WorldWideScience

Sample records for care ten lessons

  1. Providing free maternal health care: ten lessons from an evaluation of the national delivery exemption policy in Ghana

    OpenAIRE

    Witter, Sophie; Adjei, Sam; Armar-Klemesu, Margaret; Graham, Wendy

    2009-01-01

    Background: There is a growing movement, globally and in the Africa region, to reduce financial barriers to health care generally, but with particular emphasis on high priority services and vulnerable groups. Objective: This article reports on the experience of implementing a national policy to exempt women from paying for delivery care in public, mission and private health facilities in Ghana. Design: Using data from a complex evaluation which was carried out in 2005-2006, lessons are drawn ...

  2. Ten lessons for developing a health information website.

    Science.gov (United States)

    Ottmann, Goetz; Street, Annette F

    2007-11-01

    This paper outlines ten lessons derived from the development of a palliative care website, www.pallcarevic.asn.au. The following program elements contributed to the success of the project: (1) peer and stakeholder participation; (2) response to a significant need; (3) networking skills; (4) administrative skills; (5) mediation of conflicts; (6) project management skills; (7) sourcing of good evidence; (8) iterative evaluation involving users and stakeholders; (9) iterative expert evaluation; and (10) a well thought through sustainability strategy.

  3. Cross-cultural Science: Ten Lessons

    Directory of Open Access Journals (Sweden)

    Joanne Marie Horn

    2015-07-01

    Full Text Available Concerns of infectious disease outbreaks have recently reached the forefront of global security issues and resulted in new engagements among foreign science advisors, host country scientists, and officials. There are lessons to be learned from the numerous organizations working in global regions of endemic disease who are building capacity to survey pathogens and prevent and contain epidemics. Working with foreign scientists, health professionals, and administrators can be challenging; building partnerships based on respect and mutual trust is key to achieve effective change. Engendering ownership, working towards mutual success, paying close attention to cultural norms and the local regulatory climate, close collaboration with other stakeholders, and imaginative problem solving all contribute to mission success.

  4. Ten years of integrated care for the older in France

    Directory of Open Access Journals (Sweden)

    Dominique Somme

    2011-12-01

    Full Text Available Background: This paper analyzes progress made toward the integration of the French health care system for the older and chronically ill population. Policies: Over the last ten years, the French health care system has been principally influenced by two competing linkage models that failed to integrate social and health care services: local information and coordination centers, governed by the social field, and the gerontological health networks governed by the health field. In response to this fragmentation, Homes for the Integration and Autonomy for Alzheimer patients (MAIAs is currently being implemented at experimental sites in the French national Alzheimer plan, using an evidence-based model of integrated care. In addition, the state's reforms recently created regional health agencies (ARSs by merging seven strategic institutions to manage the overall delivery of care. Conclusion: The French health care system is moving from a linkage-based model to a more integrated care system. We draw some early lessons from these changes, including the importance of national leadership and governance and a change management strategy that uses both top-down and bottom-up approaches to implement these reforms.

  5. Lessons learned from ten years of distance learning outreach*

    Science.gov (United States)

    Locatis, Craig; Gaines, Cynthia; Liu, Wei-Li; Gill, Michael; Ackerman, Michael

    2015-01-01

    Objective: The study tested the efficacy of providing distance learning with real-time videoconferencing to broaden high school student knowledge of health careers. Methods: A pilot program was tried out and extended over ten years to include other schools in four different time zones and the National Library of Medicine. Survey results, site visits, and continued school participation were used as effectiveness indicators. Student ratings, site visits, and ongoing discussions were used to evaluate critical factors in the program. Results: Nine program factors contributed to success. Conclusions: Synchronous communication can be effective for outreach to special populations given appropriate infrastructure, technology, program design, and implementation. PMID:25918486

  6. Lessons learned from ten years of distance learning outreach.

    Science.gov (United States)

    Locatis, Craig; Gaines, Cynthia; Liu, Wei-Li; Gill, Michael; Ackerman, Michael

    2015-04-01

    The study tested the efficacy of providing distance learning with real-time videoconferencing to broaden high school student knowledge of health careers. A pilot program was tried out and extended over ten years to include other schools in four different time zones and the National Library of Medicine. Survey results, site visits, and continued school participation were used as effectiveness indicators. Student ratings, site visits, and ongoing discussions were used to evaluate critical factors in the program. Nine program factors contributed to success. Synchronous communication can be effective for outreach to special populations given appropriate infrastructure, technology, program design, and implementation.

  7. Social Networking Sites and Addiction: Ten Lessons Learned

    Science.gov (United States)

    Kuss, Daria J.; Griffiths, Mark D.

    2017-01-01

    Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i) social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using social networking sites; (v) Facebook addiction is only one example of SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNS addiction; and (x) there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided. PMID:28304359

  8. Social Networking Sites and Addiction: Ten Lessons Learned.

    Science.gov (United States)

    Kuss, Daria J; Griffiths, Mark D

    2017-03-17

    Online social networking sites (SNSs) have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i) social networking and social media use are not the same; (ii) social networking is eclectic; (iii) social networking is a way of being; (iv) individuals can become addicted to using social networking sites; (v) Facebook addiction is only one example of SNS addiction; (vi) fear of missing out (FOMO) may be part of SNS addiction; (vii) smartphone addiction may be part of SNS addiction; (viii) nomophobia may be part of SNS addiction; (ix) there are sociodemographic differences in SNS addiction; and (x) there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided.

  9. Social Networking Sites and Addiction: Ten Lessons Learned

    Directory of Open Access Journals (Sweden)

    Daria J. Kuss

    2017-03-01

    Full Text Available Online social networking sites (SNSs have gained increasing popularity in the last decade, with individuals engaging in SNSs to connect with others who share similar interests. The perceived need to be online may result in compulsive use of SNSs, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions. In order to present new insights into online social networking and addiction, in this paper, 10 lessons learned concerning online social networking sites and addiction based on the insights derived from recent empirical research will be presented. These are: (i social networking and social media use are not the same; (ii social networking is eclectic; (iii social networking is a way of being; (iv individuals can become addicted to using social networking sites; (v Facebook addiction is only one example of SNS addiction; (vi fear of missing out (FOMO may be part of SNS addiction; (vii smartphone addiction may be part of SNS addiction; (viii nomophobia may be part of SNS addiction; (ix there are sociodemographic differences in SNS addiction; and (x there are methodological problems with research to date. These are discussed in turn. Recommendations for research and clinical applications are provided.

  10. Articulated Multimedia Physics, Lesson 2, Significant Figures and Powers of Ten.

    Science.gov (United States)

    New York Inst. of Tech., Old Westbury.

    As the second lesson of the Articulated Multimedia Physics Course, instructional materials are presented in this study guide with relation to significant figures and powers of ten. An introductory description is given for precise measurement and numbers in scientific notation. The subject content is provided in scrambled form, and the use of…

  11. Ten years of integrated care in Switzerland

    Directory of Open Access Journals (Sweden)

    Peter Berchtold

    2011-03-01

    Full Text Available In Switzerland, a growing part of primary care is provided by networks of physicians and health maintenance organizations (HMOs acting on the principles of gatekeeping. To date, an average of one out of eight insured person in Switzerland, and one out of three in the regions in north-eastern Switzerland, opted for the provision of care by general practitioners in one of the 86 physician networks or HMOs. About 50% of all general practitioners and more than 400 other specialists have joined a physician networks. Seventy-three of the 86 networks (84% have contracts with the healthcare insurance companies in which they agree to assume budgetary co-responsibility, i.e. to adhere to set cost targets for particular groups of patients. Within and outside the physician networks, at regional and/or cantonal levels, several initiatives targeting chronic diseases have been developed, such as clinical pathways for heart failure and breast cancer patients or chronic disease management programs for patients with diabetes. The relevance of these developments towards more integration of healthcare as well as their implications for the future are discussed.

  12. The ten successful elements of an ambulatory care center.

    Science.gov (United States)

    Watkins, G

    1997-01-01

    Experts in healthcare predict that in the future, over 80% of all care will be provided either in the home or ambulatory care centers. How radiology facilities position themselves for this shifting market is critical to their long-term success, even though it appears there are endless opportunities for providing care in this atmosphere. The ten most critical elements that healthcare providers must address to ensure their preparedness are discussed. Location is critical, particularly since patients no longer want to travel to regional medical centers. The most aggressive providers are building local care centers to serve specific populations. Ambulatory care centers should project a high tech, high touch atmosphere. Patient comfort and the appeal of the overall environment must be considered. Centers need to focus on their customers' needs in multiple areas of care. A quick and easy registration process, providing dressing gowns in patient areas, clear billing functions--these are all important areas that centers should develop. Physicians practicing in the ambulatory care center are key to its overall success and can set the tone for all staff members. Staff members must be friendly and professional in their work with patients. The hours offered by the center must meet the needs of its client base, perhaps by offering evening and weekend appointments. Keeping appointments on schedule is critical if a center wants satisfied customers. It's important to identify the target before developing your marketing plan. Where do your referrals come from? Look to such sources as referring physicians, managed care plans and patients themselves. Careful billing is critical for survival in the ambulatory care world. Costs are important and systems that can track cost per exam are useful. Know your bottom line. Service remains the central focus of all successful ambulatory care center functions.

  13. Holistic System of Care: a ten-year perspective.

    Science.gov (United States)

    Nebelkopf, Ethan; Wright, Serena

    2011-01-01

    The Holistic System of Care for Native Americans in an Urban Environment is a community-focused intervention that provides behavioral health care, promotes health, and prevents disease. This approach is based on a community strategic planning process that honored Native American culture and relationships. Substance abuse, mental illness, homelessness, poverty, crime, physical illness, and violence are symptoms of historical trauma, family dysfunction, and spiritual imbalance. The holistic model links treatment, prevention, and recovery. The link between prevention and treatment is early intervention. Peer support is the link between treatment and recovery. Recovering individuals serve as role models linking recovery to prevention. Culture and spirituality build a strong and resilient foundation for recovery. This article documents the effectiveness of the holistic model over a ten-year period that it has been implemented at the Family & Child Guidance Clinic of the Native American Health Center in the San Francisco Bay Area. The holistic model has produced statistically significant reductions in substance abuse among adult Native American women, men, reentry, and homeless populations; reductions in substance abuse among Native American adolescents; reductions in HIV/AIDS high-risk behavior among Native American men, women, and adolescents; and decreases in acting out behavior among Native American severely emotionally disturbed children.

  14. Ten lessons for the next influenza pandemic-an English perspective: a personal reflection based on community surveillance data.

    Science.gov (United States)

    Fleming, Douglas M; Durnall, Hayley

    2012-01-01

    We review experience in England of the swine flu pandemic between May 2009 and April 2010. The surveillance data from the Royal College of General Practitioners Weekly Returns Service and the linked virological data collected in the integrated program with the Health Protection Agency are used as a reference frame to consider issues emerging during the pandemic. Ten lessons are summarized. (1) Delay between illness onset in the first worldwide cases and virological diagnosis restricted opportunities for containment by regional prophylaxis. (2) Pandemic vaccines are unlikely to be available for effective prevention during the first wave of a pandemic. (3) Open, realistic and continuing communication with the public is important. (4) Surveillance programs should be continued through summer as well as winter. (5) Severity of illness should be incorporated in pandemic definition. (6) The reliability of diagnostic tests as used in routine clinical practice calls for further investigation. (7) Evidence from serological studies is not consistent with evidence based on health care requests made by sick persons and is thus of limited value in cost effectiveness studies. (8) Pregnancy is an important risk factor. (9) New strategies for administering vaccines need to be explored. (10) Acceptance by the public and by health professionals of influenza vaccination as the major plank on which the impact of influenza is controlled has still not been achieved.

  15. Ten years integrated care for mental disorders in the Netherlands

    Directory of Open Access Journals (Sweden)

    Christina M van der Feltz-Cornelis

    2011-03-01

    Full Text Available Background and problem statement: Integrated care for mental disorders aims to encompass forms of collaboration between different health care settings for the treatment of mental disorders. To this end, it requires integration at several levels, i.e. integration of psychiatry in medicine, of the psychiatric discourse in the medical discourse; of localization of mental health care and general health care facilities; and of reimbursement systems.  Description of policy practice: Steps have been taken in the last decade to meet these requirements, enabling psychiatry to move on towards integrated treatment of mental disorder as such, by development of a collaborative care model that includes structural psychiatric consultation that was found to be applicable and effective in several Dutch health care settings. This collaborative care model is a feasible and effective model for integrated care in several health care settings. The Bio Psycho Social System has been developed as a feasible instrument for assessment in integrated care as well.Discussion: The discipline of Psychiatry has moved from anti-psychiatry in the last century, towards an emancipated medical discipline. This enabled big advances towards integrated care for mental disorder, in collaboration with other medical disciplines, in the last decade.Conclusion: Now is the time to further expand this concept of care towards other mental disorders, and towards integrated care for medical and mental co-morbidity. Integrated care for mental disorder should be readily available to the patient, according to his/her preference, taking somatic co-morbidity into account, and with a focus on rehabilitation of the patient in his or her social roles.

  16. Ten years integrated care for mental disorders in the Netherlands

    Directory of Open Access Journals (Sweden)

    Christina M van der Feltz-Cornelis

    2011-03-01

    Full Text Available Background and problem statement: Integrated care for mental disorders aims to encompass forms of collaboration between different health care settings for the treatment of mental disorders. To this end, it requires integration at several levels, i.e. integration of psychiatry in medicine, of the psychiatric discourse in the medical discourse; of localization of mental health care and general health care facilities; and of reimbursement systems.   Description of policy practice: Steps have been taken in the last decade to meet these requirements, enabling psychiatry to move on towards integrated treatment of mental disorder as such, by development of a collaborative care model that includes structural psychiatric consultation that was found to be applicable and effective in several Dutch health care settings. This collaborative care model is a feasible and effective model for integrated care in several health care settings. The Bio Psycho Social System has been developed as a feasible instrument for assessment in integrated care as well. Discussion: The discipline of Psychiatry has moved from anti-psychiatry in the last century, towards an emancipated medical discipline. This enabled big advances towards integrated care for mental disorder, in collaboration with other medical disciplines, in the last decade. Conclusion: Now is the time to further expand this concept of care towards other mental disorders, and towards integrated care for medical and mental co-morbidity. Integrated care for mental disorder should be readily available to the patient, according to his/her preference, taking somatic co-morbidity into account, and with a focus on rehabilitation of the patient in his or her social roles.

  17. Ten Things Lesbians Should Discuss with Their Health Care Provider

    Science.gov (United States)

    ... yearly medical exams for high blood pressure, cholesterol problems, and diabetes. Health care providers can also offer ... risk of cancer, liver disease and other health problems. 8. Substance Use Lesbians may use drugs more ...

  18. Application of TQM to mental health: lessons from ten mental health centers.

    Science.gov (United States)

    Sluyter, G V

    1996-01-01

    The principles and techniques of total quality management (TQM) have only recently been applied to the field of mental health. This article reviews issues and offers some preliminary observations, based on the author's consultation and training work with ten state-operated mental health organizations in Missouri (Jul 1, 1994-Jun 30, 1995). Since many mental health organizations have operated in the public sector as part of large, hierarchical state agencies, the legacy of bureaucratic structures and a command and control leadership style may pose additional challenges. Two types of training have proven helpful in the Missouri project: general overview or awareness training for all staff and specialized training for team leaders and facilitators. To be successful with TQM, mental health organizations should clearly delineate their governing ideas, continuously reinforce them with all staff, and use the ideas as a measuring stick for progress. Some of the organizations in the Missouri project link their governing ideas and strategic planning efforts with critical success factors and the measurement methodology to track them. This dimension, which may include a quality council, a quality department, and quality improvement (QI) teams, also extends to the way in which facilities are organized and function. The structure evolving from a team-oriented, time-limited, data-based, and problem-solving approach can facilitate the functioning of the entire organization. The philosophy and techniques of TQM are as applicable to mental health as to health care in general--the question is one more of motivation than of fit.

  19. International Space Station Passive Thermal Control System Analysis, Top Ten Lessons-Learned

    Science.gov (United States)

    Iovine, John

    2011-01-01

    The International Space Station (ISS) has been on-orbit for over 10 years, and there have been numerous technical challenges along the way from design to assembly to on-orbit anomalies and repairs. The Passive Thermal Control System (PTCS) management team has been a key player in successfully dealing with these challenges. The PTCS team performs thermal analysis in support of design and verification, launch and assembly constraints, integration, sustaining engineering, failure response, and model validation. This analysis is a significant body of work and provides a unique opportunity to compile a wealth of real world engineering and analysis knowledge and the corresponding lessons-learned. The analysis lessons encompass the full life cycle of flight hardware from design to on-orbit performance and sustaining engineering. These lessons can provide significant insight for new projects and programs. Key areas to be presented include thermal model fidelity, verification methods, analysis uncertainty, and operations support.

  20. A Good Supervisor--Ten Facts of Caring Supervision

    Science.gov (United States)

    Määttä, Kaarina

    2015-01-01

    This article describes the elements of caring supervision of doctoral theses. The purpose was to describe the best practices as well as challenges of supervision especially from the supervisor's perspective. The analysis is based on the author's extensive experience as a supervisor and related data obtained for research and developmental purposes.…

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

    Science.gov (United States)

    Steinberg, Allen T

    2015-01-01

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

  2. Ten Things Transgender Persons Should Discuss with Their Health Care Provider

    Science.gov (United States)

    ... Conference Newsroom Support GLMA Site Search Ten Things Transgender Persons Should discuss with Their Healthcare Care Provider ( ... have identified as most commonly of concern for transgender persons. While not all of these items apply ...

  3. Pain management: lessons from palliative care.

    Science.gov (United States)

    Langlois, John P

    2013-01-01

    Reducing suffering and helping patients to control their symptoms are key components of palliative care. This commentary will offer a comprehensive definition of palliative care and will present a case history to illustrate how palliative care can benefit patients with chronic pain.

  4. Lessons from the Institute for New Heads (INH) Class of 2006: Ten Headships--134 Years of Hard-Earned Experience

    Science.gov (United States)

    Raphel, Annette; Huber, John; Chandler, Carolyn; Vorenberg, Amy; Jones-Wilkins, Andy; Devey, Mark A.; Holford, Josie; Craig, Ian; Elam, Julie

    2016-01-01

    Ten years ago in July 2006, 64 mostly starry-eyed men and women attended the NAIS Institute for New Heads (INH) in order to learn the ropes of headship. These newly minted heads were filled with enthusiasm, commitment, and passion, along with humility and a bit of healthy trepidation. One core group connected under the careful guidance of…

  5. Lessons from a Transgender Patient for Health Care Professionals.

    Science.gov (United States)

    Sallans, Ryan K

    2016-11-01

    It is not uncommon for transgender patients to avoid sharing information about their identity and medical history with health care professionals, due to past negative experiences within health care settings. Professionals who show sensitivity to the topic and express care about health record documentation can increase a transgender patient's trust. There are many opportunities to increase transgender health literacy, including consultation, conferences, webinars, books, and articles focused on transgender health care. It's critical for professionals to listen closely to individual patients' stated needs. This article shares one transgender patient's encounters and experiences within health care settings and offers lessons on how health care professionals can be more inclusive, respectful, and responsive to the needs of transgender patients.

  6. Pediatric Care Coordination: Lessons Learned and Future Priorities.

    Science.gov (United States)

    Cady, Rhonda G; Looman, Wendy S; Lindeke, Linda L; LaPlante, Bonnie; Lundeen, Barbara; Seeley, Amanda; Kautto, Mary E

    2015-09-30

    A fundamental component of the medical home model is care coordination. In Minnesota, this model informed design and implementation of the state's health care home (HCH) model, a key element of statewide healthcare reform legislation. Children with medical complexity (CMC) often require care from multiple specialists and community resources. Coordinating this multi-faceted care within the HCH is challenging. This article describes the need for specialized models of care coordination for CMC. Two models of care coordination for CMC were developed to address this challenge. The TeleFamilies Model of Pediatric Care Coordination uses an advanced practice registered nurse care (APRN) coordinator embedded within an established HCH. The PRoSPer Model of Pediatric Care Coordination uses a registered nurse/social worker care coordinator team embedded within a specialty care system. We describe key findings from implementation of these models, and conclude with lessons learned. Replication of the models is encouraged to increase the evidence base for care coordination for the growing population of children with medical complexities.

  7. Coordinating health care: lessons from Norway

    Directory of Open Access Journals (Sweden)

    Trond Tjerbo

    2005-11-01

    Full Text Available Objective: What influences the coordination of care between general practitioners and hospitals? In this paper, general practitioner satisfaction with hospital—GP interaction is revealed, and related to several background variables. Method: A questionnaire was sent to all general practitioners in Norway (3388, asking their opinion on the interaction and coordination of health care in their district. A second questionnaire was sent to all the somatic hospitals in Norway (59 regarding formal routines and structures. The results were analysed using ordinary least squares regression. Results: General practitioners tend to be less satisfied with the coordination of care when their primary hospital is large and cost-effective with a high share of elderly patients. Together with the degree to which the general practitioner is involved in arenas where hospital physicians and general practitioners interact, these factors turned out to be good predictors of general practitioner satisfaction. Implication: To improve coordination between general practitioners and specialists, one should focus upon the structural traits within the hospitals in different regions as well as creating common arenas where the physicians can interact.

  8. The top ten list: lessons learned from teaching a study abroad course.

    Science.gov (United States)

    Kostovich, Carol T; Bermele, Charlene A

    2011-01-01

    In response to the need for culturally competent care, faculty can instill in students the desire to become culturally competent practitioners by providing the opportunity to participate in a short-term study abroad immersion experience. While this strategy is not considered cutting-edge or revolutionary, changing global dynamics warrant rethinking this curricular option. Nurse faculty conducted two short-term study abroad courses in Croatia. Students explored health care and nursing education in this Eastern European country and participated in a service-learning project. Based on their experiences, the authors offer five dos and five don'ts for planning and implementing a successful study abroad course.

  9. Ten patients with refractory status epilepticus in an intensive care department

    NARCIS (Netherlands)

    ter Maaten, JC; van Schijndel, RJM; Heimans, JJ; Schreuder, WO

    1998-01-01

    Status epilepticus (SE) is a serious disease, associated with a high morbidity and mortality, particularly if refractory to initial therapy. We describe the clinical manifestations and outcome in ten cases with refractory SE admitted to our medical intensive care unit. Three of these selected group

  10. Lessons from England's health care workforce redesign: no quick fixes.

    Science.gov (United States)

    Bohmer, Richard M J; Imison, Candace

    2013-11-01

    In 2000 the English National Health Service (NHS) began a series of workforce redesign initiatives that increased the number of doctors and nurses serving patients, expanded existing staff roles and developed new ones, redistributed health care work, and invested in teamwork. The English workforce redesign experience offers important lessons for US policy makers. Redesigning the health care workforce is not a quick fix to control costs or improve the quality of care. A poorly planned redesign can even result in increased costs and decreased quality. Changes in skill mix and role definitions should be preceded by a detailed analysis and redesign of the work performed by health care professionals. New roles and responsibilities must be clearly defined in advance, and teamwork models that include factors common in successful redesigns such as leadership, shared objectives, and training should be promoted. The focus should be on retraining current staff instead of hiring new workers. Finally, any workforce redesign must overcome opposition from professional bodies, individual practitioners, and regulators. England's experience suggests that progress is possible if workforce redesigns are planned carefully and implemented with skill.

  11. Medical care reform: lessons from around the world.

    Science.gov (United States)

    Rohrer, J E

    1997-01-01

    Once again the United States is in a ferment of health policy reform. Proposals abound but sage observers remark that national health insurance has been "just around the corner" more than once in the last forty years. This time may be different, however. Proposals from all across the ideological spectrum are converging on the notion of "managed care" which is perhaps best known in its guise as a health maintenance organization (HMO). Other forms of managed care exist but they have neither the history nor the incentives found in traditional HMOs. The discussion on national health insurance (NHI) proposals has focused on financing issues to the virtual exclusion of public health concerns. In this article, the author addresses rural health and public hospitals in the United States; two problems that have been with us for a long time. Then articles examining the Canadian and English medical care systems are reviewed, illustrating some of the weaknesses of these approaches to national medical care. Research studies relating to Europe and the developing nations are next. Once again, these are intended to highlight public health problems found in differing medical care systems. Finally, the author examines utopian views of the United States medical care system of the future: the reform proposal offered by the National Association for Public Health Policy, the experimental policy in Washington State, and a vision of a planned system. The review is intended to draw together the lessons offered by public health policy research in other countries and the United States and apply them to the issue at hand: reforming the United States medical care system.

  12. Reporting and Charting Residents' Behaviors and Care in an Adult Residential Care Home. Adult Residential Care Home 12, Lesson Plan No. 2.

    Science.gov (United States)

    Basuel, Terry

    Designed as part of a 40-hour course on adult residential care homes (ARCH's), this lesson plan was developed to explain the importance of and correct procedures for charting (i.e., keeping a written record of observations and care of ARCH residents). The objectives of the 50-minute lesson are to enable students to: (1) list reasons why the…

  13. Implementation of emergency obstetric care training in Bangladesh: lessons learned.

    Science.gov (United States)

    Islam, Mohammad Tajul; Haque, Yasmin Ali; Waxman, Rachel; Bhuiyan, Abdul Bayes

    2006-05-01

    The Women's Right to Life and Health project aimed to reduce maternal morbidity and mortality in Bangladesh through provision of comprehensive emergency obstetric care (EmOC) in the country's district and sub-district hospitals. Human resources development was one of the project's major activities. This paper describes the project in 2000-2004 and lessons learned. Project documents, the training database, reports and training protocols were reviewed. Medical officers, nurses, facility managers and laboratory technicians received training in the country's eight medical college hospitals, using nationally accepted curricula. A 17-week competency-based training course for teams of medical officers and nurses was introduced in 2003. At baseline in 1999, only three sub-district hospitals were providing comprehensive EmOC and 33 basic EmOC, mostly due to lack of trained staff and necessary equipment. In 2004, 105 of the 120 sub-district hospitals had become functional for EmOC, 70 with comprehensive EmOC and 35 with basic EmOC, while 53 of 59 of the district hospitals were providing comprehensive EmOC compared to 35 in 1999. The scaling up of competency-based training, innovative incentives to retain trained staff, evidence-based protocols to standardise practice and improve quality of care and the continuing involvement of key stakeholders, especially trainers, will all be needed to reach training targets in future.

  14. Combining prevention, treatment and care: lessons from South Africa.

    Science.gov (United States)

    Achmat, Zackie; Simcock, Julian

    2007-07-01

    Over one million people in sub-Saharan Africa now access HIV treatment, and as the prognosis of life expectancy on antiretroviral therapy (ART) improves, the central question that arises for governments, civil society and the private sector must be: how will we pay for the healthcare costs?This paper critically evaluates the need to provide effective treatment, prevention and care for HIV over the long term. Compelling evidence and moral argument suggest that the right combination of treatment and prevention policies, bolstered by grassroots mobilization and effective treatment literacy campaigns, can prevent new infections, save lives and mitigate the impact of HIV/AIDS. South Africa's HIV epidemic and its antiretroviral roll-out provide instructive global templates. The scale of the epidemic, the political responses, the epidemiological evidence and the outcomes data are lessons for countries where there is only a low-level epidemic at present. The investment needed to provide universal ART in South Africa will be substantial, but the economic rationale to act now is compelling. Brazil and to a lesser extent Thailand have responded with increased urgency and foresight. When compared with South Africa, their successes lend further credence to the importance of augmenting HIV prevention efforts with widespread access to treatment and care. Despite the obstacles, important gains have been made in South Africa, with community level health facilities documenting noteworthy treatment and adherence results. Our example suggests that even after tragic mistakes have been made, collective action, evidence-informed programmes, and sustained investment can still save lives and mitigate the epidemic.

  15. Writing the new playbook for U.S. health care: lessons from Wisconsin.

    Science.gov (United States)

    Toussaint, John

    2009-01-01

    U.S. taxpayers waste far too much money on health care that is merely average or worse. Some health care providers, including ThedaCare, a major Wisconsin health care company, are using the tools of lean manufacturing to eliminate millions of dollars of waste that obstructs the provision of effective medicine. ThedaCare studies care delivery processes to improve care and lower costs. Lessons from lean manufacturing and the Institute for Healthcare Improvement are lowering incidence of preterm births, improving heart attack response rates, and changing the way care is delivered in hospitals to a collaborative, team-based approach.

  16. Expansion of the Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding into Neonatal Intensive Care : Expert Group Recommendations

    NARCIS (Netherlands)

    Nyqvist, Kerstin H.; Haggkvist, Anna-Pia; Hansen, Mette N.; Kylberg, Elisabeth; Frandsen, Annemi L.; Maastrup, Ragnhild; Ezeonodo, Aino; Hannula, Leena; Haiek, Laura N.

    2013-01-01

    In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different s

  17. Ten years of sustainability evaluation using the MESMIS framework: Lessons learned from its application in 28 Latin American case studies

    NARCIS (Netherlands)

    Speelman, E.N.; López Ridaura, S.; Aliana-Colomer, N.; Astier, M.; Masera, O.

    2007-01-01

    This paper focuses on sustainability evaluation and, more specifically, it describes and analyses the Indicator-based Framework for Evaluation of Natural Resource Management Systems (MESMIS, its Spanish acronym), ten years after its development. This framework fulfilled a pioneering role by proposin

  18. Musings on management. Ten ideas designed to rile everyone who cares about management.

    Science.gov (United States)

    Mintzberg, H

    1996-01-01

    Henry Mintzberg, a professor of management at McGill University in Canada and at INSEAD in France, takes aim at the hype surrounding management fads and gurus and dares to suggest that the emperor has no clothes. In order to rile all who care about management and get them thinking creatively, he presents ten contrarian observations on such topics as the meanness of leanness, the folly of CEOs who fancy themselves strategists, the disempowering that so-called empowerment creates, the myopia of purely financial measures, and the inadequacy of M.B.A. programs. Mintzberg maintains, for example, that it is time to delayer the delayerers. He argues that delayering has created more problems than it has solved be cause it is, in essence, a process by which people who barely know what's going on get rid of those who do--a process ensuring that the real database of the organization, the key to what was its future, lines up at the unemployment office. Too many managers, he says, dream of becoming the next turnaround doctor. They fail to understand that great organizations, once created, don't need great leaders: if a company can't function on its own, a hero won't help. A leader who draws out the knowledge embedded in all parts of an organization is a leader who can help a company function alone--without heroes. Such leaders often practice what Mintzberg calls the craft style of management (as opposed to the professional style or the boss style). It is about inspiring, not empowering. It is based on mutual respect rooted in common experience and offers hope for improving what is now wrong with management.

  19. Keep It Simple: A Lesson in Linking Teens to Health Care

    Science.gov (United States)

    Eisler, Alexandra; Avellino, Lia; Chilcoat, Deborah; Schlanger, Karen

    2016-01-01

    The "Keep It Simple" package, which includes a short animated film (available online for streaming or download), a lesson plan, and supporting materials, was designed to be used with adolescents ages 15-19 to empower them to seek sexual and reproductive health care, and emphasize the availability of long-acting reversible contraception…

  20. Keep It Simple: A Lesson in Linking Teens to Health Care

    Science.gov (United States)

    Eisler, Alexandra; Avellino, Lia; Chilcoat, Deborah; Schlanger, Karen

    2016-01-01

    The "Keep It Simple" package, which includes a short animated film (available online for streaming or download), a lesson plan, and supporting materials, was designed to be used with adolescents ages 15-19 to empower them to seek sexual and reproductive health care, and emphasize the availability of long-acting reversible contraception…

  1. European long-term care programs: lessons for community living assistance services and supports?

    Science.gov (United States)

    Nadash, Pamela; Doty, Pamela; Mahoney, Kevin J; Von Schwanenflugel, Matthias

    2012-02-01

    To uncover lessons from abroad for Community Living Assistance Services and Supports (CLASS), a federally run voluntary public long-term care (LTC) insurance program created under the Accountable Care Act of 2010. Program administrators and policy researchers from Austria, England, France, Germany, and the Netherlands. Qualitative methods focused on key parameters of cash for care: how programs set benefit levels; project expenditures; control administrative costs; regulate the use of benefits; and protect workers. Structured discussions were conducted during an international conference of LTC experts, followed by personal meetings and individual correspondence. Germany's self-financing mandate and tight targeting of benefits have resulted in a solvent program with low premiums. Black markets for care are likely in the absence of regulation; France addresses this via a unique system ensuing legal payment of workers. Programs in the five countries studied have lessons, both positive and negative, relevant to CLASS design. © Health Research and Educational Trust.

  2. Expansion of the ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations for three guiding principles.

    Science.gov (United States)

    Nyqvist, Kerstin Hedberg; Häggkvist, Anna-Pia; Hansen, Mette Ness; Kylberg, Elisabeth; Frandsen, Annemi Lyng; Maastrup, Ragnhild; Ezeonodo, Aino; Hannula, Leena; Koskinen, Katja; Haiek, Laura N

    2012-08-01

    The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose, an expert group from the Nordic countries and Quebec, Canada, prepared a draft proposal, which was discussed at an international workshop in Uppsala, Sweden, in September 2011. The expert group suggests the addition of 3 "Guiding Principles" to the Ten Steps to support this vulnerable population of mothers and infants: 1. The staff attitude to the mother must focus on the individual mother and her situation. 2. The facility must provide family-centered care, supported by the environment. 3. The health care system must ensure continuity of care, that is, continuity of pre-, peri-, and postnatal care and post-discharge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care.

  3. Expansion of the ten steps to successful breastfeeding into neonatal intensive care

    DEFF Research Database (Denmark)

    Nyqvist, Kerstin Hedberg; Häggkvist, Anna-Pia; Hansen, Mette Ness

    2012-01-01

    The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose,...... to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care....

  4. Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care

    DEFF Research Database (Denmark)

    Nyqvist, Kerstin H; Häggkvist, Anna-Pia; Hansen, Mette N

    2013-01-01

    In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different...... situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including...... at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up....

  5. A sustainable primary care system: lessons from the Netherlands.

    NARCIS (Netherlands)

    Faber, M.J.; Burgers, J.S.; Westert, G.P.

    2012-01-01

    The Dutch primary care system has drawn international attention, because of its high performance at low cost. Primary care practices are easily accessible during office hours and collaborate in a unique out-of-hours system. After the reforms in 2006, there are no copayments for patients receiving ca

  6. Ten million and one penguins, or, lessons learned from booting millions of virtual machines on HPC systems.

    Energy Technology Data Exchange (ETDEWEB)

    Minnich, Ronald G.; Rudish, Donald W.

    2009-01-01

    Sandia National Laboratories, we are striving to understand the global network behavior of botnets. We are planning to take existing botnets, as found in the wild, and run them on HPC systems. We have turned to HPC systems to support the creation and operation of millions of Linux virtual machines as a means of observing the interaction of the botnet and other noninfected hosts. We started out using traditional HPC tools, but these tools are designed for a much smaller scale, typically topping out at one to ten thousand machines. HPC programming libraries and tools also assume complete connectivity between all nodes, with the attendant configuration files and data structures to match; this assumption holds up very poorly on systems with millions of nodes.

  7. Continuity in health care: lessons from supply chain management.

    Science.gov (United States)

    Meijboom, Bert R; Bakx, Saskia J W G C; Westert, Gert P

    2010-01-01

    In health care, multidisciplinary collaboration is both indispensable and complicated. We discuss organizational problems that occur in situations where multiple health care providers are required to cooperate for patients with complex needs. Four problem categories, labelled as communication, patient safety, waiting times and integration are distinguished. Then we develop a supply chain perspective on these problems in the sense of discussing remedies according to supply chain management (SCM) literature. This perspective implies a business focus on inter-organizational conditions and requirements necessary for delivering health care and cure across organizational borders. We conclude by presenting some strategic and policy recommendations.

  8. TQM STRATEGIES AND HEALTH CARE DELIVERIES: LESSONS FROM NIGERIA

    Directory of Open Access Journals (Sweden)

    Olawale Ibrahim Olateju

    2007-10-01

    Full Text Available We examine the TQM Strategies and health care delivery in Nigeria, and the various means of measuring service quality. Nigeria continues to suffer outbreaks of various diseases cholera, malaria, cerebrospinal meningitis, measles, yellow fever, Bird flu e.t.c., all these diseases combine to cause high morbidity and mortality in the population. To assess the situation this paper looks at the relevant indicators like Annual Budgets by Government, Individual’s income, the role of Nigerian Medical Association (NMA and various health care agencies vested with the sole responsibility for elaborating standards for products and processes in Health care Delivery.The paper also examines the implication of Government Budget estimates on the Life expectancy of an average Nigerian. The findings necessitated the need for the government to seek support from WHO to assist in strengthening the health care system by advocating and providing technical support to health sector reforms.

  9. Massachusetts health care reform and orthopaedic trauma: lessons learned.

    Science.gov (United States)

    Harris, Mitchel B

    2014-10-01

    Massachusetts was the first state to implement its own version of the Affordable Care Act (ACA), when it passed the Massachusetts Health Care Reform (MHR) in 2006. Similar to the ACA, its explicit purpose was universal access to health care to all residents of Massachusetts. We believe that the influence of MHR on orthopaedic trauma in Massachusetts will have implications on trauma systems across the country, given the similarities between ACA and MHR. Therefore, in this article, we discuss our experiences as Orthopaedic trauma surgeons with regard to MHR. In this regard, we reviewed the effects of the implementation of MHR on the orthopaedic trauma services at 3 of the 4 level one trauma centers in Boston, MA. Our results demonstrate a dramatic reduction in the proportion of uncompensated care at these centers in addition to the number of uninsured patients with orthopaedic trauma injuries.

  10. Ethical issues in health care institutions. Lesson 2: Ethical considerations in group decision making and groupthink.

    Science.gov (United States)

    Alie, R E

    1991-01-01

    In this second lesson of a five-part WMU/AHRA magazine course on ethics, Dr. Alie tackles an interesting concept--group-think. According to the author, this tendency occurs when cohesive groups lose their ability to critically evaluate alternatives in problem solving. Since groups such as committees or task forces frequently resolve issues and make policy in health care organizations, warning signs of this phenomenon are detailed as well as suggestions to help avoid the problem.

  11. Integrating TeamSTEPPS(®) into ambulatory reproductive health care: Early successes and lessons learned.

    Science.gov (United States)

    Paul, Maureen E; Dodge, Laura E; Intondi, Evelyn; Ozcelik, Guzey; Plitt, Ken; Hacker, Michele R

    2017-04-01

    Most medical teamwork improvement interventions have occurred in hospitals, and more efforts are needed to integrate them into ambulatory care settings. In 2014, Affiliates Risk Management Services, Inc. (ARMS), the risk management services organization for a large network of reproductive health care organizations in the United States, launched a voluntary 5-year initiative to implement a medical teamwork system in this network using the TeamSTEPPS model. This article describes the ARMS initiative and progress made during the first 2 years, including lessons learned. The ARMS TeamSTEPPS program consists of the following components: preparation of participating organizations, TeamSTEPPS master training, implementation of teamwork improvement programs, and evaluation. We used self-administered questionnaires to assess satisfaction with the ARMS program and with the master training course. In the first 2 years, 20 organizations enrolled. Participants found the preparation phase valuable and were highly satisfied with the master training course. Although most attendees felt that the course imparted the knowledge and tools critical for TeamSTEPPS implementation, they identified time restraints and competing initiatives as potential barriers. The project team has learned valuable lessons about obtaining buy-in, consolidating the change teams, making the curriculum relevant, and evaluation. Ambulatory care settings require innovative approaches to integration of teamwork improvement systems. Evaluating and sharing lessons learned will help to hone best practices as we navigate this new frontier in the field of patient safety. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

  12. The standard of medical care under the Australian Civil Liability Acts: ten years on.

    Science.gov (United States)

    Lee, Joseph

    2014-12-01

    It has been more than a decade since the modified Bolam test was legislatively enacted.by the Australian States following the medical indemnity crisis. Since its implementation, the modified Bolam test has been configured by judges as a defence to the common law standard of care in medical diagnosis and treatment. The article argues against this interpretation and suggests an alternative way of implementing this statutory test. It is proposed that the modified Bolam test ought to have been applied as a single yardstick to determine the required standard of care in diagnosis and treatment. Changes are also recommended to reform the test with a view to striking a balance between the interests of patients and doctors in medical disputes, and strengthening judicial supervision of the medical profession. These proposed reforms could resolve the shortcomings of the common law more effectively. They may also enhance the standard of medical care in Australia in the long run.

  13. Public private partnerships for emergency obstetric care: Lessons from Maharashtra

    OpenAIRE

    Sarika Chaturvedi; Bharat Randive

    2011-01-01

    Background: The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its "service guarantee" of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Me...

  14. Exporting the Buyers Health Care Action Group purchasing model: lessons from other communities.

    Science.gov (United States)

    Christianson, Jon B; Feldman, Roger

    2005-01-01

    When first implemented in Minneapolis and St. Paul, Minnesota, the Buyers Health Care Action Group's (BHCAG) purchasing approach received considerable attention as an employer-managed, consumer-driven health care model embodying many of the principles of managed competition. First BHCAG and, later, a for-profit management company attempted to export this model to other communities. Their efforts were met with resistance from local hospitals and, in many cases, apathy by employers who were expected to be supportive. This experience underscores several difficulties that appear to be inherent in implementing purchasing models based on competing care systems. It also, once again, suggests caution in drawing lessons from community-level experiments in purchasing health care.

  15. Maintaining quality of care while reducing charges in the ICU. Ten ways.

    Science.gov (United States)

    Civetta, J M; Hudson-Civetta, J A

    1985-01-01

    We believed that the dilemma of controlling costs yet maintaining quality of care might be approached in 10 ways designed to improve efficiency of care: principles of management, elimination of standing orders, classification of patients, written guidelines, mandatory communication, no repetitive orders, single order for single test, removal of monitoring catheters, constant administrative attention, and feedback. We monitored quality of care using the therapeutic intervention scoring system (TISS), mortality, utilization of bed days in the ICU, and the total hospitalization of 50 patients treated in April 1983 and, 8 months after the interventions, 50 patients treated in February 1984. There were no differences in the patient population, severity, outcome, or days. The total lab bills were $10,000 in 1983 and $6300 in 1984 (p less than 0.01). The total number of tests decreased by 2803 (42%) from 6685 to 3882, or 56 per patient per admission. Calculated ICU laboratory charges per patient decreased $3226 (53%) from $6210 to $2894. In 1983, while patients spent 15% of their hospital days in the ICU, they accumulated 61% of their total laboratory charges. In 1984, ICU days were 19% and ICU laboratory charges were 46% of the total. If the decrease of $3226 per patient is extrapolated to a year's population, this would decrease charges by over $2,000,000 in one 12-bed surgical ICU. PMID:4051601

  16. Diez cuestiones inquietantes en cuidados paliativos Ten worrying questions in palliative care

    Directory of Open Access Journals (Sweden)

    J. Barbero

    2007-01-01

    Full Text Available Desde los años noventa se está produciendo en nuestro país un creciente desarrollo en el cuidado y atención del paciente al final de la vida, como respuesta a una realidad palpable: más de la mitad de los fallecimientos ocurren por una enfermedad en situación avanzada o terminal. Los cuidados paliativos se han presentado como el modelo idóneo para abordar esta situación del final de la vida, complementando la tarea de la red normalizada de atención primaria y hospitalaria. Veinte años después del comienzo de la actividad paliativa en España, nos planteamos si es tal y como se refleja sobre el papel, en las estrategias y planes de los distintos sistemas de salud, nacionales y regionales o es que nos hemos anclado, simplemente, en el mundo del deseo. Como destaca la Organización Mundial de la Salud (OMS, los cuidados paliativos son uno de los pilares de la atención a los pacientes con cáncer y otros procesos crónicos en fases avanzadas y terminal, pero será necesario revisar si la presencia, la accesibilidad y la calidad de dichos cuidados es la que se merecen los ciudadanos. En este trabajo se plantean una serie de cuestiones inquietantes sobre los cuidados paliativos con el fin de reflexionar acerca de las posibilidades de mejora en este ámbito.Since the 1990s in our country, there has been a growing development of care and attention to the patient at the end of his/her life, as a response to a tangible reality: more than half of deaths occur due to a disease in an advanced or terminal state. Palliative care has proved to be the most suitable model for dealing with this situation of the end of life, complementing the task of the normalised network of primary and hospital care. Twenty years after the start of palliative activity in Spain, we ask whether its practice, in the strategies and plans of the different national and regional health systems, corresponds to what is set out on paper, or whether this simply reflects wishful

  17. Lessons learnt from a primary care asthma improvement project.

    Science.gov (United States)

    Lenney, Warren; Clayton, Sadie; Gilchrist, Francis J; Price, David; Small, Iain; Smith, Judy; Sutton, Emma J

    2016-01-07

    Asthma is a very common disease that can occur at any age. In the UK and in many other countries it is mainly managed in primary care. The published evidence suggests that the key to improving diagnosis and management lies in better training and education rather than in the discovery of new medications. An asthma improvement project managed through the British Lung Foundation is attempting to do this. The project has three pilot sites: two in England supported by the Department of Health and one in Scotland supported by the Scottish Government. If the project is successful it will be rolled out to other health areas within the UK. The results of this project are not yet available. This article highlights the challenges encountered in setting up the project and may well be applicable to other areas in the UK and to other countries where similar healthcare systems exist. The encountered challenges reflect the complex nature of healthcare systems and electronic data capture in primary care. We discuss the differences between general practices in their ability and willingness to support the project, the training and education of their staff on asthma management, governance issues in relation to information technology systems, and the quality of data capture. Virtually all the challenges have now been overcome, but discussing them should ensure that others become aware of them at an early stage should they wish to undertake similar projects in the future.

  18. Lessons from the business sector for successful knowledge management in health care: a systematic review.

    Science.gov (United States)

    Kothari, Anita; Hovanec, Nina; Hastie, Robyn; Sibbald, Shannon

    2011-07-25

    The concept of knowledge management has been prevalent in the business sector for decades. Only recently has knowledge management been receiving attention by the health care sector, in part due to the ever growing amount of information that health care practitioners must handle. It has become essential to develop a way to manage the information coming in to and going out of a health care organization. The purpose of this paper was to summarize previous studies from the business literature that explored specific knowledge management tools, with the aim of extracting lessons that could be applied in the health domain. We searched seven databases using keywords such as "knowledge management", "organizational knowledge", and "business performance". We included articles published between 2000-2009; we excluded non-English articles. 83 articles were reviewed and data were extracted to: (1) uncover reasons for initiating knowledge management strategies, (2) identify potential knowledge management strategies/solutions, and (3) describe facilitators and barriers to knowledge management. KM strategies include such things as training sessions, communication technologies, process mapping and communities of practice. Common facilitators and barriers to implementing these strategies are discussed in the business literature, but rigorous studies about the effectiveness of such initiatives are lacking. The health care sector is at a pinnacle place, with incredible opportunities to design, implement (and evaluate) knowledge management systems. While more research needs to be done on how best to do this in healthcare, the lessons learned from the business sector can provide a foundation on which to build.

  19. Ten steps to establishing an e-consultation service to improve access to specialist care.

    Science.gov (United States)

    Liddy, Clare; Maranger, Julie; Afkham, Amir; Keely, Erin

    2013-12-01

    There is dissatisfaction among primary care physicians, specialists, and patients with respect to the consultation process. Excessive wait times for receiving specialist services and inefficient communication between practitioners result in decreased access to care and jeopardize patient safety. We created and implemented an electronic consultation (e-consultation) system in Eastern Ontario to address these problems and improve the consultation process. The e-consultation system has passed through the proof-of-concept and pilot study stages and has effectively reduced unnecessary referrals while receiving resoundingly positive feedback from physician-users. Using our experience, we have outlined the 10 steps to developing an e-consultation service. We detail the technical, administrative, and strategic considerations with respect to (1) identifying your partners, (2) choosing your platform, (3) starting as a pilot project, (4) designing your product, (5) ensuring patient privacy, (6) thinking through the process, (7) fostering relationships with your participants, (8) being prepared to provide physician payment, (9) providing feedback, and (10) planning the transition from pilot to permanency. In following these 10 steps, we believe that the e-consultation system and its associated improvements on the consultation process can be effectively implemented in other healthcare settings.

  20. Local environment but not genetic differentiation influences biparental care in ten plover populations.

    Directory of Open Access Journals (Sweden)

    Orsolya Vincze

    Full Text Available Social behaviours are highly variable between species, populations and individuals. However, it is contentious whether behavioural variations are primarily moulded by the environment, caused by genetic differences, or a combination of both. Here we establish that biparental care, a complex social behaviour that involves rearing of young by both parents, differs between closely related populations, and then test two potential sources of variation in parental behaviour between populations: ambient environment and genetic differentiation. We use 2904 hours behavioural data from 10 geographically distinct Kentish (Charadrius alexandrinus and snowy plover (C. nivosus populations in America, Europe, the Middle East and North Africa to test these two sources of behavioural variation. We show that local ambient temperature has a significant influence on parental care: with extreme heat (above 40 °C total incubation (i.e. % of time the male or female incubated the nest increased, and female share (% female share of incubation decreased. By contrast, neither genetic differences between populations, nor geographic distances predicted total incubation or female's share of incubation. These results suggest that the local environment has a stronger influence on a social behaviour than genetic differentiation, at least between populations of closely related species.

  1. Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations.

    Science.gov (United States)

    Nyqvist, Kerstin H; Häggkvist, Anna-Pia; Hansen, Mette N; Kylberg, Elisabeth; Frandsen, Annemi L; Maastrup, Ragnhild; Ezeonodo, Aino; Hannula, Leena; Haiek, Laura N

    2013-08-01

    In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.

  2. Public private partnerships for emergency obstetric care: Lessons from Maharashtra

    Directory of Open Access Journals (Sweden)

    Sarika Chaturvedi

    2011-01-01

    Full Text Available Background: The National Rural Health Mission of India advocates public private partnerships (PPPs to meet its "service guarantee" of Emergency obstetric care (EmOC provision. The Janani Suraksha Yojana (JSY has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Methods: A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. Results: The PPP scheme for EmOC is restricted to deliveries by Caesarean section. The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. Conclusion: The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs.

  3. Public private partnerships for emergency obstetric care: lessons from maharashtra.

    Science.gov (United States)

    Chaturvedi, Sarika; Randive, Bharat

    2011-01-01

    The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its "service guarantee" of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. The PPP scheme for EmOC is restricted to deliveries by Caesarean section.The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs.

  4. When big isn't beautiful: lessons from England and Scotland on primary health care organisations.

    Science.gov (United States)

    Dunbar, James A

    2011-08-15

    United Kingdom primary care trusts resembled the primary health care organisations (PHCOs) that have been proposed for Australia--for example, Medicare Locals. They resulted in a loss of innovation, creativity, motivation and morale among general practitioners and other front-line staff. English primary care trusts are being abolished and £80 billion will be handed over to GP commissioners. Management theory and practical experience shows repeatedly the dangers of reorganising into larger units. Lessons for Australia are to defer deciding on the size of PHCOs until their purposes are clear, to enshrine the principle of subsidiarity, and to opt for networking of the current Divisions of General Practice over mergers. So far, debate on the functions and structures of PHCOs has been muted. It is now time for vigorous debate.

  5. The Spanish long-term care system in transition: Ten years since the 2006 Dependency Act.

    Science.gov (United States)

    Peña-Longobardo, Luz María; Oliva-Moreno, Juan; García-Armesto, Sandra; Hernández-Quevedo, Cristina

    2016-10-01

    At the end of 2006, a new System for Promotion of Personal Autonomy and Assistance for Persons in a Situation of Dependency (SAAD) was established in Spain through the approval of the Act 39/2006 of 14th December (the Dependency Act, DA). The DA acknowledged the universal entitlement of Spanish citizens to social services. The recent economic crisis added degrees of uncertainty to several dimensions of the SAAD implementation process. Firstly, the political consensus on which its foundation rested upon has weakened. Secondly, implementation of the SAAD was hampered by several challenges that emerged in the context of the economic crisis. Thirdly, the so-called "dependency limbo" (i.e. the existence of a large number of people eligible for benefits but who do not receive them) has become a structural feature of the system. Finally, contrary to the spirit of the DA, monetary benefits have become the norm rather than a last resort. High heterogeneity across regions regarding the number of beneficiaries covered and services provided reveal the existence of regional inequity in access to long-term care services in the country. Broadly, the current evidence on the state of the SAAD suggests the need to improve the quality of governance, to enhance coordination between health and social systems, to increase the system's transparency, to foster citizens' participation in decision-making and to implement a systematic monitoring of the system. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  6. Ten-year performance of Influenzanet: ILI time series, risks, vaccine effects, and care-seeking behaviour

    Directory of Open Access Journals (Sweden)

    Sander P. van Noort

    2015-12-01

    Full Text Available Recent public health threats have propelled major innovations on infectious disease monitoring, culminating in the development of innovative syndromic surveillance methods. Influenzanet is an internet-based system that monitors influenza-like illness (ILI in cohorts of self-reporting volunteers in European countries since 2003. We investigate and confirm coherence through the first ten years in comparison with ILI data from the European Influenza Surveillance Network and demonstrate country-specific behaviour of participants with ILI regarding medical care seeking. Using regression analysis, we determine that chronic diseases, being a child, living with children, being female, smoking and pets at home, are all independent predictors of ILI risk, whereas practicing sports and walking or bicycling for locomotion are associated with a small risk reduction. No effect for using public transportation or living alone was found. Furthermore, we determine the vaccine effectiveness for ILI for each season.

  7. The ten-year course of depression in primary care and long-term effects of psychoeducation, psychiatric consultation and cognitive behavioral therapy

    NARCIS (Netherlands)

    Conradi, Henk Jan; Bos, Elisabeth H; Kamphuis, Jan H; de Jonge, Peter

    BACKGROUND: While the majority of depressed patients are treated in primary care, long-term follow-up data on the naturalistic course of depression and treatment effectiveness in this setting are scarce. This study examined the ten-year course of depression in primary care patients who had

  8. Translating an evidence-based lifestyle intervention program into primary care: lessons learned.

    Science.gov (United States)

    Blonstein, Andrea C; Yank, Veronica; Stafford, Randall S; Wilson, Sandra R; Rosas, Lisa Goldman; Ma, Jun

    2013-07-01

    The E-LITE (Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care) trial evaluated the feasibility and potential effectiveness of translating an evidence-based lifestyle intervention for the management of obesity and related risk factors in a primary care setting. Delivered by allied health care providers, the intervention promoted at least 7% weight loss and at least 150 minutes per week of moderate-intensity physical activity through gradual, sustainable lifestyle changes. Activities included interactive group lessons, food tasting, guided physical activity, and technology-mediated self-monitoring and behavioral counseling. This article discusses insights and potential areas for improvement to strengthen program implementation for dissemination of the E-LITE program to other primary care settings. We focus on (a) the role of allied health professionals in program delivery, (b) strengthening program integration within a primary care clinic, and (c) the use of information technology to extend the reach and impact of the program. Our experience shows the feasibility of implementing an evidence-based lifestyle intervention program combining group-delivered nutrition and behavioral counseling, physical activity training, and technology-mediated follow-up in a primary care setting. Challenges remain, and we offer possible solutions to overcome them.

  9. Market competition in health care markets in the Netherlands: some lessons for England?

    Science.gov (United States)

    den Exter, André P; Guy, Mary J

    2014-01-01

    This article seeks to establish what lessons might be available to the English health care sector following enactment of the Health and Social Care Act 2012 from the Dutch experience of introducing market competition into health care via a mandatory health insurance scheme implemented by for-profit insurance companies. The existence of the Beveridge NHS model in England, and a Bismarckian insurance system in The Netherlands perhaps suggest that a comparison of the two countries is at best limited, and reinforced by the different Enthoven-inspired competitive models each has adopted. However, we contend that there are positive and negative issues arising from introducing competition into health care-, e.g. concerns about equity and benefits of efficiencies-which go beyond national boundaries and different systems and reflect the global paradigm shift towards the use of market forces in previously non-market areas such as health. The article examines the situation in England following the HSCA 2012 and The Netherlands following the 2006 reforms before analysing two areas of common ground: the focus in both countries on competition on quality (as opposed to price) and integrated care, which is assuming ever greater significance. We suggest that our combined insights (as a health lawyer and competition lawyer respectively) coupled with a comparative approach create a novel contribution to current calls for a wider public debate about the real role of markets in health care over and above simple characterisation as a force for good or bad.

  10. Lessons to Exchange: A Comparison of Long-Term Care Between Two Cultures: Uganda and Singapore.

    Science.gov (United States)

    Tam, Wai Jia; Yap, Philip

    2015-12-01

    Today, both the developed and developing world are facing fast-aging populations. Projections show that by 2050, 80% of the world's older persons will live in low and middle-income countries. As developed countries look to institutionalization as one of the means to cope with the challenges of long-term care of seniors, the developing world, with a different cultural, socioeconomic, and environmental context, may yet offer insights that instruct and inspire. By analyzing and comparing the approaches, context, and progress of Singapore and Uganda in coping with frail and dependent seniors, this article provides lessons about what the developing and developed world can offer each other, and in turn, teach us about long-term care of seniors.

  11. Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Ayman A Al-Talib

    2016-01-01

    Full Text Available Objectives: To study the clinical presentation and treatment outcome of molar pregnancy at a Tertiary Care Hospital in Dammam, Saudi Arabia. Materials and Methods: Reviewed medical records of all molar pregnancy cases among all the deliveries at a tertiary care hospital in Dammam from 2005 to 2014, after approval by institutional ethical review committee. Data abstracted included patient′s age, parity, presenting symptoms, gestational age at diagnosis, uterine size, ultrasonographic findings, BhCG level at the time of diagnosis and at follow-up after evacuation, and blood loss during evacuation. Data was entered and analyzed using Excel; frequency distribution for categorical variables and descriptive statistics for continuous variables were computed. Results: Of a total of 25,000 deliveries in ten years, 22 cases of complete molar pregnancy were encountered: 0.9 cases of molar pregnancy per 1000 pregnancies. Majority of patients (63.7% were older than 35 years, and were nulliparous (45.5%. The commonest symptom was vaginal bleeding (86.4% followed by hyperemesis gravidarum (41.0%; Hyperthyroidism was seen in 1 patient (4.5%. Ovarian enlargement by theca-lutin cyst was seen in 3 patients (13.6%. The majority of patients (63.6% had normal BhCG within 9 weeks (63 days after suction curettage. The majority of the cases followed a benign course. Conclusion: Aged older than 35 years seems a risk factor and vaginal bleeding is the commonest presenting symptom. Early booking of pregnant women to antenatal care clinics and routine first trimester ultrasound made diagnosis easier and earlier before complications appear.

  12. Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

    Science.gov (United States)

    Al-Talib, Ayman A.

    2016-01-01

    Objectives: To study the clinical presentation and treatment outcome of molar pregnancy at a Tertiary Care Hospital in Dammam, Saudi Arabia. Materials and Methods: Reviewed medical records of all molar pregnancy cases among all the deliveries at a tertiary care hospital in Dammam from 2005 to 2014, after approval by institutional ethical review committee. Data abstracted included patient's age, parity, presenting symptoms, gestational age at diagnosis, uterine size, ultrasonographic findings, BhCG level at the time of diagnosis and at follow-up after evacuation, and blood loss during evacuation. Data was entered and analyzed using Excel; frequency distribution for categorical variables and descriptive statistics for continuous variables were computed. Results: Of a total of 25,000 deliveries in ten years, 22 cases of complete molar pregnancy were encountered: 0.9 cases of molar pregnancy per 1000 pregnancies. Majority of patients (63.7%) were older than 35 years, and were nulliparous (45.5%). The commonest symptom was vaginal bleeding (86.4%) followed by hyperemesis gravidarum (41.0%); Hyperthyroidism was seen in 1 patient (4.5%). Ovarian enlargement by theca-lutin cyst was seen in 3 patients (13.6%). The majority of patients (63.6%) had normal BhCG within 9 weeks (63 days) after suction curettage. The majority of the cases followed a benign course. Conclusion: Aged older than 35 years seems a risk factor and vaginal bleeding is the commonest presenting symptom. Early booking of pregnant women to antenatal care clinics and routine first trimester ultrasound made diagnosis easier and earlier before complications appear. PMID:27625583

  13. Health Care Systems Support to Enhance Patient-Centered Care: Lessons from a Primary Care-Based Chronic Pain Management Initiative.

    Science.gov (United States)

    Elder, Charles R; Debar, Lynn L; Ritenbaugh, Cheryl; Rumptz, Maureen H; Patterson, Charlotte; Bonifay, Allison; Cowan, Penney; Lancaster, Lindsay; Deyo, Richard A

    2017-01-01

    Supporting day-to-day self-care activities has emerged as a best practice when caring for patients with chronic pain, yet providing this support may introduce challenges for both patients and primary care physicians. It is essential to develop tools that help patients identify the issues and outcomes that are most important to them and to communicate this information to primary care physicians at the point of care. We describe our process to engage patients, primary care physicians, and other stakeholders in the context of a pilot randomized controlled trial of a patient-centered assessment process implemented in an everyday practice setting. We identify lessons on how to engage stakeholders and improve patient-centered care for those with chronic conditions within the primary care setting. A qualitative analysis of project minutes, interviews, and focus groups was conducted to evaluate stakeholder experiences. Stakeholders included patients, caregivers, clinicians, medical office support staff, health plan administrators, an information technology consultant, and a patient advocate. Our stakeholders included many patients with no prior experience with research. This approach enriched the applicability of feedback but necessitated extra time for stakeholder training and meeting preparation. Types of stakeholders varied over the course of the project, and more involvement of medical assistants and Information Technology staff was required than originally anticipated. Meaningful engagement of patient and physician stakeholders must be solicited in a well-coordinated manner with broad health care system supports in place to ensure full execution of patient-centered processes.

  14. Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care

    Directory of Open Access Journals (Sweden)

    Sandra C Thompson

    2016-11-01

    Full Text Available Background: The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. Methods: The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Results: Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Conclusion: Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their

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

    Directory of Open Access Journals (Sweden)

    Reed Peter

    2012-12-01

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

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

    Science.gov (United States)

    Reed, Peter; Conrad, Douglas A; Hernandez, Susan E; Watts, Carolyn; Marcus-Smith, Miriam

    2012-12-14

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

  17. Lessons Learned from Participatory Design in Dementia Care: Placing Care Partners at the Centre.

    Science.gov (United States)

    Hendriks, Niels; Slegers, Karin; Wilkinson, Andrea

    2017-01-01

    In this paper we analyze the participatory design (PD) process of a health information technology (HIT) project. This project, AToM was situated in dementia care and involved partners from academia, industry and care. The analysis specifically focuses on the role of the care partners in the PD process. We will show that the conditions to enable 'good participatory design' were not fully met and we present a set of actions to prevent this in future HIT projects. Central to our recommended approach is placing the care partners at the centre of the PD project.

  18. Regionalized care for time-critical conditions: lessons learned from existing networks.

    Science.gov (United States)

    Carr, Brendan G; Matthew Edwards, J; Martinez, Ricardo

    2010-12-01

    The 2010 Academic Emergency Medicine (AEM) consensus conference "Beyond Regionalization" aimed to place the design of a 21st century emergency care delivery system at the center of emergency medicine's (EM's) health policy research agenda. To examine the lessons learned from existing regional systems, consensus conference organizers convened a panel discussion made up of experts from the fields of acute care surgery, interventional cardiology, acute ischemic stroke, cardiac arrest, critical care medicine, pediatric EM, and medical toxicology. The organizers asked that each member provide insight into the barriers that slowed network creation and the solutions that allowed them to overcome barriers. For ST-segment elevation myocardial infarction (STEMI) management, the American Heart Association's (AHA's) Mission: Lifeline aims to increase compliance with existing guidelines through improvements in the chain of survival, including emergency medical services (EMS) protocols. Increasing use of therapeutic hypothermia post-cardiac arrest through a network of hospitals in Virginia has led to dramatic improvements in outcome. A regionalized network of acute stroke management in Cincinnati was discussed, in addition to the effect of pediatric referral centers on pediatric capabilities of surrounding facilities. The growing importance of telemedicine to a variety of emergencies, including trauma and critical care, was presented. Finally, the importance of establishing a robust reimbursement mechanism was illustrated by the threatened closure of poison control centers nationwide. The panel discussion added valuable insight into the possibilities of maximizing patient outcomes through regionalized systems of emergency care. A primary challenge remaining is for EM to help to integrate the existing and developing disease-based systems of care into a more comprehensive emergency care system.

  19. "Who Cares for the Children?" Lessons from a Global Perspective of Child Care Policy

    Science.gov (United States)

    Lokteff, Maegan; Piercy, Kathleen W.

    2012-01-01

    We present the argument that the meaning of child care and the policies that address it are explicitly linked with national ideologies, work force participation, economic success, and child outcomes. The relationship between family and child care policies is cyclical in nature, with a nation's ideology and vision of family often driving child care…

  20. Lessons from the field: the essential elements for point-of-care transformation.

    Science.gov (United States)

    Wesorick, Bonnie; Doebbeling, Bradley

    2011-12-01

    The challenges facing healthcare in the 21st century frequently seem intractable and insurmountable. Systemic problems impair the quality and continuity of care and caregivers' quality of life. For over 25 years, the Clinical Practice Model Resource Center (CPMRC) in Grand Rapids, MI, has focused on transforming healthcare at the point of care to achieve its mission to co-create and sustain the best places to work and to receive care. The extent of the vision to transform practice at the point of care calls for a shift from the common quick fix change mindset to a Professional Practice Framework mindset that guides the actions steps to achieve greater clinical integration and standardize, sustainable transformation in a complex healthcare system. An overview of the Clinical Practice Model (CPM) Framework's conceptual underpinnings and the importance of the use of a Framework to guide transformation work across an International Consortium of hospitals are summarized. The lessons learned come from shared learning within a growing volunteer interdisciplinary, international consortium of over 276 rural, community, and university clinical settings. The Consortium's collective work has resulted in clinical, financial, and operational outcomes related to healthy work cultures, evidence-based practice, interdisciplinary, integrated documentation, and partnership councils. The cycle of organizational transformation ensures support for the professional processes, scope of practice, service across lifeline and continuum, integration and interoperability, evidence-based tools, interdisciplinary practice, and research-based and updated information. The power of organizational change flowing from a Framework is evident in replicable interventions and sustainable outcomes.

  1. Reporting intellectual capital in health care organizations: specifics, lessons learned, and future research perspectives.

    Science.gov (United States)

    Veltri, Stefania; Bronzetti, Giovanni; Sicoli, Graziella

    2011-01-01

    This article analyzes the concept of intellectual capital (IC) in the health sector sphere by studying the case of a major nonprofit research organization in this sector, which has for some time been publishing IC reports. In the last few years, health care organizations have been the object of great attention in the implementation and transfer of managerial models and tools; however, there is still a lack of attention paid to the strategic management of IC as a fundamental resource for supporting and enhancing performance improvement dynamics. The main aim of this article is to examine the IC reporting model used by the Center of Molecular Medicine (CMM), a Swedish health organization which is an outstanding benchmark in reporting its IC. We also consider the specifics of IC reporting for health organizations, the lessons learned by analyzing CMM's IC reporting, and future perspectives for research.

  2. Developing children's palliative care in Africa through beacon centres: lessons learnt.

    Science.gov (United States)

    Downing, Julia D; Marston, Joan; Selwyn, Casey; Ross-Gakava, Laura

    2013-02-18

    Much progress has been made in the provision of palliative care across sub-Saharan Africa, however much still remains to be done, particularly in the area of children's palliative care (CPC). The Beacon Centres programme was set up in 2009, aimed at improving access to CPC in South Africa, Uganda and Tanzania through more and better-trained health professionals and CPC clinical services of a high standard. Having identified sites in each country to develop into CPC Beacon Centres, Navigators were identified who would be the 'champions' for CPC in those sites and lead a programme of training, mentorship and support. Five navigators (2 in Uganda and Tanzania and 1 in South Africa) were trained between September and December 2009. Following this they undertook CPC needs assessments at the 3 centres and set up and delivered a six-month CPC training programme, providing mentorship and support to students to enable them to integrate CPC into their workplaces. To date, 188 participants have commenced the six-month course, with 80 having completed it. CPC has been integrated into the activities of the centres and a CPC virtual resource centre set up in South Africa. The achievements from the Beacon project have been great and the work of the navigators immense, but as in all projects it has not been without its challenges. Lessons learnt include issues around: the focus of the project; the length and nature of the training; assessment; accreditation; the choice of navigators; mentoring; administrative support; co-ordination; the choice of project sites; and the integration of CPC into services. The need for CPC is not going to go away and it is therefore important that models of scaling-up are found that are not only practical, feasible, affordable and sustainable, but that focus on the outcome of improved CPC for all those who need it. It is hoped that the lessons shared from the Beacon Project will help in developing and implementing such models.

  3. Risk Selection Threatens Quality Of Care For Certain Patients: Lessons From Europe's Health Insurance Exchanges.

    Science.gov (United States)

    van de Ven, Wynand P M M; van Kleef, Richard C; van Vliet, Rene C J A

    2015-10-01

    Experience in European health insurance exchanges indicates that even with the best risk-adjustment formulas, insurers have substantial incentives to engage in risk selection. The potentially most worrisome form of risk selection is skimping on the quality of care for underpriced high-cost patients--that is, patients for whom insurers are compensated at a rate lower than the predicted health care expenses of these patients. In this article we draw lessons for the United States from twenty years of experience with health insurance exchanges in Europe, where risk selection is a serious problem. Mistakes by European legislators and inadequate evaluation criteria for risk selection incentives are discussed, as well as strategies to reduce risk selection and the complex trade-off among selection (through quality skimping), efficiency, and affordability. Recommended improvements to the risk-adjustment process in the United States include considering the adoption of risk adjusters used in Europe, investing in the collection of data, using a permanent form of risk sharing, and replacing the current premium "band" restrictions with more flexible restrictions. Policy makers need to understand the complexities of regulating competitive health insurance markets and to prevent risk selection that threatens the provision of good-quality care for underpriced high-cost patients. Project HOPE—The People-to-People Health Foundation, Inc.

  4. Students' response to disaster: a lesson for health care professional schools.

    Science.gov (United States)

    Reyes, Humberto

    2010-11-16

    The response of medical students, young physicians, and other health professionals to the February 2010 earthquake and tsunami in Chile provides important lessons about health care delivery during disasters and about the development of professionalism. Tertiary and secondary care of victims of these disasters was possible because local and national resources were available and field hospitals provided by Chile's armed forces and foreign countries replaced damaged hospitals. However, primary care of persons living on the outskirts of towns and in small villages and coves that were destroyed and isolated by the disaster required the involvement of volunteer groups that were largely composed of students and other young members of the health professions, all of whom were motivated by solidarity, compassion, and social commitment. This experience, similar to previous catastrophes in Chile and elsewhere, reinforces that medical and other health professional schools must instill in graduates an understanding that the privileges of being a health professional come with responsibilities to society. Beyond providing high-quality scientific and technological education, curricula in these schools should include training that enables graduates to meaningfully contribute in the setting of unexpected disasters and that nurtures a sense of responsibility to do so.

  5. Are lessons from the education sector applicable to health care reforms? The case of Uganda.

    Science.gov (United States)

    Okuonzi, S A; Birungi, H

    2000-01-01

    The decision by donors to use external aid for poverty alleviation in very low-income countries and the redefinition of development to include human aspects of society have renewed interest in education and health services. The debate about accountability, priorities and value-for-money of social services has intensified. Uganda's universal primary education programme (UPE) has within 2 years of inception achieved 90% enrollment. The programme has been acclaimed as successful. But the health sector that has been implementing primary health care and reforms for two decades is viewed as having failed in its objectives. The paper argues that the education sector has advantages over the health sector in that its programme is simple in concept, and was internally designed involving few actors. The sector received strong political support, already has an extensive infrastructure, receives much more funding and has a straightforward objective. Nevertheless, the health sector has made some achievements in AIDS control, in the prevention and control of epidemics, and in behavioural change. But these achievements will not be noticed if only access and health-status are used to assess the health sector. However, UPE demonstrates that a universal basic health care is possible, given the same level of resources and political commitment. The lesson for the health sector is to implement a priority universal health care programme based on national values and to assess its performance using the objectives of the UPE.

  6. [Development and evolution of a balanced scorecard in primary health care: Lessons learned].

    Science.gov (United States)

    Bartolomé-Benito, E; Jiménez-Carramiñana, J; Sánchez-Perruca, L; Bartolomé-Casado, M S; Dominguez-Mandueño, A B; Marti-Argandoña, M; Hernández-Pascual, M; Miquel-Gómez, A

    To describe the design, implementation, and monitoring of eSOAP (Primary Health Care Balanced Scorecard) and its role in the deployment of strategic objectives and clinical management, as well as to show the lessons learned during six years of follow-up. Descriptive study areas: methodology (conceptual framework, strategic matrix, strategic map, and processes map), technology and standardisation. As of December 2014, 9,046 (78%) professionals are registered in eSOAP. A total of 381 indicators were measured from 16 data sources, of which 36% were of results (EFQM model), 39.1% of clinical management, and 20% were included in the Program Centre Contract. The Balanced Scorecard has enabled to deploy all strategic lines of Primary Health Care, and has enabled the healthcare professionals to evaluate the evolution of results over time, and at patient level (e.g. 16% increase in control of diabetic patients). A total of 295,779 reports were generated and 13,080 professionals were evaluated by goals. There was an increased use of the eSOAP application by the professionals. The Balanced Scorecard was the key in deploying Primary Health Care strategies. It has helped clinical management and improved relevant indicators (health, patient experience, and costs), such as the management models that we used as references (EFQM Kaplan and Norton), and new emerging scenarios (Triple aim). Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Encouraging innovation: ten research priorities for achieving universal access to HIV/AIDS prevention, treatment and care in Europe by 2010

    DEFF Research Database (Denmark)

    Lazarus, Jeff; Laukamm-Josten, Ulrich; Atun, Rifat A;

    2008-01-01

    there have been many declarations and strategies addressing HIV/AIDS, today the goal is universal access to HIV/AIDS prevention, treatment, care and support services by 2010. The articles included in this thematic issue of the Central European Journal of Public Health on HIV/AIDS reflect this, while the ten...

  8. Developing children’s palliative care in Africa through beacon centres: lessons learnt

    Science.gov (United States)

    2013-01-01

    Much progress has been made in the provision of palliative care across sub-Saharan Africa, however much still remains to be done, particularly in the area of children’s palliative care (CPC). The Beacon Centres programme was set up in 2009, aimed at improving access to CPC in South Africa, Uganda and Tanzania through more and better-trained health professionals and CPC clinical services of a high standard. Having identified sites in each country to develop into CPC Beacon Centres, Navigators were identified who would be the ‘champions’ for CPC in those sites and lead a programme of training, mentorship and support. Five navigators (2 in Uganda and Tanzania and 1 in South Africa) were trained between September and December 2009. Following this they undertook CPC needs assessments at the 3 centres and set up and delivered a six-month CPC training programme, providing mentorship and support to students to enable them to integrate CPC into their workplaces. To date, 188 participants have commenced the six-month course, with 80 having completed it. CPC has been integrated into the activities of the centres and a CPC virtual resource centre set up in South Africa. The achievements from the Beacon project have been great and the work of the navigators immense, but as in all projects it has not been without its challenges. Lessons learnt include issues around: the focus of the project; the length and nature of the training; assessment; accreditation; the choice of navigators; mentoring; administrative support; co-ordination; the choice of project sites; and the integration of CPC into services. The need for CPC is not going to go away and it is therefore important that models of scaling-up are found that are not only practical, feasible, affordable and sustainable, but that focus on the outcome of improved CPC for all those who need it. It is hoped that the lessons shared from the Beacon Project will help in developing and implementing such models. PMID:23419095

  9. Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada

    Directory of Open Access Journals (Sweden)

    Isabelle Vedel

    2011-02-01

    Full Text Available Introduction: Québec's rapidly growing elderly and chronically ill population represents a major challenge to its healthcare delivery system, attributable in part to the system's focus on acute care and fragmented delivery. Description of policy practice: Over the past few years, reforms have been implemented at the provincial policy level to integrate hospital-based, nursing home, homecare and social services in 95 catchment areas. Recent organizational changes in primary care have also resulted in the implementation of family medicine groups and network clinics. Several localized initiatives were also developed to improve integration of care for older persons or persons with chronic diseases. Conclusion and discussion: Québec has a history of integration of health and social services at the structural level. Recent evaluations of the current reform show that the care provided by various institutions in the healthcare system is becoming better integrated. The Québec health care system nevertheless continues to face three important challenges in its management of chronic diseases: implementing the reorganization of primary care, successfully integrating primary and secondary care at the clinical level, and developing effective governance and change management. Efforts should focus on strengthening primary care by implementing nurse practitioners, developing a shared information system, and achieving better collaboration between primary and secondary care.

  10. Ten years of integrated care: backwards and forwards. The case of the province of Québec, Canada

    Directory of Open Access Journals (Sweden)

    Isabelle Vedel

    2011-02-01

    Full Text Available Introduction: Québec's rapidly growing elderly and chronically ill population represents a major challenge to its healthcare delivery system, attributable in part to the system's focus on acute care and fragmented delivery. Description of policy practice: Over the past few years, reforms have been implemented at the provincial policy level to integrate hospital-based, nursing home, homecare and social services in 95 catchment areas. Recent organizational changes in primary care have also resulted in the implementation of family medicine groups and network clinics. Several localized initiatives were also developed to improve integration of care for older persons or persons with chronic diseases.Conclusion and discussion: Québec has a history of integration of health and social services at the structural level. Recent evaluations of the current reform show that the care provided by various institutions in the healthcare system is becoming better integrated. The Québec health care system nevertheless continues to face three important challenges in its management of chronic diseases: implementing the reorganization of primary care, successfully integrating primary and secondary care at the clinical level, and developing effective governance and change management.Efforts should focus on strengthening primary care by implementing nurse practitioners, developing a shared information system, and achieving better collaboration between primary and secondary care.

  11. NCALM's Lessons Learned and Insights into the Future from Ten + Years of Providing Geodetic Images for the monitoring of Hazards and the Response to Disasters

    Science.gov (United States)

    Fernandez Diaz, J. C.; Shrestha, R. L.; Carter, W. E.; Glennie, C. L.; Sartori, M. P.; Singhania, A.

    2012-12-01

    The National Center for Airborne Laser Mapping NCALM was created in 2003 through a grant from and National Science Foundation to support the use of airborne laser swath mapping technology (ALSM aka LiDAR) by the scientific community. NCALM's main goals are to provide research quality airborne LiDAR observations to the scientific community, to advance the state of the art in airborne laser mapping, and to train and educate graduate students with knowledge of airborne mapping to meet the needs of private industry, government agencies and academic institutions. Even before its creation, NCALM researchers had been exploring the application of LiDAR technologies for the monitoring of Geohazards and the response and recovery from man-made and natural disasters. Some of these applications include: mapping debris caused by the 11 September 2001 terrorist attacks in New York; mapping thousands of km of faults along the Pacific coast of the US extending from Southern California to Alaska, through the OSU/USGS B4 and UNAVCO EarthScope projects; mapping of lava fields in Hawaii; mapping post-forest-fire zones in the San Gabriel Mountains, CA and Valles Caldera, NM; mapping beach erosion/deposition induced by hurricanes along the Panhandle and Atlantic coasts of Florida; rapid-response mapping of the Iowa river floods in 2008 and the El Mayor - Cucapah Earthquake in 2010. The experience gained and lessons learned by NCALM regarding the long term monitoring of hazards for the preparation, response and recovery of disasters range from navigating the regulatory and logistic challenges of being present in a disaster area, to the production of real-time geodetic imagery and data for support of the authorities, to performing change detection (surface deformation, sediment transport, infrastructure damage) using LiDAR data products obtained by different vendors, with different equipment and operated under different specifications. End users of the information uniquely provided by

  12. An Economic Evaluation of TENS in Addition to Usual Primary Care Management for the Treatment of Tennis Elbow: Results from the TATE Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Martyn Lewis

    Full Text Available The TATE trial was a multicentre pragmatic randomized controlled trial of supplementing primary care management (PCM-consisting of a GP consultation followed by information and advice on exercises-with transcutaneous electrical nerve stimulation (TENS, to reduce pain intensity in patients with tennis elbow. This paper reports the health economic evaluation.Adults with new diagnosis of tennis elbow were recruited from 38 general practices in the UK, and randomly allocated to PCM (n = 120 or PCM plus TENS (n = 121. Outcomes included reduction in pain intensity and quality-adjusted-life-years (QALYs based on the EQ5D and SF6D. Two economic perspectives were evaluated: (i healthcare-inclusive of NHS and private health costs for the tennis elbow; (ii societal-healthcare costs plus productivity losses through work absenteeism. Mean outcome and cost differences between the groups were evaluated using a multiple imputed dataset as the base case evaluation, with uncertainty represented in cost-effectiveness planes and through probabilistic cost-effectiveness acceptability curves. Incremental healthcare cost was £33 (95%CI -40, 106 and societal cost £65 (95%CI -307, 176 for PCM plus TENS. Mean differences in outcome were: 0.11 (95%CI -0.13, 0.35 for change in pain (0-10 pain scale; -0.015 (95%CI -0.058, 0.029 for QALYEQ5D; 0.007 (95%CI -0.022, 0.035 for QALYSF6D (higher score differences denote greater benefit for PCM plus TENS. The ICER (incremental cost effectiveness ratio for the main evaluation of mean difference in societal cost (£ relative to mean difference in pain outcome was -582 (95%CI -8666, 8113. However, incremental ICERs show differences in cost-effectiveness of additional TENS, according to the outcome being evaluated.Our findings do not provide evidence for or against the cost-effectiveness of TENS as an adjunct to primary care management of tennis elbow.

  13. Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries

    Directory of Open Access Journals (Sweden)

    Naoki Ikegami

    2016-05-01

    Full Text Available When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (SHI was introduced in 1927, benefits were focused on primary care services delivered by physicians in clinics, and not on hospital services. This was reflected in the development and subsequent revisions of the fee schedule. The policy decisions which have helped to retain primary care services might provide lessons for achieving universal health coverage in low- and middle-income countries (LMICs.

  14. Essentials for emergency care: Lessons from an inventory assessment of an emergency centre in Sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Kofi Marfo Osei

    2014-12-01

    Conclusion: Beyond pointing out specific material resource deficiencies at the Surgical Medical Emergency (SME centre, our inventory assessment indicated a need to develop better implementation strategies for infection control policies, to collaborate with other departments on coordination of patient care, and to set a research agenda to develop emergency and acute care protocols that are both effective and sustainable in our setting. Equipment and supplies are essential elements of emergency preparedness that must be both available and ‘ready-to-hand’. Consequently, key factors in determining readiness to provide quality emergency care include supply-chain, healthcare financing, functionality of systems, and a coordinated institutional vision. Lessons learnt may be useful for others facing similar challenges to emergency medicine development.

  15. Implementation of an agency to improve chronic kidney disease care in Ontario: lessons learned by the Ontario Renal Network.

    Science.gov (United States)

    Woodward, Graham L; Iverson, Alex; Harvey, Rebecca; Blake, Peter G

    2015-01-01

    In 2009, Ontario's Ministry of Health and Long-Term Care initiated the transfer of oversight and coordination of chronic kidney disease (CKD) care to the Ontario Renal Network (ORN) under the auspices of Cancer Care Ontario (CCO). The aim was to replicate the quality improvement and change management practices used for cancer control within CKD. Much of the ORN's first three years were dedicated to building the infrastructure necessary to bridge the gap between provincial policy and clinical practice. This article explores the accomplishments, challenges and lessons learned over that period. The results, which are applicable to the management of chronic diseases in Ontario, Canada, and internationally, confirm that sustainable change takes time and requires strong leadership, transparency, accountability and communication, supported by a solid foundation of data and evidence.

  16. Lessons from abroad: Rebalancing accountability and pedagogy in the Irish social care sector through the use of effective leadership

    Directory of Open Access Journals (Sweden)

    Jones Cathy

    2016-08-01

    Full Text Available A concern is emerging in Ireland that social care managers and staff are moving too far away from the ‘care’ in social ‘care’ work. In this paper a discussion of the impact of the bureaucratic procedures and regulation within the social work and social care work sectors is presented along with an exploration of leadership approaches. It is argued that certain leadership approaches, in particular pedagogical leadership, could not only help social care managers to negotiate the complex issues they are facing but also facilitate putting the ‘care’ back into social ‘care’ work. Pedagogical leadership is globally supported across a variety of human service disciplines: it facilitates the creation of a learning culture within the workplace where social care managers facilitate conversations with their teams to encourage reflection, critical thinking and contributions to the professional wisdom required for quality service. The purpose of this article is to contribute to the dialogue within leadership practice for social care professionals. This discourse is necessary if lessons are to be learned from past experiences in this country and others about how to balance the need for care, learning and compassion with accountability.

  17. Exchange Transfusion in the Treatment of Neonatal Septic Shock: A Ten-Year Experience in a Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Lorenza Pugni

    2016-05-01

    Full Text Available Septic shock, occurring in about 1% of neonates hospitalized in neonatal intensive care unit (NICU, is a major cause of death in the neonatal period. In the 1980s and 90s, exchange transfusion (ET was reported by some authors to be effective in the treatment of neonatal sepsis and septic shock. The main aim of this retrospective study was to compare the mortality rate of neonates with septic shock treated only with standard care therapy (ScT group with the mortality rate of those treated with ScT and ET (ET group. All neonates with septic shock admitted to our NICU from 2005 to 2015 were included in the study. Overall, 101/9030 (1.1% neonates had septic shock. Fifty neonates out of 101 (49.5% received one or more ETs. The mortality rate was 36% in the ET group and 51% in the ScT group (p = 0.16. At multivariate logistic regression analysis, controlling for potentially confounding factors significantly associated with death (gestational age, serum lactate, inotropic drugs, oligoanuria, ET showed a marked protective effect (Odds Ratio 0.21, 95% Confidence Interval: 0.06–0.71; p = 0.01. The lack of observed adverse events should encourage the use of this procedure in the treatment of neonates with septic shock.

  18. Palliativmedizinische Lehre in Deutschland – Planungen der Fakultäten zum zukünftigen Querschnittsfach 13 [Palliative Care teaching in Germany – concepts and future developments

    Directory of Open Access Journals (Sweden)

    Ilse, B.

    2012-05-01

    higher degree of mandatory teaching in alignment with the requirements of the ÄApprO. A broad spectrum of educationally-involved occupational groups, specialist disciplines and external co-operating partners, were mentioned. Conclusion: The infrastructural prerequisites of the present curricular concepts and the degree of implementation of the Q13 according to the requirements of the new ÄApprO diverge significantly among the various medical faculties. The efforts made to produce a qualitatively high standard of teaching with regard to the multifaceted questions concerning the support for severely and terminally ill patients is as much reflected in the survey, as the special implications of an independent Chair for palliative medicine for the implementation of the requirements by law. The participation of various occupational groups in this survey as well as the broad spectrum of those involved highlights the interdisciplinary and multi-professional dimension of teaching in palliative care. [german] Fragestellung: Mit der Änderung der ärztlichen Approbationsordnung (ÄApprO im Jahre 2009 wurde die Palliativmedizin als 13. Querschnittsfach (Q13 verpflichtend in das studentische Curriculum eingeführt. Die Umsetzung dieser Änderung muss bis zum Beginn des Praktischen Jahres im August 2013 oder bei der Meldung zum Zweiten Abschnitt der Ärztlichen Prüfung für den Prüfungstermin im Oktober 2014 erfolgen.In vorangegangenen Umfragen wurden an den medizinischen Fakultäten in Deutschland sehr heterogene palliativmedizinische Lehrstrukturen beschrieben. Daher sollten nun die curricularen und prüfungsbezogenen Planungen der jeweiligen Fakultäten zur Implementierung eines verpflichtenden Q13 Palliativmedizin erfragt werden.Methodik: Die Bundesvertretung der Medizinstudierenden Deutschlands (bvmd führt seit 2006 zweijährliche Umfragen an allen medizinischen Fakultäten in Deutschland zum gegenwärtigen Stand der palliativmedizinischen Lehre durch.Nach Konzeption eines

  19. Integrated care: achieving better coordination of care for the chronically ill. Lessons from The Netherlands bundled-payment initiative.

    NARCIS (Netherlands)

    Dijk, C. van; Raams, J.; Schut, E.; Baan, C.; Struijs, J.; Vrijhoef, B.; Wildt, J.E. de; Bakker, D. de

    2013-01-01

    Background: In 2010, a bundled payment system for diabetes care, COPD care and vascular risk management was introduced nationwide in The Netherlands. In the bundled payment system, are for thesepatients is organised by a care group that provides general and more specialised care for the specific dis

  20. Developing consumer-directed care for people with a disability: 10 lessons for user participation in health and community care policy and program development.

    Science.gov (United States)

    Ottmann, Goetz F; Laragy, Carmel

    2010-11-01

    This paper outlines 10 lessons derived from the development of a consumer-directed care program for families with disabled children in Melbourne, Australia. The following program elements proved to be of importance over the course of the development process: (1) research participants should be involved as early as possible; (2) an open, inclusive communication style in conjunction with a good understanding of potential concerns and a careful framing of the policy issue is required to build trust and allow meaningful collaboration; (3) various strands of evidence have to be woven together; (4) ongoing commitment and support from management and key stakeholders; (5) effective knowledge transfer and cultural change processes; (6) capacity building; (7) mediation of power differentials; (8) community building; (9) participant re-engagement strategies; and (10) solid project management skills.

  1. Lessons Learned From a Program Evaluation of a Statewide Continuing Education Program for Staff Members Working in Assisted Living and Adult Day Care Centers in Virginia.

    Science.gov (United States)

    Gendron, Tracey L; Pryor, Jennifer M; Welleford, E Ayn

    2016-02-01

    The number of older adults residing in assisted living facilities (ALF) and utilizing adult day care services is expanding with the increasing population of older adults. Currently, there are no standardized requirements for continuing education for assisted living and adult day care service staff at a national level. Given that 62% of states within the United States require continuing education for ALF staff and/or administrators, a more formalized system is needed that provides evidence-based gerontological training to enhance the quality of care and services provided to older adults. This article describes the challenges and lessons learned from conducting a program evaluation of a Statewide Training and Continuing Education Program for Assisted Living Facility and Adult Day Care Service staff in Virginia. Survey evaluation data from a 6-year period was examined and a formative program evaluation was conducted. The findings from the survey evaluation and formative evaluation are discussed as are the lessons learned.

  2. Unregulated access to health-care services is associated with overutilization--lessons from Austria.

    Science.gov (United States)

    Pichlhöfer, Otto; Maier, Manfred

    2015-06-01

    The Austrian health-care system is characterized by free provider choice and uncontrolled access to all levels of care. Using primary data, the ECOHCARE study shows that hospitalization rates for the secondary and tertiary care levels in Austria are both 4.4 times higher than those reported from the USA using a similar methodology. At the same time, essential functions of the primary care sector are weak. We propose that regulating access to secondary and tertiary care and restricting free provider choice to the primary care level would both reverse over utilization and strengthen the primary care sector.

  3. Public Reporting of Nursing Home Quality of Care: Lessons from the United States Experience for Canadian Policy Discussion

    Science.gov (United States)

    Hutchinson, Alison M.; Draper, Kellie; Sales, Anne E.

    2009-01-01

    While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy. PMID:21037828

  4. Technology-enabled services for older people living at home independently: lessons for public long-term care authorities in the EU Member States

    OpenAIRE

    CARRETERO GOMEZ STEPHANIE

    2015-01-01

    This report collects six policy lessons to support public authorities at all levels of the EU Member States for the adequate implementation and use of new technologies in the field of long-term care service provision for older people. These policy lessons have been obtained through the ICT-AGE research project carried out by the JRC-IPTS and funded by DG EMPL, based on the cross-analysis of good practices of technology-enabled services to help older people live independently at home. These le...

  5. Minnesota's fifteen-year romance. Managed care: lessons learned and survival approaches for hospitals and physicians.

    Science.gov (United States)

    Reece, R L; Coombes, D H

    1990-01-01

    For the last 15 years, Minnesota has lived with managed care. The Minnesota story is important because it is a singularly unique example of the natural history of managed care in the United States, from the indemnity response to HMOs to PPOs to "open-ended" HMOs to comprehensive managed care.

  6. Recognition and Emergency Care of Wounds: Bleeding Control and Bandaging. First Responder Training, Lesson Plan No. 1.

    Science.gov (United States)

    Upton, Robert

    Designed for a 40-hour course in first-responder medical training, this lesson plan teaches students how to control bleeding and bandage wounds. This lesson includes discussions on skin, the circulatory system, and blood; describes seven types of wounds; and explains four bleeding control methods. The lesson plan begins with information on the…

  7. Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems

    Science.gov (United States)

    Badrinath, Padmanabhan

    2017-01-01

    The demand for healthcare is rising due to aging populations, rising chronic disease prevalence, and technological innovations. There are currently more effective and cost-effective interventions available than can be afforded within limited budgets. A new way of thinking about the optimal use of resources is needed. Ensuring that available resources are used for interventions that provide outcomes that patient’s most value, rather than a focus just on effectiveness and cost-effectiveness, may help to ensure that resources are used optimally. Value-based healthcare puts what patients value at the center of healthcare. It helps ensure that they receive the care that can provide them with outcomes they think are important and that limited resources are focused on high-value interventions. In order to do this, we need flexible definitions of ‘health’, personalized and tailored to patient values. We review the current status of value-based health care in England and identify lessons applicable to a variety of health systems. For this, we draw upon the work of the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS), Right Care Initiative, and our local experience in promoting value-based health care for specific conditions in our region. Combining the best available evidence with open and honest dialogue between patients, clinicians, and others, whilst requiring considerable time and resources are essential to building a consensus around the value that allows the best use of limited budgets. Values have been present in healthcare since its beginnings. Placing value and values at the center of healthcare could help to ensure available resources are used to provide the greatest possible benefit to patients.

  8. Management and marketing in health care. Some lessons for the United States from the British system.

    Science.gov (United States)

    Gumbiner, R; Frye, R

    1973-06-01

    The British health care system has been examined by sociologists, political scientists, and medical care specialists before, but in this presentation a section of the British health care system is viewed through the eyes of modern business management, particularly as to cost and consumer effectiveness. Examination of positive features as well as problems may be helpful in relation to some future health care delivery system in the United States. Cross fertilization between the disciplines of management and medicine has much to offer to the rapidly changing delivery of health care in the United States.

  9. Transforming Health Care Coalitions From Hospitals to Whole of Community: Lessons Learned From Two Large Health Care Organizations.

    Science.gov (United States)

    Cormier, Scott; Wargo, Michael; Winslow, Walter

    2015-12-01

    A health care emergency preparedness coalition (coalition) is a group of health care organizations, public safety agencies, and public health partners that join forces for the common cause of making their communities safer, healthier, and more resilient. Coalitions have been characterized as being focused on hospital systems instead of the health care of the community as a whole. We discuss 2 examples of coalition partners that use a more inclusive approach to planning, response, and recovery. The first is a large health care system spread across 23 states, and the other is a public safety agency in northeast Pennsylvania that took the lead to address the preparedness and response toward a large influx of burn patients and grew to encompass all aspects of community health care.

  10. Translating an Evidence-based Lifestyle Intervention Program into Primary Care: Lessons Learned

    OpenAIRE

    Blonstein, Andrea C.; Yank, Veronica; Stafford, Randall S.; Wilson, Sandra R.; Rosas, Lisa Goldman; Ma, Jun

    2013-01-01

    Obesity is one of the top health priorities in the United States. Primary care physicians are the designated “gatekeepers” for obesity prevention, detection, and treatment. However, they and the current U.S. health care structure and reimbursement systems are often ill-equipped to implement evidence-based obesity care. The Group Lifestyle Balance™ (GLB) program is a group-delivery adaptation of the predominantly one-on-one lifestyle intervention proven efficacious in the Diabetes Prevention P...

  11. Bundled Payments for Care Improvement: Lessons Learned in the First Year.

    Science.gov (United States)

    Althausen, Peter L; Mead, Lisa

    2016-12-01

    The Bundled Payments for Care Improvement (BPCI) initiative is the latest cost-saving program developed by the Center for Medicare and Medicaid Innovation. This model is intended to create a system for higher quality and more coordinated care at a lower cost to Medicare. It is currently an optional program for physician groups, hospitals and post-acute care providers to benefit financially from improved care models and cost containment measures. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. Under this initiative, there are certain fraud and abuse waivers in place that allow gainsharing among BPCI organizations and approved providers so long as certain requirements are met. Our practice entered this initiative for total joint arthroplasty episodes of care as well as the hip and femur fracture episode of care. The first year experience demonstrated that a significant learning curve is required. Keys for success include appropriate patient selection for elective surgery, implant pricing control, adherence to preoperative and postoperative protocols, diligent postcare care management, and appropriate choice of metrics to maximize gainsharing potential. Ultimately, the BPCI program has been a successful venture, saving our hospitals over $1.6 million in 2015. In the process, this provided an additional revenue stream for our physicians while decreasing the overall cost of care.

  12. Lessons from community mental health to drive implementation in health care systems for people with long-term conditions.

    Science.gov (United States)

    Tansella, Michele; Thornicroft, Graham; Lempp, Heidi

    2014-04-30

    This paper aims to identify which lessons learned from the evidence and the experiences accruing from the transformation in mental health services in recent decades may have relevance for the future development of healthcare for people with long-term physical conditions. First, nine principles are discussed which we first identified to guide mental health service organisation, and all of which can be potentially applied to long term care as well (autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and efficiency). Second, we have outlined innovative operational aspects of service user participation, many of which were first initiated and consolidated in the mental health field, and some of which are now also being implemented in long term care (including case management, and crisis plans). We conclude that long term conditions, whether mental or physical, deserve a long-term commitment from the relevant health services, and indeed where continuity and co-ordination are properly funded implemented, this can ensure that the symptomatic course is more stable, quality of life is enhanced, and the clinical outcomes are more favourable. Innovations such as self-management for long-term conditions (intended to promote autonomy and empowerment) need to be subjected to the same level of rigorous scientific scrutiny as any other treatment or service interventions.

  13. Lessons from Community Mental Health to Drive Implementation in Health Care Systems for People with Long-Term Conditions

    Directory of Open Access Journals (Sweden)

    Michele Tansella

    2014-04-01

    Full Text Available This paper aims to identify which lessons learned from the evidence and the experiences accruing from the transformation in mental health services in recent decades may have relevance for the future development of healthcare for people with long-term physical conditions. First, nine principles are discussed which we first identified to guide mental health service organisation, and all of which can be potentially applied to long term care as well (autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and efficiency. Second, we have outlined innovative operational aspects of service user participation, many of which were first initiated and consolidated in the mental health field, and some of which are now also being implemented in long term care (including case management, and crisis plans. We conclude that long term conditions, whether mental or physical, deserve a long-term commitment from the relevant health services, and indeed where continuity and co-ordination are properly funded implemented, this can ensure that the symptomatic course is more stable, quality of life is enhanced, and the clinical outcomes are more favourable. Innovations such as self-management for long-term conditions (intended to promote autonomy and empowerment need to be subjected to the same level of rigorous scientific scrutiny as any other treatment or service interventions.

  14. Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure: ten-year’s clinical experience of a Respiratory Semi-Intensive Care Unit (VERSIONE IN ITALIANO

    Directory of Open Access Journals (Sweden)

    Mario Naldi

    2007-12-01

    Full Text Available BackgroundAlthough several prospective controlled randomizedtrials demonstrated the success of non-invasive positive pressure ventilation (NIV in selected cases of acute hypercapnic respiratory failure (IRA in setting with different care levels, clinical practice data about the use of NIV in the “real world” are limited.AimTo report the results of our clinical experience in NIV applied for IRA in the Respiratory Semi-Intensive Care Unit (UTSIR allocated within the Respiratory Division of Arezzo in the years 1996-2006 in terms of: tolerance, effects upon arterial blood gases, success rate and predictors of failure.MethodsThree hundred filthy of the 1484 patients (23.6% consecutively admitted for IRA to our RespiratoryDivision during the study period received NIV in addition to standard therapy, according to the pre-defined routinely used criteria.ResultsEight patients (2.3% did not tolerated NIV becauseof mask discomfort, while the remaining 342 (M: 240, F: 102; median (interquartiles age: 74.0 (68.0-79.3 yrs; COPD: 69.3% were ventilatedfor >1 hour. Arterial blood gases significantlyimproved after two hours of NIV (mean (standard deviation pH: 7.33 (0.07 versus 7.28 (7.25-7.31, p 48 hrs of ventilation after an initial positive response.ConclusionsAs results of our ten-year’s clinical experience performed in a UTSIR, NIV is confirmed to be well tolerated, effective in improving arterial blood gases and useful in avoiding intubation in most IRA episodes non-responder to standard therapy.

  15. Non-Invasive Positive Pressure Ventilation in Acute Hypercapnic Respiratory Failure: Ten-Year’s Clinical Experience of a Respiratory Semi-Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Raffaele Scala, M.D., esp.

    2007-12-01

    Full Text Available BackgroundAlthough several prospective controlled randomizedtrials demonstrated the success of non-invasive positive pressure ventilation (NIPPV in selected cases of acute hypercapnic respiratory failure (ARF in setting with different care levels, clinical practice data about the use of VNI in the “real world” are limited.AimTo report the results of our clinical experiencein NIPPV applied for ARF in the Respiratory Semi-Intensive Care Unit (UTSIR allocated within the Respiratory Division of Arezzo betweenthe years 1996-2006 in terms of: patient tolerance, effects upon arterial blood gases, successrate and predictors of failure. Methods: Three hundred and filthy out of the 1484 patients (23.6% consecutively admittedfor ARF to our Respiratory Division during the study period received NIPPV in addition to standard therapy, according to the predeterminedroutinely used criteria. Results: Eight patients (2.3% did not tolerateNIPPV because of mask discomfort, while the remaining 342 (M: 240, F: 102; median (interquartilesage: 74.0 (68.0-79.3 yrs; COPD: 69.3% were ventilated for >1 hour. Arterial blood gases significantly improved after two hours of NIPPV (mean (standard deviation pH: 7.33 (0.07 versus 7.28 (7.25-7.31, p 48 hrs of ventilation after an initial positive response. Conclusions: As results of ten years of clinicalexperience at our UTSIR, NIPPV was shown to be well tolerated, effective in improving arterialblood gases and useful in avoiding intubationin most ARF episodes non-responsive to standard therapy.

  16. Bridging the gaps among research, policy and practice in ten low- and middle-income countries: Development and testing of questionnaire for health-care providers

    Directory of Open Access Journals (Sweden)

    Boupha Boungnong

    2010-01-01

    Full Text Available Abstract Background The reliability and validity of instruments used to survey health-care providers' views about and experiences with research evidence have seldom been examined. Methods Country teams from ten low- and middle-income countries (China, Ghana, India, Iran, Kazakhstan, Laos, Mexico, Pakistan, Senegal and Tanzania participated in the development, translation, pilot-testing and administration of a questionnaire designed to measure health-care providers' views and activities related to improving their clinical practice and their awareness of, access to and use of research evidence, as well as changes in their clinical practice that they attribute to particular sources of research evidence that they have used. We use internal consistency as a measure of the questionnaire's reliability and, whenever possible, we use explanatory factor analyses to assess the degree to which questions that pertain to a single domain actually address common themes. We assess the questionnaire's face validity and content validity and, to a lesser extent, we also explore its criterion validity. Results The questionnaire has high internal consistency, with Cronbach's alphas between 0.7 and 0.9 for 16 of 20 domains and sub-domains (identified by factor analyses. Cronbach's alphas are greater than 0.9 for two domains, suggesting some item redundancy. Pre- and post-field work assessments indicate the questionnaire has good face validity and content validity. Our limited assessment of criterion validity shows weak but statistically significant associations between the general influence of research evidence among providers and more specific measures of providers' change in approach to preventing or treating a clinical condition. Conclusion Our analysis points to a number of strengths of the questionnaire - high internal consistency (reliability and good face and content validity - but also to areas where it can be shortened without losing important conceptual

  17. Barriers in the implementation of a physical activity intervention in primary care settings: lessons learned.

    Science.gov (United States)

    Josyula, Lakshmi K; Lyle, Roseann M

    2013-01-01

    Barriers encountered in implementing a physical activity intervention in primary health care settings, and ways to address them, are described in this paper. A randomized comparison trial was designed to examine the impact of health care providers' written prescriptions for physical activity, with or without additional physical activity resources, to adult, nonpregnant patients on preventive care or chronic disease monitoring visits. Following abysmal recruitment outcomes, the research protocol was altered to make it more appealing to all the participants, i.e., health care providers, office personnel, and patients. Various barriers--financial, motivational, and executive--to the implementation of health promotion interventions in primary health care settings were experienced and identified. These barriers have been classified by the different participants in the research process, viz., healthcare providers, administrative personnel, researchers, and patients. Some of the barriers identified were lack of time and reimbursement for health promotion activities, and inadequate practice capacity, for health care providers; increased time and labor demands for administrative personnel; constrained access to participants, and limited funding, for researchers; and superseding commitments, and inaccurate comprehension of the research protocol, for patients. Solutions suggested to overcome these barriers include financial support, e.g., funding for researchers, remuneration for health care organization personnel, reimbursement for providers, payment for participants, and free or subsidized postage, and use of health facilities; motivational strategies such as inspirational leadership, and contests within health care organizations; and partnerships, with other expert technical and creative entities, to improve the quality, efficiency, and acceptability of health promotion interventions.

  18. Critical Issues in Foster Care: Lessons the Children's Ark Learned from Barbara and Nathan

    Science.gov (United States)

    Mann, Janet; Kretchmar, Molly D.; Worsham, Nancy L.

    2008-01-01

    Using an attachment theory framework, this article explores several critical issues in foster care as reflected in the case of Barbara and her 9-month-old son, Nathan. Barbara and Nathan participated in The Children's Ark, an innovative intervention for families in foster care that allowed mothers who had lost custody of their children to live,…

  19. Critical care in resource-poor settings: lessons learned and future directions.

    Science.gov (United States)

    Riviello, Elisabeth D; Letchford, Stephen; Achieng, Loice; Newton, Mark W

    2011-04-01

    Critical care faces the same challenges as other aspects of healthcare in the developing world. However, critical care faces an additional challenge in that it has often been deemed too costly or complicated for resource-poor settings. This lack of prioritization is not justified. Hospital care for the sickest patients affects overall mortality, and public health interventions depend on community confidence in healthcare to ensure participation and adherence. Some of the most effective critical care interventions, including rapid fluid resuscitation, early antibiotics, and patient monitoring, are relatively inexpensive. Although cost-effectiveness studies on critical care in resource-poor settings have not been done, evidence from the surgical literature suggests that even resource-intensive interventions can be cost effective in comparison to immunizations and human immunodeficiency virus care. In the developing world, where many critically ill patients are younger and have fewer comorbidities, critical care presents a remarkable opportunity to provide significant incremental benefit, arguably much more so than in the developed world. Key areas of consideration in developing critical care in resource-poor settings include: Personnel and training, equipment and support services, ethics, and research. Strategies for training and retaining skilled labor include tying education to service commitment and developing protocols for even complex processes. Equipment and support services need to focus on technologies that are affordable and sustainable. Ethical decision making must be based on data when possible and on transparent articulated policies always. Research should be performed in resource-poor settings and focus on needs assessment, prognostication, and cost effectiveness. The development of critical care in resource-poor settings will rely on the stepwise introduction of service improvements, leveraging human resources through training, a focus on sustainable

  20. Reducing health care hazards: lessons from the commercial aviation safety team.

    Science.gov (United States)

    Pronovost, Peter J; Goeschel, Christine A; Olsen, Kyle L; Pham, Julius C; Miller, Marlene R; Berenholtz, Sean M; Sexton, J Bryan; Marsteller, Jill A; Morlock, Laura L; Wu, Albert W; Loeb, Jerod M; Clancy, Carolyn M

    2009-01-01

    The movement to improve quality of care and patient safety has grown, but examples of measurable and sustained progress are rare. The slow progress made in health care contrasts with the success of aviation safety. After a tragic 1995 plane crash, the aviation industry and government created the Commercial Aviation Safety Team to reduce fatal accidents. This public-private partnership of safety officials and technical experts is responsible for the decreased average rate of fatal aviation accidents. We propose a similar partnership in the health care community to coordinate national efforts and move patient safety and quality forward.

  1. Tuberculosis treatment managed by providers outside the Public Health Department: lessons for the Affordable Care Act.

    Directory of Open Access Journals (Sweden)

    Melissa Ehman

    Full Text Available INTRODUCTION: Tuberculosis (TB requires at least six months of multidrug treatment and necessitates monitoring for response to treatment. Historically, public health departments (HDs have cared for most TB patients in the United States. The Affordable Care Act (ACA provides coverage for uninsured persons and may increase the proportion of TB patients cared for by private medical providers and other providers outside HDs (PMPs. We sought to determine whether there were differences in care provided by HDs and PMPs to inform public health planning under the ACA. METHODS: We conducted a retrospective, cross-sectional analysis of California TB registry data. We included adult TB patients with culture-positive, pulmonary TB reported in California during 2007-2011. We examined trends, described case characteristics, and created multivariate models measuring two standards of TB care in PMP- and HD-managed patients: documented culture conversion within 60 days, and use of directly observed therapy (DOT. RESULTS: The proportion of PMP-managed TB patients increased during 2007-2011 (p = 0.002. On univariable analysis (N = 4,606, older age, white, black or Asian/Pacific Islander race, and birth in the United States were significantly associated with PMP care (p<0.05. Younger age, Hispanic ethnicity, homelessness, drug or alcohol use, and cavitary and/or smear-positive TB disease, were associated with HD care. Multivariable analysis showed PMP care was associated with lack of documented culture conversion (adjusted relative risk [aRR] = 1.37, confidence interval [CI] 1.25-1.51 and lack of DOT (aRR = 8.56, CI 6.59-11.1. CONCLUSION: While HDs cared for TB cases with more social and clinical complexities, patients under PMP care were less likely to receive DOT and have documented culture conversion. This indicates a need for close collaboration between PMPs and HDs to ensure that optimal care is provided to all TB patients and TB transmission is

  2. Strengthening preventive care programs: a permanent challenge for healthcare systems; lessons from PREVENIMSS México

    OpenAIRE

    Cantón Sonia; Acosta Benjamín; Reyes Hortensia; Levy Santiago; Pérez-Cuevas Ricardo; Gutiérrez Gonzalo; Muñoz Onofre

    2010-01-01

    Abstract Background In 2001, the Instituto Mexicano del Seguro Social (IMSS) carried out a major reorganization to provide comprehensive preventive care to reinforce primary care services through the PREVENIMSS program. This program divides the population into programmatic age groups that receive specific preventive services: children (0-9 years), adolescents (10-19 years), men (20-59 years), women (20-59 years) and older adults (> = 60 years). The objective of this paper is to describe the i...

  3. Crossing the quality chasm: lessons from health care quality improvement efforts in England

    OpenAIRE

    Madhok, Rajan

    2002-01-01

    The second report from the US Institute of Medicine Crossing the Quality Chasm, highlighted the deficiencies in health care quality in the USA, analyzed the contributory factors, and proposed 13 recommendations for improvements. Clearly, the challenges are enormous. Can anything be learned from the experiences of other countries? This article describes the author's experiences of health care quality improvement efforts in the National Health Service in England and their implications for the U...

  4. Evacuation of a neonatal intensive care unit in a disaster: lessons from Hurricane Sandy.

    Science.gov (United States)

    Espiritu, Michael; Patil, Uday; Cruz, Hannaise; Gupta, Arpit; Matterson, Heideh; Kim, Yang; Caprio, Martha; Mally, Pradeep

    2014-12-01

    NICU patients are among those potentially most vulnerable to the effects of natural or man-made disaster on a medical center. The published data on evacuations of NICU patients in the setting of disaster are sparse. In October of 2012, New York University Langone Medical Center was evacuated during Hurricane Sandy in the setting of a power outage secondary to a coastal surge. In this setting, 21 neonates were safely evacuated from the medical center's NICU to receiving hospitals within New York City in a span of 4.5 hours. Using data recorded during the evacuation and from staff debriefings, we describe the challenges faced and lessons learned during both the power outage and vertical evacuation. From our experience, we identify several elements that are important to the functioning of an NICU in a disaster or to an evacuation that may be incorporated into future NICU-focused disaster planning. These include a clear command structure, backups (personnel, communication, medical information, and equipment), establishing situational awareness, regional coordination, and flexibility as well as special attention to families and to the availability of neonatal transport resources.

  5. The economics of choice: lessons from the U.S. health-care market.

    Science.gov (United States)

    Hanoch, Yaniv; Rice, Thomas

    2011-03-01

    The English health-care system is moving towards increasing consumers' choice. Following economic thinking, it is assumed that such a policy will improve quality, enhance patient satisfaction and reduce health disparities. Indeed, the English health-care system has already built the necessary infrastructure to increase patients' choice. Before expanding the range of choices further, however, it is important that policy makers be aware of the limitations and hurdles that such a policy contains. Here, we highlight these limitations by drawing on the influential work of Kenneth Arrow, who has argued that we cannot treat the health-care market as if it was just another market, and the ideas of Herbert Simon, who questioned whether people had sufficient cognitive abilities to make effective choices in an information-rich environment. In the light of these two strands of thought, we review evidence suggesting that many older adults have low (health) literacy levels, raising concerns over their ability to obtain, process and understand medical-related information, with its increasing complexity, associated risks and emotional involvement. We also discuss recent findings from the United States highlighting the difficulties older users of health-care face with a wide range of prescription drug insurance plans from which to choose. Thus, learning from the experience of health-care systems where choice is abundant could help any health system interested in extending patients' choice to better target the domains where more choice could be beneficial and possibly avoid those where it could be detrimental.

  6. Development of a Web-Based Health Care Intervention for Patients With Heart Disease: Lessons Learned From a Participatory Design Study.

    Science.gov (United States)

    Noergaard, Birgitte; Sandvei, Marianne; Rottmann, Nina; Johannessen, Helle; Wiil, Uffe; Schmidt, Thomas; Pedersen, Susanne S

    2017-05-17

    The use of telemedicine technologies in health care has increased substantially, together with a growing interest in participatory design methods when developing telemedicine approaches. We present lessons learned from a case study involving patients with heart disease and health care professionals in the development of a personalized Web-based health care intervention. We used a participatory design approach inspired by the method for feasibility studies in software development. We collected qualitative data using multiple methods in 3 workshops and analyzed the data using thematic analysis. Participants were 7 patients with diagnosis of heart disease, 2 nurses, 1 physician, 2 systems architects, 3 moderators, and 3 observers. We present findings in 2 parts. (1) Outcomes of the participatory design process: users gave valuable feedback on ease of use of the platforms' tracking tools, platform design, terminology, and insights into patients' monitoring needs, information and communication technologies skills, and preferences for self-management tools. (2) Experiences from the participatory design process: patients and health care professionals contributed different perspectives, with the patients using an experience-based approach and the health care professionals using a more attitude-based approach. The essential lessons learned concern planning and organization of workshops, including the finding that patients engaged actively and willingly in a participatory design process, whereas it was more challenging to include and engage health care professionals.

  7. The Affordable Care Act's pre-existing condition insurance plan: enrollment, costs, and lessons for reform.

    Science.gov (United States)

    Hall, Jean P; Moore, Janice M

    2012-09-01

    The Pre-Existing Condition Insurance Plan (PCIP) is the temporary, federal high-risk pool created under the Affordable Care Act to provide coverage to uninsured individuals with preexisting conditions until 2014, when exchange coverage becomes avail­able to them. Nearly 78,000 people have enrolled since the program was implemented two years ago. This issue brief compares the PCIP with state-based high-risk pools that existed prior to the Affordable Care Act and considers programmatic differences that may have resulted in lower-than-anticipated enrollment and higher-than-anticipated costs for the PCIP. PCIP coverage, like state high-risk pool coverage, likely remains unaffordable to most lower-income individuals with preexisting conditions, but provides much needed access to care for those able to afford it. Operational costs of these programs are also quite high, making them less than optimal as a means of broader coverage expansion.

  8. Engaging primary care physicians in quality improvement: lessons from a payer-provider partnership.

    Science.gov (United States)

    Lemak, Christy Harris; Cohen, Genna R; Erb, Natalie

    2013-01-01

    A health insurer in Michigan, through its Physician Group Incentive Program, engaged providers across the state in a collection of financially incentivized initiatives to transform primary care and improve quality. We investigated physicians' and other program stakeholders' perceptions of the program through semistructured interviews with more than 80 individuals. We found that activities across five areas contributed to successful provider engagement: (1) developing a vision of improving primary care, (2) deliberately fostering practice-practice partnerships, (3) using existing infrastructure, (4) leveraging resources and market share, and (5) managing program trade-offs. Our research highlights effective strategies for engaging primary care physicians in program design and implementation processes and creating learning communities to support quality improvement and practice change.

  9. Integrated care services: lessons learned from the deployment of the NEXES project

    Directory of Open Access Journals (Sweden)

    Carme Hernandez

    2015-03-01

    Full Text Available Objectives: To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus.Setting: One health care sector in Spain (Barcelona (n = 11.382; six municipalities in Norway (Trondheim (n = 450; and one hospital in Greece (Athens (n = 388.Method: The four services were: (i Home-based long-term maintenance of rehabilitation effects (n = 337; (ii Enhanced Care for frail patients, n = 1340; (iii Home Hospitalization and Early Discharge (n = 2404; and Support for remote diagnosis (forced spirometry testing in primary care (Support (n = 8139. Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted.Results: The project demonstrated: (i Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01; (ii Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05; (iii Reduced in-hospital days for all types of patients (p < 0.001 in Home Hospitalization/Early Discharge; and (iv Increased quality of testing (p < 0.01 for patients with respiratory symptoms in Support, with marked differences among sites.Conclusions: The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.

  10. Integrated care services: lessons learned from the deployment of the NEXES project

    Directory of Open Access Journals (Sweden)

    Carme Hernandez

    2015-03-01

    Full Text Available Objectives: To identify barriers to deployment of four articulated Integrated Care Services supported by Information Technologies in three European sites. The four services covered the entire spectrum of severity of illness. The project targeted chronic patients with obstructive pulmonary disease, cardiac failure and/or type II diabetes mellitus. Setting: One health care sector in Spain (Barcelona (n = 11.382; six municipalities in Norway (Trondheim (n = 450; and one hospital in Greece (Athens (n = 388. Method: The four services were: (i Home-based long-term maintenance of rehabilitation effects (n = 337; (ii Enhanced Care for frail patients, n = 1340; (iii Home Hospitalization and Early Discharge (n = 2404; and Support for remote diagnosis (forced spirometry testing in primary care (Support (n = 8139. Both randomized controlled trials and pragmatic study designs were combined. Two technological approaches were compared. The Model for Assessment of Telemedicine applications was adopted. Results: The project demonstrated: (i Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p < 0.01; (ii Enhanced care and fewer hospitalizations in chronic respiratory patients (p < 0.05; (iii Reduced in-hospital days for all types of patients (p < 0.001 in Home Hospitalization/Early Discharge; and (iv Increased quality of testing (p < 0.01 for patients with respiratory symptoms in Support, with marked differences among sites. Conclusions: The four integrated care services showed high potential to enhance health outcomes with cost-containment. Change management, technological approach and legal issues were major factors modulating the success of the deployment. The project generated a business plan to foster service sustainability and health innovation. Deployment strategies require site-specific adaptations.

  11. Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda

    Directory of Open Access Journals (Sweden)

    Deborah Sitrin

    2015-03-01

    Full Text Available Background: Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective: This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design: Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW during pregnancy (0, 1–2, 3+ – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results: There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion: Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of

  12. Epidemiology and cost of hospital care for Lyme borreliosis in Germany: lessons from a health care utilization database analysis.

    Science.gov (United States)

    Lohr, B; Müller, I; Mai, M; Norris, D E; Schöffski, O; Hunfeld, K-P

    2015-02-01

    To date, relatively little is known about the economic and medical impact of Lyme borreliosis (LB) on European health care systems, especially for the inpatient sector. This retrospective analysis is based on data provided for the years 2007-2011 by a German statutory health insurance company (DAK-Gesundheit) covering approximately 6 million insured. Total cost was calculated for a 1-year period both from the third-party payers and from the societal perspective, respectively. In our cohort the incident diagnosis of LB was coded for 2163 inpatient cases during the years 2008-2011. The median inpatient time was 9 days resulting in a median direct medical cost per hospital stay of 3917€ for adolescents and 2843€ for adults. Based on extrapolation of our findings to the German population, we would expect an average hospital admission of 5200 adults and 2300 adolescents (<18 years) for LB treatment incurring direct medical costs of more than 23 million Euro annually. The annual indirect costs due to loss of productivity would add up to more than 7 million Euro as assessed by the human capital method. Cases tended to accumulate between June and September with remarkable changes in disease manifestations in the course of the year documented in the coded secondary diagnoses. Also specific differences in the disease pattern of adolescents and adults became obvious. Age-specific incidence showed male predominance and a bimodal distribution. Incidence was highest in children aged between 3 and 17 (highest mean incidence of 29 cases/100,000 inhabitants in 6-9 year olds) with a second peak in 60-79 year old individuals. During the study period the nationwide inpatient incidence was 9/100,000 with marked regional variability. In summary, our study is one of the first European investigations on hospital care for LB inpatients and identifies LB as a possibly underestimated socioeconomic factor for health care in Germany.

  13. Lessons from the implementation of a near patient anticoagulant monitoring service in primary care

    Directory of Open Access Journals (Sweden)

    Simon DeLusignan

    2004-02-01

    Conclusions The group, by sharing their experiences through a structured series of workshops, developed an understanding of when it might be appropriate to vary from the decision support software’s recommendations and how this could be audited. The technological solution modelled on hospital practice proved hard to implement in primary care.

  14. How to achieve optimal organization of primary care service delivery at system level: lessons from Europe.

    NARCIS (Netherlands)

    Pelone, F.; Kringos, D.S.; Spreeuwenberg, P.; Belvis, A.G. de; Groenewegen, P.P.

    2013-01-01

    Objective: To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Design: Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data

  15. How to achieve optimal organization of primary care service delivery at system level: Lessons from Europe

    NARCIS (Netherlands)

    Pelone, F.; Kringos, D.S.; Spreeuwenberg, P.; de Belvis, A.; Groenewegen, P.P.

    2013-01-01

    OBJECTIVE: To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. DESIGN: Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data

  16. Integrated complex care model: lessons learned from inter-organizational partnership.

    Science.gov (United States)

    Cohen, Eyal; Bruce-Barrett, Cindy; Kingsnorth, Shauna; Keilty, Krista; Cooper, Anna; Daub, Stacey

    2011-01-01

    Providing integrated care for children with medical complexity in Canada is challenging as these children are, by definition, in need of coordinated care from disparate providers, organizations and funders across the continuum in order to optimize health outcomes. We describe the development of an inter-organizational team constructed as a unique tripartite partnership of an acute care hospital, a children's rehabilitation hospital and a home/community health organization focused on children who frequently use services across these three organizations. Model building and operationalization within the Canadian healthcare system is emphasized. Key challenges identified to date include communication and policy barriers as well as optimizing interactions with families; critical enablers have been alignment with policy trends in healthcare and inter-organizational commitment to integrate at the point of care. Considerations for policy developments supporting full integration across service sectors are raised. Early indicators of success include the enrolment of 34 clients and patients and the securing of funds to evaluate and expand the model to serve more children.

  17. A "Noble Bet" in Early Care and Education: Lessons from One Community's Experience.

    Science.gov (United States)

    Gill, Brian P.; Dembosky, Jacob W.; Caulkins, Jonathan P.

    The Early Childhood Initiative (ECI) was an ambitious effort launched in Pittsburgh, Pennsylvania, in 1996 to provide high-quality early care and education services to at-risk children, on a county-wide scale and under the direction of local neighborhood agencies. Four years after its launch, ECI was providing substantial social and educational…

  18. Structure of Primary Health Care: Lessons from a Rural Area in ...

    African Journals Online (AJOL)

    It is assumed that given the proper structure, quality medical care will follow. ... In addition 44.4% lacked basic equipment and none had a maintenance plan. ... of PHC Ikosi-Ejinrin LCDA, a rural area in south-west Nigeria, is inadequate.

  19. Engaging Consumer Voices in Health Care Policy: Lessons for Social Work Practice.

    Science.gov (United States)

    Law, Kristi Lohmeier; Saunders, A

    2016-02-01

    Community health centers provide comprehensive public health care in some of the most disadvantaged communities in the United States. To ensure that health centers meet the needs of their consumers, they uniquely engage them in their organizational decision-making and policy-development processes by requiring that their boards of directors encompass a 51 percent consumer majority. To understand the quality of board members' experiences, a critical ethnography was conducted using Arnstein's ladder of citizen participation and the socioecological model as a framework. The analysis identified multiple influences on the quality of participation among consumer members. Findings also confirm other research that has found that knowledge of the economic, political, and cultural factors surrounding the context of the individual health center is important to understanding meaningful participation. The experience is important to understand given the shift driven by the Patient Protection and Affordable Care Act of 2010 in health care, which emphasizes a patient-entered model of care. Social work practitioners and others in the public health arena interested in empowering consumers to have a role in the provision of services need to understand the impact of each of these areas'and the experience of this unique sample of health center board members.

  20. Continuing medical education costs and benefits: lessons for competing in a changing health care economy.

    Science.gov (United States)

    Mazmanian, Paul E

    2009-01-01

    Current approaches to evaluation in continuing medical education (CME) feature results defined as changes in participation, satisfaction, knowledge, behavior, and patient outcomes. Few studies link costs and effectiveness of CME to improved quality of care. As continuing education programs compete for scarce resources, cost-inclusive evaluation offers strategies to measure change and to determine value for resources spent.

  1. Planning Lessons

    Institute of Scientific and Technical Information of China (English)

    Linda Jensen

    2007-01-01

    @@ Jensen's "Lesson Planning"article serves aS a guide fOr novice teachers who need to create formalized lesson plans.The article covers why,when,and how teachers plan lessons,as well aS basic lesson plan principles and a lesson plan template.

  2. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC/Advancing Quality Alliance integrated care fellowship experience

    Directory of Open Access Journals (Sweden)

    Michael Gregory

    2015-05-01

    Full Text Available The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world.In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care.I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

  3. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC/Advancing Quality Alliance integrated care fellowship experience

    Directory of Open Access Journals (Sweden)

    Michael Gregory

    2015-05-01

    Full Text Available The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world. In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care. I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

  4. Challenges in interdisciplinary weight management in primary care: lessons learned from the 5As Team study.

    Science.gov (United States)

    Asselin, J; Osunlana, A M; Ogunleye, A A; Sharma, A M; Campbell-Scherer, D

    2016-04-01

    Increasingly, research is directed at advancing methods to address obesity management in primary care. In this paper we describe the role of interdisciplinary collaboration, or lack thereof, in patient weight management within 12 teams in a large primary care network in Alberta, Canada. Qualitative data for the present analysis were derived from the 5As Team (5AsT) trial, a mixed-method randomized control trial of a 6-month participatory, team-based educational intervention aimed at improving the quality and quantity of obesity management encounters in primary care practice. Participants (n = 29) included in this analysis are healthcare providers supporting chronic disease management in 12 family practice clinics randomized to the intervention arm of the 5AsT trial including mental healthcare workers (n = 7), registered dietitians (n = 7), registered nurses or nurse practitioners (n = 15). Participants were part of a 6-month intervention consisting of 12 biweekly learning sessions aimed at increasing provider knowledge and confidence in addressing patient weight management. Qualitative methods included interviews, structured field notes and logs. Four common themes of importance in the ability of healthcare providers to address weight with patients within an interdisciplinary care team emerged, (i) Availability; (ii) Referrals; (iii) Role perception and (iv) Messaging. However, we find that what was key to our participants was not that these issues be uniformly agreed upon by all team members, but rather that communication and clinic relationships support their continued negotiation. Our study shows that firm clinic relationships and deliberate communication strategies are the foundation of interdisciplinary care in weight management. Furthermore, there is a clear need for shared messaging concerning obesity and its treatment between members of interdisciplinary teams.

  5. The Optimize Heart Failure Care Program: Initial lessons from global implementation.

    Science.gov (United States)

    Cowie, Martin R; Lopatin, Yuri M; Saldarriaga, Clara; Fonseca, Cândida; Sim, David; Magaña, Jose Antonio; Albuquerque, Denilson; Trivi, Marcelo; Moncada, Gustavo; González Castillo, Baldomero A; Sánchez, Mario Osvaldo Speranza; Chung, Edward

    2017-06-01

    Hospitalization for heart failure (HF) places a major burden on healthcare services worldwide, and is a strong predictor of increased mortality especially in the first three months after discharge. Though undesirable, hospitalization is an opportunity to optimize HF therapy and advise clinicians and patients about the importance of continued adherence to HF medication and regular monitoring. The Optimize Heart Failure Care Program (www.optimize-hf.com), which has been implemented in 45 countries, is designed to improve outcomes following HF hospitalization through inexpensive initiatives to improve prescription of appropriate drug therapies, patient education and engagement, and post-discharge planning. It includes best practice clinical protocols for local adaptation, pre- and post-discharge checklists, and 'My HF Passport', a printed and smart phone application to improve patient understanding of HF and encourage involvement in care and treatment adherence. Early experience of the Program suggests that factors leading to successful implementation include support from HF specialists or 'local leaders', regular educational meetings for participating healthcare professionals, multidisciplinary collaboration, and full integration of pre- and post-hospital discharge checklists across care services. The Program is helping to raise awareness of HF and generate useful data on current practice. It is showing how good evidence-based care can be achieved through the use of simple clinician and patient-focused tools. Preliminary results suggest that optimization of HF pharmacological therapy is achievable through the Program, with little new investment. Further data collection will lead to a greater understanding of the impact of the Program on HF care and key indicators of success. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  6. Barriers of access to care in a managed competition model: lessons from Colombia

    Directory of Open Access Journals (Sweden)

    Mogollón-Pérez Amparo Susana

    2010-10-01

    Full Text Available Abstract Background The health sector reform in Colombia, initiated by Law 100 (1993 that introduced a managed competition model, is generally presented as a successful experience of improving access to care through a health insurance regulated market. The study's objective is to improve our understanding of the factors influencing access to the continuum of care in the Colombian managed competition model, from the social actors' point of view. Methods An exploratory, descriptive-interpretative qualitative study was carried out, based on case studies of four healthcare networks in rural and urban areas. Individual semi-structured interviews were conducted to a three stage theoretical sample: I cases, II providers and III informants: insured and uninsured users (35, health professionals (51, administrative personnel (20, and providers' (18 and insurers' (10 managers. Narrative content analysis was conducted; segmented by cases, informant's groups and themes. Results Access, particularly to secondary care, is perceived as complex due to four groups of obstacles with synergetic effects: segmented insurance design with insufficient services covered; insurers' managed care and purchasing mechanisms; providers' networks structural and organizational limitations; and, poor living conditions. Insurers' and providers' values based on economic profit permeate all factors. Variations became apparent between the two geographical areas and insurance schemes. In the urban areas barriers related to market functioning predominate, whereas in the rural areas structural deficiencies in health services are linked to insufficient public funding. While financial obstacles are dominant in the subsidized regime, in the contributory scheme supply shortage prevails, related to insufficient private investment. Conclusions The results show how in the Colombian healthcare system structural and organizational barriers to care access, that are common in developing countries

  7. Overfeeding and overhydration in elderly medical patients: lessons from the Liverpool Care Pathway.

    Science.gov (United States)

    Tsiompanou, Eleni; Lucas, Caroline; Stroud, Mike

    2013-06-01

    This paper describes three elderly patients who were admitted to hospital with aspiration pneumonia. They were kept nil by mouth (NBM) for a number of days, while being given intravenous hydration initially and enteral feeding subsequently. During that time they deteriorated and appeared to be dying, so the Liverpool Care Pathway (LCP) for the dying was used to support their care. Artificial nutrition and hydration were stopped. They quickly improved and the LCP was discontinued. Two of the patients deteriorated again on reintroduction of enteral feeding and/or intravenous fluids, only to improve a second time following withdrawal of feeding and fluids. Vulnerable elderly patients should not be made NBM except as a last resort. Clinicians should be alert to the possibility of refeeding syndrome and overhydration as reversible causes of clinical deterioration, particularly in frail elderly patients. Use of the LCP in these patients provided a unique opportunity to witness the positive effects of withdrawal of excessive artificial nutrition and hydration.

  8. Postpartum depression screening in the Neonatal Intensive Care Unit: program development, implementation, and lessons learned

    Directory of Open Access Journals (Sweden)

    Cherry AS

    2016-02-01

    Full Text Available Amanda S Cherry,1 Ryan T Blucker,1 Timothy S Thornberry,2 Carla Hetherington,3 Mary Anne McCaffree,3 Stephen R Gillaspy1 1Department of Pediatrics, Section of General and Community Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 2Department of Psychology, Morehead State University, Morehead, KY, 3Department of Pediatrics, College of Medicine, University of Oklahoma, Oklahoma City, OK, USA Objective: The aims of this project were to describe the development of a postpartum depression screening program for mothers of infants in the Neonatal Intensive Care Unit and assess the implementation of the screening program. Methods: Screening began at 14 days postpartum and was implemented as part of routine medical care. A nurse coordinator facilitated communication with mothers for increasing screen completion, review of critical self-harm items, and making mental health referrals. During the 18-month study period, 385 out of 793 eligible mothers completed the screen. Results: Approximately 36% of mothers had a positive screen that resulted in a mental health referral and an additional 30% of mothers had screening results indicating significant symptoms. Conclusion: Several barriers were identified, leading to adjustments in the screening process, and ultimately recommendations for future screening programs and research. Development of a postpartum depression screening process in the Neonatal Intensive Care Unit involves support, training, implementation, and coordination from administrators, medical staff, new mothers, and mental health specialists. Several predictable challenges to program development require ongoing assessment and response to these challenges. Relevance: This study highlights the expanding role of the psychologist and behavioral health providers in health care to intervene as early as possible in the life of a child and family with medical complications through multidisciplinary program development and

  9. Dermatologic challenges of health care for displaced people. lessons from a German emergency refugee camp

    Directory of Open Access Journals (Sweden)

    Uwe Wollina

    2016-04-01

    Full Text Available Background: The World faces the highest waves of displaced people since World War II. There is limited knowledge about need of dermatological care for refugees and asylum seekers. Methods: We report the experience with a temporary emergency refugee camp in Dresden form the viewpoint of a hospital department. This is a descriptive report covering the period of 10 weeks. Results: In this refugee camp up to 1 100 people were hosted. The male to female ratio was 5.3. The majority of inhabitants were young males (60%, 20% were children. While 40% of refuges came from Syria, Afghanistan, Iraq and Pakistan were also important countries of origin. Communication war a crucial issue while providing health care. Dermatologic service was granted as consultation, outpatient and inpatient clinic. Most contacts were noted in the outpatient clinic. The majority of patient attended the clinic with communicable diseases such as bacterial or viral infections and infestations. Wounds and chronic inflammatory diseases were rather uncommon. Only 4 patients had to be treated in the hospital (inpatient clinic. Conclusions: Displaced people (refugees, asylum seekers come in big waves to Europe. Dermatologic service is an important part of first aid health care in an emergency camp. Language barriers and cultural barriers have to overcome for optimal service. This is the first report from Germany.

  10. How to achieve optimal organization of primary care service delivery at system level: lessons from Europe.

    Science.gov (United States)

    Pelone, Ferruccio; Kringos, Dionne S; Spreeuwenberg, Peter; De Belvis, Antonio G; Groenewegen, Peter P

    2013-09-01

    To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. PC systems in 22 European countries in 2009/2010. Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure-process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency.

  11. The refinement of topics for systematic reviews: lessons and recommendations from the Effective Health Care Program.

    Science.gov (United States)

    Buckley, David I; Ansari, Mohammed T; Butler, Mary; Soh, Clara; Chang, Christine S

    2014-04-01

    The Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program conducts systematic reviews of health-care topics nominated by stakeholders. Topics undergo refinement to ensure relevant questions of appropriate scope and useful reviews. Input from key informants, experts, and a literature scan informs changes in the nominated topic. AHRQ convened a work group to assess approaches and develop recommendations for topic refinement. Work group members experienced in topic refinement generated a list of questions and guiding principles relevant to the refinement process. They discussed each issue and reached agreement on recommendations. Topics should address important health-care questions or dilemmas, consider stakeholder priorities and values, reflect the state of the science, and be consistent with systematic review research methods. Guiding principles of topic refinement are fidelity to the nomination, relevance, research feasibility, responsiveness to stakeholder inputs, reduced investigator bias, transparency, and suitable scope. Suggestions for stakeholder engagement, synthesis of input, and reporting are discussed. Refinement decisions require judgment and balancing guiding principles. Variability in topics precludes a prescriptive approach. Accurate, rigorous, and useful systematic reviews require well-refined topics. These guiding principles and methodological recommendations may help investigators refine topics for reviews. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. DSCOVR Contamination Lessons Learned

    Science.gov (United States)

    Graziani, Larissa

    2015-01-01

    The Triana observatory was built at NASA GSFC in the late 1990's, then placed into storage. After approximately ten years it was removed from storage and repurposed as the Deep Space Climate Observatory (DSCOVR). This presentation outlines the contamination control program lessons learned during the integration, test and launch of DSCOVR.

  13. An adaptive case management system to support integrated care services: Lessons learned from the NEXES project.

    Science.gov (United States)

    Cano, Isaac; Alonso, Albert; Hernandez, Carme; Burgos, Felip; Barberan-Garcia, Anael; Roldan, Jim; Roca, Josep

    2015-06-01

    Extensive deployment and sustainability of integrated care services (ICS) constitute an unmet need to reduce the burden of chronic conditions. The European Union project NEXES (2008-2013) assessed the deployment of four ICS encompassing the spectrum of severity of chronic patients. The current study aims to (i) describe the open source Adaptive Case Management (ACM) system (Linkcare®) developed to support the deployment of ICS at the level of healthcare district; (ii) to evaluate its performance; and, (iii) to identify key challenges for regional deployment of ICS. We first defined a conceptual model for ICS management and execution composed of five main stages. We then specified an associated logical model considering the dynamic runtime of ACM. Finally, we implemented the four ICS as a physical model with an ICS editor to allow professionals (case managers) to play active roles in adapting the system to their needs. Instances of ICS were then run in Linkcare®. Four ICS provided a framework for evaluating the system: Wellness and Rehabilitation (W&R) (number of patients enrolled in the study (n)=173); Enhanced Care (EC) in frail chronic patients to prevent hospital admissions, (n=848); Home Hospitalization and Early Discharge (HH/ED) (n=2314); and, Support to remote diagnosis (Support) (n=7793). The method for assessment of telemedicine applications (MAST) was used for iterative evaluation. Linkcare® supports ACM with shared-care plans across healthcare tiers and offers integration with provider-specific electronic health records. Linkcare® successfully contributed to the deployment of the four ICS: W&R facilitated long-term sustainability of training effects (p<0.01) and active life style (p<0.03); EC showed significant positive outcomes (p<0.05); HH/ED reduced on average 5 in-hospital days per patient with a 30-d re-admission rate of 10%; and, Support, enhanced community-based quality forced spirometry testing (p<0.01). Key challenges for regional deployment

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

    Science.gov (United States)

    DiCenzo, Jodi; Fronstin, Paul

    2008-08-01

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

  15. Affirming Life in the Face of Death: Ricoeur's Living Up to Death as a modern ars moriendi and a lesson for palliative care.

    Science.gov (United States)

    de Lange, Ds Frits

    2014-11-01

    In his posthumously published Living Up to Death Paul Ricoeur left an impressive testimony on what it means to live at a high old age with death approaching. In this article I present him as a teacher who reminds us of valuable lessons taught by patients in palliative care and their caretakers who accompany them on their way to death, and also as a guide in our search for a modern ars moriendi, after--what many at least experience as--the breakdown of traditional religious belief in a personal afterlife. These lessons can be summarized in the following theses. 'Living up to death, one cannot experience one's own death. Therefore, never consider someone dying as moribund'. 'Though everybody is alone in dying, nobody should die alone.' 'The preparation for death is an affirmation of life'. 'Life experienced as a gift can be given up'. The plausibility of the last thesis, however, may go beyond the confines of austere philosophical thinking.

  16. The new institutionalist approaches to health care reform: lessons from reform experiences in Central Europe.

    Science.gov (United States)

    Sitek, Michał

    2010-08-01

    This article discusses the applicability of the new institutionalism to the politics of health care reform in postcommunist Central Europe. The transition to a market economy and democracy after the fall of communism has apparently strengthened the institutional approaches. The differences in performance of transition economies have been critical to the growing understanding of the importance of institutions that foster democracy, provide security of property rights, help enforce contracts, and stimulate entrepreneurship. From a theoretical perspective, however, applying the new institutionalist approaches has been problematic. The transitional health care reform exposes very well some inherent weaknesses of existing analytic frameworks for explaining the nature and mechanisms of institutional change. The postcommunist era in Central Europe has been marked by spectacular and unprecedented radical changes, in which the capitalist system was rebuilt in a short span of time and the institutions of democracy became consolidated. Broad changes to welfare state programs were instituted as well. However, the actual results of the reform processes represent a mix of change and continuity, which is a challenge for the theories of institutional change.

  17. Implementing Brief Interventions in Health Care: Lessons Learned from the Swedish Risk Drinking Project

    Directory of Open Access Journals (Sweden)

    Per Nilsen

    2011-09-01

    Full Text Available The Risk Drinking Project was a national implementation endeavour in Sweden, carried out from 2004 to 2010, based on a government initiative to give alcohol issues a more prominent place in routine primary, child, maternity and occupational health care. The article describes and analyses the project. Critical factors that were important for the results are identified. The magnitude of the project contributed to its reach and impact in terms of providers’ awareness of the project goals and key messages. The timing of the project was appropriate. The increase in alcohol consumption in Sweden and diminished opportunities for primary prevention strategies since entry to the European Union in 1995 have led to increased expectations for health care providers to become more actively involved in alcohol prevention. This awareness provided favourable conditions for this project. A multifaceted approach was used in the project. Most educational courses were held in workshops and seminars to encourage learning-by-doing. Motivational interviewing was an integral aspect. The concept of risk drinking was promoted in all the activities. Subprojects were tailored to the specific conditions of each respective setting, building on the skills the providers already had to modify existing work practices. Nurses were afforded a key role in the project.

  18. Lessons for health care reform from the less developed world: the case of the Philippines.

    Science.gov (United States)

    Obermann, Konrad; Jowett, Matthew R; Taleon, Juanito D; Mercado, Melinda C

    2008-11-01

    International technical and financial cooperation for health-sector reform is usually a one-way street: concepts, tools and experiences are transferred from more to less developed countries. Seldom, if ever, are experiences from less developed countries used to inform discussions on reforms in the developed world. There is, however, a case to be made for considering experiences in less developed countries. We report from the Philippines, a country with high population growth, slow economic development, a still immature democracy and alleged large-scale corruption, which has embarked on a long-term path of health care and health financing reforms. Based on qualitative health-related action research between 2002 and 2005, we have identified three crucial factors for achieving progress on reforms in a challenging political environment: (1) strive for local solutions, (2) make use of available technology and (3) work on the margins towards pragmatic solutions whilst having your ethical goals in mind. Some reflection on these factors might stimulate and inform the debate on how health care reforms could be pursued in developed countries.

  19. 'It ain't what you do it's the way that you do it': lessons for health care from decommissioning of older people's services.

    Science.gov (United States)

    Robinson, Suzanne; Glasby, Jon; Allen, Kerry

    2013-11-01

    Public sector organisations are facing one of the most difficult financial periods in history and local decision-makers are tasked with making tough rationing decisions. Withdrawing or limiting services is an emotive and complex task and something the National Health Service has always found difficult. Over time, local authorities have gained significant experience in the closure of care homes - an equally complex and controversial issue. Drawing on local knowledge and best practice examples, this article highlights lessons and themes identified by those decommissioning care home services. We believe that such lessons are relevant to those making disinvestment decisions across public sector services, including health-care. The study employed semi-structured interviews with 12 Directors of Adult Social Services who had been highlighted nationally as having extensive experience of home closures. Interviews were conducted over a 2-week period in March 2011. Results from the study found that having local policy guidance that is perceived as fair and reasonable was advocated by those involved in home closures. Many local policies had evolved over time and had often been developed following experiences of home closures (both good and bad). Decisions to close care home services require a combination of strong leadership, clear strategic goals, a fair decision-making process, strong evidence of the need for change and good communication, alongside wider stakeholder engagement and support. The current financial challenge means that public sector organisations need to make tough choices on investment and disinvestment decisions. Any such decisions need to be influenced by what we know constitutes best practice. Sharing lessons and experiences within and between sectors could well inform and develop decision-making practices.

  20. Strengthening preventive care programs: a permanent challenge for healthcare systems; lessons from PREVENIMSS México

    Directory of Open Access Journals (Sweden)

    Cantón Sonia

    2010-07-01

    Full Text Available Abstract Background In 2001, the Instituto Mexicano del Seguro Social (IMSS carried out a major reorganization to provide comprehensive preventive care to reinforce primary care services through the PREVENIMSS program. This program divides the population into programmatic age groups that receive specific preventive services: children (0-9 years, adolescents (10-19 years, men (20-59 years, women (20-59 years and older adults (> = 60 years. The objective of this paper is to describe the improvement of the PREVENIMSS program in terms of the increase of coverage of preventive actions and the identification of unmet needs of unsolved and emergent health problems. Methods From 2003 to 2006, four nation-wide cross-sectional probabilistic population based surveys were conducted using a four stage sampling design. Thirty thousand households were visited in each survey. The number of IMSS members interviewed ranged from 79,797 respondents in 2003 to 117,036 respondents in 2006. Results The four surveys showed a substantial increase in coverage indicators for each age group: children, completed schemes of vaccination (> 90%, iron supplementation (17.8% to 65.5%, newborn screening for metabolic disorders (60.3% to 81.6%. Adolescents, measles - rubella vaccine (52.4% to 71.4%, hepatitis vaccine (9.3% to 46.2%, use of condoms (17.9% to 59.9%. Women, measles-rubella vaccine (28.5% to 59-2%, cervical cancer screening (66.7% to 75%, breast cancer screening (> 2.1%. Men, type 2 diabetes screening (38.6% to 57.8% hypertension screening (48-4% to 64.0%. Older adults, pneumococcal vaccine (13.2% to 24.9%, influenza vaccine (12.6% to 52.9 Regarding the unmet needs, the prevalence of anemia in children was 30% and a growing prevalence of overweight and obesity, type 2 diabetes, and hypertension was found in men, women and older adults. Conclusion PREVENIMSS showed an important increase in the coverage of preventive services and stressed the magnitude of the old and

  1. From Stars to Patients: Lessons from Space Science and Astrophysics for Health Care Informatics

    CERN Document Server

    Djorgovski, S G; Crichton, D; Chaudhry, B

    2015-01-01

    Big Data are revolutionizing nearly every aspect of the modern society. One area where this can have a profound positive societal impact is the field of Health Care Informatics (HCI), which faces many challenges. The key idea behind this study is: can we use some of the experience and technical and methodological solutions from the fields that have successfully adapted to the Big Data era, namely astronomy and space science, to help accelerate the progress of HCI? We illustrate this with examples from the Virtual Observatory framework, and the NCI EDRN project. An effective sharing and reuse of tools, methods, and experiences from different fields can save a lot of effort, time, and expense. HCI can thus benefit from the proven solutions to big data challenges from other domains.

  2. Reform of the Individual Insurance Market in New Jersey: Lessons for the Affordable Care Act.

    Science.gov (United States)

    Cantor, Joel C; Monheit, Alan C

    2016-08-01

    The individual health insurance market has played a small but important role in providing coverage to those without access to group insurance or public programs. With implementation of the Affordable Care Act (ACA), the individual market has attained a more prominent role. However, achieving accessible and affordable coverage in this market is a long-standing challenge, in large part due to the threat of adverse risk selection. New Jersey pursued comprehensive reforms beginning in the 1990s to achieve a stable, accessible, and affordable individual market. We review how adverse risk selection can pose a challenge to achieving such objectives in the individual health insurance market. We follow this discussion by describing the experience of New Jersey through three rounds of legislative reform and through the first year of the implementation of the ACA coverage provisions. While the New Jersey reforms did not require individuals to purchase coverage, its experiences with direct and indirect market subsidies and regulations guiding plan design, issuance, and rating have important implications for how the ACA may achieve its coverage goals in the absence of the controversial individual purchase mandate.

  3. Nurse-led health promotion interventions improve quality of life in frail older home care clients: lessons learned from three randomized trials in Ontario, Canada.

    Science.gov (United States)

    Markle-Reid, Maureen; Browne, Gina; Gafni, Amiram

    2013-02-01

    This paper explores the lessons learned from a series of three randomized controlled trials that included 498 community-living frail older adults (≥65 years) using home care services in Southern Ontario, Canada. Each study was designed to evaluate the effectiveness of different multi-component nurse-led health promotion and disease prevention (HPDP) interventions. The nurse-led HPDP interventions were 6- or 12-month multi-component and evidence-based strategies targeting known risk factors for functional decline and frailty. Across the three studies, a common approach was used to measure the change in health-related quality of life (HRQOL) (SF-36) and the costs of use of health services (Health and Social Services Utilization Inventory) from baseline to the end of the intervention. The main lesson learned from the three studies is that nurse-led HPDP interventions for frail older home care clients provide greater improvements in HRQOL compared with usual home care. Such approaches are highly acceptable to this population and can be implemented using existing home care resources. Nurse-led HPDP interventions should include multiple home visits, multidimensional screening and assessment, multi-component evidence-based HPDP strategies, intensive case management, inter-professional collaboration, providers with geriatric training and experience, referral to and coordination of community services, and theory use. The results of the three trials underscore the need to reinvest in nurse-led HPDP interventions in home care to optimize HRQOL and promote ageing in place in the target population of frail older adults. More studies are needed to evaluate the effectiveness of additional nurse-led HPDP interventions in other contexts and settings. © 2011 Blackwell Publishing Ltd.

  4. Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis

    Directory of Open Access Journals (Sweden)

    Walter P Wodchis

    2015-09-01

    Full Text Available Background: To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports.Objective: The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models.Methods: This paper provides a structured cross-case synthesis of seven integrated care programmes in Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the USA.Key findings: All seven programmes involved bottom-up innovation driven by local needs and included: (1 a single point of entry, (2 holistic care assessments, (3 comprehensive care planning, (4 care co-ordination and (5 a well-connected provider network. The process of achieving successful integration involves collaboration and, although the specific types of collaboration varied considerably across the seven case studies, all involved a care coordinator or case manager. Most programmes were not systematically evaluated but the two with formal external evaluations showed benefit and have been expanded.Conclusions: Case managers or care coordinators who support patient-centred collaborative care are key to successful integration in all our cases as are policies that provide funds and support for local initiatives that allow for bottom-up innovation. However, more robust and systematic evaluation of these initiatives is needed to clarify the ‘business case’ for integrated health and social care and to ensure successful generalization of local successes.

  5. Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis

    Directory of Open Access Journals (Sweden)

    Walter P Wodchis

    2015-09-01

    Full Text Available Background: To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports. Objective: The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models. Methods: This paper provides a structured cross-case synthesis of seven integrated care programmes in Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the USA. Key findings: All seven programmes involved bottom-up innovation driven by local needs and included: (1 a single point of entry, (2 holistic care assessments, (3 comprehensive care planning, (4 care co-ordination and (5 a well-connected provider network. The process of achieving successful integration involves collaboration and, although the specific types of collaboration varied considerably across the seven case studies, all involved a care coordinator or case manager. Most programmes were not systematically evaluated but the two with formal external evaluations showed benefit and have been expanded. Conclusions: Case managers or care coordinators who support patient-centred collaborative care are key to successful integration in all our cases as are policies that provide funds and support for local initiatives that allow for bottom-up innovation. However, more robust and systematic evaluation of these initiatives is needed to clarify the ‘business case’ for integrated health and social care and to ensure successful generalization of local successes.

  6. Lessons for non-VA care delivery systems from the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative: QUERI Series

    Directory of Open Access Journals (Sweden)

    Solberg Leif

    2009-02-01

    Full Text Available Abstract The U.S. Veterans Health Administration (VHA may have a very different structure and function from the organizations and practices that provide medical care to most Americans, but those organizations and practices could learn a lot from the VHA's Quality Enhancement Research Initiative (QUERI. There are at least six topics of increasing importance for implementation research where QUERI experience should be of value to other non-VHA organizations, both within and external to the United States: 1 Researcher-clinical leader partnerships for care improvement; 2 Attention to culture, capacity, leadership, and a supportive infrastructure; 3 Practical economic evaluation of quality implementation efforts; 4 Human subject protection problems; 5 Sustainability of improvements; and 6 Scale-up and spread of improvements. The articles in Implementation Science's QUERI Series provide the details of those lessons for others who are willing to invest the time to translate them into their different settings.

  7. Transcutaneous Electrical Nerve Stimulation (TENS) for fibromyalgia in adults

    OpenAIRE

    Johnson, MI; Claydon, LS; Herbison, GP; Paley, CA; Jones, G.

    2016-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the analgesic efficacy and adverse events of TENS for fibromyalgia in adults. We will assess TENS on its own or added to usual care in comparisons with placebo (sham) TENS, usual care, or no treatment.

  8. Establishing a new model of integrated primary and secondary care based around general practice: a case study of lessons learned and challenges.

    Science.gov (United States)

    Jackson, Claire L; Donald, Maria; Russell, Anthony W; McIntyre, H David

    2017-05-09

    This case study describes the development and implementation of an innovative integrated primary-secondary model of care for people with complex diabetes. The aim of the paper is to present the experiences of clinicians and researchers involved in implementing the 'Beacon' model by providing a discussion of the contextual factors, including lessons learned, challenges and solutions. Beacon-type models of community care for people with chronic disease are well placed to deliver on Australia's health care reform agenda, and this commentary provides rich contextual information relevant to the translation of such models into policy and practice.What is known about the topic? Better integrated clinical models of care with close cooperation between hospital-based specialists and general practitioners (GPs) is fundamental to chronic disease management.What does this paper add? A real world example of the challenges faced in implementing models of integrated care across diverse settings and business models.What are the implications for clinicians? Practice, organisational and external factors including energy clinician leadership and resourcing are critical for translation of evidence into ongoing practice.

  9. Population Education in Mathematics: Some Sample Lessons.

    Science.gov (United States)

    United Nations Educational, Scientific, and Cultural Organization, Bangkok (Thailand). Regional Office for Education in Asia and Oceania.

    This mathematics teacher's manual contains ten sample lessons on population growth and demography that were adapted from materials produced in several countries in Asia and Oceania. Among the mathematics concepts and skills students apply during these lessons are set theory, cardinal and ordinal numbers, frequency tallies, percentages, ratios,…

  10. Building the Partners HealthCare Biobank at Partners Personalized Medicine: Informed Consent, Return of Research Results, Recruitment Lessons and Operational Considerations

    Directory of Open Access Journals (Sweden)

    Elizabeth W. Karlson

    2016-01-01

    Full Text Available The Partners HealthCare Biobank is a Partners HealthCare enterprise-wide initiative whose goal is to provide a foundation for the next generation of translational research studies of genotype, environment, gene-environment interaction, biomarker and family history associations with disease phenotypes. The Biobank has leveraged in-person and electronic recruitment methods to enroll >30,000 subjects as of October 2015 at two academic medical centers in Partners HealthCare since launching in 2010. Through a close collaboration with the Partners Human Research Committee, the Biobank has developed a comprehensive informed consent process that addresses key patient concerns, including privacy and the return of research results. Lessons learned include the need for careful consideration of ethical issues, attention to the educational content of electronic media, the importance of patient authentication in electronic informed consent, the need for highly secure IT infrastructure and management of communications and the importance of flexible recruitment modalities and processes dependent on the clinical setting for recruitment.

  11. An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

    Directory of Open Access Journals (Sweden)

    Chan Brian T

    2011-10-01

    Full Text Available Abstract Background Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases. Methods We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia. Results Six key lessons emerge from this analysis: (i the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv effective strategies for HIV/AIDS care in other settings should be

  12. Developing a communitywide electronic health record disease registry in primary care practices: lessons learned from the Western new york beacon community.

    Science.gov (United States)

    Heider, Arvela R; Maloney, Nancy A; Satchidanand, Nikhil; Allen, Geoffrey M; Mueller, Raymond; Gangloff, Steven; Singh, Ranjit

    2014-01-01

    Disease registries, as part of electronic health records (EHRs), have shown promise in improving care and outcomes. However, little is known about how best to implement them across communities, especially in communities that are not highly integrated. The Western New York (WNY) primary care community consists largely of independent practices using at least 20 different EHR products. This paper discusses the processes undertaken to develop a communitywide EHR disease registry in WNY, improvements it engendered, barriers overcome, and the lessons learned. HEALTHeLINK, under the Office of the National Coordinator for Health Information Technology Beacon Community Initiative, reached out to 98 primary care practices in the WNY region to establish EHR-based diabetes registries. Working with practices, community partners, and vendors, registry specifications were created. The registry was piloted with practices using one local vendor's EHR product and then rolled out to other practices, including five other EHR products. Using identified and de-identified registry datasets, quality benchmarking within and between practices and population health management were undertaken. From 2011 to 2013, the WNY Beacon Community assisted 98 practices (344 providers) serving over 50,000 adult diabetic patients. A major focus was on EHR registry development across diverse systems, and overcoming the challenges this presented. The Beacon diabetes registry was implemented at 85 of the 98 targeted practices. Of these registries, 65 met the criteria described in a later section for quality benchmarking and population health management purposes. Practices received quarterly benchmark reports summarizing their performance on key diabetes quality metrics and were compared to community practice averages. Practices used their registries for population health management by identifying and targeting patients in need of follow-up or specific diabetes-related care. The creation of the registry

  13. Compassion in healthcare – lessons from a qualitative study of the end of life care of people with dementia

    Science.gov (United States)

    Crowther, Jacqueline; Wilson, Kenneth CM; Horton, Siobhan; Lloyd-Williams, Mari

    2013-01-01

    Objectives A lack of compassion in UK healthcare settings has received much recent attention. This study explores the experiences of people with dementia in the last year of life and time surrounding death and how the presence and lack of compassion, kindness and humanity influenced the experience of care. Design Qualitative in-depth interviews with bereaved informal carers of people with dementia. Setting United Kingdom. Participants Forty bereaved carers – 31 women and nine men – with an age range of 18–86 years and from wide socioeconomic backgrounds participated. Main outcome measures Experiences of carers of care for person with dementia during last year of life. Results The interviews highlighted differences and challenges in care settings in providing compassionate, humanistic care and the impact of the care experienced by the person with dementia during the last year of life on informal carers during the bereavement period and beyond. Excellent examples of compassionate care were experienced alongside very poor and inhumane practices. Conclusion The concepts of compassion, kindness and humanity in dementia care are discussed within the paper. The ability to deliver care that is compassionate, kind and humanistic exists along a continuum across care settings – examples of excellent care sit alongside examples of very poor care and the reasons for this are explored together with discussion as to how health and social care staff can be trained and supported to deliver compassionate care. PMID:24108538

  14. International academic service learning: lessons learned from students' travel experiences of diverse cultural and health care practices in morocco.

    Science.gov (United States)

    Kaddoura, Mahmoud; Puri, Aditi; Dominick, Christine A

    2014-01-01

    Academic service learning (ASL) is an active teaching-learning approach to engage students in meaningful hands-on activities to serve community-based needs. Nine health professions students from a private college and a private university in the northeastern United States volunteered to participate in an ASL trip to Morocco. The participants were interviewed to reflect on their experiences. This article discusses the lessons learned from students' ASL experiences regarding integrating ASL into educational programs. The authors recommend a paradigm shift in nursing and dental hygiene curricula to appreciate diversity and promote cultural competency, multidisciplinary teamwork, and ethics-based education.

  15. Humanitarian Surgical Care Provided by a French Forward Surgical Team: Ten Years of Providing Medical Support to the Population of the Ivory Coast.

    Science.gov (United States)

    Bonnet, Stéphane; Bertani, Antoine; Savoie, Pierre-Henri; Mathieu, Laurent; Boddaert, Guillaume; Gonzalez, Federico; Poichotte, Antoine; Durand, Xavier; Rongiéras, Frédéric; Balandraud, Paul; Pons, François; Rigal, Sylvain

    2015-10-01

    The aims of this study were as follows: first to quantify and review the types of surgical procedures performed by military surgeons assigned to a Forward Surgical Team (FST) providing medical support to the population (MSP) in the Ivory Coast (IC), and second to analyze how this MSP was achieved. Between 2002 and 2012, all of the local nationals operated on by the different FSTs deployed in the IC were included in the study. The surgical activity was analyzed and divided into surgical specialties, war wounds, nonwar emergency trauma, nontrauma emergencies, and elective surgery. Demographics, circumstances of health care management, wounded organs, and types of surgical procedures were described. Over this period, surgeons operated on 2,315 patients and performed 2,556 procedures. Elective surgery accounted for 78.7% of the surgical activity, nontrauma emergencies accounted for 12.7%, nonwar emergency trauma accounted for 8%, and war wounds accounted for 0.6%. The main surgical activities were visceral (43.8%) and orthopedic (including soft tissues) surgeries (38.5%). The FSTs contributed widely to MSP in the IC. This MSP required limited resources, standardization of the procedures and specific skills beyond the original surgical specialties of military surgeons to fulfill the needs of the local population. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  16. [Pediatric tracheostomy: a ten-year analysis in the Intensive Care Unit of Sancti Spiritus “José Martí” Pediatric Teaching Hospital].

    Science.gov (United States)

    Salcedo, Caridad; Martínez, Mirtha; Reyes, Ernestina

    2014-05-05

    There has been a significant change in the role of pediatric tracheostomy over the last twenty years. Obstruction of the upper airway caused by infectious agents is no longer the leading cause of tracheostomy in children. Structural anomalies of the upper airway as well as the need for prolonged ventilator assistance have become the most frequent indication for pediatric tracheostomy. The purpose of this paper is to assess the incidence, indications, complications, and role in mortality of tracheostomy in our pediatric population. A retrospective descriptive study of pediatric patients who underwent tracheostomy was conducted between 1999 and 2008 in the Pediatric Intensive Care Unit of the José Martí de Sancti Spiritus Pediatric Teaching Hospital in Cuba. Tracheostomy was performed in 14 patients during the period of the study (0.5% of admitted patients). Nine of them (64.2%) were younger than one year. The most frequent indication for the procedure was the need for prolonged mechanical ventilation in patients with neurologic disorders in 10 patients (71.42%). Upper airway malformations and acute infections were infrequent indications for tracheostomy. The most frequent complications were infectious in 10 patients (71.4%) and obstruction in four patients (28.5%). The following germs were found: Pseudomona aeruginosa in six patients (60%), Staphylococcus aureus in three patients (30%), and Enterobacter cloacae in three patients (30%). Furthermore, four patients were successfully decannulated (28.5%), five patients died (35.7%) but only in one (7.14%), death could be attributed to tracheostomy. The need for prolonged mechanical ventilation in patients with neurologic disorders was the main indication for tracheostomy in our pediatric population; most of these children were younger than one year. The procedure had little impact in overall mortality in this group of patients.

  17. Economic valuation of informal care: lessons from the application of the opportunity costs and proxy good methods.

    Science.gov (United States)

    van den Berg, Bernard; Brouwer, Werner; van Exel, Job; Koopmanschap, Marc; van den Bos, Geertrudis A M; Rutten, Frans

    2006-02-01

    This paper reports the results of the application of the opportunity costs and proxy good methods to determine a monetary value of informal care. We developed a survey in which we asked informal caregivers in The Netherlands to indicate the different types of time forgone (paid work, unpaid work and leisure) in order to be able to provide care. Moreover, we asked informal caregivers how much time they spent on a list of 16 informal care tasks during the week before the interview. Data were obtained from surveys in two different populations: informal caregivers and their care recipients with stroke and with rheumatoid arthritis (RA). A total of 218 care recipients with stroke and their primary informal caregivers completed a survey as well as 147 caregivers and their care recipients with RA. The measurement of care according to both methods is more problematic compared to the valuation. This is especially the case for the opportunity costs method and for the housework part in the proxy good method. More precise guidelines are necessary for the consistent application of both methods in order to ensure comparability of results and of economic evaluations of health care.

  18. "My Lesson Plan Was Perfect Until I Tried to Teach": Care Ethics into Practice in Classroom Management

    Science.gov (United States)

    Rabin, Colette; Smith, Grinell

    2016-01-01

    As teacher educators, the authors developed an assignment focused on care ethics to prepare teacher candidates to design classroom-management procedures aimed at cultivating caring community. The teacher candidates revised traditional classroom-management processes, such as class rules, into cocreated norms. They also designed original management…

  19. The barriers to nurturing and empowering long-term care experiments - lessons learnt to advance future healthcare projects

    NARCIS (Netherlands)

    Cramer, Hendrik; Dewulf, Geert; Voordijk, Hans

    2014-01-01

    The objective of this study is to explore the barriers to nurturing and empowering subsidized long-term care experiments that try to deal with today's long-term care challenges such as an aging population and increasing healthcare costs. Nurturing is the process of planning, implementing, and learni

  20. "My Lesson Plan Was Perfect Until I Tried to Teach": Care Ethics into Practice in Classroom Management

    Science.gov (United States)

    Rabin, Colette; Smith, Grinell

    2016-01-01

    As teacher educators, the authors developed an assignment focused on care ethics to prepare teacher candidates to design classroom-management procedures aimed at cultivating caring community. The teacher candidates revised traditional classroom-management processes, such as class rules, into cocreated norms. They also designed original management…

  1. IREDA: ten years on

    Energy Technology Data Exchange (ETDEWEB)

    Sahai, I.M.

    1998-04-01

    The Indian Renewable Energy Development Agency has a ten-year history of promoting small hydro energy sources for many communities beyond the reach of the national grid. Sources of funding for hydro installations in India are mentioned. It is suggested that the expansion of the hydro schemes would benefit from greater co-ordination between central and state governments. (UK)

  2. Tens bij bevallingen

    NARCIS (Netherlands)

    Tuin-Nuis, F.D.F.

    2000-01-01

    TENS (Transcutane Electrische Neuro Stimulatie) is een pijnverlichtingsmethode die berust op de Gate Control Theory van Melzack en Wall. Door middel van electrische pulsen via de huid zou de geleiding van nociceptieve signalen (pijnprikkels) worden beïnvloed en zou het lichaam endorfinen aanmaken: l

  3. Affordances: Ten Years On

    Science.gov (United States)

    Brown, Jill P.; Stillman, Gloria

    2014-01-01

    Ten years ago the construct, affordance, was rising in prominence in scholarly literature. A proliferation of different uses and meanings was evident. Beginning with its origin in the work of Gibson, we traced its development and use in various scholarly fields. This paper revisits our original question with respect to its utility in mathematics…

  4. Powers of ten

    CERN Multimedia

    Pyramid FILMS

    1977-01-01

    Powers of Ten is a 1977 short documentary film written and directed by Charles Eames and his wife, Ray. The film depicts the relative scale of the Universe in factors of ten (see also logarithmic scale and order of magnitude). The film begins with an aerial image of a man reclining on a blanket; the view is that of one meter across. The viewpoint, accompanied by expository voiceover, then slowly zooms out to a view ten meters across ( or 101 m in standard form), revealing that the man is picnicking in a park with a female companion. The zoom-out continues, to a view of 100 meters (102 m), then 1 kilometer (103 m), and so on, increasing the perspective—the picnic is revealed to be taking place near Soldier Field on Chicago's waterfront—and continuing to zoom out to a field of view of 1024 meters, or the size of the observable universe. The camera then zooms back in to the picnic, and then to views of negative powers of ten—10-1 m (10 centimeters), and so forth, until we are viewing a carbon nucl...

  5. Migrant beer promoters' experiences accessing reproductive health care in Cambodia, Laos, Thailand, and Vietnam: lessons for planners and providers.

    Science.gov (United States)

    Webber, Gail C; Spitzer, Denise L; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone

    2015-03-01

    Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services.

  6. Migrant Beer Promoters’ Experiences Accessing Reproductive Health Care in Cambodia, Laos, Thailand, and Vietnam: Lessons for Planners and Providers

    Science.gov (United States)

    Webber, Gail C.; Spitzer, Denise L.; Somrongthong, Ratana; Dat, Truong Cong; Kounnavongsa, Somphone

    2014-01-01

    Migrant beer promoters in Cambodia, Laos, Thailand, and Vietnam were surveyed to determine their experiences in accessing reproductive health care services in the cities of Phnom Penh, Vientiane, Bangkok, and Hanoi. A total of 7 health care institutions were chosen as popular with migrant beer promoters. Staff at these institutions provided information on the institution, and 390 beer promoters were surveyed about their experiences while accessing services. There were discrepancies between findings from the staff interviews and the experiences of the beer promoters. In general, the migrant women were satisfied with the cost, location, friendliness of the health care providers, and knowledge and skills of the providers. They were less positive about confidentiality and waiting times, though many still agreed that these were not an issue. Health care planners and providers should take note of the issues affecting access to reproductive health care services for migrant women when they design and implement services. PMID:22743859

  7. Outreach services to improve access to health care in South Africa: lessons from three community health worker programmes

    Directory of Open Access Journals (Sweden)

    Nonhlanhla Nxumalo

    2013-01-01

    Full Text Available Introduction: In South Africa, there are renewed efforts to strengthen primary health care and community health worker (CHW programmes. This article examines three South African CHW programmes, a small local non-governmental organisation (NGO, a local satellite of a national NGO, and a government-initiated service, that provide a range of services from home-based care, childcare, and health promotion to assist clients in overcoming poverty-related barriers to health care. Methods: The comparative case studies, located in Eastern Cape and Gauteng, were investigated using qualitative methods. Thematic analysis was used to identify factors that constrain and enable outreach services to improve access to care. Results: The local satellite (of a national NGO, successful in addressing multi-dimensional barriers to care, provided CHWs with continuous training focused on the social determinants of ill-health, regular context-related supervision, and resources such as travel and cell-phone allowances. These workers engaged with, and linked their clients to, agencies in a wide range of sectors. Relationships with participatory structures at community level stimulated coordinated responses from service providers. In contrast, an absence of these elements curtailed the ability of CHWs in the small NGO and government-initiated service to provide effective outreach services or to improve access to care. Conclusion: Significant investment in resources, training, and support can enable CHWs to address barriers to care by negotiating with poorly functioning government services and community participation structures.

  8. Best practices in developing a national palliative care policy in resource limited settings: lessons from five African countries.

    Science.gov (United States)

    Luyirika, Emmanuel Bk; Namisango, Eve; Garanganga, Eunice; Monjane, Lidia; Ginindza, Ntombi; Madonsela, Gugulethu; Kiyange, Fatia

    2016-01-01

    Given the high unmet need for palliative care in Africa and other resource limited settings, it is important that countries embrace the public health approach to increasing access through its integration within existing healthcare systems. To give this approach a strong foundation that would ensure sustainability, the World Health Organisation urges member states to ensure that policy environments are suitable for this intervention. The development, strengthening, and implementation of national palliative care policies is a priority. Given the lack of a critical mass of palliative care professionals in the region and deficiency in documenting and sharing best practices as part of information critical for regional development, policy development becomes a complex process. This article shares experiences with regard to best practices when advocating the national palliative care policies. It also tells about policy development process, the important considerations, and cites examples of policy content outlines in Africa.

  9. GP Participation and Recruitment of Patients to RCTs: Lessons from Trials of Acupuncture and Exercise for Low Back Pain in Primary Care

    Directory of Open Access Journals (Sweden)

    Sally E. M. Bell-Syer

    2011-01-01

    Full Text Available The objective of this study was to identify factors associated with general practitioner (GP participation and the recruitment of people to trials in primary care, based on data from two trials of interventions for treating chronic low back pain. The study was based on data from two randomized controlled trials (RCTs, one involving exercise, the other acupuncture, and subsequent reporting by GPs in a postal questionnaire. The exercise trial achieved 62% recruitment whereas the acupuncture trial achieved 100% recruitment. In both trials GPs most efficient at referring patients were those with a special interest in the subject area, and those known personally to the research team. A follow-up GP questionnaire found that both trials had maintained a high profile with over 80% of GPs, and successful recruitment strategies included project reminder letters, updates and personal contacts. Achieving target recruitment of patients in the acupuncture trial was aided by the deliberate application of lessons learned in the exercise trial, in particular the need to keep initial study entry criteria broad, with subsequent filtering undertaken by the study researcher. In addition the use of effective methods of maintaining the trial profile, the involvement of a GP advisor, the decision to maximize the recruitment of GPs early in the trial and the direct recruitment of interested individual GPs. The successful recruitment of patients to trials in primary care requires careful planning and continuous monitoring from the outset. Prior to starting recruitment, it is useful to identify previous trials in a similar environment in order to learn from their experience and optimize patient recruitment.

  10. The Changes of Ethical Dilemmas in Palliative Care. A Lesson Learned from Comparison Between 1998 and 2013 in Taiwan.

    Science.gov (United States)

    Chih, An-Hsuan; Su, Peijen; Hu, Wen-Yu; Yao, Chien-An; Cheng, Shao-Yi; Lin, Yen-Chun; Chiu, Tai-Yuan

    2016-01-01

    The current ethical dilemmas met by healthcare professionals were never compared with those 15 years ago when the palliative care system was newly developing in Taiwan. The aim of the study was to investigate the ethical dilemmas met by palliative care physicians and nurses in 2013 and compare the results with the survey in 1998. This cross-sectional study surveyed 213 physicians and nurses recruited from 9 representative palliative care units across Taiwan in 2013. The compared survey in 1998 studied 102 physicians and nurses from the same palliative care units. All participants took a questionnaire to survey the "frequency" and "difficulty" of 20 frequently encountered ethical dilemmas, which were grouped into 4 domains by factor analysis. The "ethical dilemma" scores were calculated and then compared across 15 years by Student's t tests. A general linear model analysis was used to identify significant factors relating to a high average "ethical dilemma" score in each domain. All of the highest-ranking ethical dilemmas in 2013 were related to insufficient resources. Physicians with less clinical experience had a higher average "ethical dilemma" score in clinical management. Physicians with dissatisfaction in providing palliative care were associated a higher average "ethical dilemma" score in communication. Nurses reported higher "ethical dilemma" scores in all items of resource allocation in 2013. Further analysis confirmed that, in 2013, nurses had a higher average "ethical dilemma" score in resource allocation after adjustment for other relating factors. Palliative care nursing staff in Taiwan are more troubled by ethical dilemmas related to insufficient resources than they were 15 years ago. Training of decision making in nurses under the framework of ethical principles and community palliative care programs may improve the problems. To promote the dignity of terminal cancer patients, long-term fundraising plans are recommended for countries in which the

  11. Role of nanocrystalline silver dressings in the management of toxic epidermal necrolysis (TEN) and TEN/Stevens-Johnson syndrome overlap.

    Science.gov (United States)

    Smith, Saxon D; Dodds, Annabel; Dixit, Shreya; Cooper, Alan

    2015-11-01

    Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe mucocutaneous eruptions. There is currently no defined optimal approach to wound care. The objective of this study was to evaluate silver dressings in the wound-care management of TEN and SJS/TEN syndrome overlap with a retrospective case review of nine patients with TEN and SJS/TEN overlap presenting to our institution. Nanocrystalline silver dressings appear to be useful in the rapid commencement of healing in these patients. TEN and SJS/TEN overlap are rare conditions. This contributed to a relatively small number of cases included in the study. The ease of application, antimicrobial properties and low frequency of change make nanocrystalline silver dressings ideal in TEN/SJS.

  12. The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

    Directory of Open Access Journals (Sweden)

    Odeyemi IA

    2013-03-01

    Full Text Available Isaac AO Odeyemi,1 John Nixon21Senior Director and Head of Health Economics and Outcomes Research, Astellas Pharma UK Ltd, Chertsey, UK; 2Teaching Associate in Health Economics, Department of Economics and Related Studies, University of York, York, UKBackground: Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI. This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity.Methods: A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia that illustrates the principal forms and roles of PHI. Literature describing each country's health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity.Results: In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system.Conclusion: PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications

  13. Implementing home blood glucose and blood pressure telemonitoring in primary care practices for patients with diabetes: lessons learned.

    Science.gov (United States)

    Koopman, Richelle J; Wakefield, Bonnie J; Johanning, Jennifer L; Keplinger, Lynn E; Kruse, Robin L; Bomar, Marilee; Bernt, Beth; Wakefield, Douglas S; Mehr, David R

    2014-03-01

    Prior telemonitoring trials of blood pressure and blood glucose have shown improvements in blood pressure and glycemic targets. However, implementation of telemonitoring in primary care practices may not yield the same results as research trials with extra resources and rigid protocols. In this study we examined the process of implementing home telemonitoring of blood glucose and blood pressure for patients with diabetes in six primary care practices. Grounded theory qualitative analysis was conducted in parallel with a randomized controlled effectiveness trial of home telemonitoring. Data included semistructured interviews with 6 nurse care coordinators and 12 physicians in six participating practices and field notes from exit interviews with 93 of 108 randomized patients. The three stakeholder groups (patients, nurse care coordinators, and physicians) exhibited some shared themes and some unique to the particular stakeholder group. Major themes were that practices should (1) understand the capabilities and limitations of the technology and the willingness of patient and physician stakeholders to use it, (2) understand the workflow, flow of information, and human factors needed to optimize use of the technology, (3) engage and prepare the physicians, and (4) involve the patient in the process. Although there was enthusiasm for a patient-centered medical home model that included between-visit telemonitoring, there was concern about the support and resources needed to provide this service to patients. As with many technology interventions, careful consideration of workflow and information flow will help enable effective implementations.

  14. The hearing voices network: initial lessons and future directions for mental health professionals and Systems of Care.

    Science.gov (United States)

    Styron, Thomas; Utter, Lauren; Davidson, Larry

    2017-02-01

    For more than two decades, the Hearing Voices Network (HVN) has provided alternative approaches to supporting voice hearers, and an emerging body of research is now confirming their value. HVN approaches present unique opportunities and challenges for mental health professionals and systems of care that work with individuals who hear voices. An overview of the HVN is presented, including its history, principles and approaches. HVN approaches are compared and contrasted with traditional mental health treatments. HVN's potential contribution to the transformation of mental health care is discussed. Directions for future research are presented.

  15. Renovating the built environment for dementia care: lessons learned at the Lodge at Broadmead in Victoria, British Columbia.

    Science.gov (United States)

    Gnaedinger, Nancy; Robinson, Janice; Sudbury, Fiona; Dutchak, Merv

    2007-01-01

    Major renovations were carried out in occupied dementia care units at the Lodge at Broadmead, Victoria, British Columbia. A 32-bed lodge was divided into two, requiring the relocation of three sets of doors. Home-like kitchens and living and dining rooms were built and furnished in each unit. A silent resident call system was installed. Nursing stations were moved off the unit. Murals added atmosphere and camouflaged exit doors. The process, while challenging, was successful due to comprehensive planning, careful phasing, the contractor's daily presence, the education of construction workers about residents, constant communication among key people and cooperation of lodge staff. Preliminary results are positive.

  16. Standard of Care for Neuropsychological Monitoring in Pediatric Neuro-Oncology: Lessons From the Children's Oncology Group (COG).

    Science.gov (United States)

    Walsh, Karin S; Noll, Robert B; Annett, Robert D; Patel, Sunita K; Patenaude, Andrea F; Embry, Leanne

    2016-02-01

    As the mortality of pediatric cancers has decreased, focus on neuropsychological morbidities of treatment sequelae have increased. Neuropsychological evaluations are essential diagnostic tools that assess cognitive functioning and neurobiological integrity. These tests provide vital information to support ongoing medical care, documenting cognitive morbidity and response to interventions. We frame standards for neuropsychological monitoring of pediatric patients with CNS malignancy or who received cancer-directed therapies involving the CNS and discuss billing for these services in the United States in the context of clinical research. We describe a cost-effective, efficient model of neuropsychological monitoring that may increases access to neuropsychological care.

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

    Directory of Open Access Journals (Sweden)

    Corinne Kyriacou

    2011-05-01

    Full Text Available Introduction and Background: Few financial incentives in the United States encourage coordination across the health and social care systems. Supportive Service Programs (SSPs, operating in Naturally Occurring Retirement Communities (NORCs, attempt to increase access to care and enhance care quality for aging residents.  This article presents findings from an evaluation conducted from 2004 to 2006 looking at the feasibility, quality and outcomes of linking health and social services through innovative NORC-SSP and health organization micro-collaborations.   Methods: Four NORC-SSPs participated in the study by finding a health care organization or community-based physicians to collaborate with on addressing health conditions that could benefit from a biopsychosocial approach. Each site focused on a specific population, addressed a specific condition or problem, and created different linkages to address the target problem.  Using a case study approach, incorporating both qualitative and quantitative methods, this evaluation sought to answer the following two primary questions: 1 Have the participating sites created viable linkages between their organizations that did not exist prior to the study; and, 2 To what extent have the linkages resulted in improvements in clinical and other health and social outcomes?     Results: Findings suggest that immediate outcomes were widely achieved across sites: knowledge of other sector providers’ capabilities and services increased; communication across providers increased; identification of target population increased; and, awareness of risks, symptoms and health seeking behaviors among clients/patients increased.  Furthermore, intermediate outcomes were also widely achieved: shared care planning increased across providers; continuity of care was enhanced; disease management improved; and self care among clients improved.  Finally, several linkage partnerships were also able to demonstrate

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

    Directory of Open Access Journals (Sweden)

    Corinne Kyriacou

    2011-05-01

    Full Text Available Introduction and Background: Few financial incentives in the United States encourage coordination across the health and social care systems. Supportive Service Programs (SSPs, operating in Naturally Occurring Retirement Communities (NORCs, attempt to increase access to care and enhance care quality for aging residents.  This article presents findings from an evaluation conducted from 2004 to 2006 looking at the feasibility, quality and outcomes of linking health and social services through innovative NORC-SSP and health organization micro-collaborations.  Methods: Four NORC-SSPs participated in the study by finding a health care organization or community-based physicians to collaborate with on addressing health conditions that could benefit from a biopsychosocial approach. Each site focused on a specific population, addressed a specific condition or problem, and created different linkages to address the target problem.  Using a case study approach, incorporating both qualitative and quantitative methods, this evaluation sought to answer the following two primary questions: 1 Have the participating sites created viable linkages between their organizations that did not exist prior to the study; and, 2 To what extent have the linkages resulted in improvements in clinical and other health and social outcomes?    Results: Findings suggest that immediate outcomes were widely achieved across sites: knowledge of other sector providers’ capabilities and services increased; communication across providers increased; identification of target population increased; and, awareness of risks, symptoms and health seeking behaviors among clients/patients increased.  Furthermore, intermediate outcomes were also widely achieved: shared care planning increased across providers; continuity of care was enhanced; disease management improved; and self care among clients improved.  Finally, several linkage partnerships were also able to demonstrate improvements

  19. Addressing inequities in access to primary health care: lessons for the training of health care professionals from a regional medical school.

    Science.gov (United States)

    Larkins, Sarah; Sen Gupta, Tarun; Evans, Rebecca; Murray, Richard; Preston, Robyn

    2011-01-01

    Attention to the inequitable distribution and limited access to primary health care resources is key to addressing the priority health needs of underserved populations in rural, remote and outer metropolitan areas. There is little high-quality evidence about improving access to quality primary health care services for underserved groups, particularly in relation to geographic barriers, and limited discussion about the training implications of reforms to improve access. To progress equity in access to primary health care services, health professional education institutions need to work with both the health sector and policy makers to address issues of workforce mix, recruitment and retention, and new models of primary health care delivery. This requires a fundamental shift in focus from these institutions and the health sector, to each view themselves as partners in an integrated teaching, research and service-oriented health system. This paper discusses the challenges and opportunities for primary health care professionals, educators and the health sector in providing quality teaching and clinical experiences for increasing numbers of health professionals as a result of the reform agenda. It then outlines some practical strategies based on theory and evolving experience for dealing with some of these challenges and capitalising on opportunities.

  20. Improving availability of EmOC services in Rwanda--CARE's experiences and lessons learned at Kabgayi Referral Hospital.

    Science.gov (United States)

    Kayongo, M; Butera, J; Mboninyibuka, D; Nyiransabimana, B; Ntezimana, A; Mukangamuje, V

    2006-03-01

    CARE's work in Rwanda was designed to improve the functional capacity of health facilities for the delivery of EmOC services. The project supported a comprehensive package of focused interventions that included hospital renovations, provision of essential equipment, training of staff and improvement of management systems at the Kabgayi regional referral hospital. There was an increased level of preparedness for emergencies and ability to manage common obstetric complications according to evidence-based practices. These changes ultimately led to increased availability, quality and use of services as demonstrated by an increase in the demand for care of obstetric complications at the facility. The met need increased from 16% at the start of the project (2001) to 25% in 2004, while the cesarean rate remained essentially the same (1.9% and 3.2%) over the same time period. There were progressive declines in the case fatality rates from 2.2% in 2001 to 1.2% in 2004. CARE's experience indicates that progress towards reducing maternal mortality requires specific efforts that support and strengthen existing health systems to provide skilled care that can save women's lives.

  1. How Much for Whom? Lessons from an Efficacy Study of Modest Professional Development for Child Care Providers

    Science.gov (United States)

    Gerde, Hope K.; Duke, Nell K.; Moses, Annie M.; Spybrook, Jessaca; Shedd, Meagan K.

    2014-01-01

    Research Findings: Examining the effects of professional development of the early childhood workforce that fit within the constraints of government policy is crucial for identifying types and amounts of effective training and informing child care policy. The present study used a cluster-randomized trial to evaluate the effects of a professional…

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

    Science.gov (United States)

    O'Byrne, M E

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

  3. Lessons learned from implementing a pilot RCT of transitional care model for individuals with serious mental illness.

    Science.gov (United States)

    Solomon, Phyllis; Hanrahan, Nancy P; Hurford, Matthew; DeCesaris, Marissa; Josey, LaKeetra

    2014-08-01

    We adapted an evidence-based transitional care model for older adults being released from acute care hospitals for patients with serious mental illness and medical co-morbidities being discharged from two psychiatric units of an acute care hospital (TCare) and evaluated implementation issues. An advisory group (AG) of community stakeholders assessed barriers and facilitators of a 90-day T-Care intervention delivered by a psychiatric nurse practitioner (NP) in the context of conducting a pilot randomized controlled trial. Minutes of AG and case narratives by NP of 20 intervention participants were content analyzed. Patients with immediate and pressing physical health problems were most receptive and actively utilized the service. Provider barriers consisted of communication and privacy issues making it difficult to contact patients in mental health facilities. In contrast, the NP was accepted and valued in the physical health arena. Psychosocial needs and relationship issues were demanding, and we recommend a team approach for TCare with the addition of a social worker, peer provider, and consulting psychiatrist for severely mentally ill patients being released from an acute physical health hospitalization.

  4. Methodological considerations for a randomised controlled trial of podiatry care in rheumatoid arthritis: lessons from an exploratory trial

    Directory of Open Access Journals (Sweden)

    Helliwell Philip S

    2007-11-01

    Full Text Available Abstract Background Whilst evidence exists to support the use of single treatments such as orthoses and footwear, the effectiveness of podiatry-led care as a complex intervention for patients with rheumatoid arthritis (RA related foot problems is unknown. The aim of this study was to undertake an exploratory randomised controlled parallel arm clinical trial (RheumAFooT to inform the design and implementation of a definitive trial and to understand the potential benefits of this care. Methods Patients with a definite diagnosis of RA, stable drug management 3 months prior to entry, and a current history of foot problems (pain, deformity, stiffness, skin or nail lesions, or footwear problems were recruited from a hospital outpatient rheumatology clinic and randomised to receive 12 months of podiatry treatment or no care. The primary outcome was change in foot health status using the impairment/footwear (LFISIF and activity limitation/participation restriction (LFISAP subscales of the Leeds Foot Impact Scale. Disease Activity Score (DAS, Health Assessment Questionnaire (HAQ score and walking speed (m/s were also recorded. Results Of the 80 patients identified, 64 patients were eligible to participate in the pilot and 34 were recruited. 16 patients were randomised to receive podiatry led foot care and 18 received no care. Against a backdrop of stable disease (DAS and HAQ scores, there was a statistically significant between group difference in the change in foot health status for foot impairment (LFISIF but not activity/participation (LFISAP or function (walking speed over 12 months. In the podiatry arm, 1 patient declined treatment following randomisation (did not want additional hospital visits and 3 self-withdrew (lost to follow-up. Patients received an average of 3 consultations for assessment and treatment comprising routine care for skin and nail lesions (n = 3, foot orthoses (n = 9, footwear referral to the orthotist (n = 5, and ultrasound

  5. Ten Outstanding Women Chosen

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    BEFORE the celebration of the 85th anniversary of International Women’s Day, the All-China Women’s Federation sponsored an activity to choose ten outstanding Chinese women, which involved the Ministries of Labor and Personnel, the General Political Department of the People’s Liberation Army, the All-China Federation of Trade Union, the Youth League of China, the China Association of Science and about a dozen Chinese news agencies. The results were recently announced, and including following women: Yue Xicui, one of the third generation of women aviators. Since she joined the air force she has accumulated 5,180 hours

  6. Building a global health education network for clinical care and research. The benefits and challenges of distance learning tools. Lessons learned from the Hopkins Center for Clinical Global Health Education.

    Science.gov (United States)

    Bollinger, Robert C; McKenzie-White, Jane; Gupta, Amita

    2011-06-01

    Expanding the capacity for clinical care and health research is a global priority and a global challenge. The Johns Hopkins Center for Clinical Global Health Education (CCGHE) was established in 2005 to provide access to high-quality training to health care providers in resource-limited settings. The CCGHE made a strategic decision to develop, use, and evaluate distance learning platforms to achieve its mission. In the initial years of this new program, several lessons have been learned that may be helpful to other programs considering the use of distance learning programs to expand global health clinical and research capacity.

  7. Illustrating and Analyzing the Processes of Interprofessional Collaboration: A Lesson Learned from Palliative Care in Deconstructing the Concept.

    Science.gov (United States)

    Witt Sherman, Deborah; Maitra, Kinsuk; Gordon, Yhovana; Simon, Sharon; Olenick, Maria; Barbara, Salvatore; Doherty-Restrepo, Jennifer; Hough, Monica; Randolph, Marilys; Singh, Arvindar

    2017-03-01

    A basic tenet of palliative care is interprofessional collaboration. Palliative care educators and practitioners lead the way in responding to the Institute of Medicine's (2003) challenge to transform educational and health care systems through interprofessional collaboration. Through exemplary commitment to interprofessional collaboration, a college's academic and palliative care leader, in collaboration with Department Chairs and Directors of nursing and allied health professions, can illustrate and analyze the processes of interprofessional collaboration through the development of a simulated case study of a combat veteran with traumatic brain injury. Methodologic components: (1) interprofessional development of a palliative care case study and (2) debriefing interviews regarding the experience of collaboration of interprofessional team members. The results provide the identification of steps of the interprofessional process and the shared and unique disciplinary competencies in determining a comprehensive health history, physical examination, identifying and prioritizing diagnoses, and determining collaborative discipline-specific interventions. Content analysis of debriefing team interviews provides a description of group composition, structure, process, development, and performance, as well as team member's perceptions of what fosters and challenges collaboration, benefits, and drawbacks, and what could have been done differently in developing an interprofessional initiative. Transformative change in healthcare education and clinical practice involves interprofessional collaboration of colleagues within, across, and beyond universities/colleges and healthcare systems and agencies. Advocating for teamwork has to go beyond talking about being a team player or not to having the language and behaviors we need to observe and measure. This article not only provides key processes in interprofessional collaboration but also identifies key attitudes and behaviors

  8. Whole -business securitization lands in Europa : Ten lessons to remember

    NARCIS (Netherlands)

    Vink, D.

    2007-01-01

    The most recent trend witnessed in the securitization markets is the application of securitization techniques to the financing of operating assets. This technique is called whole-business or operating-asset securitization. With the help of this technique, the British football club Arsenal sold its g

  9. "Dances with Wolves": Lessons from Loo Ten Tant's Journal.

    Science.gov (United States)

    Dozier, Lynne

    1994-01-01

    Examines the way one ninth-grade English teacher used the film "Dances with Wolves" as part of a thematic unit entitled, "Strength from Diversity." Shows how the film was used and provides responses from many students in the course to the film. (HB)

  10. Ten Decades of Rural Development: Lessons from India.

    Science.gov (United States)

    1978-01-01

    37 9.1 Imitations of the TVA model 38 9.2 Pilot projects of the sixties--Comilla, Puebla & CADU . 39 10. THE SEVENTIES--A DECADE OF CONSOLIDATION OF...three other ideologies--the Gandhian, Fabian Socialist, and Marxist Socialist. Let us glance briefly at their rural visions . For thirty years Gandhi’s...but also rejected industrialism and urbanization. His vision of the good life was not the acquisition of abundance, but the curbing of wants, an ascetic

  11. Overcoming barriers to effectiveness in a health care operational environment: building on the lessons of American industry.

    Science.gov (United States)

    Zimmerer, L W; Zimmerer, T W; Yasin, M M

    1999-01-01

    Several of the manufacturing-based philosophies, techniques and tools, such as Total Quality Management (TQM), Continuous Improvement (CI), Business Process Reengineering (BPR) and Time-based Competition (TBC) have been successfully adapted for use within the service sector. Diverse service industries including airlines, insurance, food services and hospitality have increased customer satisfaction and performance through the use of the quality driven, manufacturing-based philosophies. This article explores the reasons for the limited success of TQM/CI, BPR, TBC and benchmarking within the health care industry. Sixteen barriers to change are identified, possible counter-measures to these barriers are outlined and two conceptual frameworks are offered as possible facilitators of change for the health care industry.

  12. Lessons Learned From a Collaborative to Improve Care for Patients With Diabetes in 17 Community Health Centers, Massachusetts, 2006

    OpenAIRE

    Lemay, Celeste A.; Beagan, Brianne M.; Ferguson, Warren J.; Lee, J.

    2010-01-01

    Introduction In 2006, the Massachusetts League of Community Health Centers convened a collaborative to systematically improve health care delivery for patients with diabetes in 17 community health centers. Our goal was to identify facilitators of and barriers to success reported by teams that participated in this collaborative. Methods The collaborative's activities lasted 13 months. At their conclusion, we interviewed participating team members. We asked about their teams' successes, challen...

  13. Construction of a linked health and social care database resource--lessons on process, content and culture.

    Science.gov (United States)

    Witham, Miles D; Frost, Helen; McMurdo, Marion; Donnan, Peter T; McGilchrist, Mark

    2015-01-01

    Combining routinely collected health and social care data on older people is essential to advance both service delivery and research for this client group. Little data is available on how to combine health and social care data; this article provides an overview of a successful data linkage process and discusses potential barriers to executing such projects. We successfully obtained and linked data on older people within Dundee from three sources: Dundee Social Work Department database (30,000 individuals aged 65 years and over), healthcare data held on NHS Tayside patients by the Health Informatics Centre (400,000 individuals), Dundee, and the Dundee of Medicine for the Elderly rehabilitation database (4300 individuals). Data were linked, anonymized and transferred to a Safe Haven environment to ensuring confidentiality and strict access control. Challenges were faced around workflows, culture and documentation. Exploiting the resultant data set raises further challenges centered on database documentation, understanding the way data were collected, dealing with missing data, data validity and collection at different time periods. Routinely collected health and social care data sets can be linked, but significant process barriers must be overcome to allow successful linkage and integration of data and its full exploitation.

  14. Regulatory considerations for prospective patient care registries: lessons learned from the National Neurosurgery Quality and Outcomes Database.

    Science.gov (United States)

    Asher, Anthony L; McGirt, Matthew J; Glassman, Steven D; Groman, Rachel; Resnick, Dan K; Mehrlich, Melissa; Spivey, Elizabeth; McCormick, Paul

    2013-01-01

    Clinical registries have emerged in the current resource-restricted environment of modern medicine as useful and logical mechanisms for providing health care stakeholders with high-quality data related to the safety, effectiveness, and value of specific interventions. Temporal and qualitative requirements for data acquisition in the context of clinical registries have rapidly expanded as clinicians and other stakeholders increasingly recognize the central importance of this information to the intelligent transformation of health care processes. Despite the potential of more robust clinical data collection efforts to advance the science of care, certain aspects of these newer systems, particularly the prospective, longitudinal acquisition of clinical data and direct patient contact, represent areas of structural overlap between emerging quality improvement efforts and traditional models of human subjects research. This overlap has profound implications for the design and implementation of modern clinical registries. In this paper, the authors describe the evolution of clinical registries as important tools for advancing the science of practice, and review the existing federal regulations that apply to these systems.

  15. Factors enabling and inhibiting facilitator development: lessons learned from Essentials of Care in South Eastern Sydney Local Health District

    Directory of Open Access Journals (Sweden)

    Tamera Watling

    2015-11-01

    Full Text Available Background: Building and sustaining facilitation capacity for the creation of person-centred workplace cultures is a strategic priority of the South Eastern Sydney Local Health District Nursing and Midwifery Practice and Workforce Unit. Skilled facilitation is considered critical to the successful implementation and sustainability of practice development-based programmes, including Essentials of Care. Review of facilitator activity across the district revealed that less than half of those who had participated in a facilitation development programme were actively applying their knowledge to the facilitation of Essentials of Care. Aim: To understand the enablers and barriers to the development and application of facilitation skills and the implementation of Essentials of Care from the perspective of the programme’s facilitators. The purpose was to inform ongoing strategies to build and sustain facilitation capacity for its effective implementation. Method: A 21-question qualitative survey was designed using Survey Monkey. Questions were framed to allow free text responses for qualitative content analysis. Ethics approval was applied for and deemed unnecessary by the local health district ethics committee; the committee deemed the project to be a quality improvement activity not requiring independent ethical review. The survey was distributed electronically to 230 health professionals who had participated in the facilitation development programme between 2008 and 2013. Findings: The key enablers for both facilitator development and implementation of Essentials of Care were time, engagement of staff and leadership support. Additional enablers for facilitation development included access to development opportunities and practical application of skills. Facilitation was an enabler of Essentials of Care implementation. Leadership support is pivotal, especially where time and patient acuity impinge on the release of staff for facilitated activities

  16. Supporting Teachers in Structuring Mathematics Lessons Involving Challenging Tasks

    Science.gov (United States)

    Sullivan, Peter; Askew, Mike; Cheeseman, Jill; Clarke, Doug; Mornane, Angela; Roche, Anne; Walker, Nadia

    2015-01-01

    The following is a report on an investigation into ways of supporting teachers in converting challenging mathematics tasks into classroom lessons and supporting students in engaging with those tasks. Groups of primary and secondary teachers, respectively, were provided with documentation of ten lessons built around challenging tasks. Teachers…

  17. Evidence-based health care policy in reimbursement decisions: lessons from a series of six equivocal case-studies.

    Directory of Open Access Journals (Sweden)

    Pieter Van Herck

    Full Text Available CONTEXT: Health care technological evolution through new drugs, implants and other interventions is a key driver of healthcare spending. Policy makers are currently challenged to strengthen the evidence for and cost-effectiveness of reimbursement decisions, while not reducing the capacity for real innovations. This article examines six cases of reimbursement decision making at the national health insurance authority in Belgium, with outcomes that were contested from an evidence-based perspective in scientific or public media. METHODS: In depth interviews with key stakeholders based on the adapted framework of Davies allowed us to identify the relative impact of clinical and health economic evidence; experience, expertise & judgment; financial impact & resources; values, ideology & political beliefs; habit & tradition; lobbyists & pressure groups; pragmatics & contingencies; media attention; and adoption from other payers & countries. FINDINGS: Evidence was not the sole criterion on which reimbursement decisions were based. Across six equivocal cases numerous other criteria were perceived to influence reimbursement policy. These included other considerations that stakeholders deemed crucial in this area, such as taking into account the cost to the patient, and managing crisis scenarios. However, negative impacts were also reported, in the form of bypassing regular procedures unnecessarily, dominance of an opinion leader, using information selectively, and influential conflicts of interest. CONCLUSIONS: 'Evidence' and 'negotiation' are both essential inputs of reimbursement policy. Yet, purposely selected equivocal cases in Belgium provide a rich source to learn from and to improve the interaction between both. We formulated policy recommendations to reconcile the impact of all factors identified. A more systematic approach to reimburse new care may be one of many instruments to resolve the budgetary crisis in health care in other countries as

  18. Ten years of PAMELA

    Science.gov (United States)

    Spillantini, Piero

    2016-07-01

    Pamela experiment has been designed as a cosmic ray observatory at 1 AU, dedicated to the precise and high statistics study of CR fluxes on a three decades energy range, form a few tens MeV up to several hundred GeV region. It is the last step of the 'Russian-Italian Mission' (RIM) program born in 1992 between several Italian and Russian institutes and with the participation of the Royal Institute of Technology of Stockholm (Sweden) and the Siegen University (German). Launched the 16 June 2006 from Baikonur cosmodrome on board of the Resurs-DK1 Russian satellite by a Soyuz rocket in an elliptical (350-610 km) quasi polar orbit (70° inclination) it was activated on 21 June 2006, afterword has been in a continuous data taking mode for ten years. The Pamela program pays particular attention to the study of particles (protons and electrons) and antiparticles (antiprotons and positrons) energy spectra. It also includes search for possible signals of dark matter annihilation, search for primordial antimatter (antihelium), search for new Matter in the Universe (Strangelets?), study of cosmic-ray propagation, solar physics and solar modulation, terrestrial magnetosphere. This program is made possible thanks to the outstanding performance of the instrument, the low energy threshold, the quasi-polar orbit, the 10 years duration of the observation. Protons and helium nuclei are the most abundant components of the cosmic radiation and the precise measurements of their fluxes allow understanding the acceleration and propagation of cosmic rays in the Galaxy. Their spectral shapes cannot be well described by a single power law: at 230-240 GV they exhibit an abrupt spectral hardening. They challenge the current paradigm of cosmic-ray acceleration in supernova remnants followed by diffusive propagation in the Galaxy. Of paramount importance is the discover of the anomalous increase of the positron flux at energies higher that 50 GeV (the so called 'Pamela anomaly'). The review of

  19. Medical progress, psychological factors and global care of the patient: lessons from the treatment of childhood leukemia

    Directory of Open Access Journals (Sweden)

    Girolamo Digilio

    2013-03-01

    Full Text Available The history of treatment of childhood leukemia is a meaningful model of ethical, bioethical and organizational repercussions of medical progress. Specifically, it has provided precious indications and very useful tools to cope with several of the more important problems of modern medicine: the value of controlled randomized studies; the risks of intense medicalization impairing the quality of care; the importance of a valid doctor-patient relationship; the psycho-emotive involvement of the pediatric staff; and last but not least, the need of an unrelenting effort of humanization of the procedures and environments, hand in hand with the frequent adjustments of the protocols according to scientific and technological progress. Finally, the authors comment upon the first cures (1962-1966 observed in the Pediatrics Clinic of the Sapienza University of Rome.

  20. Promoting business and entrepreneurial awareness in health care professionals: lessons from venture capital panels at medicine 2.0 conferences.

    Science.gov (United States)

    Miron-Shatz, Talya; Shatz, Itamar; Becker, Stefan; Patel, Jigar; Eysenbach, Gunther

    2014-08-06

    There are few mechanisms that bring the academic and business worlds together in a way that would maximize the success of health technology (health tech) start-ups by increasing researchers' knowledge about how to operate in the business world. Existing solutions (eg, technology transfer offices and dual degree MD/MBA programs) are often unavailable to researchers from outside the institution or to those who have already completed their primary education, such as practicing physicians. This paper explores current solutions and offers a partial solution: include venture capital (VC) panels in medical conferences. These VC panels educate academics on 2 important and interconnected issues: how to "pitch" their ideas in the business world and what to consider when creating a company. In these sessions, academia-based start-up companies present their ideas before a VC panel composed of professional investors and receive feedback on their idea, business plan, and presentation techniques. Recent panel recommendations from Medicine 2.0 conferences fell into 7 categories: (1) the product, service, or idea you are developing into a company, (2) determine market forces and identify the target audience, (3) describe your competitive advantage, (4) the business plan, (5) current and future resources and capabilities, (6) legal aspects, and (7) general advice on the art of pitching. The academic and business literature validates many of these recommendations suggesting that VC panels may be a viable and cost-effective introduction to business and entrepreneurial education for physicians and other health care professionals. Panels benefit not only the presenting companies, but also the physicians, psychologists, and other health care professionals attending the session. Incorporating VC panels into academic conferences might also illuminate the need for incorporating relevant business training within academia.

  1. Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned From Two Pragmatic Randomized Trials.

    Science.gov (United States)

    Barnato, Amber E; Moore, Robert; Moore, Charity G; Kohatsu, Neal D; Sudore, Rebecca L

    2017-07-01

    Medicaid populations have low rates of advance care planning (ACP). Potential policy interventions include financial incentives. To test the effectiveness of patient plus provider financial incentive compared with provider financial incentive alone for increasing ACP discussions among Medicaid patients. Between April 2014 and July 2015, we conducted two sequential assessor-blinded pragmatic randomized trials in a health plan that pays primary care providers (PCPs) $100 to discuss ACP: 1) a parallel cluster trial (provider-delivered patient incentive) and 2) an individual-level trial (mail-delivered patient incentive). Control and intervention arms included encouragement to complete ACP, instructions for using an online ACP tool, and (in the intervention arm) $50 for completing the online ACP tool and a small probability of $1000 (i.e., lottery) for discussing ACP with their PCP. The primary outcome was provider-reported ACP discussion within three months. In the provider-delivered patient incentive study, 38 PCPs were randomized to the intervention (n = 18) or control (n = 20) and given 10 patient packets each to distribute. Using an intention-to-treat analysis, there were 27 of 180 ACP discussions (15%) in the intervention group and 5 of 200 (2.5%) in the control group (P = .0391). In the mail-delivered patient incentive study, there were 5 of 187 ACP discussions (2.7%) in the intervention group and 5 of 189 (2.6%) in the control group (P = .99). ACP rates were low despite an existing provider financial incentive. Adding a provider-delivered patient financial incentive, but not a mail-delivered patient incentive, modestly increased ACP discussions. PCP encouragement combined with a patient incentive may be more powerful than either encouragement or incentive alone. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  2. The Ten Thousand Kims

    CERN Document Server

    Baek, Seung Ki; Kim, Beom Jun; 10.1088/1367-2630/13/7/073036

    2011-01-01

    In the Korean culture the family members are recorded in special family books. This makes it possible to follow the distribution of Korean family names far back in history. It is here shown that these name distributions are well described by a simple null model, the random group formation (RGF) model. This model makes it possible to predict how the name distributions change and these predictions are shown to be borne out. In particular, the RGF model predicts that, for married women entering a collection of family books in a certain year, the occurrence of the most common family name "Kim" should be directly proportional the total number of married women with the same proportionality constant for all the years. This prediction is also borne out to high degree. We speculate that it reflects some inherent social stability in the Korean culture. In addition, we obtain an estimate of the total population of the Korean culture down to year 500 AD, based on the RGF model and find about ten thousand Kims.

  3. The ten thousand Kims

    Science.gov (United States)

    Baek, Seung Ki; Minnhagen, Petter; Kim, Beom Jun

    2011-07-01

    In Korean culture, the names of family members are recorded in special family books. This makes it possible to follow the distribution of Korean family names far back in history. It is shown here that these name distributions are well described by a simple null model, the random group formation (RGF) model. This model makes it possible to predict how the name distributions change and these predictions are shown to be borne out. In particular, the RGF model predicts that for married women entering a collection of family books in a certain year, the occurrence of the most common family name 'Kim' should be directly proportional to the total number of married women with the same proportionality constant for all the years. This prediction is also borne out to a high degree. We speculate that it reflects some inherent social stability in the Korean culture. In addition, we obtain an estimate of the total population of the Korean culture down to the year 500 AD, based on the RGF model, and find about ten thousand Kims.

  4. Implementing the European guidelines for cardiovascular disease prevention in the primary care setting in Cyprus: Lessons learned from a health care services study

    Directory of Open Access Journals (Sweden)

    Philalithis Anastasios

    2008-07-01

    Full Text Available Abstract Background Recent guidelines recommend assessment and treatment of the overall risk for cardiovascular disease (CVD through management of multiple risk factors in patients at high absolute risk. The aim of our study was to assess the level of cardiovascular risk in patients with known risk factors for CVD by applying the SCORE risk function and to study the implications of European guidelines on the use of treatment and goal attainment for blood pressure (BP and lipids in the primary care of Cyprus. Methods Retrospective chart review of 1101 randomly selected patients with type 2 diabetes mellitus (DM2, or hypertension or hyperlipidemia in four primary care health centres. The SCORE risk function for high-risk regions was used to calculate 10-year risk of cardiovascular fatal event. Most recent values of BP and lipids were used to assess goal attainment to international standards. Most updated medications lists were used to compare proportions of current with recommended antihypertensive and lipid-lowering drug (LLD users according to European guidelines. Results Implementation of the SCORE risk model labelled overall 39.7% (53.6% of men, 31.3% of women of the study population as high risk individuals (CVD, DM2 or SCORE ≥5%. The SCORE risk chart was not applicable in 563 patients (51.1% due to missing data in the patient records, mostly on smoking habits. The LDL-C goal was achieved in 28.6%, 19.5% and 20.9% of patients with established CVD, DM2 (no CVD and SCORE ≥5%, respectively. BP targets were achieved in 55.4%, 5.6% and 41.9% respectively for the above groups. There was under prescription of antihypertensive drugs, LLD and aspirin for all three high risk groups. Conclusion This study demonstrated suboptimal control and under-treatment of patients with cardiovascular risk factors in the primary care in Cyprus. Improvement of documentation of clinical information in the medical records as well as GPs training for implementation

  5. Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas

    Directory of Open Access Journals (Sweden)

    Nyamtema Angelo S

    2011-11-01

    Full Text Available Abstract Background With 15-30% met need for comprehensive emergency obstetrical care (CEmOC and a 3% caesarean section rate, Tanzania needs to expand the number of facilities providing these services in more remote areas. Considering severe shortage of human resources for health in the country, currently operating at 32% of the required skilled workforce, an intensive three-month course was developed to train non-physician clinicians for remote health centres. Methods Competency-based curricula for assistant medical officers' (AMOs training in CEmOC, and for nurses, midwives and clinical officers in anaesthesia and operation theatre etiquette were developed and implemented in Ifakara, Tanzania. The required key competencies were identified, taught and objectively assessed. The training involved hands-on sessions, lectures and discussions. Participants were purposely selected in teams from remote health centres where CEmOC services were planned. Monthly supportive supervision after graduation was carried out in the upgraded health centres Results A total of 43 care providers from 12 health centres located in 11 rural districts in Tanzania and 2 from Somalia were trained from June 2009 to April 2010. Of these 14 were AMOs trained in CEmOC and 31 nurse-midwives and clinical officers trained in anaesthesia. During training, participants performed 278 major obstetric surgeries, 141 manual removal of placenta and evacuation of incomplete and septic abortions, and 1161 anaesthetic procedures under supervision. The first 8 months after introduction of CEmOC services in 3 health centres resulted in 179 caesarean sections, a remarkable increase of institutional deliveries by up to 300%, decreased fresh stillbirth rate (OR: 0.4; 95% CI: 0.1-1.7 and reduced obstetric referrals (OR: 0.2; 95% CI: 0.1-0.4. There were two maternal deaths, both arriving in a moribund condition. Conclusions Tanzanian AMOs, clinical officers, and nurse-midwives can be trained as

  6. Rural health care delivery amidst federal retrenchment: lessons from the Robert Wood Johnson Foundation's Rural Practice Project.

    Science.gov (United States)

    Moscovice, I S; Rosenblatt, R A

    1982-12-01

    This paper examines the experience of the Robert Wood Johnson Foundation's Rural Practice Project (RPP), a major non-governmental effort in the last decade concentrating on the direct delivery of rural health services. The nine RPP sites started prior to 1977 showed a slow but steady increase in their utilization levels and improvement in their financial status during their initial operational years. The tempo of their development was remarkably similar to that of federally sponsored practices in underserved rural areas. After four years of operation, all of the practices had completed their period of grant support; the practices survived in all cases, with almost all of the practices still retaining community sponsorship, salaried physicians, and a commitment to comprehensive care. Practices in sparsely populated rural areas and in areas with fewer hospital beds grew more slowly than those set in rural areas with higher population density and more ancillary resources. We conclude that the use of time-limited initial subsidies is an effective strategy in starting new rural practices in underserved areas and that those practices have a good chance of surviving their start-up phase.

  7. Efforts to Support Consumer Enrollment Decisions Using Total Cost Estimators: Lessons from the Affordable Care Act’s Marketplaces.

    Science.gov (United States)

    Giovannelli, Justin; Curran, Emily

    2017-02-01

    Issue: Policymakers have sought to improve the shopping experience on the Affordable Care Act’s marketplaces by offering decision support tools that help consumers better understand and compare their health plan options. Cost estimators are one such tool. They are designed to provide consumers a personalized estimate of the total cost--premium, minus subsidy, plus cost-sharing--of their coverage options. Cost estimators were available in most states by the start of the fourth open enrollment period. Goal: To understand the experiences of marketplaces that offer a total cost estimator and the interests and concerns of policymakers from states that are not using them. Methods: Structured interviews with marketplace officials, consumer enrollment assisters, technology vendors, and subject matter experts; analysis of the total cost estimators available on the marketplaces as of October 2016. Key findings and conclusions: Informants strongly supported marketplace adoption of a total cost estimator. Marketplaces that offer an estimator faced a range of design choices and varied significantly in their approaches to resolving them. Interviews suggested a clear need for additional consumer testing and data analysis of tool usage and for sustained outreach to enrollment assisters to encourage greater use of the estimators.

  8. Evidence on equity, governance and financing after health care reform in Mexico: lessons for Latin American countries

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    2015-06-01

    Full Text Available This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002-2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders, consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER softwares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social marginalization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.

  9. Collaborations for Leadership in Applied Health Research and Care: lessons from the theory of communities of practice

    Directory of Open Access Journals (Sweden)

    Harvey Gill

    2011-06-01

    Full Text Available Abstract Background The paper combines the analytical and instrumental perspectives on communities of practice (CoPs to reflect on potential challenges that may arise in the process of interprofessional and inter-organisational joint working within the Collaborations for Leaderships in Applied Health Research and Care (CLAHRCs--partnerships between the universities and National Health Service (NHS Trusts aimed at conducting applied health research and translating its findings into day-to-day clinical practice. Discussion The paper discusses seminal theoretical literature on CoPs as well as previous empirical research on the role of these communities in healthcare collaboration, which is organised around the following three themes: knowledge sharing within and across CoPs, CoP formation and manageability, and identity building in CoPs. It argues that the multiprofessional and multi-agency nature of the CLAHRCs operating in the traditionally demarcated organisational landscape of the NHS may present formidable obstacles to knowledge sharing between various professional groupings, formation of a shared 'collaborative' identity, and the development of new communities within the CLAHRCs. To cross multiple boundaries between various professional and organisational communities and hence enable the flow of knowledge, the CLAHRCs will have to create an effective system of 'bridges' involving knowledge brokers, boundary objects, and cross-disciplinary interactions as well as address a number of issues related to professional and organisational identification. Summary The CoP approach can complement traditional 'stage-of-change' theories used in the field of implementation research and provide a basis for designing theory-informed interventions and evaluations. It can help to illuminate multiple boundaries that exist between professional and organisational groups within the CLAHRCs and suggest ways of crossing those boundaries to enable knowledge transfer

  10. Determinantes da tensão do cuidador familiar de idosos dependentes Determinantes de la tensión del cuidador familiar de ancianos dependientes Determinatives of family caregiver's tension while caring the dependent elderly

    Directory of Open Access Journals (Sweden)

    Maria das Graças Melo Fernandes

    2009-02-01

    Full Text Available Este estudo objetivou investigar os determinantes da tensão do cuidador familiar de idosos dependentes. Sua efetividade se deu no cenário domiciliar, envolvendo trinta cuidadoras principais. Os dados foram coletados por meio de entrevista estruturada gravada. A análise dos dados objetivos foi feita mediante uma abordagem quantitativa. Os dados discursivos, coletados por meio da gravação da entrevista, por serem apreendidos a partir de um instrumento estruturado, dispensaram procedimento analítico, sendo distribuídos entre as questões a que se referiam no sentido de ampliar sua compreensão. Os resultados apontam que o fenômeno investigado se origina a partir de determinantes relacionados ao cuidador, aos déficits do idoso, à interação idoso/cuidador, ao ambiente, e às demandas de cuidado.Este estudio objetivó investigar los determinantes de la tensión del cuidador familiar de ancianos dependientes. Su efectividad se dio en el escenario domiciliar, envolviendo a treinta cuidadoras principales. Los datos fueron colectados por medio de entrevista estructurada grabada. El análisis de los datos objetivos fue hecho mediante un abordaje cuantitativo. Los datos discursivos, colectados por medio de la grabación de la entrevista, por ser aprehendidos a partir de un instrumento estructurado, dispensaron procedimiento analítico, siendo distribuidos entre las cuestiones a que se referían en el sentido de ampliar su comprensión. Los resultados apuntan que el fenómeno investigado se origina a partir de determinantes relacionados al cuidador, a los déficits del anciano, a la interacción anciano/cuidador, al ambiente, y a las demandas de cuidado.This study had as objective investigate the determinatives of the tension of the dependent elderly's family caregiver. Its accomplish happened in the domestic scenery, involving thirty principal caregivers. The data were collected by a recorded and estructured interview. The analyses of the

  11. Buen Viaje: Mutually Beneficial Tourism. A Four-Lesson Unit about Traveling with Care in Mexico for Grades 8-12 and Adult Learners in English and Spanish.

    Science.gov (United States)

    Mattson, Alexandra; Ruiz, Octavio; Sommers, Meredith

    Intended for secondary students, this curriculum unit (in both English and Spanish) provides a look into Mexico's second largest industry, tourism. The curriculum unit of four lessons includes general information about tourism, maps, stories, and a code of behavior for travelers. The unit enumerates learner objectives, defines vocabulary and…

  12. Lesson Learning at JPL

    Science.gov (United States)

    Oberhettinger, David

    2011-01-01

    A lessons learned system is a hallmark of a mature engineering organization A formal lessons learned process can help assure that valuable lessons get written and published, that they are well-written, and that the essential information is "infused" into institutional practice. Requires high-level institutional commitment, and everyone's participation in gathering, disseminating, and using the lessons

  13. Lesson Learning at JPL

    Science.gov (United States)

    Oberhettinger, David

    2011-01-01

    A lessons learned system is a hallmark of a mature engineering organization A formal lessons learned process can help assure that valuable lessons get written and published, that they are well-written, and that the essential information is "infused" into institutional practice. Requires high-level institutional commitment, and everyone's participation in gathering, disseminating, and using the lessons

  14. Ten principles of good interdisciplinary team work.

    Science.gov (United States)

    Nancarrow, Susan A; Booth, Andrew; Ariss, Steven; Smith, Tony; Enderby, Pam; Roots, Alison

    2013-05-10

    Interdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes. This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over 253 staff from 11 community rehabilitation and intermediate care teams in the UK. These data sources were merged using qualitative content analysis to arrive at a framework that identifies characteristics and proposes ten competencies that support effective interdisciplinary team work. Ten characteristics underpinning effective interdisciplinary team work were identified: positive leadership and management attributes; communication strategies and structures; personal rewards, training and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles. We propose competency statements that an effective interdisciplinary team functioning at a high level should demonstrate.

  15. 2007 China Harbor Ten People

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ 2007 China Harbor Ten People elected the entrepreneurs who contributed a lot to port economy and enterprises this year trough their talent management.These ten people embody their social responsibility,professional skills,creative ability,and charming personality.Bearing full confidence in China's port economy,the port entrepreneurs are brave enough to explore a brand new area,so as to promote harbor economic development.

  16. Compromises in orchestra pit design: A ten-year trench war in The Royal Theatre, Copenhagen

    DEFF Research Database (Denmark)

    Gade, Anders Christian; Mortensen, Bo

    1998-01-01

    of opera finally opened the way for a new renovation of the pit, which solved most of the problems. The paper describes the many lessons learned during the ten-year period in which the authors were involved with the case as acoustic consultants. Questions of how pit configuration influences mutual hearing...

  17. Southwest Airlines: lessons in loyalty.

    Science.gov (United States)

    D'Aurizio, Patricia

    2008-01-01

    Southwest Airlines continues to garner accolades in the areas of customer service, workforce management, and profitability. Since both the health care and airlines industries deal with a service rather than a product, the customer experience depends on the people who deliver that experience. Employees' commitment or "loyalty" to their customers, their employer, and their work translates into millions of dollars of revenue. What employee wants to work for "the worst employer in town?" Nine loyalty lessons from Southwest can be carried over to the health care setting for the benefit of employees and patients.

  18. Challenges and Solutions in the Implementation of the School-Based Pathway to Care Model: The Lessons from Nova Scotia and beyond

    Science.gov (United States)

    Kutcher, Stan; Wei, Yifeng

    2013-01-01

    Most mental disorders often onset during the adolescent years, providing opportunities for educators, health care providers, and related stakeholders to work collaboratively in addressing adolescent mental health care needs. This report describes early implementations of various components of the School-Based Pathway to Care Model currently…

  19. [Lessons from Field Studies].

    Science.gov (United States)

    Yoshimura, Takesumi

    2015-01-01

    During my academic career for more than 40 years, I was involved in 18 epidemiological field studies, partially or fully. Among these field studies, four (1. Medical services in remote rural areas in Okinawa, 2. Yusho episode, 3. JICA Onchocerciasis Control Project in Guatemala, and 4. Miyako cohort study in Fukuoka) are introduced in this paper, including the latest situation after the presentation. Through these field works experienced by the author, the following lessons were gained. 1. Strong human reliance between researchers and the targeted population is essential in carrying out epidemiological surveys successfully in the field. 2. Data obtained from the survey should be carefully examined and analyzed so that those data may reflect the real situation.

  20. Ten-dimensional Supergravity Revisited

    NARCIS (Netherlands)

    Bergshoeff, Eric; Roo, Mees de; Kerstan, Sven; Riccioni, Fabio; Diaz Alonso, J.; Mornas, L.

    2006-01-01

    We show that the exisiting supergravity theories in ten dimensions can be extended with extra gauge fields whose rank is equal to the spacetime dimension. These gauge fields have vanishing field strength but nevertheless play an important role in the coupling of supergravity to spacetime filling bra

  1. Ten Rules of Academic Writing

    NARCIS (Netherlands)

    Donovan, S.K.

    2011-01-01

    Creative writers are well served with 'how to' guides, but just how much do they help? And how might they be relevant to academic authors? A recent survey of writing tips by twenty-eight creative authors has been condensed to the ten most relevant to the academic, supported by some comments on metho

  2. A Ten-Year Reflection

    Science.gov (United States)

    Phillip, Cyndi

    2016-01-01

    Five initiatives launched during Cyndi Phillip's term as American Association of School Librarians (AASL) President (2006-2007) continue to have an impact on school librarians ten years later. They include the rewriting of AASL's learning standards, introduction of the SKILLS Act, the presentation of the Crystal Apple Award to Scholastic Library…

  3. Ten Problems in Experimental Mathematics

    Energy Technology Data Exchange (ETDEWEB)

    Bailey, David H.; Borwein, Jonathan M.; Kapoor, Vishaal; Weisstein, Eric

    2004-09-30

    This article was stimulated by the recent SIAM ''100 DigitChallenge'' of Nick Trefethen, beautifully described in a recent book. Indeed, these ten numeric challenge problems are also listed in a recent book by two of present authors, where they are followed by the ten symbolic/numeric challenge problems that are discussed in this article. Our intent was to present ten problems that are characteristic of the sorts of problems that commonly arise in ''experimental mathematics''. The challenge in each case is to obtain a high precision numeric evaluation of the quantity, and then, if possible, to obtain a symbolic answer, ideally one with proof. Our goal in this article is to provide solutions to these ten problems, and in the process present a concise account of how one combines symbolic and numeric computation, which may be termed ''hybrid computation'', in the process of mathematical discovery.

  4. Ten Rules of Academic Writing

    NARCIS (Netherlands)

    Donovan, S.K.

    2011-01-01

    Creative writers are well served with 'how to' guides, but just how much do they help? And how might they be relevant to academic authors? A recent survey of writing tips by twenty-eight creative authors has been condensed to the ten most relevant to the academic, supported by some comments on metho

  5. Lessons in Ponapean.

    Science.gov (United States)

    Peace Corps, Washington, DC.

    This volume contains 35 beginning Ponapean lessons for native English speakers. Each lesson consists of a dialogue structured around an aspect of Ponapean grammar and substitution exercises designed for drill. Vocabulary is introduced in the substitution exercises. (CLK)

  6. Ten tendencies of criminal justice

    Institute of Scientific and Technical Information of China (English)

    HE Jiahong

    2007-01-01

    A study of the global tendencies of criminal justice will help us design a more scientific and rational pathway for the reformation of existing criminal justice system of China. In the forthcoming several hundred years to come, theworld's criminal justice is to take on ten tendencies, that is, the tendency toward unity, civilization, science, rule of law, human rights, justice, efficiency,specialization, standardization and harmony.

  7. Implementing the WHO integrated tool to assess quality of care for mothers, newborns and children: results and lessons learnt from five districts in Malawi.

    Science.gov (United States)

    Smith, Helen; Asfaw, Atnafu Getachew; Aung, Kyaw Myint; Chikoti, Lastone; Mgawadere, Florence; d'Aquino, Luigi; van den Broek, Nynke

    2017-08-25

    In 2014 the World Health Organization (WHO) developed a new tool to be used to assess the quality of care for mothers, newborns and children provided at healthcare facility level. This paper reports on the feasibility of using the tool, its limitations and strengths. Across 5 districts in Malawi, 35 healthcare facilities were assessed. The WHO tool includes checklists, interviews and observation of case management by which care is assessed against agreed standards using a Likert scale (1 lowest: not meeting standard, 5 highest: compliant with standard). Descriptive statistics were used to provide summary scores for each standard. A 'dashboard' system was developed to display the results. For maternal care three areas met standards; 1) supportive care for admitted patients (71% of healthcare facilities scored 4 or 5); 2) prevention and management of infections during pregnancy (71% scored 4 or 5); and 3) management of unsatisfactory progress of labour (84% scored 4 or 5). Availability of essential equipment and supplies was noted to be a critical barrier to achieving satisfactory standards of paediatric care (mean score; standard deviation: 2.9; SD 0.95) and child care (2.7; SD 1.1). Infection control is inadequate across all districts for maternal, newborn and paediatric care. Quality of care varies across districts with a mean (SD) score for all standards combined of 3 (SD 0.19) for the worst performing district and 4 (SD 0.27) for the best. The best performing district has an average score of 4 (SD 0.27). Hospitals had good scores for overall infrastructure, essential drugs, organisation of care and management of preterm labour. However, health centres were better at case management of HIV/AIDS patients and follow-up of sick children. There is a need to develop an expanded framework of standards which is inclusive of all areas of care. In addition, it is important to ensure structure, process and outcomes of health care are reflected.

  8. Health care in the Netherlands.

    NARCIS (Netherlands)

    Weel, C. van; Schers, H.J.; Timmermans, A.

    2012-01-01

    This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and

  9. Lessons learned from the science of caring: Extending the reach of psychosocial oncology: The International Psycho-Oncology Society 2016 Sutherland Award Lecture.

    Science.gov (United States)

    Bultz, Barry D

    2017-06-01

    In medicine, referral to a medical oncology specialty is based on recent history, physical examination, pathology, surgery reports, imaging, blood work, and the patient's vital signs. By contrast, referral to a psychosocial specialist has typically been based on the patients expressed request for psychosocial support or the health care team's observation of the patient's limited adjustment or poor coping with the diagnosis, treatment, or end-of-life distress. These observations are usually based on clinical acumen not on metrics. In psychosocial oncology, by committing to the science of caring and relying on the use of standardized tools to screen for distress, the multidisciplinary cancer care team assess, communicate, and intervene on what is measured. That is, health care providers can begin to address the patients' identified concerns. Branding distress as the 6th vital sign and incorporating screening for distress into standard cancer practice can be an effective strategy to challenging the resistance in implementation of psychosocial oncology in cancer care institutions. Accreditation agencies are endorsing the need to assess patient distress and better manage symptoms of distress as part of routine and standardized patient care. While many international organizations and societies support the importance of screening, implementing screening for distress still has a long way to go to be operationalized in many cancer care programs. Screening for distress when implemented does, however, create an opportunity for psychosocial oncology to extend its reach into cancer care programs and institutions. Copyright © 2017 John Wiley & Sons, Ltd.

  10. Challenges to Providing End-of-Life Care to Low-Income Elders with Advanced Chronic Disease: Lessons Learned from a Model Program

    Science.gov (United States)

    Kramer, Betty J.; Auer, Casey

    2005-01-01

    Purpose: This study explored the challenges in providing end-of-life care to low-income elders with multiple comorbid chronic conditions in a fully "integrated" managed care program, and it highlighted essential recommendations. Design and Methods: A case-study design was used that involved an extensive analysis of qualitative data from five focus…

  11. U-opportunities why is ten equal to ten ?

    CERN Document Server

    Julia, B L

    2002-01-01

    It seems to me at this time that two recent developments may permit fast progress on our way to understand the symmetry structure of toroidally (compactified and) reduced M-theory. The first indication of a (possibly) thin spot in the wall that prevents us from deriving a priori the U-duality symmetries of these models is to be found in the analysis of the hyperbolic billiards that control the chaotic time evolution of (quasi)homogeneous anisotropic String, Supergravity or Einstein cosmologies near a spacelike singularity. What happens is that U-duality symmetry controls chaos via negative constant curvature. On the other hand it was noticed in 1982 that (symmetrizable) ''hyperbolic'' Kac-Moody algebras have maximal rank ten, exactly like superstring models and that two of these four rank ten algebras matched physical theories. My second reason for optimism actually predates also the previous breakthrough, it was the discovery in 1998 of surprising superalgebras extending U-dualities to all (p+1)-forms (assoc...

  12. Lesson "Balance in Nature

    Science.gov (United States)

    Chapanova, V.

    2012-04-01

    Lesson "Balance in Nature" This simulation game-lesson (Balance in Nature) gives an opportunity for the students to show creativity, work independently, and to create models and ideas. It creates future-oriented thought connected to their experience, allowing them to propose solutions for global problems and personal responsibility for their activities. The class is divided in two teams. Each team chooses questions. 1. Question: Pollution in the environment. 2. Question: Care for nature and climate. The teams work on the chosen tasks. They make drafts, notes and formulate their solutions on small pieces of paper, explaining the impact on nature and society. They express their points of view using many different opinions. This generates alternative thoughts and results in creative solutions. With the new knowledge and positive behaviour defined, everybody realizes that they can do something positive towards nature and climate problems and the importance of individuals for solving global problems is evident. Our main goal is to recover the ecological balance, and everybody explains his or her own well-grounded opinions. In this work process the students obtain knowledge, skills and more responsible behaviour. This process, based on his or her own experience, dialogue and teamwork, helps the participant's self-development. Making the model "human↔ nature" expresses how human activities impact the natural Earth and how these impacts in turn affect society. Taking personal responsibility, we can reduce global warming and help the Earth. By helping nature we help ourselves. Teacher: Veselina Boycheva-Chapanova " Saint Patriarch Evtimii" Scholl Str. "Ivan Vazov"-19 Plovdiv Bulgaria

  13. Improving the quality of obstetric care for women with obstructed labour in the national referral hospital in Uganda: lessons learnt from criteria based audit.

    Science.gov (United States)

    Kayiga, Herbert; Ajeani, Judith; Kiondo, Paul; Kaye, Dan K

    2016-07-11

    Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with improved quality of obstetric care. The objective was to assess whether criteria-based audit improves quality of obstetric care provided to women with obstructed labour in Mulago hospital, Uganda. Using criteria-based audit, management of obstructed labour was analyzed prospectively in two audits. Six standards of care were compared. An initial audit of 180 patients was conducted in September/October 2013. The Audit results were shared with key stakeholders. Gaps in patient management were identified and recommendations for improving obstetric care initiated. Six standards of care (intravenous fluids, intravenous antibiotics, monitoring of maternal vital signs, bladder catheterization, delivery within two hours, and blood grouping and cross matching) were implemented. A re-audit of 180 patients with obstructed labour was conducted four months later to evaluate the impact of these recommendations. The results of the two audits were compared. In-depth interviews and focus group discussions were conducted among healthcare providers to identify factors that could have influenced the audit results. There was improvement in two standards of care (intravenous fluids and intravenous antibiotic administration) 58.9 % vs. 86.1 %; p motivation), facility factors (poor supervision, stock-outs of essential supplies, absence of protocols) and patient factors (high patient load, poor compliance to instructions) contributed to poor quality of care. Introduction of criteria based audit in the management of obstructed labour led to measurable improvements in only two out of six standards of care. The extent to which criteria based audit may improve quality of obstetric care depends on having basic effective healthcare systems in place.

  14. Ten questions about systems biology

    DEFF Research Database (Denmark)

    Joyner, Michael J; Pedersen, Bente K

    2011-01-01

    In this paper we raise 'ten questions' broadly related to 'omics', the term systems biology, and why the new biology has failed to deliver major therapeutic advances for many common diseases, especially diabetes and cardiovascular disease. We argue that a fundamentally narrow and reductionist...... to understand how whole animals adapt to the real world. We argue that a lack of fluency in these concepts is a major stumbling block for what has been narrowly defined as 'systems biology' by some of its leading advocates. We also point out that it is a failure of regulation at multiple levels that causes many...

  15. Ten Thousand Years of Solitude

    Energy Technology Data Exchange (ETDEWEB)

    Benford, G. (Los Alamos National Lab., NM (USA) California Univ., Irvine, CA (USA). Dept. of Physics); Kirkwood, C.W. (Los Alamos National Lab., NM (USA) Arizona State Univ., Tempe, AZ (USA). Coll. of Business Administration); Harry, O. (Los Alamos National Lab., NM (USA)); Pasqualetti, M.J. (Los Alamos National Lab., NM (USA) Arizona State Univ., Tempe, AZ (USA))

    1991-03-01

    This report documents the authors work as an expert team advising the US Department of Energy on modes of inadvertent intrusion over the next 10,000 years into the Waste Isolation Pilot Project (WIPP) nuclear waste repository. Credible types of potential future accidental intrusion into the WIPP are estimated as a basis for creating warning markers to prevent inadvertent intrusion. A six-step process is used to structure possible scenarios for such intrusion, and it is concluded that the probability of inadvertent intrusion into the WIPP repository over the next ten thousand years lies between one and twenty-five percent. 3 figs., 5 tabs.

  16. Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults.

    Science.gov (United States)

    Johnson, Mark I; Claydon, Leica S; Herbison, G Peter; Jones, Gareth; Paley, Carole A

    2017-10-09

    Fibromyalgia is characterised by persistent, widespread pain; sleep problems; and fatigue. Transcutaneous electrical nerve stimulation (TENS) is the delivery of pulsed electrical currents across the intact surface of the skin to stimulate peripheral nerves and is used extensively to manage painful conditions. TENS is inexpensive, safe, and can be self-administered. TENS reduces pain during movement in some people so it may be a useful adjunct to assist participation in exercise and activities of daily living. To date, there has been only one systematic review in 2012 which included TENS, amongst other treatments, for fibromyalgia, and the authors concluded that TENS was not effective. To assess the analgesic efficacy and adverse events of TENS alone or added to usual care (including exercise) compared with placebo (sham) TENS; no treatment; exercise alone; or other treatment including medication, electroacupuncture, warmth therapy, or hydrotherapy for fibromyalgia in adults. We searched the following electronic databases up to 18 January 2017: CENTRAL (CRSO); MEDLINE (Ovid); Embase (Ovid); CINAHL (EBSCO); PsycINFO (Ovid); LILACS; PEDRO; Web of Science (ISI); AMED (Ovid); and SPORTDiscus (EBSCO). We also searched three trial registries. There were no language restrictions. We included randomised controlled trials (RCTs) or quasi-randomised trials of TENS treatment for pain associated with fibromyalgia in adults. We included cross-over and parallel-group trial designs. We included studies that evaluated TENS administered using non-invasive techniques at intensities that produced perceptible TENS sensations during stimulation at either the site of pain or over nerve bundles proximal (or near) to the site of pain. We included TENS administered as a sole treatment or TENS in combination with other treatments, and TENS given as a single treatment or as a course of treatments. Two review authors independently determined study eligibility by assessing each record and

  17. An Outbreak of Vancomycin-Resistant Enterococcus faecium in an Acute Care Pediatric Hospital: Lessons from Environmental Screening and a Case-Control Study

    Directory of Open Access Journals (Sweden)

    Steven J Drews

    2008-01-01

    Full Text Available BACKGROUND: The present study describes a vancomycin-resistant enterococci (VRE outbreak investigation and a case-control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital.

  18. Translating 10 lessons from lean six sigma project in paper-based training site to electronic health record-based primary care practice: challenges and opportunities.

    Science.gov (United States)

    Aleem, Sohaib

    2013-01-01

    Lean Six Sigma is a well-proven methodology to enhance the performance of any business, including health care. The strategy focuses on cutting out waste and variation from the processes to improve the value and efficiency of work. This article walks through the journey of "green belt" training using a Lean Six Sigma approach and the implementation of a process improvement project that focused on wait time for patients to be examined in an urban academic primary care clinic without requiring added resources. Experiences of the training and the project at an urban paper-based satellite clinic have informed the planning efforts of a data and performance team, including implementing a 15-minute nurse "pre-visit" at primary care sites of an accountable care organization.

  19. Risk factors for maternal deaths in unplanned obstetric admissions to the intensive care unit-lessons for sub-Saharan Africa.

    Science.gov (United States)

    Okafor, Ugochukwu V; Efetie, Efenae R; Amucheazi, Adaobi

    2011-12-01

    This study was undertaken to determine the risk factors for maternal deaths in unplanned or unbooked obstetric admissions to the intensive care unit of a tertiary health centre. Hospital records of unbooked obstetric admissions to the intensive care unit of the hospital from January 1997 to December 2006 were retrospectively reviewed. Data collected included patients' demographics, diagnosis, duration of stay in the ICU and patient outcome. The intensive care unit records showed that there were 25 unbooked obstetric admissions. Major diagnoses for unplanned admissions to the ICU were preeclampsia/eclampsia (41.1%), obstetric haemorrhage (37.5%), and respiratory distress (12.5%). There were 12 deaths (48%). Organ dysfunction on admission, massive blood loss and late presentation were the risk factors for mortality. The high maternal mortality was mainly due to limited supply of blood products and inadequate prenatal care resulting in disease severity.

  20. A ten-year surveillance study of carbapenemase-producing Klebsiella pneumoniae in a tertiary care Greek university hospital: predominance of KPC- over VIM- or NDM-producing isolates.

    Science.gov (United States)

    Spyropoulou, Aikaterini; Papadimitriou-Olivgeris, Matthaios; Bartzavali, Christina; Vamvakopoulou, Sophia; Marangos, Markos; Spiliopoulou, Iris; Anastassiou, Evangelos D; Christofidou, Myrto

    2016-03-01

    Resistance patterns and carbapenemase gene presence among Klebsiella pneumoniae isolates from the University General Hospital of Patras, Greece during a ten-year period were analysed under a surveillance programme for multi-drug-resistant bacteria. From 2005 to 2014, K. pneumoniae isolates from clinically significant specimens were identified by the Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the agar disc diffusion method and Etest. The strains were tested for the presence of blaVIM, blaIMP, blaKPC, blaNDM and blaOXA-48 genes by PCR. PFGE of chromosomal Xbal DNA digests was performed. A total of 3449 K. pneumoniae isolates were recovered during the last decade. Among them, 1668 (48 %) were carbapenemase-producing: 1333 (80%) K. pneumoniae carbapenemase (KPC)-, 286 (17%) Verona imipenemase (VIM), 45 (3%) KPC- and VIM-, and four New Delhi metallo-beta-lactamase (NDM)-producing. Their resistance rates to gentamicin, colistin and tigecycline were 41%, 23% and 16%, respectively. VIM-producing K. pneumoniae were isolated in 2005 and since 2008 have been endemic. KPC-producing K. pneumoniae (KPC-Kp) isolates were introduced in 2008 and until now represent the predominant carbapenemase-producing K. pneumoniae in our institution. PFGE of 97 KPC-Kp strains identified three types: A, 84 (87%); B, 11 (11%); and E, two (2%). Eleven co-producing KPC and VIM K. pneumoniae isolates belonged to PFGE B. The four NDM-positives were classified to type F. The number of K. pneumoniae bacteraemias increased during the study period, which may be solely attributed to the increase of carbapenemase-producing isolates. The threat of carbapenemase-producing K. pneumoniae emphasizes the urgent need for implementation of infection control measures and budgetary allocations to infection control.

  1. A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada

    Science.gov (United States)

    Cloutier, Denise; Cox, Amy; Kampen, Ruth; Kobayashi, Karen; Cook, Heather; Taylor, Deanne; Gaspard, Gina

    2016-01-01

    Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change. PMID:27417591

  2. Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK.

    Science.gov (United States)

    Noble, B; King, N; Woolmore, A; Hughes, P; Winslow, M; Melvin, J; Brooks, J; Bravington, A; Ingleton, C; Bath, P A

    2015-03-01

    The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy-one per cent of patients died at home. This model may have application elsewhere. © 2014 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.

  3. A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada.

    Science.gov (United States)

    Cloutier, Denise; Cox, Amy; Kampen, Ruth; Kobayashi, Karen; Cook, Heather; Taylor, Deanne; Gaspard, Gina

    2016-01-04

    Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.

  4. A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM in Western Canada

    Directory of Open Access Journals (Sweden)

    Denise Cloutier

    2016-01-01

    Full Text Available Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators, and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists, working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.

  5. NASA Engineering Network Lessons Learned

    Data.gov (United States)

    National Aeronautics and Space Administration — The NASA Lessons Learned system provides access to official, reviewed lessons learned from NASA programs and projects. These lessons have been made available to the...

  6. Primary care clinicians’ experiences prescribing HIV pre-exposure prophylaxis at a specialized community health centre in Boston: lessons from early adopters

    Directory of Open Access Journals (Sweden)

    Douglas S Krakower

    2016-10-01

    Full Text Available Introduction: An estimated 1.2 million Americans have indications for using antiretroviral pre-exposure prophylaxis (PrEP to prevent HIV acquisition. For many of these at-risk individuals, the best opportunity to learn about and receive PrEP will be during routine visits to their generalist primary care clinicians. However, few generalist clinicians have prescribed PrEP, primarily because of practical concerns about providing PrEP in primary care settings. The experiences of specialized primary care clinicians who have prescribed PrEP can inform the feasibility of PrEP provision by generalists. Methods: During January to February 2015, 35 primary care clinicians at a community health centre in Boston that specializes in the care of sexual and gender minorities completed anonymous surveys about their experiences and practices with PrEP provision. Responses were analyzed with descriptive statistics. Results and discussion: Thirty-two clinicians (response rate=91% completed the surveys. Nearly all clinicians (97% had prescribed PrEP (median 20 patients, interquartile range 11–33. Most clinicians reported testing and risk-reduction counselling practices concordant with U.S. Centers for Disease Control and Prevention guidelines for PrEP. Clinicians indicated that patients using PrEP experienced medication toxicities infrequently and generally reported high adherence. However, some clinicians’ practices differed from guideline recommendations, and some clinicians observed patients with increased risk behaviours. Most clinicians (79% rated PrEP provision as easy to accomplish, and 97% considered themselves likely to prescribe PrEP in the future. Conclusions: In a primary care clinic with specialized expertise in HIV prevention, clinicians perceived that PrEP provision to large numbers of patients was safe, feasible and potentially effective. Efforts to engage generalist primary care clinicians in PrEP provision could facilitate scale-up of this

  7. Primary care clinicians’ experiences prescribing HIV pre-exposure prophylaxis at a specialized community health centre in Boston: lessons from early adopters

    Science.gov (United States)

    Krakower, Douglas S; Maloney, Kevin M; Grasso, Chris; Melbourne, Katherine; Mayer, Kenneth H

    2016-01-01

    Introduction An estimated 1.2 million Americans have indications for using antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. For many of these at-risk individuals, the best opportunity to learn about and receive PrEP will be during routine visits to their generalist primary care clinicians. However, few generalist clinicians have prescribed PrEP, primarily because of practical concerns about providing PrEP in primary care settings. The experiences of specialized primary care clinicians who have prescribed PrEP can inform the feasibility of PrEP provision by generalists. Methods During January to February 2015, 35 primary care clinicians at a community health centre in Boston that specializes in the care of sexual and gender minorities completed anonymous surveys about their experiences and practices with PrEP provision. Responses were analyzed with descriptive statistics. Results and discussion Thirty-two clinicians (response rate=91%) completed the surveys. Nearly all clinicians (97%) had prescribed PrEP (median 20 patients, interquartile range 11–33). Most clinicians reported testing and risk-reduction counselling practices concordant with U.S. Centers for Disease Control and Prevention guidelines for PrEP. Clinicians indicated that patients using PrEP experienced medication toxicities infrequently and generally reported high adherence. However, some clinicians’ practices differed from guideline recommendations, and some clinicians observed patients with increased risk behaviours. Most clinicians (79%) rated PrEP provision as easy to accomplish, and 97% considered themselves likely to prescribe PrEP in the future. Conclusions In a primary care clinic with specialized expertise in HIV prevention, clinicians perceived that PrEP provision to large numbers of patients was safe, feasible and potentially effective. Efforts to engage generalist primary care clinicians in PrEP provision could facilitate scale-up of this efficacious

  8. Improving primary health care services for young people experiencing psychological distress and mental health problems: a personal reflection on lessons learnt from Australia and England.

    Science.gov (United States)

    Roberts, Jane H

    2012-10-01

    Australia and England show high rates of psychological distress and mental health problems in young people. Both are high-income countries and have stated their intention to improve the delivery of health care to young people in primary care settings. Australia has an international reputation for improving care through innovative services and educational initiatives. England has taken a different direction and has concentrated more on developing policy and making recommendations to improve access for young people. To describe a Churchill Fellowship visit to Australia to observe initiatives in primary care based youth-friendly mental health care and to reflect upon the observations, comparing and contrasting with the English model. The observations and reflections presented draw on field notes from site visits and meeting with key players, accessing web resources and referring to the literature, both grey and published. Australia offers plurality in health care delivery and innovative responses to addressing youth mental health. There are two key approaches. The first is the development of services specializing in youth mental health. The second approach is to build capacity of existing primary care services to recognize the particular bio-psychosocial needs of adolescents (and their families). In contrast, England has tended to focus primarily on policy development and improving youth access. The paper draws attention to a number of political, clinical and educational developments in both Australia and England. Both countries demonstrate different strategies in response to the high levels of psychological distress in young people. Learning from colleagues in other settings can inform our own practice. Ultimately responding to young people's mental health needs is best served by youth-friendly policy which prepares clinicians for effective practice, informed by applied research and supported by adequate resources. Investment in young people's health must be a

  9. Deburring: technical capabilities and cost-effective approaches. Lessons 7 and 8

    Energy Technology Data Exchange (ETDEWEB)

    Gillespie, L.K.

    1980-06-01

    This ten-lesson text on deburring is designed to provide engineers and production supervisors with an overall understanding of deburring economics and current capabilities. Chapter 7 discusses deburring techniques. Electropolish and electrochemical deburring (ECD) are not the answer to everyone's deburring problems. They are high technology processes when compared to tumbling processes. They require more care, skill, and knowledge than many of the older processes. They are not mass finishing processes. In contrast, they can deburr areas totally untouchable by other processes, and electropolish can produce brilliant finishes. ECD selectively works only in one area, and neither process exerts cutting forces which would distort thin sections. ECD is applicable to all metals and all sizes of burrs. Once established, both processes can be controlled by unskilled help.

  10. An inquiry-based programming lesson

    Science.gov (United States)

    Douglas, Stephanie; Rice, Emily; Derdzinski, Andrea

    2016-03-01

    We designed a 2-day inquiry activity where students learned about error analysis and coding practices in Python. Inquiry-based lessons provide students with opportunities to independently investigate scientific concepts and tools. A general structure is developed ahead of time and minimal, careful guidance provided during the activity, but students are given as much freedom as possible to explore the concepts at their own pace. We designed our activity to help students learn to write flexible, re-usable, and readable code. I will describe the lesson structure we initially designed, as well as what aspects worked for our students (or didn't) and our experience leading the activity.

  11. Practical lessons in remote connectivity.

    Science.gov (United States)

    Kouroubali, A.; Starren, J.; Barrows, R. C.; Clayton, P. D.

    1997-01-01

    Community Health Information Networks (CHINs) require the ability to provide computer network connections to many remote sites. During the implementation of the Washington Heights and Inwood Community Health Management Information System (WHICHIS) at the Columbia-Presbyterian Medical Center (CPMC), a number of remote connectivity issues have been encountered. Both technical and non-technical issues were significant during the installation. We developed a work-flow model for this process which may be helpful to any health care institution attempting to provide seamless remote connectivity. This model is presented and implementation lessons are discussed. PMID:9357643

  12. Management strategies to effect change in intensive care units: lessons from the world of business. Part III. Effectively effecting and sustaining change.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, but would be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating an ICU environment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICU to one that is well integrated into the rest of the institution. Creating a "pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends.

  13. An online interprofessional learning resource for physicians, pharmacists, nurse practitioners, and nurses in long-term care: benefits, barriers, and lessons learned.

    Science.gov (United States)

    Macdonald, Colla J; Stodel, Emma J; Chambers, Larry W

    2008-03-01

    The importance of collaborative practice in health care has been emphasized.1,21, 2 There is a critical need for convenient and flexible education opportunities that support the development of collaborative practice skills among the health care workforce. Consequently, the purpose of this project was to create and evaluate an online learning resource for physicians, nurses, nurse practitioners, and pharmacists working in long-term care that provided practitioners with the skills, knowledge, and motivation necessary to enhance their ability to act as an interprofessional team while providing clinical care. The Demand-Driven Learning Model 3 was used to guide the project. Findings revealed learners enjoyed the programme and acquired new skills and knowledge relating to collaborative practice that they transferred to their workplace resulting in higher levels of collaborative practice. The data did not reveal significant changes in the learners' attitudes towards collaborative practice; perhaps because the participants were early adopters and already had positive attitudes. Requests to change organizational structure to enhance collaborative practice were minimal, as was the impact of the resource on resident care. Given the short time frame from completion of the learning resource to the evaluation, this is perhaps not surprising as it is reasonable to expect that these types of changes will take time to take effect within the organization. Follow-ups at a later date are suggested.

  14. Approaching Conformality with Ten Flavors

    CERN Document Server

    Appelquist, Thomas; Buchoff, Michael I; Cheng, Michael; Cohen, Saul D; Fleming, George T; Kiskis, Joe; Lin, Meifeng; Na, Heechang; Neil, Ethan T; Osborn, James C; Rebbi, Claudio; Schaich, David; Schroeder, Chris; Voronov, Gennady; Vranas, Pavlos

    2012-01-01

    We present first results for lattice simulations, on a single volume, of the low-lying spectrum of an SU(3) Yang-Mills gauge theory with ten light fermions in the fundamental representation. Fits to the fermion mass dependence of various observables are found to be globally consistent with the hypothesis that this theory is within or just outside the strongly-coupled edge of the conformal window, with mass anomalous dimension approximately equal to 1 over the range of scales simulated. We stress that we cannot rule out the possibility of spontaneous chiral-symmetry breaking at scales well below our infrared cutoff. We discuss important systematic effects, including finite-volume corrections, and consider directions for future improvement.

  15. Ten Years of Cooperation Between Mobile Robots and Sensor Networks

    Directory of Open Access Journals (Sweden)

    Jesus Capitán Fernández

    2015-06-01

    Full Text Available This paper presents an overview of the work carried out by the Group of Robotics, Vision and Control (GRVC at the University of Seville on the cooperation between mobile robots and sensor networks. The GRVC, led by Professor Anibal Ollero, has been working over the last ten years on techniques where robots and sensor networks exploit synergies and collaborate tightly, developing numerous research projects on the topic. In this paper, based on our research, we introduce what we consider some relevant challenges when combining sensor networks with mobile robots. Then, we describe our developed techniques and main results for these challenges. In particular, the paper focuses on autonomous self-deployment of sensor networks; cooperative localization and tracking; self-localization and mapping; and large-scale scenarios. Extensive experimental results and lessons learnt are also discussed in the paper.

  16. Ten Years of Cooperation Between Mobile Robots and Sensor Networks

    Directory of Open Access Journals (Sweden)

    Jesus Capitán Fernández

    2015-06-01

    Full Text Available This paper presents an overview of the work carried out by the Group of Robotics, Vision and Control (GRVC at the University of Seville on the cooperation between mobile robots and sensor networks. The GRVC, led by Professor Anibal Ollero, has been working over the last ten years on techniques where robots and sensor networks exploit synergies and collaborate tightly, developing numerous research projects on the topic. In this paper, based on our research, we introduce what we consider some relevant challenges when combining sensor networks with mobile robots. Then, we describe our developed techniques and main results for these challenges. In particular, the paper focuses on autonomous self-deployment of sensor networks; cooperative localization and tracking; self-localization and mapping; and large-scale scenarios. Extensive experimental results and lessons learnt are also discussed in the paper.

  17. Ten out of ten for LHC decapole magnets

    CERN Multimedia

    2001-01-01

    CERN's Albert Ijspeert (left) and Avinash Puntambekar of the Indian CAT laboratory with the ten Indian decapole magnets on the test bench. Tests will be carried out by the LHC-MTA group. A batch of 10 superconducting decapole magnets for the LHC has just arrived at CERN from India. These will be used to correct for slight imperfections in the dipole magnets that will steer proton beams around CERN's new accelerator. All magnets have slight imperfections in the fields they produce, and in the LHC dipoles these will be corrected for using sextupoles and decapoles. The sextupoles were the first LHC magnets to be given the production green-light following successful tests of pre-series magnets last year (Bulletin 21/2000, 22 May 2000). Now it is the turn of pre-series decapoles to go on trial at CERN. Of the LHC's 1232 dipole magnets, half will use sextupole correctors only and the other half will use both sextupoles and decapoles. That means that a total of 616 pairs of decapoles are needed. Like the sextupole...

  18. Patience, persistence and pragmatism: experiences and lessons learnt from the implementation of clinically integrated teaching and learning of evidence-based health care - a qualitative study.

    Directory of Open Access Journals (Sweden)

    Taryn Young

    Full Text Available Clinically integrated teaching and learning are regarded as the best options for improving evidence-based healthcare (EBHC knowledge, skills and attitudes. To inform implementation of such strategies, we assessed experiences and opinions on lessons learnt of those involved in such programmes.We conducted semi-structured interviews with 24 EBHC programme coordinators from around the world, selected through purposive sampling. Following data transcription, a multidisciplinary group of investigators carried out analysis and data interpretation, using thematic content analysis. Successful implementation of clinically integrated teaching and learning of EBHC takes much time. Student learning needs to start in pre-clinical years with consolidation, application and assessment following in clinical years. Learning is supported through partnerships between various types of staff including the core EBHC team, clinical lecturers and clinicians working in the clinical setting. While full integration of EBHC learning into all clinical rotations is considered necessary, this was not always achieved. Critical success factors were pragmatism and readiness to use opportunities for engagement and including EBHC learning in the curriculum; patience; and a critical mass of the right teachers who have EBHC knowledge and skills and are confident in facilitating learning. Role modelling of EBHC within the clinical setting emerged as an important facilitator. The institutional context exerts an important influence; with faculty buy-in, endorsement by institutional leaders, and an EBHC-friendly culture, together with a supportive community of practice, all acting as key enablers. The most common challenges identified were lack of teaching time within the clinical curriculum, misconceptions about EBHC, resistance of staff, lack of confidence of tutors, lack of time, and negative role modelling.Implementing clinically integrated EBHC curricula requires institutional

  19. Evaluation of interprofessional education: lessons learned through the development and implementation of an interprofessional seminar on team communication for undergraduate health care students in Heidelberg – a project report

    Directory of Open Access Journals (Sweden)

    Berger, Sarah

    2016-04-01

    Full Text Available Introduction: This project report describes the development, “piloting” and evaluation of an interprofessional seminar on team communication bringing together medical students and Interprofessional Health Care B.Sc. students at the Medical Faculty of Heidelberg University, Germany.Project Description: A five-member interprofessional team collaborated together on this project. Kolb’s concept formed the theoretical foundation for the seminar, which explored three interprofessional competency areas: team work, communication and values/ethics. Evaluation for the purposes of quality assurance and future curricula development was conducted using two quantitative measures: Results: The key finding from the standardized course evaluation was that the interprofessional seminars were rated more positively [M=2.11 (1 most positive and 5 most negative, SD=1, n=27] than the monoprofessional seminars [M=2.55, SD=0.98, n=90]. The key finding from the UWE-IP-D survey, comparing pre and post scores of the interprofessional (IP (n=40 and monoprofessional (MP groups (n=34, was that significant positive changes in mean scores for both groups towards communication, teamwork and interprofessional learning occurred. Conclusions: Lessons learnt included: a recognising the benefit of being pragmatic when introducing interprofessional education initiatives, which enabled various logistical and attitudinal barriers to be overcome; b quantitative evaluation of learning outcomes alone could not explain positive responses or potential influences of interprofessional aspects, which highlighted the need for a mixed methods approach, including qualitative methods, to enrich judgment formation on interprofessional educational outcomes.

  20. Ten No”Bottlenecks Should Be Broken for Achieving Universal Health Care%全民医保亟待打破“十不”瓶颈

    Institute of Scientific and Technical Information of China (English)

    田芬

    2014-01-01

    我国基本实现全民医保,但必须清醒地看到,目前的全民医保存在着制度不统一、管理归属不明确、经办不标化,权利义务不对等,社保商保不分,对“病”的界定不清,购买服务界线不清,本地异地就医不分,风险预测不清,供需不平衡,对欺诈骗保打击不力,税费不分等问题,亟待加快治理体系和治理能力现代化。%We have basically achieved the goal of universal health care in China. However, it must be clearly realized that there are still problems such as inconsistence in systems, unclear classification in management departments, non-standardized professional criteria for insurance agencies, non-equivalence in right and duty, non-differentiation in social insurance and commercial insurance, unclear definition of “diseases”, unclear limitation in purchasing service, unclear definition in accessing local or offsite health services, unclear risk prediction, imbalance in demands and supplies, inefficiency in combating insurance fraud, unclear definition in taxes and fees. It is also urgent to accelerate the modernization of administrative system and governance capacity.

  1. Management strategies to effect change in intensive care units: lessons from the world of business. Part I. Targeting quality improvement initiatives.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-02-01

    The business community has developed strategies to ensure the quality of the goods or services they produce and to improve the management of multidisciplinary work teams. With modification, many of these techniques can be imported into intensive care units (ICUs) to improve clinical operations and patient safety. In Part I of a three-part ATS Seminar series, we argue for adopting business management strategies in ICUs and set forth strategies for targeting selected quality improvement initiatives. These tools are relevant to health care today as focus is placed on limiting low-value care and measuring, reporting, and improving quality. In the ICU, the complexity of illness and the need to standardize processes make these tools even more appealing. Herein, we highlight four techniques to help prioritize initiatives. First, the "80/20 rule" mandates focus on the few (20%) interventions likely to drive the majority (80%) of improvement. Second, benchmarking--a process of comparison with peer units or institutions--is essential to identifying areas of strength and weakness. Third, root cause analyses, in which structured retrospective reviews of negative events are performed, can be used to identify and fix systems errors. Finally, failure mode and effects analysis--a process aimed at prospectively identifying potential sources of error--allows for systems fixes to be instituted in advance to prevent negative outcomes. These techniques originated in fields other than health care, yet adoption has and can help ICU managers prioritize issues for quality improvement.

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

    Science.gov (United States)

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

    2015-08-01

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

  3. The changing epidemiology of measles in an era of elimination: lessons from health-care-setting transmissions of measles during an outbreak in New South Wales, Australia, 2012

    Directory of Open Access Journals (Sweden)

    Alexis Pillsbury

    2016-10-01

    Full Text Available Introduction: In countries where measles is rare, health-care-setting transmissions remain problematic. Australia experienced its largest measles outbreak in 15 years in 2012 with 199 cases reported nationally; 170 cases occurred in the state of New South Wales (NSW with symptom onset between 7 April and 29 November 2012. Methods: A descriptive study was conducted using measles case data obtained from metropolitan Sydney local health districts in NSW in 2012. Characteristics of measles source and secondary cases were described. Details of health-care presentations resulting and not resulting in measles transmission were also analysed. Results: There were 168 confirmed and two probable cases resulting in 405 documented health-care presentations. Thirty-four secondary cases acquired in health-care settings were identified, including 29 cases resulting from 14 source cases and 5 cases whose source could not be identified. Health-care-acquired cases accounted for 20% of all cases in this outbreak. Source cases were more likely to be of Pacific Islander descent (p = 0.009 and to have had more presentations before diagnosis (p = 0.012 compared to other cases. The percentage of presentations to emergency departments was higher for presentations that resulted in transmission compared to those that did not (71.4% and 37.6%, respectively, p = 0.028. There were no significant differences between transmission and non-transmission presentations with respect to presence of rash and infection control measures (p = 0.762 and p = 0.221, respectively, although the power to detect these differences was limited. Rash was reported at 66% of the presentations. Conclusion: Development of and adherence to protocols for the management of patients presenting to hospitals with fever and rash will minimize secondary transmission of measles.

  4. Social media: opportunities for quality improvement and lessons for providers-a networked model for patient-centered care through digital engagement.

    Science.gov (United States)

    Bornkessel, Alexandra; Furberg, Robert; Lefebvre, R Craig

    2014-07-01

    Social media brings a new dimension to health care for patients, providers, and their support networks. Increasing evidence demonstrates that patients who are more actively involved in their healthcare experience have better health outcomes and incur lower costs. In the field of cardiology, social media are proposed as innovative tools for the education and update of clinicians, physicians, nurses, and medical students. This article reviews the use of social media by healthcare providers and patients and proposes a model of "networked care" that integrates the use of digital social networks and platforms by both patients and providers and offers recommendations for providers to optimize their use and understanding of social media for quality improvement.

  5. Assessing the Quality and Value of Psychological Health Care in Civilian Health Plans: Lessons and Implications for the Military Health System

    Science.gov (United States)

    2015-01-01

    October 2009, p. 18. Derogatis, L. R., Administration, Scoring, and Procedures Manual 1, Baltimore, Md.: Clinical Psychometric Research, SCL-90-R...Evaluating the Quality of Medical Care,” Milbank Quarterly, Vol. 83, No. 4, December 2005, pp. 691–729. Duffy, F. F., H. Chung, M. Trivedi, D. S. Rae , D...Military Treatment Facility Mental Health Clinical Outcomes Guidance Memorandum, 2013. Ware, J. E., SF 36 Health Survey: Manual and Interpretation Guide

  6. Ben Franklin. [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    Based on Benjamin Franklin's "Poor Richard's Almanac," this lesson plan presents activities designed to help students understand that Ben Franklin is known, among other things, for his wit and wisdom; that Franklin published an almanac for 25 years; and he scattered aphorisms throughout the almanac. The main activity in the lesson is for students…

  7. "Walden". [Lesson Plan].

    Science.gov (United States)

    Surber, Gretchen C.

    Based on Henry David Thoreau's book "Walden," this lesson plan presents activities designed to help students understand that acquisitiveness and simplicity can be opposing life philosophies; and that both philosophies have had notable adherents. The main activity of the lesson involves students researching historical characters (including Thoreau)…

  8. "Frankenstein." [Lesson Plan].

    Science.gov (United States)

    Simon, Melanie

    Based on Mary Shelley's novel "Frankenstein," this lesson plan presents activities designed to help students understand that active readers interpret a novel (its characters, plot, setting, and theme) in different ways; and the great literature can be and has been adapted in many ways over time. The main activity of the lesson involves students…

  9. Soybean Production Lesson Plan.

    Science.gov (United States)

    Carlson, Keith R.

    These lesson plans for teaching soybean production in a secondary or postsecondary vocational agriculture class are organized in nine units and cover the following topics: raising soybeans, optimum tillage, fertilizer and lime, seed selection, pest management, planting, troubleshooting, double cropping, and harvesting. Each lesson plan contains…

  10. Great Expectations. [Lesson Plan].

    Science.gov (United States)

    Devine, Kelley

    Based on Charles Dickens' novel "Great Expectations," this lesson plan presents activities designed to help students understand the differences between totalitarianism and democracy; and a that a writer of a story considers theme, plot, characters, setting, and point of view. The main activity of the lesson involves students working in groups to…

  11. Don Quixote. [Lesson Plan].

    Science.gov (United States)

    Rooks, Kristen

    Based on Miguel de Cervantes' novel "Don Quixote," this lesson plan presents activities designed to help students understand that Quixote's misperceptions are understandable; writers often describe one object to sound as if it were something else; and metaphors help readers see with new eyes. The main activity of the lesson involves students…

  12. Gulliver's Travels. [Lesson Plan].

    Science.gov (United States)

    Rooks, Kirsten; McLean, Mary

    Based on Jonathan Swift's novel "Gulliver's Travels," this lesson plan presents activities designed to help students understand that Swift comments on undesirable outcomes of advances in science; and other authors have also warned against abuse of science. The main activity of the lesson involves students developing a poster illustrating views of…

  13. Automatic Dance Lesson Generation

    Science.gov (United States)

    Yang, Yang; Leung, H.; Yue, Lihua; Deng, LiQun

    2012-01-01

    In this paper, an automatic lesson generation system is presented which is suitable in a learning-by-mimicking scenario where the learning objects can be represented as multiattribute time series data. The dance is used as an example in this paper to illustrate the idea. Given a dance motion sequence as the input, the proposed lesson generation…

  14. Mini Lessons from FDA.

    Science.gov (United States)

    Food and Drug Administration (DHEW), Washington, DC.

    Eight self-contained lessons present information about topics of current interest in the Food and Drug Administration. Multidisciplinary in nature, the lessons can be integrated into ongoing activities in elementary or secondary level reading, math, language arts, social studies, science, art, health, consumer education, and home economics. The…

  15. A Lesson in Tolerance

    Science.gov (United States)

    Johnt, Marlene

    2004-01-01

    This article describes one classroom's experience integrating a three-part lesson that focused on tolerance. In the lesson, students examined works by American folk-art painter Edward Hicks, researched quotes about tolerance in society, and applied calligraphy skills to an original composition.

  16. Fish Facts. Lesson Plan.

    Science.gov (United States)

    Chan, Mike

    This lesson plan is designed for a 50-minute class to teach extension home economists and homemakers about buying, storing, and using fish. The lesson plan contains references, a list of equipment needed, objectives, and the presentation. The presentation consists of an outline of instruction coordinated with methods of instruction and aids and…

  17. Lessons learnt from a cluster-randomised trial evaluating the effectiveness of Self-Management Support (SMS) delivered by practice nurses in routine diabetes care.

    Science.gov (United States)

    van Dijk-de Vries, Anneke; van Bokhoven, Marloes A; Winkens, Bjorn; Terluin, Berend; Knottnerus, J André; van der Weijden, Trudy; van Eijk, Jacques Th M

    2015-06-25

    To evaluate the effectiveness of biopsychosocial Self-Management Support (SMS) delivered by practice nurses in routine diabetes care. A pragmatic cluster-randomised controlled trial within a hybrid effectiveness-implementation study design. Practice nurses were cluster-randomised. A regional care group in the Netherlands consisting of 77 family practices. The study involved practice nurses (n=40) providing care to approximately 4000 patients with diabetes. Patients with type 2 diabetes (n=264) selected by a self-administered questionnaire aimed at measuring emotional distress and diabetes-related reduced daily functioning. Practice nurses in the intervention arm (n=19) were trained to integrate SMS into their routine consultations. SMS included detection of patients with emotional distress and reduced daily functioning, and supporting them when needed through problem solving and reattribution techniques. Practice nurses in the control arm (n=21) provided usual care. The primary outcome measure was a dichotomised score on a Visual Analogue Scale that measured the perceived effect of diabetes on daily functioning. Secondary measures included patients' diabetes-related distress, quality of life, autonomy and participation, self-efficacy, self-management and glycaemic control. Outcomes were measured at baseline and at 4-month and 12-month follow-ups. Only 16 of the 117 patients in the intervention arm (14%) who were found eligible by the posted research-driven screening questionnaire were detected by their practice nurses. Extra consultations for the self-management support were delivered to only 11 study participants. In the control arm, 147 patients received usual care. Multilevel analyses showed no significant differences in outcomes between the intervention and control arms. SMS in its present form was not effective. The research-driven screening to select trial participants appeared to be inconsistent with nurse-led detection in routine practice. Adequate follow

  18. An audit of obstetric admissions to intensive care unit in a medical college hospital of central India: lessons in preventing maternal morbidity and mortality

    Directory of Open Access Journals (Sweden)

    Manisha Jain

    2015-02-01

    Full Text Available Background: The spectrum of causes leading to maternal morbidity and mortality may be well reflected in the clinical profile of obstetric patients admitted to the Intensive Care Unit (ICU. An audit of these patients may help in devising intervention strategies and implementing preventive measures. This is expected to contribute to the ongoing concerted multipronged efforts towards reducing maternal mortality as a step towards the millennium development goals. The aim was to study the clinical and demographic profile of antenatal and postpartum women requiring admission to the ICU, the interventions required in these women and the final outcome. The overall goal is to identify the contributing factors towards maternal morbidity and mortality. Methods: A retrospective analysis of hospital records of all antenatal, post-abortal and postpartum women admitted to the ICU at People's hospital, Bhopal over a period of 3 years (June 2011 to May 2014. Results: A total of 157 records were identified and analyzed: 22 (14% antenatal, seven (4% post-abortion, 114 (73% postpartum, and 14(9% post-laparotomy women. The mean age was 25 years (Range 18-38 years; SD 4.49, two thirds being from rural areas. Majority (78% had no earlier visit. The gestational age at admission to ICU ranged from 6-43 weeks (Mean 31 weeks; SD 9.06. One third (24% of patients had severe anemia, 18 patients needed ventilation, 25 required inotropic support, 4 required dialysis and 17 underwent surgical intervention. Blood or blood component therapy was needed in 60% cases with total blood units transfused being 225. The average duration of stay in intensive care unit was 79 hours. Analyzing as organ-system dysfunctions: Cardiovascular dysfunction (22%, hematological (20%, hepatic (16%, neurological (11%, septicemia (11%, renal (9%. There were 19 maternal deaths. Conclusions: Maternal anemia and consequences still contribute significantly to maternal morbidity. Non-utilization of

  19. How Does a Lesson Plan?

    Science.gov (United States)

    New York City Board of Education, Brooklyn, NY. Div. of Curriculum and Instruction.

    This manual for secondary school teachers offers sample lesson plans that may be used to guide and stimulate experimentation and development of creative instructional units. Lesson plan components are defined, and various types of lessons and their significant characteristics are identified. These characteristic types of lessons are illustrated,…

  20. The political culture of healthcare: why substantial dental care in Canada is covered by government insurance only in Québec - lessons for the United States?

    Science.gov (United States)

    Flaer, P J; Younis, M Z; Benjamin, P L; Al-Hajeri, M

    2011-06-10

    This opinion paper explains the unique and favourable terms of dental health insurance coverage available to residents (both permanent and temporary) of the Province of Québec, Canada. In comparison, the United States and British Canada are the poor stepchildren of government-mediated provision of dental health coverage. The differences in dental healthcare provision between these regions are a question of culture - more specifically, of differing socio-political cultures and different perspectives on the importance of dental care. Lawmakers in the United States can learn from this policy of government-administered dental insurance that appears to work well in Québec.

  1. The arduous quest for translating health care productivity gains into cost savings. Lessons from their evolution at economic scoring agencies in the Netherlands and the US.

    Science.gov (United States)

    Klink, Ab; Schakel, H Christiaan; Visser, Sander; Jeurissen, Patrick

    2017-01-01

    We analyze the assessments of recent health reforms by the Congressional Budget Office (CBO) in the United States and the Bureau for Economic Policy Analysis (CPB) in the Netherlands. Both reforms aim to capitalize on productivity gains, which is appealing for policymakers because of the potential for cost savings while maintaining - or enhancing - quality and access. These measures however generally translate into more health care, rather than care that is affordable and appropriate. Scoring agencies therefore have rightfully been reluctant to assign significant savings to these measures. Thus with regard to cost savings, both agencies instead have favored more traditional policy measures in the past. They are however increasingly mapping out loose ends and dilemmas for payers, including information asymmetries, reputation issues and provider business models that contradict the goals of policymakers. This calls for further exploring this avenue and the development of more integrated agendas that might commit actors and the spread of best practices. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  2. 对我国城市居家养老服务发展的探讨--基于十城市万名老年人的调研%Exploration on the Development of Home-based Care Service for the Elderly in Urban Area of China-- Base on the Survey of 10000 Elderly People in Ten Cities

    Institute of Scientific and Technical Information of China (English)

    杨晓奇

    2014-01-01

    Social Pension Service System Construction Plan (2011-2015) puts forward that home-based care service is the basic of social pension service system. This paper uses the survey data of home-based care service for 10 thousand old people in ten cities, and analyzes the current situation of the development of home-based care service in the urban area of China. The home-based care service develops unequally, lacks of public investment and it is limited in coverage area. Overall, it develops slowly, and three inlfuence factors lead to this result. First and the most important factor is the elderly has low income. Second is the hysteretic consumption concept. And the third is that preferential policy for the elderly care service is few and the implement is not in place. The government should improve the old-age security system, introduce preferential policies, insure the implementation of the policy and promote the rapid development of the home-based care service industry.%《社会养老服务体系建设规划(2011-2015年)》提出居家养老是社会养老服务体系的基础。利用2013年“十城市万名老年人居家养老状况调查”数据,分析城市居家养老服务发展的现状。我国居家养老服务发展不平衡,社会投资力量缺乏,服务覆盖范围有限,整体来看,居家养老服务发展缓慢。究其原因,老年人收入水平低是最主要因素,此外,老年人消费观念滞后,养老优惠政策少、落实不到位也是重要原因。对此,应该完善养老保障制度,出台优惠政策,强化政策落实,促进居家养老服务业快速发展。

  3. Applying spatio-temporal models to assess variations across health care areas and regions: Lessons from the decentralized Spanish National Health System

    Science.gov (United States)

    Librero, Julián; Martínez-Lizaga, Natalia; Peiró, Salvador; Bernal-Delgado, Enrique

    2017-01-01

    Objective To illustrate the ability of hierarchical Bayesian spatio-temporal models in capturing different geo-temporal structures in order to explain hospital risk variations using three different conditions: Percutaneous Coronary Intervention (PCI), Colectomy in Colorectal Cancer (CCC) and Chronic Obstructive Pulmonary Disease (COPD). Research design This is an observational population-based spatio-temporal study, from 2002 to 2013, with a two-level geographical structure, Autonomous Communities (AC) and Health Care Areas (HA). Setting The Spanish National Health System, a quasi-federal structure with 17 regional governments (AC) with full responsibility in planning and financing, and 203 HA providing hospital and primary care to a defined population. Methods A poisson-log normal mixed model in the Bayesian framework was fitted using the INLA efficient estimation procedure. Measures The spatio-temporal hospitalization relative risks, the evolution of their variation, and the relative contribution (fraction of variation) of each of the model components (AC, HA, year and interaction AC-year). Results Following PCI-CCC-CODP order, the three conditions show differences in the initial hospitalization rates (from 4 to 21 per 10,000 person-years) and in their trends (upward, inverted V shape, downward). Most of the risk variation is captured by phenomena occurring at the HA level (fraction variance: 51.6, 54.7 and 56.9%). At AC level, the risk of PCI hospitalization follow a heterogeneous ascending dynamic (interaction AC-year: 17.7%), whereas in COPD the AC role is more homogenous and important (37%). Conclusions In a system where the decisions loci are differentiated, the spatio-temporal modeling allows to assess the dynamic relative role of different levels of decision and their influence on health outcomes. PMID:28166233

  4. Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

    Science.gov (United States)

    Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

    2014-03-01

    The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis.

  5. Who benefits from CBT for insomnia in primary care? Important patient selection and trial design lessons from longitudinal results of the Lifestyles trial.

    Science.gov (United States)

    McCurry, Susan M; Shortreed, Susan M; Von Korff, Michael; Balderson, Benjamin H; Baker, Laura D; Rybarczyk, Bruce D; Vitiello, Michael V

    2014-02-01

    Evaluate long-term effects of group interventions on sleep and pain outcomes in a primary care population of older adults with osteoarthritis pain and sleep disturbance. Double-blind, cluster-randomized controlled trial with 18-mo follow-up. Group Health and University of Washington, Seattle, WA, from 2009 to 2011. Three hundred sixty-seven adults age 60 y and older, with osteoarthritis pain and insomnia symptoms. Six weekly sessions of group cognitive behavioral therapy for insomnia and pain (CBT-PI), pain alone (CBT-P), and education-only control (EOC) delivered in patients' primary care clinics. There were no significant differences between treatment groups in sleep outcomes at 18 mo. This is a change from published significant 9-mo follow-up results for insomnia severity (Insomnia Severity Index) and sleep efficiency. There were no significant treatment differences in pain at either follow-up. Post hoc analyses of participants with greater insomnia and pain severity at baseline (n = 98) showed significant (P = 0.01) 18-mo reductions in pain comparing CBT-PI versus CBT-P (adjusted mean difference [AMD] = -1.29 [95% confidence interval (CI): -2.24,-0.33]). Moderate, albeit nonsignificant, CBT-PI versus EOC treatment effects for insomnia severity (AMD = -1.43 [95% CI: -4.71, 1.86]) and sleep efficiency (AMD = 2.50 [95% CI: -5.04, 10.05]) were also observed. Possible trial design and methodological considerations that may have affected results are discussed. Results suggest patients with higher levels of comorbid pain and insomnia may be most likely to experience sustained benefit from cognitive behavioral therapy interventions over time, and inclusion of insomnia treatment may yield more clinically meaningful improvements than cognitive behavioral therapy for pain alone. clinicaltrials.gov identifier: NCT01142349.

  6. Toxic epidermal necrolysis (TEN) in elderly patients.

    Science.gov (United States)

    Honari, S; Gibran, N S; Heimbach, D M; Gibbons, J; Pharmd; Cain, V; Engrav, L H

    2001-01-01

    Toxic epidermal necrolysis (TEN) is a severe exfoliative disease of the skin and mucous membranes that results in high mortality. As the elderly population increases, the number of elderly patients with TEN can also be expected to increase. Elderly patients with comparably sized burn wounds usually have a poor prognosis. Our purpose was to determine whether elderly TEN patients exhibit similarly high mortality. A retrospective review was conducted of 52 patients treated for TEN from October 1991 through September 1998. Eleven patients were older than 65 years. All patients were treated according to our TEN protocol. Eight of 11 patients recovered, and 3 died. The mean total body surface area (TBSA) involvement for the patients who recovered was 24%, compared with 66% for the nonsurvivors. The survival rate for elderly patients (73%) compares well with that for those younger than 65 years (89%). Therefore, we propose that we should be aggressive in treating elderly patients with TEN.

  7. Complications of peripherally inserted central venous catheters in neonates: Lesson learned over 2 years in a tertiary care centre in India

    Directory of Open Access Journals (Sweden)

    Amit Singh

    2014-01-01

    Full Text Available Background: The objective of this study was to assess the complications of peripherally inserted central venous catheters (PICC in neonates admitted to neonatal surgical intensive care unit (NSICU. Patients and Methods: Retrospective analysis of 237 neonates admitted to NSICU from January 2010 to December 2011 was done. Results: Mean age at presentation was 5.8 days and mean weight was 1.94 kg. Mean number of attempts was 1.14, mean duration of insertion 8.4 min and mean duration of patency of catheter 3.14 days. Most common site of catheter insertion was upper extremity (basilic followed by cephalic. Overall complications were seen in 47 (23% cases. Infectious complications were seen in 22 (10.7% and non-infectious in 25 (12.2% cases. Significant correlation existed between non-infective complications and insertion site (P = 0.03 and duration of PICC (P = 0.04. Conclusion: Precautions should be taken and position must be confirmed during and after PICC insertion to avoid undue complications.

  8. Availability and provision of emergency obstetric care under a public-private partnership in three districts of Gujarat, India: lessons for Universal Health Coverage.

    Science.gov (United States)

    Iyer, V; Sidney, K; Mehta, R; Mavalankar, D

    2016-01-01

    The state of Gujarat in India (population 60 million) has implemented a public-private partnership (PPP) with private obstetricians called the Chiranjeevi Yojana (CY) since 2006. This study investigated the adequacy of basic and comprehensive emergency obstetric care (BEmOC and CEmOC) services through the public and private sectors with reference to the United Nations (UN) guidelines. A cross-sectional facility survey was conducted in three districts. A total of 300 facilities, 151 public and 149 private, had provided obstetric services to a total of 53 896 births in the past 6 months. Nearly half, 135 facilities (104 public and 31 private), individually reported EmOC facilities. All the three districts exceeded the UN recommendation for EmOC availability by 3.3 to 11.3 times. Free provision, through both public and PPP facilities, ranged from 1.42 to 3.43. The actual performance was nearly double the recommendation for CEmOC but inadequate for BEmOC. Public sector EmOC availability and provision is negligible. Private sector availability is well beyond the recommended UN norms. The CY programme has resulted in increased availability and provision of EmOC services. However, the overall provision of EmOC is compromised due to the poor performance of BEmOC functions and clustering of private facilities in towns.

  9. Availability and provision of emergency obstetric care under a public–private partnership in three districts of Gujarat, India: lessons for Universal Health Coverage

    Science.gov (United States)

    Sidney, K; Mehta, R; Mavalankar, D

    2016-01-01

    Objective The state of Gujarat in India (population 60 million) has implemented a public–private partnership (PPP) with private obstetricians called the Chiranjeevi Yojana (CY) since 2006. This study investigated the adequacy of basic and comprehensive emergency obstetric care (BEmOC and CEmOC) services through the public and private sectors with reference to the United Nations (UN) guidelines. Design A cross-sectional facility survey was conducted in three districts. Results A total of 300 facilities, 151 public and 149 private, had provided obstetric services to a total of 53 896 births in the past 6 months. Nearly half, 135 facilities (104 public and 31 private), individually reported EmOC facilities. All the three districts exceeded the UN recommendation for EmOC availability by 3.3 to 11.3 times. Free provision, through both public and PPP facilities, ranged from 1.42 to 3.43. The actual performance was nearly double the recommendation for CEmOC but inadequate for BEmOC. Conclusions Public sector EmOC availability and provision is negligible. Private sector availability is well beyond the recommended UN norms. The CY programme has resulted in increased availability and provision of EmOC services. However, the overall provision of EmOC is compromised due to the poor performance of BEmOC functions and clustering of private facilities in towns. PMID:28588914

  10. Translating access into utilization: lessons from the design and evaluation of a health insurance Web site to promote reproductive health care for young women in Massachusetts.

    Science.gov (United States)

    Janiak, Elizabeth; Rhodes, Elizabeth; Foster, Angel M

    2013-12-01

    Following state-level health care reform in Massachusetts, young women reported confusion over coverage of contraception and other sexual and reproductive health services under newly available health insurance products. To address this gap, a plain-language Web site titled "My Little Black Book for Sexual Health" was developed by a statewide network of reproductive health stakeholders. The purpose of this evaluation was to assess the health literacy demands and usability of the site among its target audience, women ages 18-26 years. We performed an evaluation of the literacy demands of the Web site's written content and tested the Web site's usability in a health communications laboratory. Participants found the Web site visually appealing and its overall design concept accessible. However, the Web site's literacy demands were high, and all participants encountered problems navigating through the Web site. Following this evaluation, the Web site was modified to be more usable and more comprehensible to women of all health literacy levels. To avail themselves of sexual and reproductive health services newly available under expanded health insurance coverage, young women require customized educational resources that are rigorously evaluated to ensure accessibility. To maximize utilization of reproductive health services under expanded health insurance coverage, US women require customized educational resources commensurate with their literacy skills. The application of established research methods from the field of health communications will enable advocates to evaluate and adapt these resources to best serve their targeted audiences. © 2013.

  11. Lecciones aprendidas en la provisión de medicamentos para la atención primaria de la salud Lessons learned from drug supplies for primary health care

    Directory of Open Access Journals (Sweden)

    Federico Tobar

    2008-01-01

    Full Text Available En las reformas de salud que se llevaron a cabo en América Latina, la provisión de medicamentos no adquirió protagonismo. Cuando fue incluida, se dio prioridad a los medicamentos para internación, así como para enfermedades de baja prevalencia y alto costo. Sin embargo, en los últimos años un conjunto de programas han realizado innovaciones en la gestión de suministros para el primer nivel de atención. Aquí se abordan estas experiencias en América Latina, primero analizándolas a través de cuatro momentos del ciclo de gestión de medicamentos: selección, compra, distribución y utilización. Después, se busca identificar las lecciones aprendidas y las condiciones de un buen sistema de provisión. Las conclusiones destacan experiencias que lograron no sólo disponibilidad a costos bajos, sino también aumentos en la productividad y resolutividad del primer nivel, además de mejoras en la prescripción y el fortalecimiento del funcionamiento en red.Drug supply strategies have not been widely included in Latin American health reform programs. National efforts, when they have included such strategies, have focused on supporting drug availability for inpatient treatment and, in some cases, for ambulatory treatment of low prevalence and high-cost diseases. Nevertheless, some innovative drug supply programs for primary health care have been implemented in many countries. This article reviews and systematizes recent experiences with the supply of drugs in Latin American countries. Firstly, this article analyzes four phases of the cycle for managing drugs: selection, procurement, distribution, and use, and; secondly, it identifies lessons learned and some characteristics of efficient drug supply systems. Conclusions emphasize experiences which have not only achieved supply at low costs, but also have increased the productivity, efficiency, and effectiveness of primary health care, improved prescriptions, and strengthened the network.

  12. Lessons of Educational Technology

    Directory of Open Access Journals (Sweden)

    Manuela Repetto

    2006-01-01

    Full Text Available Reception of the book "Lessons of Educational Technology." The book contains materials work in certain aspects relevant to the formation of a teacher who is able to meet the challenges of society 'knowledge.

  13. Deburring: technical capabilities and cost-effective approaches, Lessons 3 and 4

    Energy Technology Data Exchange (ETDEWEB)

    Gillespie, L.K.

    1980-06-01

    This ten lesson text on deburring is designed to provide engineers and production supervisors with an overall understanding of deburring economics and current capabilities. The material included describes economics, side effects, process selection techniques, product design influences, standards, plantwide approaches, burr formation, and prevention. Deburring methods described include barrel, centrifugal barrel, vibratory, spindle, manual, electrochemical, electropolish, brush, abrasive jet, abrasive flow, water jet, thermal energy, and mechanized mechanical. Lessons 3 and 4 describe product design influences and burr prevention and minimization respectively.

  14. Lessons Learned for Decommissioning Planning

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Wook; Kim, Young-gook; Kim, Hee-keun [Korea Hydro and Nuclear Power Co. LTD, Daejeon (Korea, Republic of)

    2015-10-15

    The purpose of this paper is to introduce the U.S. nuclear industrial's some key lessons learned especially for decommissioning planning based on which well informed decommissioning planning can be carried out. For a successful decommissioning, it is crucial to carry out a well-organized decommissioning planning before the decommissioning starts. This paper discussed four key factors which should be decided or considered carefully during the decommissioning planning period with introduction of related decommissioning lessons learned of U.S. nuclear industry. Those factors which have been discussed in this paper include the end state of a site, the overall decommissioning strategy, the management of the spent fuels, and the spent fuel pool island. Among them, the end state of a site should be decided first as it directs the whole decommissioning processes. Then, decisions on the overall decommissioning strategy (DECON vs. SAFSTOR) and the management of the spent fuels (wet vs. dry) should follow. Finally, the spent fuel pool island should be given due consideration because its implementation will result in much cost saving. Hopefully, the results of this paper would provide useful inputs to performing the decommissioning planing for the Kori unit 1.

  15. Clinical experience with TENS and TENS combined with nitrous oxide-oxygen. Report of 371 patients.

    OpenAIRE

    Quarnstrom, F. C.; Milgrom, P.

    1989-01-01

    Transcutaneous electrical nerve stimulation (TENS) alone or TENS combined with nitrous oxide-oxygen (N2O) was administered for restorative dentistry without local anesthesia to 371 adult patients. A total of 55% of TENS alone and 84% of TENS/N2O visits were rated successful. A total of 53% of TENS alone and 82% of TENS/N2O patients reported slight or no pain. In multivariable analyses, pain reports were related to the anesthesia technique and patient fear and unrelated to sex, race, age, toot...

  16. Ten Steps to Making Evaluation Matter

    Science.gov (United States)

    Sridharan, Sanjeev; Nakaima, April

    2011-01-01

    This paper proposes ten steps to make evaluations matter. The ten steps are a combination of the usual recommended practice such as developing program theory and implementing rigorous evaluation designs with a stronger focus on more unconventional steps including developing learning frameworks, exploring pathways of evaluation influence, and…

  17. Top-Ten IT Issues, 2010

    Science.gov (United States)

    Ingerman, Bret L.; Yang, Catherine

    2010-01-01

    The eleventh annual EDUCAUSE Current Issues Survey shows some very familiar themes among the top-ten IT issues of strategic importance to technology leaders in higher education. Indeed, all ten of the issues from the 2009 survey are back, albeit in a slightly different order. In addition, Strategic Planning returns as an issue of renewed…

  18. Top-Ten IT Issues, 2010

    Science.gov (United States)

    Ingerman, Bret L.; Yang, Catherine

    2010-01-01

    The eleventh annual EDUCAUSE Current Issues Survey shows some very familiar themes among the top-ten IT issues of strategic importance to technology leaders in higher education. Indeed, all ten of the issues from the 2009 survey are back, albeit in a slightly different order. In addition, Strategic Planning returns as an issue of renewed…

  19. Should we educate care staff to improve the oral health and oral hygiene of people with intellectual disability in residential care? Real world lessons from a randomized controlled trial.

    Science.gov (United States)

    Mac Giolla Phadraig, Caoimhin; Guerin, Suzanne; Nunn, June

    2015-01-01

    This study assessed the impact of a multitiered oral health educational program on the oral health and oral hygiene of people with intellectual disabilities (ID). In a controlled pretest, posttest trial, with cluster randomization, a pyramidal training program was delivered to residential staff who cared for a randomly allocated, purposively stratified intervention group of people with ID living in community care homes. A control group lived in centers where staff received no training. Clinical measures were carried out pre- and posttest. Difference in Modified Gingival Index (MGI) and Plaque Index (PI) was measured posttest using ANCOVA. Seventy-six participants took part, representing 49.0% of the invited sample (n = 155). Fourteen did not receive clinical examination. There was one dropout 6-9 months later. A 10.5% and 8.5% reduction in mean MGI and PI was evident at posttest but did not show statistically significant difference, when controlling for baseline covariates (p > 0.05, ANCOVA). Mean MGI and PI scores were not significantly different among people with ID whose care staff had and had not received oral health training. Limitations are discussed. The results indicate that this program failed to significantly improve oral health or oral hygiene, despite the intervention being "educationally" successful. More research is needed.

  20. Adapting a tertiary-care pediatric weight management clinic to better reach Spanish-speaking families.

    Science.gov (United States)

    Guzman, Angelica; Irby, Megan B; Pulgar, Camila; Skelton, Joseph A

    2012-06-01

    Pediatric obesity continues to be an epidemic, affecting Hispanic children disproportionately. Recent recommendations outline a step-wise approach to the treatment of overweight and obese children, culminating in tertiary-care, multidisciplinary programs. We detail here how our tertiary-care, family-based, pediatric weight management clinic addressed the problem of few Spanish-speaking families enrolling in treatment after referral by adding a Bilingual Case Manager. Utilizing a family-centered, high-contact, personal approach, our program increased the number of Hispanic families enrolling over ten-fold. Further, outcomes in Hispanic families were equal to or better than other racial/ethnic groups. Lessons learned from this experience may benefit other obesity treatment programs trying to improve care of Spanish-speaking families.

  1. Breathing Life into Engineering: A Lesson Study Life Science Lesson

    Science.gov (United States)

    Lawrence, Maria; Yang, Li-Ling; Briggs, May; Hession, Alicia; Koussa, Anita; Wagoner, Lisa

    2016-01-01

    A fifth grade life science lesson was implemented through a lesson study approach in two fifth grade classrooms. The research lesson was designed by a team of four elementary school teachers with the goal of emphasizing engineering practices consistent with the "Next Generation Science Standards" (NGSS) (Achieve Inc. 2013). The fifth…

  2. Breathing Life into Engineering: A Lesson Study Life Science Lesson

    Science.gov (United States)

    Lawrence, Maria; Yang, Li-Ling; Briggs, May; Hession, Alicia; Koussa, Anita; Wagoner, Lisa

    2016-01-01

    A fifth grade life science lesson was implemented through a lesson study approach in two fifth grade classrooms. The research lesson was designed by a team of four elementary school teachers with the goal of emphasizing engineering practices consistent with the "Next Generation Science Standards" (NGSS) (Achieve Inc. 2013). The fifth…

  3. Creating A Guided- discovery Lesson

    Institute of Scientific and Technical Information of China (English)

    田枫

    2005-01-01

    In a guided - discovery lesson, students sequentially uncover layers of mathematical information one step at a time and learn new mathematics. We have identified eight critical steps necessary in developing a successful guided- discovery lesson.

  4. ALGORITHMS FOR TETRAHEDRAL NETWORK (TEN) GENERATION

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    The Tetrahedral Network(TEN) is a powerful 3-D vector structure in GIS, which has a lot of advantages such as simple structure, fast topological relation processing and rapid visualization. The difficulty of TEN application is automatic creating data structure. Al though a raster algorithm has been introduced by some authors, the problems in accuracy, memory requirement, speed and integrity are still existent. In this paper, the raster algorithm is completed and a vector algorithm is presented after a 3-D data model and structure of TEN have been introducted. Finally, experiment, conclusion and future work are discussed.

  5. A Report of At-Scale Distribution of Chlorhexidine Digluconate 7.1% Gel for Newborn Cord Care to 36,404 Newborns in Sokoto State, Nigeria: Initial Lessons Learned.

    Directory of Open Access Journals (Sweden)

    Nosakhare Orobaton

    Full Text Available With an annual estimated 276,000 neonatal deaths, Nigeria has the second highest of any country in the world. Global progress in accelerating neonatal deaths is hinged to scaled-up interventions in Nigeria. We used routine data of chlorhexidine digluconate 7.1% gel utilized by 36,404 newborns delivered by 36,370 mothers, to study lessons associated with at-scale distribution in Sokoto State, North West Nigeria.Under state government leadership, a community-based distribution system overseen by 244 ward development committees and over 3,440 community-based health volunteers and community drug keepers, was activated to deliver two locally stored medicines to women when labor commenced. Newborns and their mothers were tracked through 28 days and 42 days respectively, including verbal autopsy results. 36,404 or 26.3% of expected newborns received the gel from April 2013 to December 2013 throughout all 244 wards in the State. 99.97% of newborns survived past 28 days. There were 124 pre-verified neonatal deaths reported. Upon verification using verbal autopsy procedures, 76 deaths were stillborn and 48 were previously live births. Among the previous 48 live births, the main causes of death were sepsis (40%, asphyxia (29% and prematurity (8%. Underuse of logistics management information by government in procurement decisions and not accounting for differences in LGA population sizes during commodity distribution, severely limited program scalability.Enhancements in the predictable availability and supply of chlorhexidine digluconate 7.1% gel to communities through better, evidence-based logistics management by the state public sector will most likely dramatically increase program scalability. Infections as a cause of mortality in babies delivered in home settings may be much higher than previously conceived. In tandem with high prevalence of stillborn deaths, delivery, interventions designed to increase mothers' timely and regular use of quality

  6. Lesson Planning the Kodaly Way.

    Science.gov (United States)

    Boshkoff, Ruth

    1991-01-01

    Discusses the contribution of Zoltan Kodaly to music lesson planning. Emphasizes preparation, presentation, and practice as the three important strategies in teaching concepts and skills to be included in a lesson plan. Includes a sample lesson plan covering a semester and advice on choosing song material. (DK)

  7. Ten Leading Causes of Death and Injury

    Science.gov (United States)

    ... Drug Overdose Traumatic Brain Injury Violence Prevention Ten Leading Causes of Death and Injury Recommend on Facebook ... Treated in Hospital Emergency Departments, United States – 2014 Leading Causes of Death Charts Causes of Death by ...

  8. War Literature. [Lesson Plan].

    Science.gov (United States)

    Soderquist, Alisa

    Based on Stephen Crane's poems about war and his novel "The Red Badge of Courage," this lesson plan presents activities designed to help students understand that Crane examined war-related themes in prose and poetry; that close study of a poem for oral presentation helps readers see meaning or techniques not noted earlier; and that not all readers…

  9. A Makeup Lesson.

    Science.gov (United States)

    Eagles, Cheryl

    1991-01-01

    Presents a hands-on lesson that can integrate the use of makeup with studies of the history of Halloween; the history and practices of the theater; Native American or African tribes and their use of paint, makeup, and masks; and the history, skills, and makeup of clowns. (MDH)

  10. A Lesson from Mangroves.

    Science.gov (United States)

    Davis, Stephen

    1987-01-01

    Discusses the importance of interpretive programs in the Northern Territory of Australia. Describes the typical interpretive approach of local school science curricula, which serve 20,000 Aboriginal children. Addresses the curriculum framework, learning strategies, and process skill development, illustrating them through a lesson on mangroves. (TW)

  11. From a writing lesson

    Directory of Open Access Journals (Sweden)

    Bruno Mafra Ney Reinhardt

    Full Text Available Beginning with Jacques Derrida's interpolation of the celebrated chapter A Writing Lesson by Claude Lévi-Strauss's, and James Clifford critique of the ethnographic text, the authors of this essay reflect on the written dimension of the ethnographic métier.

  12. Cooperative Science Lesson Plans.

    Science.gov (United States)

    Cooperative Learning, 1991

    1991-01-01

    Offers several elementary level cooperative science lesson plans. The article includes a recipe for cooperative class learning, instructions for making a compost pile, directions for finding evidence of energy, experiments in math and science using oranges to test density, and discussions of buoyancy using eggs. (SM)

  13. Brothers Grimm. [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    Based on Grimm's fairy tales, this lesson plan presents activities designed to help students understand that fairy tales connect them to earlier generations, help them think about present situations, that magic figures prominently in fairy tales, and that fairy tales can inspire readers to create original works of art. The main activity in the…

  14. Rethinking lessons learned processes

    NARCIS (Netherlands)

    Buttler, T.; Lukosch, S.G.; Kolfschoten, G.L.; Verbraeck, A.

    2012-01-01

    Lessons learned are one way to retain experience and knowledge in project-based organizations, helping them to prevent reinventin,g the wheel or to repeat past mistakes. However, there are several challenges that make these lessonts learned processes a challenging endeavor. These include capturing

  15. Dracula. [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    Based on Bram Stoker's novel "Dracula," this lesson plan presents activities designed to help students understand that some fictional literary characters become so famous that they enter popular culture in other forms (movies, games, toys); and that working on a product such as a game often demands collaborative effort. The main activity of the…

  16. REVIVAL PLANS, Ten Key Sectors Benefit?

    Institute of Scientific and Technical Information of China (English)

    Yantai CHEN; Hongbo CAI; Yang XU

    2009-01-01

    @@ To revive China's industrial establishment during the biggest Great Depression in the world after World War Ⅱ,China's Central government has launched the "Revival Plans of Ten Key Sectors"plus the 4 trillion stimulus package in the early 2009.Formulated by the National Development and Planning Commission(NDRC).these revival plans aimed at reinvigorating"ten key sectors",to be specified.the iron and steel.automotive,shipbuilding,petrochemical,textile,light,nonferrous metals,equipment manufacturing,electronics and information technology,and logistics industrial sectors.

  17. Lesson Ten Atrioventricular block%房室传导阻滞

    Institute of Scientific and Technical Information of China (English)

    鲁端; 王劲

    2004-01-01

    @@ The specialized cardiac conducting system normally ensures synchronous conduction of each sinus impulse from the atria to the ventricles.Abnormalities of conduction of the sinus impulse to the ventricles may portend the development of heart block,which can ultimately lead to syncope or cardiac arrest1. In order to evaluate the clinical significance of conduction abnormalities,the physician must assess①the site of conduction disturbance, ②the risk of progression to complete block,and ③the probability that a subsidiary escape rhythm arising distal to the site of block will be electrophysiologically and hemodynamically stable2.This latter point is perhaps the most important,since the rate and stability of the escape pacemaker determine what symptoms result from heart block3.

  18. Ten design lessons from the literature on child development and children’s use of technology

    CSIR Research Space (South Africa)

    Gelderblom, H

    2009-06-01

    Full Text Available explicit. Fischer’s dynamic skill development theory has a similar view of skill transfer [16]. It regards ‘skill’ as a concept that includes both person and environment. Skill is task-specific, context-specific and dependent on factors such as emotion... by beginning writers who invent their own spelling. Their phonetic way of spelling, often leaving out vowels, can produce confusing feedback from the speech-synthesiser. For example, when a child writes ‘DVD’ for ‘David’, the synthesiser responds by naming...

  19. All Hands on Deck: Ten Lessons from Early Adopters of Competency-Based Education

    Science.gov (United States)

    Book, Patricia A.

    2014-01-01

    The perceived value of postsecondary education to economic competitiveness and individual success is driving innovation in higher education. Competency-based education (CBE) is the latest disruption that seeks to respond to the growing sense of national urgency to boost education attainment. The target audience generally includes those adult…

  20. Interpreting Medicine: Lessons From a Spanish-Language Clinic

    OpenAIRE

    Brown, Benjamin P.

    2014-01-01

    Caring for patients is an act of interpretation: we labor to understand the significance of a particular symptom and, when we have reached a diagnosis, we convert our medical jargon into plain language for the benefit of the patient. Caring for patients of limited English proficiency—a population that needs a very literal form of interpretation—underscores this lesson. Working with predominantly Spanish-speaking patients has shown me the importance of bearing witness to patients’ struggles an...

  1. Jacques Ranciere's Lesson on the Lesson

    Science.gov (United States)

    Chambers, Samuel A.

    2013-01-01

    This article examines the significance of Jacques Ranciere's work on pedagogy, and argues that to make sense of Ranciere's "lesson on the lesson" one must do more but also less than merely explicate Ranciere's texts. It steadfastly refuses to draw out the lessons of Ranciere's writings in the manner of a series of…

  2. Examining the Changes in Novice and Experienced Mathematics Teachers' Questioning Techniques through the Lesson Study Process

    Science.gov (United States)

    Ong, Ewe Gnoh; Lim, Chap Sam; Ghazali, Munirah

    2010-01-01

    The purpose of this study was to examine the changes in novice and experienced mathematics teachers' questioning techniques. This study was conducted in Sarawak where ten (experienced and novice) teachers from two schools underwent the lesson study process for fifteen months. Four data collection methods namely, observation, interview, lesson…

  3. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module X. Medical Emergencies.

    Science.gov (United States)

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    This instructor's lesson plan guide on medical emergencies is one of fifteen modules designed for use in the training of emergency medical technicians (paramedics). Ten units of study are presented: (1) diabetic emergencies; (2) anaphylactic reactions; (3) exposure to environmental extremes; (4) alcoholism and drug abuse; (5) poisoning and…

  4. Comparing Multiple Solutions in the Structured Problem Solving: Deconstructing Japanese Lessons from Learner's Perspective

    Science.gov (United States)

    Hino, Keiko

    2015-01-01

    The purpose of this study is to enhance our understanding of how students listen and attend to multiple solutions proposed by their classmates during the activity of comparison. This study examines ten consecutive lessons in each of the two eighth-grade classrooms in Tokyo that are organized in the style of "structured problem solving".…

  5. Examining the Changes in Novice and Experienced Mathematics Teachers' Questioning Techniques through the Lesson Study Process

    Science.gov (United States)

    Ong, Ewe Gnoh; Lim, Chap Sam; Ghazali, Munirah

    2010-01-01

    The purpose of this study was to examine the changes in novice and experienced mathematics teachers' questioning techniques. This study was conducted in Sarawak where ten (experienced and novice) teachers from two schools underwent the lesson study process for fifteen months. Four data collection methods namely, observation, interview, lesson…

  6. Supersymmetric R4-actions in ten dimensions

    NARCIS (Netherlands)

    Roo, M. de; Suelmann, H.; Wiedemann, A.

    1992-01-01

    We construct supersymmetric R+R4-actions in ten dimensions. Two invariants, of which the bosonic parts are known from string amplitude and sigma model calculations, are obtained. One of these invariants can be generalized to an R+F2+F4-invariant for supersymmetric Yang-Mills theory coupled to superg

  7. Orbits of Ten Visual Binary Stars

    Institute of Scientific and Technical Information of China (English)

    B.Novakovi(c)

    2007-01-01

    We present the orbits of ten visual binary stars:WDS 01015+6922.WDS 01424-0645,WDS 01461+6349,WDS 04374-0951,WDS 04478+5318,WDS 05255-0033,WDS 05491+6248,WDS 06404+4058,WDS 07479-1212,and WDS 18384+0850.We have also determined their masses,dynamical parallaxes and ephemerides.

  8. Ten recommendations for software engineering in research.

    Science.gov (United States)

    Hastings, Janna; Haug, Kenneth; Steinbeck, Christoph

    2014-01-01

    Research in the context of data-driven science requires a backbone of well-written software, but scientific researchers are typically not trained at length in software engineering, the principles for creating better software products. To address this gap, in particular for young researchers new to programming, we give ten recommendations to ensure the usability, sustainability and practicality of research software.

  9. Strahlungsfelder und Strahlungsqualitäten

    Science.gov (United States)

    Krieger, Hanno

    Das Kapitel beginnt mit einer Darstellung der wichtigsten Größen zur Beschreibung von Strahlungsfeldern. Diese Größen können sowohl auf die Teilchenzahl als auch auf die Teilchenenergie bezogen sein. Im zweiten Teil werden ausführlich die Verfahren zur Charakterisierung der Strahlungsqualitäten der verschiedenen in der Radiologie verwendeten Strahlungsarten dargestellt.

  10. Editor's Journal: Poor Elijah's Almanack Top Ten.

    Science.gov (United States)

    Berger, Peter N.

    1998-01-01

    Reports on and responds to a list from the American Association of School Administrators detailing the "Top Ten Changes Affecting Students Since the 1960s." Argues that the list is part common sense, part nonsense, and part obvious. Concludes that there is almost nothing the schools can do about these problems because they are societal problems,…

  11. Czech, Slovak science ten years after split

    CERN Document Server

    2003-01-01

    Ten years after the split of Czechoslovakia Czech and Slovak science are facing the same difficulties: shortage of money for research, poor salaries, obsolete equipment and brain drain, especially of the young, according to a feature in the Daily Lidove Noviny (1 page).

  12. TEN MASTER TEACHER AND PROGRAM AWARD PROGRAMS.

    Science.gov (United States)

    KOVACH, EDITH M.A.

    IN 1966 THE AMERICAN CLASSICAL LEAGUE HONORED THREE TEACHERS WITH ITS MASTER SECONDARY SCHOOL LATIN TEACHER AND PROGRAM AWARD. AMONG THE 32 PROGRAMS CITED FOR RECOGNITION, TEN (INCLUDING THOSE OF THE AWARD WINNERS) POSSESS CLEARLY INNOVATIVE FEATURES. IN BRIEF THEY FEATURE (1) A FIFTH YEAR ADVANCED PLACEMENT PROGRAM, LATIN AS INTRODUCTORY TO…

  13. Ten themes of viscous liquid dynamics

    DEFF Research Database (Denmark)

    Dyre, J. C.

    2007-01-01

    Ten ‘themes' of viscous liquid physics are discussed with a focus on how they point to a general description of equilibrium viscous liquid dynamics (i.e., fluctuations) at a given temperature. This description is based on standard time-dependent Ginzburg-Landau equations for the density fields...

  14. 'Safe handling of nanotechnology' ten years on

    Science.gov (United States)

    Maynard, Andrew D.; Aitken, Robert J.

    2016-12-01

    In 2006, a group of scientists proposed five grand challenges to support the safe handling of nanotechnology. Ten years on, Andrew Maynard and Robert Aitken -- two of the original authors -- look at where we have come, and where we still need to go.

  15. Ten-year urban forestry action plan

    Science.gov (United States)

    J.W." Jerry" Van Sambeek

    2017-01-01

    The Ten-year Urban Forestry Action Plan: 2016-2026 was published in September, 2015 (see http://www.urbanforestry.subr.edu/FinalActionPlan_Complete_11_17_15.pdf). This 260 page heavily illustrated document was prepared by the National Urban and Community Forestry Advisory Council (NUCFAC) under leadership and funding from the USDA Forest Service. The Plan's...

  16. Top-Ten IT Issues: 2009

    Science.gov (United States)

    Agee, Anne Scrivener; Yang, Catherine

    2009-01-01

    This article presents the top-ten IT-related issues in terms of strategic importance to the institution, as revealed by the tenth annual EDUCAUSE Current Issues Survey. These IT-related issues include: (1) Funding IT; (2) Administrative/ERP Information Systems; (3) Security; (4) Infrastructure/Cyberinfrastructure; (5) Teaching and Learning with…

  17. Lesson plans in surgical training.

    Science.gov (United States)

    Lester, S E; Robson, A K R

    2007-06-01

    Lesson plans in surgery enable trainers and trainees to agree on goals that balance training needs with service commitments. Lesson plans are individualised to the trainee and encourage ownership of learning. They are based on SMART criteria and therefore have a sound educational footing. Most of the work in creating a lesson plan falls to the trainee. The total time for creation of each plan is approximately 20 min. Our use of lesson plans for surgical training has been met with favourable response from both trainer and trainees.

  18. RUSSIAN LESSONS FOR 1999

    CERN Multimedia

    1999-01-01

    This autumn, Russian courses will be continued at CERN for beginners and advanced.The first lesson for advanced students will take place on 6th September at 12.00 noon as scheduled.A general briefing for beginners is planned for Thursday30th September at 17.00 in 54-1-002.For further details, please contact the teacher, Mrs Macha Mikhailova by e-mail at: Vladimir.Mikhailov@cern.ch

  19. Somalia Operations: Lessons Learned

    Science.gov (United States)

    1995-01-01

    are the only other • .o" ’" "- THE OPERATIONAL COwnTEX FI(GUM1, EI Smoall Gulf of Aden DJIEBO U.S. and SomaMa Flelol Sin 12 SOMALIA OPERATIONS: LESSONS...demeanor that sawess q-d let diplomacy and reasuing wMii achiev- more than arogance. anger, disdain. coon. or sarcasm . PmmmeI mut be able to cope pq

  20. Best Practice Lesson Plans: A Lesson Plan in Cognitive Restructuring

    Science.gov (United States)

    Sayre, Gary W.

    2006-01-01

    This particular lesson was developed for Cognitive Skills I, a central course in cognitive restructuring at the Mt. Olive Correctional Center. In this lesson the author developed a series of classroom activities to allow students to examine and assess current beliefs they possess, and to understand how these beliefs--whether judged rational or…

  1. CNPC's Ten Major Technological Events in 2004

    Institute of Scientific and Technical Information of China (English)

    Technological Development Department of CNPC

    2005-01-01

    @@ Editor's note: To make a timely introduction of the latest technologies developed by CNPC, Technological Development Department of CNPC entrusted Petroleum Economic & Technological Research Center of CNPC to appraise the oil company 's major technological developments. Based on three rounds of voting by nearly 100 oil experts, ten major technological events in 2004 are finally selected from more than 1 00 technological projects of CNPC according to the measurement standards of innovation, technological maturity, function and scientific value.

  2. Identification of ten new Galactic HII regions

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    We discovered ten large HII regions in the Sino-German λ6 cm polarization survey of the Galactic plane. They have been identified according to their flat spectral indexes and the high ratio between the 60 μm infrared emission and the λ6 cm emission. The integrated flux densities as well as the sizes of these sources are given at 4800 MHz. Cross-identifications are made with other major radio catalogs.

  3. Ten new withanolides from Physalis peruviana.

    Science.gov (United States)

    Fang, Sheng-Tao; Liu, Ji-Kai; Li, Bo

    2012-01-01

    Ten new withanolides, including four perulactone-type withanolides, perulactones E-H (1-4), three 28-hydroxy-withanolides, withaperuvins I-K (5-7), and three other withanolides, withaperuvins L-N (8-10), together with six known compounds (11-16) were isolated from the aerial parts of Physalis peruviana. The structures of these compounds were elucidated on the basis of extensive spectroscopic analyses (1D and 2D NMR, IR, HR-MS) and chemical methods.

  4. Ten years of monetary union in retrospect

    OpenAIRE

    2008-01-01

    1 January 1999 saw the start of the third and final phase of European Economic and Monetary Union (EMU). Ten years on, membership has expanded from the initial 11 members to reach 16 countries by January 2009. This article reviews the first decade of monetary union from a number of angles. Monetary policy under EMU managed to secure historically low inflation, thereby creating the conditions for sustainable economic growth. Despite large relative price movements stemming from globalisation, i...

  5. EEG Correlates of Ten Positive Emotions

    Science.gov (United States)

    Hu, Xin; Yu, Jianwen; Song, Mengdi; Yu, Chun; Wang, Fei; Sun, Pei; Wang, Daifa; Zhang, Dan

    2017-01-01

    Compared with the well documented neurophysiological findings on negative emotions, much less is known about positive emotions. In the present study, we explored the EEG correlates of ten different positive emotions (joy, gratitude, serenity, interest, hope, pride, amusement, inspiration, awe, and love). A group of 20 participants were invited to watch 30 short film clips with their EEGs simultaneously recorded. Distinct topographical patterns for different positive emotions were found for the correlation coefficients between the subjective ratings on the ten positive emotions per film clip and the corresponding EEG spectral powers in different frequency bands. Based on the similarities of the participants’ ratings on the ten positive emotions, these emotions were further clustered into three representative clusters, as ‘encouragement’ for awe, gratitude, hope, inspiration, pride, ‘playfulness’ for amusement, joy, interest, and ‘harmony’ for love, serenity. Using the EEG spectral powers as features, both the binary classification on the higher and lower ratings on these positive emotions and the binary classification between the three positive emotion clusters, achieved accuracies of approximately 80% and above. To our knowledge, our study provides the first piece of evidence on the EEG correlates of different positive emotions. PMID:28184194

  6. Transformation of China's rural health care financing.

    Science.gov (United States)

    Liu, Y; Hsiao, W C; Li, Q; Liu, X; Ren, M

    1995-10-01

    In the late 1970s China launched its agricultural reforms which initiated a decade of continued economic growth and significant transformation of the Chinese society. The agricultural reforms altered the peasants' incentives, weakened community organization and lessened the central government's control over local communities. These changes largely caused the collapse of the widely acclaimed rural cooperative medical system in China. Consequently China experienced a decreased supply of rural health workers, increased burden of illnesses, disintegration of the three tier medical system, reduced primary health care, and an increased demand for hospital medical services. More than ten years have elapsed since China changed its agricultural economic system and China is still struggling to find an equitable, efficient and sustainable way of financing and organizing its rural health services. The Chinese experiences provided several important lessons for other nations: there is a need to understand the limits of the market forces and to redefine the role of the government in rural health care under a market economy; community participation in and control of local health financing schemes is essential in developing a sustainable rural health system; the rural health system needs to be dynamic, rather than static, to keep pace with changing demand and needs of the population.

  7. Design for Life. Abortion. A Student's Lesson Plan [and] A Teacher's Lesson Plan [and] A Lawyer's Lesson Plan.

    Science.gov (United States)

    Howard, Estelle; And Others

    One of a series of secondary level teaching units presenting case studies with pro and con analyses of particular legal problems, the document consists of a student's lesson plan, a teacher's lesson plan, and a lawyer's lesson plan for a unit on abortion. The lessons are designed to expose students to the Supreme Court's decision concerning…

  8. Keiko, Killer Whale. [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    This lesson plan presents activities designed to help students understand that Keiko, the killer whale, lived for a long time in an aquarium and had to be taught to live independently; and that computer users can get updates on how Keiko is doing. The main activity of the lesson involves middle school students working in small groups to produce a…

  9. Geometrical Analogies in Mathematics Lessons

    Science.gov (United States)

    Eid, Wolfram

    2007-01-01

    A typical form of thinking to approach problem solutions humanly is thinking in analogous structures. Therefore school, especially mathematical lessons should help to form and to develop corresponding heuristic abilities of the pupils. In the contribution, a summary of possibilities of mathematics lessons regarding this shall particularly be…

  10. Masterwork Art Lesson: Kandinsky Watercolors.

    Science.gov (United States)

    LiPira, Michael

    2003-01-01

    Presents an art lesson used with sixth-grade students which also can be used with other grade levels. Explains that the artwork of Wassily Kandinsky served as inspiration for this lesson. Explains that the students learned about abstract art and used watercolors to create their own paintings in the style of Kandinsky. (CMK)

  11. Can You Haiku? [Lesson Plan].

    Science.gov (United States)

    National Endowment for the Humanities (NFAH), Washington, DC.

    In this lesson plan, students learn the rules and conventions of haiku, study examples by Japanese masters, and create haiku of their own. Its 4 lessons seek to help students be able to: (1) describe the traditional rules and conventions of haiku; (2) interpret examples of haiku; (3) characterize the image-evoking power of haiku; (4) develop a…

  12. Heart of Darkness. [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    Based on Joseph Conrad's novel "Heart of Darkness," this lesson plan presents activities designed to help students understand that critics have debated some of Conrad's choices in the novel; and that the novel reflects the world as Conrad saw it. The main activity of the lesson involves students rewriting the ending of the novel so that Marlow…

  13. The next ten years in neonatology: new directions in research

    Directory of Open Access Journals (Sweden)

    Vassilios Fanos

    2014-06-01

    Full Text Available This paper is a prelude to proceedings of the 10th International Workshop on Neonatology to be held in Cagliari, Italy from October 21st to 25th, 2014. These proceedings will be a significant milestone, highlighting the new frontiers of perinatal and neonatal research. Over the five days of this meeting, we aim to (1 examine the roots of the new directions in perinatal and neonatal research; (2 predict the trajectories of advancement in medical technologies, research, clinical care and teaching that will be the future of perinatology and neonatology. The discussion will be in four sections:back to the future: the placenta and perinatal programming;paradigm shift: the revolution of metabolomics in perinatalogy and neonatology;brave new world: the microbiome and microbiomics from perinatal to adult life;new inhabitants on the planet earth: adults who were born with extremely low birth weight. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  14. Breast Cancer in Transgender Veterans: A Ten-Case Series.

    Science.gov (United States)

    Brown, George R

    2015-03-01

    All known cases of breast cancer in patients with a diagnosis consistent with transgender identification were identified in the Veterans Health Administration (1996-2013). Ten cases were confirmed: seven birth sex females and three birth sex males. Of the three birth sex males, two identified as gender dysphoric male-to-female and one identified as transgender with transvestic fetishism. The birth sex males all presented with late-stage disease that proved fatal, whereas most of the birth sex female transgender veterans presented with earlier stage disease that could be treated. These cases support the importance of screening for breast cancer using standard guidelines in birth sex males and females. Family history of breast cancer should be obtained from transgender people as part of routine care. This report expands the known cases of breast cancer in transgender persons from 5 to 12 (female-to-male) and from 10 to 13 (male-to-female).

  15. The history of a lesson

    DEFF Research Database (Denmark)

    Rasmussen, Mikkel Vedby

    2003-01-01

    and emphasises the need to study the history of lessons rather than the lessons of history. This approach shows that Munich is the end point of a constitutive history that begins in the failure of the Versailles treaty to create a durable European order following the First World War. The Munich lesson is thus...... one element of the lesson of Versailles, which is a praxeology that defines how the West is to make peace, and against whom peace must be defended. The lesson of Versailles has been, at least in part, constitutive of the outbreak of the Cold War, and it continues to define the Western conception...... of what defines peace and security even in the 'war against terrorism'....

  16. International nurse migration: lessons from the Philippines.

    Science.gov (United States)

    Brush, Barbara L; Sochalski, Julie

    2007-02-01

    Developed countries facing nursing shortages have increasingly turned to aggressive foreign nurse recruitment, primarily from developing nations, to offset their lagging domestic nurse supplies and meet growing health care demands. Few donor nations are prepared to manage the loss of their nurse workforce to migration. The sole country with an explicit nurse export policy and the world's leading donor of nurse labor - the Philippines - is itself facing serious provider maldistribution and countrywide health disparities. Examining the historical roots of Philippines nurse migration provides lessons from which other nurse exporting countries may learn. The authors discuss factors that have predicated nurse migration and policies that have eased the way. Furthermore, the authors analyze how various stakeholders influence migratory patterns, the implications of migration for nurses and the public in their care, and the challenges that future social policy and political systems face in addressing global health issues engendered by unfettered recruitment of nurses and other health workers.

  17. How Creative Are Your Art Lessons?

    Science.gov (United States)

    Asch, Rosalie

    1976-01-01

    How a teacher achieves a balance between structure and freedom in his art lessons requires a critical awareness of the methods he chooses. Discusses the problems in teaching art lessons, the basic characteristics of creative art lessons, and provides a checklist for analyzing the effectiveness of an art lesson. (Author/RK)

  18. Classroom Management and Lesson Planning(4)

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Lesson Planning Task 1 As teachers,we all need to plan our lessons before we teach.Make a list of things that you think need to be included in a lesson plan.Then compare and discuss your list with another teacher.Also think about reasons why we need to plan our lessons.

  19. Classroom Management and Lesson Planning(4)

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Lesson PlanningTask 1As teachers,we all need to plan our lessons before we teach.Make a list of things that you think need tobe included in a lesson plan.Then compare and discuss your list with another teacher.Also think about reasonswhy we need to plan our lessons.

  20. Geographic Alliance of Iowa. Lesson Plans.

    Science.gov (United States)

    Weller, Kay E.; Howe-Ford, Nancy

    This collection of five lesson plans in geography can be adapted for use with K-12 students. Each lesson plan explains the lesson and provides basic instructions. The lesson plans are titled: "Teaching Geography Using Literature in K-University Classrooms" (Kay Weller); "Geography and a Mystery Novel" (Kay Weller);…

  1. CEBAF Upgrade: Cryomodule Performance And Lessons Learned

    Energy Technology Data Exchange (ETDEWEB)

    Drury, Michael A.; Davis, G. Kirk; Hogan, John P.; Hovater, J. Curt; King, Lawrence; Marhauser, Frank; Park, HyeKyoung; Preble, Joe; Reece, Charles E.; Rimmer, Robert A.; Wang, Haipeng; Wiseman, Mark A.

    2014-02-01

    The Thomas Jefferson National Accelerator Facility is currently engaged in the 12 GeV Upgrade Project. The goal of the 12 GeV Upgrade is a doubling of the available beam energy of the Continuous Electron Beam Accelerator Facility (CEBAF) from 6 GeV to 12 GeV. This increase in beam energy will be due in large part to the addition of ten C100 cryomodules plus associated new RF in the CEBAF linacs. The C100 cryomodules are designed to deliver 100 MeV per installed cryomodule. Each C100 cryomodule is built around a string of eight seven-cell, electro-polished, superconducting RF cavities. While an average performance of 100MV per cryomodule is needed to achieve the overall 12 GeV beam energy goal, the actual performance goal for the cryomodules is an average energy gain of 108 MV to provide operational headroom. Cryomodule production started in December 2010. All ten of the C100 cryomodules are installed in the linac tunnels and are on schedule to complete commissioning by September 2013. Performance during Commissioning has ranged from 104 MV to 118 MV. In May, 2012 a test of an early C100 achieved 108 MV with full beam loading. This paper will discuss the performance of the C100 cryomodules along with operational challenges and lessons learned for future designs.

  2. TENS (transcutaneous electrical nerve stimulation) for labour pain.

    Science.gov (United States)

    Francis, Richard

    2012-05-01

    Because TENS is applied inconsistently and not always in line with optimal TENS application theory, this may explain why TENS for labour pain appears to be effective in some individuals and not in others. This article reviews TENS theory, advises upon optimal TENS application for labour pain and discusses some of the limitations of TENS research on labour pain. TENS application for labour pain may include TENS applied to either side of the lower spine, set to 200 mus pulse duration and 100 pulses per second. As pain increases, TENS intensity should be increased and as pain decreases, TENS intensity should be reduced to maintain a strong but pain free intensity of stimulation. This application may particularly reduce back pain during labour.

  3. The Top Ten Algorithms in Data Mining

    CERN Document Server

    Wu, Xindong

    2009-01-01

    From classification and clustering to statistical learning, association analysis, and link mining, this book covers the most important topics in data mining research. It presents the ten most influential algorithms used in the data mining community today. Each chapter provides a detailed description of the algorithm, a discussion of available software implementation, advanced topics, and exercises. With a simple data set, examples illustrate how each algorithm works and highlight the overall performance of each algorithm in a real-world application. Featuring contributions from leading researc

  4. Ten steps to successful poster presentation.

    Science.gov (United States)

    Hardicre, Jayne; Devitt, Patric; Coad, Jane

    Receiving a letter confirming acceptance for you to present a poster at a conference can evoke mixed emotions. Joy, panic, fear and dread are among the many possible emotions and this is not exclusive to first time presenters. Developing an effective poster presentation is a skill that you can learn and can provide a rewarding way to present your work in a manner less intimidating than oral presentation (Shelledy, 2004). The key to successful poster presentation is meticulous, timely, well informed preparation. This article outlines ten steps to help guide you through the process to maximize your success.

  5. Ten essential skills for electrical engineers

    CERN Document Server

    Dorr, Barry

    2014-01-01

    Engineers know that, as in any other discipline, getting a good job requires practical, up-to-date skills. An engineering degree provides a broad set of fundamentals. Ten Essential Skills applies those fundamentals to practical tasks required by employers. Written in a user-friendly, no-nonsense format, the book reviews practical skills using the latest tools and techniques, and features a companion website with interview practice problems and advanced material for readers wishing to pursue additional skills. With this book, aspiring and current engineers may approach job interviews confident

  6. Shuttle Lesson Learned - Toxicology

    Science.gov (United States)

    James, John T.

    2010-01-01

    This is a script for a video about toxicology and the space shuttle. The first segment is deals with dust in the space vehicle. The next segment will be about archival samples. Then we'll look at real time on-board analyzers that give us a lot of capability in terms of monitoring for combustion products and the ability to monitor volatile organics on the station. Finally we will look at other issues that are about setting limits and dealing with ground based lessons that pertain to toxicology.

  7. Lessons from Mayan Astronomy

    CERN Document Server

    Loeb, Abraham

    2016-01-01

    The Mayan culture collected exquisite astronomical data for over a millennium. However, it failed to come up with the breakthrough ideas of modern astronomy because the data was analyzed within a mythological culture of astrology that rested upon false but mathematically sophisticated theories about the Universe. Have we learned the necessary lessons to prevent our current scientific culture from resembling Mayan Astronomy? Clearly, data collection by itself is not a guarantee for good science as commonly assumed by funding agencies. A vibrant scientific culture should cultivate multiple approaches to analyzing existing data and to collecting new data.

  8. French Lessons A Memoir

    CERN Document Server

    Kaplan, Alice

    2009-01-01

    Brilliantly uniting the personal and the critical, French Lessons is a powerful autobiographical experiment. It tells the story of an American woman escaping into the French language and of a scholar and teacher coming to grips with her history of learning. Kaplan begins with a distinctly American quest for an imaginary France of the intelligence. But soon her infatuation with all things French comes up against the dark, unimagined recesses of French political and cultural life.The daughter of a Jewish lawyer who prosecuted Nazi war criminals at Nuremburg, Kaplan grew up in the 1960s in the Mi

  9. Financial Lessons Learned

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    @@ As the Wall Street chaos of 2008 swept the globe,China-with little exposure to subprime mortgages-was one of the only calm ports in the growing financial storm.Ifone lesson can be learned from the crisis,it is this: maintain a constant state of financial vigilance against risks even in boom times.China now faces the task of ensuring its financial health as it further opens to the world amid a global financial landscape reshaped by deep recessions.Economists and finance professors discussed these challenges at the Asia-Pacific Economic and Financial Forum recently held in Beijing.Edited excerpts follow:

  10. Financial Lessons Learned

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    As the Wall Street chaos of 2008 swept the globe,China-with little exposure to subprime mortgages-was one of the only calm ports in the growing financial storm.If one lesson can be learned from the crisis,it is this: maintain a constant state of financial vigilance against risks even in boom times.China now faces the task of ensuring its financial health as it further opens to the world amid a global financial landscape reshaped by deep recessions.Economists and finance professors discussed these challenges at the Asia-Pacific Economic and Financial Forum recently held in Beijing.Edited excerpts follow

  11. Implementation, monitoring and utilization of an integrated Hospital Information System--lessons from a case study.

    Science.gov (United States)

    Cruz-Correia, Ricardo João

    2010-01-01

    In most hospitals several heterogeneous Information Systems (IS) store parts of a still scattered patient record. Virtual Patient Records (VPR) are systems that aggregate known data elements about the patient from different IS in real-time. This papers aims to present the main lessons learned from the implementation and the usage during 6 years of a VPR system. Ten major lessons were divided in recommendations for software developers, information managers and institutional policy makers. Implementing and using a VPR is a difficult journey but can generate great value for the institution if most of these recommendations are taken in consideration.

  12. Accountable Care Units: A Disruptive Innovation in Acute Care Delivery.

    Science.gov (United States)

    Castle, Bryan W; Shapiro, Susan E

    2016-01-01

    Accountable Care Units are a disruptive innovation that has moved care on acute care units from a traditional silo model, in which each discipline works separately from all others, to one in which multiple disciplines work together with patients and their families to move patients safely through their hospital stay. This article describes the "what," "how," and "why" of the Accountable Care Units model as it has evolved in different locations across a single health system and includes the lessons learned as different units and hospitals continue working to implement the model in their complex care environments.

  13. Ten years of health workforce planning in the Netherlands: a tentative evaluation of GP planning as an example.

    NARCIS (Netherlands)

    Greuningen, M. van; Batenburg, R.S.; Velden, L.F.J. van der

    2012-01-01

    INTRODUCTION: In many countries, health-care labour markets are constantly being challenged by an alternation of shortage and oversupply. Avoiding these cyclic variations is a major challenge. In the Netherlands, a workforce planning model has been used in health care for ten years. Case description

  14. St. Louis FUSRAP Lessons Learned

    Energy Technology Data Exchange (ETDEWEB)

    Eberlin, J.; Williams, D.; Mueller, D.

    2003-02-26

    The purpose of this paper is to present lessons learned from fours years' experience conducting Remedial Investigation and Remedial Action activities at the St. Louis Downtown Site (SLDS) under the Formerly Utilized Sites Remedial Action Program (FUSRAP). Many FUSRAP sites are experiencing challenges conducting Remedial Actions within forecasted volume and budget estimates. The St. Louis FUSRAP lessons learned provide insight to options for cost effective remediation at FUSRAP sites. The lessons learned are focused on project planning (budget and schedule), investigation, design, and construction.

  15. Ten new and emerging trends in residential group living environments.

    Science.gov (United States)

    Regnier, Victor; Denton, Alexis

    2009-01-01

    Residential styled environments for physically challenged people with neuro disabilities are rapidly replacing the standard institutional skilled nursing home. Ten trends are described that utilize residential design approaches to the physical environment while relying on home-care style methods for service delivery. Combined these two forces create powerful differentiators which make group residential settings more friendly and humane. Northern European, as well as, US best practices and prototypes are described that combine housing with services in a range of contexts. The success of northern Europeans in promulgating models of aging-in-place that keep those at risk more independent in the community or within family settings are remarkable. Topics like the impact of small group living clusters, interior design treatments, access to landscape gardens, life skill management methods, movement systems for circulation and exercise, shared space priorities, unit design trends and innovative care giving techniques are introduced. The focus of the article is on specific practices gleaned from cultures and exemplars that appear to increase autonomy, independence and privacy for those who are threatened because of their disabilities with the loss of these lifestyle attributes. Promising concepts of service organization and community outreach are combined with detailed recommendations that address the need for lift technology and safety features in bathrooms and kitchens.

  16. Periprosthetic Knee Infection: Ten Strategies That Work

    Science.gov (United States)

    Cavanaugh, Priscilla Ku; Diaz-Ledezma, Claudio

    2013-01-01

    Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). The demand for TKA is rapidly increasing, resulting in a subsequent increase in infections involving knee prosthesis. Despite the existence of common management practices, the best approach for several aspects in the management of periprosthetic knee infection remains controversial. This review examines the current understanding in the management of the following aspects of PJI: preoperative risk stratification, preoperative antibiotics, preoperative skin preparation, outpatient diagnosis, assessing for infection in revision cases, improving culture utility, irrigation and debridement, one and two-stage revision, and patient prognostic information. Moreover, ten strategies for the management of periprosthetic knee infection based on available literature, and experience of the authors were reviewed. PMID:24368992

  17. The ten grand challenges of synthetic life.

    Science.gov (United States)

    Porcar, Manuel; Danchin, Antoine; de Lorenzo, Victor; Dos Santos, Vitor A; Krasnogor, Natalio; Rasmussen, Steen; Moya, Andrés

    2011-06-01

    The construction of artificial life is one of the main scientific challenges of the Synthetic Biology era. Advances in DNA synthesis and a better understanding of regulatory processes make the goal of constructing the first artificial cell a realistic possibility. This would be both a fundamental scientific milestone and a starting point of a vast range of applications, from biofuel production to drug design. However, several major issues might hamper the objective of achieving an artificial cell. From the bottom-up to the selection-based strategies, this work encompasses the ten grand challenges synthetic biologists will have to be aware of in order to cope with the task of creating life in the lab.

  18. Review - Scripture of the Ten Kings

    Directory of Open Access Journals (Sweden)

    Paul K. Nietupski

    2013-12-01

    Full Text Available Review of: Daniel Berounský (with Luboš Bělka, "Comparative Description of the Paintings". 2012. The Tibetan Version of the Scripture on the Ten Kings and the Quest for Chinese Influence on the Tibetan Perception of the Afterlife. Prague: Triton Publishing House. This book is a study of the various influences on the complex Tibetan visions of the afterlife. It is based on new text-critical research and includes an introduction and translation of a rare Tibetan manuscript entitled Scripture on the Ten Kings, housed in the National Gallery, Prague. The book includes extensive references to secondary scholarship, as well as collaborative work by competent scholars and an appended study of the text illustrations by Luboš Bělka From the outset, the book raises a range of interpretive questions of central importance to at least Tibetan and Asian studies. The author describes the plan of the book and its parameters in the Introduction, noting that the manuscript under study does not include tantric perspectives (12, and is instead more oriented to popular understanding and use. This is an important and controversial methodological position, consistent with the formalized one circulated in scholastic and monastic circles that emphasizes secrecy and limited access to fully developed tantric studies. This position can, however, be contrasted with, for example, the uses of texts noted by Cuevas (2003, and further emphasized by Prude (2005:1-3, who suggests more popular use of tantric texts. This view is discussed in detail by others, including Thurman (2006, in his obviously tantric-influenced introduction and translation of the..

  19. Over ten thousand cases and counting

    DEFF Research Database (Denmark)

    Elbers, Paul W G; Van Regenmortel, Niels; Gatz, Rainer

    2015-01-01

    Acidbase.org has been serving the critical care community for over a decade. The backbone of this online resource consists of Peter Stewart's original text "How to understand Acid-Base" which is freely available to everyone. In addition, Stewart's Textbook of Acid Base, which puts the theory in t...

  20. Ten things to consider when entering into public-private digitization partnerships

    Directory of Open Access Journals (Sweden)

    Simon Bell

    2012-03-01

    Full Text Available Over the past three years the British Library has brokered mass digitization partnerships with Google, Brightsolid, Find my Past, Cengage Learning and others. This article explores some of the major challenges underlying digitization partnerships, particularly public-private, covering many of the important aspects to be considered such as ownership, access, control and standards. It also covers topics like term (length of time, the importance of flexibility, maximizing use/re-use of digitized material and market penetration. Legal and other aspects of such partnerships are also detailed, with sections on the type of partnership that needs to be entered into (non-exclusive and the role of the commercial partner. Finally, there is sound advice about risk assessment and cover. These lessons learned from experience are itemized in a handy ten-point checklist for anyone considering entering into a digitization partnership, and recommendations are made based on a wealth of acquired knowledge.

  1. Best Short Stories. Middle Level. 10 Stories for Young Adults--With Lessons for Teaching the Basic Elements of Literature.

    Science.gov (United States)

    Harris, Raymond

    This workbook contains ten short stories by modern masters aimed at young adult readers, with each story followed by a concise lesson on a basic element of literature (such as plot, setting, or mood) clearly illustrated in the story. Some of the authors represented in the book are John Updike, Isaac Bashevis Singer, Carson McCullers, and Ray…

  2. Lessons for the new CMS innovation center from the Medicare health support program.

    Science.gov (United States)

    Barr, Michael S; Foote, Sandra M; Krakauer, Randall; Mattingly, Patrick H

    2010-07-01

    The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS's role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program that ran between 2005 and 2008, illustrate the value of drawing on experience in planning for the center and future pilot programs. The lessons include the importance of strong leadership; collaboration and flexibility to foster innovation; receptivity of beneficiaries to care management; and the need for timely data on patients' status. The lessons also highlight pitfalls to be avoided in planning future pilot programs, such as flawed strategies for selecting populations to target when testing payment and service delivery reforms.

  3. Preparing Science-Trained Professionals for the Biotechnology Industry: A Ten-Year Perspective on a Professional Science Master's Program.

    Science.gov (United States)

    Hamilton, Paul T; Luginbuhl, Sarah C; Hyman, Michael

    2012-01-01

    The biotechnology industry has a need for business-savvy scientists; however, this is not the way scientists are traditionally trained at universities and colleges. To address this need, universities have developed Professional Science Master's (PSM) degree programs that offer advanced training in a technical field along with professional skills development through team-based projects and internships. Nearly ten years ago, the Department of Microbiology at NCSU started a PSM program in Microbial Biotechnology (MMB). This article provides an overview of the MMB program, and shares some of the lessons that we have learned.

  4. Make That Shock Lesson Shocking

    Science.gov (United States)

    Moskowitz, Gertrude

    1975-01-01

    Notes a tendency among foreign language teachers to attempt to cover too much material too quickly with beginning students. A lesson used with prospective foreign language teachers is described which recalls the difficulties of beginning language students. (RM)

  5. Teacher Training: The Demonstration Lesson

    Science.gov (United States)

    Moore, Alan C.

    1977-01-01

    A teacher training technique is discussed involving a demonstration class given by a local teacher and observed by prospective teachers. After the class a discussion is held analyzing lesson content and teaching techniques. (CHK)

  6. Simultaneous determination of ten preservatives in ten kinds of foods by micellar electrokinetic chromatography.

    Science.gov (United States)

    Ding, Xiao-Jing; Xie, Na; Zhao, Shan; Wu, Yu-Chen; Li, Jiang; Wang, Zhi

    2015-08-15

    An improved micellar electrokinetic capillary chromatography method (MEKC) for the simultaneous determination of ten preservatives in ten different kinds of food samples was reported. An uncoated fused-silica capillary with 50 μm i.d. and 70 cm total length was used. Under the optimized conditions, the linear response was observed in the range of 1.2-200mg/L for the analytes. The limits of detection (LOD, S/N=3) and limits of quantitation (LOQ, S/N=10) ranging from 0.4 to 0.5mg/L and 1.2 to 1.5mg/L, respectively were obtained. The method was used for the determination of sorbic and benzoic acids in two FAPAS® (Food Analysis Performance Assessment Scheme) proficiency test samples (jam and chocolate cake). The results showed that the current method with simple sample pretreatment and small reagent consumption could meet the needs for routine analysis of the ten preservatives in ten types of food products.

  7. Lessons learned from accidents investigations

    Energy Technology Data Exchange (ETDEWEB)

    Zuniga-Bello, P. [Consejo Nacional de Ciencia y Tecnologia (CONACYT), Mexico City (Mexico); Croft, J. [National Radiological Protection Board (United Kingdom); Glenn, J

    1997-12-31

    Accidents from three main practices: medical applications, industrial radiography and industrial irradiators are used to illustrate some common causes of accidents and the main lessons to be learned. A brief description of some of these accidents is given. Lessons learned from the described accidents are approached by subjects covering: safety culture, quality assurance, human factors, good engineering practice, defence in depth, security of sources, safety assessment and monitoring and verification compliance. (author)

  8. Lessons Learned from FUSRAP

    Energy Technology Data Exchange (ETDEWEB)

    Castillo, Darina [U.S. Department of Energy, Office of Legacy Management; Carpenter, Cliff [U.S. Department of Energy, Office of Legacy Management; Miller, Michele [Navarro Research and Engineering

    2016-03-06

    The US DOE Office of Legacy Management (LM) is the long-term steward for 90 sites remediated under numerous regulatory regimes including the Formerly Utilized Sites Remedial Action Program (FUSRAP) sites. In addition, LM holds considerable historical information, gathered in the 1970s, to determine site eligibility for remediation under FUSRAP. To date, 29 FUSRAP sites are in LM’s inventory of sites for long-term surveillance and maintenance (LTS&M), and 25 are with the US Army Corps of Engineers (USACE) for remediation or in the process of being transitioned to LM. It is forecasted that 13 FUSRAP sites will transfer from the USACE to LM over the next 10 years; however, the timing of the transfers is strongly dependent upon federal funding of the ongoing remedial actions. Historically, FUSRAP sites were generally cleaned up for “unrestricted” industrial use or remediated to the “cleanup standards” at that time, and their use remained unchanged. Today, these sites as well as the adjacent properties are now changing or envisioned to have changes in land use, typically from industrial to commercial or residential uses. The implication of land-use change affects DOE’s LTS&M responsibility for the sites under LM stewardship as well as the planning for the additional sites scheduled to transition in time. Coinciding with land-use changes at or near FUSRAP sites is an increased community awareness of these sites. As property development increases near FUSRAP sites, the general public and interested stakeholders regularly inquire about the sufficiency of cleanups that impact their neighborhoods and communities. LM has used this experience to address a series of lessons learned to improve our program management in light of the changing conditions of our sites. We describe these lessons learned as (1) improved stakeholder relations, (2) enhanced LTS&M requirements for the sites, and (3) greater involvement in the transition process.

  9. 10 lessons learned by a misguided physician.

    Science.gov (United States)

    Levin, Barry E

    2017-07-01

    It was a great and humbling honor to receive the 2016 Distinguished Career Award from my SSIB colleagues. This paper summarizes the major points of my DCA talk at the 2016 annual meeting. It is a reflection on my 50year medical and research career and 10 lessons I have learned over those years which might be of help to young investigators near the beginning of their own research careers. These lessons include: the value of being receptive to the opportunities provided you; how clinician-scientists can serve as critical role models for young investigators like me and a history of how my career developed as a result of their influence; the importance of carefully examining your own data, particularly when it doesn't agree with your preconceived ideas; the critical role that students, postdocs and PhD (and even veterinarian) colleagues can play in developing one's career; the likelihood that your career path will have many interesting twists and turns determined by changes in your own scientific interests and how rewarding various areas of research focus are to you; the importance of building a close-knit laboratory staff family; the fact that science and romance can mix. Finally, I offer 3 somewhat self-evident free pieces of advice for building and maintaining a rewarding career. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Ten major trends now emerging in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Naisbitt, J.

    1978-01-01

    Using a special analytical procedure for tracking and assessing events reported in the nation's newspapers, the Center for Policy Process has identified ten emerging trends in the United States that are having a major impact on all our lives and on all businesses and industries--and especially on the electric utility industry. Although the trends may move in contradictory directions and have different degrees of significance, all have been carefully monitored for a considerable length of time. All are firmly established--and are not to be viewed as the momentary interests of certain radical elements of the population. The ten trends are: the fast-emerging clash between nuclear fuel and coal as an environmental health issue; displacement of racism and sexism by ''ageism'' as society's most prominent anti-discrimination preoccupation, and the complete elimination soon of mandatory retirement; in government and technology, the phenomenon of ''appropriate scale'' replacing economies of scale, emergence of single-issue political organizations; coming-of-age of the recycling ethic; emergence of ''access to capital'' as the new equity issue--the new rights issue; continuing shift from centralization to decentralization; movement of society in the dual directions of high technology/high touch; business' increasing involvement with the well-established accountability trend; and shift from a representative democracy to a participatory democracy--this profound change in American democracy actually began about a decade or so ago.

  11. Ten principles of good interdisciplinary team work

    OpenAIRE

    Nancarrow, S.A.; Booth, A; Ariss, S; T. Smith; Enderby, P; Roots, A.

    2013-01-01

    Background\\ud Interdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes.\\ud \\ud Method\\ud This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary te...

  12. Ten Years of ENA Imaging from Cassini

    Science.gov (United States)

    Brandt, Pontus; Mitchell, Donald; Westlake, Joseph; Carbary, James; Paranicas, Christopher; Mauk, Barry; Krimigis, Stamatios

    2014-05-01

    In this presentation we will provide a detailed review of the science highlights of the ENA observations obtained by The Ion Neutral Camera (INCA) on board Cassini. Since the launch of Cassini, INCA has unveiled an invisible world of hot plasma and neutral gas of the two biggest objects of our solar system: the giant magnetosphere of Jupiter and Saturn. Although more than ten years ago, INCA captured the first ENA images of the Jovian system revealing magnetospheric dynamics and an asymmetric Europa neutral gas torus. Approaching Saturn, INCA observed variability of Saturn's magnetospheric activity in response to changes in solar wind dynamic pressure, which was contrary to expectations and current theories. In orbit around Saturn, INCA continued the surprises including the first imaging and global characterization of Titan's exosphere extended out to its gravitational Hill sphere; recurring injections correlating with periodic Saturn Kilometric Radiation (SKR) bursts and magnetic field perturbations; and the discovery of energetic ionospheric outflow. Perhaps most significant, and the focal point of this presentation, is INCA's contribution to the understanding of global magnetospheric particle acceleration and transport, where the combination between ENA imaging and in-situ measurements have demonstrated that transport and acceleration of plasma is likely to occur in a two-step process. First, large-scale injections in the post-midnight sector accelerate and transport plasma in to about 12 RS up to energies of several hundreds of keV. Second, centrifugal interchange acts on the plasma inside of this region and provides further heating and transport in to about 6RS. We discuss this finding in the context of the two fundamental types of injections (or ENA intensifications) that INCA has revealed during its ten years of imaging. The first type is large-scale injections appearing beyond 12 RS in the post-midnight sector that have in many cases had an inward component

  13. Comparative Genomics of Ten Solanaceous Plastomes

    Directory of Open Access Journals (Sweden)

    Harpreet Kaur

    2014-01-01

    Full Text Available Availability of complete plastid genomes of ten solanaceous species, Atropa belladonna, Capsicum annuum, Datura stramonium, Nicotiana sylvestris, Nicotiana tabacum, Nicotiana tomentosiformis, Nicotiana undulata, Solanum bulbocastanum, Solanum lycopersicum, and Solanum tuberosum provided us with an opportunity to conduct their in silico comparative analysis in depth. The size of complete chloroplast genomes and LSC and SSC regions of three species of Solanum is comparatively smaller than that of any other species studied till date (exception: SSC region of A. belladonna. AT content of coding regions was found to be less than noncoding regions. A duplicate copy of trnH gene in C. annuum and two alternative tRNA genes for proline in D. stramonium were observed for the first time in this analysis. Further, homology search revealed the presence of rps19 pseudogene and infA genes in A. belladonna and D. stramonium, a region identical to rps19 pseudogene in C. annum and orthologues of sprA gene in another six species. Among the eighteen intron-containing genes, 3 genes have two introns and 15 genes have one intron. The longest insertion was found in accD gene in C. annuum. Phylogenetic analysis using concatenated protein coding sequences gave two clades, one for Nicotiana species and another for Solanum, Capsicum, Atropa, and Datura.

  14. Ten unanswered questions in multimodal communication.

    Science.gov (United States)

    Partan, Sarah R

    2013-01-01

    The study of multimodal communication has become an active and vibrant field. This special issue of Behavioral Ecology and Sociobiology brings together new developments in this rapidly expanding area. In this final contribution to the special issue, I look to the future and discuss ten questions in need of further work, touching on issues ranging from theoretical modeling and the evolution of behavior to molecular mechanisms and the development of behavior. In particular, I emphasize that the use of multimodal communication allows animals to switch between sensory channels when one channel becomes too noisy, and suggest that a better understanding of this process may help us both to understand the evolution of multisensory signaling and to predict the success of species facing environmental changes that affect signaling channels, such as urbanization and climate change. An expanded section is included on the effects of climate change on animal communication across sensory channels, urging researchers to pursue this topic due to the rapidity with which the environment is currently transforming.

  15. Ten years for the public Web

    CERN Multimedia

    2003-01-01

    Ten years ago, CERN issued a statement declaring that a little known piece of software called the World Wide Web was in the public domain. Nowadays, the Web is an indispensable part of modern communications. The idea for the Web goes back to March 1989 when CERN Computer scientist Tim Berners-Lee wrote a proposal for a 'Distributed Information Management System' for the high-energy physics community. The Web was originaly conceived and developed to meet the demand for information sharing between scientists working all over the world. There were many obstacles in the 1980s to the effective exchange of information. There was, for example a great variety of computer and network systems, with hardly any common features. The main purpose of the web was to allow scientists to access information from any source in a consistent and simple way. By Christmas 1990, Berners-Lee's idea had become the World Wide Web, with its first server and browser running at CERN. Through 1991, the Web spread to other particle physics ...

  16. Button Osteoma: A Review of Ten Cases.

    Science.gov (United States)

    Chae, Soo Yuhl; Sim, Hyun Bo; Kim, Min Ji; Jang, Yong Hyun; Lee, Seok-Jong; Kim, Do Won; Lee, Weon Ju

    2015-08-01

    Button osteoma presents as small circumscribed ivory-like lumps on the skull vault. Although not rare, its diagnosis can be challenging for dermatologists. To clarify the clinical characteristics of button osteoma by reviewing 10 cases. Ten patients diagnosed with button osteoma at the Department of Dermatology, Kyungpook National University Hospital, between January 2011 and August 2014 were enrolled. We retrospectively reviewed medical records and analyzed demographic and clinical characteristics including sex, age, sites, number of lesions, symptoms, duration, histopathological finding, radiological findings, and treatment. All patients presented with an asymptomatic small circumscribed hard lump fixed to a bony structure. There were 9 female and 1 male patient, and the mean age was 54 years (range, 28~61 years). The most common site was the forehead, and disease duration ranged from 2 weeks to more than 20 years. The differential diagnosis included cranial exostosis, ballooned osteoma, epidermal cyst, and lipoma. Simple radiography, ultrasonography, and computed tomography (CT) were used to make a confirmative diagnosis. Histopathological findings showed lamellated bony structures with poor vascularization. Ostectomy was performed for 5 patients, and no recurrence was detected within an average of 13.4 months after treatment. This review characterized button osteoma. Surgical excision is a useful therapeutic modality after CT-based diagnosis. Further studies with more patients are required to confirm the findings.

  17. Choledochal cysts: our ten year experience.

    LENUS (Irish Health Repository)

    Cianci, F

    2012-04-01

    We present our experience in the management of choledochal cysts from 1999 to 2009. A retrospective review of all charts with a diagnosis of choledochal cysts in our institution in this ten-year period. Data was collated using Excel. A total of 17 patients were diagnosed with choledochal cyst: 9 females and 8 males. The average age at diagnosis was 28 months (range from 0 to 9 years). The most common presenting symptoms were obstructive jaundice 6 (35%) and abdominal pain and vomiting 4 (23%). Ultrasound (US) was the initial diagnostic test in all cases with 4 patients requiring further investigations. All patients underwent Roux-en-Y Hepaticojejunostomy. The average length of stay was 11 days. Patients were followed up with Liver Function Tests (LFTS) and US 4-6 weeks post-operatively. Three patients developed complications including post-op collection, high drain output requiring blood transfusion and adhesive bowel obstruction. Our overall experience with choledochal cyst patients has been a positive one with effective management and low complication rates.

  18. Ten tips for authors of scientific articles.

    Science.gov (United States)

    Hong, Sung-Tae

    2014-08-01

    Writing a good quality scientific article takes experience and skill. I propose 'Ten Tips' that may help to improve the quality of manuscripts for scholarly journals. It is advisable to draft first version of manuscript and revise it repeatedly for consistency and accuracy of the writing. During the drafting and revising the following tips can be considered: 1) focus on design to have proper content, conclusion, points compliant with scope of the target journal, appropriate authors and contributors list, and relevant references from widely visible sources; 2) format the manuscript in accordance with instructions to authors of the target journal; 3) ensure consistency and logical flow of ideas and scientific facts; 4) provide scientific confidence; 5) make your story interesting for your readers; 6) write up short, simple and attractive sentences; 7) bear in mind that properly composed and reflective titles increase chances of attracting more readers; 8) do not forget that well-structured and readable abstracts improve citability of your publications; 9) when revising adhere to the rule of 'First and Last' - open your text with topic paragraph and close it with resolution paragraph; 10) use connecting words linking sentences within a paragraph by repeating relevant keywords.

  19. Lessons premier hospitals learned about implementing electronic health records.

    Science.gov (United States)

    DeVore, Susan D; Figlioli, Keith

    2010-04-01

    Implementing health information technology (IT) is a major strategic objective for providers. To pinpoint considerations that tie to success, the Premier health care alliance surveyed hospitals to develop an electronic health record best-practices library. Compiled from diverse health care organizations, the library outlines considerations to support "meaningful use" in the areas of computerized physician order entry, medication management, clinical documentation, reporting of measures, privacy, information exchange, management of populations' health, and personal health records. Best practices also uncovered strategies for securing executive leadership, culture change, communication, and support for clinicians. This paper summarizes lessons from the library, providing recommendations to speed up health IT implementation.

  20. Interpreting medicine: lessons from a Spanish-language clinic.

    Science.gov (United States)

    Brown, Benjamin P

    2014-01-01

    Caring for patients is an act of interpretation: we labor to understand the significance of a particular symptom and, when we have reached a diagnosis, we convert our medical jargon into plain language for the benefit of the patient. Caring for patients of limited English proficiency-a population that needs a very literal form of interpretation-underscores this lesson. Working with predominantly Spanish-speaking patients has shown me the importance of bearing witness to patients' struggles and has brought me to realize that good physicians must work to forge a common language with all their patients, not only with those who do not speak English.

  1. Designing and Adapting Tasks in Lesson Planning: A Critical Process of Lesson Study

    Science.gov (United States)

    Fujii, Toshiakira

    2016-01-01

    There is no doubt that a lesson plan is a necessary product of Lesson Study. However, the collaborative work among teachers that goes into creating that lesson plan is largely under-appreciated by non-Japanese adopters of Lesson Study, possibly because the effort involved is invisible to outsiders, with our attention going to its most visible…

  2. Designing and Adapting Tasks in Lesson Planning: A Critical Process of Lesson Study

    Science.gov (United States)

    Fujii, Toshiakira

    2016-01-01

    There is no doubt that a lesson plan is a necessary product of Lesson Study. However, the collaborative work among teachers that goes into creating that lesson plan is largely under-appreciated by non-Japanese adopters of Lesson Study, possibly because the effort involved is invisible to outsiders, with our attention going to its most visible…

  3. "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

    LENUS (Irish Health Repository)

    Walsh, E K

    2010-09-01

    Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

  4. "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

    LENUS (Irish Health Repository)

    Walsh, E K

    2012-02-01

    Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.

  5. The TEN-T core network and the Fehmarnbelt region

    DEFF Research Database (Denmark)

    Guasco, Clement Nicolas

    This note is a snapshot picture, taken in early 2014, that places the Green STRING corridor project within the context of the TEN-T strategy and gives a summarized overview on the impact of this strategy in the region. Chapter 1 contains a summary of the TEN-T strategy today, chapter 2 presents...... the sources used for this note, chapter 3 presents all the relevant EU regulations with direct impact on the development of TEN-T corridors, chapter 4 gives practical examples of the challenges for the development of TEN-T corridors, chapter 5 pre-sents the national initiatives related to the TEN-T corridor...

  6. Rural Entrepreneurship in Nigeria: Lessons From Scientific ...

    African Journals Online (AJOL)

    Rural Entrepreneurship in Nigeria: Lessons From Scientific Management. ... Lwati: A Journal of Contemporary Research. Journal Home ... This article focussed on the lessons that can be garnered from the tenets of Scientific Management.

  7. Didactic Contracts in Realistic Mathematics Education Teaching Practice in Indonesia: A lesson on addition

    DEFF Research Database (Denmark)

    Putra, Zetra Hainul

    This paper aims to investigate characterize features of didactic contracts in realistic mathematics education teaching practice in Indonesia in the case of a lesson on addition. We just focus on some episodes of 26 first grade students and a female teacher from SDN 197 Palembang learning...... combinations that make ten based on a Palembang traditional food, pempek, and tablets of medicine. The result shows that some features such as formulation and validation appear during the teaching and learning process. The students are able to produce combinations that make ten individually and collectively...

  8. Customer care in the NHS.

    Science.gov (United States)

    Ruddick, Fred

    2015-01-20

    Viewing individuals in need of NHS care as customers has the potential to refocus the way their care is delivered. This article highlights some of the benefits of reframing the nurse-patient relationship in terms of customer care, and draws parallels between good customer care and the provision of high quality patient care in the NHS. It explores lessons to be learned from those who have studied the customer experience, which can be adapted to enhance the customer care experience within the health service. Developing professional expertise in the knowledge and skills that underpin good-quality interpersonal encounters is essential to improve the customer experience in health care and should be prioritised alongside the development of more technical skills. Creating a culture where emotional intelligence, caring and compassion are essential requirements for all nursing staff will improve patient satisfaction.

  9. Lesson Plan Design for Facilitating Differentiated Instruction

    Science.gov (United States)

    Baker, Pamela Hudson; Fleming, Louise Conn

    2005-01-01

    This study examines the role of lesson plan design in helping teacher candidates to meet diverse learning needs. The authors studied student teachers who had been taught to use a differential lesson plan to see if they were differentiating in their planning, assessment, and instruction. They concluded that, indeed, lesson plan design does…

  10. Lessons from 30 Years of Flight Software

    Science.gov (United States)

    McComas, David C.

    2015-01-01

    This presentation takes a brief historical look at flight software over the past 30 years, extracts lessons learned and shows how many of the lessons learned are embodied in the Flight Software product line called the core Flight System (cFS). It also captures the lessons learned from developing and applying the cFS.

  11. Environmental Restoration Disposal Facility Lessons Learned

    Energy Technology Data Exchange (ETDEWEB)

    Caulfield, R.

    2012-07-12

    The purpose of lessons learned is to identify insight gained during a project – successes or failures – that can be applied on future projects. Lessons learned can contribute to the overall success of a project by building on approaches that have worked well and avoiding previous mistakes. Below are examples of lessons learned during ERDF’s ARRA-funded expansion project.

  12. More than Tolerance for Engineering Lessons

    Science.gov (United States)

    Burrows, Andrea; Herfat, Safa; Truesdell, Pam; Miller, Richard

    2013-01-01

    Described herein is a science, mathematics, engineering, and technology (STEM) secondary lesson created by graduate engineering student Safa Herfat, with modifications by her co-authors. The lessons learned from this case study are explored through an explanation of tolerance, a description of the lesson, the results obtained, and participant…

  13. Lessons from the Sun

    Directory of Open Access Journals (Sweden)

    Robitaille P.-M.

    2011-07-01

    Full Text Available In this brief note, the implications of a condensed Sun will be examined. A celestial body composed of liquid metallic hydrogen brings great promise to astronomy, relative to understanding thermal emission and solar structure. At the same time, as an incom- pressible liquid, a condensed Sun calls into question virtually everything which is cur- rently believed with respect to the evolution and nature of the stars. Should the Sun be condensed, then neutron stars and white dwarfs will fail to reach the enormous densities they are currently believed to possess. Much of cosmology also falls into question, as the incompressibility of matter curtails any thought that a primordial atom once existed. Aging stars can no longer collapse and black holes will know no formative mechanism. A condensed Sun also hints that great strides must still be made in understanding the nature of liquids. The Sun has revealed that liquids possess a much greater potential for lattice order than previously believed. In addition, lessons may be gained with regards to the synthesis of liquid metallic hydrogen and the use of condensed matter as the basis for initiating fusion on Earth.

  14. Femtosecond photography lessons

    Science.gov (United States)

    Fanchenko, S. D.

    1999-06-01

    Antic scientists, sailors, warriors, physician, etc. were perceiving the space by means of their eye vision system. Nowadays the same people use eyeglasses, telescopes, microscopes, image converters. All these devices fit the necessary magnification, intensification gain and image spectrum to the eyes. The human brain is processing the image data offered to him in a format pertaining to eyes. Hence, the cognition of images can be regarded as a direct measurement. As to the time scale converters, they turned out to be harder done as compared with the spatial scale converters. Hence, the development of the high-speed photography (HSP) continues for more than a hundred and fifty years. The recent pico- femtosecond HSP branch sprang up in 1949 at the Kurchatov Institute -- its cradle. All about the HSP had been advertised. Instead of reprinting what is already well known, it makes sense to emphasize some instructive lessons drawn from past experience. Also it is tempting to look a bit into the high-speed photography future.

  15. Lessons from Rotor 37

    Institute of Scientific and Technical Information of China (English)

    J.D.Denton

    1997-01-01

    NASA rotor 37 was used as a blind test case for turbomachinery CFD by the Turbomachinery Committee of the IGTI.The rotor is a transonic compressor with a tip speed of 454 m/s(1500ft/s)and a relatively high pressure ratio of 2.1.It was tested in isolation with a circumferentially uniform inlet flow so that the flow through it should be steady apart from and effects of passage to passage geometry variation and mechanical vibration.As such it represents the simplest possible type of test for three-dimensional turbomachinery flow solvers.Howerver,the rotor still presents a real challenge to 3D viscous flow solvers because the shock wave-boudary layer interaction is strong and the effects of viscosity are dominant in determining the flow deviation and hence the pressure ration.Eleven blind solutions were submittewd and in addition a non-blind solution was used to prepare for the exercies.This paper reviews the flow in the test case and the comparisons of the CFD solutions with the test data.Lessons for both the Flow physics in transonic fans and for the application of CFD to such machines are pointed out.

  16. Ten Core Competencies for Hospital Administrators.

    Science.gov (United States)

    Freed, David H

    Ever-increasing complexity and contradiction in the health care industry often leave hospital administrators wondering whether they can still make a positive difference for patients. In this context, hospital administrators can regain both perspective and enthusiasm by revitalizing their direct connections with the patients, caregivers, and organizations they serve. Hospital administration remains a special calling, and this article profiles 10 core competencies that will keep health professionals close to their customers, colleagues, and the reasons they entered the helping professions. This intimate knowledge of the organization and its resources coupled with the ability to communicate effectively typically trump advanced education or technical skills in successfully navigating genuinely consequential situations. Hospital administrators who master and practice the 10 competencies can indeed make a positive difference for patients and find great personal reward in doing so.

  17. Ten-Year Mortality after a Breast Cancer Diagnosis in Women with Severe Mental Illness

    DEFF Research Database (Denmark)

    Ribe, Anette Riisgaard; Laurberg, Tinne; Laursen, Thomas Munk

    2016-01-01

    % higher for women with SMI and breast cancer (MRR: 4.27, 95% CI: 3.98-4.57). Among women with both disorders, 15% of deaths could be attributed to interaction. In a sub-cohort of women with breast cancer, the ten-year all-cause-mortality was 59% higher after taking tumor stage into account (MRR: 1.59, 95...... to diagnostics, provision of care for breast cancer or physical comorbidity, health-seeking-behavior, and adherence to treatment....

  18. Tenåringsdrikking i utviklingspsykologisk perspektiv

    Directory of Open Access Journals (Sweden)

    Hilde Pape

    2009-10-01

    Full Text Available  SAMMENDRAGHvorfor er alkohol så populært blant unge mennesker? Dette viktige spørsmålet har vært gjenstand for fåempiriske studier. Forskningsbasert kunnskap om alkoholens positive sider og forsterkende egenskaper erderfor av begrenset omfang. Derimot har tallrike undersøkelser fokusert på ulike skadevirkninger som følgeav tenåringsdrikking. Resultatene av denne forskningen har bidratt til å understreke behovet for en aktivrusforebyggende innsats. Innsikt i alkoholens opplevde goder er imidlertid nødvendig for å kunne utvikleeffektive forebyggingsstrategier. På denne bakgrunn er søkelyset i artikkelen rettet mot psykososiale funksjonerved unge menneskers drikkevaner. Spørsmål knyttet til gruppepress og modell-læring vil også bli berørt.Hensikten er å formidle sentrale funn fra nyere forskning på feltet. Oppsummeringsvis tyder resultatene på atalkohol har en særlig appell til ungdom som er veltilpassede og sosialt anlagte. Samtidig ser det ut til atdrikking kan bidra til å fremme utviklingsprosessen i ungdomstida, men at det primært handler om indirekteeffekter. Hvilke implikasjoner de ulike funnene har mht. forebygging, er skissert i avslutningsdelen.Pape H. Teenage alcohol use from the perspective of psychological development.Nor J EpidemiolEWhy is alcohol so popular among young people? So far, few studies have addressed this important question.The body of scientific research on the positive and reinforcing aspects of drinking is accordingly of limitedextent. Numerous studies have focused on the harmful effects of teenage alcohol use and the findings clearlyunderscore the importance of primary prevention. Knowledge about the perceived advantages of alcohol useis needed to develop effective preventive programs, however. On this background, the article focuses onpsychosocial functions of youthful drinking. Findings from recent research regarding the link between alcoholuse and various indicators of adolescent

  19. Lessons from Queer Bioethics: A Response to Timothy F. Murphy.

    Science.gov (United States)

    Richie, Cristina

    2016-06-01

    'Bioethics still has important work to do in helping to secure status equality for LGBT people' writes Timothy F. Murphy in a recent Bioethics editorial. The focus of his piece, however, is much narrower than human rights, medical care for LGBT people, or ending the HIV/AIDS pandemic. Rather, he is primarily concerned with sexuality and gender identity, and the medical intersections thereof (i.e. DSM diagnosis; access to SrS or ARTs). It is the objective of this response to provide an alternate account of bioethics from a Queer perspective. I will situate Queer bioethics within Queer studies, and offer three 'lessons' that bioethics can derive from this perspective. These are not definitive rules for Queer bioethics, since it is a field which fundamentally opposes categorizations, favoring pastiche over principles. These lessons are exploratory examples, which both complement and contradict LGBT bioethics. My latter two lessons - on environmental bioethics and disability - overlap with some of Murphy's concerns, as well as other conceptions of LGBT bioethics. However, the first lesson takes an antithetical stance to Murphy's primary focus by resisting all forms of heteroconformity and disavowing reproduction as consonant with Queer objectives and theory. The first lesson, which doubles as a primer in Queer theory, does heavy philosophical lifting for the remainder of the essay. This response to Timothy F. Murphy, whose work is certainly a legacy in bioethics, reveals the multiplicity of discourses in LGBT/Queer studies, many of which are advantageous - even essential - to other disciplines like bioethics. © 2016 John Wiley & Sons Ltd.

  20. Long-term Care Insurance of Germany:Recent Reform and Lessons%德国长期护理保险最新改革动态及启示

    Institute of Scientific and Technical Information of China (English)

    华颖

    2016-01-01

    After the New Grand Coalition Government of Germany took offce, it has initiated a new round of reforms in the statutory long-term care insurance. The First and Second Bill of “Strengthen Long-Term Care”have come into operation in 2015 and 2016, aiming to implement reform by two steps, with the main contents of new deifnition of long-term care needs, further classifying the care grades to ifve levels, increasing fund contribution while gradually expanding beneifts, and more supporting for home care. The system has achieved the goal of meeting the long-term care needs of disabled, sustaining home care, stimulating private investment and reducing costs of health insurance and social assistance. While it adapting to the changing society by adjusting itself to be a precise system design, it remains and intensiifes its original features such as partial co-payment, sharing responsibilities and home care ifrst.%本届德国大联合政府上台后,法定长期护理保险迎来了新一轮改革和调整。《护理加强法案》第一部、第二部于2015年、2016年先后生效,旨在通过两个阶段实现改革计划,主要内容包括对长期护理需求重新界定、进一步细分护理等级、提高缴费率的同时提高待遇、为居家护理提供更多支持等。德国长期护理保险制度实现了解决失能护理问题、维系家庭护理、鼓励民间资本投入、减少医疗保险和社会救助支出等多重功能。在因应时代背景变化不断进行调整,走向制度设计精细化的同时,保持并强化着初建时的部分险(需自负一部分)、责任共担、居家护理优先等特色。

  1. Lessons to be learned from an analysis of ammonium nitrate disasters in the last 100 years

    Energy Technology Data Exchange (ETDEWEB)

    Pittman, William; Han, Zhe; Harding, Brian; Rosas, Camilo; Jiang, Jiaojun; Pineda, Alba; Mannan, M. Sam, E-mail: mannan@tamu.edu

    2014-09-15

    Highlights: • Root causes and contributing factors from ammonium nitrate incidents are categorized into 10 lessons. • The lessons learned from the past 100 years of ammonium nitrate incidents can be used to improve design, operation, and maintenance procedures. • Improving organizational memory to help improve safety performance. • Combating and changing organizational cultures. - Abstract: Process safety, as well as the safe storage and transportation of hazardous or reactive chemicals, has been a topic of increasing interest in the last few decades. The increased interest in improving the safety of operations has been driven largely by a series of recent catastrophes that have occurred in the United States and the rest of the world. A continuous review of past incidents and disasters to look for common causes and lessons is an essential component to any process safety and loss prevention program. While analyzing the causes of an accident cannot prevent that accident from occurring, learning from it can help to prevent future incidents. The objective of this article is to review a selection of major incidents involving ammonium nitrate in the last century to identify common causes and lessons that can be gleaned from these incidents in the hopes of preventing future disasters. Ammonium nitrate has been involved in dozens of major incidents in the last century, so a subset of major incidents were chosen for discussion for the sake of brevity. Twelve incidents are reviewed and ten lessons from these incidents are discussed.

  2. Caring Teacher in Developing Empathy in Moral Education

    Science.gov (United States)

    Narinasamy, Ilhavenil; Mamat, Wan Hasmah Wan

    2013-01-01

    In this paper, a case study of an experienced teacher is highlighted illuminating her understanding as a caring agent in the classroom, her caring ways to enhance teacher-student relationships and how she incorporated empathy as a basis of caring in her moral lessons. Methods such as non-participant observations, semi-structured interviews,…

  3. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain

    OpenAIRE

    Little, Paul; Lewith, George; Webley, Fran; Evans, Maggie; Beattie, Angela; Middleton, Karen; Barnett, Jane; Ballard, Kathleen; Oxford, Frances; Smith, Peter; Yardley, Lucy; Hollinghurst, Sandra; Sharp, Debbie

    2008-01-01

    Objective To determine the effectiveness of lessons in the Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain. Design Factorial randomised trial. Setting 64 general practices in England. Participants 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons...

  4. Measured Zero Net Energy Performance: Results, Lessons, and Surprises

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Carrie; LaRue, Anna; Pigman, Margaret; Roberts, Jon; Kaneda, David; Connelly, Dylan; Elliott, John; Pless, Shanti; Pande, Abhijeet; Dean, Edward; Anbarlilar, Can

    2016-08-26

    As more and more zero net energy (ZNE) buildings are built and monitored, we can learn from both careful case studies of individual projects as well as a broader perspective of trends over time. In a forum sponsored by Pacific Gas and Electric Company (PG&E), eight expert speakers discussed: results and lessons from monitoring occupied ZNE buildings; best practices for setting performance targets and getting actionable performance information, and; things that have surprised them about monitored ZNE buildings. This paper distills the content of the forum by laying out the most common hurdles that are encountered in setting up monitoring projects, frequent performance issues that the monitoring uncovers, and lessons learned that can be applied to future projects.

  5. Late lessons from early warnings: science, precaution, innovation

    DEFF Research Database (Denmark)

    Hansen, Steffen Foss

    2013-01-01

    rather than present specific estimates for these costs. Making the best use of environmental science and modelling helps to make environmental protection and precaution a priority. Producing cost estimates should not be left to economists alone, but should rather be seen as a starting point for a broader...... innovations whilst minimising harms. This chapter revisits some key environmental issues for which estimates of costs of inaction have been carefully developed over many years of research. The aim is to consider the methodological challenges involved in producing estimates that are credible and appropriate......The 2013 Late lessons from early warnings report is the second of its type produced by the European Environment Agency (EEA) in collaboration with a broad range of external authors and peer reviewers. The case studies across both volumes of Late lessons from early warnings cover a diverse range...

  6. Transcutaneous electric nerve stimulation (TENS) in dentistry- A review.

    Science.gov (United States)

    Kasat, Vikrant; Gupta, Aditi; Ladda, Ruchi; Kathariya, Mitesh; Saluja, Harish; Farooqui, Anjum-Ara

    2014-12-01

    Transcutaneous electric nerve stimulation (TENS) is a non-pharmacological method which is widely used by medical and paramedical professionals for the management of acute and chronic pain in a variety of conditions. Similarly, it can be utilized for the management of pain during various dental procedures as well as pain due to various conditions affecting maxillofacial region. This review aims to provide an insight into clinical research evidence available for the analgesic and non analgesic uses of TENS in pediatric as well as adult patients related to the field of dentistry. Also, an attempt is made to briefly discuss history of therapeutic electricity, mechanism of action of TENS, components of TENs equipment, types, techniques of administration, advantages and contradictions of TENS. With this we hope to raise awareness among dental fraternity regarding its dental applications thereby increasing its use in dentistry. Key words:Dentistry, pain, TENS.

  7. Refuah Shlema: a cross-cultural programme for promoting communication and health among Ethiopian immigrants in the primary health care setting in Israel: evidence and lessons learned from over a decade of implementation.

    Science.gov (United States)

    Levin-Zamir, Diane; Keret, Sandra; Yaakovson, Orit; Lev, Boaz; Kay, Calanit; Verber, Giora; Lieberman, Niki

    2011-03-01

    The Refuah Shlema programme was established to reduce health disparities, promote health literacy and health indicators of the Ethiopian immigrant community in Israel, and included: (i) integrating Ethiopian immigrant liaisons in primary care as inter-cultural mediators; (ii) in-service training of clinical staff to increase cultural awareness and sensitivity; and (iii) health education community activities. Qualitative and quantitative evidence showed improvements in: (i) clinic staff–patient relations; (ii) availability and accessibility of health services, and health system navigation without increasing service expenditure; (iii) perception of general well-being; and (iv) self-care practice with regards to chronic conditions. Evidence significantly contributed to sustaining the programme for over 13 years.

  8. Lessons from Neno, Malawi

    African Journals Online (AJOL)

    developed that do not overload a health system that is already heavily ... The NCD screening models were integrated into existing platforms, utilising ... Data were collected on specifically designed .... HIV care was fully decentralised in all health facilities and ... Figure 1: Map of Neno District, Malawi, showing locations of.

  9. The origin of the future ten questions for the next ten years

    CERN Document Server

    Gribbin, John

    2006-01-01

    How did the universe begin? Where do galaxies come from? How do stars and planets form? Where do the material particles we are made of come from? How did life begin? Today we have only provisional answers to such questions. But scientific progress will improve these answers dramatically over the next ten years, predicts John Gribbin in this riveting book. He focuses on what we know—or think we know—about ten controversial, unanswered issues in the physical sciences and explains how current cutting-edge research may yield solutions in the very near future. With his trademark facility for engaging readers with or without a scientific background, the author explores ideas concerning the creation of the universe, the possibility of other forms of life, and the fate of the expanding cosmos. He examines “theories of everything,” including grand unified theories and string theory, and he discusses the Big Bang theory, the origin of structure and patterns of matter in the galaxies, and dark mass and dark ene...

  10. Pengaruh Tehnik Akupresur dan TENS Terhadap Intensitas Nyeri Persalinan Kala I Fase Aktif

    Directory of Open Access Journals (Sweden)

    Nelly Karlinah

    2015-09-01

    Full Text Available Abstrak Pengelolaan nyeri persalinan membutuhkan asuhan sayang ibu. Diperlukan suatu manajemen nyeri dalam persalinan dengan metode non farmakologi, salah satunya akupresur dan Transcutaneous Electrical Nerve Stimulation (TENS dengan tujuan meningkatkan rasa aman dan nyaman pada ibu bersalin.Tujuan penelitian ini adalah menentukan pengaruh tehnik akupresur dan TENS terhadap intensitas nyeri persalinan kala I fase aktif. Penelitian dilakukan diwilayah kerja Puskesmas Kampar Kiri Tengah dan Puskesmas Perhentian Raja. Jenis penelitian eksperimental dengan post test only control group desain dengan pengambilan sampel secara consecutive sampling. Jumlah sampel 20 responden setiap kelompok total sampel 60 responden. Data dianalisis univariat dan bivariatmenggunakan uji chi-square. Proporsi intensitas nyeri dengan kategori sedang pada kelompok intervensi akupresur lebih besar dari pada kelompok kontrol pada pembukaan serviks 4 cm.  Berdasarkan uji statistik terdapat pengaruh bermakna dimana nilai p=0,011 (<0,05. Terdapat pengaruh yang bermakna antara kelompok intervensi TENS dankontrol pada pembukaan serviks 8 cm dengan nilai p=0,011 (<0,05. Kesimpulan pengaruh akupresur lebih baik digunakan pada pembukaan 4 cm, sedangkan pengaruh TENS lebih baik digunakan pada pembukaan 8 cm.Kata kunci: intensitas nyeri, akupresur, TENS Abstract Management of pain labor pain needs safe motherhood. It needs a pain management in labor by using nonpharmacological methods, such as acupressure and Transcutaneous Electrical Nerve Stimulation (TENS that may increase safety and comfortable in childbirth. The objective of this study was to determine the effect of acupressure and TENS techniques on pain intensity first stage of labor active phase. This study had been done in Kampar Kiri Tengah and Perhentian Raja health care centres. It was an experimental research study with post test only control group design by using consecutive sampling method. Each group consist of 20

  11. The Design of Lessons Using Mathematics Analysis Software to Support Multiple Representations in Secondary School Mathematics

    Science.gov (United States)

    Pierce, Robyn; Stacey, Kaye; Wander, Roger; Ball, Lynda

    2011-01-01

    Current technologies incorporating sophisticated mathematical analysis software (calculation, graphing, dynamic geometry, tables, and more) provide easy access to multiple representations of mathematical problems. Realising the affordances of such technology for students' learning requires carefully designed lessons. This paper reports on design…

  12. The Design of Lessons Using Mathematics Analysis Software to Support Multiple Representations in Secondary School Mathematics

    Science.gov (United States)

    Pierce, Robyn; Stacey, Kaye; Wander, Roger; Ball, Lynda

    2011-01-01

    Current technologies incorporating sophisticated mathematical analysis software (calculation, graphing, dynamic geometry, tables, and more) provide easy access to multiple representations of mathematical problems. Realising the affordances of such technology for students' learning requires carefully designed lessons. This paper reports on design…

  13. National Training Course. Emergency Medical Technician. Paramedic. Instructor's Lesson Plans. Module Course Guide.

    Science.gov (United States)

    National Highway Traffic Safety Administration (DOT), Washington, DC.

    Designed to help administrators plan and implement an emergency medical technician (EMT) training program, this course guide is intended for use with a series of fifteen instructor lesson plan modules. (The EMT-Paramedic is described as a professional in emergency medical care who has successfully completed a training program that includes formal…

  14. Writing Lessons with Gavin Curtis.

    Science.gov (United States)

    Fu, Danling; Lamme, Linda

    2002-01-01

    Discusses a literature-inspired model of teaching writing and two scenarios of reading and writing connections in the classroom. Presents several reading and writing lessons drawn from the children's book "The Bat Boy and His Violin" by Gavin Curtis. Discusses Curtis' craft and demonstrates how to use this book to teach writing. Includes brief…

  15. Salem Witch Trials. [Lesson Plan].

    Science.gov (United States)

    Maupin, Lara

    Based on Arthur Miller' play "The Crucible," this lesson plan presents activities designed to help students understand that in 17th-century New England, people were persecuted for allegedly practicing witchcraft; students of this period have looked into the allegations and offer alternatives to witchcraft to explain the people's behavior; and…

  16. For Sale: Your Lesson Plans

    Science.gov (United States)

    Greene, Kim

    2016-01-01

    The last several years has seen an increasingly popular trend of teachers buying and selling their lesson plans and other self-created classroom materials in online marketplaces. The leader in this space is a website called Teachers Pay Teachers, which boasts 3.8 million active users. In this article, the author examines why these sites became…

  17. Student-Negotiated Lesson Style

    Science.gov (United States)

    Sampson, Richard J.

    2010-01-01

    This paper presents an overview of action research conducted in an EFL university context, in which data was collected about students' past English learning experiences and hopes for college speaking classes. This data was then used to guide the lesson style for the semester. The study used three cycles of action research over one 15-week…

  18. Analysing student teachers’ lesson plans

    DEFF Research Database (Denmark)

    Carlsen, Louise Meier

    2015-01-01

    I investigate 17 mathematics student teachers’ productions, in view of examining the synergy and interaction between their mathematical and didactical knowledge. The concrete data material consists in lesson plans elaborated for the final exam of a unit on “numbers, arithmetic and algebra...

  19. NASA Materials Related Lessons Learned

    Science.gov (United States)

    Garcia, Danny; Gill, Paul S.; Vaughan, William W.

    2003-01-01

    Lessons Learned have been the basis for our accomplishments throughout the ages. They have been passed down from father to son, mother to daughter, teacher to pupil, and older to younger worker. Lessons Learned have also been the basis for the nation s accomplishments for more than 200 years. Both government and industry have long recognized the need to systematically document and utilize the knowledge gained from past experiences in order to avoid the repetition of failures and mishaps. Through the knowledge captured and recorded in Lessons Learned from more than 80 years of flight in the Earth s atmosphere, NASA s materials researchers are constantly working to develop stronger, lighter, and more durable materials that can withstand the challenges of space. The Agency s talented materials engineers and scientists continue to build on that rich tradition by using the knowledge and wisdom gained from past experiences to create futuristic materials and technologies that will be used in the next generation of advanced spacecraft and satellites that may one day enable mankind to land men on another planet or explore our nearest star. These same materials may also have application here on Earth to make commercial aircraft more economical to build and fly. With the explosion in technical accomplishments over the last decade, the ability to capture knowledge and have the capability to rapidly communicate this knowledge at lightning speed throughout an organization like NASA has become critical. Use of Lessons Learned is a principal component of an organizational culture committed to continuous improvement.

  20. A Lesson in Number Pattern

    Science.gov (United States)

    Fletcher, Rodney

    2008-01-01

    This article presents a guided investigation into the spacial relationships between the centres of the squares in a Fibonacci tiling. It is essentially a lesson in number pattern, but includes work with surds, coordinate geometry, and some elementary use of complex numbers. The investigation could be presented to students in a number of ways…

  1. The Great Gatsby. [Lesson Plan].

    Science.gov (United States)

    Zelasko, Ken

    Based on F. Scott Fitzgerald's novel "The Great Gatsby," this lesson plan presents activities designed to help students understand that adapting part of a novel into a dramatic reading makes students more intimate with the author's intentions and craft; and that a part of a novel may lend itself to various oral interpretations. The main activity…

  2. "Pride and Prejudice". [Lesson Plan].

    Science.gov (United States)

    Soderquist, Alisa

    Based on Jane Austen's novel "Pride and Prejudice," this lesson plan presents activities designed to help students understand that classics are those pieces of literature that continue to be popular long after they were written; classics tend to have universal themes; and Austen's writing has been updated and dramatized and, most likely, will…

  3. Children of War. [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    This lesson plan presents activities in which students read, analyze, and discuss excerpts from children's war diaries; and create a storyboard for a public service announcement on children's rights in wartime. It includes objectives, materials, procedures, extension activities, excerpts of children's war diaries, suggested readings, and web…

  4. Plant ID. Agricultural Lesson Plans.

    Science.gov (United States)

    Southern Illinois Univ., Carbondale. Dept. of Agricultural Education and Mechanization.

    This lesson plan is intended for use in conducting classes on plant identification. Presented first are a series of questions and answers designed to convey general information about the scientific classification of plants. The following topics are among those discussed: main types of plants; categories of vascular plants; gymnosperms and…

  5. Dr. King's Dream. [Lesson Plan].

    Science.gov (United States)

    National Endowment for the Humanities (NFAH), Washington, DC.

    This lesson plan teaches students about the life and work of Martin Luther King, Jr. Students listen to a brief biography, view photographs of the March on Washington, hear a portion of King's "I Have a Dream" speech, and discuss what King's words mean to them. Finally, they will create picture books about their own dreams of freedom for…

  6. In Old Pompeii. [Lesson Plan].

    Science.gov (United States)

    2001

    In this Web-based interdisciplinary lesson (involving social studies, geography, history, and language arts) students take a virtual field trip to the ruins of Pompeii to learn about everyday life in Roman times, then create a travelogue to attract visitors to the site and write an account of their field trip modeled on a description of Pompeii…

  7. Charismatic Leaders: A Lesson Plan.

    Science.gov (United States)

    Johns, Robert W.

    1983-01-01

    Focusing upon Franklin D. Roosevelt and Adolf Hitler, these lessons for high school students in U.S. or world history courses deal with what charismatic leadership is, what circumstances and personality factors generate charismatic movements, and the role, results, and dangers of charismatic leadership. (RM)

  8. Lessons Learned from Exemplary Schools

    Science.gov (United States)

    Schrum, Lynne; Levin, Barbara B.

    2013-01-01

    This article presents lessons learned about successful professional development for promoting technology integration from eight exemplary schools. Through a qualitative investigation into school leaders' and teachers' intentional goals of improving student engagement and achievement, formal, informal, and individual opportunities are described…

  9. "The Scarlet Letter". [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    Based on Nathaniel Hawthorne's novel "The Scarlet Letter," this lesson plan presents activities designed to help students understand that the ending of a novel does not resolve all of the questions that may occur to readers; and that readers may imagine characters living out their lives beyond the ending the author gave to a novel. The main…

  10. Moby-Dick. [Lesson Plan].

    Science.gov (United States)

    Soderquist, Alisa

    Based on Herman Melville's novel "Moby-Dick," this lesson plan presents activities designed to help students understand that the novel is grounded in facts that Melville acquired in his own experiences at sea; New England was the center of a prospering whaling industry in the 19th century; and journal keeping was not uncommon among 19th-century…

  11. Multimedia Principle in Teaching Lessons

    Science.gov (United States)

    Kari Jabbour, Khayrazad

    2012-01-01

    Multimedia learning principle occurs when we create mental representations from combining text and relevant graphics into lessons. This article discusses the learning advantages that result from adding multimedia learning principle into instructions; and how to select graphics that support learning. There is a balance that instructional designers…

  12. Magna Carta at 800: Ten Key Questions Answered

    Science.gov (United States)

    Kaplan, Howard

    2014-01-01

    2015 marks the 800th anniversary of Magna Carta. For Americans, this iconic document is a formative element of our own legal and political heritage. This "Lessons on the Law" column offers an overview of the "Great Charter," why it is significant, and what students and teachers should know about it. The article also highlights…

  13. Ten Things Every Professor Should Know about Assessment

    Science.gov (United States)

    Wolf, Kenneth; Dunlap, Joanna; Stevens, Ellen

    2012-01-01

    This article describes ten key assessment practices for advancing student learning that all professors should be familiar with and strategically incorporate in their classrooms and programs. Each practice or concept is explained with examples and guidance for putting it into practice. The ten are: learning outcomes, performance assessments,…

  14. TRANSCUTANEOUS ELECTRICAL NERVE-STIMULATION (TENS) IN RAYNAUDS-PHENOMENON

    NARCIS (Netherlands)

    MULDER, P; DOMPELING, EC; VANSLOCHTERENVANDERBOOR, JC; KUIPERS, WD; SMIT, AJ

    1991-01-01

    Transcutaneous nerve stimulation (TENS) has been described as resulting in vasodilatation. The effect of 2 Hz TENS of the right hand during forty-five minutes on skin temperature and plethysmography of the third digit of both hands and feet and on transcutaneous oxygen tension (TcpO2) of the right h

  15. Higher Education's Top-Ten Strategic Technologies for 2014

    Science.gov (United States)

    Grajek, Susan

    2014-01-01

    The annual "EDUCAUSE" top-ten IT issues in higher education receives a great deal of interest and attention. IT and higher education leaders use it to calibrate their IT-related activities and inform their strategic planning. This year "EDUCAUSE" is introducing a complementary list: the top-ten strategic technologies in higher…

  16. Benchmark Dose Software Development and Maintenance Ten Berge Cxt Models

    Science.gov (United States)

    This report is intended to provide an overview of beta version 1.0 of the implementation of a concentration-time (CxT) model originally programmed and provided by Wil ten Berge (referred to hereafter as the ten Berge model). The recoding and development described here represent ...

  17. Galileo's Finger - The Ten Great Ideas of Science

    Science.gov (United States)

    Atkins, Peter

    2003-06-01

    Why Galileo's finger? Galileo, one of whose fingers is preserved in a vessel displayed in Florence, provided much of the impetus for modern science, pointing the way out of medieval ignorance. In this brilliant account of the central ideas of contemporary science, Peter Atkins celebrates the effectiveness of Galileo's symbolic finger for revealing the nature of our universe, our world, and ourselves. Galileo's Finger takes the reader on an extraordinary journey that embraces the ten central ideas of current science. "By a great idea," writes Peter Atkins, "I mean a simple concept of great reach, an acorn of an idea that ramifies into a great oak tree of application, a spider of an idea that can spin a great web and draw in a feast of explanation and elucidation." With wit, charm, and patience, Atkins leads the reader to an understanding of the essence of the whole of science, from evolution and the emergence of complexity, to entropy, the spring of all change in the universe; from energy, the universalization of accountancy, to symmetry, the quantification of beauty; and from cosmology, the globalization of reality, to spacetime, the arena of all action. "My intention is for us to travel to the high ridges of science," Atkins tells us. "As the journey progresses and I lead you carefully to the summit of understanding, you will experience the deep joy of illumination that science alone provides." Galileo's Finger breaks new ground in communicating science to the general reader. Here are the essential ideas of today's science, explained in magical prose.

  18. SPECIFIC GRAVITY DETERMINATION OF TEN OVER-THE-COUNTER PRODUCTS

    Directory of Open Access Journals (Sweden)

    Antoine Al-Achi

    2012-10-01

    Full Text Available Commercially available products serve as good examples for the compounding pharmacist to produce quality compounded dosage forms. Their physical and chemical properties, when known, can provide valuable information for preparing similar dosage forms to patients. One of the important physical characteristics of preparations is their specific gravity. The specific gravity is defined as the density of the substance divided by the density of water at a given temperature. We purchased ten non-prescription products from a store in North Carolina. We tested three bottles of each product for their specific gravity using Densito 30PX (Metter Toledo; Switzerland. The instrument is easy to use and allows calibration with a standard liquid (purified water or alcohol, U.S.P. at different temperatures (0oC to 40oC. We measured each bottle of the same product thrice. The following products were tested for their specific gravity at room temperature: Alka-seltzer Plus (Bayer Health Care; Lot#-276698L; Children’s Advil (Wyeth Consumer Healthcare; Lot#-B58397; Children’s Motrin (McNeil Consumer Healthcare; Lot#-ABM011; Children’s Tylenol (McNeil Consumer Healthcare; Lot#-SSM015; Children’s Zyrtec (McNeil Consumer Healthcare; Lot# for bottle 1-809301; Lot# for bottles 2 and 3- 809302; Listerine (Lot#-0619LZ; Oral Health Rinse (TopCare; Lot#-90F1001; Scope (Proctor & Gamble; Lot#-95609187; Theraflu (Novartis Consumer Health; Lot# for bottles 1 and 3-10061769; Lot# for bottle 2-10063059; Tylenol Cold (McNeil Consumer Healthcare; Lot# for bottles 1 and 2-900009; Lot# for bottle 3-808311. The results are summarized in Table 1. The specific gravity for Children’s Motrin, Children’s Tylenol, Listerine, and Scope agree with previously published values using a pycnometer (1.164, 1.306, 1.042, and 1.009, respectively.1 In general, the presence of suspended solid particles increases the specific gravity (e.g., Childrens Tylenol, whereas diluted hydroalcoholic

  19. Using TENS for pain control: the state of the evidence.

    Science.gov (United States)

    Vance, Carol G T; Dailey, Dana L; Rakel, Barbara A; Sluka, Kathleen A

    2014-05-01

    Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological intervention that activates a complex neuronal network to reduce pain by activating descending inhibitory systems in the central nervous system to reduce hyperalgesia. The evidence for TENS efficacy is conflicting and requires not only description but also critique. Population-specific systemic reviews and meta-analyses are emerging, indicating both HF and LF TENS being shown to provide analgesia, specifically when applied at a strong, nonpainful intensity. The purpose of this article is to provide a critical review of the latest basic science and clinical evidence for TENS. Additional research is necessary to determine if TENS has effects specific to mechanical stimuli and/or beyond reduction of pain and will improve activity levels, function and quality of life.

  20. Lessons to be learned from the oldest community psychiatric service in the world: Geel in Belgium

    Science.gov (United States)

    van Bilsen, Henck P. J. G.

    2016-01-01

    This article reviews the family foster care model practised in the small Belgian town of Geel. A historical introduction is followed by a description of a family foster care project in its current form. Issues are raised as to whether the current culture of care pathways, managed care, payment by results and an emphasis on ‘cure’ are conducive to recovery as promoted by the recovery model. Finally, the lessons from Geel are summarised and it is argued that there is much that can be learned from this way of working to support the recovery movement. PMID:27512591

  1. Leveraging Trauma Lessons from War to Win in a Complex Global Environment.

    Science.gov (United States)

    Remick, Kyle N

    2016-01-01

    The US military has made great strides in combat casualty care since 2001. As the Army concludes combat operations in Iraq and Afghanistan, it faces new operational challenges in trauma care. The military medical community must stay ahead of the curve through sustaining current investments in combat casualty care research. This article describes lessons learned at war from a Joint Trauma System perspective in order to place in context how we should proceed in order to provide optimal care for our Warfighters in the future.

  2. Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

    Science.gov (United States)

    Delon, Sandra; Mackinnon, Blair

    2009-01-01

    Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

  3. Lessons learned about ageing and gerontological nursing in South Africa

    Directory of Open Access Journals (Sweden)

    Staja Q. Booker

    2015-02-01

    Full Text Available Background: The unprecedented global growth in older adults merits high-quality gerontological nursing care. As gerontological nursing grows in visibility in developed and developing countries, nurses must possess a broader worldview of ageing with knowledge of physiological, psychosocial, and cultural issues.Purpose: The purpose of this article is to: (1 highlight lessons learned on differences and similarities in ageing and care of older adults in the United States of America (USA and South Africa (SA; and (2 provide recommendations on how to advance gerontological nursingeducation in SA.Methods: A two-week international service-learning project was undertaken by visiting SA and learning about their nursing system and care of older adults. Service-learning is an innovative teaching-learning-service method that provided reflective and hands-on experience of gerontological nursing. This article provides a personal reflection of lessons learned about ageing and gerontological nursing during the service-learning project.Findings: Care of older adults in SA is in many ways different from and similar to that in the USA. Consequently global nurses should recognise those differences and provide culturally appropriate care. This service-learning experience also demonstrated the need for gerontological nursing education in SA. Based on this, recommendations on how to infuse and advance gerontological nursing education in SA are provided.Conclusion: Caring for older adults in a global context requires knowledge and understanding of cultures and their values and practices. With a growing population of diverse older adults, there is a need for incorporation

  4. Utilization of Lesson Analysis as Teacher Self Reflection to Improve the Lesson Design on Chemical Equation Topic

    Science.gov (United States)

    Edyani, E. A.; Supriatna, A.; Kurnia; Komalasari, L.

    2017-02-01

    The research is aimed to investigate how lesson analysis as teacher’s self-reflection changes the teacher’s lesson design on chemical equation topic. Lesson Analysis has been used as part of teacher training programs to improve teacher’s ability in analyzing their own lesson. The method used in this research is a qualitative method. The research starts from build lesson design, implementation lesson design to senior high school student, utilize lesson analysis to get information about the lesson, and revise lesson design. The revised lesson design from the first implementation applied to the second implementation, resulting in better design. This research use lesson analysis Hendayana&Hidayat framework. Video tapped and transcript are employed on each lesson. After first implementation, lesson analysis result shows that teacher-centered still dominating the learning because students are less active in discussion, so the part of lesson design must be revised. After second implementation, lesson analysis result shows that the learning already student-centered. Students are very active in discussion. But some part of learning design still must be revised. In general, lesson analysis was effective for teacher to reflect the lessons. Teacher can utilize lesson analysis any time to improve the next lesson design.

  5. Lessons in redesigning a quality program across the continuum.

    Science.gov (United States)

    Brown, Diane Storer; Church, Lauri; Heywood, Terry; Hills, John F; McCarthy, Sarah; Serway, Cindy

    2003-01-01

    The Kaiser Permanente North East Bay service area redesigned its quality program beginning in 1995, to better mirror how care was provided across the continuum. The old model had evolved over time, was based on departmental structure, and did not focus on all patient populations. The purpose of this article is to describe the redesign process, the quality model implemented, and future directions, with the hope that the lessons learned will provide other healthcare quality professionals some of the knowledge needed and, perhaps, the courage to "design" their quality programs.

  6. Management of civilian and military vascular trauma: lessons learned.

    Science.gov (United States)

    Nguyen, Tony; Kalish, Jeffrey; Woodson, Jonathan

    2010-12-01

    Management of vascular trauma has evolved tremendously since the turn of the 20(th) century. The lessons from each major military conflict over the past 100 years have refined our understanding of how to care for soldiers and civilians with vascular injuries. The recent wars in Iraq and Afghanistan have likewise improved our strategy for treating victims of vascular trauma. Understanding the principles that guide management of vascular injuries will result in preservation of life and limb. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Ballistic Trauma: Lessons Learned from Iraq and Afghanistan

    Science.gov (United States)

    Shin, Emily H.; Sabino, Jennifer M.; Nanos, George P.; Valerio, Ian L.

    2015-01-01

    Management of upper extremity injuries secondary to ballistic and blast trauma can lead to challenging problems for the reconstructive surgeon. Given the recent conflicts in Iraq and Afghanistan, advancements in combat-casualty care, combined with a high-volume experience in the treatment of ballistic injuries, has led to continued advancements in the treatment of the severely injured upper extremity. There are several lessons learned that are translatable to civilian trauma centers and future conflicts. In this article, the authors provide an overview of the physics of ballistic injuries and principles in the management of such injuries through experience gained from military involvement in Iraq and Afghanistan. PMID:25685099

  8. The keys to successful diversification: lessons from leading hospital systems.

    Science.gov (United States)

    Shortell, S M; Morrison, E; Hughes, S

    1989-01-01

    Hospitals have engaged in a variety of diversification activities over the past five years--many of which have not met expectations. Based on a nationwide study of 570 hospitals belonging to eight leading hospital systems (both investor-owned and not-for-profit), four key factors are identified that differentiate the winners from the losers. These include strategies for working effectively with physicians; learning to combine centralized and decentralized strategic planning approaches; understanding partially related diversification; and effectively applying the experience curve. Putting these lessons to work will increase the probability of a more effectively diversified health care system in the future.

  9. Transcutaneous electrical nerve stimulation (TENS) in angina pectoris.

    Science.gov (United States)

    Mannheimer, C; Carlsson, C A; Vedin, A; Wilhelmsson, C

    1986-09-01

    The aim of this study was to determine the efficacy of transcutaneous electrical nerve stimulation (TENS) in the treatment of chronic stable severe angina pectoris. In a short-term study the effect of TENS was studied in 10 male patients with angina pectoris (functional class III and IV). All patients had previously been stabilized on long-term maximal oral treatment. The effects of the treatment were measured by means of repeated bicycle ergometer tests. All patients had an increased working capacity (16-85%), decreased ST segment depression and reduced recovery time during TENS. No adverse effects were observed. A long-term study of TENS on similarly selected patients showed beneficial effects in terms of pain reduction, reduced frequency of anginal attacks, increased physical activity and increased working capacity during bicycle ergometer tests. An invasive study was carried out with respect to systemic and coronary hemodynamics and myocardial metabolism during pacing provoked myocardial ischemia in 13 patients. The results showed that TENS led to an increased tolerance to pacing, improved lactate metabolism, less pronounced ST segment depression. A drop in systolic blood pressure during TENS treatment at identical pacing rates indicated a decreased afterload. An increased coronary flow to ischemic areas in the myocardium was supported by the fact that the rate pressure product during anginal pain increased during TENS.

  10. Educators' Curriculum Guide. Quality Assurance and Animal Care: Youth Education Program.

    Science.gov (United States)

    Busboom, Jan R.; Newman, Jerry A.; Shulaw, William P.; Jeffreys, J. Bradford

    This curriculum guide contains a six-unit, two-level program combining animal science and veterinary care for youth club leaders and members in grades three through twelve. The Facilitator and Educator/Leader Introductions describe the program, the goals, and the students who will participate. The six lesson plans contain what the lesson is about,…

  11. Implementing Business Process Redesign: early lessons from the Australian experience

    Directory of Open Access Journals (Sweden)

    Marianne Broadbent

    1995-05-01

    Full Text Available Business Process Redesign (BPR is a change management approach aimed at achieving quantum improvements in business performance. Industry interest levels in BPR are high as a direct result of current difficulties in the global economic climate and tight business conditions. Integral to BPR is the availability of new stable technologies which both stimulate and enable process changes. This paper highlights the experiences of a number of Australian firms which have implemented BPR. A ten step framework for BPR is presented together with a series of caveats. BPR is a difficult, messy and often non-linear activity which challenges many of the ways organisations operate. Information Technology plays a pivotal role in BPR as both an enabler and disenabler for change. Lessons emerging from early Australian experiences with BPR focus on the role of executive sponsorship, consultants, measurements, education and training, technology and people involved in the change process.

  12. Nuclear Instrumentation and Control Cyber Testbed Considerations – Lessons Learned

    Energy Technology Data Exchange (ETDEWEB)

    Jonathan Gray; Robert Anderson; Julio G. Rodriguez; Cheol-Kwon Lee

    2014-08-01

    Abstract: Identifying and understanding digital instrumentation and control (I&C) cyber vulnerabilities within nuclear power plants and other nuclear facilities, is critical if nation states desire to operate nuclear facilities safely, reliably, and securely. In order to demonstrate objective evidence that cyber vulnerabilities have been adequately identified and mitigated, a testbed representing a facility’s critical nuclear equipment must be replicated. Idaho National Laboratory (INL) has built and operated similar testbeds for common critical infrastructure I&C for over ten years. This experience developing, operating, and maintaining an I&C testbed in support of research identifying cyber vulnerabilities has led the Korean Atomic Energy Research Institute of the Republic of Korea to solicit the experiences of INL to help mitigate problems early in the design, development, operation, and maintenance of a similar testbed. The following information will discuss I&C testbed lessons learned and the impact of these experiences to KAERI.

  13. Care Transitions in Long-term Care and Acute Care: Health Information Exchange and Readmission Rates.

    Science.gov (United States)

    Yeaman, Brian; Ko, Kelly J; Alvarez del Castillo, Rodolfo

    2015-09-30

    Care transitions between settings are a well-known cause of medical errors. A key component of transition is information exchange, especially in long-term care (LTC). However, LTC is behind other settings in adoption of health information technologies (HIT). In this article, we provide some brief background information about care transitions in LTC and concerns related to technology. We describe a pilot project using HIT and secure messaging in LTC to facilitate electronic information exchange during care transitions. Five LTC facilities were included, all located within Oklahoma and serviced by the same regional health system. The study duration was 20 months. Both inpatient readmission and return emergency department (ED) visit rates were lower than baseline following implementation. We provide discussion of positive outcomes, lessons learned, and limitations. Finally, we offer implications for practice and research for implementation of HIT and information exchange across care settings that may contribute to reduction in readmission rates in acute care and ED settings.

  14. Lessons-Learned from an Event during Overhaul

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jitae [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2013-05-15

    The event frequency, also including portion of human errors, has been decreasing compared to last ten years. However, events due to human errors during overhaul occur every year. From analyzed results for human-related events during overhaul, similar problems were identified. And organizational and safety cultural factors were also identified. On the other hand, another event during overhaul is analyzed and Lessons-Learned is drawn in an aspect of the operators' situation awareness. There was an event during overhaul and the analyzed results drawn Lessons-Learned in the aspect of the operators' situation awareness. From the analysis, several alarms and variation of plant parameters during overhaul can occur due to various maintenance works and tests. And in the aspect of the situation awareness, operators can miss, neglect, or not recognize the abnormal situation due to other maintenance activities occurring simultaneously. Therefore, countermeasures such as operator education or training, development of operator support systems, and further researches should be necessary to cope with these problems.

  15. System safety management lessons learned

    Energy Technology Data Exchange (ETDEWEB)

    Piatt, J.A.

    1989-05-01

    The Assistant Secretary of the Army for Research, Development and Acquisition directed the Army Safety Center to provide an audit of the causes of accidents and safety of use restrictions on recently fielded systems by tracking residual hazards back through the acquisition process. The objective was to develop ''lessons learned'' that could be applied to the acquisition process to minimize mishaps in fielded systems. System safety management lessons learned are defined as Army practices or policies, derived from past successes and failures, that are expected to be effective in eliminating or reducing specific systemic causes of residual hazards. They are broadly applicable and supportive of the Army structure and acquisition objectives. 29 refs., 7 figs.

  16. USING LITERATURE IN GEOGRAPHY LESSONS

    Directory of Open Access Journals (Sweden)

    ROXANA HOBAI

    2015-01-01

    Full Text Available Including in a novel information about relief, climate, vegetation, fauna and various aspects of socio-economic life can make literature a real source of geographical information. Using realistic literary works in Geography lessons has multiple benefits, which are not limited only to geographical knowledge. In this paper there are some fragments from literature, suggestions of activities about how to integrate the fragments during Geography lessons and the results of these activities. The activities are from fifth to twelfth grade, passing through a first example of water pollution resulting from a Hercules labour, through the lyricism of the aurora borealis description, through the dramatic life of a refugee from Darfur, through the Dobrudgea winter landscape, through the grey urban landscape of Bucharest in the 90s and so on. Students were put into learning situations that stimulated their creativity, developed communication competencies and enriched their general knowledge.

  17. New Lessons for Districtwide Reform

    Science.gov (United States)

    Fullan, Micheal; Bertani, Al; Quinn, Joanne

    2004-01-01

    Successful district level institutions share ten principles for successful reforms. The crucial components of change for effective leadership include a collective moral purpose, capacity building, ongoing learning, and demanding culture among others.

  18. Nonresponse error in mail surveys: top ten problems

    National Research Council Canada - National Science Library

    Daly, Jeanette M; Jones, Julie K; Gereau, Patricia L; Levy, Barcey T

    2011-01-01

    ... utilizing the Dillman Total Design Method. Ten nonresponse error problems were identified, such as inserter machine gets sequence out of order, capitalization in databases, and mailing discarded by postal service...

  19. Nonresponse Error in Mail Surveys: Top Ten Problems

    National Research Council Canada - National Science Library

    Daly, Jeanette M; Jones, Julie K; Gereau, Patricia L; Levy, Barcey T

    2011-01-01

    ... utilizing the Dillman Total Design Method. Ten nonresponse error problems were identified, such as inserter machine gets sequence out of order, capitalization in databases, and mailing discarded by postal service...

  20. Managing mountain hardwoods - a ten-year appraisal

    Science.gov (United States)

    George R., Jr. Trimble

    1961-01-01

    Ten years ago - in 1949 - four 5-acre plots were established on the Fernow Experimental Forest near Parsons, West Virginia, to show the effects upon mountain hardwoods of each of four management treatments.