble typical ethical decision-making and problem-solving models, the probes under those headings direct attention to considerations relevant to rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a suitable tool for rehabilitation professionals to use (in real time, for retrospective review, and for training purposes) to help arrive at ethical outcomes.

  15. Tests and visits before surgery

    Science.gov (United States)

    Before surgery - tests; Before surgery - doctor visits ... Pre-op is the time before your surgery. It means "before operation." During this time, you will meet with one of your doctors. This may be your surgeon or primary care ...

  16. The shifting landscape of health care: toward a model of health care empowerment.

    Science.gov (United States)

    Johnson, Mallory O

    2011-02-01

    In a rapidly changing world of health care information access and patients' rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities.

  17. The Effect of Using Peplau's Therapeutic Relationship Model on Anxiety of Coronary Artery Bypass Graft Surgery Candidates

    Directory of Open Access Journals (Sweden)

    Maghsoodi

    2014-08-01

    Full Text Available Background Anxiety is a one of the psychological aftereffect of cardiac surgery, which affects the outcome of treatment. One of the most effective ways to reduce anxiety is to train and establish a targeted relationship based on a functional model. Objectives The present study aimed to determine the effect of Peplau's therapeutic relationship model on anxiety of patients who were candidate for coronary artery bypass graft surgery (CABG. Patients and Methods In this clinical trial, 74 patients were enrolled according to eligibility criteria and were randomly allocated to intervention and control groups of 37 people. We evaluated anxiety of the patients using the Beck anxiety inventory before, immediately after, and two and four months after intervention. Based on Peplau's therapeutic relationship model, therapeutic communication sessions were conducted in four phases during seven sessions. Data analysis was performed with the statistical test of covariance analysis using SPSS version 16. Results The results of our study showed that after therapeutic communication, the mean score of anxiety decreased from 30.35 to 25.38 in the intervention group (P < 0.001, while the scores decreased from 33.22 to 31.46 in the control group. Furthermore, the mean score of anxiety in the intervention group decreased at two and four months after the intervention. Conclusions The findings showed a positive effect of therapeutic relationship based on Peplau's model on reducing anxiety of patients undergoing CABG. Therefore, health care teams, including nurses, should take advantage of appropriate communication with patients in their care procedures. In that regard, Peplau's communication model is recommended as a simple, low-cost, and efficient method.

  18. Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial.

    Science.gov (United States)

    Boitor, Mădălina; Martorella, Géraldine; Arbour, Caroline; Michaud, Cécile; Gélinas, Céline

    2015-06-01

    Although many intensive care unit patients experience significant pain, very few studies explored massage to maximize their pain relief. This study aimed to evaluate the preliminary effects of hand massage on pain after cardiac surgery in the adult intensive care unit. A pilot randomized controlled trial was used for this study. The study was conducted in a Canadian medical-surgical intensive care unit. Forty adults who were admitted to the intensive care unit after undergoing elective cardiac surgery in the previous 24 hours participated in the study. They were randomly assigned to the experimental (n = 21) or control (n = 19) group. The experimental group received a 15-minute hand massage, and the control group received a 15-minute hand-holding without massage. In both groups the intervention was followed by a 30-minute rest period. The interventions were offered on 2-3 occasions within 24 hours after surgery. Pain, muscle tension, and vital signs were assessed. Pain intensity and behavioral scores were decreased for the experimental group. Although hand massage decreased muscle tension, fluctuations in vital signs were not significant. This study supports potential benefits of hand massage for intensive care unit postoperative pain management. Although larger randomized controlled trials are necessary, this low-cost nonpharmacologic intervention can be safely administered.

  19. Counseling People Living in Poverty: The CARE Model

    Science.gov (United States)

    Foss, Louisa L.; Generali, Margaret M.; Kress, Victoria E.

    2011-01-01

    Counselors frequently counsel clients who live in poverty. The authors describe the new CARE model that addresses the influence of multiple systems on poor clients' experiences. A social justice, humanistic intervention, the CARE model emphasizes cultivating a positive counseling relationship with poor clients, empathizing with their unique…

  20. Comparison and clinical suitability of eight prediction models for cardiac surgery-related acute kidney injury

    NARCIS (Netherlands)

    Kiers, H.D.; Boogaard, M.H.W.A. van den; Schoenmakers, M.C.J.; Hoeven, J.G. van der; Swieten, H.A. van; Heemskerk, S.; Pickkers, P.

    2013-01-01

    BACKGROUND: Cardiac surgery-related acute kidney injury (CS-AKI) results in increased morbidity and mortality. Different models have been developed to identify patients at risk of CS-AKI. While models that predict dialysis and CS-AKI defined by the RIFLE criteria are available, their predictive powe

  1. Real-time volumetric deformable models for surgery simulation using finite elements and condensation

    DEFF Research Database (Denmark)

    Bro-Nielsen, Morten; Cotin, S.

    1996-01-01

    This paper discusses the application of SD solid volumetric Finite Element models to surgery simulation. In particular it introduces three new ideas for solving the problem of achieving real-time performance for these models. The simulation system we have developed is described and we demonstrate...

  2. Correction, improvement and model verification of CARE 3, version 3

    Science.gov (United States)

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

    1987-01-01

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

  3. Creating A Sustainable Model of Spine Care in Underserved Communities

    DEFF Research Database (Denmark)

    Haldeman, Scott; Nordin, Margareta; Outerbridge, Geoff

    2015-01-01

    The world lacks sustainable models of care to manage spinal disorders in poor and underserved communities. The purpose of this article is to: (1) review the rationale and importance of developing a sustainable evidence-based model of care at low cost for people with spinal disorders in underserved...... leadership, research and a model of care, there is an opportunity to help reduce the burden of the leading cause of disability in the world....... adequate care, World Spine Care (WSC) was established to "improve lives in underserved communities through sustainable, integrated, evidence-based, spinal care." WSC is comprised of volunteers and institutions from 6 continents and several countries, and incorporates a Board of Directors, an executive...

  4. Childhood craniopharyngioma: greater hypothalamic involvement before surgery is associated with higher homeostasis model insulin resistance index

    Directory of Open Access Journals (Sweden)

    Sainte-Rose Christian

    2009-04-01

    Full Text Available Abstract Background Obesity seems to be linked to the hypothalamic involvement in craniopharyngioma. We evaluated the pre-surgery relationship between the degree of this involvement on magnetic resonance imaging and insulin resistance, as evaluated by the homeostasis model insulin resistance index (HOMA. As insulin-like growth factor 1, leptin, soluble leptin receptor (sOB-R and ghrelin may also be involved, we compared their plasma concentrations and their link to weight change. Methods 27 children with craniopharyngioma were classified as either grade 0 (n = 7, no hypothalamic involvement, grade 1 (n = 8, compression without involvement, or grade 2 (n = 12, severe involvement. Results Despite having similar body mass indexes (BMI, the grade 2 patients had higher glucose, insulin and HOMA before surgery than the grade 0 (P = 0.02, The data for the whole population before and 6–18 months after surgery showed increases in BMI (P Conclusion The hypothalamic involvement by the craniopharyngioma before surgery seems to determine the degree of insulin resistance, regardless of the BMI. The pre-surgery HOMA values were correlated with the post-surgery weight gain. This suggests that obesity should be prevented by reducing inn secretion in those cases with hypothalamic involvement.

  5. Center of Cardiac Surgery Robotic Computerized Telemanipulation as Part of a Comprehensive Approach to Advanced Heart Care

    Science.gov (United States)

    2011-10-01

    Robotic OR Appendix E: Comparison Chart of daVinci Simulator Skill Sets and Training Exercise Activities 1 INTRODUCTION Robotic surgery recently...techniques in endoscopic cardiac bypass surgery is important not only for surgeons and surgical teams just beginning to perform robotic surgery , but also...Director, Robotic Surgery Scott Keith, PhD Faculty, Division of Biostatistics Rebecca O’Shea, MBA Senior Vice President for Clinical

  6. Children's health care assistance according to their families: a comparison between models of Primary Care

    Directory of Open Access Journals (Sweden)

    Vanessa Bertoglio Comassetto Antunes de Oliveira

    2015-02-01

    Full Text Available OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS with the Family Health Strategy (ESF units for presence and extent of attributes of Primary Health Care (APS, specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care, but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil.

  7. Mechanisms underlying weight loss and metabolic improvements in rodent models of bariatric surgery.

    Science.gov (United States)

    Arble, Deanna M; Sandoval, Darleen A; Seeley, Randy J

    2015-02-01

    Obesity is a growing health risk with few successful treatment options and fewer still that target both obesity and obesity-associated comorbidities. Despite ongoing scientific efforts, the most effective treatment option to date was not developed from basic research but by surgeons observing outcomes in the clinic. Bariatric surgery is the most successful treatment for significant weight loss, resolution of type 2 diabetes and the prevention of future weight gain. Recent work with animal models has shed considerable light on the molecular underpinnings of the potent effects of these 'metabolic' surgical procedures. Here we review data from animal models and how these studies have evolved our understanding of the critical signalling systems that mediate the effects of bariatric surgery. These insights could lead to alternative therapies able to accomplish effects similar to bariatric surgery in a less invasive manner.

  8. Development and feasibility of a set of quality indicators relative to the timeliness and organisation of care for new breast cancer patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Ferrua Marie

    2012-06-01

    Full Text Available Abstract Background Because breast cancer is a major public health issue, it is particularly important to measure the quality of the care provided to patients. Survival rates are affected by the timeliness of care, and waiting times constitute key quality criteria. The aim of this study was to develop and validate a set of quality indicators (QIs relative to the timeliness and organisation of care in new patients with infiltrating, non-inflammatory and metastasis-free breast cancer undergoing surgery. The ultimate aim was to use these QIs to compare hospitals. Methods The method of QI construction and testing was developed by COMPAQ-HPST. We first derived a set of 8 QIs from consensus guidelines with the aid of experts and professional associations and then tested their metrological properties in a panel of 60 volunteer hospitals. We assessed feasibility using a grid exploring 5 dimensions, discriminatory power using the Gini coefficient as a measure of dispersion, and inter-observer reliability using the Kappa coefficient. Results Overall, 3728 records were included in the analyses. All 8 QIs showed acceptable feasibility (but one QI was subject to misinterpretation, fairly strong agreement between observers (Kappa = 0.66, and wide variations in implementation among hospitals (Gini coefficient  Conclusions Of the 8 QIs, 3 are ready for nationwide implementation (time to surgery, time to postoperative multidisciplinary team meeting (MDTM, conformity of MDTM. Four are suitable for use only in hospitals offering surgery with on-site postoperative treatment (waiting time to first appointment after surgery, patient information, time to first postoperative treatment, and traceability of information relating to prognosis. Currently, in the French healthcare system, a patient receives cancer care from different institutions whose databases cannot as yet be easily merged. Nationwide implementation of QIs covering the entire care pathway will thus

  9. Simultaneous modelling of operative mortality and long-term survival after coronary artery bypass surgery.

    Science.gov (United States)

    Ghahramani, M; Dean, C B; Spinelli, J J

    2001-07-15

    Typical analyses of lifetime data treat the time to death or failure as the response variable and use a variety of modelling strategies such as proportional hazards or fully parametric, to investigate the relationship between the response and covariates. In certain circumstances it may be more natural to view the distribution of the response variable as consisting of two or more parts since the survival curve appears segmented. This article addresses such a scenario and we propose a model for simultaneously investigating the effects of covariates over the two segments. The model is an analogue of that proposed by Lambert for zero-inflated Poisson regression. The application is central to the model development and is concerned with survival after coronary artery bypass surgery. Here operative mortality, defined as death within 30 days after surgery, and long-term mortality, are viewed as distinct outcomes. For the application considered, the survivor function displays much steeper descent during the first 30 days after surgery, that is, for operative mortality, than after this period. An investigation of the effects of covariates on operative and long-term mortality after coronary artery bypass surgery illustrates the usefulness of the proposed model.

  10. Prehospital care and new models of regionalization.

    Science.gov (United States)

    Cone, David C; Brooke Lerner, E; Band, Roger A; Renjilian, Chris; Bobrow, Bentley J; Crawford Mechem, C; Carter, Alix J E; Kupas, Douglas F; Spaite, Daniel W

    2010-12-01

    This article summarizes the discussions of the emergency medical services (EMS) breakout session at the June 2010 Academic Emergency Medicine consensus conference "Beyond Regionalization: Integrated Networks of Emergency Care." The group focused on prehospital issues such as the identification of patients by EMS personnel, protocol-driven destination selection, bypassing closer nondesignated centers to transport patients directly to more distant designated specialty centers, and the modes of transport to be used as they relate to the regionalization of emergency care. It is our hope that the proposed research agenda will be advanced in a way that begins to rigorously approach the unanswered research questions and that these answers, in turn, will lead to an evidence-based, cohesive, comprehensive, and more uniform set of guidelines that govern the delivery and practice of prehospital emergency care.

  11. Better Patient Care At High-Quality Hospitals May Save Medicare Money And Bolster Episode-Based Payment Models.

    Science.gov (United States)

    Tsai, Thomas C; Greaves, Felix; Zheng, Jie; Orav, E John; Zinner, Michael J; Jha, Ashish K

    2016-09-01

    US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality. We found that patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions, for both thirty- and ninety-day periods. The difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5 percent of the difference in thirty-day episode spending, and readmissions, which accounted for 19.9 percent. These findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care.

  12. Toward population management in an integrated care model.

    Science.gov (United States)

    Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

    2013-01-01

    Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative.

  13. A simple clinical model for planning transfusion quantities in heart surgery

    Directory of Open Access Journals (Sweden)

    Biagioli Bonizella

    2011-06-01

    Full Text Available Abstract Background Patients undergoing heart surgery continue to be the largest demand on blood transfusions. The need for transfusion is based on the risk of complications due to poor cell oxygenation, however large transfusions are associated with increased morbidity and risk of mortality in heart surgery patients. The aim of this study was to identify preoperative and intraoperative risk factors for transfusion and create a reliable model for planning transfusion quantities in heart surgery procedures. Methods We performed an observational study on 3315 consecutive patients who underwent cardiac surgery between January 2000 and December 2007. To estimate the number of packs of red blood cells (PRBC transfused during heart surgery, we developed a multivariate regression model with discrete coefficients by selecting dummy variables as regressors in a stepwise manner. Model performance was assessed statistically by splitting cases into training and testing sets of the same size, and clinically by investigating the clinical course details of about one quarter of the patients in whom the difference between model estimates and actual number of PRBC transfused was higher than the root mean squared error. Results Ten preoperative and intraoperative dichotomous variables were entered in the model. Approximating the regression coefficients to the nearest half unit, each dummy regressor equal to one gave a number of half PRBC. The model assigned 4 units for kidney failure requiring preoperative dialysis, 2.5 units for cardiogenic shock, 2 units for minimum hematocrit at cardiopulmonary bypass less than or equal to 20%, 1.5 units for emergency operation, 1 unit for preoperative hematocrit less than or equal to 40%, cardiopulmonary bypass time greater than 130 minutes and type of surgery different from isolated artery bypass grafting, and 0.5 units for urgent operation, age over 70 years and systemic arterial hypertension. Conclusions The regression

  14. Does point of care prothrombin time measurement reduce the transfusion of fresh frozen plasma in patients undergoing major surgery? The POC-OP randomized-controlled trial

    Directory of Open Access Journals (Sweden)

    Alberio Lorenzo

    2009-11-01

    Full Text Available Abstract Background Bleeding is a frequent complication during surgery. The intraoperative administration of blood products, including packed red blood cells, platelets and fresh frozen plasma (FFP, is often live saving. Complications of blood transfusions contribute considerably to perioperative costs and blood product resources are limited. Consequently, strategies to optimize the decision to transfuse are needed. Bleeding during surgery is a dynamic process and may result in major blood loss and coagulopathy due to dilution and consumption. The indication for transfusion should be based on reliable coagulation studies. While hemoglobin levels and platelet counts are available within 15 minutes, standard coagulation studies require one hour. Therefore, the decision to administer FFP has to be made in the absence of any data. Point of care testing of prothrombin time ensures that one major parameter of coagulation is available in the operation theatre within minutes. It is fast, easy to perform, inexpensive and may enable physicians to rationally determine the need for FFP. Methods/Design The objective of the POC-OP trial is to determine the effectiveness of point of care prothrombin time testing to reduce the administration of FFP. It is a patient and assessor blind, single center randomized controlled parallel group trial in 220 patients aged between 18 and 90 years undergoing major surgery (any type, except cardiac surgery and liver transplantation with an estimated blood loss during surgery exceeding 20% of the calculated total blood volume or a requirement of FFP according to the judgment of the physicians in charge. Patients are randomized to usual care plus point of care prothrombin time testing or usual care alone without point of care testing. The primary outcome is the relative risk to receive any FFP perioperatively. The inclusion of 110 patients per group will yield more than 80% power to detect a clinically relevant relative risk

  15. An Experimental Animal Model for Abdominal Fascia Healing after Surgery

    DEFF Research Database (Denmark)

    Burcharth, J; Pommergaard, H-C; Klein, M

    2013-01-01

    Background: Incisional hernia (IH) is a well-known complication after abdominal surgical procedures. The exact etiology of IH is still unknown even though many risk factors have been suggested. The aim of this study was to create an animal model of a weakly healed abdominal fascia that could...... be used to evaluate the actively healing fascia. Such an animal model may promote future research in the prevention of IH. Methods: 86 male Sprague-Dawley rats were used to establish a model involving six experiments (experiments A-F). Mechanical testing of the breaking strength of the healed fascia...... of mechanical breaking strength. This new animal model employed myofascial closing after a full thickness abdominal incision using a running suture with fast-absorbable suture material. This technique produced a weak myofascial layer compared with the control tissue measured in terms of breaking strength after...

  16. Orbital and Maxillofacial Computer Aided Surgery: Patient-Specific Finite Element Models To Predict Surgical Outcomes

    CERN Document Server

    Luboz, V; Swider, P; Payan, Y; Luboz, Vincent; Chabanas, Matthieu; Swider, Pascal; Payan, Yohan

    2005-01-01

    This paper addresses an important issue raised for the clinical relevance of Computer-Assisted Surgical applications, namely the methodology used to automatically build patient-specific Finite Element (FE) models of anatomical structures. From this perspective, a method is proposed, based on a technique called the Mesh-Matching method, followed by a process that corrects mesh irregularities. The Mesh-Matching algorithm generates patient-specific volume meshes from an existing generic model. The mesh regularization process is based on the Jacobian matrix transform related to the FE reference element and the current element. This method for generating patient-specific FE models is first applied to Computer-Assisted maxillofacial surgery, and more precisely to the FE elastic modelling of patient facial soft tissues. For each patient, the planned bone osteotomies (mandible, maxilla, chin) are used as boundary conditions to deform the FE face model, in order to predict the aesthetic outcome of the surgery. Seven F...

  17. The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality.

    Science.gov (United States)

    Fennell, Mary L; Das, Irene Prabhu; Clauser, Steven; Petrelli, Nicholas; Salner, Andrew

    2010-01-01

    Quality cancer treatment depends upon careful coordination between multiple treatments and treatment providers, the exchange of technical information, and regular communication between all providers and physician disciplines involved in treatment. This article will examine a particular type of organizational structure purported to regularize and streamline the communication between multiple specialists and support services involved in cancer treatment: the multidisciplinary treatment care (MDC) team. We present a targeted review of what is known about various types of MDC team structures and their impact on the quality of treatment care, and we outline a conceptual model of the connections between team context, structure, process, and performance and their subsequent effects on cancer treatment care processes and patient outcomes. Finally, we will discuss future research directions to understand how MDC teams improve patient outcomes and how characteristics of team structure, culture, leadership, and context (organizational setting and local environment) contribute to optimal multidisciplinary cancer care.

  18. Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2013-11-01

    Full Text Available Stacey J Ackerman1, David W Polly Jr2, Tyler Knight3, Karen Schneider4, Tim Holt5, John Cummings61Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Covance Market Access Services Inc, Sydney, NSW, Australia; 5Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USAIntroduction: The economic burden associated with the treatment of low back pain (LBP in the United States is significant. LBP caused by sacroiliac (SI joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS options may offer potential cost savings to Medicare.Methods: An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG payments of $46,700 (with major complications - DRG 459 and $27,800 (without major complications - DRG 460, weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were

  19. A new model to predict acute kidney injury requiring renal replacement therapy after cardiac surgery

    Science.gov (United States)

    Pannu, Neesh; Graham, Michelle; Klarenbach, Scott; Meyer, Steven; Kieser, Teresa; Hemmelgarn, Brenda; Ye, Feng; James, Matthew

    2016-01-01

    Background: Acute kidney injury after cardiac surgery is associated with adverse in-hospital and long-term outcomes. Novel risk factors for acute kidney injury have been identified, but it is unknown whether their incorporation into risk models substantially improves prediction of postoperative acute kidney injury requiring renal replacement therapy. Methods: We developed and validated a risk prediction model for acute kidney injury requiring renal replacement therapy within 14 days after cardiac surgery. We used demographic, and preoperative clinical and laboratory data from 2 independent cohorts of adults who underwent cardiac surgery (excluding transplantation) between Jan. 1, 2004, and Mar. 31, 2009. We developed the risk prediction model using multivariable logistic regression and compared it with existing models based on the C statistic, Hosmer–Lemeshow goodness-of-fit test and Net Reclassification Improvement index. Results: We identified 8 independent predictors of acute kidney injury requiring renal replacement therapy in the derivation model (adjusted odds ratio, 95% confidence interval [CI]): congestive heart failure (3.03, 2.00–4.58), Canadian Cardiovascular Society angina class III or higher (1.66, 1.15–2.40), diabetes mellitus (1.61, 1.12–2.31), baseline estimated glomerular filtration rate (0.96, 0.95–0.97), increasing hemoglobin concentration (0.85, 0.77–0.93), proteinuria (1.65, 1.07–2.54), coronary artery bypass graft (CABG) plus valve surgery (v. CABG only, 1.25, 0.64–2.43), other cardiac procedure (v. CABG only, 3.11, 2.12–4.58) and emergent status for surgery booking (4.63, 2.61–8.21). The 8-variable risk prediction model had excellent performance characteristics in the validation cohort (C statistic 0.83, 95% CI 0.79–0.86). The net reclassification improvement with the prediction model was 13.9% (p < 0.001) compared with the best existing risk prediction model (Cleveland Clinic Score). Interpretation: We have developed

  20. Virtual skeletal complex model- and landmark-guided orthognathic surgery system.

    Science.gov (United States)

    Lee, Sang-Jeong; Woo, Sang-Yoon; Huh, Kyung-Hoe; Lee, Sam-Sun; Heo, Min-Suk; Choi, Soon-Chul; Han, Jeong Joon; Yang, Hoon Joo; Hwang, Soon Jung; Yi, Won-Jin

    2016-05-01

    In this study, correction of the maxillofacial deformities was performed by repositioning bone segments to an appropriate location according to the preoperative planning in orthognathic surgery. The surgery was planned using the patient's virtual skeletal models fused with optically scanned three-dimensional dentition. The virtual maxillomandibular complex (MMC) model of the patient's final occlusal relationship was generated by fusion of the maxillary and mandibular models with scanned occlusion. The final position of the MMC was simulated preoperatively by planning and was used as a goal model for guidance. During surgery, the intraoperative registration was finished immediately using only software processing. For accurate repositioning, the intraoperative MMC model was visualized on the monitor with respect to the simulated MMC model, and the intraoperative positions of multiple landmarks were also visualized on the MMC surface model. The deviation errors between the intraoperative and the final positions of each landmark were visualized quantitatively. As a result, the surgeon could easily recognize the three-dimensional deviation of the intraoperative MMC state from the final goal model without manually applying a pointing tool, and could also quickly determine the amount and direction of further MMC movements needed to reach the goal position. The surgeon could also perform various osteotomies and remove bone interference conveniently, as the maxillary tracking tool could be separated from the MMC. The root mean square (RMS) difference between the preoperative planning and the intraoperative guidance was 1.16 ± 0.34 mm immediately after repositioning. After surgery, the RMS differences between the planning and the postoperative computed tomographic model were 1.31 ± 0.28 mm and 1.74 ± 0.73 mm for the maxillary and mandibular landmarks, respectively. Our method provides accurate and flexible guidance for bimaxillary orthognathic surgery based on

  1. The Effect of Mobile App Follow-up Care on the Number of In-person Visits Following Ambulatory Surgery: A Randomized Control Trial.

    Science.gov (United States)

    Armstrong, Kathleen; Coyte, Peter; Semple, John

    2015-01-01

    Women's College Hospital (WCH) in Toronto offers specialized ambulatory surgical procedures. A feasibility study using a mobile appliciation (app) to supplement in-person follow-up care after surgery suggests that the mobile app adequately detects postoperative complications, eliminates the need for in-person follow-up care and is cost-effective. This is concordant with other postoperative telemedicine studies. The purpose of this study is to determine if we can avert in-person follow-up care through the use of mobile app compared to conventional, in-person follow-up care in the first month following surgery amongst breast reconstruction patients at WCH. This will be a pragmatic, single-centre, open, controlled, 2-arm parallel-group superiority randomized trial. Mobile app follow-up care is a novel approach to managing patients postoperatively with the potential to avert in-person follow-up and generate cost-savings for the healthcare system and patient.

  2. Roles and responsibilities in the secondary level eye care model

    Directory of Open Access Journals (Sweden)

    Saibaba Saravanan

    2005-12-01

    Full Text Available In any secondary level eye care clinic, a number of tasks must be completed. In different countries and different settings, different people will carry out these tasks. The manager is responsible for ensuring that all the tasks are covered, that people are carefully selected to perform them, and that staff are supported and managed. The International Centre for Advancement of Rural Eye Care (ICARE, within the L.V. Prasad Eye Institute (LVPEI in India, has evolved an eye care team to provide secondary level eye care services to a population of 0.5 to 1 million. The ICARE model emphasises that all cadres of clinical and non-clinical personnel are equally important. Below is a description of the range of jobs at secondary level centres. The tertiary centre at LVPEI manages leadership and training for this model.

  3. A new model for health care delivery

    Directory of Open Access Journals (Sweden)

    Kepros John P

    2009-04-01

    Full Text Available Abstract Background The health care delivery system in the United States is facing cost and quality pressures that will require fundamental changes to remain viable. The optimal structures of the relationships between the hospital, medical school, and physicians have not been determined but are likely to have a large impact on the future of healthcare delivery. Because it is generally agreed that academic medical centers will play a role in the sustainability of this future system, a fundamental understanding of the relative contributions of the stakeholders is important as well as creativity in developing novel strategies to achieve a shared vision. Discussion Core competencies of each of the stakeholders (the hospital, the medical school and the physicians must complement the others and should act synergistically. At the same time, the stakeholders should determine the common core values and should be able to make a meaningful contribution to the delivery of health care. Summary Health care needs to achieve higher quality and lower cost. Therefore, in order for physicians, medical schools, and hospitals to serve the needs of society in a gratifying way, there will need to be change. There needs to be more scientific and social advances. It is obvious that there is a real and urgent need for relationship building among the professionals whose duty it is to provide these services.

  4. The Cardiovascular Intensive Care Unit-An Evolving Model for Health Care Delivery.

    Science.gov (United States)

    Loughran, John; Puthawala, Tauqir; Sutton, Brad S; Brown, Lorrel E; Pronovost, Peter J; DeFilippis, Andrew P

    2017-02-01

    Prior to the advent of the coronary care unit (CCU), patients having an acute myocardial infarction (AMI) were managed on the general medicine wards with reported mortality rates of greater than 30%. The first CCUs are believed to be responsible for reducing mortality attributed to AMI by as much as 40%. This drastic improvement can be attributed to both advances in medical technology and in the process of health care delivery. Evolving considerably since the 1960s, the CCU is now more appropriately labeled as a cardiac intensive care unit (CICU) and represents a comprehensive system designed for the care of patients with an array of advanced cardiovascular disease, an entity that reaches far beyond its early association with AMI. Grouping of patients by diagnosis to a common physical space, dedicated teams of health care providers, as well as the development and implementation of evidence-based treatment algorithms have resulted in the delivery of safer, more efficient care, and most importantly better patient outcomes. The CICU serves as a platform for an integrated, team-based patient care delivery system that addresses a broad spectrum of patient needs. Lessons learned from this model can be broadly applied to address the urgent need to improve outcomes and efficiency in a variety of health care settings.

  5. Animal models in bariatric surgery--a review of the surgical techniques and postsurgical physiology.

    Science.gov (United States)

    Rao, Raghavendra S; Rao, Venkatesh; Kini, Subhash

    2010-09-01

    Bariatric surgery is considered the most effective current treatment for morbid obesity. Since the first publication of an article by Kremen, Linner, and Nelson, many experiments have been performed using animal models. The initial experiments used only malabsorptive procedures like intestinal bypass which have largely been abandoned now. These experimental models have been used to assess feasibility and safety as well as to refine techniques particular to each procedure. We will discuss the surgical techniques and the postsurgical physiology of the four major current bariatric procedures (namely, Roux-en-Y gastric bypass, gastric banding, sleeve gastrectomy, and biliopancreatic diversion). We have also reviewed the anatomy and physiology of animal models. We have reviewed the literature and presented it such that it would be a reference to an investigator interested in animal experiments in bariatric surgery. Experimental animal models are further divided into two categories: large mammals that include dogs, cats, rabbits, and pig and small mammals that include rats and mice.

  6. Prometheus payment model: application to hip and knee replacement surgery.

    Science.gov (United States)

    Rastogi, Amita; Mohr, Beth A; Williams, Jeffery O; Soobader, Mah-Jabeen; de Brantes, Francois

    2009-10-01

    The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs. Of the 2076 commercially insured patients undergoing hip arthroplasty in our study, PAC costs totaled $7.8 million (14% of total costs; n = 699 index PAC stays). Similarly, PAC costs were $12.7 million (14% of total costs; n = 897 index PAC stays) for 3403 patients undergoing knee arthroplasty. By holding the providers clinically and financially responsible for PACs, and by segmenting and quantifying the type of PACs generated during and after the procedure, the Prometheus model creates an opportunity for providers to focus on the reduction of PACs, including readmissions, making the data actionable and turn the waste related to PAC costs into potential savings.

  7. Evaluation of an In Silico PBPK Post-Bariatric Surgery Model through Simulating Oral Drug Bioavailability of Atorvastatin and Cyclosporine

    OpenAIRE

    2013-01-01

    An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (F oral). In the absence of clinical data, an indication of changes to F oral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual “post-bariatric surgery” population was evaluated through mimicki...

  8. [The transformation of the healthcare model in Catalonia to improve the quality of care].

    Science.gov (United States)

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

    2015-11-01

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

  9. [Analysis of knowledge attitudes and practices of health care workers facing blood exposure accidents in a general surgery service].

    Science.gov (United States)

    Ennigrou, Samir; Ben Ameur Khechine, Imène; Cherif, Ali; Najah, Nabil; Ben Hamida, Abdelmajid

    2004-06-01

    In order to assess the degree of knowledge, attitudes and the personnel's practices exercising in a service of general surgery of the hospital Charles Nicolle of Tunis, concerning blood exposure accidents, we did a transverse survey during the month of January of the year 2002. A questionnaire has been addressed to 114 people while using the technique of the direct interview. The middle age of investigated is 35.7 years. The sex ratio is 0.7. Only the 2/3 declare have been vaccinated against the B hepatitis. The results show a good knowledge of the exposure risk to a communicable disease by blood (95.6%), but less good for the risk of contamination by the three viruses HBV, HCV and HIV. The resheathing of needles, considered like gesture to risk, is underestimated by 71.2% of investigated. The majority of investigated declare to know universal precaution principles (85.8%). However, to the maximum 4 measures only on the 10 advisable have been mentioned by investigated. The conduct to hold in case of blood exposure accident seems insufficiently known by our sample. It is represented, in 78.8% of cases, in the application of disinfectants Betadine type or alcohol iodized, whereas the practice of a serology to the patient source is ignored completely. 75% of investigated having had a blood exposure accident lasting the last 12 months (n = 44) didn't declare their blood exposure accident and only 11.4% declare to have undergone cares. Actions of information and formation, to the intention of the whole of the personnel of the service, on risks incurred by the nursing, gestures and procedures to risk, the universal precaution respect, the conduct to hold in case of a blood exposure accident, the interest of the declaration and the interest of the vaccination against the B hepatitis, are primordial.

  10. Minimally invasive measurement of cardiac output during surgery and critical care: a meta-analysis of accuracy and precision.

    Science.gov (United States)

    Peyton, Philip J; Chong, Simon W

    2010-11-01

    When assessing the accuracy and precision of a new technique for cardiac output measurement, the commonly quoted criterion for acceptability of agreement with a reference standard is that the percentage error (95% limits of agreement/mean cardiac output) should be 30% or less. We reviewed published data on four different minimally invasive methods adapted for use during surgery and critical care: pulse contour techniques, esophageal Doppler, partial carbon dioxide rebreathing, and transthoracic bioimpedance, to assess their bias, precision, and percentage error in agreement with thermodilution. An English language literature search identified published papers since 2000 which examined the agreement in adult patients between bolus thermodilution and each method. For each method a meta-analysis was done using studies in which the first measurement point for each patient could be identified, to obtain a pooled mean bias, precision, and percentage error weighted according to the number of measurements in each study. Forty-seven studies were identified as suitable for inclusion: N studies, n measurements: mean weighted bias [precision, percentage error] were: pulse contour N = 24, n = 714: -0.00 l/min [1.22 l/min, 41.3%]; esophageal Doppler N = 2, n = 57: -0.77 l/min [1.07 l/min, 42.1%]; partial carbon dioxide rebreathing N = 8, n = 167: -0.05 l/min [1.12 l/min, 44.5%]; transthoracic bioimpedance N = 13, n = 435: -0.10 l/min [1.14 l/min, 42.9%]. None of the four methods has achieved agreement with bolus thermodilution which meets the expected 30% limits. The relevance in clinical practice of these arbitrary limits should be reassessed.

  11. Pharmaceutical Care for the Patient after Cardiac Surgery%心脏术后患者的药学监护

    Institute of Scientific and Technical Information of China (English)

    陈岷; 童荣生; 黄晓波

    2011-01-01

    目的:临床药师参与临床药物治疗,对患者进行药学监护.方法:以一位心脏术后患者为例,临床药师参与药物治疗方案的制订,分析患者所用相关药物,跟踪其治疗效果及不良反应,对药物治疗过程进行综合评估.结果:患者的各项指标趋于正常.结论:临床药师的参与使药物治疗更趋合理,在达到治疗目标的同时,可减少药物的不良反应,有利于提高临床的药物治疗水平.%Objective: Clinical pharmacists involved in clinical drug therapy and pharmaceutical care for patients and cooperated with clinicians in order to promote rational drug use in clinics. Method: Clinical pharmacists involved in therapeutic scheme making, medication analysis and evaluation,such as anticoagulant drugs,antibiotics,cardiac drugs,and diuretics,etc. Used in the patient after cardiac surgery,and made a comprehensive drug treatment assessment including effectiveness and adverse reactions in whole therapy process. Result: All the indices of the patient trended toward normal. Conclusion: The participation of clinical pharmacists in clinical treatment team and clinical practice can make drug treatment more rational with therapeutic goal reached and adverse drug reactions reduced to improve the level of clinical drug treatment.

  12. Models of helping and coping in cancer care.

    Science.gov (United States)

    Northouse, L L; Wortman, C B

    1990-02-01

    This paper provides a theoretical analysis of four models of helping and coping as they relate to cancer care. The four conceptual models focus on the issue of whether or not patients should be viewed as responsible for the cause or the treatment of their cancer. The moral model, characterized by the holistic health movement, holds patients responsible for both causing and resolving health problems. The compensatory model, exemplified by cancer education programs, attributes low responsibility to patients for causing health problems but high responsibility for resolving them. The medical model views patients as neither responsible for causing nor for resolving health problems. The enlightenment model, typified by the healing movement, holds people responsible for causing their health problems, but not for resolving them. An attempt is made to examine existing programs in cancer care in light of these models. The present analysis addresses the following questions. Why is each of these models appealing? Why are they sometimes embraced by patients or health care providers? What are the benefits and disadvantages of using each of these models with cancer patients? What happens when the health care provider and patient hold different models regarding the patient's responsibility or participation in the cause of the disease or its treatment? Further research is needed to determine the conditions under which a particular model results in better health outcomes for patients, and to assess how factors such as extent of disease or type of cancer influence the patient's choice of a model.

  13. Use of three-dimensional medical modeling methods for precise planning of orthognathic surgery.

    Science.gov (United States)

    Mavili, Mehmet Emin; Canter, Halil Ibrahim; Saglam-Aydinatay, Banu; Kamaci, Soner; Kocadereli, Ilken

    2007-07-01

    Stereolithographic (medical rapid prototyping) biomodeling allows three-dimensional computed tomography to be used to generate solid plastic replicas of anatomic structures. Reports in the literature suggest that such biomodels may have a use in maxillofacial surgery, craniofacial surgery, orthopedics, neurosurgery, otology, vascular, and nasal research. A prospective trial to assess the usefulness of biomodeling in orthognathic surgery has been performed. In 12 patients with mandibular prognathism and/or maxillary retrusion, in addition to routine preoperative cephalometric analysis, preoperative high-resolution (cutting slice thickness of 1 mm) three-dimensional computed tomography scan of the patients was obtained. Raw data obtained from computed tomography scanning was processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Belgium). Fabrication of three-dimensional medical models was obtained through a process called powder depositional modeling by use of a Spectrum Z 510 3D Color Printer (Z Corporation, Burlington, MA). Alveolar arches of the maxilla and mandibula of the models were replaced with orthodontic dental cast models. Temporomandibular joints of the models were fixed with Kirschner wire. Maxillary and mandibular bony segments were mobilized according to preoperative orthodontic planning done by analysis of cephalometric plain radiographs. The relation between proximal and distal mandibular segments after bilateral sagittal split osteotomies were evaluated on models preoperatively. The same surgeon had a role in both model cutting preoperatively and as an instructor preoperatively. The same bony relation was observed both in preoperative modelsand in the perioperative surgical field in all patients. Condylar malpositioning was not observed in any of the patients. Studying preoperative planned movements of osteotomized bone segments and observing relations of osteotomized segments of mandibula and maxilla in

  14. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    NARCIS (Netherlands)

    W.M. Looman (Willemijn); I.N. Fabbricotti (Isabelle); R. Huijsman (Robbert)

    2014-01-01

    markdownabstract__Abstract__ Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty w

  15. Kansas Primary Care Weighs In: A Pilot Randomized Trial of a Chronic Care Model Program for Obesity in 3 Rural Kansas Primary Care Practices

    Science.gov (United States)

    Ely, Andrea C.; Banitt, Angela; Befort, Christie; Hou, Qing; Rhode, Paula C.; Grund, Chrysanne; Greiner, Allen; Jeffries, Shawn; Ellerbeck, Edward

    2008-01-01

    Context: Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. Purpose: To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary…

  16. Chiropractic as spine care: a model for the profession

    Directory of Open Access Journals (Sweden)

    Metz R Douglas

    2005-07-01

    Full Text Available Abstract Background More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. Objective To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. Discussion The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. Conclusion This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.

  17. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

    DEFF Research Database (Denmark)

    Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge

    2010-01-01

    Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments m...

  18. [Plastic surgery in day hospital conditions: comparison between two hospital models].

    Science.gov (United States)

    Faga, A; Carminati, M; Falconi, D; Gatti, S; Rottino, A

    2003-12-01

    Personal experience of plastic surgery carried out in Day Hospital conditions is reported. The experience took place within the hospital structure through two different organisational models called here transversal and divisional organisation models: characteristic of the former is that it uses a dedicated interdivisional structure within the hospital involving the centralization of all day-surgery activities, whereas the latter organizes Day Surgery activities within the operating unit whose structures it shares. On the basis of a comparison between the two models we were able to note advantages and disadvantages. We can review our experience in brief by stating that our own preference went to the transversal model which presents the indubitable advantage of being a logistic structure which is hinged on daytime activity and is ready therefore to satisfy on the one hand the needs of this type of patient and, on the other, the needs of the structure itself in efficiency terms. We propose to correct the disadvantages of the transversal model which can be outlined in its lack of homogeneity in the pathology treated and in the subtraction of the criterion of clinical priority in waiting lists through the attainment of a critical dimensional threshold such as to permit programmable sessions with patients with homogeneous pathology (i.e. belonging to the same hospital unit) and through the maintenance of a certain number of Day Hospital beds (around 25%) reserved for new emergency clinical cases.

  19. Towards standardized measurement of adverse events in spine surgery: conceptual model and pilot evaluation

    Directory of Open Access Journals (Sweden)

    Deyo Richard A

    2006-06-01

    Full Text Available Abstract Background Independent of efficacy, information on safety of surgical procedures is essential for informed choices. We seek to develop standardized methodology for describing the safety of spinal operations and apply these methods to study lumbar surgery. We present a conceptual model for evaluating the safety of spine surgery and describe development of tools to measure principal components of this model: (1 specifying outcome by explicit criteria for adverse event definition, mode of ascertainment, cause, severity, or preventability, and (2 quantitatively measuring predictors such as patient factors, comorbidity, severity of degenerative spine disease, and invasiveness of spine surgery. Methods We created operational definitions for 176 adverse occurrences and established multiple mechanisms for reporting them. We developed new methods to quantify the severity of adverse occurrences, degeneration of lumbar spine, and invasiveness of spinal procedures. Using kappa statistics and intra-class correlation coefficients, we assessed agreement for the following: four reviewers independently coding etiology, preventability, and severity for 141 adverse occurrences, two observers coding lumbar spine degenerative changes in 10 selected cases, and two researchers coding invasiveness of surgery for 50 initial cases. Results During the first six months of prospective surveillance, rigorous daily medical record reviews identified 92.6% of the adverse occurrences we recorded, and voluntary reports by providers identified 38.5% (surgeons reported 18.3%, inpatient rounding team reported 23.1%, and conferences discussed 6.1%. Trained observers had fair agreement in classifying etiology of 141 adverse occurrences into 18 categories (kappa = 0.35, but agreement was substantial (kappa ≥ 0.61 for 4 specific categories: technical error, failure in communication, systems failure, and no error. Preventability assessment had moderate agreement (mean weighted

  20. Does a "continuous care model" affect the quality of life of patients undergoing coronary artery bypass grafting?

    Science.gov (United States)

    Razmjoee, Nasrin; Ebadi, Abbas; Asadi-Lari, Mohsen; Hosseini, Marziyeh

    2017-03-01

    The physical and mental needs of patients with coronary heart disease are affected by both the disease and the heart surgery in different ways. Such diverse needs require different approaches. A continuous care model, which involves orientation, sensitization, control, and evaluation, may favorably influence patient outcomes following coronary artery bypass grafting (CABG). We were interested to ascertain whether a continuous care model might lead to improved quality of life, compared with a routine care model, in patients undergoing CABG. A total of 66 patients scheduled for CABG were identified and randomized to receive either continuous care (based on the continuous care model) or routine postoperative management for 2 months. The subjects' quality of life and its physical and mental dimensions were measured by the 12-item Short-Form Health Survey. Each dimension was scored between 0 and 100, and higher scores indicated better quality of life. One and 2 months after the intervention, the scores of quality of life and its two dimensions were significantly higher in the intervention group than in the control group (P care model can promote health-related quality of life in patients after CABG.

  1. Modeling Safety Outcomes on Patient Care Units

    Science.gov (United States)

    Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

    In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

  2. Infections in outpatient surgery.

    Science.gov (United States)

    Nazarian Mobin, Sheila S; Keyes, Geoffrey R; Singer, Robert; Yates, James; Thompson, Dennis

    2013-07-01

    In the plastic surgery patient population, outpatient surgery is cost effective and will continue to grow as the preferred arena for performing surgery in healthy patients. Although there is a widespread myth that outpatient surgery centers may suffer from increased infection rates due to lax infection control, the data presented from American Association for Accreditation of Ambulatory Surgery Facilities-accredited facilities prove the contrary. There is a lack of data investigating infection prevention in the perioperative period in plastic surgery patients. As data collection becomes more refined, tracking the postoperative care environment should offer additional opportunities to lower the incidence of postoperative infections.

  3. Does Parsonnet scoring model predict mortality following adult cardiac surgery in India?

    Directory of Open Access Journals (Sweden)

    Moningi Srilata

    2015-01-01

    Full Text Available Aims and Objectives: To validate the Parsonnet scoring model to predict mortality following adult cardiac surgery in Indian scenario. Materials and Methods: A total of 889 consecutive patients undergoing adult cardiac surgery between January 2010 and April 2011 were included in the study. The Parsonnet score was determined for each patient and its predictive ability for in-hospital mortality was evaluated. The validation of Parsonnet score was performed for the total data and separately for the sub-groups coronary artery bypass grafting (CABG, valve surgery and combined procedures (CABG with valve surgery. The model calibration was performed using Hosmer-Lemeshow goodness of fit test and receiver operating characteristics (ROC analysis for discrimination. Independent predictors of mortality were assessed from the variables used in the Parsonnet score by multivariate regression analysis. Results: The overall mortality was 6.3% (56 patients, 7.1% (34 patients for CABG, 4.3% (16 patients for valve surgery and 16.2% (6 patients for combined procedures. The Hosmer-Lemeshow statistic was <0.05 for the total data and also within the sub-groups suggesting that the predicted outcome using Parsonnet score did not match the observed outcome. The area under the ROC curve for the total data was 0.699 (95% confidence interval 0.62-0.77 and when tested separately, it was 0.73 (0.64-0.81 for CABG, 0.79 (0.63-0.92 for valve surgery (good discriminatory ability and only 0.55 (0.26-0.83 for combined procedures. The independent predictors of mortality determined for the total data were low ejection fraction (odds ratio [OR] - 1.7, preoperative intra-aortic balloon pump (OR - 10.7, combined procedures (OR - 5.1, dialysis dependency (OR - 23.4, and re-operation (OR - 9.4. Conclusions: The Parsonnet score yielded a good predictive value for valve surgeries, moderate predictive value for the total data and for CABG and poor predictive value for combined procedures.

  4. Use of a biomechanical tongue model to predict the impact of tongue surgery on speech production

    CERN Document Server

    Buchaillard, Stéphanie; Perrier, Pascal; Payan, Yohan

    2008-01-01

    This paper presents predictions of the consequences of tongue surgery on speech production. For this purpose, a 3D finite element model of the tongue is used that represents this articulator as a deformable structure in which tongue muscles anatomy is realistically described. Two examples of tongue surgery, which are common in the treatment of cancers of the oral cavity, are modelled, namely a hemiglossectomy and a large resection of the mouth floor. In both cases, three kinds of possible reconstruction are simulated, assuming flaps with different stiffness. Predictions are computed for the cardinal vowels /i, a, u/ in the absence of any compensatory strategy, i.e. with the same motor commands as the one associated with the production of these vowels in non-pathological conditions. The estimated vocal tract area functions and the corresponding formants are compared to the ones obtained under normal conditions

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

    NARCIS (Netherlands)

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

    2015-01-01

    Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this stu

  6. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

    DEFF Research Database (Denmark)

    Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge;

    2010-01-01

    Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments...... might be too brief for the hospital to initiate these programmes. Therefore, it was relevant to evaluate a new clinical practice which combined the general practitioner's (GP) referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway....

  7. Animal models of chronic wound care

    DEFF Research Database (Denmark)

    Trostrup, Hannah; Thomsen, Kim; Calum, Henrik

    2016-01-01

    . An inhibiting effect of bacterial biofilms on wound healing is gaining significant clinical attention over the last few years. There is still a paucity of suitable animal models to recapitulate human chronic wounds. The etiology of the wound (venous insufficiency, ischemia, diabetes, pressure) has to be taken...... on nonhealing wounds. Relevant hypotheses based on clinical or in vitro observations can be tested in representative animal models, which provide crucial tools to uncover the pathophysiology of cutaneous skin repair in infectious environments. Disposing factors, species of the infectious agent(s), and time...... of establishment of the infection are well defined in suitable animal models. In addition, several endpoints can be involved for evaluation. Animals do not display chronic wounds in the way that humans do. However, in many cases, animal models can mirror the pathological conditions observed in humans, although...

  8. ATTEND: Toward a Mindfulness-Based Bereavement Care Model

    Science.gov (United States)

    Cacciatore, Joanne; Flint, Melissa

    2012-01-01

    Few, if any, mindfulness-based bereavement care models exist. The ATTEND (attunement, trust, touch, egalitarianism, nuance, and death education) model is an interdisciplinary paradigm for providers, including physicians, social workers, therapists, nursing staff, and others. Using a case example to enhance the breadth and depth of understanding,…

  9. Four-dimensional modeling of the heart for image guidance of minimally invasive cardiac surgeries

    Science.gov (United States)

    Wierzbicki, Marcin; Drangova, Maria; Guiraudon, Gerard; Peters, Terry

    2004-05-01

    Minimally invasive surgery of the beating heart can be associated with two major limitations: selecting port locations for optimal target coverage from x-rays and angiograms, and navigating instruments in a dynamic and confined 3D environment using only an endoscope. To supplement the current surgery planning and guidance strategies, we continue developing VCSP - a virtual reality, patient-specific, thoracic cavity model derived from 3D pre-procedural images. In this work, we apply elastic image registration to 4D cardiac images to model the dynamic heart. Our method is validated on two image modalities, and for different parts of the cardiac anatomy. In a helical CT dataset of an excised heart phantom, we found that the artificial motion of the epicardial surface can be extracted to within 0.93 +/- 0.33 mm. For an MR dataset of a human volunteer, the error for different heart structures such as the myocardium, right and left atria, right ventricle, aorta, vena cava, and pulmonary artery, ranged from 1.08 +/- 0.18 mm to 1.14 +/- 0.22 mm. These results indicate that our method of modeling the motion of the heart is not only easily adaptable but also sufficiently accurate to meet the requirements for reliable cardiac surgery training, planning, and guidance.

  10. Cost Analysis in Shoulder Arthroplasty Surgery

    Directory of Open Access Journals (Sweden)

    Matthew J. Teusink

    2012-01-01

    Full Text Available Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved. Given its reproducible nature, shoulder arthroplasty is ideally situated to become a model for an episode of care. Currently, there is little research into cost in shoulder arthroplasty surgery. The current analyses do not provide surgeons with a method for determining the cost and outcomes of their interventions, which is necessary to the success of bundled payment. Surgeons are ideally positioned to become leaders in ACOs, but in order for them to do so a methodology must be developed where accurate costs and outcomes can be determined for the episode of care.

  11. Towards a model for integrative medicine in Swedish primary care

    Directory of Open Access Journals (Sweden)

    Falkenberg Torkel

    2007-07-01

    Full Text Available Abstract Background Collaboration between providers of conventional care and complementary therapies (CTs has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM. The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care. Methods Investigative procedures involved research group and key informant meetings with multiple stakeholders including general practitioners, CT providers, medical specialists, primary care administrators and county council representatives. Data collection included meeting notes which were fed back within the research group and used as ongoing working documents. Data analysis was made by immersion/crystallisation and research group consensus. Results were categorised within a public health systems framework of structures, processes and outcomes. Results The outcome was an IM model that aimed for a patient-centered, interdisciplinary, non-hierarchical mix of conventional and complementary medical solutions to individual case management of patients with pain in the lower back and/or neck. The IM model case management adhered to standard clinical practice including active partnership between a gate-keeping general practitioner, collaborating with a team of CT providers in a consensus case conference model of care. CTs with an emerging evidence base included Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong. Conclusion Despite identified barriers such as no formal recognition of CT professions in Sweden, it was possible to develop a model for IM adapted to Swedish primary care. The IM model calls for testing and refinement in a pragmatic randomised controlled trial to explore its clinical effectiveness.

  12. Cancer patient-centered home care: a new model for health care in oncology

    Directory of Open Access Journals (Sweden)

    Tralongo P

    2011-09-01

    Full Text Available Paolo Tralongo1, Francesco Ferraù2, Nicolò Borsellino3, Francesco Verderame4, Michele Caruso5, Dario Giuffrida6, Alfredo Butera7, Vittorio Gebbia81Medical Oncology Unit, Azienda Sanitaria Provinciale, Siracusa; 2Medical Oncology Unit, Ospedale San Vincenzo, Taormina; 3Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo; 4Medical Oncology Unit, Ospedale Giovanni Paolo II, Sciacca; 5Medical Oncology Unit, Istituto Humanitas, Catania; 6Medical Oncology Unit, Istituto Oncologico del Mediterraneo, Catania; 7Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento; 8Medical Oncology Unit, Dipartimento Oncologico, La Maddalena, Università degli Studi, Palermo, ItalyAbstract: Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients' needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients' needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.Keywords: cancer, home care

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

    Science.gov (United States)

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

    2016-01-01

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

  14. System dynamics modeling on health care : supply and demand of dementia care

    NARCIS (Netherlands)

    Rouwette, E.A.J.A.

    2006-01-01

    This presentation will address the use of system dynamics models to analyze complex problems in health care. System dynamics has been used on health related issues since at least the 1960s and in the Netherlands since the 1980s. In this approach a group of experts and stakeholders participates in de

  15. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...... to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients....

  16. The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery

    DEFF Research Database (Denmark)

    Platon, Anna Maria; Erichsen, Rune; Christiansen, Christian Fynbo;

    2014-01-01

    all patients undergoing CRC surgery in the period 2005-2011, identified through medical databases. We categorised the patients according to the history of COPD. We assessed the rate of complications within 30 days. We computed 30-day mortality among patients with/without COPD using the Kaplan......-Meier method. We used Cox regression to compute HRs for death, controlling for age, gender, type of admission, cancer stage, hospital volume, alcohol-related diseases, obesity and Charlson comorbidity score. RESULTS: We identified 18 302 CRC surgery patients. Of these, 7.9% had a prior diagnosis of COPD. Among...... patients with COPD, 16.1% were admitted postoperatively to the intensive care unit, 1.9% were treated with mechanical ventilation, and 3.6% were treated with non-invasive ventilation. In patients without COPD, the corresponding proportions were 9.7%, 1.1% and 1.1%. The reoperation rate was 10.6% among...

  17. HETEAC: The Aerosol Classification Model for EarthCARE

    Directory of Open Access Journals (Sweden)

    Wandinger Ulla

    2016-01-01

    Full Text Available We introduce the Hybrid End-To-End Aerosol Classification (HETEAC model for the upcoming EarthCARE mission. The model serves as the common baseline for development, evaluation, and implementation of EarthCARE algorithms. It shall ensure the consistency of different aerosol products from the multi-instrument platform as well as facilitate the conform specification of broad-band optical properties necessary for the EarthCARE radiative closure efforts. The hybrid approach ensures the theoretical description of aerosol microphysics consistent with the optical properties of various aerosol types known from observations. The end-to-end model permits the uniform representation of aerosol types in terms of microphysical, optical and radiative properties.

  18. Patient specific finite element model of the face soft tissues for computer-assisted maxillofacial surgery.

    Science.gov (United States)

    Chabanas, Matthieu; Luboz, Vincent; Payan, Yohan

    2003-06-01

    This paper addresses the prediction of face soft tissue deformations resulting from bone repositioning in maxillofacial surgery. A generic 3D Finite Element model of the face soft tissues was developed. Face muscles are defined in the mesh as embedded structures, with different mechanical properties (transverse isotropy, stiffness depending on muscle contraction). Simulations of face deformations under muscle actions can thus be performed. In the context of maxillofacial surgery, this generic soft-tissue model is automatically conformed to patient morphology by elastic registration, using skin and skull surfaces segmented from a CT scan. Some elements of the patient mesh could be geometrically distorted during the registration, which disables Finite Element analysis. Irregular elements are thus detected and automatically regularized. This semi-automatic patient model generation is robust, fast and easy to use. Therefore it seems compatible with clinical use. Six patient models were successfully built, and simulations of soft tissue deformations resulting from bone displacements performed on two patient models. Both the adequation of the models to the patient morphologies and the simulations of post-operative aspects were qualitatively validated by five surgeons. Their conclusions are that the models fit the morphologies of the patients, and that the predicted soft tissue modifications are coherent with what they would expect.

  19. Embodying, calibrating and caring for a local model of obesity

    DEFF Research Database (Denmark)

    Winther, Jonas; Hillersdal, Line

    and technologies herein lead to the emergence of what we propose to be local models of obesity. Describing the emergence of local models of obesity we show how a specific model is being cared for, calibrated and embodied by research staff as well as research subjects and how interdisciplinary obesity research...... is an ongoing process of configuring but also extending beyond already established models of obesity. We argue that an articulation of such practices of local care, embodiment and calibration are crucial for the appreciation, evaluation and transferability of interdisciplinary obesity research....... highlighted as such a problem. Within research communities disparate explanatory models of obesity exist (Ulijaszek 2008) and some of these models of obesity are brought together in the Copenhagen-based interdisciplinary research initiative; Governing Obesity (GO) with the aim of addressing the causes...

  20. Behavior modification in primary care: the pressure system model.

    Science.gov (United States)

    Katz, D L

    2001-01-01

    The leading causes of death in the United States are predominantly attributable to modifiable behaviors. Patients with behavioral risk factors for premature death and disability, including dietary practices; sexual practices; level of physical activity; motor vehi cle use patterns; and tobacco, alcohol, and illicit sub stance use, are seen far more consistently by primary care providers than by mental health specialists. Yet models of behavior modification are reported, debated, and revised almost exclusively in the psychology literature. While the Stages of Change Model, or Transtheo retical Model, has won application in a broadening array of clinical settings, its application in the primary care setting is apparently quite limited despite evidence of its utility [Prochaska J, Velicer W. Am J Health Promot 1997;12:38-48]. The lack of a rigorous behavioral model developed for application in the primary care setting is an impediment to the accomplishment of public health goals specified in the Healthy People objectives and in the reports of the U.S. Preventive Services Task Force. The Pressure System Model reported here synthesizes elements of established behavior modification theories for specific application under the constraints of the primary care setting. Use of the model in both clinical and research settings, with outcome evaluation, is encouraged as part of an effort to advance public health.

  1. [Basic standards for a department of cardiac surgery. Quality requirements for the care of cardiac patients in connection with operations on the heart, the heart vessels and thoracic organ transplantation].

    Science.gov (United States)

    Beckmann, Andreas; Beyersdorf, F; Diegeler, A; Mohr, F W; Welz, A; Rein, J-G; Cremer, J

    2013-12-01

    Current evolutions and substantial amendments of the German health care system in combination with distinguished progress in cardiac surgery over the past years require both a reflection of principles in patient-centered care and an update of basic standard requirements for a department of cardiac surgery in Germany. In due consideration of the data from the voluntary registry of the German Society for Thoracic and Cardiovascular Surgery, this article accurately defines core requirements for a cardiac surgical department (cardiac surgery on-site), subdivided into facilities, staff and processes. If based on these standards, one may anticipate that cardiac surgical care is performed under appropriate conditions leading to an intrinsic benefit for patients.

  2. [Citizen constitution and social representations: reflecting about health care models].

    Science.gov (United States)

    da Silva, Sílvio Eder Dias; Ramos, Flávia Regina Souza; Martins, Cleusa Rios; Padilha, Maria Itayra; Vasconcelos, Esleane Vilela

    2010-12-01

    This article presents a reflection on the meaning of the terms citizenship and health, addressing the Theory of Social Representations as a strategy for implementing and evaluating health care models in Brazil. First, a brief history about the concept of citizenship is presented; then the article addresses the principles of freedom and equality according to Kant; the third section of the article shows that health is as a right of the citizen and a duty of the state. Finally, the Theory of Social Representations is emphasized as a strategy to evaluate and implement the health services provided to citizens by the current health care models in Brazil.

  3. Measuring satisfaction: factors that drive hospital consumer assessment of healthcare providers and systems survey responses in a trauma and acute care surgery population.

    Science.gov (United States)

    Kahn, Steven A; Iannuzzi, James C; Stassen, Nicole A; Bankey, Paul E; Gestring, Mark

    2015-05-01

    Hospital quality metrics now reflect patient satisfaction and are measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Understanding these metrics and drivers will be integral in providing quality care as this process evolves. This study identifies factors associated with patient satisfaction as determined by HCAHPS survey responses in trauma and acute care surgery patients. HCAHPS survey responses from acute care surgery and trauma patients at a single institution between 3/11 and 10/12 were analyzed. Logistic regression determined which responses to individual HCAHPS questions predicted highest hospital score (a rating of 9-10/10). Demographic and clinical variables were also analyzed as predictors of satisfaction. Subgroup analysis for trauma patients was performed. In 70.3 per cent of 182 total survey responses, a 9-10/10 score was given. The strongest predictors of highest hospital ranking were respect from doctors (odds ratio [OR] = 24.5, confidence interval [CI]: 5.44-110.4), doctors listening (OR: 9.33, CI: 3.7-23.5), nurses' listening (OR = 8.65, CI: 3.62-20.64), doctors' explanations (OR = 8.21, CI: 3.5-19.2), and attempts to control pain (OR = 7.71, CI: 3.22-18.46). Clinical factors and outcomes (complications, intensive care unit/hospital length of stay, mechanism of injury, and having an operation) were nonsignificant variables. For trauma patients, Injury Severity Score was inversely related to score (OR = 0.93, CI: 0.87-0.98). Insurance, education, and disposition were also tied to satisfaction, whereas age, gender, and ethnicity were nonsignificant. In conclusion, patient perception of interactions with the healthcare team was most strongly associated with satisfaction. Complications did not negatively influence satisfaction. Insurance status might potentially identify patients at risk of dissatisfaction. Listening to patients, treating them with respect, and explaining the care plan are integral to a

  4. [Determination of Virtual Surgery Mass Point Spring Model Parameters Based on Genetic Algorithms].

    Science.gov (United States)

    Chen, Ying; Hu, Xuyi; Zhu, Qiguang

    2015-12-01

    Mass point-spring model is one of the commonly used models in virtual surgery. However, its model parameters have no clear physical meaning, and it is hard to set the parameter conveniently. We, therefore, proposed a method based on genetic algorithm to determine the mass-spring model parameters. Computer-aided tomography (CAT) data were used to determine the mass value of the particle, and stiffness and damping coefficient were obtained by genetic algorithm. We used the difference between the reference deformation and virtual deformation as the fitness function to get the approximate optimal solution of the model parameters. Experimental results showed that this method could obtain an approximate optimal solution of spring parameters with lower cost, and could accurately reproduce the effect of the actual deformation model as well.

  5. Pain relief in day care arthroscopic knee surgery: A comparison between intra-articular ropivacaine and levobupivacaine: A prospective, double-blinded, randomized controlled study

    Directory of Open Access Journals (Sweden)

    Anjan Das

    2014-01-01

    Full Text Available Background: Post-operative pain frequently hampers implementation of day care arthroscopic knee surgery in spite of so many analgesic, local anesthetic drugs and routes of administration. Aims: The aim of the present study was carried out to compare the efficacy of ropivacaine and levobupivacaine when administered through intra-articular route in controlling pain after day care arthroscopic knee surgery. Setting and Design: It was a prospective, double-blinded and randomized controlled study. Materials and Methods: April 2008-December 2008, 60 patients of both sex, of American Society of Anesthesiologists physical status I and II, undergoing day care arthroscopic knee surgery were randomly assigned into two groups (R, L. Group R received 10 ml of 0.75% ropivacaine, whereas group L received 10 ml of 0.50% levobupivacaine through intra-articular route at the end of the procedure. Pain assessed using visual analog scale (VAS and diclofenac sodium given as rescue analgesia when VAS >3. Time of first analgesic request and total rescue analgesic were calculated. Statistical Analysis and Results: based on comparable demographic profiles; time for the requirement of first post-operative rescue analgesia (242.16 ± 23.86 vs. 366.62 ± 24.42 min and total mean rescue analgesic requirement was (104.35 ± 18.96 vs. 76.82 ± 14.28 mg in group R and L respectively. Group R had higher mean VAS score throughout the study period. No side effects found among the groups. These two results were clinically and statistically significant (P < 0.05. Conclusion: Hence, it was evident that intra-articular levobupivacaine give better post-operative pain relief, with an increase in time of first analgesic request and decreased need of total post-operative analgesia compared with ropivacaine.

  6. Surgery center joint ventures.

    Science.gov (United States)

    Zasa, R J

    1999-01-01

    Surgery centers have been accepted as a cost effective, patient friendly vehicle for delivery of quality ambulatory care. Hospitals and physician groups also have made them the vehicles for coming together. Surgery centers allow hospitals and physicians to align incentives and share benefits. It is one of the few types of health care businesses physicians can own without anti-fraud and abuse violation. As a result, many surgery center ventures are now jointly owned by hospitals and physician groups. This article outlines common structures that have been used successfully to allow both to own and govern surgery centers.

  7. The Phase of Illness Paradigm: A Checklist Centric Model to Improve Patient Care in the Burn Intensive Care Unit

    Science.gov (United States)

    2016-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Anderson DR

    2016-11-01

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

  9. Technologies of birth and models of midwifery care

    Directory of Open Access Journals (Sweden)

    Christine McCourt

    2014-08-01

    Full Text Available This article is based on a study of a reform in the organisation of maternity services in the United Kingdom, which aimed towards developing a more woman-centred model of care. After decades of fragmentation and depersonalisation of care, associated with the shift of birth to a hospital setting, pressure by midwives and mothers prompted government review and a relatively radical turnaround in policy. However, the emergent model of care has been profoundly influenced by concepts and technologies of monitoring. The use of such technologies as ultrasound scans, electronic foetal monitoring and oxytocic augmentation of labour, generally supported by epidural anaesthesia for pain relief, have accompanied the development of a particular ecological model of birth – often called active management –, which is oriented towards the idea of an obstetric norm. Drawing on analysis of women’s narrative accounts of labour and birth, this article discusses the impact on women’s embodiment in birth, and the sources of information they use about the status of their own bodies, their labour and that of the child. It also illustrates how the impact on women’s experiences of birth may be mediated by a relational model of support, through the provision of caseload midwifery care.

  10. Combined drug and surgery treatment of plutonium-contaminated wounds: indications obtained using a rodent model.

    Science.gov (United States)

    Griffiths, Nina M; Coudert, Sylvie; Wilk, Jean Claude; Renault, Daniel; Angulo, Jaime F; Van der Meeren, Anne

    2014-06-01

    There is an important requirement following accidental actinide contamination of wounds to limit the dissemination and retention of such alpha-emitting radionuclides. To reduce wound and systemic contamination, treatment approaches include chelation therapy with or without wound excision. However, it has been hypothesized that wound excision could lead to increased contaminant release and systemic organ retention. This study in the rat addresses this question. Anesthetized rats were contaminated with plutonium nitrate following wounding by deep incision of hind leg muscle. Excision of tissue at the contaminated site was performed 7 d later with or without Diethylene Triamine Pentaacetic Acid (DTPA) treatment (30 μmol kg⁻¹ i.v.). Pu urinary excretion was then measured for a further 3 d, and animals were euthanized at 14 d after contamination. Tissue samples were evaluated for Pu activity and histology. At 7 d after contamination, around 50% of the initial activity remained at the wound site. An average of 16% of this activity was then removed by surgery. Surgery alone resulted in increased urinary excretion, suggesting release from the wound site, but no subsequent increases in organ retention (bone, liver) were observed at 14 d. Indeed, organ Pu activity was slightly reduced. The combination of surgery and DTPA or DTPA treatment alone was much more effective than excision alone as shown by the markedly increased urinary Pu excretion and decreased tissue levels. This is the first report in an experimental rodent model of resection of Pu-contaminated wound. Urinary excretion data provide evidence for the release of activity as a result of surgery, but this does not appear to lead to further Pu organ retention. However, a combination of prior DTPA treatment with wound excision is particularly effective.

  11. Pin care

    Science.gov (United States)

    ... gov/pubmed/24302374 . Nagy K. Discharge instructions for wound cares. The American Association of the Surgery of Trauma. www.aast.org/discharge-instructions-for-wound-cares . Accessed May 13, 2016.

  12. Effects of Clown Doctors on child and caregiver anxiety at the entrance to the surgery care unit and separation from caregivers

    Directory of Open Access Journals (Sweden)

    Patrícia Arriaga

    2016-04-01

    Full Text Available This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care. Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children’s anxiety, while the State-Trait Anxiety Inventory measured caregiver’s state anxiety. In addition, caregivers assessed the children’s functional health problems by completing the Functional Status Questionnaire. Although no effects of Clown Doctors were found on children’s anxiety, results showed that both low functional health problems and Clown Doctors intervention were significant predictors of lower caregiver anxiety. Caregivers also reported being very satisfied with their intervention. Overall, this study demonstrated the positive role of Clown Doctors for caregivers at a specific paediatric hospital setting.

  13. Applying a managerial approach to day surgery.

    Science.gov (United States)

    Onetti, Alberto

    2008-01-01

    The present article explores the day surgery topic assuming a managerial perspective. If we assume such a perspective, day surgery can be considered as a business model decision care and not just a surgical procedure alternative to the traditional ones requiring patient hospitalization. In this article we highlight the main steps required to develop a strategic approach [Cotta Ramusino E, Onetti A. Strategia d'Impresa. Milano; Il Sole 24 Ore; Second Edition, 2007] at hospital level (Onetti A, Greulich A. Strategic management in hospitals: the balanced scorecard approach. Milano: Giuffé; 2003) and to make day surgery part of it. It means understanding: - how and when day surgery can improve the health care providers' overall performance both in terms of clinical effectiveness and financial results, and, - how to organize and integrate it with the other hospital activities in order to make it work. Approaching day surgery as a business model decision requires to address in advance a list of potential issues and necessitates of continued audit to verify the results. If it does happen, day surgery can be both safe and cost effective and impact positively on surgical patient satisfaction. We propose a sort of "check-up list" useful to hospital managers and doctors that are evaluating the option of introducing day surgery or are trying to optimize it.

  14. [The role of physiology in modern surgery].

    Science.gov (United States)

    2006-04-01

    Through the analysis of recent achievements in the field of surgery we have demonstrated convincingly that physiological studies in both humans and animal models are the keystone of modern surgery. Physiological studies of blood circulation, respiration, digestion and other functions have laid the foundations for major fields of surgery. Their role is the most evident in the development of cardiac surgery. Notably, one of the outstanding breakthroughs in the medical science of the 20th century--the extracorporeal blood circulation--was made by the Russian physiologist S. S. Bryukhovenko. We have shown that noninvasive diagnostic procedures such as echocardiography are of outmost significance on all stages of the surgical treatment (pre- and intraoperational diagnostics and medical rehabilitation). The great impact of physiology on the development of surgery has also led to the progress of related fields of medicine--anesthesiology, intensive care, functional diagnostics, transplantation, rehabilitation, and many others.

  15. Study on Perioperative Care of Patients Treated With Circumcision Surgery%包皮手术患者的围手术期护理探析

    Institute of Scientific and Technical Information of China (English)

    马美艳

    2015-01-01

    Objective To explore perioperative care of patients treated with circumcision surgery.MethodsSelected 45 patients treated with circumcision surgery who are received and treated in hospital from November 2013 to December 2014 and divide them into two groups according to hospitalization sequence with 24 patients in study group and 21 patients in control group, patients in study group were given perioperative care, while patients in control group were given conventional care intervention, and then care effects of two groups was compared.ResultsPatients’ satisfaction rate, treatment efficacy and complication incidence in study group were much better than counterparts in control group, there is a differential between these two groups, and such a differential has statistic value (P<0.05). Conclusionperioperative care is of significance for patients treated with circumcision surgery, which is conducive to improving patients’ satisfaction with treatment, to increasing treatment efficacy and to decrease complication incidence.%目的:探讨包皮手术患者的围手术期护理探析。方法选取2013年11月~2014年12月我院接诊的45例包皮手术患者,按照入院的先后顺序分为24例实验组和21例对照组,实验组给予围手术期护理,对照组采用常规护理干预,观察两组患者的护理效果。结果实验组患者的护理满意度、治疗总有效率及并发症的发生率明显优于对照组,P<0.05,差异有统计学意义。结论包皮手术患者采用围手术期护理的效果显著,可以有效提高患者的满意度,提高治疗效果,降低并发症的发生率。

  16. Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury

    Directory of Open Access Journals (Sweden)

    J.H.A. Bloemen-Vrencken

    2005-06-01

    Full Text Available Purposes: The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. Methods: The transmural care model was developed in cooperation with the Dutch Association of Spinal Cord Injured Patients, community nurses, general practitioners, rehabilitation nurses, rehabilitation managers, physiatrists and researchers. The core component of the care model consists of a transmural nurse, who ‘liaises’ between people with SCI living in the community, professional primary care professionals and the rehabilitation centre. The transmural care model provides a job description containing activities to support people with SCI and their family/partners and activities to promote continuity of care. The transmural care model was implemented in two Dutch rehabilitation centres. The following three aspects, as experienced by the transmural nurses, were evaluated: the extent to which the care model was implemented; enabling factors and barriers for implementation; strength and weakness of the care model. Results: The transmural care model was not implemented in all its details, with a clear difference between the two rehabilitation centres. Enabling factors and barriers for implementation were found at three levels: 1. the level of the individual professional (e.g. competencies, attitude and motivation, 2. the organisational and financing level (e.g. availability of facilities and finances, and 3. the social context (the opinion of colleagues, managers and other professionals involved with the care. The most important weakness experienced was that there was not enough time to put all the activities into practice

  17. Care 3 model overview and user's guide, first revision

    Science.gov (United States)

    Bavuso, S. J.; Petersen, P. L.

    1985-01-01

    A manual was written to introduce the CARE III (Computer-Aided Reliability Estimation) capability to reliability and design engineers who are interested in predicting the reliability of highly reliable fault-tolerant systems. It was also structured to serve as a quick-look reference manual for more experienced users. The guide covers CARE III modeling and reliability predictions for execution in the CDC CYber 170 series computers, DEC VAX-11/700 series computer, and most machines that compile ANSI Standard FORTRAN 77.

  18. Incidence and predictors of readmission to the cardiac surgery intensive care unit: A retrospective cohort study in Greece

    Directory of Open Access Journals (Sweden)

    Konstantinos Giakoumidakis

    2014-01-01

    Conclusions: One intraoperative and three preoperative variables are associated strongly with higher probability for ICU readmission. Shorter CPB duration could contribute to lower ICU readmission incidence. In addition, the early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both the more efficient healthcare planning and resources allocation.

  19. International variations in availability and diffusion of alternatives to in-patient care in Europe : the case of day surgery

    NARCIS (Netherlands)

    Kroneman, Madelon W.; Westert, Gert P.; Groenewegen, Peter P.; Delnoij, Diane M.J.

    2001-01-01

    Objectives: Technological and medical developments have contributed to the increasing number of surgical procedures carried out as a day-case rather than an inpatient hospital setting. The diffusion of day surgery varies among European countries. This study aims at explaining this variation in healt

  20. International variations in availability and diffusion of alternatives to in-patient care in Europe: the case of day surgery.

    NARCIS (Netherlands)

    Kroneman, M.W.; Westert, G.P.; Groenewegen, P.P.; Delnoij, D.M.J.

    2001-01-01

    Objectives: Technological and medical developments have contributed to the increasing number of surgical procedures carried out as a day-case rather than an inpatient hospital setting. The diffusion of day surgery varies among European countries. This study aims at explaining this variation in healt

  1. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review

    NARCIS (Netherlands)

    Meyer, Z.C.; Schreinemakers, J.M.J.; Waal, R.A. de; Laan, L. van der

    2015-01-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in

  2. Cirugía: un contexto diferente de cuidado Cirurgia: um contexto diferente de cuidados Surgery: a different care concept

    Directory of Open Access Journals (Sweden)

    Ángela María Salazar Maya

    2011-07-01

    fundamental theory. Data were collected through observation, informal and formal interviews to 20 patients, 19 nursing assistants and 8 nurses working in different second level surgical settings in the Valle de Aburra. Results: a theoretical scheme comprising twelve categories arises from data collected. This study shall present the category comprised in the following context: Working and being in a different area. It comprises the following subcategories: attention attracted by the environment, entering, being operated and going out, working under stress and team working. Final considerations: the surgical context, as any sphere, has an influence on nursing care; it supposes challenges for the nursing team regarding interactions, as they should be efficient and effective. The patient's status, his/her vulnerability, the risk implied by the anesthetic and surgical procedure, plus the simultaneousness of tasks faced by the nursing team makes their work stressful; therefore, the surgery service requires a nursing team capable of working under stress.

  3. Neuro-adaptive control in beating heart surgery based on the viscoelastic tissue model

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    Setareh Rezakhani

    2014-04-01

    Full Text Available In this paper, the problem of 3D heart motion in beating heart surgery is resolved by proposing a parallel force-motion controller. Motion controller is designed based on neuro-adaptive approach to compensate 3D heart motion and deal with uncertainity in dynamic parameters, while an implicit force control is implemented by considering a viscoelastic tissue model. Stability analysis is proved through Lypanov’s stability theory and Barballet’s lemma. Simulation results, for D2M2 robot, which is done in nominal case and viscoelastic parameter mismatches demonstrate the robust performance of the controller.

  4. An Application of Bayesian Approach in Modeling Risk of Death in an Intensive Care Unit.

    Directory of Open Access Journals (Sweden)

    Rowena Syn Yin Wong

    Full Text Available There are not many studies that attempt to model intensive care unit (ICU risk of death in developing countries, especially in South East Asia. The aim of this study was to propose and describe application of a Bayesian approach in modeling in-ICU deaths in a Malaysian ICU.This was a prospective study in a mixed medical-surgery ICU in a multidisciplinary tertiary referral hospital in Malaysia. Data collection included variables that were defined in Acute Physiology and Chronic Health Evaluation IV (APACHE IV model. Bayesian Markov Chain Monte Carlo (MCMC simulation approach was applied in the development of four multivariate logistic regression predictive models for the ICU, where the main outcome measure was in-ICU mortality risk. The performance of the models were assessed through overall model fit, discrimination and calibration measures. Results from the Bayesian models were also compared against results obtained using frequentist maximum likelihood method.The study involved 1,286 consecutive ICU admissions between January 1, 2009 and June 30, 2010, of which 1,111 met the inclusion criteria. Patients who were admitted to the ICU were generally younger, predominantly male, with low co-morbidity load and mostly under mechanical ventilation. The overall in-ICU mortality rate was 18.5% and the overall mean Acute Physiology Score (APS was 68.5. All four models exhibited good discrimination, with area under receiver operating characteristic curve (AUC values approximately 0.8. Calibration was acceptable (Hosmer-Lemeshow p-values > 0.05 for all models, except for model M3. Model M1 was identified as the model with the best overall performance in this study.Four prediction models were proposed, where the best model was chosen based on its overall performance in this study. This study has also demonstrated the promising potential of the Bayesian MCMC approach as an alternative in the analysis and modeling of in-ICU mortality outcomes.

  5. Medical care transition planning and dental care use for youth with special health care needs during the transition from adolescence to young adulthood: a preliminary explanatory model.

    Science.gov (United States)

    Chi, Donald L

    2014-05-01

    The aims of the study were to test the hypotheses that youth with special health care needs (YSHCN) with a medical care transition plan are more likely to use dental care during the transition from adolescence to young adulthood and that different factors are associated with dental utilization for YSHCN with and YSHCN without functional limitations. National Survey of CSHCN (2001) and Survey of Adult Transition and Health (2007) data were analyzed (N = 1,746). The main predictor variable was having a medical care transition plan, defined as having discussed with a doctor how health care needs might change with age and having developed a transition plan. The outcome variable was dental care use in 2001 (adolescence) and 2007 (young adulthood). Multiple variable Poisson regression models with robust standard errors were used to estimate covariate-adjusted relative risks (RR). About 63 % of YSHCN had a medical care transition plan and 73.5 % utilized dental care. YSHCN with a medical care transition plan had a 9 % greater RR of utilizing dental care than YSHCN without a medical care transition plan (RR 1.09; 95 % CI 1.03-1.16). In the models stratified by functional limitation status, having a medical care transition plan was significantly associated with dental care use, but only for YSHCN without functional limitations (RR 1.11; 95 % CI 1.04-1.18). Having a medical care transition plan is significantly associated with dental care use, but only for YSHCN with no functional limitation. Dental care should be an integral part of the comprehensive health care transition planning process for all YSHCN.

  6. The Arkansas AHEC model of community-oriented primary care.

    Science.gov (United States)

    Hartwig, M S; Landis, B J

    1999-07-01

    This article explicates the Arkansas Area Health Education Center (AHEC) model of community-oriented primary care (COPC) and the role of the family nurse practitioner (FNP) in its implementation. The AHECs collaborate with local agencies to provide comprehensive, accessible, quality health care to specific patient populations, and offer learning opportunities to a wide variety of health professions students. The FNP demonstrates organizational and role competencies that include directing patient care, providing professional leadership, and developing the advanced practice nursing role. Two case studies are used to illustrate the FNPs' approach to COPC: (1) selection of interdisciplinary, multidisciplinary, and transdisciplinary approaches to management of a patient with chronic illnesses, and (2) the Sexual Assault Nurse Examiners Training Project.

  7. A Model of Induction for Specialised Residential Care

    Directory of Open Access Journals (Sweden)

    Ann McWilliams

    2006-01-01

    Full Text Available The Social Care Education and Training Project at the Dublin Institute of Technology is a four year project funded by the Department of Health and Children. The project has increased the number of students enrolled in social care courses at the Institute and delivers Continued Professional Development courses for workers in the specialised residential units. The article describes an induction model developed and delivered by the project team to new workers in the specialised residential units in the Dublin region although the course is suitable for all residential care settings. The evaluation suggests that the majority of participants found the induction module worthwhile because it had a positive effect on their professional practice and increased their self confidence. This supports the need for formal induction training for all new workers to ensure they perform their professional duties effectively as possible in their new working environment.

  8. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    Directory of Open Access Journals (Sweden)

    Marc Carreras

    2016-08-01

    Full Text Available Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care. Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain for the year 2012 (N = 92,498 individuals. A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG patient classification system. Results: Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained. Conclusion: The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

  9. The Preventable Admissions Care Team (PACT): A Social Work-Led Model of Transitional Care.

    Science.gov (United States)

    Basso Lipani, Maria; Holster, Kathleen; Bussey, Sarah

    2015-10-01

    In 2010, the Preventable Admissions Care Team (PACT), a social work-led transitional care model, was developed at Mount Sinai to reduce 30-day readmissions among high-risk patients. PACT begins with a comprehensive bedside assessment to identify the psychosocial drivers of readmission. In partnership with the patient and family, a patient-centered action plan is developed and carried out through phone calls, accompaniments, navigations and home visits, as needed, in the first 30 days following discharge. 620 patients were enrolled during the pilot from September 2010-August 2012. Outcomes demonstrated a 43% reduction in inpatient utilization and a 54% reduction in emergency department visits among enrollees. In addition, 93% of patients had a follow-up appointment within 7-10 days of discharge and 90% of patients attended the appointment. The success of PACT has led to additional funding from the Centers for Medicare and Medicaid Services under the Community-based Care Transitions Program and several managed care companies seeking population health management interventions for high risk members.

  10. Clinical nursing care of 79 gastric cancer patients with radical surgery%胃癌根治术79例临床护理

    Institute of Scientific and Technical Information of China (English)

    朱凯

    2011-01-01

    Objective: To explore the nursing methods for gastric cancer patients with radical surgery.Methods: 79 gastric cancer patients with radical surgery were given preoperative psychological care, nutritional support, effective coughing and deep breathing training; the preparation of the gastrointestinal tract was fully done; the close postoperative observation on the patient's condition, clearance of the air passage, gastrointestinal decompression and a reasonable diet were effectively carried ont and provided Results: The surgical results were satisfactory and no post - operative deaths.70 patients were cured and 9 patients got the control of disease, the average days of hospitalization were 16.9 days.Conclusion: The meticulous nursing care can increase the success rate of radical surgery and also lay a good foundation for the rehabilitation of the patients.%目的:探讨胃癌根治术患者的护理方法.方法:对79例胃癌根治术患者术前进行心理护理、营养支持、有效咳嗽和深呼吸的训练,做了充分的胃肠道准备,术后密切观察患者的病情变化,保持呼吸道畅通,进行有效的胃肠减压及合理饮食.结果:本组手术疗效满意,无手术后死亡.治愈出院70例,9例病情控制,平均住院16.9 d.结论:耐心细致地护理可提高胃癌根治术的成功率,同时也为患者的康复奠定了良好的基础.

  11. Developing cross-sectoral quality assurance for cataract surgery in the statutory quality assurance program of the German health care system: Experiences and lessons learned.

    Science.gov (United States)

    Bramesfeld, Anke; Pauletzki, Jürgen; Behrenz, Lars; Szecsenyi, Joachim; Willms, Gerald; Broge, Björn

    2015-08-01

    Since 2001, statutory external quality assurance (QA) for hospital care has been in place in the German health system. In 2009, the decision was taken to expand it to cross-sectoral procedures. This novel and unprecedented form of national QA aims at (1) making the quality procedures comparable that are provided both in inpatient and outpatient care, (2) following-up outcomes of hospital care after patients' discharge and (3) measuring the quality of complex treatment chains across interfaces. As a pioneer procedure a QA procedure in cataract surgery QA was developed. Using this as an example, challenges of cross-sectoral QA are highlighted. These challenges relate, in particular, to three technical problems: triggering cases for documentation, following-up patients' after hospital discharge, and the burden of documentation in outpatient care. These problems resulted finally in the haltering of the development of the QA procedure. However, the experiences gained with this first development of cross-sectoral QA inspired the reorientation and further development of the field in Germany. Future cross-sectoral QA will rigorously aim at keeping burden of documentation small. It will draw data for QA mainly at three sources: routine data, patient surveys and peer reviews using indicators. Policy implications of this reorientation are discussed.

  12. Gallbladder Removal Simulation for Laparoscopic Surgery Training:A Hybrid Modeling Method

    Institute of Scientific and Technical Information of China (English)

    Youngjun Kim; Dongjune Chang; Jungsik Kim; Sehyung Park

    2013-01-01

    Laparoscopic surgery has many advantages,but it is difficult for a surgeon to achieve the necessary surgical skills.Recently,virtual training simulations have been gaining interest because they can provide a safe and efficient learning environment for medical students and novice surgeons.In this paper,we present a hybrid modeling method for simulating gallbladder removal that uses both the boundary element method (BEM) and the finite element method (FEM).Each modeling method is applied according to the deformable properties of human organs:BEM for the liver and FEM for the gallbladder.Connective tissues between the liver and the gallbladder are also included in the surgical simulation.Deformations in the liver and the gallbladder models are transferred via connective tissue springs using a mass-spring method.Special effects and techniques are developed to achieve realistic simulations,and the software is integrated into a custom-designed haptic interface device.Various computer graphical techniques are also applied in the virtual gallbladder removal laparoscopic surgery training.The detailed techniques and the results of the simulations are described in this paper.

  13. Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

    Directory of Open Access Journals (Sweden)

    Miguel Angel Maluf

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS: First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS: The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION: 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

  14. The effect of an educational intervention on coronary artery bypass graft surgery patients' participation rate in cardiac rehabilitation programs: a controlled health care trial

    Directory of Open Access Journals (Sweden)

    Novikov Ilia

    2011-10-01

    Full Text Available Abstract Background Cardiac rehabilitation has a beneficial effect on the prognosis and quality of life of cardiac patients, and has been found to be cost-effective. This report describes a comprehensive and low cost educational intervention designed to increase the attendance at cardiac rehabilitation programs of patients who have undergone coronary artery bypass graft surgery. Methods/Design A controlled prospective intervention trial. The control arm comprised 520 patients who underwent coronary artery bypass graft surgery between January 2004 and May 2005 in five medical centers across Israel. This group received no additional treatment beyond usual care. The intervention arm comprised 504 patients recruited from the same cardiothoracic departments between June 2005 and November 2006. This group received oral and written explanations about the advantages of participating in cardiac rehabilitation programs and a telephone call two weeks after hospital discharge intended to further encourage their enrollment. The medical staff attended a one-hour seminar on cardiac rehabilitation. In addition, it was recommended that referral to cardiac rehabilitation be added to the letter of discharge from the hospital. Both study groups were interviewed before surgery and one-year post surgery. A one-year post-operative interview assessed factors affecting patient attendance at cardiac rehabilitation programs, as well as the structure and content of the cardiac rehabilitation programs attended. Anthropometric parameters were measured at pre- and post-operative interviews;- and medical information was obtained from patient medical records. The effect of cardiac rehabilitation on one- and three-year mortality was assessed. Discussion We report a low cost yet comprehensive intervention designed to increase cardiac rehabilitation participation by raising both patient and medical staff awareness to the potential benefits of cardiac rehabilitation. Trial

  15. Cuidados imediatos no pós-operatório de cirurgia cardíaca Immediate post-operative care following cardiac surgery

    Directory of Open Access Journals (Sweden)

    Paulo Ramos David João

    2003-11-01

    Full Text Available OBJETIVO: Apresentar uma rotina de atendimento para crianças submetidas à cirurgia cardíaca. FONTES DOS DADOS: Realizada revisão bibliográfica através de bancos de dados (Medline, Mdconsult, PubMed, analisando as condutas sugeridas por diversos serviços fora do Brasil e comparando com a rotina de atendimento no Hospital Infantil Pequeno Príncipe, de Curitiba, onde foram realizadas cerca de 8.000 cirurgias cardíacas desde 1977 até abril de 2003. SÍNTESE DOS DADOS: O serviço citado é referência em cardiologia e cirurgia cardíaca no estado do Paraná e estados vizinhos. A evolução das condições de diagnóstico, preparo da equipe clínica e cirúrgica, unidade de terapia intensiva (UTI melhor equipada com monitorização mais avançada, equipe da UTI com pessoal treinado em todas as áreas para fazer pós-operatório de cirurgia cardíaca, estrutura hospitalar adequada, oferecendo atendimento avançado em todas as especialidades pediátricas e paramédicas, fazem com que o resultado das intervenções cirúrgicas realizadas em crianças com cardiopatias congênitas ou adquiridas, principalmente nos recém-nascidos e lactentes jovens com cardiopatias complexas, apresente sensível melhora quando comparado com anos anteriores. CONCLUSÃO: As crianças com cardiopatias, principalmente as complexas, devem ser encaminhadas para um local que seja centro de referência, onde haja condições para um atendimento global no pré, per e pós-operatório.OBJECTIVE: To present a care routine for children submitted to heart surgery. SOURCE OF DATA: Literature review of Medscape, MD Consult and PubMed. Analysis of the suggested conducts adopted by various services from different countries and comparison with the care routine at the Pequeno Príncipe Children's Hospital (Curitiba, state of Paraná, where approximately 8,000 heart surgeries were performed in children from 1977 to April 2003. SUMMARY OF THE FINDINGS: Our hospital is a reference

  16. Evaluation of the integrated community based home care model

    Directory of Open Access Journals (Sweden)

    LR Uys

    2001-09-01

    Full Text Available In 1999-2000 the Integrated Community-Based Home Care model for the care of people with AIDS in communities were implemented in seven sites across the country. The post-implementation evaluation showed that most respondents felt that the model could be replicated if a functioning and informed network including all partners, and a strong management team were in place. The effects of the project were mainly positive for all stakeholders (hospice, clinic, hospital, PWA and their carers, professionals and other community members. Hospitals and community- based services became more aware of and involved in the needs of PWA and felt that the model enabled them to address these needs. PWA and their carers felt supported and respected.

  17. Cost-effectiveness of ward-based pharmacy care in surgical patients: protocol of the SUREPILL (Surgery & Pharmacy In Liaison study

    Directory of Open Access Journals (Sweden)

    Kuks Paul F

    2011-03-01

    Full Text Available Abstract Background Preventable adverse drug events (pADEs are widely known to be a health care issue for hospitalized patients. Surgical patients are especially at risk, but prevention of pADEs in this population is not demonstrated before. Ward-based pharmacy interventions seem effective in reducing pADEs in medical patients. The cost-effectiveness of these preventive efforts still needs to be assessed in a comparative study of high methodological standard and also in the surgical population. For these aims the SUREPILL (Surgery & Pharmacy in Liaison study is initiated. Methods/Design A multi-centre controlled trial, with randomisation at ward-level and preceding baseline assessments is designed. Patients admitted to the surgical study wards for elective surgery with an expected length of stay of more than 48 hours will be included. Patients admitted to the intervention ward, will receive ward-based pharmacy care from the clinical pharmacy team, i.e. pharmacy practitioners and hospital pharmacists. This ward-based pharmacy intervention includes medication reconciliation in consultation with the patient at admission, daily medication review with face-to-face contact with the ward doctor, and patient counselling at discharge. Patients admitted in the control ward, will receive standard pharmaceutical care. The primary clinical outcome measure is the number of pADEs per 100 elective admissions. These pADEs will be measured by systematic patient record evaluation using a trigger tool. Patient records positive for a trigger will be evaluated on causality, severity and preventability by an independent expert panel. In addition, an economic evaluation will be performed from a societal perspective with the costs per preventable ADE as the primary economic outcome. Other outcomes of this study are: severity of pADEs, number of patients with pADEs per total number of admissions, direct (non-medical costs and indirect non-medical costs, extra costs per

  18. [ANALYSIS OF A NEW ORGANIZATIONAL MODEL APPLIED TO THE PHYSIOTERAPY SERVICE C/O SURGERY DEPARTMENTS].

    Science.gov (United States)

    Rancati, Jacopo Matteo; Incarbone, Fina Maria Teresa; Pinna, Selene; Panella, Lorenzo

    2015-01-01

    The lowering number of physiotherapists c/o surgery departments of Orthopaedic Institute Gaetano Pini of Milan, required the application of a new organizational model based on the centralization of government activities, in order to optimize employment of staff. A programming and reporting tool was developed throught a database. The collected data (from January to December 2013) related to the reported physiotherapists activities were analysed and matched to operating theater's activities in order to find the correlation value. The results are lined up the hypothesis stated in the planning phase of the organizational model's project (in absence of hystorical referral). Correlation between Physiotherapists and Operation Theather's activities was good (r=0.59), giving us a reliable predictional model. This study has some limitations mostly related to the resistence expressed by employees in the change management.

  19. Evaluation of usefulness and availability for orthopedic surgery using clavicle fracture model manufactured by desktop 3D printer

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Wang Kyun [Dept. of Diagnostic Radiology, Cheongju Medical Center, Cheongju (Korea, Republic of)

    2014-09-15

    Usefulness and clinical availability for surgery efficiency were evaluated by conducting pre-operative planning with a model manufactured by desktop 3D printer by using clavicle CT image. The patient-customized clavicle fracture model was manufactured by desktop 3D printer of FDM wire laminated processing method by converting the CT image into STL file in Open Source DICOM Viewer Osirix. Also, the model of the original shape before damaged was restored and manufactured by Mirror technique based on STL file of not fractured clavicle of the other side by using the symmetry feature of the human body. For the model, the position and size, degree of the fracture was equally printed out. Using the clavicle model directly manufactured with low cost and less time in Department of Radiology is considered to be useful because it can reduce secondary damage during surgery and increase surgery efficiency with Minimal invasive percutaneous plate osteosynthesis(MIPO)

  20. Pediatric Oncology Clinic Care Model: Achieving Better Continuity of Care for Patients in a Medium-sized Program.

    Science.gov (United States)

    Johnston, Donna L; Halton, Jacqueline; Bassal, Mylène; Klaassen, Robert J; Mandel, Karen; Ramphal, Raveena; Simpson, Ewurabena; Peckan, Li

    2016-10-25

    Providing the best care in both the inpatient and outpatient settings to pediatric oncology patients is all programs goal. Using continuous improvement methodologies, we changed from a solely team-based physician care model to a hybrid model. All patients were assigned a dedicated oncologist. There would then be 2 types of weeks of outpatient clinical service. A "Doc of the Day" week where each oncologist would have a specific day in clinic when their assigned patients would be scheduled, and then a "Doc of the Week" week where one physician would cover clinic for the week. Patient satisfaction surveys done before and 14 months after changing the model of care showed that patients were very satisfied with the care they received in both models. A questionnaire to staff 14 months after changing showed that the biggest effect was increased continuity of care, followed by more efficient clinic workflow and increased consistency of care. Staff felt it provided better planning and delivery of care. A hybrid model of care with a primary physician for each patient and assigned clinic days, alternating with weeks of single physician coverage is a feasible model of care for a medium-sized pediatric oncology program.

  1. Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods versus 3D Surgical Planning

    Directory of Open Access Journals (Sweden)

    Jeffrey A. Hammoudeh, MD, DDS

    2015-02-01

    Conclusions: It is our opinion that virtual model surgery will displace and replace traditional model surgery as it will become cost and time effective in both the private and academic setting for practitioners providing orthognathic surgical care in cleft and noncleft patients.

  2. A multidimensional model of the antecedents of stress and coping appraisals: an approach to studying patients' perceptions of post cardiac surgery pain and their coping strategies.

    Science.gov (United States)

    Shih, F J; Huang, L H

    1996-04-01

    Lazarus' stress and coping theory has been recognized as a valued conceptual framework for nursing scholars who are interested in studying their client's experiences of stress and coping. However, little data provide in-depth critiques in concepts, availability and limitations of employing Lazarus' theory in nursing phenomena in Taiwan, nor did data provide culturally sensitive propositions for Taiwanese nursing scholars to better understand their clients' stress experience such as post cardiac surgery pain. In order to help Taiwanese critical care nurses better understand the process of theoretical development while assessing their clients' perceptions of post cardiac surgery pain, the historical perspective of the concept of stress and the core components of Lazarus' theory are examined. Following is a critical critique of Lazarus' theory as a conceptual framework with which to study how patients perceive post cardiac surgery pain as a stressor. A multidimensional model of the antecedents of stress and coping appraisals for nurses to assess their clients' perceptions of pain and the resulting coping behaviors is further developed based on the aforementioned critiques. Finally, suggestions for testing theoretical propositions related to this phenomenon, as well as implications for nursing practice, research, as theory are delineated and discussed.

  3. Evaluation of the indication for surgical extraction of third molars according to the oral surgeon and the primary care dentist. Experience in the Master of Oral Surgery and Implantology at Barcelona University Dental School

    OpenAIRE

    Fuster Torres, M. Angeles; Gargallo Albiol, Jordi; Berini Aytés, Leonardo; Gay Escoda, Cosme

    2008-01-01

    Introduction: Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method: A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology...

  4. A Numerical Multiscale Framework for Modeling Patient-Specific Coronary Artery Bypass Surgeries

    Science.gov (United States)

    Ramachandra, Abhay B.; Kahn, Andrew; Marsden, Alison

    2014-11-01

    Coronary artery bypass graft (CABG) surgery is performed to revascularize diseased coronary arteries, using arterial, venous or synthetic grafts. Vein grafts, used in more than 70% of procedures, have failure rates as high as 50% in less than 10 years. Hemodynamics is known to play a key role in the mechano-biological response of vein grafts, but current non-invasive imaging techniques cannot fully characterize the hemodynamic and biomechanical environment. We numerically compute hemodynamics and wall mechanics in patient-specific 3D CABG geometries using stabilized finite element methods. The 3D patient-specific domain is coupled to a 0D lumped parameter circulatory model and parameters are tuned to match patient-specific blood pressures, stroke volumes, heart rates and heuristic flow-split values. We quantify differences in hemodynamics between arterial and venous grafts and discuss possible correlations to graft failure. Extension to a deformable wall approximation will also be discussed. The quantification of wall mechanics and hemodynamics is a necessary step towards coupling continuum models in solid and fluid mechanics with the cellular and sub-cellular responses of grafts, which in turn, should lead to a more accurate prediction of the long term outcome of CABG surgeries, including predictions of growth and remodeling.

  5. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

  6. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities.

    Science.gov (United States)

    Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen

    2015-01-01

    Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes.

  7. Characteristics of evolving models of care for arthritis: A key informant study

    OpenAIRE

    Veinot Paula; MacKay Crystal; Badley Elizabeth M

    2008-01-01

    Abstract Background The burden of arthritis is increasing in the face of diminishing health human resources to deliver care. In response, innovative models of care delivery are developing to facilitate access to quality care. Most models have developed in response to local needs with limited evaluation. The primary objective of this study is to a) examine the range of models of care that deliver specialist services using a medical/surgical specialist and at least one other health care provide...

  8. A model for ubiquitous care of noncommunicable diseases.

    Science.gov (United States)

    Vianna, Henrique Damasceno; Barbosa, Jorge Luis Victória

    2014-09-01

    The ubiquitous computing, or ubicomp, is a promising technology to help chronic diseases patients managing activities, offering support to them anytime, anywhere. Hence, ubicomp can aid community and health organizations to continuously communicate with patients and to offer useful resources for their self-management activities. Communication is prioritized in works of ubiquitous health for noncommunicable diseases care, but the management of resources is not commonly employed. We propose the UDuctor, a model for ubiquitous care of noncommunicable diseases. UDuctor focuses the resources offering, without losing self-management and communication supports. We implemented a system and applied it in two practical experiments. First, ten chronic patients tried the system and filled out a questionnaire based on the technology acceptance model. After this initial evaluation, an alpha test was done. The system was used daily for one month and a half by a chronic patient. The results were encouraging and show potential for implementing UDuctor in real-life situations.

  9. A porcine model: surgical anatomy of the orbit for maxillofacial surgery.

    Science.gov (United States)

    Kyllar, Michal; Štembírek, Jan; Danek, Zdenek; Hodan, Radek; Stránský, Jiří; Machoň, Vladimír; Foltán, René

    2016-04-01

    Due to its similarity to humans, the pig has proven to be a suitable biomodel for both research purposes and for training medical professionals, particularly in surgical specializations. For example, new implant materials have been tested on pig jaws and pigs have also been used in the development of new surgical techniques. For optimizing the effectiveness of such research or training, detailed data on the anatomy of their particular features are needed. At present, however, only limited information related to surgical and imaging anatomy of the facial and orbital areas of the pig and its comparison to human structures from the experimental surgery point of view is available in the literature. The aim of this study was to obtain such data and to compare the morphological structures of the porcine and human orbital regions and to lay down the foundation for practical use in experimental surgery. Ten pig heads were examined using computed tomography (CT) and magnetic resonance imaging (MRI) and, subsequently, a dissection of the orbit was carried out. Attention was focused on the structure of the orbit (floor, rim and nerves) frequently affected by pathological processes in humans (such as trauma, infection or tumours) and which consequently are frequently the subject of maxillofacial surgery. The porcine orbit is suitable for use in experimental medicine. However, if used in experiments, its anatomical peculiarities must be taken into consideration. Our study presents a foundation of basic knowledge for researchers who plan to use the pig as a biomedical model to investigate alternative treatments in the head region.

  10. Model surgery technique for Le Fort I osteotomy--alteration in occlusal plane associated with upward transposition of posterior maxilla.

    Science.gov (United States)

    Yosano, Akira; Yamamoto, Masae; Shouno, Takahiro; Shiiki, Sayaka; Hamase, Maki; Kasahara, Kiyohiro; Takaki, Takashi; Takano, Nobuo; Uchiyama, Takeshi; Shibahara, Takahiko

    2005-08-01

    It is difficult to translate analytical values into accurate model surgery by traditional methods, especially when moving the posterior maxilla. This is because cephalometric radiographic analysis generated information on movement of the posterior nasal spine (PNS) can not be recreated in model surgery. Therefore, we propose a method that accurately reflects such analysis and simulation of movement using Quick Ceph 2000 (Orthodontic Processing Corporation, USA). This will allow the enrichment of model surgery prior to actual surgery in cases where upward movement of the posterior maxilla is involved. All patients who participated in this study had skeletal mandibular prognathism characterized by a small occlusal plane angle in respect to the S-N plane. Cephalometric radiographs were taken and analyzed with the Quick Ceph 2000. Pre- and post-surgical evaluations were performed using Sassouni arc analysis and Ricketts analysis. Prior to transposition, we then prepared an anterior occlusal bite record on a model mounted on an articulator. This bite was then used as a reference when the molar parts were to be transposed upwards. The use of a occlusal bite permitted an accurate translation of the preoperative computer simulation into model surgery, thus facilitating favorable surgical results.

  11. 78 FR 29139 - Medicare Program; Bundled Payments for Care Improvement Model 1 Open Period

    Science.gov (United States)

    2013-05-17

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

  12. Orem自理理论在宫颈癌术后化疗患者护理中的应用%Application of Orem self-care theory in nursing of patients receiving chemotherapy after cervical cancer surgery

    Institute of Scientific and Technical Information of China (English)

    邵冬梅; 于晓吉; 康春梅; 王阿颖; 齐霁

    2012-01-01

    目的 探讨Orem自理理论在宫颈癌术后化疗患者护理中的应用效果.方法 将60例行宫颈癌术后化疗患者随机分为自护组与对照组各30例,对照组按常规方法进行护理干预,自护组在此基础上根据患者不同的护理需求运用Orem自理理论的3个护理模式—辅助教育、部分补偿、完全补偿系统方面给予相应的护理干预.比较2组护理效果.结果 自护组患者的胃肠道反应发生率明显降低,焦虑、抑郁症状明显减轻,患者及家属对护理满意度、患者自理能力明显提高,与对照组比较均有显著差异.结论 将Orem自理理论应用于宫颈癌术后化疗患者的护理,能极大地调动患者与家属的积极性,减少胃肠道不良反应的发生.同时,可密切护患关系,提升患者与家属的满意度,提高患者的自理能力,提高护理工作质量,减轻患者心理症状,具有显著的社会与经济效益.%Objective To study the application effect of Orem self-care theory in nursing of postoperative chemotherapy patients after cervical cancer surgery. Methods 60 patients receiving chemotherapy after cervical cancer surgery were randomly divided into the self-care group and the control group with 30 cases in each group,the control group received routine nursing,on this basis the self-care group was given nursing intervention according to different requirement of patients by using three nursing model of Orem self-care theory-supportive education,part compensation,complete compensation system.The nursing effect was compared between two groups. Results Compared with the control group,the rate of gastrointestinal adverse reaction was lower,the anxiety and depression symptom alleviated,satisfaction degree of patients and their relatives with nursing improved,self-care ability of patients was enhanced in the self-care group,all had significant differences. Conclusions Application of self-care theory in nursing care of patients during

  13. KinoHaptics: An Automated, Wearable, Haptic Assisted, Physio-therapeutic System for Post-surgery Rehabilitation and Self-care.

    Science.gov (United States)

    Rajanna, Vijay; Vo, Patrick; Barth, Jerry; Mjelde, Matthew; Grey, Trevor; Oduola, Cassandra; Hammond, Tracy

    2016-03-01

    A carefully planned, structured, and supervised physiotherapy program, following a surgery, is crucial for the successful diagnosis of physical injuries. Nearly 50 % of the surgeries fail due to unsupervised, and erroneous physiotherapy. The demand for a physiotherapist for an extended period is expensive to afford, and sometimes inaccessible. Researchers have tried to leverage the advancements in wearable sensors and motion tracking by building affordable, automated, physio-therapeutic systems that direct a physiotherapy session by providing audio-visual feedback on patient's performance. There are many aspects of automated physiotherapy program which are yet to be addressed by the existing systems: a wide classification of patients' physiological conditions to be diagnosed, multiple demographics of the patients (blind, deaf, etc.), and the need to pursue patients to adopt the system for an extended period for self-care. In our research, we have tried to address these aspects by building a health behavior change support system called KinoHaptics, for post-surgery rehabilitation. KinoHaptics is an automated, wearable, haptic assisted, physio-therapeutic system that can be used by a wide variety of demographics and for various physiological conditions of the patients. The system provides rich and accurate vibro-haptic feedback that can be felt by the user, irrespective of the physiological limitations. KinoHaptics is built to ensure that no injuries are induced during the rehabilitation period. The persuasive nature of the system allows for personal goal-setting, progress tracking, and most importantly life-style compatibility. The system was evaluated under laboratory conditions, involving 14 users. Results show that KinoHaptics is highly convenient to use, and the vibro-haptic feedback is intuitive, accurate, and has shown to prevent accidental injuries. Also, results show that KinoHaptics is persuasive in nature as it supports behavior change and habit building

  14. Plastic Surgery

    Science.gov (United States)

    ... Surgery? A Week of Healthy Breakfasts Shyness Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A A ... forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word "plastic" ...

  15. Nose Surgery

    Science.gov (United States)

    ... Marketplace Find an ENT Doctor Near You Nose Surgery Nose Surgery Patient Health Information News media interested ... high a priority as appearance. Can Cosmetic Nasal Surgery Create A "Perfect" Nose? Aesthetic nasal surgery (rhinoplasty) ...

  16. Health care policy development: a critical analysis model.

    Science.gov (United States)

    Logan, Jean E; Pauling, Carolyn D; Franzen, Debra B

    2011-01-01

    This article describes a phased approach for teaching baccalaureate nursing students critical analysis of health care policy, including refinement of existing policy or the foundation to create new policy. Central to this approach is the application of an innovative framework, the Grand View Critical Analysis Model, which was designed to provide a conceptual base for the authentic learning experience. Students come to know the interconnectedness and the importance of the model, which includes issue selection and four phases: policy focus, colleagueship analysis, evidence-based practice analysis, and policy analysis and development.

  17. Modeling and control of tissue compression and temperature for automation in robot-assisted surgery.

    Science.gov (United States)

    Sinha, Utkarsh; Li, Baichun; Sankaranarayanan, Ganesh

    2014-01-01

    Robotic surgery is being used widely due to its various benefits that includes reduced patient trauma and increased dexterity and ergonomics for the operating surgeon. Making the whole or part of the surgical procedure autonomous increases patient safety and will enable the robotic surgery platform to be used in telesurgery. In this work, an Electrosurgery procedure that involves tissue compression and application of heat such as the coaptic vessel closure has been automated. A MIMO nonlinear model characterizing the tissue stiffness and conductance under compression was feedback linearized and tuned PID controllers were used to control the system to achieve both the displacement and temperature constraints. A reference input for both the constraints were chosen as a ramp and hold trajectory which reflect the real constraints that exist in an actual surgical procedure. Our simulations showed that the controllers successfully tracked the reference trajectories with minimal deviation and in finite time horizon. The MIMO system with controllers developed in this work can be used to drive a surgical robot autonomously and perform electrosurgical procedures such as coaptic vessel closures.

  18. The Attending Nurse Caring Model: integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice.

    Science.gov (United States)

    Watson, Jean; Foster, Roxie

    2003-05-01

    This paper presents a proposed model: The Attending Nursing Caring Model (ANCM) as an exemplar for advancing and transforming nursing practice within a reflective, theoretical and evidence-based context. Watson's theory of human caring is used as a guide for integrating theory, evidence and advanced therapeutics in the area of children's pain. The ANCM is offered as a programme for renewing the profession and its professional practices of caring-healing arts and science, during an era of decline, shortages, and crises in care, safety, and hospital and health reform. The ANCM elevates contemporary nursing's caring values, relationships, therapeutics and responsibilities to a higher/deeper order of caring science and professionalism, intersecting with other professions, while sustaining the finest of its heritage and traditions of healing.

  19. 76 FR 33306 - Medicare Program; Pioneer Accountable Care Organization Model, Request for Applications; Correction

    Science.gov (United States)

    2011-06-08

    ... Care Organization Model: Request for Applications.'' FOR FURTHER INFORMATION CONTACT: Maria Alexander... http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco... HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare Program; Pioneer Accountable...

  20. Developing a Total Quality Management Model for Health Care Systems

    Directory of Open Access Journals (Sweden)

    AM Mosadegh Rad

    2005-10-01

    Full Text Available Background: Total quality management (TQM is a managerial practice to improve the effectiveness, efficiency, flexibility, and competitiveness of a business as a whole. However, in practice, these TQM benefits are not easy to achieve. Despite its theoretical promise and the enthusiastic response to TQM, recent evidence suggests that attempts to implement it are often unsuccessful. Many of these TQM programmes have been cancelled, or are in the process of being cancelled, as a result of the negative impact on profits. Therefore, there is a pressing need for a clinical approach to establishing TQM. Method: The aim of this article is therefore: “To identify the strengths and weakness of TQM, the logical steps towards TQM, and to develop a model so that health care organizations aiming at using TQM to achieve excellence can follow through easily”. Based on the research questions proposed in this study, the research strategies of a literature review, a questionnaire survey, semi-structured interviews, and a participatory action research were adopted in this study. For determining the success and barriers of TQM in health care organizations, a questionnaire survey has done in 90 health acre organizations in Isfahan Province, which implement TQM. The results of this survey were used for introducing a new model of TQM. This model will be developed via a semi-structured interview with at minimum 10 health care and quality managers. Then, through a participatory action research, this model will be implemented in 3 sites. At this time, the questionnaire survey has done and the model is introduced. Therefore, developing the model and its implementation will be done later. Results: In this survey, the mean score of TQM success was 3.48±0.68 (medium from 5 credits. Implementation of TQM was very low, low, medium, high and very high successful respectively in 3.6, 10.9, 21.8, 56.4 and 7.3 percent of health care organizations. TQM had the most effect on

  1. Integration of a hospital information system in a Greek cardiac surgery hospital through specific education programs for health care personnel: development of nursing documentation.

    Science.gov (United States)

    Tsirintani, M

    1995-01-01

    This study represents an educative effort for integrating an innovative Hospital Information System (HIS) in Greece for quality impact on nursing practice and conductive research. The Hospital involved is the Onassis Cardiac Surgery Center (OCSC), a new 150 bedded state-of-the-art hospital in Athens. The aims of this study are the following: 1) To present the educational assessment concerning the HIS of Onassis Center, 2) To develop Nursing documentation to support the educational needs of nurses and clerks in correlation with the Nursing/Medical record of HIS, and 3) To show the meaning of continuing education for new and old hospital staff and the use of the system as an educative and consultative tool for decision support for health care personnel, especially nurses.

  2. [An Experience Promoting the Interdisciplinary Care Model for Dengue Fever].

    Science.gov (United States)

    Kuo, Wen-Fu; Ke, Ya-Ting

    2016-08-01

    Emergency departments represent the first line in facing major healthcare events. During major epidemic outbreaks, patients crowding into the emergency departments increase the wait time for patients and overload the staffs that are on duty. The dengue fever outbreak in southern Taiwan during the summer 2015 presented a huge management challenge for physicians and nurses in local hospitals. We responded to this challenge by integrating resources from different hospital departments. This strategy successfully increased group cohesiveness among the medical team, ensuring that they could not only ultimately cope with the outbreak together but also effectively provide patient-centered care. This interdisciplinary care model may serve as a reference for medical professionals for the management of future epidemics and similar events.

  3. The content and development trend of acute care surgery in America and its enlightenment to the training of acute care surgeons in China%美国急诊外科的内涵和发展趋势及对我国创伤救治医师培养的启示

    Institute of Scientific and Technical Information of China (English)

    宗兆文

    2015-01-01

    Acute care surgery are both a emergency surgical care system and a training paradigm developed by American trauma care society.Its development is very helpful in improving the trauma care ability and efficiency in U.S.A.The training curriculum includes elective general surgery, emergency surgery, trauma surgery and surgi-cal critical care.Part of neurological surgery, orthopedics and interventional radiology skills are also included. These successful experiences are worth learning by the trauma care society in China.%美国急诊外科是其创伤学界为应对创伤医师短缺而创建的外科急症救治模式和培训模式,对提高美国的创伤救治水平和效率具有重要的积极意义。其课程设置包括选择性普通外科、急症普通外科、创伤外科和外科重症监护,同时还选择性加入部分神经外科、骨科和介入性放射学技能的培训。美国急诊外科的成功经验值得我国创伤学界借鉴。

  4. Evaluation of an In Silico PBPK Post-Bariatric Surgery Model through Simulating Oral Drug Bioavailability of Atorvastatin and Cyclosporine.

    Science.gov (United States)

    Darwich, A S; Pade, D; Rowland-Yeo, K; Jamei, M; Asberg, A; Christensen, H; Ashcroft, D M; Rostami-Hodjegan, A

    2013-06-12

    An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (Foral). In the absence of clinical data, an indication of changes to Foral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual "post-bariatric surgery" population was evaluated through mimicking clinical investigations on cyclosporine and atorvastatin after bariatric surgery. Cyclosporine simulations displayed a reduced fraction absorbed through gut wall (fa) and Foral after surgery, consistent with reported observations. Simulated atorvastatin Foral postsurgery was broadly reflective of observed data with indications of counteracting interplay between reduced fa and an increased fraction escaping gut wall metabolism (FG). Inability to fully recover observed atorvastatin exposure after biliopancreatic diversion with duodenal switch highlights the current gap regarding the knowledge of associated biological changes.CPT: Pharmacometrics & Systems Pharmacology (2013) 2, e47; doi:10.1038/psp.2013.23; advance online publication 12 June 2013.

  5. Timing of surgery for sciatica

    NARCIS (Netherlands)

    Peul, Wilco C.

    2008-01-01

    The frequently diagnosed lumbar disc herniation can disappear by natural course, but still leads to high low back surgery rates. The optimal period of conservative care, before surgery is executed, was unknown. It is surprising that scientific evidence was lacking which justified “early” surgery. Su

  6. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  7. Integrated bariatric surgery residency

    Directory of Open Access Journals (Sweden)

    Eltorai AE

    2014-11-01

    Full Text Available Adam EM Eltorai Warren Alpert Medical School of Brown University, RI, USA Abstract: Obesity is a major public health concern. Given its lasting efficacy for improving obesity and obesity-related diseases, bariatric surgery is an increasingly common treatment option. As the implementation of the Affordable Care Act progresses, the impending physician shortage will become more severe. Thus there will be an even greater need for doctors specialized in the management and treatment of obese patients. The development of integrated bariatric surgery residency programs could be considered and is discussed herein. Keywords: obesity, bariatric surgery, integrated residency, surgery education

  8. A framework to support team-based models of primary care within the Australian health care system.

    Science.gov (United States)

    Naccarella, Lucio; Greenstock, Louise N; Brooks, Peter M

    2013-09-01

    Health systems with strong primary care orientations are known to be associated with improved equity, better access for patients to appropriate services at lower costs, and improved population health. Team-based models of primary care have emerged in response to health system challenges due to complex patient profiles, patient expectations and health system demands. Successful team-based models of primary care require a combination of interprofessional education and learning; organisational and management policies and systems; and practice support systems. To ensure evidence is put into practice, we propose a framework comprising five domains (theory, implementation, infrastructure, sustainability and evaluation) to assist policymakers, educators, researchers, managers and health professionals in supporting team-based models of primary care within the Australian health care system.

  9. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months.Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files.Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis.Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is required

  10. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

    Directory of Open Access Journals (Sweden)

    Wilhelmina Mijntje Looman

    2014-12-01

    Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is

  11. Non-Opioid Analgesics Consumption At The Surgery Departments Of A Secondary Care Hospital In General Hospital In Kraljevo, Serbia

    OpenAIRE

    Aleksic Dejan; Bukonjic Andriana; Stefanovic Srdjan

    2015-01-01

    The aim of this study was to determine the amount of non-opioid analgesics consumed at the surgical departments of a secondary care hospital in Serbia, a developing country undergoing a socioeconomic transition that thus lacks sufficient funds to finance and invest in the healthcare system.

  12. Non-Opioid Analgesics Consumption At The Surgery Departments Of A Secondary Care Hospital In General Hospital In Kraljevo, Serbia

    Directory of Open Access Journals (Sweden)

    Aleksic Dejan

    2015-09-01

    Full Text Available The aim of this study was to determine the amount of non-opioid analgesics consumed at the surgical departments of a secondary care hospital in Serbia, a developing country undergoing a socioeconomic transition that thus lacks sufficient funds to finance and invest in the healthcare system.

  13. Prevalence of alcohol misuse among men and women undergoing major noncardiac surgery in the Veterans Affairs health care system

    DEFF Research Database (Denmark)

    Bradley, Katharine A; Rubinsky, Anna D; Sun, Haili;

    2012-01-01

    Patients who screen positive for alcohol misuse on the Alcohol Use Disorder Identification Test Consumption Questionnaire (AUDIT-C ≥5 points) have significantly increased postoperative complications. Severe alcohol misuse (AUDIT-C ≥9 points) is associated with increased postoperative health care ...

  14. 75 FR 2562 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Science.gov (United States)

    2010-01-15

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care Continuation... document announces the availability of the model health care continuation coverage notices required by...

  15. 75 FR 26276 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Science.gov (United States)

    2010-05-11

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the Availability of the Model Health Care Continuation... announces the availability of the model health care continuation coverage notices required by ARRA,...

  16. 76 FR 29249 - Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications

    Science.gov (United States)

    2011-05-20

    ... participate in the Pioneer Accountable Care Organization Model for a period beginning in 2011 and ending...://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco . Application Submission... Accountable Care Organization Model or the application process. SUPPLEMENTARY INFORMATION: I. Background...

  17. 75 FR 13595 - Publication of Model Notices for Health Care Continuation Coverage Provided Pursuant to the...

    Science.gov (United States)

    2010-03-22

    ... Benefits Security Administration Publication of Model Notices for Health Care Continuation Coverage... Administration, Department of Labor. ACTION: Notice of the availability of the Model Health Care Continuation... document announces the availability of the model health care continuation coverage notices required by...

  18. 78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement

    Science.gov (United States)

    2013-02-06

    ... Disease Care Model Announcement AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION... the testing of the Comprehensive End- Stage Renal Disease (ESRD) Care Model, a new initiative from the... (CHIP) beneficiaries. We are interested in identifying models designed to improve care for...

  19. 76 FR 34712 - Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission...

    Science.gov (United States)

    2011-06-14

    ...: This notice extends the deadlines for the submission of the Pioneer Accountable Care Organization Model...-coordinated-care-models/pioneer-aco . Application Submission Deadline: Applications must be postmarked on or before August 19, 2011. The Pioneer Accountable Care Organization Model ] Application is available...

  20. Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury

    NARCIS (Netherlands)

    Bloemen-Vrencken, J.H.A.; De Witte, L.P.; Engels, J.P.G.M.; Van den Heuvel, W.J.A.; Post, M.W.M.

    2005-01-01

    Purposes: The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purp

  1. Modelling of a laser-pumped light source for endoscopic surgery

    Science.gov (United States)

    Nadeau, Valerie J.; Elson, Daniel S.; Hanna, George B.; Neil, Mark A. A.

    2008-09-01

    A white light source, based on illumination of a yellow phosphor with a fibre-coupled blue-violet diode laser, has been designed and built for use in endoscopic surgery. This narrow light probe can be integrated into a standard laparoscope or inserted into the patient separately via a needle. We present a Monte Carlo model of light scattering and phosphorescence within the phosphor/silicone matrix at the probe tip, and measurements of the colour, intensity, and uniformity of the illumination. Images obtained under illumination with this light source are also presented, demonstrating the improvement in illumination quality over existing endoscopic light sources. This new approach to endoscopic lighting has the advantages of compact design, improved ergonomics, and more uniform illumination in comparison with current technologies.

  2. Statistical modelling for thoracic surgery using a nomogram based on logistic regression.

    Science.gov (United States)

    Liu, Run-Zhong; Zhao, Ze-Rui; Ng, Calvin S H

    2016-08-01

    A well-developed clinical nomogram is a popular decision-tool, which can be used to predict the outcome of an individual, bringing benefits to both clinicians and patients. With just a few steps on a user-friendly interface, the approximate clinical outcome of patients can easily be estimated based on their clinical and laboratory characteristics. Therefore, nomograms have recently been developed to predict the different outcomes or even the survival rate at a specific time point for patients with different diseases. However, on the establishment and application of nomograms, there is still a lot of confusion that may mislead researchers. The objective of this paper is to provide a brief introduction on the history, definition, and application of nomograms and then to illustrate simple procedures to develop a nomogram with an example based on a multivariate logistic regression model in thoracic surgery. In addition, validation strategies and common pitfalls have been highlighted.

  3. A Porcine Liver Model for Validation of Registration Accuracy in Image-Guided Surgery

    Science.gov (United States)

    Peterhans, Matthias; Dagon, Benoît; Berg, Anne Vom; Inderbitzin, Daniel; Baur, Charles; Weber, Stefan

    Correct registration between pre-operative high-resolution images and intra-operative data of lower detail is a fundamental requirement in image-guided liver surgery. We propose a multi modality liver model for measuring the accuracy of such registration methods. A freshly explanted porcine liver is artificially perfused by a peristaltic pump and liver motion is simulated by means of inflatable objects positioned around the liver. Co-registered ultrasound and CT data sets are acquired in different deformation scenarios and allow compar-ing registration outcomes with a CT data set serving as ground truth. The pre-sent work describes the experimental setup and summarizes the results from ultrasound and CT imaging.

  4. Characteristics of evolving models of care for arthritis: A key informant study

    Directory of Open Access Journals (Sweden)

    Veinot Paula

    2008-07-01

    Full Text Available Abstract Background The burden of arthritis is increasing in the face of diminishing health human resources to deliver care. In response, innovative models of care delivery are developing to facilitate access to quality care. Most models have developed in response to local needs with limited evaluation. The primary objective of this study is to a examine the range of models of care that deliver specialist services using a medical/surgical specialist and at least one other health care provider and b document the strengths and challenges of the identified models. A secondary objective is to identify key elements of best practice models of care for arthritis. Methods Semi-structured interviews were conducted with a sample of key informants with expertise in arthritis from jurisdictions with primarily publicly-funded health care systems. Qualitative data were analyzed using a constant comparative approach to identify common types of models of care, strengths and challenges of models, and key components of arthritis care. Results Seventy-four key informants were interviewed from six countries. Five main types of models of care emerged. 1 Specialized arthritis programs deliver comprehensive, multidisciplinary team care for arthritis. Two models were identified using health care providers (e.g. nurses or physiotherapists in expanded clinical roles: 2 triage of patients with musculoskeletal conditions to the appropriate services including specialists; and 3 ongoing management in collaboration with a specialist. Two models promoting rural access were 4 rural consultation support and 5 telemedicine. Key informants described important components of models of care including knowledgeable health professionals and patients. Conclusion A range of models of care for arthritis have been developed. This classification can be used as a framework for discussing care delivery. Areas for development include integration of care across the continuum, including primary

  5. Mechanisms driving local breast cancer recurrence in a model of breast-conserving surgery.

    LENUS (Irish Health Repository)

    Smith, Myles J

    2012-02-03

    OBJECTIVE: We aimed to identify mechanisms driving local recurrence in a model of breast-conserving surgery (BCS) for breast cancer. BACKGROUND: Breast cancer recurrence after BCS remains a clinically significant, but poorly understood problem. We have previously reported that recurrent colorectal tumours demonstrate altered growth dynamics, increased metastatic burden and resistance to apoptosis, mediated by upregulation of phosphoinositide-3-kinase\\/Akt (PI3K\\/Akt). We investigated whether similar characteristics were evident in a model of locally recurrent breast cancer. METHODS: Tumours were generated by orthotopic inoculation of 4T1 cells in two groups of female Balb\\/c mice and cytoreductive surgery performed when mean tumour size was above 150 mm(3). Local recurrence was observed and gene expression was examined using Affymetrix GeneChips in primary and recurrent tumours. Differential expression was confirmed with quantitative real-time polymerase chain reaction (qRT-PCR). Phosphorylation of Akt was assessed using Western immunoblotting. An ex vivo heat shock protein (HSP)-loaded dendritic cell vaccine was administered in the perioperative period. RESULTS: We observed a significant difference in the recurrent 4T1 tumour volume and growth rate (p < 0.05). Gene expression studies suggested roles for the PI3K\\/Akt system and local immunosuppression driving the altered growth kinetics. We demonstrated that perioperative vaccination with an ex vivo HSP-loaded dendritic cell vaccine abrogated recurrent tumour growth in vivo (p = 0.003 at day 15). CONCLUSION: Investigating therapies which target tumour survival pathways such as PI3K\\/Akt and boost immune surveillance in the perioperative period may be useful adjuncts to contemporary breast cancer treatment.

  6. Application of Porter’s Five Forces Model and generic strategies for vascular surgery: should be stuck in the middle?

    Science.gov (United States)

    Sumpio, Bauer E

    2013-06-01

    There are many stakeholders in the vascular marketplace from clinicians to hospitals, third party payers, medical device manufacturers and the government. Economic stress, threats of policy reform and changing health-care delivery are adding to the challenges faced by vascular surgeons. Use of Porter's Five Forces analysis to identify the sources of competition, the strength and likelihood of that competition existing, and barriers to competition that affect vascular surgery will help our specialty understand both the strength of our current competition and the strength of a position that our specialty will need to move to. By understanding the nature of the Porter's Five Forces as it applies to vascular surgery, and by appreciating their relative importance, our society would be in a stronger position to defend itself against threats and perhaps influence the forces with a long-term strategy. Porter's generic strategies attempt to create effective links for business with customers and suppliers and create barriers to new entrants and substitute products. It brings an initial perspective that is convenient to adapt to vascular surgery in order to reveal opportunities.Vascular surgery is uniquely situated to pursue both a differentiation and high value leadership strategy.

  7. Aortic aneurysm disease vs. aortic occlusive disease - differences in outcome and intensive care resource utilisation after elective surgery

    DEFF Research Database (Denmark)

    Bisgaard, Jannie; Gilsaa, Torben; Rønholm, Ebbe;

    2013-01-01

    clamping is more pronounced in patients with aortic aneurysm disease, which may affect outcome. OBJECTIVES: The aim of this observational cohort study was to evaluate outcome after open elective abdominal aortic surgery, hypothesising a higher 30-day mortality, a higher incidence of postoperative organ...... dysfunction and a longer length of stay in patients with aortic aneurysm compared with aortic occlusive disease. DESIGN: Cohort observational study based on prospective registrations from national databases. SETTING: Eight Danish hospitals, including four university and four non-university centres, from 1...... or inotropes, ICU stay more than 24 h, hospital length of stay and mortality. RESULTS: Compared with aortic occlusive disease, more patients with aortic aneurysm disease had ICU stays more than 24 h (62 vs. 45%, P ...

  8. Efficiency of a Care Coordination Model: A Randomized Study with Stroke Patients

    Science.gov (United States)

    Claiborne, Nancy

    2006-01-01

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

  9. EPEC-O for African Americans - Plenary 2 AA - Models of Comprehensive Care

    Science.gov (United States)

    The second plenary of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans reviews the various models for integration of hospice and palliative care into traditional cancer care that have been shown to improve outcomes.

  10. A Clinic Model: Post-Intensive Care Syndrome and Post-Intensive Care Syndrome-Family.

    Science.gov (United States)

    Huggins, Elizabeth L; Bloom, Sarah L; Stollings, Joanna L; Camp, Mildred; Sevin, Carla M; Jackson, James C

    2016-01-01

    The number of patients surviving critical illness in the United States has increased with advancements in medicine. Post-intensive care syndrome and post-intensive care syndrome-family are terms developed by the Society of Critical Care Medicine in order to address the cognitive, psychological, and physical sequelae emerging in patients and their families after discharge from the intensive care unit. In the United Kingdom and Europe, intensive care unit follow-up clinics have been used to address the complications of post-intensive care syndrome for some time. However, the interprofessional clinic at Vanderbilt University Medical Center is among the first in the United States to address the wide variety of problems experienced by intensive care survivors and to provide patients and their families with care after discharge from the intensive care unit.

  11. Mortality after surgery in Europe

    DEFF Research Database (Denmark)

    Pearse, Rupert M; Moreno, Rui P; Bauer, Peter;

    2012-01-01

    Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international...... study designed to assess outcomes after non-cardiac surgery in Europe....

  12. An agent-based simulation model of patient choice of health care providers in accountable care organizations.

    Science.gov (United States)

    Alibrahim, Abdullah; Wu, Shinyi

    2016-10-04

    Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.

  13. A model for 'reverse innovation' in health care.

    Science.gov (United States)

    Depasse, Jacqueline W; Lee, Patrick T

    2013-08-30

    'Reverse innovation,' a principle well established in the business world, describes the flow of ideas from emerging to more developed economies. There is strong and growing interest in applying this concept to health care, yet there is currently no framework for describing the stages of reverse innovation or identifying opportunities to accelerate the development process. This paper combines the business concept of reverse innovation with diffusion of innovation theory to propose a model for reverse innovation as a way to innovate in health care. Our model includes the following steps: (1) identifying a problem common to lower- and higher-income countries; (2) innovation and spread in the low-income country (LIC); (3) crossover to the higher-income country (HIC); and (4) innovation and spread in the HIC. The crucial populations in this pathway, drawing from diffusion of innovation theory, are LIC innovators, LIC early adopters, and HIC innovators. We illustrate the model with three examples of current reverse innovations. We then propose four sets of specific actions that forward-looking policymakers, entrepreneurs, health system leaders, and researchers may take to accelerate the movement of promising solutions through the reverse innovation pipeline: (1) identify high-priority problems shared by HICs and LICs; (2) create slack for change, especially for LIC innovators, LIC early adopters, and HIC innovators; (3) create spannable social distances between LIC early adopters and HIC innovators; and (4) measure reverse innovation activity globally.

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

    Directory of Open Access Journals (Sweden)

    Vedel Isabelle

    2013-01-01

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

  15. iGuide to plastic surgery: iPhone apps, the plastic surgeon, and the health care environment.

    Science.gov (United States)

    Mohan, Anita Tanniru; Branford, Olivier Alexandre

    2012-07-01

    The growth in the adoption of smartphones among clinicians has been phenomenal. The demand for medical applications, or "apps," downloaded by smartphone users has led to the development of practical and educational apps for clinicians, medical students, and patients. In addition to being a valuable resource for the clinician, mobile technologies are revolutionizing the nature and delivery of health care services. This article summarizes the current trends in the smartphone market and explores the medical apps that are currently available.

  16. End-of-life care in the United States: policy issues and model programs of integrated care

    Directory of Open Access Journals (Sweden)

    Joshua M. Wiener

    2003-05-01

    Full Text Available Background: End-of-life care financing and delivery in the United States is fragmented and uncoordinated, with little integration of acute and long-term care services. Objective: To assess policy issues involving end-of-life care, especially involving the hospice benefit, and to analyse model programs of integrated care for people who are dying. Methods: The study conducted structured interviews with stakeholders and experts in end-of-life care and with administrators of model programs in the United States, which were nominated by the experts. Results: The two major public insurance programs—Medicare and Medicaid—finance the vast majority of end-of-life care. Both programs offer a hospice benefit, which has several shortcomings, including requiring physicians to make a prognosis of a six month life expectancy and insisting that patients give up curative treatment—two steps which are difficult for doctors and patients to make—and payment levels that may be too low. In addition, quality of care initiatives for nursing homes and hospice sometimes conflict. Four innovative health systems have overcome these barriers to provide palliative services to beneficiaries in their last year of life. Three of these health systems are managed care plans which receive capitated payments. These providers integrate health, long-term and palliative care using an interdisciplinary team approach to management of services. The fourth provider is a hospice that provides palliative services to beneficiaries of all ages, including those who have not elected hospice care. Conclusions: End-of-life care is deficient in the United States. Public payers could use their market power to improve care through a number of strategies.

  17. Erratum to: Many diseases, one model of care?

    Directory of Open Access Journals (Sweden)

    Tit Albreht

    2016-02-01

    Full Text Available Abstract Erratum to: Albreht T, Dyakova M, Schellevis FG, Van den Broucke S. Many diseases, one model of care? J Comorbidity 2016;6(1:12−20. doi: 10.15256/joc.2016.6.73. The received and accepted dates for this article were incorrectly published as Jan 4, 2015 and Jan 25, 2015, respectively, instead of Jan 4, 2016 and Jan 25, 2016, respectively. The original article has now been updated to reflect the correct submission and acceptance dates. Journal of Comorbidity 2016;6(1:34 The original article can be found at: http://dx.doi.org/10.15256/joc.2016.6.73

  18. A Quadratic Nonlinear Prediction-Based Heart Motion Model Following Control Algorithm in Robotic-Assisted Beating Heart Surgery

    Directory of Open Access Journals (Sweden)

    Fan Liang

    2013-01-01

    Full Text Available Off‐pump coronary artery bypass graft surgery outperforms the traditional on‐pump surgery because the assisted robotic tools can cancel the relative motion between the beating heart and the robotic tools, which reduces post‐surgery complications for patients. The challenge for the robot assisted tool when tracking the beating heart is the abrupt change caused by the nonlinear nature of heart motion and high precision surgery requirements. A characteristic analysis of 3D heart motion data through bi‐spectral analysis demonstrates the quadratic nonlinearity in heart motion. Therefore, it is necessary to introduce nonlinear heart motion prediction into the motion tracking control procedures. In this paper, the heart motion tracking problem is transformed into a heart motion model following problem by including the adaptive heart motion model into the controller. Moreover, the model following algorithm with the nonlinear heart motion model embedded inside provides more accurate future reference by the quadratic term of sinusoid series, which could enhance the tracking accuracy of sharp change point and approximate the motion with sufficient detail. The experiment results indicate that the proposed algorithm outperforms the linear prediction‐based model following controller in terms of tracking accuracy (root mean square.

  19. The Norrtaelje model: a unique model for integrated health and social care in Sweden.

    Science.gov (United States)

    Bäck, Monica Andersson; Calltorp, Johan

    2015-01-01

    Many countries organise and fund health and social care separately. The Norrtaelje model is a Swedish initiative that transformed the funding and organisation of health and social care in order to better integrate care for older people with complex needs. In Norrtaelje model, this transformation made it possible to bringing the team together, to transfer responsibility to different providers, to use care coordinators, and to develop integrated pathways and plans around transitions in and out of hospital and from nursing homes to hospital. The Norrtaelje model operates in the context of the Swedish commitment to universal coverage and public programmes based on tax-funded resources that are pooled and redistributed to citizens on the basis of need. The experience of Norrtaelje model suggests that one way to promote integration of health and social care is to start with a transformation that aligns these two sectors in terms of high level organisation and funding. This transformation then enables the changes in operations and management that can be translated into changes in care delivery. This "top-down" approach must be in-line with national priorities and policies but ultimately is successful only if the culture, resource allocation and management are changed throughout the local system.

  20. Testing cost-benefit models of parental care evolution using lizard populations differing in the expression of maternal care.

    Directory of Open Access Journals (Sweden)

    Wen-San Huang

    Full Text Available Parents are expected to evolve tactics to care for eggs or offspring when providing such care increases fitness above the costs incurred by this behavior. Costs to the parent include the energetic demands of protecting offspring, delaying future fecundity, and increased risk of predation. We used cost-benefit models to test the ecological conditions favoring the evolution of parental care, using lizard populations that differ in whether or not they express maternal care. We found that predators play an important role in the evolution of maternal care because: (1 evolving maternal care is unlikely when care increases predation pressure on the parents; (2 maternal care cannot evolve under low levels of predation pressure on both parents and offspring; and (3 maternal care evolves only when parents are able to successfully defend offspring from predators without increasing predation risk to themselves. Our studies of one of the only known vertebrate species to exhibit interpopulation differences in the expression of maternal care provide clear support for some of the hypothesized circumstances under which maternal care should evolve (e.g., when nests are in exposed locations, parents are able to defend the eggs from predators, and egg incubation periods are brief, but do not support others (e.g., when nest-sites are scarce, life history strategies are "risky", reproductive frequency is low, and environmental conditions are harsh. We conclude that multiple pathways can lead to the evolution of parental care from a non-caring state, even in a single population of a widespread species.

  1. Cataract Surgery: Fraud, Waste, and Abuse. A Report by the Chairman of the Subcommittee on Health and Long-Term Care of the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, First Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. House Select Committee on Aging.

    This report is a summary of the findings from the Subcommittee on Health and Long-Term Care of the United States House of Representatives Select Committee on Aging investigation of cataract surgery and the use of intraocular lenses (IOL's) in the United States. The document provides background on the definition and treatment of cataracts and…

  2. Comparison of linear and non-linear soft tissue models with post-operative CT scan in maxillofacial surgery

    CERN Document Server

    Chabanas, M; Marecaux, C; Swider, P; Boutault, F; Chabanas, Matthieu; Payan, Yohan; Marecaux, Christophe; Swider, Pascal; Boutault, Franck

    2004-01-01

    A Finite Element model of the face soft tissue is proposed to simulate the morphological outcomes of maxillofacial surgery. Three modelling options are implemented: a linear elastic model with small and large deformation hypothesis, and an hyperelastic Mooney-Rivlin model. An evaluation procedure based on a qualitative and quantitative comparison of the simulations with a post-operative CT scan is detailed. It is then applied to one clinical case to evaluate the differences between the three models, and with the actual patient morphology. First results shows in particular that for a "simple" clinical procedure where stress is less than 20%, a linear model seams sufficient for a correct modelling.

  3. Psychological evaluation of patients after breast cancer surgery and care strategies improvement%乳腺癌术后患者心理状态评估及干预策略改进

    Institute of Scientific and Technical Information of China (English)

    Yanjun Zhang; Caigang Liu; Feng Jin

    2011-01-01

    Objective: The aim of the study was to investigate the level of self-image of patients after breast cancer surgery, and explore factors influencing self-image among patients who have experienced different types of surgeries, and set out a foundation for the improvement of care strategies. Methods: The 538 patients with primary breast cancer who underwent surgery in the Department of Breast Surgery, First Hospital of China Medical University, Shenyang, China, from January 2004 to January 2009 were included in the study. The psychological status of the patients was evaluated by body image after breast cancer questionnaire (BIBCQ), social support rating scale (SSRS), self-rating anxiety scale (SRAS), depression rat-ing scale (DRS), and general information questionnaire. The factors influencing the self-image were selected by a stepwise regression analysis. Results: The patients who underwent breast-conserving surgery were the most satisfied with their body image, followed by those underwent surgery of modified radical mastectomy with reconstruction. However, cases treated by modified radical mastectomy without reconstruction had negative outcomes. Regardless of operation type, the self-image was influenced by anxiety, level of abuse by husband, and sexual satisfaction after operation. Conclusion: The self-image of patients who underwent different breast cancer surgeries was influenced by different factors, and individualized nursing should be offered in accordance with the specific situation.

  4. Monks' Health: Holistic Health Care Model by Community Participation

    Directory of Open Access Journals (Sweden)

    Decha Buates

    2010-01-01

    Full Text Available Problem statement: Monks’ health tended to be a continuous increased problem. They were groups who had limitations to access health services due to their monastic disciplines and their most importance for Buddhist institution. Without urgent solution, their normal way of life would have been affected. Approach: This research aimed to study current conditions and to develop monks’ holistic health care models by community participation in central region of Thailand. The study was a qualitative research conducted in 9 temples; 3 temples in urban area, 3 in semi-urban area and 3 in rural area. Samples were 224 persons; consisted of monks, public health officers from Department of Religious Affairs, local administrative organizations and people; selected by purposive sampling method. Observation form, survey form, interview form, focus group discussion and workshop were used as research tools while data was analyzed by descriptive research. Results: The result founded that in former time culture of monks’ health care was leaned on community, social, culture and tradition. People spoke in style of central Thai language and were in agricultural sector as well as had their belief in merit, sin and elder respect. Relation in communities was in form of generosity and living as similar as relatives. When some monk got sick, they would visit, take care and give foods and medicines. Most of medicines were household remedy and Thai herbal medicine that bought from drug stores in local market or grocery stores in village and monks were sent to hospital in case of severe illness. Temple was a part of community, so they had close relation. Nowadays people increasingly worked in manufactories that caused conflicts and alienations among them. Monks leaned on local markets for receiving foods offering and most of foods were cooked from flour, sugar, coconut milk and fat. These caused three-fourth of monks having chronic disease as diabetes

  5. External model validation of binary clinical risk prediction models in cardiovascular and thoracic surgery.

    Science.gov (United States)

    Hickey, Graeme L; Blackstone, Eugene H

    2016-08-01

    Clinical risk-prediction models serve an important role in healthcare. They are used for clinical decision-making and measuring the performance of healthcare providers. To establish confidence in a model, external model validation is imperative. When designing such an external model validation study, thought must be given to patient selection, risk factor and outcome definitions, missing data, and the transparent reporting of the analysis. In addition, there are a number of statistical methods available for external model validation. Execution of a rigorous external validation study rests in proper study design, application of suitable statistical methods, and transparent reporting.

  6. A predictive model of suitability for minimally invasive parathyroid surgery in the treatment of primary hyperparathyroidism [corrected].

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2012-05-01

    Improved preoperative localizing studies have facilitated minimally invasive approaches in the treatment of primary hyperparathyroidism (PHPT). Success depends on the ability to reliably select patients who have PHPT due to single-gland disease. We propose a model encompassing preoperative clinical, biochemical, and imaging studies to predict a patient\\'s suitability for minimally invasive surgery.

  7. [Advantages of midwife-led continuity model of care

    NARCIS (Netherlands)

    Prins, M.; Dillen, J. van; Jonge, A de

    2014-01-01

    In the Dutch maternity care system women at low risk of complications in pregnancy and birth are distinguished from women at an increased risk. Primary care midwives are responsible for the care in the low-risk group, whereas obstetricians are responsible for care when the risk is increased. Most pr

  8. The implementation of integrated care: The empirical validation of the development model for integrated care

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella); R.P. Vermeulen (Robert); C.T.B. Ahaus (Kees); R. Huijsman (Robbert)

    2011-01-01

    textabstractBackground: Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be

  9. The implementation of integrated care : The empirical validation of the development model for integrated care

    NARCIS (Netherlands)

    Minkman, M.M.N.; Vermeulen, Robbert; Ahaus, C.T.B.; Huijsman, R.

    2011-01-01

    Background: Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented

  10. How Repeated Time To Event (RTTE) modelling of opioid requests after surgery may improve future post-operative pain management

    DEFF Research Database (Denmark)

    Juul, Rasmus Vestergaard; Rasmussen, Sten; Kreilgaard, Mads

    : (1) Dept. of Drug Design and Pharmacology, University of Copenhagen, Denmark (2) Orthopaedic Surgery Research Unit, Aalborg University Hospital, Denmark (3) Dept. of Pharmaceutical Biosciences, Uppsala University, Sweden Type: Poster: Drug/Disease modelling – CNS Objectives: Amount of opioid (eg...... at Orthopaedic Department, Aalborg University Hospital, Denmark during the period May-Dec 2012. Morphine administration times (estimated precision: ±5mins), formulations and doses were extracted from medical journals in the hospitalization period or until 96 hours after surgery. RTTE modelling was performed...... in NONMEM 7.2 with Pirana, PsN and Xpose- and ggplot2 libraries for R3,4. Weibull and Gompertz distributions were investigated as hazard models. Visual Predictive Check (VPC) of Kaplan Meier survival curves as well objective function value was used to evaluate the model fit. Results: A base RTTE model based...

  11. Cost analysis of prenatal care using the activity-based costing model: a pilot study.

    Science.gov (United States)

    Gesse, T; Golembeski, S; Potter, J

    1999-01-01

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

  12. Do new and traditional models of primary care differ with regard to access?

    Science.gov (United States)

    Miedema, Baukje; Easley, Julie; Thompson, Ashley E.; Boivin, Antoine; Aubrey-Bassler, Kris; Katz, Alan; Hogg, William E.; Breton, Mylaine; Francoeur, Danièle; Wong, Sabrina T.; Wodchis, Walter P.

    2016-01-01

    Abstract Objective To examine access to primary care in new and traditional models using 2 dimensions of the concept of patient-centred access. Design An international survey examining the quality and costs of primary health care (the QUALICOPC study) was conducted in 2013 in Canada. This study adopted a descriptive cross-sectional survey method using data from practices across Canada. Each participating practice filled out the Family Physician Survey and the Practice Survey, and patients in each participating practice were asked to complete the Patient Experiences Survey. Setting All 10 Canadian provinces. Participants A total of 759 practices and 7172 patients. Main outcome measures Independent t tests were conducted to examine differences between new and traditional models of care in terms of availability and accommodation, and affordability of care. Results Of the 759 practices, 407 were identified as having new models of care and 352 were identified as traditional. New models of care were distinct with respect to payment structure, opening hours, and having an interdisciplinary work force. Most participating practices were from large cities or suburban areas. There were few differences between new and traditional models of care regarding accessibility and accommodation in primary care. Patients under new models of care reported easier access to other physicians in the same practice, while patients from traditional models reported seeing their regular family physicians more frequently. There was no difference between the new and traditional models of care with regard to affordability of primary care. Patients attending clinics with new models of care reported that their physicians were more involved with them as a whole person than patients attending clinics based on traditional models did. Conclusion Primary care access issues do not differ strongly between traditional and new models of care; however, patients in the new models of care believed that their

  13. [Fusing empowerment concept into patient-centered collaborative care model].

    Science.gov (United States)

    Wu, Chia-Chen; Lin, Chiu-Chu

    2014-12-01

    Chronic diseases are incurable, long-term illnesses. To improve quality of life, patients with chronic diseases must adjust their own personal lifestyle to cope with their diseases and eventually learn to achieve a balance between disease control and daily life. Therefore, self-management necessarily plays a key role in chronic disease management. Different from physician-centered healthcare, the self-management practiced by chronic disease patients is more patient-centered with a greater emphasis on active patient participation. The main goal of this article is to elucidate the essence of the empowerment concept. An example of diabetes care, this article introduces a detailed five-step application as a basic model for incorporating the empowerment concept into the healthcare of patients with chronic disease. The author suggests that healthcare providers apply the empowerment model in clinical practice to assist patients to maintain an optimal balance between their health status and personal lives.

  14. Goals and Characteristics of Long-Term Care Programs: An Analytic Model.

    Science.gov (United States)

    Braun, Kathryn L.; Rose, Charles L.

    1989-01-01

    Used medico-social analytic model to compare five long-term care programs: Skilled Nursing Facility-Intermediate Care Facility (SNF-ICF) homes, ICF homes, foster homes, day hospitals, and home care. Identified similarities and differences among programs. Preliminary findings suggest that model is useful in the evaluation and design of long-term…

  15. The benefit of non contrast-enhanced magnetic resonance angiography for predicting vascular access surgery outcome: a computer model perspective.

    Directory of Open Access Journals (Sweden)

    Maarten A G Merkx

    Full Text Available INTRODUCTION: Vascular access (VA surgery, a prerequisite for hemodialysis treatment of end-stage renal-disease (ESRD patients, is hampered by complication rates, which are frequently related to flow enhancement. To assist in VA surgery planning, a patient-specific computer model for postoperative flow enhancement was developed. The purpose of this study is to assess the benefit of non contrast-enhanced magnetic resonance angiography (NCE-MRA data as patient-specific geometrical input for the model-based prediction of surgery outcome. METHODS: 25 ESRD patients were included in this study. All patients received a NCE-MRA examination of the upper extremity blood vessels in addition to routine ultrasound (US. Local arterial radii were assessed from NCE-MRA and converted to model input using a linear fit per artery. Venous radii were determined with US. The effect of radius measurement uncertainty on model predictions was accounted for by performing Monte-Carlo simulations. The resulting flow prediction interval of the computer model was compared with the postoperative flow obtained from US. Patients with no overlap between model-based prediction and postoperative measurement were further analyzed to determine whether an increase in geometrical detail improved computer model prediction. RESULTS: Overlap between postoperative flows and model-based predictions was obtained for 71% of patients. Detailed inspection of non-overlapping cases revealed that the geometrical details that could be assessed from NCE-MRA explained most of the differences, and moreover, upon addition of these details in the computer model the flow predictions improved. CONCLUSIONS: The results demonstrate clearly that NCE-MRA does provide valuable geometrical information for VA surgery planning. Therefore, it is recommended to use this modality, at least for patients at risk for local or global narrowing of the blood vessels as well as for patients for whom an US-based model

  16. Home-based chronic care. An expanded integrative model for home health professionals.

    Science.gov (United States)

    Suter, Paula; Hennessey, Beth; Harrison, Gregory; Fagan, Martha; Norman, Barbara; Suter, W Newton

    2008-04-01

    The Chronic Care Model (CCM) developed by is an influential and accepted guide for the care of patients with chronic disease. Wagner acknowledges a current healthcare focus on acute care needs that often circumvents chronic care coordination. He identifies the need for a "division of labor" to assist the primary care physician with this neglected function. This article posits that the role of chronic care coordination assistance and disease management fits within the purview of home healthcare and should be central to home health chronic care delivery. An expanded Home-Based Chronic Care Model (HBCCM) is described that builds on Wagner's model and integrates salient theories from fields beyond medicine. The expanded model maximizes the potential for disease self-management success and is intended to provide a foundation for home health's integral role in chronic disease management.

  17. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22 patients received enhanced recovery programme (ERAS management and rest twenty-five (n = 25 conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h when compared to conventional group (140 ± 28 h. ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h. There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43 g/L vs. (73.07 ± 19.32 g/L, d3 (126.10 ± 18.62 g/L vs. (160.72 ± 26.18 g/L]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

  18. Cataract Surgery

    Science.gov (United States)

    ... and Videos: What Do Cataracts Look Like? Cataract Surgery Written by: Kierstan Boyd Reviewed by: Elena M ... how they work. What to expect with cataract surgery Before surgery: Your ophthalmologist will measure your eye ...

  19. Sheep (Ovis aries) as a model for cardiovascular surgery and management before, during, and after cardiopulmonary bypass.

    Science.gov (United States)

    DiVincenti, Louis; Westcott, Robin; Lee, Candice

    2014-09-01

    Because of its similarity to humans in important respects, sheep (Ovis aries) are a common animal model for translational research in cardiovascular surgery. However, some unique aspects of sheep anatomy and physiology present challenges to its use in these complicated experiments. In this review, we discuss relevant anatomy and physiology of sheep and discuss management before, during, and after procedures requiring cardiopulmonary bypass to provide a concise source of information for veterinarians, technicians, and researchers developing and implementing protocols with this model.

  20. Evaluating the Quality of the Learning Outcome in Healthcare Sector: The Expero4care Model

    Science.gov (United States)

    Cervai, Sara; Polo, Federica

    2015-01-01

    Purpose: This paper aims to present the Expero4care model. Considering the growing need for a training evaluation model that does not simply fix processes, the Expero4care model represents the first attempt of a "quality model" dedicated to the learning outcomes of healthcare trainings. Design/Methodology/Approach: Created as development…

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

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Oliver Reich

    2012-01-01

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

  3. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    Science.gov (United States)

    ... Your 1- to 2-Year-Old Weight Loss Surgery (Bariatric Surgery) KidsHealth > For Parents > Weight Loss Surgery (Bariatric Surgery) ... bariatric surgery might be an option. About Bariatric Surgery Bariatric surgery had its beginnings in the 1960s, ...

  4. Vouchers for Day Care of Children: Evaluating a Program Model.

    Science.gov (United States)

    Parker, Michael D.

    1989-01-01

    Examined effects of a pilot voucher program on the price, supply, and quality of day care. Findings offered no conclusive evidence concerning expected benefits. Discusses vouchers' potential for easing the day care crisis. (RJC)

  5. Comparison of artificial neural network and logistic regression models for predicting in-hospital mortality after primary liver cancer surgery.

    Directory of Open Access Journals (Sweden)

    Hon-Yi Shi

    Full Text Available BACKGROUND: Since most published articles comparing the performance of artificial neural network (ANN models and logistic regression (LR models for predicting hepatocellular carcinoma (HCC outcomes used only a single dataset, the essential issue of internal validity (reproducibility of the models has not been addressed. The study purposes to validate the use of ANN model for predicting in-hospital mortality in HCC surgery patients in Taiwan and to compare the predictive accuracy of ANN with that of LR model. METHODOLOGY/PRINCIPAL FINDINGS: Patients who underwent a HCC surgery during the period from 1998 to 2009 were included in the study. This study retrospectively compared 1,000 pairs of LR and ANN models based on initial clinical data for 22,926 HCC surgery patients. For each pair of ANN and LR models, the area under the receiver operating characteristic (AUROC curves, Hosmer-Lemeshow (H-L statistics and accuracy rate were calculated and compared using paired T-tests. A global sensitivity analysis was also performed to assess the relative significance of input parameters in the system model and the relative importance of variables. Compared to the LR models, the ANN models had a better accuracy rate in 97.28% of cases, a better H-L statistic in 41.18% of cases, and a better AUROC curve in 84.67% of cases. Surgeon volume was the most influential (sensitive parameter affecting in-hospital mortality followed by age and lengths of stay. CONCLUSIONS/SIGNIFICANCE: In comparison with the conventional LR model, the ANN model in the study was more accurate in predicting in-hospital mortality and had higher overall performance indices. Further studies of this model may consider the effect of a more detailed database that includes complications and clinical examination findings as well as more detailed outcome data.

  6. Evaluation of Health Care System Model Based on Collaborative Algorithms

    OpenAIRE

    2015-01-01

    The rapid development and use of information and communication technologies in the last two decades has influenced a dramatic transformation of public health and health care, changing the roles of the health care support systems and services. Recent trends in health care support systems are focused on developing patient-centric pervasive environments and the use of mobile devices and technologies in medical monitoring and health care systems [1].

  7. In vivo perfusion assessment of an anastomosis surgery on porcine intestinal model (Conference Presentation)

    Science.gov (United States)

    Le, Hanh N. D.; Opferman, Justin; Decker, Ryan; Cheon, Gyeong W.; Kim, Peter C. W.; Kang, Jin U.; Krieger, Axel

    2016-04-01

    Anastomosis, the connection of two structures, is a critical procedure for reconstructive surgery with over 1 million cases/year for visceral indication alone. However, complication rates such as strictures and leakage affect up to 19% of cases for colorectal anastomoses and up to 30% for visceral transplantation anastomoses. Local ischemia plays a critical role in anastomotic complications, making blood perfusion an important indicator for tissue health and predictor for healing following anastomosis. In this work, we apply a real time multispectral imaging technique to monitor impact on tissue perfusion due to varying interrupted suture spacing and suture tensions. Multispectral tissue images at 470, 540, 560, 580, 670 and 760 nm are analyzed in conjunction with an empirical model based on diffuse reflectance process to quantify the hemoglobin oxygen saturation within the suture site. The investigated tissues for anastomoses include porcine small (jejunum and ileum) and large (transverse colon) intestines. Two experiments using interrupted suturing with suture spacing of 1, 2, and 3 mm and tension levels from 0 N to 2.5 N are conducted. Tissue perfusion at 5, 10, 20 and 30 min after suturing are recorded and compared with the initial normal state. The result indicates the contrast between healthy and ischemic tissue areas and assists the determination of suturing spacing and tension. Therefore, the assessment of tissue perfusion will permit the development and intra-surgical monitoring of an optimal suture protocol during anastomosis with less complications and improved functional outcome.

  8. A Technical Evaluation of Wireless Connectivity from Patient Monitors to an Anesthesia Information Management System During Intensive Care Unit Surgery.

    Science.gov (United States)

    Simpao, Allan F; Galvez, Jorge A; England, W Randall; Wartman, Elicia C; Scott, James H; Hamid, Michael M; Rehman, Mohamed A; Epstein, Richard H

    2016-02-01

    Surgical procedures performed at the bedside in the neonatal intensive care unit (NICU) at The Children's Hospital of Philadelphia were documented using paper anesthesia records in contrast to the operating rooms, where an anesthesia information management system (AIMS) was used for all cases. This was largely because of logistical problems related to connecting cables between the bedside monitors and our portable AIMS workstations. We implemented an AIMS for documentation in the NICU using wireless adapters to transmit data from bedside monitoring equipment to a portable AIMS workstation. Testing of the wireless AIMS during simulation in the presence of an electrosurgical generator showed no evidence of interference with data transmission. Thirty NICU surgical procedures were documented via the wireless AIMS. Two wireless cases exhibited brief periods of data loss; one case had an extended data gap because of adapter power failure. In comparison, in a control group of 30 surgical cases in which wired connections were used, there were no data gaps. The wireless AIMS provided a simple, unobtrusive, portable alternative to paper records for documenting anesthesia records during NICU bedside procedures.

  9. Monitored anaesthesia care – Comparison of nalbuphine/dexmedetomidine versus nalbuphine/propofol for middle ear surgeries: A double-blind randomised trial

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao Nallam

    2017-01-01

    Full Text Available Background and Aims: Middle ear surgeries (MESs are usually performed under sedation with local anaesthesia and can be well tolerated by the patient with minimal discomfort. In the present study, we compare the effect of nalbuphine/dexmedetomidine combination with nalbuphine/propofol on sedation and analgesia in monitored anaesthesia care. Methods: One hundred adult patients undergoing MESs under monitored anaesthesia care (MAC were randomly allocated into two groups. All patients in both groups received injection nalbuphine 50 μg/kg intravenously (IV. Group D received a bolus dose of injection dexmedetomidine 1 μg/kg IV over 10 min followed by an infusion started at 0.4 μg/kg/h IV. Group P received a bolus dose of injection propofol 0.75 mg/kg followed by an infusion started at 0.025 mg/kg/min IV. Sedation was titrated to Ramsay Sedation Score (RSS of 3. Patient's mean arterial pressure, heart rate, saturation peripheral pulse and need for intraoperative rescue sedation/analgesia were recorded and compared. The data analysis was carried out with Z test and Chi-square test. Results: Mean RSS was significantly more in Group D (4.24 ± 1.54 as compared to Group P (2.58 ± 0.95. Overall VAS score was also significantly less in Group D (3.5 ± 1.7 than in Group P (5.4 ± 1.8. In total, 16 patients (32% in Group D had hypotension whereas 7 patients (14% only in Group P had hypotension. Conclusion: Nalbuphine/dexmedetomidine combination is superior to nalbuphine/propofol in producing sedation and decreasing VAS in patients undergoing MESs under MAC. Better surgeon and patient satisfaction were observed with nalbuphine/dexmedetomidine. Haemodynamics need to be closely monitored.

  10. Establishment of wound care center and development of burns and plastic surgery discipline%伤口治疗中心建立与烧伤整形学科发展

    Institute of Scientific and Technical Information of China (English)

    刘毅

    2011-01-01

    @@ 伴随着我国社会经济的高速发展,人民生活水平日益提高,生活习惯和饮食习惯逐渐发生变化,由此也导致疾病谱出现相应改变.以糖尿病为例,我国糖尿病发病率呈逐年增高的趋势.%To study the interaction between establishment of wound care center and development of discipline of burns and plastic surgery. The changes in number of outpatient,time for dressing change per patient, outpatient service income,number of inpatients and operations in our hospital were summarized and retrospectively analyzed before and after establishment of wound care center. The proportion of patients with chronic wounds and skin and soft tissue defects after trauma among all inpatients in the same term were investigated. Meanwhile, the development of discipline of burns and plastic surgery before and after establishment of wound care center was analyzed. Compared with those in the year before establishment of wound care center, outpatient number, time for dressing change per patient,outpatient service income, inpatient number, and amount of operations were all increased(with increase rate of 330% , 569%,325%, 161% , and 173%, respectively) in the year after establishment of wound care center. The ratio of patients with chronic wounds and skin and soft tissue defects after trauma among all inpatients was respectively increased from 4.3% and 4.5% in the year before establishment of wound care center to 9.2% and 12.4% in the year after establishment of wound care center. Patient satisfaction, bed utilization rate, levels of wound treatment and repair were all improved after establishment of wound care center. So we come to conclusions as follows. Establishment of wound care center can promote development of the standard of burns and plastic surgery. Comprehensive use of multidisciplinary theories and techniques concerning burns, plastic and aesthetic surgery, medical aesthetics, etc. can be beneficial for improvement of quality of wound

  11. Management of blunt splenic injuries Retrospective cohort study of early experiences in an Acute Care Surgery Service recently established.

    Science.gov (United States)

    Occhionorelli, Savino; Morganti, Lucia; Andreotti, Dario; Cappellari, Lorenzo; Stano, Rocco; Portinari, Mattia; Vasquez, Giorgio

    2015-01-01

    Il trattamento conservativo dei trauma splenici è ormai il “gold standard” per i bassi gradi di lesione splenica (III grado), mentre è ancora dibattuta la gestione dei traumi splenici severi (IV-V grado). Controversa rimane la gestione dei traumi splenici di III grado, che potrebbero beneficiare del trattamento conservativo, associato o meno ad angioembolizzazione dell’arteria splenica, in centri specializzati ed idonei alla gestione conservativa dei traumi degli organi parenchimatosi. Le ultime linee guida pubblicate dalla “Eastern Association of Surgery of Trauma” risalgono al 2012 e provvedono a dare solo delle raccomandazioni di livello II-III sulla gestioni dei traumi splenici. Il fattore che maggiormente influenza il successo del trattamento conservativo è la selezione dei pazienti che potrebbero beneficiare di tale gestione. Alla luce di ciò, l’obiettivo primario del nostro studio è di identificare i pazienti con lesioni spleniche post-traumatiche, che dovrebbero essere sottoposti a trattamento conservativo; l’obiettivo secondario è di confrontare il decorso clinico e la durata della degenza nei pazienti trattati conservativamente e in quelli sottoposti a splenectomia. Tutti i pazienti con trauma splenico, ricoverati presso l’U.O. di Chirurgia d’Urgenza dell’Azienda Ospedaliera- Universitaria Sant’Anna, Ferrara (Italia) tra Novembre 2010 (anno in cui è stata istituita l’U.O.) e Dicembre 2014, sono stati inclusi nello studio, per un totale di 54 pazienti. Di questi 54 pazienti, 29 (53.7%) sono stati immediatamente sottoposti ad intervento chirurgico di laparotomia esplorativa e splenectomia, mentre 25 (46.3%) sono stati sottoposti a trattamento conservativo. I pazienti sottoposti ad angioembolizzazione sono stati 9 su 25 (36%). Sono stati raccolti dati epidemiologici, dati riguardanti il decorso clinico e le indagini laboratoristiche e radiologiche a cui i pazienti sono stati sottoposti al momento dell’accesso in Pronto

  12. Diabetes Care as an Active Learning Model of Postgraduate Education and Training for Pharmaceutical Care.

    Science.gov (United States)

    Koda-Kimble, Mary Anne; Batz, Forrest R.

    1994-01-01

    In a University of California continuing pharmacy education course in diabetes care, practicing pharmacists lived as patients with diabetes for two days and role-played in small groups. One year later, participants reported making changes in their diabetes care-related practice, suggesting its effectiveness in improving practitioners' skill…

  13. Pressley Ridge Treatment Foster Care: The Model of Care Thirty Years Later

    Science.gov (United States)

    Trunzo, Annette C.; Bishop-Fitzpatrick, Lauren; Strickler, Amy; Doncaster, James

    2012-01-01

    Since the early 1950s, trends in children's mental health have moved care from residential and office-based treatment to community-based interventions. The Pressley Ridge Treatment Foster Care (PRTFC) program was developed in 1981 in response to these trends. Currently, Pressley Ridge provides PR-TFC treatment in 15 programs in six states and the…

  14. Formative evaluation of practice changes for managing depression within a Shared Care model in primary care.

    Science.gov (United States)

    Beaulac, Julie; Edwards, Jeanette; Steele, Angus

    2017-01-01

    Aim To investigate the implementation and initial impact of the Physician Integrated Network (PIN) mental health indicators, which are specific to screening and managing follow-up for depression, in three primary care practices with Shared Mental Health Care in Manitoba.

  15. Effects of Strontium Ranelate on Spinal Interbody Fusion Surgery in an Osteoporotic Rat Model

    Science.gov (United States)

    Tsai, Tsung-Ting; Ho, Natalie Yi-Ju; Lai, Po-Liang; Fu, Tsai-Sheng; Niu, Chi-Chien; Chen, Lih-Huei; Chen, Wen-Jer

    2017-01-01

    Osteoporosis is a bone disease that afflicts millions of people around the world, and a variety of spinal integrity issues, such as degenerative spinal stenosis and spondylolisthesis, are frequently concomitant with osteoporosis and are sometimes treated with spinal interbody fusion surgery. Previous studies have demonstrated the efficacy of strontium ranelate (SrR) treatment of osteoporosis in improving bone strength, promoting bone remodeling, and reducing the risk of fractures, but its effects on interbody fusion surgery have not been adequately investigated. SrR-treated rats subjected to interbody fusion surgery exhibited significantly higher lumbar vertebral bone mineral density after 12 weeks of treatment than rats subjected to the same surgery but not treated with SrR. Furthermore, histological and radiographic assessments showed that a greater amount of newly formed bone tissue was present and that better fusion union occurred in the SrR-treated rats than in the untreated rats. Taken together, these results show significant differences in bone mineral density, PINP level, histological score, SrR content and mechanical testing, which demonstrate a relatively moderate effect of SrR treatment on bone strength and remodeling in the specific context of recovery after an interbody fusion surgery, and suggest the potential of SrR treatment as an effective adjunct to spinal interbody fusion surgery for human patients. PMID:28052066

  16. Planning for Your Child's Surgery (Osteogenesis Imperfecta)

    Science.gov (United States)

    ... Blue Jeans for Better Bones Calendar Online Store Planning for Your Child's Surgery: What Parents Need to ... but the entire family as well. Before Surgery: Planning Become well informed. Taking care of your child ...

  17. Weight-loss surgery and children

    Science.gov (United States)

    ... more likely to have problems such as: Low self-esteem Poor grades in school Depression ... weight-loss surgery should receive care at an adolescent bariatric surgery center. There, a team of experts ...

  18. The Safety and Efficacy of Dexmedetomidine versus Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial

    Directory of Open Access Journals (Sweden)

    Wenming Wang

    2016-11-01

    Full Text Available Background: Chronic subdural hematoma (CSDH is a very common clinical emergency encountered in neurosurgery. While both general anesthesia (GA and monitored anesthesia care (MAC can be used during CSDH surgery, MAC is the preferred choice among surgeons. Further, while dexmedetomidine (DEX is reportedly a safe and effective agent for many diagnostic and therapeutic procedures, there have been no trials to evaluate the safety and efficacy of DEX vs. sufentanil in CSDH surgery. Objective: To evaluate the safety and efficacy of DEX vs. sufentanil in MAC during burr-hole surgery for CSDH.Methods: In all, 215 fifteen patients underwent burr-hole surgery for CSDH with MAC and were divided into three groups: Group D1 (n=67, DEX infusion at 0.5 μg·kg–1 for 10 min, Group D2 (n=75, DEX infusion at 1 μg·kg–1 for 10 min, and Group S (n=73, sufentanil infusion 0.3 μg·kg–1 for 10 min. Ramsay sedation scale (RSS of all three groups was maintained at 3. Anesthesia onset time, total number of intraoperative patient movements, hemodynamics, total cumulative dose of DEX, time to first dose and amount of rescue midazolam or fentanyl, percentage of patients converted to alternative sedative or anesthetic therapy, postoperative recovery time, adverse events, and patient and surgeon satisfaction scores were recorded.Results: The anesthesia onset time was significantly less in group D2 (17.36±4.23 vs. 13.42±2.12 vs. 15.98±4.58 min, respectively, for D1, D2, S; P<0.001. More patients in groups D1 and S required rescue midazolam to achieve RSS=3 (74.63% vs. 42.67% vs. 71.23%, respectively, for D1, D2, S; P<0.001. However, the total dose of rescue midazolam was significantly higher in group D1 (2.8±0.3 vs. 1.9±0.3 vs. 2.0±0.4 mg, respectively, for D1, D2, S; P<0.001. The time to first dose of rescue midazolam was significantly longer in group D2 (17.32±4.47 vs. 23.56±5.36 vs. 16.55±4.91 min, respectively, for D1, D2, S; P<0.001. Significantly fewer

  19. Patient-Specific Biomechanical Modeling for Guidance During Minimally-Invasive Hepatic Surgery.

    Science.gov (United States)

    Plantefève, Rosalie; Peterlik, Igor; Haouchine, Nazim; Cotin, Stéphane

    2016-01-01

    During the minimally-invasive liver surgery, only the partial surface view of the liver is usually provided to the surgeon via the laparoscopic camera. Therefore, it is necessary to estimate the actual position of the internal structures such as tumors and vessels from the pre-operative images. Nevertheless, such task can be highly challenging since during the intervention, the abdominal organs undergo important deformations due to the pneumoperitoneum, respiratory and cardiac motion and the interaction with the surgical tools. Therefore, a reliable automatic system for intra-operative guidance requires fast and reliable registration of the pre- and intra-operative data. In this paper we present a complete pipeline for the registration of pre-operative patient-specific image data to the sparse and incomplete intra-operative data. While the intra-operative data is represented by a point cloud extracted from the stereo-endoscopic images, the pre-operative data is used to reconstruct a biomechanical model which is necessary for accurate estimation of the position of the internal structures, considering the actual deformations. This model takes into account the patient-specific liver anatomy composed of parenchyma, vascularization and capsule, and is enriched with anatomical boundary conditions transferred from an atlas. The registration process employs the iterative closest point technique together with a penalty-based method. We perform a quantitative assessment based on the evaluation of the target registration error on synthetic data as well as a qualitative assessment on real patient data. We demonstrate that the proposed registration method provides good results in terms of both accuracy and robustness w.r.t. the quality of the intra-operative data.

  20. Lung surgery

    Science.gov (United States)

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using a ... clot from the pulmonary artery ( pulmonary embolism ) Treat complications of tuberculosis Video-assisted thoracoscopic surgery can be used to treat many of these ...

  1. Broken toe - self-care

    Science.gov (United States)

    Fractured toe - self-care; Broken bone - toe - self-care; Fracture - toe - self-care; Fracture phalanx - toe ... often treated without surgery and can be taken care of at home. Severe injuries include: Breaks that ...

  2. Health Insurance, Medical Care, and Health Outcomes: A Model of Elderly Health Dynamics

    Science.gov (United States)

    Yang, Zhou; Gilleskie, Donna B.; Norton, Edward C.

    2009-01-01

    Prescription drug coverage creates a change in medical care consumption, beyond standard moral hazard, arising both from the differential cost-sharing and the relative effectiveness of different types of care. We model the dynamic supplemental health insurance decisions of Medicare beneficiaries, their medical care demand, and subsequent health…

  3. Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care

    OpenAIRE

    Symon, A; J. Pringle; Cheyne, H.; Downe, S.; Hundley, Vanora; Lee, E; Lynn, F; McFadden, A.; McNeill, J.; Renfrew, M. J.; Ross-Davie, M.; Van Teijlingen, Edwin; Whitford, H.; Alderdice, F.

    2016-01-01

    Background: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportu...

  4. Clinical outcomes of HIV care delivery models in the US: a systematic review.

    Science.gov (United States)

    Kimmel, April D; Martin, Erika G; Galadima, Hadiza; Bono, Rose S; Tehrani, Ali Bonakdar; Cyrus, John W; Henderson, Margaret; Freedberg, Kenneth A; Krist, Alexander H

    2016-10-01

    With over 1 million people living with HIV, the US faces national challenges in HIV care delivery due to an inadequate HIV specialist workforce and the increasing role of non-communicable chronic diseases in driving morbidity and mortality in HIV-infected patients. Alternative HIV care delivery models, which include substantial roles for advanced practitioners and/or coordination between specialty and primary care settings in managing HIV-infected patients, may address these needs. We aimed to systematically review the evidence on patient-level HIV-specific and primary care health outcomes for HIV-infected adults receiving outpatient care across HIV care delivery models. We identified randomized trials and observational studies from bibliographic and other databases through March 2016. Eligible studies met pre-specified eligibility criteria including on care delivery models and patient-level health outcomes. We considered all available evidence, including non-experimental studies, and evaluated studies for risk of bias. We identified 3605 studies, of which 13 met eligibility criteria. Of the 13 eligible studies, the majority evaluated specialty-based care (9 studies). Across all studies and care delivery models, eligible studies primarily reported mortality and antiretroviral use, with specialty-based care associated with mortality reductions at the clinician and practice levels and with increased antiretroviral initiation or use at the clinician level but not the practice level. Limited and heterogeneous outcomes were reported for other patient-level HIV-specific outcomes (e.g., viral suppression) as well as for primary care health outcomes across all care delivery models. No studies addressed chronic care outcomes related to aging. Limited evidence was available across geographic settings and key populations. As re-design of care delivery in the US continues to evolve, better understanding of patient-level HIV-related and primary care health outcomes, especially

  5. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Stewart Allison

    2008-05-01

    Full Text Available Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1 organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2 community linkages – facilitated by working together with community organisations (e.g. local stores and running community-based programs (e.g. "health week", but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3 self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4 decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5 delivery system

  6. A model to prioritize access to elective surgery on the basis of clinical urgency and waiting time

    Directory of Open Access Journals (Sweden)

    Santori Gregorio

    2009-01-01

    Full Text Available Abstract Background Prioritization of waiting lists for elective surgery represents a major issue in public systems in view of the fact that patients often suffer from consequences of long waiting times. In addition, administrative and standardized data on waiting lists are generally lacking in Italy, where no detailed national reports are available. This is true although since 2002 the National Government has defined implicit Urgency-Related Groups (URGs associated with Maximum Time Before Treatment (MTBT, similar to the Australian classification. The aim of this paper is to propose a model to manage waiting lists and prioritize admissions to elective surgery. Methods In 2001, the Italian Ministry of Health funded the Surgical Waiting List Info System (SWALIS project, with the aim of experimenting solutions for managing elective surgery waiting lists. The project was split into two phases. In the first project phase, ten surgical units in the largest hospital of the Liguria Region were involved in the design of a pre-admission process model. The model was embedded in a Web based software, adopting Italian URGs with minor modifications. The SWALIS pre-admission process was based on the following steps: 1 urgency assessment into URGs; 2 correspondent assignment of a pre-set MTBT; 3 real time prioritization of every referral on the list, according to urgency and waiting time. In the second project phase a prospective descriptive study was performed, when a single general surgery unit was selected as the deployment and test bed, managing all registrations from March 2004 to March 2007 (1809 ordinary and 597 day cases. From August 2005, once the SWALIS model had been modified, waiting lists were monitored and analyzed, measuring the impact of the model by a set of performance indexes (average waiting time, length of the waiting list and Appropriate Performance Index (API. Results The SWALIS pre-admission model was used for all registrations in the

  7. The internationalization of health care: the UZ Brussel model for international partnerships.

    Science.gov (United States)

    Noppen, Marc

    2012-01-01

    Globalization of health care, flat medicine, cross-boarder health care, medical tourism, are all terms describing some, but not all, aspects of a growing trend: patients seeking health care provision abroad, and health care providers travelling abroad for temporary or permanent health care delivery services. This trend is a complex, bilateral and multifaceted phenomenon, which in our opinion, cannot be sustained in a single, comprehensive description. Individual hospitals have the unique opportunity to develop a model for appropriate action. The specific model created by the university hospital UZ Brussel is presented here.

  8. Technical elements, demonstration projects, and fiscal models in Medicaid managed care for people with developmental disabilities.

    Science.gov (United States)

    Kastner, T A; Walsh, K K; Criscione, T

    1997-08-01

    We presented a general model of the structure and functioning of managed care and described elements (provider networks, fiscal elements, risk estimation, case-mix, management information systems, practice parameters, and quality improvement) critical to service delivery for people with developmental disabilities. A number of technical elements of managed care systems were delineated and reviewed in relation to the inclusion of people with developmental disabilities. Several managed care demonstration projects were described and, finally, a multi-year hypothetical budget model, including long-term care, was presented as a framework for considering how managed care affects specific service structures. Implications for people with developmental disabilities were discussed.

  9. [Pathogenic variants of brain injuries and pharmalogic cerebroprotection performed on the model of brain condition during cardiovascular bypass surgery].

    Science.gov (United States)

    Tsygan, N V; Trashkov, A P

    2014-10-01

    Developed and approved a pathogenic grounded experimental model of brain condition during cardiovascular bypass surgery. Undertaken in Wistar rats research allowed to evaluate in detail effectiveness and safety of protracted cerebroprotective treatment. Advantages of this model are researches in laboratory animals with the aim to research condition of nerve tissue, not intensive procedures and consequently high reproducibility and possibility of complex evaluation of changes at every stage of research. Results of neurons, neuroglia and activation of neurotrophic mechanisms prove that simulation of brain condition during cardiovascular bypass surgery is accompanied with acute and delayed brain injuries. Use of Cytoflavin under pharmalogic cerebroprotection had prolonged multimodal and neuroprotactive effect, leading to improvement of neurotrophic protection from the first days.

  10. Robotic mitral valve surgery.

    Science.gov (United States)

    Kypson, Alan P; Nifong, L Wiley; Chitwood, W Randolph

    2003-12-01

    A renaissance in cardiac surgery has begun. The early clinical experience with computer-enhanced telemanipulation systems outlines the limitations of this approach despite some procedural success. Technologic advancements, such as the use of nitinol U-clips (Coalescent Surgical Inc., Sunnyvale, CA) instead of sutures requiring manual knot tying, have been shown to decrease operative times significantly. It is expected that with further refinements and development of adjunct technologies, the technique of computer-enhanced endoscopic cardiac surgery will evolve and may prove to be beneficial for many patients. Robotic technology has provided benefits to cardiac surgery. With improved optics and instrumentation, incisions are smaller. The ergometric movements and simulated three-dimensional optics project hand-eye coordination for the surgeon. The placement of the wristlike articulations at the end of the instruments moves the pivoting action to the plane of the mitral annulus. This improves dexterity in tight spaces and allows for ambidextrous suture placement. Sutures can be placed more accurately because of tremor filtration and high-resolution video magnification. Furthermore, the robotic system may have potential as an educational tool. In the near future, surgical vision and training systems might be able to model most surgical procedures through immersive technology. Thus, a "flight simulator" concept emerges where surgeons may be able to practice and perform the operation without a patient. Already, effective curricula for training teams in robotic surgery exist. Nevertheless, certain constraints continue to limit the advancement to a totally endoscopic computer-enhanced mitral valve operation. The current size of the instruments, intrathoracic instrument collisions, and extrathoracic "elbow" conflicts still can limit dexterity. When smaller instruments are developed, these restraints may be resolved. Furthermore, a working port incision is still required for

  11. Application of comfort care in perioperative period of general surgery%舒适护理在普外科围手术期的应用探讨

    Institute of Scientific and Technical Information of China (English)

    史娟

    2014-01-01

    目的:探讨舒适护理在普外科患者围手术期护理中的应用效果。方法将142例普外科手术患者随机分为观察组和对照组各71例,对照组采用常规护理,观察组采用舒适护理,对比分析两组患者术后疼痛、心理状态及满意度情况。结果观察组患者术后12 h,24 h及48 h疼痛程度评分均明显低于对照组(2.81±0.21)vs (3.43±0.23),(2.61±0.12) vs (3.22±0.20),(2.50±0.14)vs(3.24±0.25),护理满意度评分明显低于对照组(89.72±5.63)vs.(98.28±5.91),术后人际关系、焦虑、抑郁、恐惧、强迫症状、敌对、躯体化评分均明显优于对照组(2.64±0.35)vs(1.10±0.27),(1.22±0.32)vs(0.69±0.11),(1.03±0.30)vs(1.64±0.46),(0.29±0.08)vs(1.18±0.41),(1.37±0.45)vs(1.90±0.46),(1.10±0.37)vs(1.33±0.52),(1.02±0.22)vs(1.17±0.37),差异有统计学意义(P<0.05或P<0.01)。结论围手术期舒适护理可明显缓解患者术后疼痛,改善心理状态,提高护理服务满意度,护理效果优于常规护理,值得临床推广应用。%Objective To investigate the nursing effect of comfort care in general surgery. Methods 142 patients underwent gener-al surgery were randomly divided into observation group and control group with 71 cases in each group. Patients in control group received routine care, while observation group received comfort care, the postoperative pain, mental status and satisfaction with the situation were compared between the two group. Results The pain scores postoperative 12h, 24h and 48h of observation group were significantly lower than those of the control group (2.81 ±0.21)vs (3.43 ±0.23), (2.61 ±0.12) vs (3.22 ±0.20), (2.50 ±0.14)vs (3.24±0.25); The care satisfaction scores were significantly lower than the control group(89.72±5.63) vs(98.28±5.91); The post-operative relationships, anxiety, depression, fear

  12. Personality, personal model beliefs, and self-care in adolescents and young adults with type 1 diabetes

    OpenAIRE

    Skinner, TC; Hampson, SE; Fife-Schaw, CR

    2002-01-01

    This study compared 3 models of association between personality, personal model beliefs, and self-care in a cross-sectional design. These models were as follows: (a) Emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness is a direct predictor of self-care; (b) emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness moderates the association between beliefs and self-care; (c) both emotional sta...

  13. Sheep (Ovis aries) as a Model for Cardiovascular Surgery and Management before, during, and after Cardiopulmonary Bypass

    OpenAIRE

    DiVincenti, Louis; Westcott, Robin; Lee, Candice

    2014-01-01

    Because of its similarity to humans in important respects, sheep (Ovis aries) are a common animal model for translational research in cardiovascular surgery. However, some unique aspects of sheep anatomy and physiology present challenges to its use in these complicated experiments. In this review, we discuss relevant anatomy and physiology of sheep and discuss management before, during, and after procedures requiring cardiopulmonary bypass to provide a concise source of information for veteri...

  14. Perioperative nursing care for orbital fat flap correction of upper eyelid surgery depression%眶脂肪瓣转移矫正上睑凹陷的围术期护理

    Institute of Scientific and Technical Information of China (English)

    丁祖烈; 陈志鹏; 陈滔; 严巧玲

    2012-01-01

    目的:探讨眶脂肪瓣转移矫正上睑凹陷的围术期护理方法.方法:选择2008年1月~ 2010年5月采用眶脂肪瓣转移术矫正上睑凹陷92例患者,围术期给予积极的心理疏导、合理的饮食指导、眼部护理,对患者的病情进行密切的观察,遵医嘱适时服用抗生素.结果:92例患者术后随访观察无眼部血肿及眼部神经损伤,上睑平整自然,外形改善明显.88例(95.6 5%)上睑完全修复.结论:开展眶脂肪瓣转移矫正上睑凹陷术的围手术期护理,在术前对患者进行有效的心理干预,做好皮肤的护理,术中防止眼部感染,术后做好患者心理护理、饮食护理、创面护理,同时积极预防各种并发症,可以提高手术的成功率,值得临床借鉴.%Objective Discuss the perioperative nursing methods for correction of higher eyelid orbital fat flap depression. Methods Select January 2008~May 2010 with the orbital fat flap correction of upper eyelid depression in 92 patients in the perioperative give positive psychological counseling, reasonable dietary guidance, eye care, on the condition of the patient in close observation, and timely prescribed antibiotics. Results The 92 patients were followed up free eye surgery and eye nerve injury hematoma, eyelid smooth natural shape to improve significantly. That of 88 (95.65%) upper eyelid fully restored. Conclusions To carry out correction of upper eyelid orbital fat flap surgery depression perioperative care of patients before surgery effective psychological intervention, good skin care, eye surgery infection prevention and control patients, postoperative patients with good psychological care, diet care, wound care while actively preventing complicantions, can increase the success rate of surgery, and that is worthy of reference.

  15. 老年白内障超声乳化人工晶体手术护理的临床分析%Care clinical analysis of senile cataract phacoemulsification and intraocular lens surgery

    Institute of Scientific and Technical Information of China (English)

    阚泽云

    2012-01-01

      目的:分析60例老年白内障超声乳化人工晶体手术护理配合方法,方法:分析我院2012年1月-2012年6月间60例老年白内障手术的手术配合经验。手术室与巡回护士积极沟通,完成手术。结论:通过积极和沟通和配合,全部老年白内障手术顺利进行,人员配合好,减少或避免了患者不良反应,提高效率,反应较好。%  Objective: To analyze 60 cases of senile cataract phacoemulsification and intraocular lens surgery care with the method, the method of surgery: analysis of 60 elderly patients in our hospital in January 2012 -2012 in June cataract surgery with the experience. Operating room and roving nurses actively communicate with the completion of the surgery. Conclusion: through active communication and coordination, all of senile cataract surgery carried out smoothly, with the good, and to reduce or avoid adverse reactions in patients, improve efficiency, better reaction.

  16. Pregnancy management following bariatric surgery.

    Science.gov (United States)

    Uzoma, A; Keriakos, R

    2013-02-01

    Bariatric surgery is gaining in popularity, due to globally increasing rates of obesity. In the UK, this has manifested as a 14-fold increase in bariatric surgery between 2004 and 2010, making it necessary to develop strategies to manage women who become pregnant following bariatric surgery. This review paper has explored all the current evidence in the literature and provided a comprehensive management strategy for pregnant women following bariatric surgery. The emphasis is on a multidisciplinary team approach to all aspects of care. Adequate pre-conception and antenatal and postnatal care is essential to good pregnancy outcomes with emphasis on appropriate nutritional supplementation. This is especially important following malabsorptive procedures. There is no evidence to suggest that pregnancy outcome is worse after bariatric surgery, though women who remain obese are prone to obesity-related risks in pregnancy. Neonatal outcome post-bariatric surgery is no different from the general population.

  17. Peer Collaboration: A Model to Support Counsellor Self-Care

    Science.gov (United States)

    Barlow, Constance A.; Phelan, Anne M.

    2007-01-01

    In the context of a larger case study on how continuous learning in the workplace could be achieved through the implementation of peer collaboration, the process of how counsellors engaged in self-care within a large health care organization became clearer. This article is based on data derived from a qualitative analysis of nine transcribed…

  18. The Women's Health Care Empowerment Model as a Catalyst for Change in Developing Countries.

    Science.gov (United States)

    Mitroi, Lavinia R; Sahak, Medina; Sherzai, Ayesha Z; Sherzai, Dean

    2016-01-01

    Women's empowerment has been attempted through a number of different fields including the realms of politics, finance, and education, yet none of these domains are as promising as health care. Here we review preliminary work in this domain and introduce a model for women's empowerment through involvement in health care, titled the "women's health care empowerment model." Principles upon which our model is built include: acknowledging the appropriate definition of empowerment within the cultural context, creating a women's network for communication, integrating local culture and tradition into training women, and increasing the capability of women to care for their children and other women.

  19. Cirurgia bariátrica: existe necessidade de internação em unidade de terapia intensiva? Bariatric surgery: is admission to the intensive care unit necessary?

    Directory of Open Access Journals (Sweden)

    Saulo Maia D'Avila Melo

    2009-06-01

    Full Text Available OBJETIVOS: Determinar o local de internação no pós-operatório de cirurgia bariátrica primária e verificar as complicações clínicas-cirúrgicas que justificassem internação em unidade de terapia intensiva, inclusive morte. MÉTODOS: Estudo transversal, prospectivo, aberto, sendo avaliados 120 pacientes submetidos à cirurgia bariátrica primária por vídeolaparoscopia no período de maio de 2007 a abril de 2008 em um hospital terciário. Utilizou-se o índice de Aldrete e Kroulik para liberação da sala de recuperação pós-anestésica e definição do local de encaminhamento no pós-operatório. RESULTADOS: Entre os 120 pacientes, havia 83 mulheres e 37 homens, com média de idade 35,4 ± 10,5 anos (18 a 66 anos, índice de massa corpórea médio 45,6 ± 10,5. O tempo entre admissão hospitalar e inicio da cirurgia foi de 140,7 ± 81,8 minutos, o tempo cirúrgico 105,0 ± 28,6 minutos, o tempo de permanência na sala de recuperação pós-anestésica foi 125,0 ± 38,0 minutos e tempo de internação hospitalar 47,7 ± 12,4 horas, com 100% dos pacientes deambulando em 24 horas. O índice de Aldrete e Kroulik da sala de recuperação pós-anestésica alcançou pontuação de 10 com 120 minutos em todos os pacientes, com sobrevida de 100%. CONCLUSÃO: Com o uso do índice Aldrete e Kroulik na sala de recuperação pós-anestésica de bypass gástrico por videolaparoscopia em cirurgia bariátrica primária, nenhum paciente foi internado em unidade de terapia intensiva e nenhuma complicação maior foi observada.OBJECTIVE: The purpose of this study was to determine the place of stay at postoperative and to verify medical-surgical complications that would justify admission to the intensive care unit, including death. METHODS: Cross-over, prospective, open study that evaluated 120 patients who were submitted to primary bariatric surgery by video laparoscopy from May 2007 to April 2008 in a tertiary hospital. The Aldrete Kroulik index was

  20. 正颌外科手术并发症观察与护理%Observation and Nursing Care of Orthognathic Surgery Complications

    Institute of Scientific and Technical Information of China (English)

    王梦松

    2013-01-01

      目的:探讨正颌外科手术并发症的护理。方法:选取笔者所在医院进行正颌外科手术的35例患者,针对实施正颌手术患者出现的并发症进行有针对性的护理。结果:35例患者手术后,其中1例出现活动性出血并发症,呼吸道梗阻1例,下牙槽神经感觉障碍4例,但经过相应的和资料和护理,患者均恢复良好。结论:正颌术后容易出现呼吸道梗阻、出血、下牙槽神经感觉障碍等并发症,手术前后对患者进行精心护理,能够减少术后并发症的出现,促进患者迅速康复。%  Objective:To explore the nursing orthognathic surgical operation complications.Method:To select 35 patients in our hospital for orthognathic surgery operation,for the implementation of positive patients and operation complications were targeted nursing.Result:35 patients after operation,including 1 cases of active bleeding complications,1 cases of respiratory tract obstruction,4 cases of inferior alveolar nerve sensory disorder, but after the corresponding and data and nursing,all patients recovered well.Conclusion:Postoperative complications and prone to respiratory tract obstruction,hemorrhage,inferior alveolar nerve sensory disorder of patients before and after operation,careful nursing,can reduce complications, promote the patient a speedy recovery.

  1. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

    Science.gov (United States)

    Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

    2014-07-01

    Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  2. Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan

    Directory of Open Access Journals (Sweden)

    Daniel Alyeshmerni

    2014-07-01

    Full Text Available Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA, and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

  3. The Model Standards Project: Creating Inclusive Systems for LGBT Youth in Out-of-Home Care

    Science.gov (United States)

    Wilber, Shannan; Reyes, Carolyn; Marksamer, Jody

    2006-01-01

    This article describes the Model Standards Project (MSP), a collaboration of Legal Services for Children and the National Center for Lesbian Rights. The MSP developed a set of model professional standards governing the care of lesbian, gay, bisexual and transgender (LGBT) youth in out-of-home care. This article provides an overview of the…

  4. A quality management model for integrated care : results of a Delphi and Concept Mapping study

    NARCIS (Netherlands)

    Minkman, Mirella; Ahaus, Kees; Fabbricotti, Isabelle; Nabitz, Udo; Huijsman, Robbert

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

  5. Embedding Care and Unpaid Work in Macroeconomic Modeling: A Structuralist Approach

    NARCIS (Netherlands)

    E. Braunstein (Elissa); I.P. van Staveren (Irene); D. Tavani (Daniele)

    2011-01-01

    textabstractThis study embeds paid and unpaid care work in a structuralist macroeconomic model. Care work is formally modeled as a gendered input into the market production process via its impact on the current and future labor force, with altruistic motivations determining both how much support peo

  6. International care models for chronic kidney disease: methods and economics--United States.

    Science.gov (United States)

    Crooks, Peter

    2004-01-01

    In the United States, there is a major chronic kidney disease (CKD) problem with over 8 million adults having stage 3 or 4 CKD. There is good medical evidence that many of these patients can benefit from focused interventions. And while there are strong theoretical reasons to believe these interventions are cost-effective, there are little published data to back up this assertion. However, despite the lack of financial data proving cost-effectiveness and against the background of a disorganized health care system in the US, some models of CKD care are being employed. At the present time, the most comprehensive models of care in the US are emerging in vertically integrated health care programs. Other models of care are developing in the setting of managed care health plans that employ CKD disease management programs, either developed internally or in partnership with renal disease management companies.

  7. After Surgery

    Science.gov (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  8. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery ... There are several types of turbinate surgery: Turbinectomy: All or part of the lower turbinate is taken out. This can be done in several different ways, but sometimes a ...

  9. 围手术期脊柱侧弯患儿父母照顾体验的质性研究%Qualitative study on care experience of parents of children with scoliosis surgery in perioperative period

    Institute of Scientific and Technical Information of China (English)

    李翠翠; 惠慧; 郑林宏; 胡靖

    2015-01-01

    Objective To explore the real situation of the burden of the parents who take care of patients with scoliosis surgery in perioperative period. Methods Using phenomenological research methods of qualitative study, the data of 11 parents of patients with scoliosis surgery in perioperative period were collected through semi-structured interviews. Results The burden of caring experience was prevalent in the parents of patients with scoliosis surgery in perioperative period, characterized by obviously psychological burden, heavily economic burden, lack of care knowledge and declining health. And obviously psychological burden included two sub-themes: worry about whether the surgery will succeeded or not and concern about the child's future. Conclusion Care burden of par-ents of patients with scoliosis surgery in perioperative period is heavy. The government, hospitals and family should pay more attention to this. And targeted nursing intervention should be taken to minimize the burden of caring.%目的:探讨围手术期脊柱侧弯患儿父母照顾体验的真实情况。方法采用质性研究中现象学研究方法对11名围手术期脊柱侧弯患儿父母进行半结构式深入访谈。结果围手术期脊柱侧弯患儿父母普遍存在照顾负担体验,特点为心理负担明显,经济负担沉重,照顾知识缺乏,身体状况下降;其中心理负担明显包括担心手术是否成功和担忧孩子将来两个次主题。结论围手术期脊柱侧弯患儿父母照顾负担沉重,应引起政府、医院及家庭的重视,护理工作者应针对性地进行护理干预,从而最大限度降低照顾负担。

  10. The Key Variables for the Development of a Care Model for Stroke

    Directory of Open Access Journals (Sweden)

    Stavrianopoulos T.

    2011-10-01

    Full Text Available Introduction Stroke is a major cause of death, threatened and reduced health, and a patient’s dependence on support after the acute phase. The increase in knowledge of neurological recovery after a stroke has led to new treatment strategies, where the importance of the physical environment and rehabilitation is on par with the importance of the medical treatment. It is crucial that the whole stroke team is involved in assessing, planning, and evaluating the care provided. Aim The presentation of the variables that are needed for the development of a general model of care for stroke. Material and Methods Method was used is to search electronic databases (MEDLINE, CINAHL for a review of international literature to 2009 and became selection of books, articles and studies from libraries. The search was done the December of 2010. Results The key variables to develop a model of care are: the care planning, the team culture, the care culture, the professional knowledge, the quality of space, the observation and assessment, the patient participation and the inter-professional teamwork. Conclusions The model presents stroke care as a complex system, with many feedback relationships between key variables for care. The development of the model, with the contributions of existing literature, enables further tests in practice and improvements in stroke care and further refinement of variables which include the model of care.

  11. Staged diabetes management. Toward an integrated model of diabetes care.

    Science.gov (United States)

    Mazze, R S; Etzwiler, D D; Strock, E; Peterson, K; McClave, C R; Meszaros, J F; Leigh, C; Owens, L W; Deeb, L C; Peterson, A

    1994-06-01

    This paper introduces a new and innovative approach to diabetes management in the primary-care setting. Staged diabetes management (SDM) represents a four-year effort to develop and test a data-based approach to diabetes management that could be easily adapted to a variety of health-care settings in which diabetes management is principally under the direction of primary-care physicians was limited access to specialists. After testing under controlled circumstances at the International Diabetes Center (Minneapolis, MN), SDM was subjected to substantial field trials under conditions that represent the scope and variety of primary-care practices in diabetes. The following represents the work of several investigators who independently undertook a review of SDM.

  12. Accelerating a Network Model of Care: Taking a Social Innovation to Scale

    Directory of Open Access Journals (Sweden)

    Kerry Byrne

    2012-07-01

    Full Text Available Government-funded systems of health and social care are facing enormous fiscal and human-resource challenges. The space for innovation in care is wide open and new disruptive patterns are emerging. These include self-management and personal budgets, participatory and integrated care, supported decision making and a renewed focus on prevention. Taking these disruptive patterns to scale can be accelerated by a technologically enabled shift to a network model of care to co-create the best outcomes for individuals, family caregivers, and health and social care organizations. The connections, relationships, and activities within an individual’s personal network lay the foundation for care that health and social care systems/policy must simultaneously support and draw on for positive outcomes. Practical tools, adequate information, and tangible resources are required to coordinate and sustain care. Tyze Personal Networks is a social venture that uses technology to engage and inform the individual, their personal networks, and their care providers to co-create the best outcomes. In this article, we demonstrate how Tyze contributes to a shift to a network model of care by strengthening our networks and enhancing partnerships between care providers, individuals, and family and friends.

  13. Conformity of pediatric/adolescent HIV clinics to the patient-centered medical home care model.

    Science.gov (United States)

    Yehia, Baligh R; Agwu, Allison L; Schranz, Asher; Korthuis, P Todd; Gaur, Aditya H; Rutstein, Richard; Sharp, Victoria; Spector, Stephen A; Berry, Stephen A; Gebo, Kelly A

    2013-05-01

    The patient-centered medical home (PCMH) has been introduced as a model for providing high-quality, comprehensive, patient-centered care that is both accessible and coordinated, and may provide a framework for optimizing the care of youth living with HIV (YLH). We surveyed six pediatric/adolescent HIV clinics caring for 578 patients (median age 19 years, 51% male, and 82% black) in July 2011 to assess conformity to the PCMH. Clinics completed a 50-item survey covering the six domains of the PCMH: (1) comprehensive care, (2) patient-centered care, (3) coordinated care, (4) accessible services, (5) quality and safety, and (6) health information technology. To determine conformity to the PCMH, a novel point-based scoring system was devised. Points were tabulated across clinics by domain to obtain an aggregate assessment of PCMH conformity. All six clinics responded. Overall, clinics attained a mean 75.8% [95% CI, 63.3-88.3%] on PCMH measures-scoring highest on patient-centered care (94.7%), coordinated care (83.3%), and quality and safety measures (76.7%), and lowest on health information technology (70.0%), accessible services (69.1%), and comprehensive care (61.1%). Clinics moderately conformed to the PCMH model. Areas for improvement include access to care, comprehensive care, and health information technology. Future studies are warranted to determine whether greater clinic PCMH conformity improves clinical outcomes and cost savings for YLH.

  14. Intervening at the Setting Level to Prevent Behavioral Incidents in Residential Child Care: Efficacy of the CARE Program Model.

    Science.gov (United States)

    Izzo, Charles V; Smith, Elliott G; Holden, Martha J; Norton, Catherine I; Nunno, Michael A; Sellers, Deborah E

    2016-07-01

    The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions.

  15. Health care policy reform: a microanalytic model for comparing hospitals in the United States and Germany.

    Science.gov (United States)

    Parsons, R J; Woller, G M; Neubauer, G; Rothaemel, F T; Zelle, B

    1999-01-01

    Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available, and these were similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.

  16. Rethinking prenatal care within a social model of health: an exploratory study in Northern Ireland.

    Science.gov (United States)

    McNeill, Jenny A; Reiger, Kerreen M

    2015-01-01

    Implementation of maternity reform agendas remains limited by the dominance of a medical rather than social model of health. This article considers group prenatal care as a complex health intervention and explores its potential in the socially divided, postconflict communities of Northern Ireland. Using qualitative inquiry strategies, we sought key informants' views on existing prenatal care provision and on an innovative group care model (CenteringPregnancy®) as a social health initiative. We argue that taking account of the locally specific context is critical to introducing maternity care interventions to improve the health of women and their families and to contribute to community development.

  17. Heart Surgery Terms

    Science.gov (United States)

    ... Patients Choosing Wisely® Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Other Types of Surgery Clinical ...

  18. Modelling of resource allocation to health care authorities in Stockholm county

    DEFF Research Database (Denmark)

    Andersson, Paula; Varde, E; Diderichsen, Finn

    2000-01-01

    Since the Stockholm County Council introduced a system of purchasers and providers there has been a quest for population-based resource allocation models to allocate monies to purchasers of health care. In contrast to models used in Britain, Swedish models have been based on individual level data....... This paper presents recent developments in the model used in Stockholm for all care except primary care, testing new statistical methods for compression and clustering of the matrices used and the effect of introducing diagnostic information in addition to the demographic and socio-economic information used...... ahead. Moreover, two calibration methods are compared: Cross-sectional modelling, based on data for one year only, versus prospective modelling, using population characteristics for one year and registered health-care costs for a following year. While models including diagnostic information are deemed...

  19. Cardiac CT for planning redo cardiac surgery: effect of knowledge-based iterative model reconstruction on image quality

    Energy Technology Data Exchange (ETDEWEB)

    Oda, Seitaro [MedStar Washington Hospital Center, Department of Cardiology, Washington, DC (United States); Kumamoto University, Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto (Japan); Weissman, Gaby; Weigold, W. Guy [MedStar Washington Hospital Center, Department of Cardiology, Washington, DC (United States); Vembar, Mani [Philips Healthcare, CT Clinical Science, Cleveland, OH (United States)

    2015-01-15

    The purpose of this study was to investigate the effects of knowledge-based iterative model reconstruction (IMR) on image quality in cardiac CT performed for the planning of redo cardiac surgery by comparing IMR images with images reconstructed with filtered back-projection (FBP) and hybrid iterative reconstruction (HIR). We studied 31 patients (23 men, 8 women; mean age 65.1 ± 16.5 years) referred for redo cardiac surgery who underwent cardiac CT. Paired image sets were created using three types of reconstruction: FBP, HIR, and IMR. Quantitative parameters including CT attenuation, image noise, and contrast-to-noise ratio (CNR) of each cardiovascular structure were calculated. The visual image quality - graininess, streak artefact, margin sharpness of each cardiovascular structure, and overall image quality - was scored on a five-point scale. The mean image noise of FBP, HIR, and IMR images was 58.3 ± 26.7, 36.0 ± 12.5, and 14.2 ± 5.5 HU, respectively; there were significant differences in all comparison combinations among the three methods. The CNR of IMR images was better than that of FBP and HIR images in all evaluated structures. The visual scores were significantly higher for IMR than for the other images in all evaluated parameters. IMR can provide significantly improved qualitative and quantitative image quality at in cardiac CT for planning of reoperative cardiac surgery. (orig.)

  20. Sir David Cuthbertson Medal Lecture. Bariatric surgery as a model to study appetite control.

    Science.gov (United States)

    Bueter, Marco; le Roux, Carel W

    2009-08-01

    The obesity epidemic and its associated morbidity and mortality have led to major research efforts to identify mechanisms that regulate appetite. Gut hormones have recently been found to be an important element in appetite regulation as a result of the signals from the periphery to the brain. Candidate hormones include ghrelin, peptide YY, glucagon-like peptide-1 and gastric inhibitory polypeptide, all of which are currently being investigated as potential obesity treatments. Bariatric surgery is currently the most effective therapy for substantial and sustained weight loss. Understanding how levels of gut hormones are modulated by such procedures has greatly contributed to the comprehension of the underlying mechanisms of appetite and obesity. The present paper is a review of how appetite and levels of gastrointestinal hormones are altered after bariatric surgery. Basic principles of common bariatric procedures and potential mechanisms for appetite regulation by gut hormones are also addressed.

  1. Effects of Strontium Ranelate on Spinal Interbody Fusion Surgery in an Osteoporotic Rat Model

    OpenAIRE

    Tsai, Tsung-Ting; Tai, Ching-Lung; Ho, Natalie Yi-Ju; Lai, Po-Liang; Fu, Tsai-Sheng; Niu, Chi-Chien; Chen, Lih-Huei; Chen, Wen-Jer

    2017-01-01

    Osteoporosis is a bone disease that afflicts millions of people around the world, and a variety of spinal integrity issues, such as degenerative spinal stenosis and spondylolisthesis, are frequently concomitant with osteoporosis and are sometimes treated with spinal interbody fusion surgery. Previous studies have demonstrated the efficacy of strontium ranelate (SrR) treatment of osteoporosis in improving bone strength, promoting bone remodeling, and reducing the risk of fractures, but its eff...

  2. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    Science.gov (United States)

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  3. A Prospective Validation Study of a Rainbow Model of Integrated Care Measurement Tool in Singapore

    Directory of Open Access Journals (Sweden)

    Milawaty Nurjono

    2016-01-01

    Full Text Available Introduction: The conceptual ambiguity of the integrated care concept precludes a full understanding of what constitutes a well-integrated health system, posing a significant challenge in measuring the level of integrated care. Most available measures have been developed from a disease-specific perspective and only measure certain aspects of integrated care. Based on the Rainbow Model of Integrated Care, which provides a detailed description of the complex concept of integrated care, a measurement tool has been developed to assess integrated care within a care system as a whole gathered from healthcare providers’ and managerial perspectives. This paper describes the methodology of a study seeking to validate the Rainbow Model of Integrated Care measurement tool within and across the Singapore Regional Health System. The Singapore Regional Health System is a recent national strategy developed to provide a better-integrated health system to deliver seamless and person-focused care to patients through a network of providers within a specified geographical region. Methods: The validation process includes the assessment of the content of the measure and its psychometric properties. Conclusion: If the measure is deemed to be valid, the study will provide the first opportunity to measure integrated care within Singapore Regional Health System with the results allowing insights in making recommendations for improving the Regional Health System and supporting international comparison.

  4. Perceptions of a Primary Nursing Care Model in a Pediatric Hematology/Oncology Unit.

    Science.gov (United States)

    Nadeau, Katie; Pinner, Kerri; Murphy, Katie; Belderson, Kristin M

    2016-02-22

    The primary nursing care model optimizes relationship-based care. Despite using a primary nursing model on a pediatric hematology/oncology inpatient unit, it was hypothesized patients and nurses were dissatisfied with the structure of primary care teams and inconsistency of primary assignments. The purpose of this study was to evaluate patient/family and nurse perceptions of our current care model through assessing gaps in its operationalization and satisfaction. This study used a descriptive cross-sectional design featuring patient/family and nurse surveys. Of the 59 patient/family respondents, 93.2% prefer to have a primary nurse care for them and 85% are satisfied with how often they are assigned a primary care team member. Similarly, 63% of the 57 nurse respondents are satisfied with the current implementation of our primary nursing model and 61% state the model reflects good continuity of care. Yet 80.7% of nurses believe safety would improve for a patient whose nurse works shifts consecutively even if not a primary nurse. Overall, patients, families, and nurses value care continuity and meaningful nurse-patient relationships, which is fundamental to primary nursing.

  5. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    Directory of Open Access Journals (Sweden)

    Grace Haeson Park

    2014-03-01

    Full Text Available Background: A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. Description of integrated practice: An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. Early results: The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased. Conclusion: Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

  6. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    Directory of Open Access Journals (Sweden)

    Grace Haeson Park

    2014-03-01

    Full Text Available Background: A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions.Description of integrated practice: An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues.Early results: The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased.Conclusion: Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

  7. What is Patient-Centered Care? A Typology of Models and Missions.

    Science.gov (United States)

    Tanenbaum, Sandra J

    2015-09-01

    Recently adopted health care practices and policies describe themselves as "patient-centered care." The meaning of the term, however, remains contested and obscure. This paper offers a typology of "patient-centered care" models that aims to contribute to greater clarity about, continuing discussion of, and further advances in patient-centered care. The paper imposes an original analytic framework on extensive material covering mostly US health care and health policy topics over several decades. It finds that four models of patient-centered care emphasize: patients versus their parts; patients versus providers; patients/providers/states versus "the system"; and patients and providers as persons. Each type is distinguishable along three dimensions: epistemological orientations, practical accommodations, and policy tools. Based on this analysis, the paper recommends that four questions be asked of any proposal that claims to provide patient-centered care: Is this care a means to an end or an end in itself? Are patients here subjects or objects? Are patients here individuals or aggregates? How do we know what patients want and need? The typology reveals that models are neither entirely compatible nor entirely incompatible and may be usefully combined in certain practices and policies. In other instances, internal contradictions may jeopardize the realization of coherent patient-centered care.

  8. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program

    Directory of Open Access Journals (Sweden)

    Francisco J. Ramos-Gomez

    2014-01-01

    Full Text Available The Affordable Care Act (ACA mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0–5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC, and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance “in health” not in “disease modality”. IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the “age-one visit”. This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children.

  9. Delayad Mandibular Reconstruction with Free Fibular Flap Using Rapid Prototype Modeling and Virtual Surgery Designing: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Abadi

    2016-12-01

    Full Text Available At present, mandibular reconstruction using free fibular flap (FFF is the gold standard to restore esthetic and functional demands after ablative oncological surgery. Mandible complex anatomy creates a great challenge for surgeon to rehabilitate its form and function with a linear fibula bone. In recent year's innovation of 3Dprinter and rapid prototype modelling (RPM has increased these standards and resulted in patient specific reconstruction. Because of requiring delicate technical procedure and manufacturing technology , these methods are not widely used and review of literature shows this case report present the first application of RPM technology for delayed mandibular reconstruction in middle east countries .

  10. Forecasting the use of elderly care: a static micro-simulation model.

    Science.gov (United States)

    Eggink, Evelien; Woittiez, Isolde; Ras, Michiel

    2016-07-01

    This paper describes a model suitable for forecasting the use of publicly funded long-term elderly care, taking into account both ageing and changes in the health status of the population. In addition, the impact of socioeconomic factors on care use is included in the forecasts. The model is also suitable for the simulation of possible implications of some specific policy measures. The model is a static micro-simulation model, consisting of an explanatory model and a population model. The explanatory model statistically relates care use to individual characteristics. The population model mimics the composition of the population at future points in time. The forecasts of care use are driven by changes in the composition of the population in terms of relevant characteristics instead of dynamics at the individual level. The results show that a further 37 % increase in the use of elderly care (from 7 to 9 % of the Dutch 30-plus population) between 2008 and 2030 can be expected due to a further ageing of the population. However, the use of care is expected to increase less than if it were based on the increasing number of elderly only (+70 %), due to decreasing disability levels and increasing levels of education. As an application of the model, we simulated the effects of restricting access to residential care to elderly people with severe physical disabilities. The result was a lower growth of residential care use (32 % instead of 57 %), but a somewhat faster growth in the use of home care (35 % instead of 32 %).

  11. 心胸外科患者术后疼痛的护理%Cardiothoracic Surgery Patients and Nursing Care of Postoperative Pain

    Institute of Scientific and Technical Information of China (English)

    文红英

    2012-01-01

      目的分析针对性护理干预对心胸外科患者术后疼痛的效果.方法取本院心胸外科2011年7月至2012年5月接受手术治疗的术后疼痛患者112例,随机均分为观察组和对照组.比较2组患者接受不同护理方法后的疼痛评分、负面情绪评分、护理满意度等情况.结果观察组患者接受针对性干预措施后其疼痛评分明显低于对照组患者(P<0.05);负面情绪评分明显低于对照组患者(P<0.05);对于护理的满意度情况明显高于对照组患者(P<0.05).结论使用针对性疼痛干预措施可以有效减少患者疼痛及抑郁情绪,提高护理满意度.%  Objective: to analyze the cardiothoracic surgical patients with pain nursing effect. Methods Choose 112 patiens who had accept cardiothoracic surgery at2011.7-2012.5 month as the cases, randomly divided into observation group and control group. Comparison of two groups undergoing different ways of nursing at the pain score, negative mood scores, satisfaction with nursing care. Results The pain score of the patients in the observation group was significantly lower than that of control group (P<0.05); negative mood scores were significantly lower than those in control group (P<0.05); the nursing satisfaction were significantly higher than those in control group (P<0.05). Conclusion The use of targeted interventions can be effective in reducing pain in patients with pain and depressive mood, improve nursing satisfaction.

  12. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum.

    Science.gov (United States)

    Gloviczki, Peter; Comerota, Anthony J; Dalsing, Michael C; Eklof, Bo G; Gillespie, David L; Gloviczki, Monika L; Lohr, Joann M; McLafferty, Robert B; Meissner, Mark H; Murad, M Hassan; Padberg, Frank T; Pappas, Peter J; Passman, Marc A; Raffetto, Joseph D; Vasquez, Michael A; Wakefield, Thomas W

    2011-05-01

    The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping

  13. Use of narrative as an awareness strategy for a Family-Centered Care model

    Directory of Open Access Journals (Sweden)

    Daniela Doulavince Amador

    Full Text Available The aim of this study was to comprehend the meaning of using illness narratives to raise awareness among nursing students and healthcare professionals toward the family-centred care model. The adopted methodological framework was Qualitative Content Analysis based on the philosophy of Family-Centered Care. Data were collected by means of assessments provided by 29 participants at an event in 2013, in São Paulo. The resulting analytical category was "transformed by the family narrative", which consisted of three sub-categories: Favours a better understanding of the family's experience; facilitates learning of family issues; and triggers thought on family-centered care. Results showed that hearing the family narrative on experiences with illness and hospitalization raises awareness among nursing students and healthcare professionals toward the family-centered care model, and facilitates learning of this model of care.

  14. Shared care is a model for patients with stable prostate cancer

    DEFF Research Database (Denmark)

    Lund, Lars; Jønler, Morten; Graversen, Hans Peder

    2013-01-01

    general practitioners (GPs) can handle follow-up. MATERIAL AND METHODS: A Steering Committee was established in collaboration with health-care professionals to devise a strategy for a shared care model. An action plan was designed that included 1) the development of a shared care model for follow......-up and treatment, 2) implementation of the shared care model in cooperation between the parties involved, 3) design of procedures for re-referral, and 4) evaluation of effect, change processes and contextual factors. RESULTS: A total of 2,585 patients with PC were included in the study: 1,172 had disseminated...... to follow-up with a GP and 2,055 were not transferred to their GP. The main reason why patients were considered not suitable for transfer to primary health care was the patients' own desire (33%), followed by clinical or biochemical disease progression (33%). The evaluation found that 96% of the patients...

  15. Model of learning for practitioners in dementia care with music therapy as the joint focal point

    DEFF Research Database (Denmark)

    Ottesen, Aase Marie

    Abstract to the 21st Nordic Congress of Gerontology in June 10th - 13th, 2012 Title Model of learning for practitioners in dementia care with music therapy as the joint focal point The project is a PhD research in progress, which aims to develop a model of learning for practitioners in dementia...... of tangible tools from the musical activities? And further: What impact does the emphasis on development of the care provider’s musical and interpersonal competencies have on quality of life and well-being among persons suffering from dementia? The model of learning includes using the Dementia Care Mapping...... care, which has music therapy as the joint focal point and focus on the relational meeting.Through development of a cross-disciplinary cooperation between the music therapist and the care providers in connection with a course of music therapy, will following areas be elucidated: How can the musical...

  16. Effect of Continuing Care on Bladder Cancer Patients after Abdominal Stoma Surgery%连续性护理在膀胱癌腹壁造口术后病人护理中的应用

    Institute of Scientific and Technical Information of China (English)

    蔺玉霞

    2015-01-01

    Objective To observe and analyze the effect of continuing care on bladder cancer patients after abdominal stoma surgery. Methods 100 bladder cancer patients underwent abdominal stoma surgery in the Department of Urology of our hospital from April 2012 to April 2014 were selected as the subjects of this study. The patients were randomly and equally divided into two groups, the control group and the observation group in accordance with the postoperative nursing model given to them. 50 cases in the control group were given the conventional postoperative nursing, while 50 cases in the observation group were given continuing care intervention based on the conventional nursing. And the nursing efficacy was observed and compared between the two groups. Results After surgery, compared with the patients in the control group, the 50 cases in the observation group were much better in grasping the health care knowledge about self-monitoring, prevention of complications, dietary knowledge, replacement of ostomy bag and so on with statistically significant difference (P<0.05). After postoperative nursing, the observation group had much better ADL, mental state, and Spitzer QOL scores than the control group (P<0.05). The nursing satisfaction of the observation group was obviously higher than that of the control group (100.00%vs 88.00%) with statistically significant difference (P<0.05). Conclusion For bladder cancer patients underwent abdominal ostomy, conventional nursing combined with continuing care intervention can ef-fectively ensure the postoperative quality of life, improve the postoperative self-care ability and self-protection ability after dis-charge, enhance the level of rehabilitation with high nursing satisfaction, so it has the value of clinical application.%目的:观察分析连续性护理措施在膀胱癌腹壁造口术后病人护理中的护理效果。方法随机选取该院泌尿外科2012年4月-2014年4月期间接收进行腹壁造口术治疗的100

  17. The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands

    Directory of Open Access Journals (Sweden)

    Fransina J. de Jong

    2009-06-01

    Full Text Available Background: In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands. Aim: Description of a collaborative care model for major depressive disorder (MDD and of the factors influencing its implementation in the primary care setting in the Netherlands. Data sources: Data collected during the preparation phase of the CC:DIP trial of the Depression Initiative, literature, policy documents, information sheets from professional associations. Results: Factors facilitating the implementation of the collaborative care model are continuous supervision of the care managers by the consultant psychiatrist and the trainers, a supportive web-based tracking system and the new reimbursement system that allows for introduction of a mental health care-practice nurse (MHC-PN in the general practices and coverage of the treatment costs. Impeding factors might be the relatively high percentage of solo-primary care practices, the small percentage of professionals that are located in the same building, unfamiliarity with the concept of collaboration as required for collaborative care, the reimbursement system that demands regular negotiations between each health care provider and the insurance companies and the reluctance general practitioners might feel to expand their responsibility for their depressed patients. Conclusion: Implementation of the collaborative care model in the Netherlands requires extensive training and supervision on micro level, facilitation of reimbursement on meso- and macro level and structural effort to change the treatment culture for chronic mental disorders in the primary care setting.

  18. Disruptive innovation in health care delivery: a framework for business-model innovation.

    Science.gov (United States)

    Hwang, Jason; Christensen, Clayton M

    2008-01-01

    Disruptive innovation has brought affordability and convenience to customers in a variety of industries. However, health care remains expensive and inaccessible to many because of the lack of business-model innovation. This paper explains the theory of disruptive innovation and describes how disruptive technologies must be matched with innovative business models. The authors present a framework for categorizing and developing business models in health care, followed by a discussion of some of the reasons why disruptive innovation in health care delivery has been slow.

  19. Partnership and empowerment program: a model for patient-centered, comprehensive, and cost-effective care.

    Science.gov (United States)

    Brown, Corinne; Bornstein, Elizabeth; Wilcox, Catina

    2012-02-01

    The Partnership and Empowerment Program model offers a comprehensive, patient-centered, and cost-effective template for coordinating care for underinsured and uninsured patients with cancer. Attention to effective coordination, including use of internal and external resources, may result in decreased costs of care and improved patient compliance and health outcomes.

  20. A theoretical model to address organizational human conflict and disruptive behavior in health care organizations.

    Science.gov (United States)

    Piper, Llewellyn E

    2006-01-01

    This article proposes a theoretical model for leaders to use to address organizational human conflict and disruptive behavior in health care organizations. Leadership is needed to improve interpersonal relationships within the workforce. A workforce with a culture of internal conflict will be unable to achieve its full potential to delivery quality patient care.

  1. Filipino Nursing Students' Behavioral Intentions toward Geriatric Care: A Structural Equation Model (SEM)

    Science.gov (United States)

    de Guzman, Allan B.; Jimenez, Benito Christian B.; Jocson, Kathlyn P.; Junio, Aileen R.; Junio, Drazen E.; Jurado, Jasper Benjamin N.; Justiniano, Angela Bianca F.

    2013-01-01

    Anchored on the key constucts of Ajzen's Theory of Planned Behavior (1985), this paper seeks to test a model that explores the influence of knowledge, attitude, and caring behavior on nursing students' behavioral intention toward geriatric care. A five-part survey-questionnaire was administered to 839 third and fourth year nursing students from a…

  2. Opening the Black Box of Clinical Collaboration in Integrated Care Models for Frail, Elderly Patients

    Science.gov (United States)

    de Stampa, Matthieu; Vedel, Isabelle; Bergman, Howard; Novella, Jean-Luc; Lechowski, Laurent; Ankri, Joel; Lapointe, Liette

    2013-01-01

    Purpose: The purpose of the study was to understand better the clinical collaboration process among primary care physicians (PCPs), case managers (CMs), and geriatricians in integrated models of care. Methods: We conducted a qualitative study with semistructured interviews. A purposive sample of 35 PCPs, 7 CMs, and 4 geriatricians was selected in…

  3. Teaching Wound Care Management: A Model for the Budget Conscious Educator

    Science.gov (United States)

    Berry, David C.

    2012-01-01

    For the author, the concept of wound care has always been a challenging topic to demonstrate. How to teach the concept without having a student in need of wound care or without having to spend money to buy another simulation manikin/model? The author has recently created a simulation to demonstrate and practice the cleaning, closing, and dressing…

  4. Archimedes: a new model for simulating health care systems--the mathematical formulation.

    Science.gov (United States)

    Schlessinger, Leonard; Eddy, David M

    2002-02-01

    This paper designs an object-oriented, continuous-time, full simulation model for addressing a wide range of clinical, procedural, administrative, and financial decisions in health care at a high level of biological, clinical, and administrative detail. The full model has two main parts, which with some simplification can be designated "physiology models" and "models of care processes." The models of care processes, although highly detailed, are mathematically straightforward. However, the mathematics that describes human biology, diseases, and the effects of interventions are more difficult. This paper describes the mathematical formulation and methods for deriving equations, for a variety of different sources of data. Although Archimedes was originally designed for health care applications, the formulation, and equations are general and can be applied to many natural systems.

  5. 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.

  6. Stepped care model for pain management and quality of pain care in long-term opioid therapy

    Directory of Open Access Journals (Sweden)

    Brent A. Moore, PhD

    2016-02-01

    Full Text Available Successful organizational improvement processes depend on application of reliable metrics to establish targets and to monitor progress. This study examined the utility of the Pain Care Quality (PCQ extraction tool in evaluating implementation of the Stepped Care Model for Pain Management at one Veterans Health Administration (VHA healthcare system over 4 yr and in a non-VHA Federally qualified health center (FQHC over 2 yr. Two hundred progress notes per year from VHA and 150 notes per year from FQHC primary care prescribers of long-term opioid therapy (>90 consecutive days were randomly sampled. Each note was coded for the presence or absence of key dimensions of PCQ (i.e., pain assessment, treatment plans, pain reassessment/outcomes, patient education. General estimating equations controlling for provider and facility were used to examine changes in PCQ items over time. Improvements in the VHA were noted in pain reassessment and patient education, with trends in positive directions for all dimensions. Results suggest that the PCQ extraction tool is feasible and may be responsive to efforts to promote organizational improvements in pain care. Future research is indicated to improve the reliability of the PCQ extraction tool and enhance its usability.

  7. Stepped care model of pain management and quality of pain care in long-term opioid therapy.

    Science.gov (United States)

    Moore, Brent A; Anderson, Daren; Dorflinger, Lindsey; Zlateva, Ianita; Lee, Allison; Gilliam, Wesley; Tian, Terrence; Khatri, Khushbu; Ruser, Christopher B; Kerns, Robert D

    2016-01-01

    Successful organizational improvement processes depend on application of reliable metrics to establish targets and to monitor progress. This study examined the utility of the Pain Care Quality (PCQ) extraction tool in evaluating implementation of the Stepped Care Model for Pain Management at one Veterans Health Administration (VHA) healthcare system over 4 yr and in a non-VHA Federally qualified health center (FQHC) over 2 yr. Two hundred progress notes per year from VHA and 150 notes per year from FQHC primary care prescribers of long-term opioid therapy (>90 consecutive days) were randomly sampled. Each note was coded for the presence or absence of key dimensions of PCQ (i.e., pain assessment, treatment plans, pain reassessment/outcomes, patient education). General estimating equations controlling for provider and facility were used to examine changes in PCQ items over time. Improvements in the VHA were noted in pain reassessment and patient education, with trends in positive directions for all dimensions. Results suggest that the PCQ extraction tool is feasible and may be responsive to efforts to promote organizational improvements in pain care. Future research is indicated to improve the reliability of the PCQ extraction tool and enhance its usability.

  8. Asian perspectives in thoracic surgery: clinical innovation in Taiwan.

    Science.gov (United States)

    Liu, Chao-Yu; Lin, Chen-Sung; Liu, Chia-Chuan

    2016-08-01

    The development of minimally-invasive surgery of the thorax began in the 1990s, but not until the recent decade did we see dramatic improvements in patient care and refinement of technique. The current generation has witnessed the evolution from traditional thoracotomy, to a single-port, non-intubated thoracoscopic approach. The investigation of subxiphoid single-port, transumbilical approach, and natural orifice transluminal endoscopic surgery (NOTES) in animal model are also undergoing. In Taiwan, several talented young surgeons have vigorously devoted their ideas and innovations to this field, making the Taiwan surgical society vivid and prosperous. The desire to improve, and willingness to change are the foundation of those surgeons. Providing better patient care is their impetus to strive for improvement. This article provides an account of how minimally-invasive thoracic surgery has evolved in recent years, and what clinical innovations have been developed by the Taiwan surgical society.

  9. Influence of Role Models and Hospital Design on the Hand Hygiene of Health-Care Workers

    OpenAIRE

    2003-01-01

    We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) we...

  10. A 3D Finite Element model of the face for simulation in plastic and maxillo-facial surgery

    CERN Document Server

    Chabanas, M; Chabanas, Matthieu; Payan, Yohan

    2000-01-01

    This paper introduces a new Finite Element biomechanical model of the human face, which has been developed to be integrated into a simulator for plastic and maxillo-facial surgery. The idea is to be able to predict, from an aesthetic and functional point of view, the deformations of a patient face, resulting from repositioning of the maxillary and mandibular bone structures. This work will complete the simulator for bone-repositioning diagnosis that has been developed by the laboratory. After a description of our research project context, each step of the modeling is precisely described: the continuous and elastic structure of the skin tissues, the orthotropic muscular fibers and their insertions points, and the functional model of force generation. First results of face deformations due to muscles activations are presented. They are qualitatively compared to the functional studies provided by the literature on face muscles roles and actions.

  11. Trends in day surgery in the Netherlands

    NARCIS (Netherlands)

    Wasowicz-Kemps, D.K.

    2008-01-01

    Hospital care has been subject to important changes during the last century. In stead of treating patients with various diseases with bed rest, medical care has shifted from in hospital to an ambulatory or outpatient setting as much as possible. Admission time after surgery shortened and day surgery

  12. Aligning health information technologies with effective service delivery models to improve chronic disease care

    Science.gov (United States)

    Bauer, Amy M.; Thielke, Stephen M.; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-01-01

    Objective Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. Method A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Results Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. Conclusion HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. PMID:24963895

  13. Multi-level model of missed nursing care in the context of hospital merger.

    Science.gov (United States)

    Castner, Jessica; Wu, Yow-Wu B; Dean-Baar, Susan

    2015-04-01

    The aim of this study was to delineate the multi-level relationships of individual registered nurse (RN) and nursing unit factors on missed nursing care. This was a quantitative model-building study using a descriptive, cross-sectional design. Surveys (N = 553) and administrative unit records from nurses in one hospital system undergoing merger were included. The results showed that 36% of the variation in missed nursing care is due to the unit context, with a corresponding 64% due to individual nurse differences. At the unit level, workload, skill mix, and critical unit type affected the amount of missed nursing care. At the individual nurse level, more experience, supplies problems, communication problems, and involvement in errors of commission all increased the perception of the amount of missed nursing care. Education level was not related to the amount of missed nursing care. The findings highlight the importance of unit- and individual-level interventions to redesign hospital nursing care.

  14. Hospital-in-the-Home — essential to an integrated model of paediatric care

    LENUS (Irish Health Repository)

    Hensey, CC

    2017-01-01

    The National Clinical Programme for Paediatrics and Neonatology is proposing a model of care that will determine the future delivery of children’s health services in Ireland1. The focus is on the provision of an integrated service with improved co-ordination between primary, secondary, and tertiary level facilities. A parallel goal is improvements in chronic care and medical care in the home. An expanded role for ambulatory care and hospital at home schemes with a reduced reliance on inpatient care is proposed in line with international best practice. Achieving these goals requires a paradigm shift in delivery of children’s health care, and reconfiguration of current services to deliver multidisciplinary care in hospital and at home. The recently approved planning application for the new children’s hospital provides an opportunity and heralds a change in the structure of paediatric services in Ireland. It will act as the nexus of paediatric care throughout Ireland; supporting paediatric services nationally through outreach programmes, and ensuring children are treated as close to home as possible. A Hospital-in-the-Home (HITH) program would help meet these objectives; and could provide home based acute paediatric care, leading to economic benefits, and the delivery of quality family-centred care.

  15. Robotic surgery of the pancreas

    Science.gov (United States)

    Joyce, Daniel; Morris-Stiff, Gareth; Falk, Gavin A; El-Hayek, Kevin; Chalikonda, Sricharan; Walsh, R Matthew

    2014-01-01

    Pancreatic surgery is one of the most challenging and complex fields in general surgery. While minimally invasive surgery has become the standard of care for many intra-abdominal pathologies the overwhelming majority of pancreatic surgery is performed in an open fashion. This is attributed to the retroperitoneal location of the pancreas, its intimate relationship to major vasculature and the complexity of reconstruction in the case of pancreatoduodenectomy. Herein, we describe the application of robotic technology to minimally invasive pancreatic surgery. The unique capabilities of the robotic platform have made the minimally invasive approach feasible and safe with equivalent if not better outcomes (e.g., decreased length of stay, less surgical site infections) to conventional open surgery. However, it is unclear whether the robotic approach is truly superior to traditional laparoscopy; this is a key point given the substantial costs associated with procuring and maintaining robotic capabilities. PMID:25356035

  16. Multiaxial mechanical properties and constitutive modeling of human adipose tissue: a basis for preoperative simulations in plastic and reconstructive surgery.

    Science.gov (United States)

    Sommer, Gerhard; Eder, Maximilian; Kovacs, Laszlo; Pathak, Heramb; Bonitz, Lars; Mueller, Christoph; Regitnig, Peter; Holzapfel, Gerhard A

    2013-11-01

    A preoperative simulation of soft tissue deformations during plastic and reconstructive surgery is desirable to support the surgeon's planning and to improve surgical outcomes. The current development of constitutive adipose tissue models, for the implementation in multilayer computational frameworks for the simulation of human soft tissue deformations, has proved difficult because knowledge of the required mechanical parameters of fat tissue is limited. Therefore, for the first time, human abdominal adipose tissues were mechanically investigated by biaxial tensile and triaxial shear tests. The results of this study suggest that human abdominal adipose tissues under quasi-static and dynamic multiaxial loadings can be characterized as a nonlinear, anisotropic and viscoelastic soft biological material. The nonlinear and anisotropic features are consequences of the material's collagenous microstructure. The aligned collagenous septa observed in histological investigations causes the anisotropy of the tissue. A hyperelastic model used in this study was appropriate to represent the quasi-static multiaxial mechanical behavior of fat tissue. The constitutive parameters are intended to serve as a basis for soft tissue simulations using the finite element method, which is an apparent method for obtaining promising results in the field of plastic and reconstructive surgery.

  17. [The permanence of access to health care: a tradition of hospitality and innovative organizational model].

    Science.gov (United States)

    Georges-Tarragano, C

    2015-01-01

    The PASS ("Permanence d'Accès aux Soins de Santé") are hospital-based units providing primary care services to patients who lack health care coverage. Using a "whole person" approach and providing a combination of health and social care, the PASS offer an appropriately adapted response to complex health problems within a context of marked social vulnerability and contribute to reducing health inequalities. The PASS are an example of an interdisciplinary approach to health care which contrasts with the segmentary approach typical of conventional hospital departments. Operating at the interface between primary and secondary care, the PASS have the potential to become key players in developing models of patient pathways. Their presence reduces inappropriate emergency attendances and hospitalisation by offering medical care in a timely fashion, in an outpatient-type setting. The PASS can provide a resource for research into optimum models of health care, where the social context of health needs are fully recognized and inform medical treatment appropriately. According to their potential development, PASS are living labs of an innovative organizational model of care.

  18. Understanding the health care business model: the financial analysts' point of view.

    Science.gov (United States)

    Bukh, Per Nikolaj; Nielsen, Christian

    2010-01-01

    This study focuses on how financial analysts understand the strategy of a health care company and which elements, from such a strategy perspective, they perceive as constituting the cornerstone of a health care company's business model. The empirical part of this study is based on semi-structured interviews with analysts following a large health care company listed on the Copenhagen Stock Exchange. The authors analyse how the financial analysts view strategy and value creation within the framework of a business model. Further, the authors analyze whether the characteristics emerging from a comprehensive literature review are reflected in the financial analysts' perceptions of which information is decision-relevant and important to communicate to the financial markets. Among the conclusions of the study is the importance of distinguishing between the health care companies' business model and the model by which the payment of revenues are allocated between end users and reimbursing organizations.

  19. The Integrated Medical Model: A Decision Support Tool for In-flight Crew Health Care

    Science.gov (United States)

    Butler, Doug

    2009-01-01

    This viewgraph presentation reviews the development of an Integrated Medical Model (IMM) decision support tool for in-flight crew health care safety. Clinical methods, resources, and case scenarios are also addressed.

  20. Using trauma informed care as a nursing model of care in an acute inpatient mental health unit: A practice development process.

    Science.gov (United States)

    Isobel, Sophie; Edwards, Clair

    2017-02-01

    Without agreeing on an explicit approach to care, mental health nurses may resort to problem focused, task oriented practice. Defining a model of care is important but there is also a need to consider the philosophical basis of any model. The use of Trauma Informed Care as a guiding philosophy provides a robust framework from which to review nursing practice. This paper describes a nursing workforce practice development process to implement Trauma Informed Care as an inpatient model of mental health nursing care. Trauma Informed Care is an evidence-based approach to care delivery that is applicable to mental health inpatient units; while there are differing strategies for implementation, there is scope for mental health nurses to take on Trauma Informed Care as a guiding philosophy, a model of care or a practice development project within all of their roles and settings in order to ensure that it has considered, relevant and meaningful implementation. The principles of Trauma Informed Care may also offer guidance for managing workforce stress and distress associated with practice change.

  1. A multiscale model for the study of cardiac biomechanics in single-ventricle surgeries: a clinical case.

    Science.gov (United States)

    Meoli, Alessio; Cutrì, Elena; Krishnamurthy, Adarsh; Dubini, Gabriele; Migliavacca, Francesco; Hsia, Tain-Yen; Pennati, Giancarlo; Taylor, Andrew; Giardini, Alessandro; Khambadkone, Sachin; Schievano, Silvia; de Leval, Marc; Hsia, T-Y; Bove, Edward; Dorfman, Adam; Baker, G Hamilton; Hlavacek, Anthony; Migliavacca, Francesco; Pennati, Giancarlo; Dubini, Gabriele; Marsden, Alison; Feinstein, Jeffrey; Vignon-Clementel, Irene; Figliola, Richard; McGregor, John

    2015-04-06

    Complex congenital heart disease characterized by the underdevelopment of one ventricular chamber (single ventricle (SV) circulation) is normally treated with a three-stage surgical repair. This study aims at developing a multiscale computational framework able to couple a patient-specific three-dimensional finite-element model of the SV to a patient-specific lumped parameter (LP) model of the whole circulation, in a closed-loop fashion. A sequential approach was carried out: (i) cardiocirculatory parameters were estimated by using a fully LP model; (ii) ventricular material parameters and unloaded geometry were identified by means of the stand-alone, three-dimensional model of the SV; and (iii) the three-dimensional model of SV was coupled to the LP model of the circulation, thus closing the loop and creating a multiscale model. Once the patient-specific multiscale model was set using pre-operative clinical data, the virtual surgery was performed, and the post-operative conditions were simulated. This approach allows the analysis of local information on ventricular function as well as global parameters of the cardiovascular system. This methodology is generally applicable to patients suffering from SV disease for surgical planning at different stages of treatment. As an example, a clinical case from stage 1 to stage 2 is considered here.

  2. Implementing integrated models of care: the importance of the macro-level context.

    Science.gov (United States)

    Ashton, Toni

    2015-01-01

    Reports of how different countries are responding to the need to develop more integrated health and social care services for older adults can provide useful lessons for other health systems. However an understanding of how the wider structural, political, economic and cultural context affects implementation of these models of care is essential when considering the potential for models to be scaled up or transferred to other jurisdictions.

  3. Understanding Spiritual Care: The Faith-Hope-Love Model of Spiritual Wellness.

    Science.gov (United States)

    Christman, Sharon K; Mueller, Julia R

    Spiritual care has been associated with positive patient outcomes. Although nurses want to provide spiritual care, many have difficulty conceptualizing spiritual care outside of religion and religious activities. The Faith-Hope-Love Model of Spiritual Wellness, a theoretical model of spirituality and spiritual well-being, grounded in Christian theology and biblical text, can help nurses provide spiritual support to patients and families from multiple faith traditions or those without a faith background. Spirituality concepts are discussed, and description of how spirituality is related to finding meaning and purpose in life along with a summary of the spiritual needs identified from healthcare literature and the Bible, are provided.

  4. Collaborative care for depression: a literature review and a model for implementation in developing countries.

    Science.gov (United States)

    Farooq, Saeed

    2013-03-01

    Depression will soon be the leading cause of disability in developing countries but effective treatments are not widely available. There is compelling evidence for the effectiveness and cost-effectiveness of the multicondition collaborative care (MCC) model for depression in developing and developed countries. In the MCC model integrated care for depression is provided along with care for different non-communicable disorders. MCC has been shown to reduce hyperglycaemia and hyperlipidaemia and can lead to depression-free days when integrated care for depression and diabetes is provided. However, due to limited resources, it is not possible to make this effective model of care available at the population level. It is suggested that a public health intervention based on the MCC model can lead to better care for depression in developing countries. A public health programme of MCC which provides treatment for depression, diabetes and hypertension in a collaborative care programme will be a cost-effective way of providing treatment for depression in developing countries. This will cater for the leading cause of disability (unipolar depression) and the leading projected causes of mortality (ischaemic heart disease and cerebrovascular disease) in low-income and middle-income countries.

  5. Care episode retrieval: distributional semantic models for information retrieval in the clinical domain.

    Science.gov (United States)

    Moen, Hans; Ginter, Filip; Marsi, Erwin; Peltonen, Laura-Maria; Salakoski, Tapio; Salanterä, Sanna

    2015-01-01

    Patients' health related information is stored in electronic health records (EHRs) by health service providers. These records include sequential documentation of care episodes in the form of clinical notes. EHRs are used throughout the health care sector by professionals, administrators and patients, primarily for clinical purposes, but also for secondary purposes such as decision support and research. The vast amounts of information in EHR systems complicate information management and increase the risk of information overload. Therefore, clinicians and researchers need new tools to manage the information stored in the EHRs. A common use case is, given a--possibly unfinished--care episode, to retrieve the most similar care episodes among the records. This paper presents several methods for information retrieval, focusing on care episode retrieval, based on textual similarity, where similarity is measured through domain-specific modelling of the distributional semantics of words. Models include variants of random indexing and the semantic neural network model word2vec. Two novel methods are introduced that utilize the ICD-10 codes attached to care episodes to better induce domain-specificity in the semantic model. We report on experimental evaluation of care episode retrieval that circumvents the lack of human judgements regarding episode relevance. Results suggest that several of the methods proposed outperform a state-of-the art search engine (Lucene) on the retrieval task.

  6. Interprofessional education for students of the health professions: the "Seamless Care" model.

    Science.gov (United States)

    Mann, K V; Mcfetridge-Durdle, J; Martin-Misener, R; Clovis, J; Rowe, R; Beanlands, H; Sarria, M

    2009-05-01

    "Seamless Care" was one of 21 grants awarded by Health Canada to inform policymakers of the effectiveness of interprofessional education in promoting collaborative patient-centred practice among health professionals. The "Seamless Care" model of interprofessional education was designed with input from three Faculties at Dalhousie University (Medicine, Dentistry and Health Professions). The design was grounded in relevant learning theories--Social Cognitive Theory, Self-efficacy, Situated Learning theory and Constructivism. The intervention was informed by principles of active learning, problem-based learning, reflection and role modeling. The primary goal of Seamless Care was to develop students' interprofessional patient-centred collaborative skills through experiential learning. Fourteen student teams, each including one student from medicine, nursing, pharmacy, dentistry and dental hygiene, learned with, from and about each other while they were mentored in the collaborative care of patients transitioning from acute care to the community. Student teams providing collaborative care assisted patients experiencing a chronic illness to become more active in managing their health through development of self-management and decision-making skills. This paper describes the Seamless Care model of interprofessional education and discusses the theoretical underpinnings of this experiential model of interprofessional education designed to extend classroom-based interprofessional education to the clinical setting.

  7. Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

    Directory of Open Access Journals (Sweden)

    Hogg William

    2011-10-01

    Full Text Available Abstract Background Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. Methods This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. Results The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69% than in fee-for-service (45% practices (Adjusted Odds Ratio (AOR = 2.4 [95% CI 1.4-4.2], p = 0.001. Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006, and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007. Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices

  8. Task-role-based Access Control Model in Smart Health-care System

    Directory of Open Access Journals (Sweden)

    Wang Peng

    2015-01-01

    Full Text Available As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for the medical health-care environment, task-role-based access control model, which overcomes the disadvantages of traditional access control models. The task-role-based access control (T-RBAC model introduces a task concept, dividing tasks into four categories. It also supports supervision role hierarchy. T-RBAC is a proper access control model for Smart Health-care System, and it improves the management of access rights. This paper also proposes an implementation of T-RBAC, a binary two-key-lock pair access control scheme using prime factorization.

  9. Family Models for Earning and Caring: Implications for Child Care and for Family Policy

    Directory of Open Access Journals (Sweden)

    Ravanera, Zenaida

    2009-01-01

    Full Text Available AbstractCanadian families have changed, in part due to an economy that provides more work opportunities for women, and a cultural orientation that values equal opportunity and diversity infamilies. In spite of the change, both quantitative and qualitative evidence suggest a continued preference for mothers to spend considerable time with children, especially in the infant andtoddler years. Thus, in an average couple, the presence of young children in the home brings wives to reduce their paid work and husbands to increase their paid work. Our reading of parentalpreferences suggests an interest in more services for young children in the form of early childhood education and child care, but also an interest in policies that would allow parents to spend more time with children through parental leaves, part-time work with good benefits, and subsidies that supplement market income. Many options available to two-parent families are often less feasible for lone parents, giving a higher priority to child care.RésuméLa famille canadiennes a changé, dû en partie à une économie qui offre plus de possibilités d’emploi pour les femmes, et à une tendance culturelle qui valorise l’égalité des chances et la diversité dans les familles. En dépit de ces changements, les preuves quantitatives et qualitatives suggèrent une préférence continue pour les mères de passer plus de temps avec les enfants, particulièrement quand il s’agit de nouveau-nés ou d’enfants en bas âge. Donc, pour un couple moyen, la présence de jeunes enfants au foyer pousse les femmes à réduire leurs emplois rémunérés et les maris à augmenter les leurs. Notre étude des préférences parentales suggère un intérêt pour un accroissement des services pour jeunes enfants sous la forme d’éducation préscolaire et de garde d’enfants, et aussi un intérêt pour des politiques qui permettraient aux parents de passer plus de temps avec leurs enfants tels que cong

  10. Thyroid Surgery

    Science.gov (United States)

    ... etc.). Surgery is also an option for the treatment of hyperthyroidism (Grave’s disease or a “toxic nodule” (see Hyperthyroidism brochure ), for large and multinodular goiters and for any goiter that may be causing ... MEANS OF TREATMENT? Surgery is definitely indicated to remove nodules suspicious ...

  11. Effects of surgery, immunization, and laser immunotherapy on a non-immunogenic metastic tumor model

    Science.gov (United States)

    Chen, Wei R.; Huang, Zheng; Andrienko, Kirill; Stefanov, Stefan; Wolf, Roman F.; Liu, Hong

    2006-08-01

    Traditional local cancer treatment modalities include surgery and radiation, which has the immediate tumor response due to tumor removal or radiation induced cell death. However, such therapeutic approaches usually do not result in eradiation of tumors, particularly when treating metastatic tumors. In fact, local treatment of primary tumors may stimulate the growth and spread of remote metastasis. Commonly used systemic therapies include chemotherapy and immunotherapy, which target the dividing cells or the immune systems. However, in addition to the severe side effects, chemotherapy often suppresses the immune systems, hence lessening the host's ability to fight the disease. Immunotherapy, on the other hand, aims at educating and stimulating immune systems using either general immune enhancements or antigen-oriented specific immune stimulation. However, so far, the traditional immunotherapy has yielded only limited success in treating cancer patients. A different approach is needed. To combine the advantages of both local therapies for acute and targeted treatment responses and the systemic therapies for stimulation of the immune systems, laser immunotherapy was proposed to use selective photothermal therapy as the local treatment modality and the adjuvant-assisted immunotherapy for systemic control. Laser immunotherapy has show positive results in treating metastatic tumors. In this study, we conducted a comparative study using surgery, freeze-thaw immunization and laser immunotherapy in the treatment of metastatic rat mammary tumors. Our results showed that removal of the primary tumors was unsuccessful at changing the course of tumor progression. The tumor cell lysate immunization delayed the emergence of metastases but did not provide immunity against the tumor challenge. Laser immunotherapy, on the other hand, resulted in regression and eradication.

  12. Integrating the Chronic Care Model into a Novel Medical Student Course

    Science.gov (United States)

    Block, Robert C.; Tran, Bill; McIntosh, Scott

    2011-01-01

    Objective: To determine whether integration of the Chronic Care Model into undergraduate medical education is associated with anticipated use of the Model and whether student perceptions match actual integration of the Model into their community projects. Design: This was a cross-sectional study using qualitative and quantitative data. Setting: A…

  13. Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

    Directory of Open Access Journals (Sweden)

    Shantanu Nundy

    2012-01-01

    Full Text Available Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time. Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral. Conclusion. Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.

  14. Prerequisites for sustainable care improvement using the reflective team as a work model.

    Science.gov (United States)

    Jonasson, Lise-Lotte; Carlsson, Gunilla; Nyström, Maria

    2014-01-01

    Several work models for care improvement have been developed in order to meet the requirement for evidence-based care. This study examines a work model for reflection, entitled the reflective team (RT). The main idea behind RTs is that caring skills exist among those who work closest to the patients. The team leader (RTL) encourages sustainable care improvement, rooted in research and proven experience, by using a lifeworld perspective to stimulate further reflection and a developmental process leading to research-based caring actions within the team. In order to maintain focus, it is important that the RTL has a clear idea of what sustainable care improvement means, and what the prerequisites are for such improvement. The aim of the present study is, therefore, to explore the prerequisites for improving sustainable care, seeking to answer how RTLs perceive these and use RTs for concrete planning. Nine RTLs were interviewed, and their statements were phenomenographically analysed. The analysis revealed three separate qualitative categories, which describe personal, interpersonal, and structural aspects of the prerequisites. In the discussion, these categories are compared with previous research on reflection, and the conclusion is reached that the optimal conditions for RTs to work, when focussed on sustainable care improvement, occur when the various aspects of the prerequisites are intertwined and become a natural part of the reflective work.

  15. Proactive intervention dentistry: a model for oral care through life.

    Science.gov (United States)

    Goldstep, Fay

    2012-06-01

    Tools and techniques are available to oral care providers that have been found to be effective in reversing and controlling the caries process. In addition to fluoride, these tools include new remineralization therapies that can be incorporated into solutions, creams, and dentifrices, and bioactive restorative materials that work effectively with dental hard tissues. By incorporating such "proactive interventions" into their practice and educating patients on maintaining a daily oral hygiene regimen, clinicians can inhibit the multifactorial disease process of demineralization and caries before more extensive treatment becomes necessary.

  16. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in......-depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  17. CenteringParenting: an innovative dyad model for group mother-infant care.

    Science.gov (United States)

    Bloomfield, Joanna; Rising, Sharon Schindler

    2013-01-01

    CenteringParenting is a group model that brings a cohort of 6 to 7 mothers and infants together for care during the first year of life. During 9 group sessions the clinician provides well-baby care and also attends to the health, development, and safety issues of the mother. Ideally, CenteringParenting provides continuity of care for a cohort of women who have received care in CenteringPregnancy, group prenatal care that is 10 sessions throughout the entire pregnancy and that leads to community building, better health outcomes, and increased satisfaction with prenatal care. The postpartum year affects the entire family, but especially the mother, who is redefining herself and her own personal goals. Issues of weight/body image, breastfeeding, depression, contraception, and relationship issues all may surface. In traditional care, health resources for support and intervention are frequently lacking or unavailable. Women's health clinicians also note the loss of contact with women they have followed during the prenatal period, often not seeing a woman again until she returns for another pregnancy. CenteringParenting recognizes that the health of the mother is tied to the health of the infant and that assessment and interventions are more appropriate and efficient when done in a dyad context. Facilitative leadership, rather than didactic education, encourages women to fully engage in their care, to raise issues of importance to them, and to discuss concerns within an atmosphere that allows for the surfacing of culturally appropriate values and beliefs. Implementing the model calls for system changes that are often significant. It also requires the building of a substantial team relationship among care providers. This overview describes the CenteringParenting mother-infant dyad care model with special focus on the mother and reviews the perspectives and experiences of staff from several practice sites.

  18. Exporting the Buyers Health Care Action Group purchasing model: lessons from other communities.

    Science.gov (United States)

    Christianson, Jon B; Feldman, Roger

    2005-01-01

    When first implemented in Minneapolis and St. Paul, Minnesota, the Buyers Health Care Action Group's (BHCAG) purchasing approach received considerable attention as an employer-managed, consumer-driven health care model embodying many of the principles of managed competition. First BHCAG and, later, a for-profit management company attempted to export this model to other communities. Their efforts were met with resistance from local hospitals and, in many cases, apathy by employers who were expected to be supportive. This experience underscores several difficulties that appear to be inherent in implementing purchasing models based on competing care systems. It also, once again, suggests caution in drawing lessons from community-level experiments in purchasing health care.

  19. A research model of health-care competition and customer satisfaction.

    Science.gov (United States)

    Asoh, Derek A; Rivers, Patrick A

    2007-11-01

    In all industries, competition among businesses has long been encouraged as a mechanism to increase value for customers. In other words, competition ensures the provision of better products and services to satisfy the needs of customers. Various perspectives of competition, the nature of service quality, health-care system costs and customer satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts customer satisfaction as an outcome measure directly dependent on competition. Quality of care and health-care system costs, while also directly dependent on competition, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research.

  20. Application of the expanded Creme RIFM consumer exposure model to fragrance ingredients in cosmetic, personal care and air care products.

    Science.gov (United States)

    Safford, B; Api, A M; Barratt, C; Comiskey, D; Ellis, G; McNamara, C; O'Mahony, C; Robison, S; Rose, J; Smith, B; Tozer, S

    2017-02-28

    As part of a joint project between the Research Institute for Fragrance Materials (RIFM) and Creme Global, a Monte Carlo model (here named the Creme RIFM model) has been developed to estimate consumer exposure to ingredients in personal care products. Details of the model produced in Phase 1 of the project have already been published. Further data on habits and practises have been collected which enable the model to estimate consumer exposure from dermal, oral and inhalation routes for 25 product types. . In addition, more accurate concentration data have been obtained which allow levels of fragrance ingredients in these product types to be modelled. Described is the use of this expanded model to estimate aggregate systemic exposure for eight fragrance ingredients. Results are shown for simulated systemic exposure (expressed as μg/kg bw/day) for each fragrance ingredient in each product type, along with simulated aggregate exposure. Highest fragrance exposure generally occurred from use of body lotions, body sprays and hydroalcoholic products. For the fragrances investigated, aggregate exposure calculated using this model was 11.5-25 fold lower than that calculated using deterministic methodology. The Creme RIFM model offers a very comprehensive and powerful tool for estimating aggregate exposure to fragrance ingredients.