WorldWideScience

Sample records for care surgery model

  1. LAPAROSCOPIC APPENDECTOMY AS A CARE MODEL OF "FAST TRACK SURGERY"

    Directory of Open Access Journals (Sweden)

    F. Ferrara

    2012-01-01

    Full Text Available "Fast track surgery" is a model of care pathway that is gradually replacing and incorporating all the other models so far applied in surgery. In particular, this is possible thanks to minimally invasive procedures widely disseminated for the several benefits they offer. The authors present a preliminary study of laparoscopic appendectomy using endo-GIA as a model of fast track surgery. At the Department of Pediatric Surgery of the University of Siena, from December 2008 to May 2009 were carried out 10 surgery procedures of laparoscopic appendectomy. Patients were subjected to emergency surgery for acute appendicitis diagnosed by clinical examination, laboratory tests and ultrasound study. The mean age was 10.8 years (range 7-14 years. All procedures were performed under general anesthesia with the patient in supine decubitus and using three trocars. The first 12 mm, was introduced through the umbilical incision with "open" approach, the second, 12 mm in the left iliac fossa and the third, 5 mm, in sovrapubic seat. In each patient the appendectomy was carried out with endo-GIA (a linear stapling device that can be used for the section of appendix and vessels. Results: Any patient needed to convert to “open surgery”. The duration of surgery procedure was in mean 80 minutes (range 60-90 minutes. In any case intraoperative complications were observed. In 1 patient (10% further surgery procedure with technique "open" was necessary due to presence of purulent exudate in peritoneal cavity, depending to severity of endo-abdominal infection. The hospitalization was in mean 4.3 days (range 3-10 days with intestinal canalization on the 1st post-operative day. Laparoscopic appendectomy is a feasible and safe method with advantages for patients such as lower incidence of septic complications (better toilet of peritoneal cavity and possible placement of drainage, reduced time of hospitalization and convalescence, better control of postoperative pain, and

  2. 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

  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. 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...

  5. Monitoring and improving care in thoracic surgery

    NARCIS (Netherlands)

    R.C. Numan

    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 incr

  6. Caring with difficulty: Brazilian nurses' experiences of gynaecological surgery care.

    OpenAIRE

    Vargens, O; Berterö, Carina

    2010-01-01

    This study was made by a qualitative approach based on symbolic interactionism and grounded theory. The subject was defined as what mutilation means for nurses who take care of women submitted to gynaecological surgery. The aim was to identify the interaction relationship of nurses as female with the phenomenon of mutilation in gynaecological surgeries and how it affects their relationship with female patients in this situation. Data were obtained by interviews with 16 nurses who work in gyna...

  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. Associated with Health Care-Associated Infections in Cardiac Surgery

    Science.gov (United States)

    Greco, Giampaolo; Shi, Wei; Michler, Robert E.; Meltzer, David O.; Ailawadi, Gorav; Hohmann, Samuel F.; Thourani, Vinod; Argenziano, Michael; Alexander, John; Sankovic, Kathy; Gupta, Lopa; Blackstone, Eugene H.; Acker, Michael A.; Russo, Mark J.; Lee, Albert; Burks, Sandra G.; Gelijns, Annetine C.; Bagiella, Emilia; Moskowitz, Alan J.; Gardner, Timothy J.

    2014-01-01

    BACKGROUND Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. OBJECTIVES To determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery. METHODS Prospectively collected data from a multicenter observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data, routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, adjusting for patient demographics, clinical history, baseline laboratory values, and surgery type. RESULTS Among 4,320 cardiac surgery patients, mean age of 64 ± 13 years, 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%) and C. Difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions, among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAI was on average nearly three times as much as readmissions not related to HAI. CONCLUSIONS Hospital cost, length of stay, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. PMID:25572505

  9. Bariatric surgery and implications for stoma care.

    Science.gov (United States)

    Swash, Carolyn

    In the UK, 62% of the population are now described as being either overweight or obese. People with weight-management issues are more likely to suffer from cardiovascular disease and diabetes, as well as having an increased risk of cancer, including bowel cancer. Following the initial National Institute for Health and Care Excellence guidance in 2006, revised in 2014, health professionals have a more proactive role in identifying people with weight-management issues and supporting them to achieve a weight that helps reduce their health risks. This includes referrals to bariatric surgeons for consideration for surgery if appropriate. One particular surgical procedure, the Roux-en-Y, is not reversible and alters the capacity of the stomach and function of the small bowel in order to achieve weight loss. Using a case study, this article will highlight the role of the stoma nurse in managing a patient, who previously had a Roux-en-Y procedure for weight loss and subsequently needed formation of a loop ileostomy after surgery for bowel cancer. PMID:26973009

  10. Enhanced recovery after surgery (ERAS) versus conventional postoperative care in colorectal surgery.

    NARCIS (Netherlands)

    Teeuwen, P.H.; Bleichrodt, R.P.; Strik, C.; Groenewoud, J.J.; Brinkert, W.; Laarhoven, C.J.H.M. van; Goor, H. van; Bremers, A.J.A.

    2010-01-01

    BACKGROUND: Enhanced Recovery After Surgery (ERAS) programs are associated with reduced hospital morbidity and mortality. The aim of the present study was to evaluate whether the introduction of ERAS care improved the adverse events in colorectal surgery. In a cohort study, mortality, morbidity, and

  11. 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.

  12. Bedside Neonatal Intensive Care Unit Surgery- Myth or Reality!

    OpenAIRE

    Shandip Kumar Sinha; Sujoy Neogi

    2013-01-01

    Neonatal transport is associated with complications, more so in sick and unstable neonates who need immediate emergency surgery. To circumvent these problems, surgery in Neonatal intensive care unit (NICU) is proposed for these neonates. This article reviews the literature regarding feasibility of this novel concept and based on the generated evidence, suggest the NICU planners to always include infrastructure for this. Also neonatal surgical team can be developed that could be transported.

  13. 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

  14. 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.

  15. Best Practice Updates for Multidisciplinary Care in Weight Loss Surgery

    OpenAIRE

    Apovian, Caroline M; Cummings, Sue; Anderson, Wendy; Borud, Loren; Boyer, Kelly; Day, Kristina; Hatchigian, Edward; Hodges, Barbara; Patti, Mary E.; Pettus, Mark; Perna, Frank; Rooks, Daniel; Saltzman, Edward; Skoropowski, June; Tantillo, Michael B.

    2009-01-01

    The objective of this study is to update evidence-based best practice guidelines for multidisciplinary care of weight loss surgery (WLS) patients. We performed systematic search of English-language literature on WLS, patient selection, and medical, multidisciplinary, and nutritional care published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence...

  16. 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

    ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality. RESULTS: In total, 286 patients were included in the modified intention-to-treat analysis. The trial...... was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2......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...

  17. 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...

  18. 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.

  19. 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.

  20. 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

    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....... 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...

  1. Advances in laparoscopy for acute care surgery and trauma.

    Science.gov (United States)

    Mandrioli, Matteo; Inaba, Kenji; Piccinini, Alice; Biscardi, Andrea; Sartelli, Massimo; Agresta, Ferdinando; Catena, Fausto; Cirocchi, Roberto; Jovine, Elio; Tugnoli, Gregorio; Di Saverio, Salomone

    2016-01-14

    The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers, for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a

  2. 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

  3. Analysis of a new model in nursing care ward round in the hand surgery department%手外科护理业务查房新模式的探析

    Institute of Scientific and Technical Information of China (English)

    齐常萍

    2013-01-01

    Objective To analyze the effect of a new model in the nursing care ward round in the hand surgery department.Methods The implementation of nursing care ward round in the hand surgery department was retrospectively analyzed.Results The comprehensive quality of nurses were increased obviously when the new model ward round was implemented.Patients were more satisfied with the work of nursing care.The evaluation of new model ward round by nurses was higher than before.Conclusions The new model of nursing ward round showed a great help for increasing the comprehensive quality of nurses,the responsibility awareness of nurses and the nursing quality.It presented an significant application value by developing new nursing care technique and helping establish harmonious relationship between the nursing staff and patients.%目的 探析护理业务查房新模式在手外科病房的临床应用效果.方法 对2010年1月至2012年12月手外科病房实施护理业务查房新模式进行回顾性分析.结果 护理业务查房新模式实施后,手外科护士的综合素质水平明显提高,患者对护理工作的满意度明显提高,护理人员对新的查房模式效果评价与以往查房效果比较差异有统计学意义.结论 护理业务查房新模式对提高护士综合素质,增强护士责任意识,提高护理质量,拓展护理新技术新业务,促进护患关系和谐发展,具有显著的应用价值.

  4. Colonic surgery with accelerated rehabilitation or conventional care

    DEFF Research Database (Denmark)

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

    2004-01-01

    BACKGROUND: For patients undergoing colonic surgery, the postoperative hospital stay is usually 6 to 10 days, and the morbidity rate is 15 to 20 percent. Fast-track rehabilitation programs have reduced the hospital stay to 2 to 3 days. The aim of this study was to evaluate the postoperative outcome...... 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 day 4.5 in group 1 and day 2 in group 2 ( P hospital stay was 8 days in group 1 and 2 days in group 2 ( P

  5. [Information system at Department of Cardiac Surgery Intensive Care Unit].

    Science.gov (United States)

    Dokozić, Josipa

    2014-03-01

    This paper analyzes the aspects of using computer technology in nursing practice. Transfer and managing of data, information and knowledge in nursing is enabled by using modern technology and suitable applications. Cardio applications at the Intensive Care Unit of Department of Cardiac Surgery in Osijek enables nurses/technicians to gain insight into patient personal data, medical history, microbiological findings, interventions that have been made as well as those scheduled in the field of health care, all this by using a few simple connections. Nurses/technicians are those who enter patient data into his/her Electronic Health Record. There are multiple contributions of cardiac system. In comparison with previous paper-based managing of nursing documentation, this program has considerably facilitated and improved nursing practice.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Cost-effectiveness of cataract surgery in a public health eye care programme in Nepal.

    OpenAIRE

    Marseille, E.

    1996-01-01

    Presented is an assessment of the cost-effectiveness of cataract surgery using cost and services data from the Lumbini Zonal Eye Care Programme in Nepal. The analysis suggests that cataract surgery may be even more cost-effective than previously reported. Under a "best estimate" scenario, cataract surgery had a cost of US$5.06 per disability-adjusted life year (DALY). This places it among the most cost-effective of public health interventions. Sensitivity analysis indicates that cataract surg...

  13. 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.

  14. Surgery versus conservative care for neck pain: A systematic review

    NARCIS (Netherlands)

    M. van Middelkoop (Marienke); S.M. Rubinstein (Sidney); R.W.J.G. Ostelo (Raymond); M.W. van Tulder (Maurits); W.C. Peul (Wilco); B.W. Koes (Bart); A.P. Verhagen (Arianne)

    2013-01-01

    textabstractObjective: General practitioners refer patients with continued neck pain that do not respond well to conservative care frequently to secondary care for further assessment. Are surgical interventions to the cervical spine effective when compared to conservative care for patients with neck

  15. 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, the...

  16. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2014-01-01

    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......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...

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

    OpenAIRE

    Aliya Ahmed; Naveed Latif; Robyna Khan

    2013-01-01

    Background: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Aims: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. Settings and Design: Prospective observational study conducted at a tertiary care hospital. Materials and Methods: Patients undergoing elective major abdominal surgeries w...

  18. 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

    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...... 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...... surgery' were independently associated with 30 day mortality; odds ratio 5.45 (95% CI: 3.48-8.56) and 3.27 (95% CI: 2.45-4.36), respectively. CONCLUSIONS: Mortality in emergency major GI surgical patients remains high. Failure to allocate patients to the appropriate level of care immediately after surgery...

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

    OpenAIRE

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

    2014-01-01

    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, g...

  1. 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. PMID:25535000

  2. 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

  3. Predicting postoperative mortality after colorectal surgery : a novel clinical model

    NARCIS (Netherlands)

    van der Sluis, F. J.; Espin, E.; Vallribera, F.; de Bock, G. H.; Hoekstra, H. J.; van Leeuwen, B. L.; Engel, A. F.

    2014-01-01

    Aim The aim of this study was to develop and externally validate a clinically, practical and discriminative prediction model designed to estimate in-hospital mortality of patients undergoing colorectal surgery. Method All consecutive patients who underwent elective or emergency colorectal surgery fr

  4. 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

  5. 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. PMID:18840233

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Orthopaedic surgeries - assessment of ionising radiations exposure in health care workers

    Energy Technology Data Exchange (ETDEWEB)

    Leite, E.S.; Uva, A.S. [Lisbon Univ., National School of Public Health/New (Portugal)

    2006-07-01

    Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of

  13. Orthopaedic surgeries - assessment of ionising radiations exposure in health care workers

    International Nuclear Information System (INIS)

    Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of

  14. [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. PMID:27026564

  15. 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.

  16. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen

    OpenAIRE

    Tominaga, Tetsuro; Nonaka, Takashi; Takeshita, Hiroaki; Honda, Yuichiro; Nagura, Hiroki; Shiraishi, Toshio; Kunizaki, Masaki; Sumida, Yorihisa; Hidaka, Shigekazu; Sawai,Terumitsu; Nagayasu, Takeshi

    2016-01-01

    Introduction Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending colon c...

  17. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen

    OpenAIRE

    Tetsuro Tominaga; Takashi Nonaka; Hiroaki Takeshita; Yuichiro Honda; Hiroki Nagura; Toshio Shiraishi; Masaki Kunizaki; Yorihisa Sumida; Shigekazu Hidaka; Terumitsu Sawai; Takeshi Nagayasu

    2016-01-01

    Introduction: Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case: A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending co...

  18. Nursing care in the perioperative period for patients undergoing bariatric surgery

    OpenAIRE

    Maria Beatriz Guimarães Ferreira; Márcia Marques dos Santos Felix; Cristina Maria Galvão

    2014-01-01

    This integrative review aimed to analyze the available evidence in the literature regarding nursing care in the perioperative period for patients who underwent bariatric surgery. The search for primary studies was carried out in the US National Library of Medicine National Institutes of Health, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences Literature databases. The sample was comprised of 11 primary studies, published between January...

  19. 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...

  20. 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

  1. [The wound care center in surgery: an interdisciplinary concept for diagnostic and treatment of chronic wounds].

    Science.gov (United States)

    Coerper, S; Schäffer, M; Enderle, M; Schott, U; Köveker, G; Becker, H D

    1999-04-01

    In Germany there is no standardized wound care for patients with chronic wounds in specialized centers. We have established a wound care unit for the past 6 years. The principal concept of therapy was characterized by standardized local surgery, moist wound dressings and concomitant treatment of the underlying disease. We performed local therapy, coordinated the interdisciplinary treatment and developed a new wound documentation system for quality control. We established a close network, integrating general practitioners and home care organizations to realize a mainly outpatient treatment supported by short hospital therapy. Exclusive outpatient treatment was performed in 42% of all patients. According to our prospective data, we achieved an improvement in wound care: 69% of the wounds resistant to therapy for a mean of 30 months healed within 12 months after therapy according to our protocol. Our data strongly supported the importance of local surgery: neither wound depth nor wound infection had any influence on the healing rate, presumably due to radical excisional debridement of necrotic tissue. The presented data justify on medical and economic grounds the establishment of such wound care centers in Germany. PMID:10354850

  2. 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.

  3. A MIP Model for Rolling Horizon Surgery Scheduling.

    Science.gov (United States)

    Luo, Li; Luo, Yong; You, Yang; Cheng, Yuanjun; Shi, Yingkang; Gong, Renrong

    2016-05-01

    Most surgery scheduling is done 1 day in advance. Caused by lack of overall planning, this scheduling scheme often results in unbalanced occupancy time of the operating rooms. So we put forward a rolling horizon mixed integer programming model for the scheduling. Rolling horizon scheduling refers to a scheduling scheme in which cyclic surgical requests are taken into account. Surgical requests are updated daily. The completed surgeries are eliminated, and new surgeries are added to the scheduling list. Considering day-to-day demand for surgery, we develop a non-rolling scheduling model (NRSM) and a rolling horizon scheduling model (RSM). By comparing the two, we find that the quality of surgery scheduling is significantly influenced by the variation in demand from day to day. A rolling horizon scheduling will enable a more flexible planning of the pool of surgeries that have not been scheduled into this main blocks, and hence minimize the idle time of operating rooms. The strategy of the RSM helps balance the occupancy time among operating rooms. Using surgical data from five departments of the West China Hospital (WCH), we generate surgical demands randomly to compare the NRSM and the RSM. The results show the operating rooms' average utilization rate using RSM is significantly higher than when applying NRSM. PMID:27071394

  4. 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.

  5. Force modeling for incision surgery into tissue with haptic application

    Science.gov (United States)

    Kim, Pyunghwa; Kim, Soomin; Choi, Seung-Hyun; Oh, Jong-Seok; Choi, Seung-Bok

    2015-04-01

    This paper presents a novel force modeling for an incision surgery into tissue and its haptic application for a surgeon. During the robot-assisted incision surgery, it is highly urgent to develop the haptic system for realizing sense of touch in the surgical area because surgeons cannot sense sensations. To achieve this goal, the force modeling related to reaction force of biological tissue is proposed in the perspective on energy. The force model describes reaction force focused on the elastic feature of tissue during the incision surgery. Furthermore, the force is realized using calculated information from the model by haptic device using magnetorheological fluid (MRF). The performance of realized force that is controlled by PID controller with open loop control is evaluated.

  6. 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.

  7. Many diseases, one model of care?

    NARCIS (Netherlands)

    Albreht, T.; Dyakova, M.; Schellevis, F.G.; Broucke, S. van den

    2016-01-01

    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 pat

  8. 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.

  9. 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.

  10. 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.

  11. 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. PMID:25296488

  12. 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

  13. 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

  14. 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 ...

  15. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial

    Directory of Open Access Journals (Sweden)

    Swart Annemiek

    2006-11-01

    Full Text Available Abstract Background Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. Methods/design The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a, open colectomy with fast track program (b, laparoscopic colectomy with standard care (c, and laparoscopic surgery with fast track program (d. Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8. With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36 questionnaire and social functioning can be detected. Discussion The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in

  16. Italian Society of Surgery and Association of Stoma Care Nurses Joint Position Statement on Preoperative Stoma Siting.

    Science.gov (United States)

    Roveron, Gabriele; De Toma, Giorgio; Barbierato, Maria

    2016-01-01

    Drawing on the existing position statements approved by the Wound, Ostomy and Continence Nursing Society in collaboration with the American Society of Colon & Rectal Surgeons and the American Urological Association, the Italian Association of Stoma care Nurses and the Italian Society of Surgery jointly developed and approved this document on July 27, 2013. Its purpose was to provide a formal recommendation for preoperative stoma siting and associated counseling for all patients undergoing enterostomy or urostomy surgery, with the goals of preventing complications, enhancing health-related quality of life, improving care, achieving better health outcomes, and reducing health care costs. PMID:26938165

  17. 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.

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

    DEFF Research Database (Denmark)

    Kehlet, H.; Wilmore, D.W.

    2008-01-01

    implementation issues were based on data published within the past 5 years from major anesthesiological and surgical journals, using systematic reviews where appropriate instead of multiple references of original work. DATA SYNTHESIS: Based on an increasing amount of multinational, multicenter cohort studies......, 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......, despite being based on a combination of evidence-based unimodal principles of care, recent surveys have demonstrated slow adaptation and implementation of the fast-track methodology. CONCLUSION: Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery...

  19. 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.

  20. 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),…

  1. 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…

  2. 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

  3. The specialty of colon and rectal surgery: its impact on patient care and role in academic medicine.

    OpenAIRE

    Walter E. Longo

    2003-01-01

    The specialty of colon and rectal surgery, a specialty of general surgery, has evolved from the field of proctology. Clinical care has demonstrated decreased number of patients requiring intestinal stomas, improved quality of life in patients with benign anorectal disorders, and more favorable results in patients afflicted with primary and recurrent colorectal cancer. Basic science investigations have spawned from clinical questions such as the molecular biology of colorectal cancer, use of c...

  4. 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. PMID:27630506

  5. 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.

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  8. The Gold Coast Integrated Care Model

    OpenAIRE

    Connor, Martin; Cooper, Helen; McMurray, Anne

    2016-01-01

    This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve ...

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

    Directory of Open Access Journals (Sweden)

    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

  10. 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.

  11. 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

  12. American Board of Surgery

    Science.gov (United States)

    ... Exam Results Results of our fall exams in vascular surgery, pediatric surgery, surgical critical care and surgical oncology ... Feedback Joint Pathway - General & Thoracic Surgery Specialty Definition Vascular Surgery Training Pathways Related Policies Credit for Foreign Medical ...

  13. Urinary neutrophil gelatinase-associated lipocalin as an early predictor of prolonged intensive care unit stay after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Elena Bignami

    2012-01-01

    Full Text Available Neutrophil gelatinase-associated lipocalin (NGAL is a protein of lipocalin family highly expressed in various pathologic states and is an early biomarker of acute kidney injury in cardiac surgery. We performed an observational study to evaluate the role of NGAL in predicting postoperative intensive care stay in high-risk patients undergoing cardiac surgery. We enrolled 27 consecutive patients who underwent high-risk cardiac surgery with cardiopulmonary bypass. Urinary NGAL (uNGAL was measured before surgery, at intensive care unit (ICU arrival and 24 h later. Univariate and multivariate predictors of ICU stay were performed. uNGAL was 18.0 (8.7-28.1 ng/mL at baseline, 10.7 (4.35-36.0 ng/mL at ICU arrival and 29.6 (9.65-29.5 24 h later. The predictors of prolonged ICU stay at the multivariate analysis were body mass index (BMI, uNGAL 24 h after surgery, and aortic cross-clamp time. The predictors of high uNGAL levels 24 h after at a multivariate analysis were preoperative uNGAL and logistic European System for Cardiac Operative Risk Evaluation. At a multivariate analysis the only independent predictors of prolonged ICU stay were BMI, uNGAL 24 h after surgery and aortic cross-clamp time.

  14. 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.

  15. 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.

  16. 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.

  17. The Gold Coast Integrated Care Model

    Directory of Open Access Journals (Sweden)

    Martin Connor

    2016-07-01

    Full Text Available This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve the capacity of specialist outpatients, and decrease planned and unplanned admission rates. Central to the model is a shared care record which is maintained and accessed by staff in the Coordination Centre. We provide a process map outlining the care protocols from initial assessment to care of the patient presenting for emergency care. The model is being evaluated over a pilot three year proof of concept phase to determine economic and process perspectives. If found to be cost-effective, acceptable to patients and professionals and as good as or better than usual care in terms of outcomes, the strategic intent is to scale the programme beyond the local health service.

  18. 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

  19. Augmenting Surgery via Multi-scale Modeling and Translational Systems Biology in the Era of Precision Medicine: A Multidisciplinary Perspective.

    Science.gov (United States)

    Kassab, Ghassan S; An, Gary; Sander, Edward A; Miga, Michael I; Guccione, Julius M; Ji, Songbai; Vodovotz, Yoram

    2016-09-01

    In this era of tremendous technological capabilities and increased focus on improving clinical outcomes, decreasing costs, and increasing precision, there is a need for a more quantitative approach to the field of surgery. Multiscale computational modeling has the potential to bridge the gap to the emerging paradigms of Precision Medicine and Translational Systems Biology, in which quantitative metrics and data guide patient care through improved stratification, diagnosis, and therapy. Achievements by multiple groups have demonstrated the potential for (1) multiscale computational modeling, at a biological level, of diseases treated with surgery and the surgical procedure process at the level of the individual and the population; along with (2) patient-specific, computationally-enabled surgical planning, delivery, and guidance and robotically-augmented manipulation. In this perspective article, we discuss these concepts, and cite emerging examples from the fields of trauma, wound healing, and cardiac surgery. PMID:27015816

  20. 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.

  1. 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.

  2. 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.

  3. 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...

  4. 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. PMID:27018909

  5. 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.

  6. [Current aspects of war surgery. From the trauma center to precarious medical care].

    Science.gov (United States)

    Houdelette, P

    1997-01-01

    War, said Carl von Clausewitz, is a cameleon. In this century, each armed conflict has proved to be unique, particularly in its medical aspects, with its own features and teaching its won lessons. As recent events show, no conflict is a fact of the past. Medical care delivered to war casualties depend on the circumstances of the war, on the medical resources available, but also on the price that cultures or circumstances place on it. Everything separates these two paradigms; on the one hand the "precious" casualty of western armies whose medical support is organized in a concept (forward medical and surgical care, ultra-rapid medical evacuation) tailored to each case, and as close as possible to the medical care of a civilian trauma patient whose models remains the North-American ballistic wound managed in trauma centers; on the other hand, civilian victims, in large numbers, in poor and disorganized countries, often abandoned to their own fate or sorted by "epidemiological" triage, which guarantees a distribution, as efficient as possible, of limited medical care. In war, advanced medical care and precarious medicine may work side by side according to two logics which do not exclude one another and constantly improve. PMID:9297902

  7. Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India

    OpenAIRE

    Sumathi Matta; Jiwon Park; Ghanshyam Palamaner Subash Shantha; Rohit C Khanna; Gullapalli N Rao

    2016-01-01

    Purpose To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India. Methods The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We au...

  8. 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

  9. 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.

  10. 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. PMID:26941968

  11. Abdominal surgery process modeling framework for simulation using spreadsheets.

    Science.gov (United States)

    Boshkoska, Biljana Mileva; Damij, Talib; Jelenc, Franc; Damij, Nadja

    2015-08-01

    We provide a continuation of the existing Activity Table Modeling methodology with a modular spreadsheets simulation. The simulation model developed is comprised of 28 modeling elements for the abdominal surgery cycle process. The simulation of a two-week patient flow in an abdominal clinic with 75 beds demonstrates the applicability of the methodology. The simulation does not include macros, thus programming experience is not essential for replication or upgrading the model. Unlike the existing methods, the proposed solution employs a modular approach for modeling the activities that ensures better readability, the possibility of easily upgrading the model with other activities, and its easy extension and connectives with other similar models. We propose a first-in-first-served approach for simulation of servicing multiple patients. The uncertain time duration of the activities is modeled using the function "rand()". The patients movements from one activity to the next one is tracked with nested "if()" functions, thus allowing easy re-creation of the process without the need of complex programming. PMID:26004999

  12. 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.

  13. Pharmaceutical treatments to prevent recurrence of endometriosis following surgery: a model-based economic evaluation

    Science.gov (United States)

    Sanghera, Sabina; Barton, Pelham; Bhattacharya, Siladitya; Horne, Andrew W; Roberts, Tracy Elizabeth

    2016-01-01

    Objective Conduct an economic evaluation based on best currently available evidence comparing alternative treatments levonorgestrel-releasing intrauterine system, depot-medroxyprogesterone acetate, combined oral contraceptive pill (COCP) and ‘no treatment’ to prevent recurrence of endometriosis after conservative surgery in primary care, and to inform the design of a planned trial-based economic evaluation. Methods We developed a state transition (Markov) model with a 36-month follow-up. The model structure was informed by a pragmatic review and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per quality-adjusted life year (QALY). As available data were limited, intentionally wide distributions were assigned around model inputs, and the average costs and outcome of the probabilistic sensitivity analyses were reported. Results On average, all strategies were more expensive and generated fewer QALYs compared to no treatment. However, uncertainty attributing to the transition probabilities affected the results. Inputs relating to effectiveness, changes in treatment and the time at which the change is made were the main causes of uncertainty, illustrating areas where robust and specific data collection is required. Conclusions There is currently no evidence to support any treatment being recommended to prevent the recurrence of endometriosis following conservative surgery. The study highlights the importance of developing decision models at the outset of a trial to identify data requirements to conduct a robust post-trial analysis. PMID:27084280

  14. 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.

  15. [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.

  16. [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. PMID:20649010

  17. 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.

  18. Comparison of mechanical and manual ventilation during transport of patients to the intensive care unit after cardiac surgery

    OpenAIRE

    Canbulat, Atilla; Goren, Suna; Moğol, Elif Başağan; Kaya, Fatma Nur

    2012-01-01

    Objectives: We compared effects of mechanical and manual ventilation during transport to the intensive care unit(ICU) in cardiac surgeries. Materials and methods: After ethical approval, 66 patients (ASAgrade II and III, 20-80years) were assigned randomly. Ventilation during transport to ICU was performed manual (Group EV; n=36) or mechanical ventilation (Group MV; n=30). Measurements were recorded: operation room (A), during transport (T) and in ICU (YB). Systolic, diastolic pressures (S...

  19. The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians.

    Science.gov (United States)

    Stanford, Fatima Cody; Johnson, Erica D; Claridy, Mechelle D; Earle, Rebecca L; Kaplan, Lee M

    2015-01-01

    Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH). We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20-39) were more likely to have received some obesity training than those aged 40-49 (OR: 0.08, 95% CI: 0.008-0.822) or those 50+ (OR: 0.03, 95% CI: 0.004-0.321). Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight. PMID:26339506

  20. The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians

    Directory of Open Access Journals (Sweden)

    Fatima Cody Stanford

    2015-01-01

    Full Text Available Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH. We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39 were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822 or those 50+ (OR: 0.03, 95% CI: 0.004–0.321. Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight.

  1. The Island Hospice model of palliative care

    Science.gov (United States)

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Prediction model for outcome after low-back surgery: individualized likelihood of complication, hospital readmission, return to work, and 12-month improvement in functional disability.

    Science.gov (United States)

    McGirt, Matthew J; Sivaganesan, Ahilan; Asher, Anthony L; Devin, Clinton J

    2015-12-01

    OBJECT Lumbar spine surgery has been demonstrated to be efficacious for many degenerative spine conditions. However, there is wide variability in outcome after spine surgery at the individual patient level. All stakeholders in spine care will benefit from identification of the unique patient or disease subgroups that are least likely to benefit from surgery, are prone to costly complications, and have increased health care utilization. There remains a large demand for individual patient-level predictive analytics to guide decision support to optimize outcomes at the patient and population levels. METHODS One thousand eight hundred three consecutive patients undergoing spine surgery for various degenerative lumbar diagnoses were prospectively enrolled and followed for 1 year. A comprehensive patient interview and health assessment was performed at baseline and at 3 and 12 months after surgery. All predictive covariates were selected a priori. Eighty percent of the sample was randomly selected for model development, and 20% for model validation. Linear regression was performed with Bayesian model averaging to model 12-month ODI (Oswestry Disability Index). Logistic regression with Bayesian model averaging was used to model likelihood of complications, 30-day readmission, need for inpatient rehabilitation, and return to work. Goodness-of-fit was assessed via R(2) for 12-month ODI and via the c-statistic, area under the receiver operating characteristic curve (AUC), for the categorical endpoints. Discrimination (predictive performance) was assessed, using R(2) for the ODI model and the c-statistic for the categorical endpoint models. Calibration was assessed using a plot of predicted versus observed values for the ODI model and the Hosmer-Lemeshow test for the categorical endpoint models. RESULTS On average, all patient-reported outcomes (PROs) were improved after surgery (ODI baseline vs 12 month: 50.4 vs 29.5%, p offer spine surgery specifically to those who are most

  7. Global specialized stroke care delivery models.

    Science.gov (United States)

    Theofanidis, Dimitrios; Savopoulos, Christos; Hatzitolios, Apostolos

    2016-03-01

    Stroke services still vary enormously from country to country, with many countries providing no special services at all. The aim of this article is to provide a concise overview of the various types of acute stroke delivery systems at present available and critically describe merits and shortcomings. A systematic literature review was undertaken from 1990 to July 2014. Several models for stroke services have been developed mostly in the past 3 decades, mainly in the Western world. These include state-of-the-art stroke services ranging from highly specialized stroke centers to mobile stroke units for the community. In this light, the recommendations of the structure and organization of stroke units and stroke centers by the European Stroke Organization were recently published. What differentiates the various models of stroke care delivery across the globe is the diversity of services ranging from low key conventional care to highly sophisticated facilities with life saving interventional features via integrated stroke care infrastructure. Effective in-hospital care for stroke should start in the emergency department where a swift and appropriate diagnosis should be made. The role of all brain neuroimaging procedures should have a defined a priori and proper demarcation between actions according to updated stroke care pathways and clinical protocols, which should be followed closely. These essential actions initiated by well-trained staff in the emergency department, should then be carried on in dedicated stroke facilities that is, a stroke unit.

  8. Application of Computer Modeling for Planning Plastic Surgeries

    OpenAIRE

    Jamrozik Klaudia; Rusek Jakub; Szozda Dominik; Karbowski Krzysztof

    2014-01-01

    The paper presents the application results of reverse engineering technology for planning the plastic surgery. First step is digitalization of the patient body. It is realized by 3D structured light scanner. The scanning data are transferred into 3dsMax software and used for planning plastic surgery. The planning effect is shown using stereoscopy visualization method.

  9. Computational and analytical modeling of eye refractive surgery

    Science.gov (United States)

    Cabrera, Delia

    As the number of corneal refractive procedures increases annually, concerns about their long-term stability and predictability have become the center of attention in the ophthalmic community. This thesis focuses on developing quantitative biomechanical models of the cornea that will overcome shortcomings of previous models and incorporate new observations of corneal elastic properties. Our intent is to provide a more accurate model of the corneal structure to guide current and future developments. The second chapter shows that neural networks could rapidly prototype practical solutions to obtain a better estimate of the average corneal power using the contrast and image size parameters provided by the topographic systems. After establishing improved measurements of the corneal shape the thesis focuses on the development of various corneal models. The analytical model proposed shows that geometric optics, corneal structural properties and surgical nomograms could be used to gain a better understanding of corneal response to surgical interventions. The predictions of this model are closer to the values provided by the published nomograms and clinical data than that obtained by the traditional geometric model. Three surgical procedures (Ultrafast Laser-Automated Lamellar Keratomileusis, Corneal Transplant and Intrastromal Refractive Keratectomy) were simulated using the finite element method. A new formulation was developed that simulates the changes on corneal curvature after refractive surgery when the stiffness inhomogeneities across the corneal thickness are considered. It has been shown that the predictability of the surgical outcome is improved when the stiffness inhomogeneities and nonlinearities of the deformations are included in the finite element simulations. Moreover, a finite element formulation has been developed first time to characterize the intrastromal refractive keratectomy procedure. An inhomogeneous (small displacements) model was identified as an

  10. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy.

    Science.gov (United States)

    Kumari, Archana; Nigam, Aruna

    2015-11-01

    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional status and the importance of regular check-ups must be explained. Nutritional supplementation should be tailored to the patient's status and the type of bariatric surgery performed. PMID:26672514

  11. 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...... of the components of fast-track surgery, where surgical stress, fluid and pain management are key factors. There is an urgent need for better design of studies, especially in minimal invasive surgery to achieve maximal outcome effects when integrated into the fast-track methodology....

  12. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy

    OpenAIRE

    Kumari, Archana; Nigam, Aruna

    2015-01-01

    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional statu...

  13. 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).…

  14. 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

  15. Using the Vascular Quality Initiative to improve quality of care and patient outcomes for vascular surgery patients.

    Science.gov (United States)

    Bensley, Rodney P; Beck, Adam W

    2015-06-01

    The Society for Vascular Surgery Vascular Quality Initiative (VQI) is a collaborative network of vascular specialists from various specialties that seeks to improve the quality and safety of vascular care by sharing data among physicians, medical centers, and regions. Working under a Patient Safety Organization designation by the Agency for Healthcare Research and Quality, the VQI provides a protected environment where data can be pooled and evaluated for trends that might provide opportunities to improve the care we provide our patients. Since its inception in 2011, this national organization has grown rapidly and now involves >300 medical centers that are separated into 18 active regional groups who meet twice yearly to discuss quality improvement. The structure of the VQI provides a powerful platform for data collection and analysis, and has allowed the development of a large body of literature that demonstrates the importance and benefits of participation. Here we provide a brief overview of the VQI to date.

  16. Effects of transfer from the operating room to the intensive care unit after cardiac surgery on hemodynamics and blood gases

    International Nuclear Information System (INIS)

    Objective was to evaluate the effect of transferring open-heart surgery patients from the operating room to the intensive care unit on hemodynamic parameters and blood gases. The study was conducted as a prospective, observational study at the German Hospital, Istanbul, Turkey in 2007. Hemodynamic, blood gas values and oxygen saturation measured by pulse oximetry SpO2 values were recorded in 37 patients who undergone open-heart surgery. Data were evaluated by descriptive statistical methods, Friedman's test and correlation analysis. Thirty-seven patients were included in this study. The low systolic and diastolic arterial blood pressure values prior to transfer, while patients were still under the effect of anesthesia, increased during the transfer and to one and 30 minutes after completion of transfer and return to normal values p<0.05. The SpO2 value measured at 30 minutes after completion of transfer was higher than the first value p<0.05. The pH p<0.001 and arterial partial pressure of oxygen p<0.001 values at the beginning of the transfer had significantly increased at the end of transfer and arterial partial pressure of carbon dioxide values had significantly decreased p<0.001. The transfer of open-heart surgery patients was observed to safe. (author)

  17. 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.

  18. 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

  19. 78 FR 62506 - TRICARE; Coverage of Care Related to Non-Covered Initial Surgery or Treatment

    Science.gov (United States)

    2013-10-22

    ... therapy following surgery) and/or a significant financial hardship for the beneficiary. The Agency did not... treatment, such as physical therapy following a non-covered surgical procedure in an MTF. It would also... Defense to administer the medical and dental benefits provided in chapter 55 of title 10, United...

  20. Answers to Clinical Questions in the Primary Care Management of People with Obesity: Bariatric Surgery.

    Science.gov (United States)

    Braverman-Panza, Jill; Horn, Deborah Bade

    2016-07-01

    The role of bariatric surgery in the management of patients with obesity is expanding owing to the amount of data that are accumulating; these data demonstrate significant short- and long-term health benefits, including control or remission of obesity-related complications, as well as acceptable long-term safety. PMID:27565108

  1. Facilitators and barriers of implementing the chronic care model in primary care: a systematic review

    OpenAIRE

    Kadu, Mudathira K; Stolee, Paul

    2015-01-01

    Background The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identi...

  2. Care production for tuberculosis cases:analysis according to the elements of the Chronic Care Model

    OpenAIRE

    Daiane Medeiros da Silva; Hérika Brito Gomes de Farias; Tereza Cristina Scatena Villa; Lenilde Duarte de Sá; Maria Eugênia Firmino Brunello; Jordana Almeida Nogueira

    2016-01-01

    Abstract OBJECTIVE: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. METHOD: Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum...

  3. Aesthetic Surgery Training during Residency in the United States: A Comparison of the Integrated, Combined, and Independent Training Models

    OpenAIRE

    Arash Momeni; Kim, Rebecca Y.; Wan, Derrick C.; Ali Izadpanah; Lee, Gordon K.

    2014-01-01

    Background. Three educational models for plastic surgery training exist in the United States, the integrated, combined, and independent model. The present study is a comparative analysis of aesthetic surgery training, to assess whether one model is particularly suitable to provide for high-quality training in aesthetic surgery. Methods. An 18-item online survey was developed to assess residents’ perceptions regarding the quality of training in aesthetic surgery in the US. The survey had three...

  4. Effect of transsphenoidal surgery and standard care on fertility related indicators of patients with prolactinomas during child-bearing period

    Science.gov (United States)

    Yan, Zhiyue; Wang, Yiming; Shou, Xuefei; Su, Jianguang; Lang, Liwei

    2015-01-01

    Objective: To explore the surgical therapeutic effects in the endocrine and reproductive system of women with prolactinoma at child-bearing age, and to investigate the potential influencing factors for therapeutic outcome. Methods: This retrospective study was performed using the medical records of 99 cases of female patients with pituitary PRL adenomas at child-bearing age, who underwent transsphenoidal surgery and took standard perioperative care from January, 2013 to June, 2013 in Huashan hospital, in which micro adenoma (≤1 cm) of 68 cases, large adenomas (> 1 cm) of 31 cases, 88 cases were total resection, 9 cases were subtotal resection, and 2 cases were massive resection. Retrospective study on the preoperative serum level of PRL, menstruation, galactorrhea and reproductive function, etc. Patients were followed up in 1, 3, 6 and 12 months after operation for endocrine indicators, the situation of menstruation and pregnancy. Results: Overall, 88.9%, 9.1%, and 2% patients underwent total, subtotal, and massive resection of prolactinoma in 99 cases of patients. Before accepting transsphenoidal surgery and standard care, all 99 cases with serum PRL level higher than normal 25 ng/ml, 71.7% (71 cases, all total resection) patients had their serum PRL 0.05). 14 patients out of 17 infertility patients got pregnant after surgery. Conclusion: Transsphenoidal operation combining standardized nursing measures is an effective way to treat pituitary PRL adenoma, and it has high cure rate on abnormal menstruation caused by pituitary PRL adenoma which can recover the fertility of female patients. The preoperative serum level of prolactin could be used as an indicator for postoperative improvement in the endocrine system. The serum level of prolactin on the first day after operation could accurately reflect prognosis, so be regarded as one of the assessment factors for surgical therapeutic effect. PMID:26885105

  5. 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.

  6. 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.

  7. 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.

  8. 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…

  9. 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. PMID:16163102

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. Explanatory model for nursing and care 2007

    OpenAIRE

    Jedid-Jah Jonker; Klarita Sadiraj; Isolde Woittiez; Michiel Ras; Meike Morren

    2007-01-01

    Original title: Verklaringsmodel verpleging en verzorging 2007. Population ageing means the demand for and take-up of care is likely to increase sharply in the coming years. Older people make particularly heavy use of home care, nursing homes and care homes, collectively referred to as 'nursing and care'. The Dutch Ministry of Health, Welfare and Sport is therefore interested in the likely trend in nursing and care in the coming decades. This study presents forecasts of the demand for and tak...

  15. 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

  16. Models for Primary Eye Care Services in India

    Directory of Open Access Journals (Sweden)

    Vasundhra Misra

    2015-01-01

    In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

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

    Directory of Open Access Journals (Sweden)

    Shogo Kato

    2013-01-01

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

  18. A better model for care — virtual care coordination

    OpenAIRE

    Herbert, Chris; Medd, Claire

    2012-01-01

    Telehealth is a proven tool for reducing costs, improving quality of life, reducing hospital visits/length of stay and enhancing relationships between patients and community nurses. There have been many trials demonstrating these benefits, and findings have always demonstrated return on investment. However, uptake has been slow—68% of providers have no plans to roll out a telehealth solution in the next 24 months. Through a decade of ethnographic research, Care Innovations has visited 20 coun...

  19. The implementation of integrated care: the empirical validation of the Development Model for Integrated Care

    OpenAIRE

    Ahaus Kees TB; Vermeulen Robbert P; Minkman Mirella MN; Huijsman Robbert

    2011-01-01

    Abstract 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 like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the i...

  20. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

    OpenAIRE

    Stellefson, Michael; Dipnarine, Krishna; Stopka, Christine

    2013-01-01

    Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academi...

  1. 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%.

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

    Science.gov (United States)

    Campbell, James P; Vaughn, Byron P

    2016-01-01

    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. PMID:27540307

  3. 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. PMID:27339580

  4. 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.

  5. 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

  6. 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

  7. [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. PMID:27063134

  8. [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.

  9. Who do you prefer? A study of public preferences for health care provider type in performing cutaneous surgery and cosmetic procedures in the United States

    OpenAIRE

    Bangash, HK; Ibrahimi, OA; Green, LJ; Alam, M.; Eisen, DB; Armstrong, AW

    2014-01-01

    BACKGROUND: The public preference for provider type in performing cutaneous surgery and cosmetic procedures is unknown in the United States. METHODS: An internet-based survey was administered to the lay public. Respondents were asked to select the health care provider (dermatologist, plastic surgeon, primary care physician, general surgeon, and nurse practitioner/physician's assistant) they mostly prefer to perform different cutaneous cosmetic and surgical procedures. RESULTS: Three hundred f...

  10. 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...

  11. 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. PMID:27180683

  12. 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.

  13. Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention

    Science.gov (United States)

    Leung, Patricia; Chiu, Chun Hung; Ho, Ka Man; Gomersall, Charles David; Underwood, Malcolm John

    2016-01-01

    Introduction Patients and their families are understandably anxious about the risk of complications and unfamiliar experiences following cardiac surgery. Providing information about postoperative care in the intensive care unit (ICU) to patients and families may lead to lower anxiety levels, and increased satisfaction with healthcare. The objectives of this study are to evaluate the effectiveness of preoperative patient education provided for patients undergoing elective cardiac surgery. Methods and analysis 100 patients undergoing elective coronary artery bypass graft, with or without valve replacement surgery, will be recruited into a 2-group, parallel, superiority, double-blinded randomised controlled trial. Participants will be randomised to either preoperative patient education comprising of a video and ICU tour with standard care (intervention) or standard education (control). The primary outcome measures are the satisfaction levels of patients and family members with ICU care and decision-making in the ICU. The secondary outcome measures are patient anxiety and depression levels before and after surgery. Ethics and dissemination Ethical approval has been obtained from the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee (reference number CREC 2015.308). The findings will be presented at conferences and published in peer-reviewed journals. Study participants will receive a 1-page plain language summary of results. Trial registration number ChiCTR-IOR-15006971. PMID:27334883

  14. 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

  15. 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

  16. Teamwork in skull base surgery: An avenue for improvement in patient care

    OpenAIRE

    McLaughlin, Nancy; Ricardo L. Carrau; Daniel F. Kelly; Prevedello, Daniel M.; Kassam, Amin B.

    2013-01-01

    Background: During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges. Methods: Pubmed and Medline databases were searched for pu...

  17. 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 ...

  18. 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. PMID:27323926

  19. 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.

  20. Modeling Market Shares of Competing (e)Care Providers

    Science.gov (United States)

    van Ooteghem, Jan; Tesch, Tom; Verbrugge, Sofie; Ackaert, Ann; Colle, Didier; Pickavet, Mario; Demeester, Piet

    In order to address the increasing costs of providing care to the growing group of elderly, efficiency gains through eCare solutions seem an obvious solution. Unfortunately not many techno-economic business models to evaluate the return of these investments are available. The construction of a business case for care for the elderly as they move through different levels of dependency and the effect of introducing an eCare service, is the intended application of the model. The simulation model presented in this paper allows for modeling evolution of market shares of competing care providers. Four tiers are defined, based on the dependency level of the elderly, for which the market shares are determined. The model takes into account available capacity of the different care providers, in- and outflow distribution between tiers and churn between providers within tiers.

  1. 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.

  2. Variation in day surgery among Dutch hospitals: the development of a theoretical model to explain variations.

    NARCIS (Netherlands)

    Kroneman, M.; Oort, M. van; Groenewegen, P.; Jong, D. de

    2003-01-01

    The aim of this paper is providing a first step in explaining variations in day surgery rates among Dutch hospitals. A theoretical model was set up to explain variations based on diffusion theory and environmental characteristics. We tried to test our model by means of routinely collected data from

  3. 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...

  4. 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.

  5. The distribution of cataract surgery services in a public health eye care program in Nepal.

    Science.gov (United States)

    Marseille, E; Brand, R

    1997-11-01

    The cost-effectiveness of public health cataract programs in low-income countries has been well documented. Equity, another important dimension of program quality which has received less attention is analyzed here by comparisons of surgical coverage rates for major sub-groups within the intended beneficiary population of the Nepal blindness program (NBP). Substantial differences in surgical coverage were found between males and females and between different age groups of the same gender. Among the cataract blind, the surgical coverage of males was 70% higher than that of females. For both genders, the cataract blind over 55 received proportionately fewer services than younger people blind from cataract. Blind males aged 45-54 had a 500% higher rate of surgical coverage than blind males over 65. Blind females aged 35-44 had nearly a 600% higher rate of surgical coverage than blind females over 65. There was wide variation in overall surgical coverage between geographic zones, but little variation by terrain type, an indicator of the logistical difficulties in delivery of services. Members of the two highest caste groupings had somewhat lower surgical coverage than members of lower castes. Program managers should consider developing methods to increase services to women and to those over 65. Reaching these populations will become increasingly important as those most readily served receive surgery and members of the under-served groups form a growing portion of the remaining cataract backlog. PMID:10175620

  6. Use of neonatal intensive care unit as a safe place for neonatal surgery

    OpenAIRE

    Gavilanes, A.; Heineman, E; Herpers, M.; Blanco, C; BURGE, D.

    1997-01-01

    AIM—To evaluate the advantages, disadvantages, and short term morbidity and mortality of major surgical interventions performed in the neonatal intensive care unit.
METHODS—A retrospective case review of 45 neonates was performed from April 1991 to September 1995. The characteristics of the patients were: gestational age 29 (SD 4) weeks (range 24 to 41 weeks); birthweight 1305 (870) g ( range 540 to 4040 g); presurgical weight 1430 (895) g ( range 550 to 4370 g); postconceptional age at surge...

  7. Minimally invasive esophageal surgery-standard of care-our experience

    Directory of Open Access Journals (Sweden)

    Snigdha Patnaik

    2015-08-01

    30 days Mortality (1 and ndash;pulmonary embolus. Operative time (minutes: THE-234, TTE-322. Blood loss (ml/patient: THE-265, TTE-380. Hospital stays (days: THE-7.3, TTE-10. Conclusions: 79% of properly selected and evaluated cases underwent MIES, with one Mortality and 26 events of morbidity. 6% required conversion. The procedure detected inoperability in 16% cases. The nodal yield, status of margins, operative time, blood loss and hospital stay indicates that MIES has a future to become a standard of care in the treatment of esophageal cancers. [Int J Res Med Sci 2015; 3(8.000: 2046-2052

  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. 无痛病房模式在肛肠术后患者护理中的效果%Painless anorectal surgery ward mode effects in patient care

    Institute of Scientific and Technical Information of China (English)

    于丽丽; 姜晓丽

    2014-01-01

    目的:探讨无痛病房模式在肛肠术后患者护理中的效果。方法:将2013年6月至2013年12月在我院接受肛肠手术的156例患者,随机分为普通护理组和无痛护理组各78例。前者给予常规护理,后者则在常规护理的基础上实施无痛病房护理模式,分析比较两组患者的护理情况及满意率。结果:采用无痛病房模式的无痛护理组患者疼痛程度得分显著低于普通护理组,患者对护理人员的护理方式接受程度、护理服务质量满意度得分均显著高于普通护理组,差异具有统计学意义(均p<0.03)。结论:实施无痛病房模式的疼痛护理,减轻了患者的术后疼痛,促进了患者的康复,使患者术后镇痛效果满意度显著提高。%Objective: To investigate the effect of pain in anorectal surgery ward model of patient care. Methods: June 2013 to December 2013 in our hospital anorectal surgery, 156 patients were randomly divided into general nursing care groups and each group 78 cases painless. The former received routine care, the latter on the basis of the implementation of routine nursing care model painless ward, analysis and comparison of two groups of patient care conditions and satisfaction. RESULTS: The degree of pain painless painless care ward patients scored significantly lower than model group of ordinary care, nursing care of patients the way for acceptance, care quality of service satisfaction scores were significantly higher than usual care group, the difference is statistical y significance (al p <0.03). Conclusion: The implementation painless pain care ward mode, reducing the patient's postoperative pain, and promote the rehabilitation of patients, so that patients significantly improved analgesia satisfaction.

  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. 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.

  12. A model for integrating independent physicians into accountable care organizations.

    Science.gov (United States)

    Shields, Mark C; Patel, Pankaj H; Manning, Martin; Sacks, Lee

    2011-01-01

    The Affordable Care Act encourages the formation of accountable care organizations as a new part of Medicare. Pending forthcoming federal regulations, though, it is unclear precisely how these ACOs will be structured. Although large integrated care systems that directly employ physicians may be most likely to evolve into ACOs, few such integrated systems exist in the United States. This paper demonstrates how Advocate Physician Partners in Illinois could serve as a model for a new kind of accountable care organization, by demonstrating how to organize physicians into partnerships with hospitals to improve care, cut costs, and be held accountable for the results. The partnership has signed its first commercial ACO contract effective January 1, 2011, with the largest insurer in Illinois, Blue Cross Blue Shield. Other commercial contracts are expected to follow. In a health care system still dominated by small, independent physician practices, this may constitute a more viable way to push the broader health care system toward accountable care. PMID:21163804

  13. Searching for the Holy Grail of Care Delivery Models.

    Science.gov (United States)

    Mensik, Jennifer

    2016-01-01

    Too often health care executives state the need for more research, knowledge, and information in staffing. Perhaps what we really need is education and support for innovation in operations. In looking for the holy grail of staffing solutions, focused attention will need to be placed on creating innovative care delivery models. Leaders who are tasked with developing innovative care delivery models must have a supportive environment and given time to be successful. PMID:27265951

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

    OpenAIRE

    Falkenberg Torkel; Warenmark Anders; Halpin Jeremy; Sundberg Tobias

    2007-01-01

    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 st...

  15. A Transitional Care Model Using Faith Community Nurses.

    Science.gov (United States)

    Ziebarth, Deborah; Campbell, Katora P

    2016-01-01

    The Medicare mandatory readmission reduction program has hospitals scrambling to reduce 30-day readmissions. A Faith Community Nurse (FCN) Transitional Care Model was developed from systematic literature review of predictive factors of readmission and pre- and postdischarge interventions that decrease readmission. The model presents specific FCN care that occurs pre- and posthospital discharge to support the patient in transitioning from one level of care to another, move toward wholistic health, and avoid unnecessary readmission. PMID:27119808

  16. Protocol for a multicentre, parallel-arm, 12-month, randomised, controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN)

    Science.gov (United States)

    Griffin, D R; Dickenson, E J; Wall, P D H; Donovan, J L; Foster, N E; Hutchinson, C E; Parsons, N; Petrou, S; Realpe, A; Achten, J; Achana, F; Adams, A; Costa, M L; Griffin, J; Hobson, R; Smith, J

    2016-01-01

    Introduction Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to compare the clinical and cost-effectiveness of arthroscopic surgery versus best conservative care for patients with FAI syndrome. Methods We will conduct a multicentre, pragmatic, assessor-blinded, two parallel arm, RCT comparing arthroscopic surgery to physiotherapy-led best conservative care. 24 hospitals treating NHS patients will recruit 344 patients over a 26-month recruitment period. Symptomatic adults with radiographic signs of FAI morphology who are considered suitable for arthroscopic surgery by their surgeon will be eligible. Patients will be excluded if they have radiographic evidence of osteoarthritis, previous significant hip pathology or previous shape changing surgery. Participants will be allocated in a ratio of 1:1 to receive arthroscopic surgery or conservative care. Recruitment will be monitored and supported by qualitative intervention to optimise informed consent and recruitment. The primary outcome will be pain and function assessed by the international hip outcome tool 33 (iHOT-33) measured 1-year following randomisation. Secondary outcomes include general health (short form 12), quality of life (EQ5D-5L) and patient satisfaction. The primary analysis will compare change in pain and function (iHOT-33) at 12 months between the treatment groups, on an intention-to-treat basis, presented as the mean difference between the trial groups with 95% CIs. The study is funded by the Health Technology Assessment Programme (13/103/02). Ethics and dissemination Ethical approval is granted by the Edgbaston Research Ethics committee (14/WM/0124). The results will be disseminated through open access peer

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

    OpenAIRE

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

    2013-01-01

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

  18. 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...

  19. Cataract Surgery Visual Outcomes and Associated Risk Factors in Secondary Level Eye Care Centers of L V Prasad Eye Institute, India.

    Directory of Open Access Journals (Sweden)

    Sumathi Matta

    Full Text Available To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI, India.The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs and attached vision centres (VCs that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.Mean age was 61.8 years (SD: 8.9 years and 1,133 (55.3% surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%. The most common procedure was small incision cataract surgery (SICS with intraocular lens (IOL implantation (91.8%. Intraoperative complications were seen in 29 eyes (1.4%. At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA, 61.8% had a good outcome and based on best-corrected visual acuity (BCVA, 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30, in females (OR 1.58; 95% CI 1.04, 2.41, those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57, with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04, eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25 and those undergoing extracapsular cataract extraction (OR 9

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

    Directory of Open Access Journals (Sweden)

    Ackerman SJ

    2014-05-01

    Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Karen Schneider,4 Tim Holt,5 John Cummings Jr6 1Covance 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, Australia; 5Montgomery Spine Center, Orthopedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI joint (15%–30% of cases is commonly treated with nonoperative care, but new minimally invasive surgery (MIS options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods: An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier's Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results: The cumulative 3-year (base-case analysis and 5-year (sensitivity analysis differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS were $14,545 and $6,137 per patient, respectively (2012 US dollars. Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality

  1. A Moral Hazard Model of Parental Care

    OpenAIRE

    Baomin Dong; Tianpeng Zhou

    2013-01-01

    One perplexing observation is that although men and women have different comparative advantages, cooperation is often only seen during child-bearing and rearing periods. One interpretation is that the juvenile offspring serves as an indivisible public goods to facilitate cooperation between opposite sexes of adults. We show that moral hazard in maternal parental care will either force the father to pay the mother a rent in order to induce optimal care (when the child is of intrinsic high qual...

  2. A taxonomy of nursing care organization models in hospitals

    Directory of Open Access Journals (Sweden)

    Dubois Carl-Ardy

    2012-08-01

    Full Text Available Abstract Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs and assistive staff (orderlies to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an

  3. 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

  4. 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.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    both 7 and 28 days. Conclusion: It was possible to create a healed but weak abdominal fascia in rats with a minimum of defects after incision using a running suture technique in the fascia. In contrast to other models, regular tissue defects were absent, and the model can therefore be used to evaluate......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...

  6. A Model for Risk Assessment in Health Care.

    Science.gov (United States)

    Prijatelj, Vesna; Rajkovič, Vladislav; Šušteršič, Olga

    2016-01-01

    The purpose of our research is to reduce risks and hence prevent errors in the health care process. The aim is to design an organizational information model using error prevention methods for risk assessment in a clinical setting. The model is based on selected indicators of quality nursing care, resulting from the world-known theoretical and practical models combined with experience in the Slovenian health care. The proposed organizational information model and software solution has a significant impact on the professional attention, communication and information, critical thinking, experience and knowledge. PMID:27332383

  7. 腹腔镜手术治疗子宫内膜异位症围手术期护理效果%Laparoscopic Surgery for Endometriosis Perioperative Nursing Care

    Institute of Scientific and Technical Information of China (English)

    李守香

    2015-01-01

    目的:探讨腹腔镜手术治疗子宫内膜异位症围手术期的护理效果。方法将74例子宫内膜异位症患者分为两组,对照组采用常规护理模式护理,观察组在对照组基础上采用综合护理模式护理。结果观察组患者的总满意度为97.30%,对照组患者的总满意度为72.97%,对比差异显著(P<0.05)。结论腹腔镜手术治疗子宫内膜异位症患者在围手术期实施综合护理模式,能够明显提高患者对护理工作的满意度,值得在临床上大力推广。%Objective To investigate the laparoscopic surgery for endometriosis perioperative nursing effect.Methods74 cases of uterine endometriosis patients were divided into two groups, the control group received routine nursing care model, the observation group in the control group on the basis of a comprehensive care model of care. ResultsThe overall satisfaction of patients in the observation group was 97.30%, the total satisfaction of the patients in the control group was 72.97%.Conclusion Laparoscopic surgery endometriosis patients in the perioperative period the implementation of integrated care model can signiifcantly improve patient satisfaction with care, and worthy of clinical promoting.

  8. Computer-based decision making in medicine : A model for surgery of colorectal liver metastases

    NARCIS (Netherlands)

    Langenhoff, B S; Krabbe, P F M; Ruers, T J M

    2007-01-01

    AIMS: Seeking the best available treatment for patients with colorectal liver metastases may be complex due to the interpretation of many variables. In this study conjoint analysis is used to develop a decision model to help clinicians selecting patients eligible for surgery of liver metastases. MET

  9. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    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...

  10. 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.

  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. PMID:27605651

  12. 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...

  13. A preliminary outcome analysis of the patterns of care study in Japan for esophageal cancer patients with special reference to age: non surgery group

    International Nuclear Information System (INIS)

    Background: The Patterns of Care Study (PCS) was imported to Japan from the United States in July 1996. A preliminary outcome analysis of the PCS for esophageal cancer patients in Japan was made with special reference to age, because the elderly population is rapidly increasing in Japan. Patients and Methods: From July 1996 to February 1998, external PCS audits were performed for 37 institutions nationwide and detailed information of 561 esophageal cancer patients treated during the period 1992-1994 was collected by using the fifth PCS data format developed in the United States. This format was provided courtesy of the American College of Radiology. For this study, patients who had not undergone surgery (n = 336) were selected. The patients were classified into three age groups: < 65 years old (n = 119), between 65 and 74 years (n = 93), and 75 years or older (n =123). Cox's proportional hazards model was used for the statistical analysis, with survival, acute/subacute complication and late complication of grade 3 or more based on RTOG criteria, as the endpoints. Results: Significant prognostic factors for the entire non-surgery group were Karnofsky Performance Status (KPS) (p 0.0007), stage (p = 0.0001), and external irradiation dose (p = 0.0001). For the younger group, KPS (p = 0.0004), stage (p = 0.0197), and utilization of brachytherapy (p = 0.0010) were significant, while for the intermediate age group it was KPS (p = 0.0027), history of pulmonary disease (p = 0.0339), stage (p = 0.0001), and external dose (p = 0.0001), and for the elderly group, stage (p = 0.0001) and external irradiation dose (p = 0.0224) were significant. Significant risk factors for complications for the entire group were stage (p = 0.0411), external dose (p = 0.0163), and stratification of institution (academic vs. nonacademic) (p = 0.0114). Significant risk factors for the younger group were history of pulmonary disease (p = 0.0495) and external dose (p = 0.0037), and the other age

  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. 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.

  16. 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

  17. 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

  18. Composite bone models in orthopaedic surgery research and education.

    Science.gov (United States)

    Elfar, John; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas; Stanbury, Spencer

    2014-02-01

    Composite bone models are increasingly used in orthopaedic biomechanics research and surgical education-applications that traditionally relied on cadavers. Cadaver bones are suboptimal for many reasons, including issues of cost, availability, preservation, and inconsistency between specimens. Further, cadaver samples disproportionately represent the elderly, whose bone quality may not be representative of the greater orthopaedic population. The current fourth-generation composite bone models provide an accurate reproduction of the biomechanical properties of human bone when placed under bending, axial, and torsional loads. The combination of glass fiber and epoxy resin components into a single phase has enabled manufacturing by injection molding. The high level of anatomic fidelity of the cadaver-based molds and negligible shrinkage properties of the epoxy resin results in a process that allows for excellent definition of anatomic detail in the cortical wall and optimized consistency of features between models. Recent biomechanical studies of composites have validated their use as a suitable substitute for cadaver specimens. PMID:24486757

  19. A multicentre randomised controlled trial of Transfusion Indication Threshold Reduction on transfusion rates, morbidity and health-care resource use following cardiac surgery (TITRe2).

    Science.gov (United States)

    Reeves, Barnaby C; Pike, Katie; Rogers, Chris A; Brierley, Rachel Cm; Stokes, Elizabeth A; Wordsworth, Sarah; Nash, Rachel L; Miles, Alice; Mumford, Andrew D; Cohen, Alan; Angelini, Gianni D; Murphy, Gavin J

    2016-01-01

    BACKGROUND Uncertainty about optimal red blood cell transfusion thresholds in cardiac surgery is reflected in widely varying transfusion rates between surgeons and cardiac centres. OBJECTIVE To test the hypothesis that a restrictive compared with a liberal threshold for red blood cell transfusion after cardiac surgery reduces post-operative morbidity and health-care costs. DESIGN Multicentre, parallel randomised controlled trial and within-trial cost-utility analysis from a UK NHS and Personal Social Services perspective. We could not blind health-care staff but tried to blind participants. Random allocations were generated by computer and minimised by centre and operation. SETTING Seventeen specialist cardiac surgery centres in UK NHS hospitals. PARTICIPANTS Patients aged > 16 years undergoing non-emergency cardiac surgery with post-operative haemoglobin research steps to address the new hypothesis about the possible harm of red blood cell transfusion. TRIAL REGISTRATION Current Controlled Trials ISRCTN70923932. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 60. See the NIHR Journals Library website for further project information. PMID:27527344

  20. 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

  1. Consulting Psychiatry within an Integrated Primary Care Model

    OpenAIRE

    Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L; Serrano, Neftali

    2013-01-01

    After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population.

  2. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  3. A Holomorphic 0-Surgery Model for Open Books with Application to Cylindrical Contact Homology

    OpenAIRE

    Yau, Mei-Lin

    2004-01-01

    We give a simple model in the complex plane of the 0-surgery along a fibered knot of a closed 3-manifold M to yield a mapping torus M'. This model allows explicit relations between pseudoholomorphic curves in the symplectizations of M and M'. As an application we use it to compute the cylindrical contact homology of open books resulting from a positive Dehn twist on a torus with boundary.

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

    OpenAIRE

    Miguel Angel Maluf; Walter José Gomes; Ademir Massarico Bras; Thiago Cavalcante Vila Nova de Araújo; André Lupp Mota; Caio Cesar Cardoso; Rafael Viana dos S. Coutinho

    2015-01-01

    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 compr...

  5. Renal hemodynamics, function, and oxygenation during cardiac surgery performed on cardiopulmonary bypass: a modeling study

    OpenAIRE

    Sgouralis, Ioannis; Evans, Roger G.; Gardiner, Bruce S; Smith, Julian A.; Fry, Brendan C.; Layton, Anita T.

    2015-01-01

    Abstract Acute kidney injury, a prevalent complication of cardiac surgery performed on cardiopulmonary bypass (CPB), is thought to be driven partly by hypoxic damage in the renal medulla. To determine the causes of medullary hypoxia during CPB, we modeled its impact on renal hemodynamics and function, and thus oxygen delivery and consumption in the renal medulla. The model incorporates autoregulation of renal blood flow and glomerular filtration rate and the utilization of oxygen for tubular ...

  6. The Integrated Patient's Self-Care Process Model.

    Science.gov (United States)

    Milavec Kapun, Marija; Šusteršič, Olga; Rajkovič, Vladislav

    2016-01-01

    Long-term care is more efficient and effective when it involves the active participation of the empowered patient and informal caregivers. To achieve this, it is necessary to guide the patient and informal caregivers through the systematic process of self-care. Well-documented observations and assessments are fundamental to plan further interventions of the interdisciplinary team. A systematic literature review revealed that the self-care process and the support of information technology are focused on just one chronic disease. Defined self-care process has a positive impact on the functionality and satisfaction of patients with comorbidity and on their caregivers. The model of the patient's self-care process should be an integral part of the long-term care. PMID:27332172

  7. 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 prosthesis placement (OR = 1.5 [1.0-2.0], P = 0.029), and vocal cord paralysis (OR = 11.6 [8.3-16.1], P 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 intervention appears underutilized in this population. PMID:23943072

  8. 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.

  9. 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

  10. Two models of primary health care training.

    Science.gov (United States)

    Hill, P; Samisoni, J

    1993-01-01

    In 1991, the Fiji School of Medicine restructured the training of its medical students, dividing the 7-year course into two phases. Students now undertake a 3-year community-oriented primary care practitioners course, after which they may elect to continue practice in a primary health care role, or to undertake further hospital-based training to complete their medical degree. The course responds to the health needs of the South Pacific, and the local patterns of morbidity and mortality, rather than measuring itself against the curricular demands of its more developed neighbours, Australia and New Zealand. At the same time, the Tropical Health Program of the University of Queensland Medical School responded to demands from the Aboriginal and Torres Strait Islander community to develop primary health care training at degree level. This was intended to complement other strategies undertaken by the Aboriginal and Torres Strait Islander Studies Unit such as the recruitment and support of indigenous students through mainstream health professional education. There was a need to address health priorities that are very different to those of the Australian population as a whole, as well as the sociopolitical and cultural context as it affects both students themselves and health issues in their communities. Both institutions have chosen problem-based teaching/learning as appropriate to their courses, and content is also similar, though with emphases that reflect the differing contexts. The two courses are examples of innovative responses by centres with university medical faculties to specific issues in health education. PMID:8433664

  11. 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.

  12. 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.

  13. 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

  14. [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.

  15. [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. PMID:14663412

  16. Latent class models for utilisation of health care

    OpenAIRE

    Teresa Bago d’Uva

    2005-01-01

    This paper explores different approaches to econometric modelling of count measures of health care utilisation, with an emphasis on latent class models. A new model is proposed that combines the features of the two most common approaches- the hurdle model and the finite mixture Negative Binomial. Additionally, the panel structure of the data is taken into account. The proposed model is shown to perform better than the existing models for a particular application with data from the RAND Health...

  17. [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. PMID:26711056

  18. [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.

  19. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial).

    NARCIS (Netherlands)

    Wind, J.; Hofland, J.; Preckel, B.; Hollman, M.W.; Bossuyt, P.M.M.; Gouma, D.J.; Berge Henegouwen, M.I.; Fuhring, J.W.; Dejong, C.H.C.; Dam, R.M. van; Cuesta, M.A.; Noordhuis, A.; Jong, D. de; Zalingen, E. van; Engel, A.F.; Goei, T.H.; Stoppelaar, I.E. de; Tets, W.F. van; Wagensveld, B.A. van; Swart, A.; Elsen, M.J.L.J. van den; Gerhards, M.F.; Wit, L.Th. De; Siepel, M.A.M.; Geloven, A.A.W. van; Juttmann, J.-W.; Clevers, J.C.; Bemelman, W.A.

    2006-01-01

    BACKGROUND: Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay.The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst t

  20. Robotic surgery

    Science.gov (United States)

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  1. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    OpenAIRE

    Phillips, Charles D

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

  2. 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.

  3. Using 3-dimensional printing to create presurgical models for endodontic surgery.

    Science.gov (United States)

    Bahcall, James K

    2014-09-01

    Advances in endodontic surgery--from both a technological and procedural perspective-have been significant over the last 18 years. Although these technologies and procedural enhancements have significantly improved endodontic surgical treatment outcomes, there is still an ongoing challenge of overcoming the limitations of interpreting preoperative 2-dimensional (2-D) radiographic representation of a 3-dimensional (3-D) in vivo surgical field. Cone-beam Computed Tomography (CBCT) has helped to address this issue by providing a 3-D enhancement of the 2-D radiograph. The next logical step to further improve a presurgical case 3-D assessment is to create a surgical model from the CBCT scan. The purpose of this article is to introduce 3-D printing of CBCT scans for creating presurgical models for endodontic surgery. PMID:25197746

  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. 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.

  6. Basic Plastic Surgery Skills Training Program on Inanimate Bench Models during Medical Graduation

    OpenAIRE

    Rafael Denadai; Andréia Padilha Toledo; Luis Ricardo Martinhão Souto

    2012-01-01

    Due to ethical and medical-legal drawbacks, high costs, and difficulties of accessibility that are inherent to the practice of basic surgical skills on living patients, fresh human cadaver, and live animals, the search for alternative forms of training is needed. In this study, the teaching and learning process of basic surgical skills pertinent to plastic surgery during medical education on different inanimate bench models as a form of alternative and complementary training to the teaching p...

  7. Modified biological training model for percutaneous renal surgery with ultrasound and fluoroscopy guidance

    Institute of Scientific and Technical Information of China (English)

    QIU Zhi; YANG Yong; ZHANG Yi; SUN Yu-cheng

    2011-01-01

    Background The 12th rib is an important anatomic marker in the process of percutaneous renal surgery; while the previous models without ribs can not provide close simulation conditions to human upper abdomen. To facilitate the learning and training of percutaneous renal access and intrarenal procedures under ultrasound and fluoroscopy guidance, we reported a biological bench model for percutaneous renal surgery. Methods The model was developed using an ex vivo porcine kidney with a longer than 3 cm ureter, a flap of full thickness of thoracic wall with skin, subcutaneous fascia, muscle and two ribs, as well as the standard equipment for percutaneous nephrolithotomy. The porcine kidney with a catheterized ureter was placed within the porcine flap and fixed to a wooden board with two long steel nails. Afterward, contrast medium or physiological saline (0.9% sodium chloride solution) was injected through the ureter, and the urinary system was examined with a fluoroscopy unit or an ultrasound. Artificial stone material was implanted in the renal pelvis. After practicing, the model could be dissected for kidney examination and a technical analysis. Results The advantage of this model was simple to set up and inexpensive, by using widely available material. The biological bench model can be employed for percutanous renal access, tract dilation, nephroscopy, and stone disintegration in the training and learning of clinical practice. Imaging is feasible under fluoroscopic and ultrasound guidance. The kidney models were utilized in hands on courses with over 100 people, and 90.5% attendants rated the porcine kidney model for simulation of percutaneous renal surgery as 'very helpful" or "helpful". Conclusion This biological training model simulates realistically the clinical procedure of percutaneous nephrolithotomy under fluoroscopic and ultrasound guidance.

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

    OpenAIRE

    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

    Abstract 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 w...

  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. Modelling lifetime cost consequences of ReSTOR® in cataract surgery in four European countries

    Directory of Open Access Journals (Sweden)

    Berdeaux Gilles

    2008-07-01

    Full Text Available Abstract Background To compare the lifetime costs of liberating patients from spectacles after cataract surgery by implanting the multifocal intraocular lens (IOL 'ReSTOR®' versus monofocal IOLs in France, Italy, Germany and Spain. Methods A Markov model was created to follow patient cohorts from cataract surgery until death. Prevalence rates of patients not needing spectacles after cataract surgery were obtained from clinical trials. Resource utilisation included implant surgery, IOLs, spectacles, visits to ophthalmologists and eye centres, transport, and time lost by patients. Economic perspectives were those of Society and Sickness Funds (SFs. Results The mean number of spectacles purchased after ReSTOR® was 1.34–1.61 and after monofocal IOLs 6.05–7.27. From the societal perspective, total cost estimates discounted by 3% were between €3,551 and €4,052 with ReSTOR® compared to €3,989 and €5,548 with monofocal IOLs. Undiscounted savings related to ReSTOR® ranged from €815 to €2,164. From the SFs' perspective total cost estimates discounted by 3% were between €2,150 and €2,524 with ReSTOR® compared to €2,324 and €2,610 with monofocal IOLs. Savings related to ReSTOR®, once costs discounted, ranged from €61 to €219. Discount and spectacle freedom prevalence rates were the most sensitive parameters. Conclusion The bulk of the savings related to ReSTOR® were realized outside the SF. From both a societal and SF perspective, savings, after a 3% discounting, achieved by liberating patients from spectacles counterbalanced the initially higher cost of ReSTOR®. ReSTOR® is a cost saving alternative to spectacles for patients requiring cataract surgery.

  11. 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).

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

    Science.gov (United States)

    Tralongo, Paolo; Ferraù, Francesco; Borsellino, Nicolò; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio

    2011-01-01

    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. PMID:21941445

  13. 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....

  14. A Model for Implementing Integrative Practice in Health Care Agencies

    Directory of Open Access Journals (Sweden)

    Chris Patterson

    2008-01-01

    Full Text Available Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a professional and research development, b health human resource planning, c regulation and legislation and d practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals.

  15. 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.

  16. A Model of Induction for Specialised Residential Care

    OpenAIRE

    Ann McWilliams; Siobhan Quinlan Cooke; Niall Hanlon

    2006-01-01

    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 unit...

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

    OpenAIRE

    Campbell, James; Vaughn,Byron

    2016-01-01

    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 ...

  18. 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

  19. 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...

  20. 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,…

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. Cosmetic Surgery

    Science.gov (United States)

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

  6. Nose Surgery

    Science.gov (United States)

    ... is as high a priority as appearance. Can Cosmetic Nasal Surgery Create A "Perfect" Nose? Aesthetic nasal surgery (rhinoplasty) ... Cover Nasal Surgery? Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, ...

  7. Cosmetic Surgery

    Science.gov (United States)

    ... Submit Home > Body Image > Cosmetic surgery Body Image Cosmetic surgery ASPS list of inappropriate candidates for surgery ... their appearance. Return to top Additional resources on cosmetic surgery Breast surgery Explore other publications and websites ...

  8. Development of a Bayesian model to estimate health care outcomes in the severely wounded

    Directory of Open Access Journals (Sweden)

    Alexander Stojadinovic

    2010-08-01

    Full Text Available Alexander Stojadinovic1, John Eberhardt2, Trevor S Brown3, Jason S Hawksworth4, Frederick Gage3, Douglas K Tadaki3, Jonathan A Forsberg5, Thomas A Davis3, Benjamin K Potter5, James R Dunne6, E A Elster31Combat Wound Initiative Program, 4Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA; 2DecisionQ Corporation, Washington, DC, USA; 3Regenerative Medicine Department, Combat Casualty Care, Naval Medical Research Center, Silver Spring, MD, USA; 5Integrated Department of Orthopaedics and Rehabilitation, 6Department of Surgery, National Naval Medical Center, Bethesda, MD, USABackground: Graphical probabilistic models have the ability to provide insights as to how clinical factors are conditionally related. These models can be used to help us understand factors influencing health care outcomes and resource utilization, and to estimate morbidity and clinical outcomes in trauma patient populations.Study design: Thirty-two combat casualties with severe extremity injuries enrolled in a prospective observational study were analyzed using step-wise machine-learned Bayesian belief network (BBN and step-wise logistic regression (LR. Models were evaluated using 10-fold cross-validation to calculate area-under-the-curve (AUC from receiver operating characteristics (ROC curves.Results: Our BBN showed important associations between various factors in our data set that could not be developed using standard regression methods. Cross-validated ROC curve analysis showed that our BBN model was a robust representation of our data domain and that LR models trained on these findings were also robust: hospital-acquired infection (AUC: LR, 0.81; BBN, 0.79, intensive care unit length of stay (AUC: LR, 0.97; BBN, 0.81, and wound healing (AUC: LR, 0.91; BBN, 0.72 showed strong AUC.Conclusions: A BBN model can effectively represent clinical outcomes and biomarkers in patients hospitalized after severe wounding, and is confirmed by 10-fold

  9. 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.

  10. 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. PMID:19131286

  11. Empirical modeling of renal motion for improved targeting during focused ultrasound surgery.

    Science.gov (United States)

    Abhilash, R H; Chauhan, Sunita

    2013-05-01

    Non-invasive surgery looks at ways of eliminating physical contact with the target tissues while maintaining necessary levels of accuracy. Focused Ultrasound Surgery (FUS) is one such treatment modality, which uses a tightly focused beam of high intensity ultrasound to ablate tumors in various parts of the body. For trans-abdominal access, respiration induced movement of the tissue targets remains a major issue during FUS. Respiration induced movements are known to be significant in liver and kidney. In this paper, we attempt to address this problem using non-linear prediction and modeling techniques as applicable to kidney movement patterns. Kidney movement patterns are known to be three dimensional and vastly complicated compared to movement patterns of the liver. Monitoring and quantification of the nature and extent of kidney movement is yet to be explored in depth for effective compensation and accurate targeting. Apart from the respiratory cycle, the movement of the kidney is also affected by several factors, such as the movement of the ribs, spleen and liver. Modeling of these movements is imperative for motion adaptive FUS. Since kidney movements are highly subject specific, generic statistical models cannot be used for compensation. The system latency and real-time performance of the imaging modality also induce additional parametric dependence in target tracking. In this work, we focus on empirical modeling and prediction of the kidney movement to for error analysis and computing system latency. The accuracy of existing modeling techniques is compared with a newly developed empirical model. From the study conducted in healthy volunteers, it was found that the kidney movement was complex and subject specific and could be effectively modeled using the new shape function based model. The model was further fine-tuned using Kalman filter based predictors and Adaptive Neuro-Fuzzy Inference System (ANFIS) which gave more than 85% accuracy in prediction. PMID

  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. Model-based decision support in diabetes care.

    Science.gov (United States)

    Salzsieder, E; Vogt, L; Kohnert, K-D; Heinke, P; Augstein, P

    2011-05-01

    The model-based Karlsburg Diabetes Management System (KADIS®) has been developed as a patient-focused decision-support tool to provide evidence-based advice for physicians in their daily efforts to optimize metabolic control in diabetes care of their patients on an individualized basis. For this purpose, KADIS® was established in terms of a personalized, interactive in silico simulation procedure, implemented into a problem-related diabetes health care network and evaluated under different conditions by conducting open-label mono- and polycentric trials, and a case-control study, and last but not least, by application in routine diabetes outpatient care. The trial outcomes clearly show that the recommendations provided to the physicians by KADIS® lead to significant improvement of metabolic control. This model-based decision-support system provides an excellent tool to effectively guide physicians in personalized decision-making to achieve optimal metabolic control for their patients. PMID:20621384

  14. Modeling and motion compensation of a bidirectional tendon-sheath actuated system for robotic endoscopic surgery.

    Science.gov (United States)

    Sun, Zhenglong; Wang, Zheng; Phee, Soo Jay

    2015-04-01

    Recent study shows that tendon-sheath system (TSS) has great potential in the development of surgical robots for endoscopic surgery. It is able to deliver adequate power in a light-weight and compact package. And the flexibility and compliance of the tendon-sheath system make it capable of adapting to the long and winding path in the flexible endoscope. However, the main difficulties in precise control of such system fall on the nonlinearities of the system behavior and absence of necessary sensory feedback at the surgical end-effectors. Since accurate position control of the tool is a prerequisite for efficacy, safety and intuitive user-experience in robotic surgery, in this paper we propose a system modeling approach for motion compensation. Based on a bidirectional actuated system using two separate tendon-sheaths, motion transmission is firstly characterized. Two types of positional errors due to system backlash and environment loading are defined and modeled. Then a model-based feedforward compensation method is proposed for open-loop control, giving the system abilities to adjust according to changes in the transmission route configuration without any information feedback from the distal end. A dedicated experimental platform emulating a bidirectional TSS robotic system for endoscopic surgery is built for testing. Proposed positional errors are identified and verified. The performance of the proposed motion compensation is evaluated by trajectory tracking under different environment loading conditions. And the results demonstrate that accurate position control can be achieved even if the transmission route configuration is updated. PMID:25819033

  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. Meal-Induced Hormone Responses in a Rat Model of Roux-en-Y Gastric Bypass Surgery

    OpenAIRE

    Shin, Andrew C.; Zheng, Huiyuan; Townsend, R. Leigh; Sigalet, David L.; Berthoud, Hans-Rudolf

    2010-01-01

    Roux-en-Y gastric bypass (RYGB) surgery is the most effective treatment for morbid obesity and remission of associated type 2 diabetes, but the mechanisms involved are poorly understood. The aim of the present study was to develop and validate a rat model for RYGB surgery that allows repeated measurement of meal-induced changes in gut and pancreatic hormones via chronic venous catheters. Male Sprague Dawley rats made obese on a palatable high-fat diet were subjected to RYGB or sham surgery an...

  17. 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.

  18. Basic Plastic Surgery Skills Training Program on Inanimate Bench Models during Medical Graduation

    Directory of Open Access Journals (Sweden)

    Rafael Denadai

    2012-01-01

    Full Text Available Due to ethical and medical-legal drawbacks, high costs, and difficulties of accessibility that are inherent to the practice of basic surgical skills on living patients, fresh human cadaver, and live animals, the search for alternative forms of training is needed. In this study, the teaching and learning process of basic surgical skills pertinent to plastic surgery during medical education on different inanimate bench models as a form of alternative and complementary training to the teaching programs already established is proposed.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. 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

  1. 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

  2. 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.

  3. Experience with Humanistic Concern in Nursing Care after Cervical Cancer Surgery%宫颈癌术后人文关怀护理体会

    Institute of Scientific and Technical Information of China (English)

    李翠萍

    2014-01-01

    Objective:To explore the effects of general nursing methods and the humanistic care after cervical cancer sur-gery on the recovery time of patients. Methods:66 cervical cancer postoperative patients were randomly divided into the control group(33 cases)and the intervention group(33 cases),with conventional care taken in the control group,and with humanistic care and psychological care taken in addition to the conventional nursing in the intervention group. Results:The patients in the intervention group recovered sooner,with hospitalization time shorter. Those in the control group recovered less soon,with hospi-tal stay longer. Conclusion:Various complications,frequent and serious,may occur after cervical cancer surgery and clinical care should be taken seriously. Humanistic concern and psychological nursing are very important in the care work of cervical cancer patients,which is beneficial to the improvement of the quality of clinical nursing and the development of whole nursing care.%目的:探讨宫颈癌术后的一般护理方法及人文关怀对患者康复时间的影响。方法:66例宫颈癌术后患者随机分为对照组和干预组,每组33例,对照组采用常规护理;干预组除常规护理外,给予人文关怀和心理护理。结果:干预组患者恢复快、住院时间短,对照组恢复慢、住院时间长。结论:宫颈癌术后并发症较多且严重,应当引起重视;人文关怀与心理护理在对宫颈癌患者的护理中十分重要,有利于临床护理质量的提高和整体护理的发展。

  4. 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.

  5. 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.

  6. Three-dimensional rapid prototyping models in cranio-maxillofacial surgery: systematic review and new clinical applications

    OpenAIRE

    Olszewski, Raphaël

    2013-01-01

    Medical models represent portions of human anatomy obtained from three-dimensional (3D) medical imaging. The aim was to provide a current review of clinical applications, technical accuracy and artefacts explanation with rapid prototyping (RP) technologies in cranio-maxillofacial (CMF) surgery. We also presented new RP clinical applications in reconstructive, orthognathic, and malformative CMF surgery. A systematic review of the literature was conducted on PubMed, and based on title-abstract ...

  7. 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

  8. 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

  9. 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

  10. [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.

  11. [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. PMID:26364444

  12. 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)

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

    International Nuclear Information System (INIS)

    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)

  14. 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.

  15. 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.

  16. Patients’ opinions on quality of care before and after implementation of a short stay programme following breast cancer surgery.

    NARCIS (Netherlands)

    Kok, M. de; Weijden, T. van der; Kessels, A.G.H.; Dirksen, C.D.; Sixma, H.J.M.; Velde, C.J.H. van de; Roukema, J.A.; Finaly-Marais, C.; Ent, F.W.C. van der; Meyenfeldt, M.F. von

    2010-01-01

    PURPOSE: To assess breast cancer patients' opinions on quality of care during an implementation study on short hospital stay, and to formulate patient inspired targets for further quality improvement based on results of the QUOTE (Quality of Care Through the Patients' Eyes) breast cancer instrument.

  17. Assessment of Patient and Relatives Satisfaction in a Cardiac Surgery ICU Model

    Directory of Open Access Journals (Sweden)

    Kamran Shadvar

    2015-10-01

    Full Text Available Introduction: Evaluation of patients’ and their families’ satisfaction regarding the quality of care in the ICU is an important concern that can identify deficiencies of this field and help to improve satisfaction of both patients and their families. Considering the fact that problems related to cardiac surgery ICUs differ from other ICUs, recognition of these problems and the factors that lead to patient or family dissatisfaction can not only improve the quality and quantity of services provided in this section but also lead to increased satisfaction in these groups and promote scientific and practical knowledge related to sectors at regional levels. The aim of this study was to evaluate the satisfaction of patients and their families from the quantity and quality of services provided in the cardiac surgical ICU of Madani hospital, Tabriz, Iran. Materials and Methods: In this descriptive study, satisfaction of patients and their relatives from cardiac surgery ICU of Shahid Madani Hospital was evaluated using Modified MISS questionnaire for patients and CCMFNA questionnaires for their relatives during one year (1391-1390. The obtained data were statistically analyzed using descriptive statistics (frequency, percentage, mean ± SD and SPSS ver. 15. Results: Majority of patients expressed moderate to high satisfaction. The overall satisfaction of doctors was higher than nurses (27% vs. 22%. The lowest level of satisfaction related to the possibility of meeting relatives (14.3%. Most relatives were spouses of patients who contributed to the highest rate of satisfaction; however, the location and meets expectations were less satisfactory. Conclusion: Improving waiting room quality, increasing duration of family meetings and increasing nursing attention are the factors that could be associated with further satisfaction. Keywords: ICU; Patient satisfaction; Family satisfaction

  18. 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.

  19. A novel finite element method based biomechanical model for HIT-robot assisted orthopedic surgery system.

    Science.gov (United States)

    Jia, Zhiheng; Du, Zhijiang; Wang, Monan

    2006-01-01

    To build a biomechanical human model can make much sense for surgical training and surgical rehearse. Especially, it will be more meaningful to develop a biomechanical model to guide the control strategy for the medical robots in HIT-Robot Assisted Orthopedic Surgery System (HIT-RAOS). In this paper, based the successful work of others, a novel reliable finite element method based biomechanical model for HIT-RAOS was developed to simulate the force needed in reposition procedure. Geometrical model was obtained from 3D reconstruction from CT images of a just died man. Using this boundary information, the finite element model of the leg including part of femur, broken upper tibia, broken lower tibia, talus, calcaneus, Kirschner nail, muscles and other soft tissues was created in ANSYS. Furthermore, as it was too difficult to reconstruct the accurate geometry model from CT images, a new simplified muscle model was presented. The bony structures and tendons were defined as linearly elastic, while soft tissues and muscle fibers were assumed to be hyper elastic. To validate this model, the same dead man was involved to simulate the patient, and a set of data of the force needed to separate the two broken bones and the distance between them in reposition procedure was recorded. Then, another set of data was acquired from the finite element analysis. After comparison, the two sets of data matched well. The Finite Element model was proved to be acceptable. PMID:17959437

  20. Larger Centers Produce Better Outcomes in Pediatric Cardiac Surgery: Regionalization is a Superior Model - The Con Prospective.

    Science.gov (United States)

    Danton, Mark H D

    2016-01-01

    Regionalization, in the context of congenital heart surgery, describes a process where smaller units close and patients are redistributed to larger centers. Proponents argue this will produce superior patient outcome based primarily on a volume-outcome effect. The potential disadvantage is that, as distance to center increases, access to service is compromised. In this article the volume-outcome effect is appraised and the effect of risk-stratification and threshold volumes explored. Access to service, and how certain congenital lesions and demographics might be disadvantaged, is reviewed. Alternative models are considered including collaborative programing and a standardizing approach of agreed parameters in personnel and infrastructure. Finally the influence of newer developments and quality metrics, including outcome databases, digital technologies and team-cognitive performance, needs to be factored in as the future unfolds. Ultimately, the design of a national congenital cardiac program should aspire to deliver care that is optimal, equitable and economic for the whole population. The solution lies in the distillation of competing variables cognizant of regional demographics and geography. PMID:27060038

  1. 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.

  2. 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.

  3. 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.

  4. Support for total hip replacement surgery: Structures modeling, Gait Data Analysis and Report system

    Directory of Open Access Journals (Sweden)

    Gianluca Mario Izzo

    2012-03-01

    Full Text Available For the treatment of advanced damages of hip joints, Total Hip Arthroplasty is well proven. Due to the different mechanical properties of the prosthesis material and the bone tissue, a partial unloading of the periprosthetic bone occurs. The bone cement causes reduction in bone density as a result of removal of normal stress from the bone, leading to weakening of the bone in that area and the fracture risk increases. Bone loss is identified as one of the main reasons for loosening of the stem. Otherwise, thanks to the press-fit of the non-cemented stem achieved by surgery, the bone layers immediately adjacent to the stem are preloaded, thus encouraged growing, and the bone getting stronger. The non-cemented stem would be the better choice for every patient, but the question remains if the femur can handle the press- fitting surgery. This studies aim to develop a monitoring techniques based on Gait analysis and bone density changes to assess patient recovery after Total Hip Arthroplasty. Furthermore, to validate computational processes based on 3D modeling and Finite Element Methods for optimizing decision making in the operation process and selecting the suited surgical procedure. A vision could be minimizing risk of periprosthetic fracture during and after surgery. Patients: The sample presents 11 patients receiving cemented implant and 13 for the uncemented. Patients are grouped by type of implant. Three checkpoints were considered: before, after operation and one year later. CT scans, gaitrite and kinepro measurements have been realized. Main outcome measures: Fracture risk probability is higher in bone with low bone mineral density; therefore bones are more fragile in elderly people. BMD is indeed one parameter considered among all the observations. Periprosthetic fracture of the femur is a rare but complex complication of THA, and requires demanding surgery. As such, they result in considerable morbidity and dysfunction. Thus, tests of

  5. 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.

  6. Comparison of mechanical and manual ventilation during transport of patients to the intensive care unit after cardiac surgery

    OpenAIRE

    Atilla Canbulat; Suna Gören; Elif Başağan Moğol; Fatma Nur Kaya

    2012-01-01

    Objectives: We compared effects of mechanical andmanual ventilation during transport to the intensive careunit(ICU) in cardiac surgeries.Materials and methods: After ethical approval, 66 patients(ASAgrade II and III, 20-80years) were assignedrandomly. Ventilation during transport to ICU was performedmanual (Group EV; n=36) or mechanical ventilation(Group MV; n=30). Measurements were recorded:operation room (A), during transport (T) and in ICU (YB).Systolic, diastolic pressures (SAP, DAP), pul...

  7. Efficacy of a new video-based training model in spinal surgery

    Directory of Open Access Journals (Sweden)

    D H Heiland

    2014-01-01

    Full Text Available Background: An important part of neurosurgical training is the improvement of surgical skills. Acquiring microsurgical skills follows a learning curve, influenced by specific exercises, feedback, and training. Aim of training should be rapid learning success. The study shows the way in which video-based training can influence the learning curve. Methods: Over a period of 18 months (2011-2012 12 residents were evaluated in spinal surgery (12 cases per resident by a skilled evaluator based on different criteria. The evaluation criteria (exposition of important anatomy, intraoperative bleeding, efficacy of using bipolar cauterization were weighted and added to a single quality-score. The participating residents were divided into two groups. Only one group (n = 5 received video-based training. Results: Residents showed an individually different but explicit increase in microsurgical skills. The quality-score during the first surgery compared with the end point of the study demonstrated a faster improvement of surgical skills in the group with video-based training than in the group without special training. Considering all residents together, the video-training group displayed a steeper gradient of microsurgical success. Comparison of the single resident′s microsurgical skills showed individual disparities. Various biases that influence the learning success are under examination. Conclusion: Video-based training can improve microsurgical skills, leading to an improved learning curve. An earlier entry of the learning curve plateau in the video-training group promotes a higher acquisition of surgical skills. Because of the positive effect, we plan to apply the video-based training model to other neurosurgical subspecialties, especially neurovascular and skull base surgery.

  8. 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.

  9. Cataract Surgery

    Science.gov (United States)

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ...

  10. 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 ...

  11. A New Long-Term Care Facilities Model in Nova Scotia, Canada: Protocol for a Mixed Methods Study of Care by Design

    OpenAIRE

    Marshall, Emily Gard; Boudreau, Michelle Anne; Jensen, Jan L; Edgecombe, Nancy; Clarke, Barry; Burge, Frederick; Archibald, Greg; Taylor, Anthony; Andrew, Melissa K.

    2013-01-01

    Background Prior to the implementation of a new model of care in long-term care facilities in the Capital District Health Authority, Halifax, Nova Scotia, residents entering long-term care were responsible for finding their own family physician. As a result, care was provided by many family physicians responsible for a few residents leading to care coordination and continuity challenges. In 2009, Capital District Health Authority (CDHA) implemented a new model of long-term care called “Care b...

  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. 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. PMID:25499658

  15. A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP

    Directory of Open Access Journals (Sweden)

    Francis Rebecca

    2010-01-01

    Full Text Available Abstract Background Cardiac rehabilitation programs offer effective means to prevent recurrence of a cardiac event, but poor uptake of current programs have been reported globally. Home based models are considered as a feasible alternative to avoid various barriers related to care centre based programs. This paper sets out the study design for a clinical trial seeking to test the hypothesis that these programs can be better and more efficiently supported with novel Information and Communication Technologies (ICT. Methods/Design We have integrated mobile phones and web services into a comprehensive home- based care model for outpatient cardiac rehabilitation. Mobile phones with a built-in accelerometer sensor are used to measure physical exercise and WellnessDiary software is used to collect information on patients' physiological risk factors and other health information. Video and teleconferencing are used for mentoring sessions aiming at behavioural modifications through goal setting. The mentors use web-portal to facilitate personal goal setting and to assess the progress of each patient in the program. Educational multimedia content are stored or transferred via messaging systems to the patients phone to be viewed on demand. We have designed a randomised controlled trial to compare the health outcomes and cost efficiency of the proposed model with a traditional community based rehabilitation program. The main outcome measure is adherence to physical exercise guidelines. Discussion The study will provide evidence on using mobile phones and web services for mentoring and self management in a home-based care model targeting sustainable behavioural modifications in cardiac rehabilitation patients. Trial registration The trial has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR with number ACTRN12609000251224.

  16. 13A. Integrative Cancer Care: The Life Over Cancer Model

    OpenAIRE

    Block, Keith; Block, Penny; Gyllenhaal, Charlotte; Shoham, Jacob

    2013-01-01

    Focus Areas: Integrative Algorithms of Care Integrative cancer treatment fully blends conventional cancer treatment with integrative therapies such as diet, supplements, exercise and biobehavioral approaches. The Life Over Cancer model comprises three spheres of intervention: improving lifestyle, improving biochemical environment (terrain), and improving tolerance of conventional treatment. These levels are applied within the context of a life-affirming approach to cancer patients and treatme...

  17. Monks' Health: Holistic Health Care Model by Community Participation

    OpenAIRE

    Decha Buates; Songkoon Chantachon; Kosit Paengsoi; Anongrit Kangrang

    2010-01-01

    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 ...

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

    DEFF Research Database (Denmark)

    Winther, Jonas; Hillersdal, Line

    Interdisciplinary research collaborations are increasingly made a mandatory 'standard' within strategic research grants. Collaborations between the natural, social and humanistic sciences are conceptualized as uniquely suited to study pressing societal problems. The obesity epidemic has been...... 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....

  19. Attitudes of Doctors and Nurses toward the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Rolando Bonal Ruiz

    2015-06-01

    Full Text Available Background: the fact that chronic diseases replace traditional causes of morbidity and mortality in a country, or are on a par with major common health problems, demands the development of new strategies to address them. Objective: to explore attitudes of doctors and nurses from the Rolando López Peña Polyclinic toward the Chronic Care Model. Methods: a quantitative and qualitative cross-sectional study was conducted including the 22 family physicians and 26 nurses who provide care to patients with chronic diseases and were at the polyclinic at the time of the study. All were administered a 5 point Likert scale and a focus group interview, which was taped, transcribed and analyzed. Results: the attitudinal results correspond with the actions assessed in each component of the model, being the most common barriers: the lack of awareness and training on the new approaches to care of these patients, work overload created by other programs such as the maternal-child and vector control programs, uncertainties on the effectiveness of patient education and ignorance of the practice guidelines. Conclusions: favorable attitudes toward the introduction of the model to the practice of the family physician and nurse predominated as long as organizational changes are made and the suggestions of these service providers are put into practice with the support of the decision makers of the health sector.

  20. Providing care for critically ill surgical patients: challenges and recommendations.

    Science.gov (United States)

    Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

    2013-07-01

    Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed. PMID:23754675

  1. 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

  2. The redefinition of the familialist home care model in France: the complex formalization of care through cash payment.

    Science.gov (United States)

    Le Bihan, Blanche

    2012-05-01

    This article investigates the impact of policy measures on the organisation of home-based care for older people in France, by examining the balance between formal and informal care and the redefinition of the initial familialist model. It focuses on the specific cash for care scheme (the Allocation personnalisée d'autonomie - Personalised allowance for autonomy) which is at the core of the French home-based care policy. The author argues that in a redefined context of 'welfare mix', the French public strategy for supporting home-based care in France is articulated around two major objectives, which can appear contradictory. It aims to formalise a professional care sector, with respect to the employment policy while allowing the development of new forms of informal care, which cannot be considered to be formal employment. The data collection is two-fold. Firstly, a detailed analysis was made of different policy documents and public reports, together with a systematic review of existing studies. Secondly, statistical analysis on home-based care resources were collected, which was not easy, as home-care services for older people in France are part of a larger sector of activity, 'personal services' (services à la personne). The article exposes three main findings. First, it highlights the complexity of the formalisation process related to the introduction of the French care allowance and demonstrates that formalisation, which facilitates the recognition of care as work, does not necessarily mean professionalisation. Second, it outlines the diversity of the resources available: heterogeneous professional care, semi-formal forms of care work with the possibility to employ a relative and informal family care. Finally, the analysis outlines the importance of the regulation of cash payments on the reshaping of formal and informal care and comments on its impact on the redefinition of informal caring activities.

  3. 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....

  4. Adenoviral targeting of malignant melanoma for fluorescence-guided surgery prevents recurrence in orthotopic nude-mouse models

    Science.gov (United States)

    Yano, Shuya; Takehara, Kiyoto; Kishimoto, Hiroyuki; Urata, Yasuo; Kagawa, Shunsuke; Bouvet, Michael; Fujiwara, Toshiyoshi; Hoffman, Robert M.

    2016-01-01

    Malignant melanoma requires precise resection in order to avoid metastatic recurrence. We report here that the telomerase-dependent, green fluorescent protein (GFP)-containing adenovirus OBP-401 could label malignant melanoma with GFP in situ in orthotopic mouse models. OBP-401-based fluorescence-guided surgery (FGS) resulted in the complete resection of malignant melanoma in the orthotopic models, where conventional bright-light surgery (BLS) could not. High-dose administration of OBP-401 enabled FGS without residual cancer cells or recurrence, due to its dual effect of cancer-cell labeling with GFP and killing. PMID:26701857

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

    OpenAIRE

    Shogo Kato; Satoko Tsuru; Yoshinori Iizuka

    2013-01-01

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

  6. Diffusion of good practices of care and decline of the association with case volume: the example of breast conserving surgery

    Directory of Open Access Journals (Sweden)

    Zorzi Manuel

    2007-10-01

    Full Text Available Abstract Background Several previous studies conducted on cancer registry data and hospital discharge records (HDR have found an association between hospital volume and the recourse to breast conserving surgery (BCS for breast cancer. The aim of the current study is to depict concurrent time trends in the recourse to BCS and its association with hospital volume. Methods Admissions of breast cancer patients for BCS or mastectomy in the period 2000–2004 were identified from the discharge database of the Veneto Region (Italy. The role of procedural volume (low 100 breast cancer surgeries/year, and of individual risk factors obtainable from HDR was assessed through a hierarchical log-binomial regression. Results Overall, the recourse to BCS was higher in medium (risk ratio = 1.12, 95% confidence interval 1.07–1.18 and high-volume (1.09, 1.03–1.14 compared to low-volume hospitals. The proportion of patients treated in low-volume hospitals dropped from 22% to 12%, with a concurrent increase in the activity of medium-volume providers. The increase over time in breast conservation (globally from 56% to 67% was steeper in the categories of low- and medium-volume hospitals with respect to high caseload. Conclusion The growth in the recourse to BCS was accompanied by a decline of the association with hospital volume; larger centers probably acted as early adopters of breast conservation strategies that subsequently spread to smaller providers.

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

    OpenAIRE

    Carreras, Marc; Sánchez-Pérez, Inma; Ibern, Pere; Coderch, Jordi; Inoriza, José María

    2016-01-01

    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 burd...

  8. 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.

  9. 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。

  10. 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.

  11. 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. PMID:23518839

  12. Patients in a depression collaborative care model of care: comparison of 6-month cost utilization data with usual care.

    Science.gov (United States)

    Angstman, Kurt B; Williams, Mark D

    2010-04-01

    A collaborative care model (CCM) has been implemented for management of depression. This paper studies the impact that the CCM had on cost measures for the period of six months after initial diagnosis of depression compared to patients receiving usual care (UC). There was a significant increase in the CPT costs for the six months following diagnosis in the CCM group ($451.35 vs. $323.50, P < 0.001). The average CPT cost rank and CPT cost differential were also significantly increased in the CCM group. The adjusted means of the CPT costs were (when controlling for prior utilization) $452.11 for the CCM group and $322.09 for UC (P < 0.001). In the CCM group; there were 161 patients (73.5%) that achieved a clinical response for their depression compared to the UC group, which had a 15.1% (18/119) response rate (P < 0.001). There also was a significant difference between the groups in those who were symptoms free of their depression (PHQ-9 score < 5), with the CCM having 59.4% of the patients symptom-free compared to 10.9% of the UC group (P < 0.001). In this group of patients, CCM is associated with markedly improved clinical outcomes for depression, however with a modest short-term increase in CPT costs. PMID:23804062

  13. Porcine acute liver failure model established by two-phase surgery and treated with hollow fiber bioartificial liver support system

    Institute of Scientific and Technical Information of China (English)

    Yi Gao; Ning Mu; Xiao-Ping Xu; Yan Wang

    2005-01-01

    AIM: To establish a highly reproducible animal model of acute liver failure (ALF), for assessing theeffect of bioartificial liver support system (BALSS).METHODS: A two-phase complete liver devascularization procedure was performed in eight loco-hybrid pigs. Blood biochemical index and liver biopsy were studied every 2 h after surgery, and survival time was recorded. The BALSS constructed with high volume recirculating technique was a hollow fiber circulating system consisting of a hepatocyte reactor-hollow fiber module inoculated with microcarrieradhering hepatocytes, and a double pump, heparinized,thermostabilized, micro-capsulized activated carbonadsorbing plasmapheresis system. Twelve pigs undergoing two-phase surgery were randomized into: control group (perfused without hepatocytes, n = 6) and treatment group (perfused with hepatocytes, n = 6). Intergroup liver biochemical indexes, survival time, and liver pathological changes were analyzed at regular intervals.RESULTS: Two-phase surgery was performed in all the experimental pigs, and there was no obvious difference between their biochemical indexes. After 3 h of phase Ⅱ surgery, ammonia (Amm) increased to (269±37) μmol/L.After 5 h of the surgery, fibrinogen (Fib) decreased to (1.5±0.2) g/L. After 7 h of the surgery, ALT, AST, Tbil and PT were (7.6±1.8) nka/L, (40±5) nka/L, (55±8) μmol/L and (17.5±1.7) nka/L respectively. After 9 h of surgery, ALB and Cr were (27±4) g/L and (87±9) μmol/L. After 13 h of surgery, BUN was (3.5±0.9) μmol/L. All the above values were different from those determined before surgery.Survival time of pigs averaged 13.5±1.4 h. ALF pigs in the other group were treated with BALSS. The comparison analysis between the treated and control animals showed the changes of Tbil, PT, Alb, BUN, Cr, Fib, and Amm (P<0.01), but there was no change of ALT and AST. The survival time was statistically different (P<0.01), and there was no significant difference in histological changes

  14. 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.

  15. 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.

  16. 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 ...

  17. 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

  18. 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....

  19. [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. PMID:27492305

  20. Do telemonitoring projects of heart failure fit the Chronic Care Model?

    OpenAIRE

    Willemse, Evi; Adriaenssens, Jef; Dilles, Tinne; Remmen, Roy

    2014-01-01

    This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner.Background: The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation.Methods: This...

  1. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program

    OpenAIRE

    RAMOS-GOMEZ, FRANCISCO J.

    2014-01-01

    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 ca...

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

    OpenAIRE

    De la Poza, E.; Alkasadi, M. S. S.; L. Jódar

    2013-01-01

    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. Pl...

  3. 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 ...

  4. 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.

  5. Comparison of mechanical and manual ventilation during transport of patients to the intensive care unit after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Atilla Canbulat

    2012-12-01

    Full Text Available Objectives: We compared effects of mechanical andmanual ventilation during transport to the intensive careunit(ICU in cardiac surgeries.Materials and methods: After ethical approval, 66 patients(ASAgrade II and III, 20-80years were assignedrandomly. Ventilation during transport to ICU was performedmanual (Group EV; n=36 or mechanical ventilation(Group MV; n=30. Measurements were recorded:operation room (A, during transport (T and in ICU (YB.Systolic, diastolic pressures (SAP, DAP, pulmonary arterialpressure (PAP, pulmonary capillary wedge pressure(PCWP, central venous pressure (CVP, heart rate (HR,cardiac output (CO, blood gases (pH, PCO2, PO2, BEand peripheral oxygen saturation (SpO2 were recorded.Stroke volume index (SVI, systemic and pulmonary vascularresistance indices (SVRI, PVRI and mean arterialpressures(MAP were calculated.Results: Patients were similar. Duration of transportwas shorter in Group MV (p< 0.01. The alterations inHR, MAP, DAP, CVP, PAP, PCWP, PVRI, SVRI, SVI, CO,SpO2 were similar, the increase in SAP during T periodwas higher in Group MV (p<0.05. Pulmonary arterial pHin Group MV was lower (p< 0.05. Arterial and pulmonaryarterial pO2, pCO2 decreased in Group MV, there was increasein Group EV during ICU (p< 0.001, p< 0.01, p<0.01, p< 0.05. During T period hypotension and tachycardiain Group EV, and hypertension in Group MV wereobserved.Conclusions: Mechanical ventilation had short transporttime, less alterations in hemodynamic and respiration valuesand less complication rates. We concluded that theuse of mechanical ventilation is a safer method for theintrahospital transport of critical patients. J Clin Exp Invest2012; 3(4: 521-528Key words: Cardiac surgery, patient transport, mechanicalventilator, manual ventilator, hemodynamia

  6. 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. PMID:25370088

  7. 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.

  8. 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

  9. Plastic Surgery for Teenagers

    Science.gov (United States)

    ... Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC), or the Joint Commission on Accreditation of ... requirements. Informed Consent At the highest level of care, ... physician-patient relationship is one of shared decision-making. This decision- ...

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

    OpenAIRE

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

    2013-01-01

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

  11. 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

  12. 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.

  13. 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

  14. 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. PMID:22628896

  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. Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition)

    OpenAIRE

    Muntinga Maaike E; Hoogendijk Emiel O; van Leeuwen Karen M; van Hout Hein PJ; Twisk Jos WR; van der Horst Henriette E; Nijpels Giel; Jansen Aaltje PD

    2012-01-01

    Abstract Background Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling...

  17. 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.

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

    OpenAIRE

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

    2006-01-01

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

  19. 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…

  20. Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life

    OpenAIRE

    Christine Ritchie; Robin Andersen; Jessica Eng; Garrigues, Sarah K.; Gina Intinarelli; Helen Kao; Suzanne Kawahara; Kanan Patel; Lisa Sapiro; Anne Thibault; Erika Tunick; Barnes, Deborah E.

    2016-01-01

    Introduction The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers. Aims To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center. Setting 152 high-risk patients (≥5 ED visits or ≥2 hosp...

  1. 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.

  2. 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.

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

    Science.gov (United States)

    Depasse, Jacqueline W; Lee, Patrick T

    2013-01-01

    '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. PMID:24001367

  4. 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.

  5. 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.

  6. 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.

  7. The Norrtaelje model: a unique model for integrated health and social care in Sweden

    Directory of Open Access Journals (Sweden)

    Monica Andersson Bäck

    2015-09-01

    Full Text Available 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.

  8. 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. PMID:26528093

  9. A systematic review of contemporary models of shared HIV care and HIV in primary care in high-income settings.

    Science.gov (United States)

    Mapp, Fiona; Hutchinson, Jane; Estcourt, Claudia

    2015-12-01

    HIV shared care is uncommon in the UK although shared care could be a beneficial model of care. We review the literature on HIV shared care to determine current practice and clinical, economic and patient satisfaction outcomes. We searched MEDLINE, EMBASE, NICE Evidence, Cochrane collaboration, Google and websites of the British HIV Association, Aidsmap, Public Health England, World Health Organization and Terrence Higgins Trust using relevant search terms in August 2014. Studies published after 2000, from healthcare settings comparable to the UK that described links between primary care and specialised HIV services were included and compared using principles of the Critical Appraisal Skills Programme and Authority, Accuracy, Coverage, Objectivity, Date, Significance frameworks. Three of the nine included models reported clinical or patient satisfaction outcomes but data collection and analyses were inadequate. None reported economic outcomes although some provided financial costings. Facilitators of shared care included robust clinical protocols, training and timely communication. Few published examples of HIV shared care exist and quality of evidence is poor. There is no consistent association with improved clinical outcomes, cost effectiveness or acceptability. Models are context specific, driven by local need, although some generalisable features could inform novel service delivery. Further evaluative research is needed to determine optimal components of shared HIV care. PMID:25804421

  10. 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

  11. Spatially-oriented EMR for Dental Surgery

    OpenAIRE

    Wu, Min; Koenig, Lisa; Lynch, John; Wirtz, Thomas

    2006-01-01

    As digital dental images become widely available, a new Electronic MR system (EMR) will be critical for the success of applying new technology to dental care. This project is designed an image-based and spatially-oriented EMR for dental surgery. A new panoramic image-based annotation model will be developed, which will complement dental charting precisely locating specific spatial findings for each patient. A spatially-oriented, multilayered data model for dental EMR will be developed using G...

  12. Plastic Surgery

    Science.gov (United States)

    ... How Can I Help a Friend Who Cuts? Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  13. Foot Surgery

    Science.gov (United States)

    ... in the toe to maintain realignment. Neuroma Surgery: Neuroma surgery involves removing a benign enlargement of a nerve, usually between the metatarsal heads in the ball of the foot. This soft tissue surgery tends to have a ...

  14. Lung surgery

    Science.gov (United States)

    ... Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... You will have general anesthesia before surgery. You will be asleep and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video- ...

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

    Science.gov (United States)

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

    2011-09-01

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

  16. Robust model-based 3d/3D fusion using sparse matching for minimally invasive surgery.

    Science.gov (United States)

    Neumann, Dominik; Grbic, Sasa; John, Matthias; Navab, Nassir; Hornegger, Joachim; Ionasec, Razvan

    2013-01-01

    Classical surgery is being disrupted by minimally invasive and transcatheter procedures. As there is no direct view or access to the affected anatomy, advanced imaging techniques such as 3D C-arm CT and C-arm fluoroscopy are routinely used for intra-operative guidance. However, intra-operative modalities have limited image quality of the soft tissue and a reliable assessment of the cardiac anatomy can only be made by injecting contrast agent, which is harmful to the patient and requires complex acquisition protocols. We propose a novel sparse matching approach for fusing high quality pre-operative CT and non-contrasted, non-gated intra-operative C-arm CT by utilizing robust machine learning and numerical optimization techniques. Thus, high-quality patient-specific models can be extracted from the pre-operative CT and mapped to the intra-operative imaging environment to guide minimally invasive procedures. Extensive quantitative experiments demonstrate that our model-based fusion approach has an average execution time of 2.9 s, while the accuracy lies within expert user confidence intervals. PMID:24505663

  17. Resident Education in Principles and Technique of Bowel Surgery Using an Ex-Vivo Porcine Model

    Directory of Open Access Journals (Sweden)

    M. Bijoy Thomas

    2010-01-01

    Full Text Available Objective. improve competency of residents with lysis of adhesion (LOA and bowel surgery using a porcine model. Study Design. Pig bowel was removed at time of an anatomy laboratory, cleansed, and used to demonstrate surgical techniques and principles of LOA, repair of enterotomy, bowel resection, and anastomosis. Participants were surveyed pre- and posttraining session using 10 point Likert scale. Results. Thirty one residents at varying levels of training participated. After the training session, there was a significant improvement noted in mean scores for comfort level with LOA (6.3 versus 7.7, =.007, comfort level with enterotomy repair (2.8 versus 6.4, <.0001, understanding principles of LOA (5.0 versus 7.7, <.0001, understanding principles of enterotomy repair (3.5 versus 7.0, <.0001, and familiarity with instruments used (5.8 versus 7.3, =.01. Conclusion. Training sessions using ex-vivo porcine model improve resident perception of knowledge and comfort with LOA and enterotomy repair.

  18. Victoria BGY palliative care model--a new model for the 1990s.

    Science.gov (United States)

    Downing, G M; Braithwaite, D L; Wilde, J M

    1993-01-01

    If, as palliative care practitioners, we ensure that distressing symptoms such as pain, vomiting, dyspnea, confusion, and pre-death restlessness are fully controlled (note "fully"), then most people are deeply appreciative and continue to live until they die, confident that whatever happens, their worth, desires, and comfort are secure. Credibility (Latin, fides dignus) is remaining true and reliable to what was agreed. Patients registering with palliative care generally desire comfort, which can only occur when palliative care physicians and programs are capable and willing to apply all three types of palliation discussed here--the BGY model. PMID:7510798

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

    OpenAIRE

    Noël Polly H; Jordan Michelle; McDaniel Reuben R; Lanham Holly; Palmer Ray; Leykum Luci K; Parchman Michael

    2011-01-01

    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 ...

  20. 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

  1. Implementation of the Measures and Effects of Humanistic Nursing Care of Hand and Foot Surgery%探讨手足外科实施人性化护理的措施和效果

    Institute of Scientific and Technical Information of China (English)

    马丽英

    2015-01-01

    Objective To explore the measures and effects of humanistic nursing care of hand and foot surgery.MethodsIn our hospital from February 2014 to February 2015,96 cases of hand and foot surgery implemented of humanistic nursing care. The satisfaction of patients were recorded and analyzed. ResultsThrough the implementation of humanistic nursing care on the patients,patients' satisfaction with nursing errors as high as 98%.Conclusion The implementation of humanistic nursing care can improve the quality of nursing care of hand and foot surgery patients,increase patient satisfaction.%目的:探讨手足外科实施人性化护理的措施和效果。方法对我院2014年2月~2015年2月96例手足外科患者实施人性化护理,对患者的满意度进行分析记录。结果通过对患者实施人性化护理,患者满意度高达98%,护理中未出现护理差错。结论对手足外科患者实施人性化护理提高了护理质量,增加了患者的满意度。

  2. 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

  3. 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

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

    Directory of Open Access Journals (Sweden)

    Sophie L W Spoorenberg

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

  5. 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.

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

    OpenAIRE

    Gesse, Theresa; Golembeski, Susan; Potter, Jonell

    1999-01-01

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

  7. 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

  8. 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.

  9. A Web-Based Model for Diabetes Education and Decision Support for the Home Care Nurse

    OpenAIRE

    Hill, Michelle; Kirby, Judy

    1998-01-01

    Diabetes education for the home care population requires expert knowledge to be available at the point-of-care, the patient's home. This poster displays a model for Web-based diabetes education and decision support for the home care nurse. The system utilizes the line of reasoning (LOR) model to organize and represent expert decision-making thought processes.

  10. 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.

  11. 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.

  12. Familial hypercholesterolaemia: a model of care for Australasia.

    Science.gov (United States)

    Watts, Gerald F; Sullivan, David R; Poplawski, Nicola; van Bockxmeer, Frank; Hamilton-Craig, Ian; Clifton, Peter M; O'Brien, Richard; Bishop, Warrick; George, Peter; Barter, Phillip J; Bates, Timothy; Burnett, John R; Coakley, John; Davidson, Patricia; Emery, Jon; Martin, Andrew; Farid, Waleed; Freeman, Lucinda; Geelhoed, Elizabeth; Juniper, Amanda; Kidd, Alexa; Kostner, Karam; Krass, Ines; Livingston, Michael; Maxwell, Suzy; O'Leary, Peter; Owaimrin, Amal; Redgrave, Trevor G; Reid, Nicola; Southwell, Lynda; Suthers, Graeme; Tonkin, Andrew; Towler, Simon; Trent, Ronald

    2011-10-01

    Familial hypercholesterolaemia (FH) is a dominantly inherited disorder present from birth that causes marked elevation in plasma cholesterol and premature coronary heart disease. There are at least 45,000 people with FH in Australia and New Zealand, but the vast majority remains undetected and those diagnosed with the condition are inadequately treated. To bridge this major gap in coronary prevention the FH Australasia Network (Australian Atherosclerosis Society) has developed a consensus model of care (MoC) for FH. The MoC is based on clinical experience, expert opinion, published evidence and consultations with a wide spectrum of stakeholders, and has been developed for use primarily by specialist centres intending starting a clinical service for FH. This MoC aims to provide a standardised, high-quality and cost-effective system of care that is likely to have the highest impact on patient outcomes. The MoC for FH is presented as a series of recommendations and algorithms focusing on the standards required for the detection, diagnosis, assessment and management of FH in adults and children. The process involved in cascade screening and risk notification, the backbone for detecting new cases of FH, is detailed. Guidance on treatment is based on risk stratifying patients, management of non-cholesterol risk factors, safe and effective use of statins, and a rational approach to follow-up of patients. Clinical and laboratory recommendations are given for genetic testing. An integrative system for providing best clinical care is described. This MoC for FH is not prescriptive and needs to be complemented by good clinical judgment and adjusted for local needs and resources. After initial implementation, the MoC will require critical evaluation, development and appropriate modification. PMID:21917530

  13. Introduction of a team-based care model in a general medical unit

    OpenAIRE

    Hastings, Stephanie E.; Suter, Esther; Bloom, Judy; Sharma, Krishna

    2016-01-01

    Background Alberta Health Services is a provincial health authority responsible for healthcare for more than four million people. The organization recognized a need to change its care delivery model to make care more patient- and family-centred and use its health human resources more effectively by enhancing collaborative practice. A new care model including changes to how providers deliver care and skill mix changes to support the new processes was piloted on a medical unit in a large urban ...

  14. Task-role-based Access Control Model in Smart Health-care System

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

    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...

  15. Heart Valve Surgery Recovery and Follow Up

    Science.gov (United States)

    ... Stroke More Heart Valve Surgery Recovery and Follow Up Updated:May 27,2016 Surgery Recovery Checklist English | ... self-care and are soon encouraged to get up, to breathe deeply, and to resume eating, drinking ...

  16. 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. PMID:26797553

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. 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.

  2. The role of point-of-care platelet function testing in predicting postoperative bleeding following cardiac surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Corredor, C; Wasowicz, M; Karkouti, K; Sharma, V

    2015-06-01

    This systematic review and meta-analysis appraises the utility of point-of-care platelet function tests for predicting blood loss and transfusion requirements in cardiac surgical patients, and analyses whether their use within a transfusion management algorithm is associated with improved patient outcomes. We included 30 observational studies incorporating 3044 patients in the qualitative assessment, and nine randomised controlled trials including 1057 patients in the meta-analysis. Platelet function tests demonstrated significant variability in their ability to predict blood loss and transfusion requirements. Their use within a blood transfusion algorithm demonstrated a reduction in blood loss at longest follow-up (mean difference -102.9 ml (95% CI -149.9 to -56.1 ml), p < 0.001), and transfusion of packed red cells (RR 0.86 (95% CI 0.78-0.94), p = 0.001) and fresh frozen plasma (RR 0.42 (95% CI 0.30-0.59), p < 0.001). Viscoelastic methods used in combination with other platelet function tests achieved greater reduction in blood loss (mean difference -111.8 ml (95% CI -174.9 to -49.1 ml), p = 0.0005) compared with their use alone (mean difference -90.6 ml (95% CI 166.1-15.0 ml), p = 0.02). We conclude that incorporation of point-of-care platelet function tests into transfusion management algorithms is associated with a reduction in blood loss and transfusion requirements in cardiac surgery patients. PMID:25916344

  3. 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)

  4. Perspective: A new model of leadership performance in health care.

    Science.gov (United States)

    Souba, Wiley

    2011-10-01

    Current leadership models are based largely on concepts and explanations, which provide limited access to the being and actions of an effective leader in health care. Rather than teaching leadership from a theoretical vantage point, the ontological perspective teaches leadership as it is lived and experienced. When one exercises leadership "as lived," concurrently informed by theories, one performs at one's best. A distinctive feature of the ontological approach resides in its capacity to disclose human ways of being and acting that limit our freedom to lead effectively as our natural self-expression. Ontological leadership maintains that our worldviews and mental maps affect the way we lead and are shaped by and accessible through language--hence, to lead more effectively, mastery of a new conversational domain of leadership is required. This emerging model of leadership performance reveals that (1) our actions as leaders are correlated with the way in which the leadership situation we are dealing with occurs for us, and (2) this "occurring" is shaped by the context we bring to that situation. Master leaders use language to recontextualize their leadership challenges so that their naturally correlated ways of being and acting can emerge, resulting in effective leadership. When leaders linguistically unveil limiting contexts, they are freed up to create new contexts that shift the way leadership challenges occur for them. This provides leaders--physicians, scientists, educators, executives--with new opportunity sets (previously unavailable) for exercising exemplary leadership. The ontological approach to leadership offers a powerful framework for tackling health care's toughest challenges. PMID:21869664

  5. 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

  6. 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

  7. [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.

  8. Edmonton, Canada: a regional model of palliative care development.

    Science.gov (United States)

    Fainsinger, Robin L; Brenneis, Carleen; Fassbender, Konrad

    2007-05-01

    Palliative care developed unevenly in Edmonton in the 1980s and early 1990s. Health care budget cuts created an opportunity for innovative redesign of palliative care service delivery. This report describes the components that were developed to build an integrated comprehensive palliative care program, the use of common clinical assessments and outcome evaluation that has been key to establishing credibility and ongoing support. Our program has continued to develop and grow with an ongoing focus on the core areas of clinical care, education, and research. PMID:17482060

  9. 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 ...

  10. Gamma Knife Surgery as Monotherapy with Clinically Relevant Doses Prolongs Survival in a Human GBM Xenograft Model

    OpenAIRE

    Bente Sandvei Skeie; Jian Wang; Ernest Dodoo; Jan Ingeman Heggdal; Janne Grønli; Linda Sleire; Sidsel Bragstad; Ganz, Jeremy C.; Martha Chekenya; Sverre Mørk; Paal-Henning Pedersen; Per Øyvind Enger

    2013-01-01

    Object. Gamma knife surgery (GKS) may be used for recurring glioblastomas (GBMs). However, patients have then usually undergone multimodal treatment, which makes it difficult to specifically validate GKS independent of established treatments. Thus, we developed an experimental brain tumor model to assess the efficacy and radiotoxicity associated with GKS. Methods. GBM xenografts were implanted intracerebrally in nude rats, and engraftment was confirmed with MRI. The rats were allocated to GKS...

  11. 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...

  12. Poor Sleep Quality in Patients after Coronary Artery Bypass Graft Surgery: An Intervention Study Using the PRECEDE-PROCEED Model

    OpenAIRE

    Soheila Ranjbaran; Tahereh Dehdari; Khosro Sadeghniiat- Haghighi; Mahmood Mahmoodi-Majdabadi

    2015-01-01

    Background: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG.Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifest...

  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. [Family-centered care: A model for approaching dementia care in the community].

    Science.gov (United States)

    Esandi, Nuria; Canga, Ana

    2016-04-01

    Along with ageing population, there has been an increase in the prevalence and incidence of chronic and debilitating conditions, such as dementia which, in turn, has increased the demands for long term care in the community. This is challenging current health care systems that wish to provide an appropriate response whilst intensify its efforts to contain costs. This paper, through a critical reflection, argues for an integrative, positive, and systemic care approach, focused not only on the person with dementia but also on the entire family unit. For this purpose, it approaches the impact that dementia has for the family, and therefore for Primary Health Care professional. In addition care strategies aimed at strengthening the whole family system are suggested. PMID:26968688

  15. Retrospective US database analysis of drug utilization patterns, health care resource use, and costs associated with adjuvant interferon alfa-2b therapy for treatment of malignant melanoma following surgery

    Directory of Open Access Journals (Sweden)

    Krishna A

    2012-06-01

    Full Text Available Michelle D Hackshaw,1 Arun Krishna,2 David J Mauro31,2Global Health Outcomes, Merck, Sharpe and Dohme Corporation, Whitehouse Station, NJ, USA; 3Clinical Research, Merck Research Laboratories, Upper Gwynedd, PA, USABackground: The purpose of this study was to identify a real-world US population having undergone surgery for malignant melanoma and describe treatment patterns, health care resource utilization, and costs for patients who subsequently received interferon alfa-2b (IFN therapy or other standard of care chemotherapies.Methods: A retrospective cohort study was conducted using administrative claims from MarketScan® databases among melanoma patients diagnosed between 2004 and 2008 who had surgery and were subsequently treated with IFN or other chemotherapies. Health care resource utilization and costs of services (converted to 2009 dollars were evaluated. Cost refers to the amount paid to providers associated with the health service.Results: Of 18,075 subjects with melanoma surgery claims, 1525 (8.4% were treated with IFN and 1194 (6.6% with other chemotherapies. Median duration (days and number of doses of IFN therapy were 29 and 20, respectively. Approximately half of patients who received IFN discontinued therapy within or after the one-month induction phase. For IFN therapy patients, average total cost per patient for the last melanoma-related surgery prior to start of therapy, including costs of the surgery itself, pathology, anesthesia, and hospital care, was $2219. The average total cost per patient related to IFN therapy was $1188; this included costs for drug, office visits, blood work, and infusions. Other chemotherapy costs ranged from $146 to $2678.Conclusion: There is an unmet treatment need, considering that this study observed that melanoma patients on IFN therapy post-surgery do not complete the recommended one-year course of treatment which may compromise its full therapeutic benefits. Further study to investigate reasons

  16. 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…

  17. 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

  18. Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life.

    Directory of Open Access Journals (Sweden)

    Christine Ritchie

    Full Text Available The Geriatric Resources for the Assessment and Care of Elders (GRACE program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers.To describe adaptation of the GRACE model to include adults of all ages (named Care Support and to evaluate the process and impact of Care Support implementation at an urban academic medical center.152 high-risk patients (≥5 ED visits or ≥2 hospitalizations in the past 12 months enrolled from four medical clinics from 4/29/2013 to 5/31/2014.Patients received a comprehensive in-home assessment by a nurse practitioner/social worker (NP/SW team, who then met with a larger interdisciplinary team to develop an individualized care plan. In consultation with the primary care team, standardized care protocols were activated to address relevant key issues as needed.A process evaluation based on the Consolidated Framework for Implementation Research identified key adaptations of the original model, which included streamlining of standardized protocols, augmenting mental health interventions and performing some assessments in the clinic. A summative evaluation found a significant decline in the median number of ED visits (5.5 to 0, p = 0.015 and hospitalizations (5.5 to 0, p<0.001 6 months before enrollment in Care Support compared to 6 months after enrollment. In addition, the percent of patients reporting better self-rated health increased from 31% at enrollment to 64% at 9 months (p = 0.002. Semi-structured interviews with Care Support team members identified patients with multiple, complex conditions; little community support; and mild anxiety as those who appeared to benefit the most from the program.It was feasible to implement GRACE/Care Support at an academic medical center by making adaptations based on local needs. Care Support patients experienced significant reductions in acute care utilization and significant improvements

  19. 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

  20. 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. PMID:23445128

  1. The Surgery Club- A Model for Development of Graduate Entrepreneurial Skills

    OpenAIRE

    Kakkar, Rosie; Nawrocki, Philip

    2011-01-01

    This paper is a reflective journey through the process of development of an extra- curricular project. A group of medical students on the St Georges Programme in their first year of medicine were keen to specialise in surgery in their clinical years yet to come. The idea of a ‘Surgery Club’ was thus born. Paperwork was submitted, to ensure recognition of the Club by the Institution, setting the bylaws, the constitution and a mission statement along with budgeting projections for the Term to c...

  2. 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. PMID:23484427

  3. 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.

  4. Modelling the landscape of palliative care for people with dementia: a European mixed methods study

    OpenAIRE

    Iliffe, Steve; Davies, Nathan; Vernooij-Dassen, Myrra; van Riet Paap, Jasper; Sommerbakk, Ragni; Mariani, Elena; Jaspers, Birgit; Radbruch, Lukas; Manthorpe, Jill; Maio, Laura; Haugen, Dagny; Engels, Yvonne

    2013-01-01

    BACKGROUND: Palliative care for people with dementia is often sub-optimal. This is partly because of the challenging nature of dementia itself, and partly because of system failings that are particularly salient in primary care and community services. There is a need to systematize palliative care for people with dementia, to clarify where changes in practice could be made.To develop a model of palliative care for people with dementia that captures commonalities and differences across Europe,...

  5. An empowerment health education program for children undergoing surgery for congenital heart diseases.

    Science.gov (United States)

    Ni, Zhihong; Chao, Yannfen; Xue, Xiaoling

    2016-09-01

    Since the surgery for congenital heart disease (CHD) is considered highly risky, appropriate postoperative care is crucial. After the surgery, children are often discharged with unhealed wounds, incomplete recovery, and continuing pain. Health education programs based on empowerment education model can assist clients to develop skills in self-management. This study aimed to evaluate the effectiveness of an empowerment health education program for improving caregiving knowledge, caring behaviors, and self-efficacy of parents caring for children after corrective surgery for CHD. This prospective clinical trial enrolled pediatric patients undergoing surgical correction for CHD. Patients were divided into two groups: the control group (n = 42), which received the standard education program, and the intervention group (n = 44), which participated in the empowerment theory-based education program. We collected data on left ventricular ejection fraction (LVEF); peripheral oxygen saturation (SpO2); New York Heart Association classification of the patients; and the parents' caregiving knowledge, caring behaviors, and self-efficacy before surgery and one month and three months after surgery. At one month and three months after surgery, the intervention group scored higher than the control group in caregiving knowledge, caring behavior, and self-efficacy. By the third month after surgery, the intervention group had significantly higher values of LVEF and SpO2 than the control group. PMID:26105060

  6. Do telemonitoring projects of heart failure fit the Chronic Care Model?

    Directory of Open Access Journals (Sweden)

    Evi Willemse

    2014-07-01

    Full Text Available This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner.Background: The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation.Methods: This qualitative study describes seven non-invasive home-care telemonitoring projects in patients with heart failure in Belgium. A qualitative design, including interviews and literature review, was used to describe the correspondence of these home-care telemonitoring projects with the dimensions of the Chronic Care Model.Results: The projects were situated in primary and secondary health care. Their primary goal was to reduce the number of readmissions for chronic heart failure. None of these projects succeeded in a final implementation of telemonitoring in home care after the pilot phase. Not all the projects were initiated to accomplish all of the dimensions of the Chronic Care Model. A central role for the patient was sparse.Conclusion: Limited financial resources hampered continuation after the pilot phase. Cooperation and coordination in telemonitoring appears to be major barriers but are, within primary care as well as between the lines of care, important links in follow-up. This discrepancy can be prohibitive for deployment of good chronic care. Chronic Care Model is recommended as basis for future.

  7. Do telemonitoring projects of heart failure fit the Chronic Care Model?

    Directory of Open Access Journals (Sweden)

    Evi Willemse

    2014-07-01

    Full Text Available This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner. Background: The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation. Methods: This qualitative study describes seven non-invasive home-care telemonitoring projects in patients with heart failure in Belgium. A qualitative design, including interviews and literature review, was used to describe the correspondence of these home-care telemonitoring projects with the dimensions of the Chronic Care Model. Results: The projects were situated in primary and secondary health care. Their primary goal was to reduce the number of readmissions for chronic heart failure. None of these projects succeeded in a final implementation of telemonitoring in home care after the pilot phase. Not all the projects were initiated to accomplish all of the dimensions of the Chronic Care Model. A central role for the patient was sparse. Conclusion: Limited financial resources hampered continuation after the pilot phase. Cooperation and coordination in telemonitoring appears to be major barriers but are, within primary care as well as between the lines of care, important links in follow-up. This discrepancy can be prohibitive for deployment of good chronic care. Chronic Care Model is recommended as basis for future.

  8. Evolution of surgery in advanced epithelial ovarian cancer in a dedicated gynaecologic oncology unit—seven year audit from a tertiary care centre in a developing country

    OpenAIRE

    Rajanbabu, Anupama; Kuriakose, Santhosh; Ahmad, Sheikh Zahoor; Khadakban, Tejal; Khadakban, Dhiraj; R. Venkatesan; Vijaykumar, D. K.

    2014-01-01

    Aims To audit our performance as a dedicated gynaecologic oncology unit and to analyse how it has evolved over the years. To retrospectively evaluate the outcome of advanced ovarian cancer treated with neoadjuvant chemotherapy (NACT) followed by interval surgery versus upfront surgery. Methods and results One hundred and ninety-eight patients with advanced epithelial ovarian cancer (EOC) who were treated from 2004 to 2010 were analysed. Eighty-two patients (41.4%) underwent primary surgery an...

  9. 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...

  10. Quality and Value in an Evolving Health Care Landscape.

    Science.gov (United States)

    Kamal, Robin N

    2016-07-01

    Demonstrating and improving value of care continues to be increasingly important in hand surgery. To prepare for emerging models that transition payment from volume to value, hand surgeons will benefit from a clear understanding of quality, cost, and value. National organizations and both public and private payers increasingly advocate for patient-reported outcome measures for pay for reporting and pay for performance initiatives. These are intended to incentivize providers and health systems to improve patient-centered care while minimizing costs. Appreciating the limitations to using patient-reported outcomes in hand surgery can ensure hand surgery is appropriately assessed in novel payment models. PMID:27374791

  11. Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

    Science.gov (United States)

    Wallace, Cara L

    2016-08-01

    This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care. PMID:27332743

  12. Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach

    OpenAIRE

    Kitson, Nicole A; Price, Morgan; Lau, Francis Y; Showler, Grey

    2013-01-01

    Background Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication managemen...

  13. Survey on nursing of breast cancer patients treated with radiotherapy following to breast-conserving surgery. Actual states and problems for nursing care by certified nurses in breast cancer nursing

    International Nuclear Information System (INIS)

    The purpose of the present study is to elucidate the actual states and problems of nursing care provided by certified nurses in breast cancer patients treated with radiotherapy following to breast-conserving surgery. The survey was conducted by a postal anonymous questionnaire. Participants were drawn from the list of certified nurses on the website of Japanese Nursing Association. The questionnaires consisted of multiple choice questions regarding the contents of care performed before, during and after radiotherapy, and free questionnaire on the related problems. The rate of valid replies was 41.2% (40 out of 97 subjects). Before radiotherapy, the accomplishing rate exceeded 70% in about half of all nursing cares. The accomplishing rates were 30 to 50% in about 90% of all cares and 40 to 60% in all cares during and after radiotherapy, respectively. Problems were classified into three categories high-quality practice of radiotherapy nursing, establishment of continuing care system and improvement of cooperation. It is recommended to achieve high quality radiotherapy nursing by certified nurses, the establishment of continuing care system and the improvement of cooperation in order to improve nursing care during and after radiotherapy. (author)

  14. Differences in referral rates to specialised health care from four primary health care models in Klaipeda, Lithuania

    Science.gov (United States)

    Zielinski, Andrzej; Håkansson, Anders; Jurgutis, Arnoldas; Ovhed, Ingvar; Halling, Anders

    2008-01-01

    Background Lithuanian primary health care (PHC) is undergoing changes from the systems prevalent under the Soviet Union, which ensured free access to specialised health care. Currently four different PHC models work in parallel, which offers the opportunity to study their respective effect on referral rates. Our aim was to investigate whether there were differences in referrals rates from different Lithuanian PHC models in Klaipeda after adjustment for co-morbidity. Methods The population listed with 18 PHC practices serving inhabitants in Klaipeda city and region (250 070 inhabitants). Four PHC models: rural state-owned family medicine practices, urban privately owned family medicine practices, state-owned polyclinics and privately owned polyclinics. Information on listed patients and referrals during 2005 from each PHC practice in Klaipeda was obtained from the Lithuanian State Sickness Fund database. The database records included information on age, gender, PHC model, referrals and ICD 10 diagnoses. The Johns Hopkins ACG Case-Mix system was used to study co-morbidity. Referral rates from different PHC models were studied using Poisson regression models. Results Patients listed with rural state-owned family medicine practices had a significantly lower referral rate to specialised health care than those in the other three PHC models. An increasing co-morbidity level correlated with a higher physician- to self-referral ratio. Conclusion Family medicine practices located in rural-, but not in urban areas had significantly lower referral rates to specialised health care. It could not be established whether this was due to organisation, training of physicians or financing, but suggests there is room for improving primary health care in urban areas. Patient's place of residence and co morbidity level were the most important factors for referral rate. We also found that gatekeeping had an effect on the referral pattern with respect to co-morbidity level, so that those

  15. Using your shoulder after surgery

    Science.gov (United States)

    ... Rotator cuff problems Rotator cuff repair Shoulder arthroscopy Shoulder pain Patient Instructions Rotator cuff exercises Rotator cuff - self-care Shoulder surgery - discharge Update Date 11/26/2014 Updated ...

  16. The Ethics of Aesthetic Surgery

    OpenAIRE

    S R Mousavi

    2010-01-01

    Advances in plastic and reconstructive surgery have revolutionized the management of patients suffering from disfiguring congenital abnormalities, burns and skin cancers. The demand for aesthetic surgery has increased in recent years, as our culture has become more concerned with image and appearance. Several ethical considerations such as patient′s right for informed counseling, beneficience and maleficience need to be given careful consideration.

  17. 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 ...

  18. 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 ...

  19. Activity Diagrams for DEVS Models: A Case Study Modeling Health Care Behavior

    Energy Technology Data Exchange (ETDEWEB)

    Ozmen, Ozgur [ORNL; Nutaro, James J [ORNL

    2015-01-01

    Discrete Event Systems Specification (DEVS) is a widely used formalism for modeling and simulation of discrete and continuous systems. While DEVS provides a sound mathematical representation of discrete systems, its practical use can suffer when models become complex. Five main functions, which construct the core of atomic modules in DEVS, can realize the behaviors that modelers want to represent. The integration of these functions is handled by the simulation routine, however modelers can implement each function in various ways. Therefore, there is a need for graphical representations of complex models to simplify their implementation and facilitate their reproduction. In this work, we illustrate the use of activity diagrams for this purpose in the context of a health care behavior model, which is developed with an agent-based modeling paradigm.

  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. 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…

  2. 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. PMID:24945243

  3. Arthrofibrotic remodeling after knee replacement surgery, a stress-related disease? - Clinic, biochemical model, therapy, research -

    Science.gov (United States)

    Traut, Philip; Faust, Isabel

    2016-01-01

    Aims and Objectives: The predicted incidence of arthrofibrosis after knee replacement surgery is 5 - 10%. Arthrofibrosis is defined as painful impairment of joint flexibility occurring postoperatively. To counteract symptoms and to accomplish quality standards (E/F 0-0-90) several therapeutic strategies as for instance physiotherapy or mobilization under anaesthesia are applied. Although it is known that mechanical and emotional stress induce myofibroblast differentiation, extracellular matrix (ECM) synthesis and xylosyltransferase (XT) activity, biochemical processes of fibrotic diseases receive little attention in orthopaedics. Until today, neither an adequate disease model nor a diagnostic marker for arthrofibrosis has been described. Materials and Methods: Surgical procedures (e.g. endoprosthesis, cruciate ligament replacement) initiate physiological wound healing and the release of inflammatory mediators from platelets, damaged tissue and other cells of the immune system. Secreted cytokines such as transforming growth factor (TGF-beta 1) or platelet derived growth factor (PDGF) promote myofibroblast proliferation and differentiation. Mechanical strain (stretching exercises with pain inhibition) leads to activation of latent TGF-beta 1, which triggers scarring via ECM/XT synthesis and prevents myofibroblast apoptosis. Our recent study carried out a decreased platelet count in arthrofibrosis patients compared to healthy controls. Thus, an elevated platelet consumption might take place. Analogous to TGF-beta 1, PDGF also inhibits myofibroblast apoptosis and expression of matrix metalloproteinase expression, which degrade ECM. Emotional stress might not only matter in other fibrotic diseases e.g. tako-tsubo cardiomyopathy (TTC) but also in arthrofibrosis. Sympathicotonic destabilization (due to pain, frustration or social burden) results in increased catecholamine synthesis and sympathetic activity. These effects are recognizable by vegetative symptoms (e

  4. 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 ...

  5. Program Implementation in the Prison System: An Organizational Study of the Chronic Care Model Program

    OpenAIRE

    Robinson, Greg

    2013-01-01

    This study provides evidence of a successful implementation of a not-for-profit operational model within a public setting. The federal government placed a receiver in charge of improving health care within the California Department of Corrections and Rehabilitation. To achieve the receivership's goals, a chronic care model from the not-for-profit sector was selected and implemented to improve the delivery of health care to inmates. The data suggest that operational programs developed outsi...

  6. 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.)

  7. 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…

  8. A quality management model for integrated care: results of a Delphi and Concept Mapping study

    NARCIS (Netherlands)

    M. Minkman; K. Ahaus; I. Fabbricotti; U. Nabitz; R. Huijsman

    2009-01-01

    The objective of this study is to identify the elements and clusters of a quality management model for integrated care. In order to develop the model a combination of three methods were applied. A literature study was conducted to identify elements of integrated care. In a Delphi study experts comme

  9. 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

  10. Cost/effectiveness model of dabigatran in the prevention of venous thromboembolism in major orthopedic surgery: Adaptation for Italy

    Directory of Open Access Journals (Sweden)

    Orietta Zaniolo

    2010-06-01

    Full Text Available Venous thromboembolic events (VTE represent a dangerous complication of major orthopedic surgery, especially in total hip replacement (THR and total knee replacement (TKR procedures. Dabigatran etexilate (DBG, a direct and reversible thrombin inhibitor, has proven its non-inferiority with respect to enoxaparin 40mg once-daily, a low molecular weight heparin (LMWH, in the prevention of VTE in patients undergoing THR and TKR, in the RE-NOVATE and RE-MODEL trials, respectively. The objective of this analysis was to estimate cost/effectiveness and cost/utility of DBG compared to standard care for the prevention of VTE in Italy. A decision analytic, Markov-chain based model, originally developed for the UK, was adapted to the Italian context. The adaptation involved cost and demographic characteristics, clinical and utility data were not altered. Costs were taken from national observational studies, where available. Otherwise, current prices and tariffs were applied. Resource consumption was derived from practice guidelines or taken from the UK model. According to the prevalent national practice, extended prophylaxis is considered for both surgical procedures. The time horizon of the analysis was patients’ lifetimes. In order to consider different alternatives for drug dispensation and, consequently, National Health Service acquisition costs, alternative scenarios were developed. A further scenario, excluding LMWHs administration costs (“worst-case” scenario, was considered. Compared to LMWHs, DBG was associated with an expected increase of 0.019 life-years (LYs and 0.014 quality-adjusted life-years (QALYs per THR patient and of 0.024 LYs and 0.019 QALYs per TKR patient. DBG-related costs were lower than LMWH in both procedures, with a mean difference ranging from 89 to 116 € for THR, and 107 to 142 for TKR, depending on the LMWH product. Higher acquisition costs for DBG were completely offset and inverted by avoided administration expenses

  11. 胃肠外科疾病合并糖尿病患者的围手术期护理%Gastrointestinal surgery patients with diabetes, the authors combined perioperative care

    Institute of Scientific and Technical Information of China (English)

    周驰艳

    2012-01-01

    Objective To gastrointestinal surgery with diabetic patients perioperative care, nursing curative effect, improve nursing level. Methods In June 2011 in July 2012 in our hospital,were 60 cases with gastrointestinal surgery combined with diabetes patients.the patients preoperative and intraoperative urgent postoperative nursing, etc are analyzed, in order to improve the patient's quality of life, fast to its body back to health. Results All of the gastrointestinal surgery with diabetes mellitus patients after timely treatment, elaborate care, make a more satisfactory effect, patients are improving hospital discharge, and no complications appeared. Conclusion Gastrointestinal surgery with diabetic patients perioperative care, has the vital significance,and improve the patient's quality of life.%目的:对胃肠外科疾病合并糖尿病患者的围术期护理进行分析,观察护理疗效,提高护理水平及患者的生活质量,促进患者身体快速恢复.方法:将2011年6月~2012年7月在我院收治的60例胃肠外科疾病合并糖尿病患者,对其术前与术中及术后等方面的护理进行分析.结果:所有的胃肠外科合并糖尿患者者经过及时治疗、精心护理,取得较为满意的效果,患者均好转出院,无并发症出现.结论:对胃肠外科伴有糖尿病患者的围术期进行护理,具有重要的意义,提高了患者的生活质量.

  12. Le «Chronic care model» en médecine de famille en Suisse

    OpenAIRE

    Steurer-Stey, C.; Frei, A; Rosemann, T

    2010-01-01

    The Chronic care model in Swiss primary care The care of patients with chronic disease is one of the most urgent medical challenges of actual society. The chronic care model (CCM) is an organizational, proactive approach for chronic disease in primary care. The system creates practical, supportive, evidence-based interactions between an informed, activated patient and a proactive practice team. CCM identifies six essential elements of high-quality health care : community ; heal...

  13. Features of nursing care provided for breast cancer patients treated with radiotherapy following breast-conserving surgery. Comparison of nursing practices between certified nurses in breast cancer nursing and non-specialist nurses working with breast cancer patients

    International Nuclear Information System (INIS)

    This study aimed to identifying features of nursing care provided for breast cancer patients during the course of radiotherapy following breast-conserving surgery and improve the quality of nursing care. Subjects were certified nurses in breast cancer nursing (CN) and non-specialist nurses working with breast cancer patients (NS). An anonymous survey questionnaire on nursing care and other practices provided before, during, and after radiotherapy was conducted by postal mail and the results were compared between CN and NS. Valid responses were obtained from 40 CN (41.2%) and 102 NS (56.7%). Significant differences between CN and NS were observed for 15 of 27 (55.6%) care items before radiotherapy, 18 of 18 (100%) items during radiotherapy, and 9 of 20 (45.0%) items after radiotherapy. Among the items with significant differences, significantly more NS than CN performed all nursing care items during the course of radiotherapy, except for one item provided before radiotherapy. These results demonstrate that it is necessary to facilitate enhanced collaboration and coordination between CN and NS providing nursing care for breast cancer patients in order to improve the quality of nursing care delivered to patients. (author)

  14. 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.

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

    OpenAIRE

    Poza Plaza, Elena de la; Alkasadi, M. S. S.; Jódar Sánchez, Lucas Antonio

    2013-01-01

    Copyright © 2013 E. De la Poza et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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 sur...

  16. Efficacy of a new video-based training model in spinal surgery

    OpenAIRE

    Heiland, D. H.; Petridis, A. K.; Maslehaty, H.; Thissen, J.; Kinzel, A; Scholz, M.; Schreiber, L.

    2014-01-01

    Background: An important part of neurosurgical training is the improvement of surgical skills. Acquiring microsurgical skills follows a learning curve, influenced by specific exercises, feedback, and training. Aim of training should be rapid learning success. The study shows the way in which video-based training can influence the learning curve. Methods: Over a period of 18 months (2011-2012) 12 residents were evaluated in spinal surgery (12 cases per resident) by a skilled evaluator base...

  17. 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.

  18. 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.

  19. 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.

  20. National Epilepsy Surgery Support Activity

    Directory of Open Access Journals (Sweden)

    K Radhakrishnan

    2014-01-01

    Full Text Available While there are over one million people with drug-resistant epilepsy in India, today, there are only a handful of centers equipped to undertake presurgical evaluation and epilepsy surgery. The only solution to overcome this large surgical treatment gap is to establish comprehensive epilepsy care centers across the country that are capable of evaluating and selecting the patients for epilepsy surgery with the locally available technology and in a cost-effective manner. The National Epilepsy Surgery Support Activity (NESSA aims to provide proper guidance and support in establishing epilepsy surgery programs across India and in neighboring resource-poor countries, and in sustaining them.

  1. Transauricular embolization of the rabbit coronary artery for experimental myocardial infarction: comparison of a minimally invasive closed-chest model with open-chest surgery

    Directory of Open Access Journals (Sweden)

    Katsanos Konstantinos

    2012-02-01

    Full Text Available Abstract Introduction To date, most animal studies of myocardial ischemia have used open-chest models with direct surgical coronary artery ligation. We aimed to develop a novel, percutaneous, minimally-invasive, closed-chest model of experimental myocardial infarction (EMI in the New Zealand White rabbit and compare it with the standard open-chest surgical model in order to minimize local and systemic side-effects of major surgery. Methods New Zealand White rabbits were handled in conformity with the "Guide for the Care and Use of Laboratory Animals" and underwent EMI under intravenous anesthesia. Group A underwent EMI with an open-chest method involving surgical tracheostomy, a mini median sternotomy incision and left anterior descending (LAD coronary artery ligation with a plain suture, whereas Group B underwent EMI with a closed-chest method involving fluoroscopy-guided percutaneous transauricular intra-arterial access, superselective LAD catheterization and distal coronary embolization with a micro-coil. Electrocardiography (ECG, cardiac enzymes and transcatheter left ventricular end-diastolic pressure (LVEDP measurements were recorded. Surviving animals were euthanized after 4 weeks and the hearts were harvested for Hematoxylin-eosin and Masson-trichrome staining. Results In total, 38 subjects underwent EMI with a surgical (n = 17 or endovascular (n = 21 approach. ST-segment elevation (1.90 ± 0.71 mm occurred sharply after surgical LAD ligation compared to progressive ST elevation (2.01 ± 0.84 mm;p = 0.68 within 15-20 min after LAD micro-coil embolization. Increase of troponin and other cardiac enzymes, abnormal ischemic Q waves and LVEDP changes were recorded in both groups without any significant differences (p > 0.05. Infarct area was similar in both models (0.86 ± 0.35 cm in the surgical group vs. 0.92 ± 0.54 cm in the percutaneous group;p = 0.68. Conclusion The proposed model of transauricular coronary coil embolization avoids

  2. 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.

  3. 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.

  4. A Model Humanitarian Cleft Mission: 312 Cleft Surgeries in 7 Days

    Directory of Open Access Journals (Sweden)

    Ghulam Qadir Fayyaz, MBBS, DSS, MS

    2015-03-01

    Conclusion: A locoregional cleft team can be more effective to care for the patients with cleft in countries where surgical and other expertise can be utilized by proper organization of cleft missions on a national level.

  5. Application of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis

    Institute of Scientific and Technical Information of China (English)

    Xu Mao; Li Xiaoxi; Wang Jun; Guo Xiangyang

    2014-01-01

    Background Airway management is crucial in clinical anesthesia.Many complications associated with airway management result from unexpected difficult airway,but predicting a difficult airway is a major challenge.We investigated the efficacy of a new combined model including radiological indicators to predict difficult airway in patients undergoing surgery for cervical spondylosis,a population with a high incidence of difficult airway.Methods We randomly enrolled 303 patients scheduled for elective surgery for cervical spondylosis at Peking University Third Hospital between August 2012 and March 2013.Preoperatively,patients were evaluated for difficult airway according to a clinical index and parameters on lateral cervical radiographs and magnetic resonance images.Difficult airway was defined as Cormack-Lehane grades Ⅲ-Ⅳ.Logistic regression was used to identify a combined (clinical and radiological) model for difficult airway.A receiver operating characteristic (ROC) curve was used to describe the effectiveness of prediction.Results We identified three clinical predictive factors using the ROC curve:mouth opening,stemomental distance,and neck mobility.We created a clinical model using three factors:gender,age,and mouth opening,with odds ratios (OR) of 0.370,1.034,and 0.358,respectively.Using the clinical and radiological parameters,we formulated a combined model with five risk factors:gender,mouth opening,atlanto-occipital gap,the angle from the second to sixth cervical vertebraes in the neutral position,and the angle difference of δ (the angle between the laryngeal axis and the epiglottic axis) from the neutral position to extension (OR:0.107,0.355,0.846,1.057,and 0.952,respectively).The sensitivity and specificity of the combined model were 80.0% and 65.7%,respectively,and the ROC curve confirmed that the combined model was better than any single clinical predictor and the clinical model.Conclusion The efficacy of the combined model including both clinical

  6. NHF-McMaster Guideline on Care Models for Haemophilia Management.

    Science.gov (United States)

    Pai, M; Key, N S; Skinner, M; Curtis, R; Feinstein, M; Kessler, C; Lane, S J; Makris, M; Riker, E; Santesso, N; Soucie, J M; Yeung, C H T; Iorio, A; Schünemann, H J

    2016-07-01

    This guideline was developed to identify evidence-based best practices in haemophilia care delivery, and discuss the range of care providers and services that are most important to optimize outcomes for persons with haemophilia (PWH) across the United States. The guideline was developed following specific methods described in detail in this supplement and based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation approach). Direct evidence from published literature and the haemophilia community, as well as indirect evidence from other chronic diseases, were reviewed, synthesized and applied to create evidence-based recommendations. The Guideline panel suggests that the integrated care model be used over non-integrated care models for PWH (conditional recommendation, moderate certainty in the evidence). For PWH with inhibitors and those at high risk for inhibitor development, the same recommendation was graded as strong, with moderate certainty in the evidence. The panel suggests that a haematologist, a specialized haemophilia nurse, a physical therapist, a social worker and round-the-clock access to a specialized coagulation laboratory be part of the integrated care team, over an integrated care team that does not include all of these components (conditional recommendation, very low certainty in the evidence). Based on available evidence, the integrated model of care in its current structure, is suggested for optimal care of PWH. There is a need for further appropriately designed studies that address unanswered questions about specific outcomes and the optimal structure of the integrated care delivery model in haemophilia. PMID:27348396

  7. Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care.

    Science.gov (United States)

    Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S

    2015-07-01

    In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided. PMID:25803647

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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. PMID:27651935

  13. Cattle Uterus: A Novel Animal Laboratory Model for Advanced Hysteroscopic Surgery Training

    Directory of Open Access Journals (Sweden)

    Ayman A. A. Ewies

    2015-01-01

    Full Text Available In recent years, due to reduced training opportunities, the major shift in surgical training is towards the use of simulation and animal laboratories. Despite the merits of Virtual Reality Simulators, they are far from representing the real challenges encountered in theatres. We introduce the “Cattle Uterus Model” in the hope that it will be adopted in training courses as a low cost and easy-to-set-up tool. It adds new dimensions to the advanced hysteroscopic surgery training experience by providing tactile sensation and simulating intraoperative difficulties. It complements conventional surgical training, aiming to maximise clinical exposure and minimise patients’ harm.

  14. Blood flow modeling for patient-specific bypass surgery in lower-limb arteries

    OpenAIRE

    Willemet, Marie

    2012-01-01

    Every day in Belgium, at least one or two people will undergo a bypass surgery in the lower-limb arteries. This medical procedure consists of replacing an occluded section of the leg arteries with an artificial vessel, in order to allow blood to flow downwards of this blockage. Even though this intervention is very common, failure of this treatment within five years reaches up to 60%. In order to improve our understanding of the causes of bypass failure, one approach is to study the local hem...

  15. 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

  16. Paying for Primary Care: The Factors Associated with Physician Self-selection into Payment Models.

    Science.gov (United States)

    Rudoler, David; Deber, Raisa; Barnsley, Janet; Glazier, Richard H; Dass, Adrian Rohit; Laporte, Audrey

    2015-09-01

    To determine the factors associated with primary care physician self-selection into different payment models, we used a panel of eight waves of administrative data for all primary care physicians who practiced in Ontario between 2003/2004 and 2010/2011. We used a mixed effects logistic regression model to estimate physicians' choice of three alternative payment models: fee for service, enhanced fee for service, and blended capitation. We found that primary care physicians self-selected into payment models based on existing practice characteristics. Physicians with more complex patient populations were less likely to switch into capitation-based payment models where higher levels of effort were not financially rewarded. These findings suggested that investigations aimed at assessing the impact of different primary care reimbursement models on outcomes, including costs and access, should first account for potential selection effects. PMID:26190516

  17. Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions

    OpenAIRE

    Leppin, Aaron L; Victor M Montori; Gionfriddo, Michael R

    2015-01-01

    An increasing proportion of healthcare resources in the United States are directed toward an expanding group of complex and multimorbid patients. Federal stakeholders have called for new models of care to meet the needs of these patients. Minimally Disruptive Medicine (MDM) is a theory-based, patient-centered, and context-sensitive approach to care that focuses on achieving patient goals for life and health while imposing the smallest possible treatment burden on patients’ lives. The MDM Care...

  18. Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

    OpenAIRE

    Shantanu Nundy; Jonathan J. Dick; Goddu, Anna P.; Patrick Hogan; Lu, Chen-Yuan E.; Solomon, Marla C; Arnell Bussie; Chin, Marshall H; Peek, Monica E.

    2012-01-01

    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...

  19. Critical Care Team

    Science.gov (United States)

    ... of these areas: Surgery Internal medicine Pediatrics Anesthesiology Critical care nurse: A highly skilled nurse who provides all aspects ... and can often uphold the patient's wishes. The critical care nurse becomes an important part of decision-making with ...

  20. Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: 'the Belgian experience'

    OpenAIRE

    Van Royen Paul; Vermeire Etienne; Wens Johan; Nobels Frank; Snauwaert Boris; Feyen Luc; Bastiaens Hilde; Sunaert Patricia; De Maeseneer Jan; De Sutter An; Willems Sara

    2009-01-01

    Abstract Background Most research publications on Chronic Care Model (CCM) implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Bel...

  1. A new model of care collaboration for community-dwelling elders: findings and lessons learned from the NORC-health care linkage evaluation

    OpenAIRE

    Kyriacou, Corinne

    2009-01-01

    Purpose Providing care for older individuals with chronic illnesses in the community requires a model of service delivery that takes into account both physical health and social health needs. However, packaging care in this way does not fit into existing service or reimbursement structures in the US, and there are few financial incentives that encourage service coordination. Lack of coordinated care can negatively affect access to high quality, appropriate care, putting seniors' physical and ...

  2. 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.

  3. 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.

  4. 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

  5. Understanding the implementation of complex interventions in health care: the normalization process model

    OpenAIRE

    Rogers Anne; Rapley Tim; Murray Elizabeth; MacFarlane Anne; Gask Linda; Eccles Martin; Dowrick Christopher; Ballini Luciana; Mair Frances; Finch Tracy; May Carl; Treweek Shaun; Wallace Paul; Anderson George; Burns Jo

    2007-01-01

    Abstract Background The Normalization Process Model is a theoretical model that assists in explaining the processes by which complex interventions become routinely embedded in health care practice. It offers a framework for process evaluation and also for comparative studies of complex interventions. It focuses on the factors that promote or inhibit the routine embedding of complex interventions in health care practice. Methods A formal theory structure is used to define the model, and its in...

  6. Exploring implementation and sustainability of models of care: can theory help?

    OpenAIRE

    Forster Della A; Newton Michelle; McLachlan Helen L; Willis Karen

    2011-01-01

    Abstract Objective Research on new models of care in health service provision is complex, as is the introduction and embedding of such models, and positive research findings are only one factor in whether a new model of care will be implemented. In order to understand why this is the case, research design must not only take account of proposed changes in the clinical encounter, but the organisational context that must sustain and normalise any changed practices. We use two case studies where ...

  7. 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.

  8. Strabismus Surgery

    Science.gov (United States)

    ... used. Some surgeons prescribe an antibiotic or combination antibiotic/steroid drop or ointment after surgery. More technical ... Screening Recommendations Loading... Most Common Searches Adult ...

  9. Model of learning for practitioners in dementia care with music therapy as the joint focal point

    DEFF Research Database (Denmark)

    Ottesen, Aase Marie

    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...... results indicate that the care providers are able to develop and transfer new knowledge and acquired skills to the daily nursing and care through the application of tangible tools from the musical activities, which has an effect on quality of life and wellbeing for persons suffering from dementia.......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...

  10. 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.

  11. Corrective Jaw Surgery

    Science.gov (United States)

    ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of ...

  12. Compassionate Accountability in Residential Care: A Trauma Informed Model

    Science.gov (United States)

    Cimmarusti, Rocco A.; Gamero, Soe L.

    2009-01-01

    This article examines techniques for holding youth in residential care accountable for their behavior. Based on the use of trauma treatment theory, the authors believe that holding one accountable can actually be conceptualized and put into practice as a nurturing operation. For traumatized individuals, more traditional approaches to…

  13. A Dual-Driver Model of Retention and Turnover in the Direct Care Workforce

    Science.gov (United States)

    Mittal, Vikas; Rosen, Jules; Leana, Carrie

    2009-01-01

    Purpose: The purpose of this study was to understand the factors associated with turnover and retention of direct care workers. We hypothesize that a dual-driver model that includes individual factors, on-the-job factors, off-the-job factors, and contextual factors can be used to distinguish between reasons for direct care workforces (DCWs)…

  14. The System-of-Care Model: Implementation in Twenty-Seven Communities.

    Science.gov (United States)

    Vinson, Nina B.; Brannan, Ana Maria; Baughman, Lela N.; Wilce, Maureen; Gawron, Timothy

    2001-01-01

    A 4-year study of 27 system-of-care sites designed to provides mental health services to children and adolescents, found that despite many changes in each local service system, no site was able to fully implement all 16 key attributes comprising an ideal system-of-care model (including sites with previous system-building experience). (Contains…

  15. 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…

  16. 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…

  17. 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…

  18. 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.

  19. A Quadratic Nonlinear Prediction-Based Heart Motion Model Following Control Algorithm in Robotic-Assisted Beating Heart Surgery

    OpenAIRE

    Fan Liang; Xiaofeng Meng

    2013-01-01

    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 thro...

  20. 肥胖患者妇科腹腔镜手术的围术期护理分析%Analysis of obese patients undergoing gynecologic laparoscopic surgery perioperative nursing care

    Institute of Scientific and Technical Information of China (English)

    胡珍

    2016-01-01

    Objective:To analyze the effect of perioperative nursing care of obese patients undergoing gynecological laparoscopic operation.Methods:100 cases of obese patients were treated with gynecological laparoscopic surgery.They were divided in two groups.50 cases in control group were given routine nursing,and 50 cases in the observation group were treated with perioperative nursing care in 50 cases.The blood pressure,heart rate and complications were compared before and after surgery.Results:There were significant differences in heart rate and blood pressure before and after treatment in the control group,complications of the two groups had significant difference(P<0.05).Conclusion:The perioperative nursing care of obese patients undergoing gynecological laparoscopic surgery can improve blood pressure and heart rate and reduce complications.The effect is significant.%目的:分析肥胖患者妇科腹腔镜手术围术期护理效果。方法:收治实施妇科腹腔镜手术治疗的肥胖患者100例,分两组,对照组50例实施常规护理,观察组50例实施围术期护理,对比手术前后血压、心率以及并发症情况。结果:对照组治疗前后心率血压、两组并发症情况差异有统计学意义(P<0.05)。结论:肥胖患者实施妇科腹腔镜手术的围术期护理可改善血压心率,减少并发症,效果显著。