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Sample records for care ten lessons

  1. Ten Lessons from Ten Years PPP Experience in Belgium

    NARCIS (Netherlands)

    Willems, T.; Verhoest, K.; Voets, J.; Coppens, T.; van Dooren, W.; van den Hurk, M.

    2017-01-01

    In 2004 Flanders, the northern region of Belgium launched a range of large public–private partnership (PPP) projects for a total value of 6 billion euros. Ten years later, PPP has become a well-embedded procurement method for long-term public infrastructure projects. This article makes a critical

  2. 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.

  3. Treating Social Anxiety in Adolescents: Ten Group Therapy Lesson Plans

    Science.gov (United States)

    Mazur-Elmer, Alison; McBride, Dawn

    2009-01-01

    This project provides a comprehensive overview of the research literature on social anxiety disorder (SAD) in adolescents and concludes by offering a set of 10 group therapy lesson plans for SAD that therapists can use in their practice. The overview includes a description of social anxiety disorder and highlights various theories of anxiety. The…

  4. Social Networking Sites and Addiction: Ten Lessons Learned

    OpenAIRE

    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 onl...

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. The Top Ten Websites in Critical Care Medicine Education Today.

    Science.gov (United States)

    Wolbrink, Traci A; Rubin, Lucy; Burns, Jeffrey P; Markovitz, Barry

    2018-01-01

    The number of websites for the critical care provider is rapidly growing, including websites that are part of the Free Open Access Med(ical ed)ucation (FOAM) movement. With this rapidly expanding number of websites, critical appraisal is needed to identify quality websites. The last major review of critical care websites was published in 2011, and thus a new review of the websites relevant to the critical care clinician is necessary. A new assessment tool for evaluating critical care medicine education websites, the Critical Care Medical Education Website Quality Evaluation Tool (CCMEWQET), was modified from existing tools. A PubMed and Startpage search from 2007 to 2017 was conducted to identify websites relevant to critical care medicine education. These websites were scored based on the CCMEWQET. Ninety-seven websites relevant for critical care medicine education were identified and scored, and the top ten websites were described in detail. Common types of resources available on these websites included blog posts, podcasts, videos, online journal clubs, and interactive components such as quizzes. Almost one quarter of websites (n = 22) classified themselves as FOAM websites. The top ten websites most often included an editorial process, high-quality and appropriately attributed graphics and multimedia, scored much higher for comprehensiveness and ease of access, and included opportunities for interactive learning. Many excellent online resources for critical care medicine education currently exist, and the number is likely to continue to increase. Opportunities for improvement in many websites include more active engagement of learners, upgrading navigation abilities, incorporating an editorial process, and providing appropriate attribution for graphics and media.

  10. 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.

  11. Ten good reasons to practice ultrasound in critical care.

    Science.gov (United States)

    Lichtenstein, Daniel; van Hooland, Simon; Elbers, Paul; Malbrain, Manu L N G

    2014-01-01

    Over the past decade, critical care ultrasound has gained its place in the armamentarium of monitoring tools. A greater understanding of lung, abdominal, and vascular ultrasound plus easier access to portable machines have revolutionised the bedside assessment of our ICU patients. Because ultrasound is not only a diagnostic test, but can also be seen as a component of the physical exam, it has the potential to become the stethoscope of the 21st century. Critical care ultrasound is a combination of simple protocols, with lung ultrasound being a basic application, allowing assessment of urgent diagnoses in combination with therapeutic decisions. The LUCI (Lung Ultrasound in the Critically Ill) consists of the identification of ten signs: the bat sign (pleural line); lung sliding (seashore sign); the A-lines (horizontal artefact); the quad sign and sinusoid sign indicating pleural effusion; the fractal and tissue-like sign indicating lung consolidation; the B-lines and lung rockets indicating interstitial syndromes; abolished lung sliding with the stratosphere sign suggesting pneumothorax; and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. The BLUE protocol (Bedside Lung Ultrasound in Emergency) is a fast protocol (respiratory failure. With this protocol, it becomes possible to differentiate between pulmonary oedema, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, asthma, and pneumothorax, each showing specific ultrasound patterns and profiles. The FALLS protocol (Fluid Administration Limited by Lung Sonography) adapts the BLUE protocol to be used in patients with acute circulatory failure. It makes a sequential search for obstructive, cardiogenic, hypovolemic, and distributive shock using simple real-time echocardiography in combination with lung ultrasound, with the appearance of B-lines considered to be the endpoint for fluid therapy

  12. 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.

  13. [Dental care in pregnancy. Ten questions and answers].

    Science.gov (United States)

    Patcas, Raphael; Schmidlin, Patrick R; Zimmermann, Roland; Gnoinski, Wanda

    2012-01-01

    Dental care of pregnant patients is a demanding task. On one hand, clinicians are facing patients with an altered physiology that may cause a greater need for treatment. On the other hand, pregnancy in itself as well as the unborn child involves potential contraindications to dental interventions. It is therefore essential that dentists be knowledgeable of the ramifications pregnancy has on medical findings and therapy. Also, clinicians must be able to conduct their treatment based on well-grounded data to avoid any harm to the pregnant woman and her unborn child. This article focuses on facts specifically relevant to clinicians. Based on most current scientific data, we aim to answer the following ten questions: 1. What are the physiological changes during pregnancy? 2. What is the adequate lying position for a pregnant patient? 3. Is there a pregnancy-related gingivitis? 4. What is the association between periodontitis, pregnancy and preterm birth? 5. Are there oral manifestations of pregnancy-related therapies? 6. Are caries and erosions inevitable during pregnancy? 7. Should the intake of fluoride be advocated? 8. Is it permissible to x-ray pregnant patients? 9. Is orthodontics contraindicated during pregnancy and 10. Which medication should be administered with caution?

  14. 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.

  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. 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.

  17. 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.

  18. From the Games Industry: Ten Lessons for Game-Based Learning

    Science.gov (United States)

    Hollins, Paul; Whitton, Nicola

    2011-01-01

    This paper draws on lessons learned from the development process of the entertainment games industry and discusses how they can be applied to the field of game-based learning. This paper examines policy makers and those wishing to commission or develop games for learning and highlights potential opportunities as well as pitfalls. The paper focuses…

  19. 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.…

  20. 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 sampling, data collection and data analysis [15]. We used multiple case sampling [28] to establish a trustworthy profile of five to eight year old children and reputational case selection [28] to choose the relevant theories of development, research... here will confirm. For this paper we selected, from the complete framework, ten themes to focus on. We present the guidelines associated with these themes as ten ‘lessons’ grounded in respected theoretical or empirical research results...

  1. 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…

  2. The Aethereal Network on Chip after Ten Years: Goals, Evolution, Lessons, and Future

    NARCIS (Netherlands)

    Goossens, Kees; Hansson, A.

    2010-01-01

    The goals for the Æthereal network on silicon, as it was then called, were set in 2000 and its concepts were defined early 2001. Ten years on, what has been achieved? Did we meet the goals, and what is left of the concepts? In this paper we answer those questions, and evaluate different

  3. The aethereal network on chip after ten years: Goals, evolution, lessons and future

    NARCIS (Netherlands)

    Goossens, K.G.W.; Hansson, M.A.

    2010-01-01

    The goals for the Æthereal network on silicon, as it was then called, were set in 2000 and its concepts were defined early 2001. Ten years on, what has been achieved? Did we meet the goals, and what is left of the concepts? In this paper we answer those questions, and evaluate different

  4. 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.

  5. 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

  6. Applying squeezing technique to clay-rocks: lessons learned from ten years experiments at Mont Terri

    International Nuclear Information System (INIS)

    Fernandez, A. M.; Melon, A.; Sanchez-Ledesma, D.M.; Tournassat, C.; Gaucher, E.; Astudillo, J.; Vinsot, A.

    2012-01-01

    Document available in extended abstract form only. Argillaceous formations of low permeability are considered in several countries as potential host rocks for the disposal of high level radioactive wastes (HLRW). In order to determine their suitability for waste disposal, evaluations of the hydro-geochemistry and transport mechanisms from such geologic formations to the biosphere must be undertaken. The migration of radionuclides through the geosphere will occur predominantly in the aqueous phase, and hence the pore water chemistry plays an important role in determining ion diffusion characteristics in argillaceous formations. Consequently, a great effort has been made to characterise the pore water chemistry in clay-rocks formations. In the last 10 years various techniques were developed for determining pore water composition of clay-rocks including both direct and indirect methods: 1) In situ pore water sampling (water and gas) from sealed boreholes (Pearson et al., 2003; Vinsot et al. 2008); 2) Laboratory pore water sampling from unaltered core samples by the squeezing technique at high pressures (Fernandez et al., 2009); and 3) Characterization of the water chemistry by geochemical modelling (Gaucher et al. 2009). Pore water chemistry in clay-rocks and extraction techniques were documented and reviewed in different studies (Sacchi et al., 2001). Recovering pristine pore water from low permeable and low water content systems is very difficult and sometimes impossible. Besides, uncertainties are associated to each method used for the pore water characterization. In this paper, a review about the high pressure squeezing technique applied to indurate clay-rocks was performed. For this purpose, the experimental work on Opalinus Clay at the Mont Terri Research Laboratory during the last ten years was evaluated. A complete discussion was made about different issues such as: a) why is necessary to obtain the pore water by squeezing in the context of radioactive waste

  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. Implementing Indigenous community control in health care: lessons from Canada.

    Science.gov (United States)

    Lavoie, Josée G; Dwyer, Judith

    2016-09-01

    Objective Over past decades, Australian and Canadian Indigenous primary healthcare policies have focused on supporting community controlled Indigenous health organisations. After more than 20 years of sustained effort, over 89% of eligible communities in Canada are currently engaged in the planning, management and provision of community controlled health services. In Australia, policy commitment to community control has also been in place for more than 25 years, but implementation has been complicated by unrealistic timelines, underdeveloped change management processes, inflexible funding agreements and distrust. This paper discusses the lessons from the Canadian experience to inform the continuing efforts to achieve the implementation of community control in Australia. Methods We reviewed Canadian policy and evaluation grey literature documents, and assessed lessons and recommendations for relevance to the Australian context. Results Our analysis yielded three broad lessons. First, implementing community control takes time. It took Canada 20 years to achieve 89% implementation. To succeed, Australia will need to make a firm long term commitment to this objective. Second, implementing community control is complex. Communities require adequate resources to support change management. And third, accountability frameworks must be tailored to the Indigenous primary health care context to be meaningful. Conclusions We conclude that although the Canadian experience is based on a different context, the processes and tools created to implement community control in Canada can help inform the Australian context. What is known about the topic? Although Australia has promoted Indigenous control over primary healthcare (PHC) services, implementation remains incomplete. Enduring barriers to the transfer of PHC services to community control have not been addressed in the largely sporadic attention to this challenge to date, despite significant recent efforts in some jurisdictions

  9. Ten clinician-driven strategies for maximising value of Australian health care.

    Science.gov (United States)

    Scott, Ian

    2014-05-01

    To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low- or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia. What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of

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

    African Journals Online (AJOL)

    Structure of Primary Health Care: Lessons from a Rural Area in South-West Nigeria. ... of the facilities enjoyed community participation in planning and management. There ... None of the facilities had a functional 2-way referral system in place.

  11. Associations of government health expenditures, the supply of health care professionals, and country literacy with prenatal care use in ten West African countries.

    Science.gov (United States)

    Taylor, Yhenneko J; Laditka, Sarah B; Laditka, James N; Brunner Huber, Larissa R; Racine, Elizabeth F

    2017-03-01

    Social and health care context may influence prenatal care use. We studied associations of government health expenditures, supply of health care professionals, and country literacy rates with prenatal care use in ten West African countries, controlling for individual factors. We used data from Demographic and Health Surveys (n = 58,512) and random effect logistic regression models to estimate the likelihood of having any prenatal care and adequate prenatal care. Each percentage increase in the literacy rate was associated with 4% higher odds of having adequate prenatal care (p = .029). Higher literacy rates among women may help to promote adequate prenatal care.

  12. Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative.

    Science.gov (United States)

    Anglin, Grace; Tu, H A; Liao, Kristie; Sessums, Laura; Taylor, Erin Fries

    2017-09-01

    Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations. With increasing frequency, public and private payers are joining forces to align goals and resources for primary care transformation. However, sustaining engagement and achieving coordination among payers can be challenging. The Comprehensive Primary Care (CPC) initiative is one of the largest multipayer initiatives ever tested. Drawing on the experience of the CPC initiative, this paper examines the factors that influence the effectiveness of multipayer collaboration. This paper draws largely on semistructured interviews with CPC-participating payers and payer conveners that facilitated CPC discussions and on observation of payer meetings. We coded and analyzed these qualitative data to describe collaborative dynamics and outcomes and assess the factors influencing them. We found that several factors appeared to increase the likelihood of successful payer collaboration: contracting with effective, neutral payer conveners; leveraging the support of payer champions, and seeking input on decisions from practice representatives. The presence of these factors helped some CPC regions overcome significant initial barriers to achieve common goals. We also found that leadership from the Centers for Medicare & Medicaid

  13. Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care.

    Science.gov (United States)

    Yedidia, Michael J

    2007-01-01

    Palliative care was studied for its potential to yield lessons for transforming doctor-patient relationships to promote patient-centered care. Examination of patient and provider experiences of the transition from curative to palliative care promises valuable insights about establishing and maintaining trust as the goals of care shift and about addressing a broad spectrum of patient needs. The study was guided by a conceptual framework grounded in existing models to address five dimensions of doctor-patient relationships: range of needs addressed, source of authority, maintenance of trust, emotional involvement, and expression of authenticity. Data collection included observation of the care of 40 patients in the inpatient hospice unit and at home, interviews with patients and family members, and in-depth interviews with 22 physicians and two nurses providing end-of-life care. Standard qualitative procedures were used to analyze the data, incorporating techniques for maximizing the validity of the results and broadening their relevance to other contexts. Findings provide evidence for challenging prominent assumptions about possibilities for doctor-patient relationships: questioning the merits of the prohibition on emotional involvement, dependence on protocols for handling difficult communication issues, unqualified reliance on consumer empowerment to assure that care is responsive to patients' needs, and adoption of narrowly defined boundaries between medical and social service systems in caring for patients. Medical education can play a role in preparing doctors to assume new roles by openly addressing management of emotions in routine clinical work, incorporating personal awareness training, facilitating reflection on interactions with patients through use of standardized patients and videotapes, and expanding capacity to effectively address a broad range of needs through teamwork training.

  14. 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.

  15. Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

    OpenAIRE

    Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

    2017-01-01

    Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to su...

  16. Ten Things Gay Men Should Discuss with Their Health Care Provider

    Science.gov (United States)

    ... Conference Newsroom Support GLMA Site Search Ten Things Gay Men Should discuss with Their Healthcare Provider ( Download . ... have identified as most commonly of concern for gay men. While not all of these items apply ...

  17. Ten years of ASTER thermal infrared data from Terra: Discoveries, lessons learned, and insights into future missions

    Science.gov (United States)

    Ramsey, M. S.; Dehn, J.; Duda, K.; Hughes, C. G.; Lee, R.; Rose, S.; Scheidt, S. P.; Wessels, R. L.

    2009-12-01

    instrument particularly useful for numerous aspects of volcanic and eolian remote sensing. The lessons learned in applying these data to a wide range of surface science questions are critically important to consider during the planning for the next generation of orbital TIR sensors such as the proposed NASA Hyperspectral Infrared Imager (HyspIRI) mission.

  18. Associations of Household Wealth and Individual Literacy with Prenatal Care in Ten West African Countries.

    Science.gov (United States)

    Taylor, Yhenneko J; Laditka, Sarah B; Laditka, James N; Huber, Larissa R Brunner; Racine, Elizabeth F

    2016-11-01

    Objective To examine associations of household wealth and individual literacy with prenatal care in West Africa. Methods Data on women with recent births in Benin, Burkina Faso, Ghana, Guinea, Liberia, Mali, Nigeria, Niger, Senegal and Sierra Leone were obtained from 2006 to 2010 Demographic and Health Surveys (n = 58,512). Separate logistic regressions estimated associations of literacy and wealth quintiles with prenatal care, controlling for age, parity, marital status, rural/urban residence, religion, multiple births, pregnancy wantedness, and the woman's involvement in decision-making at home. Any prenatal care was defined by ≥1 prenatal care visit. Adequate prenatal care was defined as at least four prenatal care visits beginning in the first trimester, at least one with a skilled provider. Results Seventy-eight percent of women had any prenatal care; 23 % had adequate care. Women who were not literate had lower odds of having any prenatal care (odds ratio, OR 0.29; 95 % confidence interval, CI 0.26-0.33) and lower odds of adequate care (OR 0.73, CI 0.68-0.78). Women in the poorest wealth quintile were substantially less likely to have any prenatal care than women in the wealthiest quintile (OR 0.24, CI 0.11-0.18), and less likely to have adequate care (OR 0.31, CI 0.27-0.35). Conclusions for Practice A substantial percentage of women in West Africa have no prenatal care. Few have adequate care. Illiteracy and poverty are important risk factors for having little or no prenatal care. Increasing education for girls, promoting culturally appropriate messages about prenatal care, and building trust in providers may increase prenatal care.

  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. 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...... 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......; 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...

  1. 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...... 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...

  2. Funding models in palliative care: Lessons from international experience

    Science.gov (United States)

    Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss EM

    2017-01-01

    Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest. PMID:28156188

  3. Funding models in palliative care: Lessons from international experience.

    Science.gov (United States)

    Groeneveld, E Iris; Cassel, J Brian; Bausewein, Claudia; Csikós, Ágnes; Krajnik, Malgorzata; Ryan, Karen; Haugen, Dagny Faksvåg; Eychmueller, Steffen; Gudat Keller, Heike; Allan, Simon; Hasselaar, Jeroen; García-Baquero Merino, Teresa; Swetenham, Kate; Piper, Kym; Fürst, Carl Johan; Murtagh, Fliss Em

    2017-04-01

    Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. To assess national models and methods for financing and reimbursing palliative care. Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest.

  4. Lessons from the domestic Ebola response: Improving health care system resilience to high consequence infectious diseases.

    Science.gov (United States)

    Meyer, Diane; Kirk Sell, Tara; Schoch-Spana, Monica; Shearer, Matthew P; Chandler, Hannah; Thomas, Erin; Rose, Dale A; Carbone, Eric G; Toner, Eric

    2018-05-01

    The domestic response to the West Africa Ebola virus disease (EVD) epidemic from 2014-2016 provides a unique opportunity to distill lessons learned about health sector planning and operations from those individuals directly involved. This research project aimed to identify and integrate these lessons into an actionable checklist that can improve health sector resilience to future high-consequence infectious disease (HCID) events. Interviews (N = 73) were completed with individuals involved in the domestic EVD response in 4 cities (Atlanta, Dallas, New York, and Omaha), and included individuals who worked in academia, emergency management, government, health care, law, media, and public health during the response. Interviews were transcribed and analyzed qualitatively. Two focus groups were then conducted to expand on themes identified in the interviews. Using these themes, an evidence-informed checklist was developed and vetted for completeness and feasibility by an expert advisory group. Salient themes identified included health care facility issues-specifically identifying assessment and treatment hospitals, isolation and treatment unit layout, waste management, community relations, patient identification, patient isolation, limitations on treatment, laboratories, and research considerations-and health care workforce issues-specifically psychosocial impact, unit staffing, staff training, and proper personal protective equipment. The experiences of those involved in the domestic Ebola response provide critical lessons that can help strengthen resilience of health care systems and improve future responses to HCID events. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  5. Clinical review: International comparisons in critical care - lessons learned.

    Science.gov (United States)

    Murthy, Srinivas; Wunsch, Hannah

    2012-12-12

    Critical care medicine is a global specialty and epidemiologic research among countries provides important data on availability of critical care resources, best practices, and alternative options for delivery of care. Understanding the diversity across healthcare systems allows us to explore that rich variability and understand better the nature of delivery systems and their impact on outcomes. However, because the delivery of ICU services is complex (for example, interplay of bed availability, cultural norms and population case-mix), the diversity among countries also creates challenges when interpreting and applying data. This complexity has profound influences on reported outcomes, often obscuring true differences. Future research should emphasize determination of resource data worldwide in order to understand current practices in different countries; this will permit rational pandemic and disaster planning, allow comparisons of in-ICU processes of care, and facilitate addition of pre- and post-ICU patient data to better interpret outcomes.

  6. Not the Color Purple: Black Feminist Lessons for Educational Caring.

    Science.gov (United States)

    Thompson, Audrey

    1998-01-01

    Asserts that theories of caring in education have avoided issues of racial imbalance. Reinterprets these themes from a black feminist perspective: moral relevance, primacy of survival, significance of one's standpoint, and the moral power of narrative. (SK)

  7. Ten Simple Rules for the Care and Feeding of Scientific Data

    OpenAIRE

    Goodman, A.; Pepe, A.; Blocker, A.W.; Borgman, C.L.; Cranmer, K.; Crosas, M.; Di Stefano, R.; Gil, Y; Groth, P.T.; Hedstrom, M.; Hogg, D.W.; Kashyap, V.; Mahabal, A.; Siemiginowska, A.; Slavkovic, A.

    2014-01-01

    In the early 1600s, Galileo Galilei turned a telescope toward Jupiter. In his log book each night, he drew to-scale schematic diagrams of Jupiter and some oddly moving points of light near it. Galileo labeled each drawing with the date. Eventually he used his observations to conclude that the Earth orbits the Sun, just as the four Galilean moons orbit Jupiter. History shows Galileo to be much more than an astronomical hero, though. His clear and careful record keeping and publication style no...

  8. Over ten thousand cases and counting: acidbase.org is serving the critical care community.

    Science.gov (United States)

    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 today's clinical context is available for purchase from the website. However, many intensivists use acidbase.org on a daily basis for its educational content and in particular for its analysis module. This review provides an overview of the history of the website, a tutorial and descriptive statistics of over 10,000 queries submitted to the analysis module.

  9. 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.

  10. The Importance of play During Childhood: The Lesson for care ...

    African Journals Online (AJOL)

    Lack of knowledge on the importance of play for children has ledparents, care givers and pre-school teachers deny children their rights to play,instead they have placed more emphasis on reading and arithmetic. This paper isbased on literature review, and presents the developmental stages of childhood anddiscusses the ...

  11. 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.

  12. Lessons in Integrating Shared Decision-Making Into Cancer Care

    DEFF Research Database (Denmark)

    Steffensen, Karina Dahl; Vinter, Mette; Crüger, Dorthe

    2018-01-01

    The benefits of shared decision-making (SDM) in health care delivery are well documented, but implementing SDM at the institutional level is challenging, particularly when patients have complex illnesses and care needs, as in cancer. Denmark's Lillebaelt Hospital, in creating The Patient's Cancer...... championed. It organized multiple demonstration projects focused on use of decision aids, patient-reported outcome measures, and better communication tools and practices. It designed programs to train clinicians in the art of doctor-patient communication. It used research evidence to inform development...... of the decision aids that its clinicians use with their patients. And it rigorously measured SDM performance in an ongoing fashion so that progress could be tracked and refined to ensure continuous improvement. Initial data on the institution's SDM initiatives from the Danish national annual survey of patients...

  13. Advances in Health Care in Taiwan: Lessons for Developing Countries

    Directory of Open Access Journals (Sweden)

    John R. Watt

    2008-11-01

    Full Text Available Taiwan's health services, now among the best in the world, were largely developed after 1947 under conditions of epidemiological and political crisis. Its medical, nursing, and public health leaders knew the importance of focusing on preventive health strategies, and its central government leaders knew how important health care was to the achievement of economic goals. Although there were from time to time setbacks and difficulties, the leadership learned from their mistakes and made effective use of international advice and resources. Taiwan's record makes the case that modernization of health care contributes to economic development and should not be viewed solely as a budgetary cost. Its record provides a mine of information for countries seeking to develop health services compatible with sustained economic and social development.

  14. Non-infant adoption from care: lessons for safeguarding children.

    Science.gov (United States)

    Rees, C A; Selwyn, J

    2009-07-01

    To explore use of adoption in remedying abuse and neglect, to inform child protection practice and to identify professional responsibilities to adoptive families. A cohort of 130 children was identified for whom adoption was recommended in 1991-1996 at a mean age of 5.7 years (range 3-11). All were in local authority care for child protection reasons. information was gathered from social work records. The children were traced between 6 and 11 years later and their adopters interviewed. The Strengths and Difficulties Questionnaire and the Parent-Child Communication Scale were completed. All but three birth parents had traumatic childhoods involving abuse, neglect and/or time in care. Eighty-six per cent had violent adult relationships. Mental illness, learning difficulties and substance abuse were prominent. Sixty-seven per cent of families were known to social services when children were born, but 98% experienced abuse or neglect. Most adopters found the first year challenging, though rewarding. Depression, anxiety and marital problems were common. Children's learning difficulties, conduct problems, emotional 'phoniness' and rejection affected closeness. At follow-up 28% described rewarding, happy placements, and 62% described continuing difficulties tempered by rewards. However, 10% reported no rewards. Hyperactivity and inattention frequently persisted despite stable adoption and were associated with conduct and attachment difficulties. Use of professional services was substantial. Thirty-eight per cent of children failed to achieve stable adoption. Later entry to care correlated with poorer outcome. This study highlights the importance in safeguarding children of considering the implications of parental childhood experiences, and indicates the risk of delay. The high prevalence of domestic violence in birth families indicates the need for better resources for managing emotional dysregulation. Adoption is a valuable therapeutic tool, but professional

  15. Driving improvement in patient care: lessons from Toyota.

    Science.gov (United States)

    Thompson, Debra N; Wolf, Gail A; Spear, Steven J

    2003-11-01

    Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)--a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care.

  16. 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.

  17. Primary Dental Care 1994-2004: the first ten years. A chronology.

    Science.gov (United States)

    Renson, Ted

    2004-10-01

    The prime purpose of a professional journal is to keep its readers informed of changes of importance affecting the practise of that profession. That is the criterion that I have applied in producing this chronology of the papers that have been published in Primary DENTAL CARE during the past decade. The ambition which has guided me since I received the invitation to carry out this review is a simple one: to include as much as may generally be found useful by general dental practitioners (GDPs), who form the bulk of our readership. In 1789 the English philosopher Jeremy Bentham extolled the virtues of utility for mankind when he declared that 'the greatest happiness of the greatest number is the foundation of morals and legislation'. The contributors that I have included, by contrast, think of their utilitarianism as striving after the most practical. The principal purpose of this chronology is to achieve a summary, without weighing causes or consequences. From past experience, an outstanding virtue of such an aggregated record is that it can inspire fresh patterns of thought and thus encourage the submission of manuscripts as a result of those thoughts. I can think of scarcely any facet of the general practice of dentistry that has not been touched upon, for the most part authoritatively. I hope that these brief aide-memoires may persuade old readers to return to those articles of particular interest to them and that new readers will feel informed about past papers. Every issue of the journal to date has been reviewed. Dates, volume and issue numbers and principal authors' names are all included. With these identifying features any paper, to which reference is made, may be quickly found. It would be manifestly absurd to use precious space on a formal listing of more than 250 references and this listing has, therefore, been omitted.

  18. Long-term care financing: lessons from France.

    Science.gov (United States)

    Doty, Pamela; Nadash, Pamela; Racco, Nathalie

    2015-06-01

    POLICY POINTS: France's model of third-party coverage for long-term services and supports (LTSS) combines a steeply income-adjusted universal public program for people 60 or older with voluntary supplemental private insurance. French and US policies differ: the former pay cash; premiums are lower; and take-up rates are higher, in part because employer sponsorship, with and without subsidization, is more common-but also because coverage targets higher levels of need and pays a smaller proportion of costs. Such inexpensive, bare-bones private coverage, especially if marketed as a supplement to a limited public benefit, would be more affordable to those Americans currently most at risk of "spending down" to Medicaid. An aging population leads to a growing demand for long-term services and supports (LTSS). In 2002, France introduced universal, income-adjusted, public long-term care coverage for adults 60 and older, whereas the United States funds means-tested benefits only. Both countries have private long-term care insurance (LTCI) markets: American policies create alternatives to out-of-pocket spending and protect purchasers from relying on Medicaid. Sales, however, have stagnated, and the market's viability is uncertain. In France, private LTCI supplements public coverage, and sales are growing, although its potential to alleviate the long-term care financing problem is unclear. We explore whether France's very different approach to structuring public and private financing for long-term care could inform the United States' long-term care financing reform efforts. We consulted insurance experts and conducted a detailed review of public reports, academic studies, and other documents to understand the public and private LTCI systems in France, their advantages and disadvantages, and the factors affecting their development. France provides universal public coverage for paid assistance with functional dependency for people 60 and older. Benefits are steeply income

  19. Reinventing primary care: lessons from Canada for the United States.

    Science.gov (United States)

    Starfield, Barbara

    2010-05-01

    Canada is, in many respects, culturally and economically similar to the United States, and until relatively recently, the two countries had similar health systems. However, since passage of the Canada Health Act in the 1970s, that nation's health statistics have become increasingly superior. Although the costs of Canada's health system are high by international standards, they are much lower than U.S. costs. This paper describes several factors likely to be responsible for Canada's better health at lower cost: universal financial coverage through a so-called single payer; features conducive to a strong primary care infrastructure; and provincial autonomy under general principles set by national law.

  20. Targeting health visitor care: lessons from Starting Well.

    Science.gov (United States)

    Wright, C M; Jeffrey, S K; Ross, M K; Wallis, L; Wood, R

    2009-01-01

    UK child health promotion guidelines expect health visitors to assess family needs before new babies are aged 4 months and offer targeted care on that basis thereafter. Data from an intensive family support programme were used to assess how accurately family needs can be predicted at this stage. A population based cohort of 1202 families with new babies receiving an intensive health visiting programme. Analysis of routinely recorded data. Starting Well project, Glasgow, UK. Health visitor rating of family needs. Families receiving high visiting rates or referred to social work services. Of 302 families rated high need, only 143 (47%) were identified by age 4 months. Visiting rates in the first year for those initially rated high need were nearly double those for the remainder, but around two thirds of those with high contact rates/referred to social work were not initially rated high need. Six family characteristics (no income, baby born preterm, multiple pregnancy, South Asian, prior social work/criminal justice involvement, either parent in care as a child) were identified as the commonest/strongest predictors of contact rates; 1003 (83%) families had one such characteristics and/or lived in a highly deprived area, including 228 (93%) of those with high contact rates and 157 (96%) of those referred to social work. Most families at risk will not be identified on an individual basis in the early weeks. Most families in deprived areas need continued input if the most vulnerable families are to be reliably identified.

  1. 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.

  2. Through Their Eyes: Lessons Learned Using Participatory Methods in Health Care Quality Improvement Projects.

    Science.gov (United States)

    Balbale, Salva N; Locatelli, Sara M; LaVela, Sherri L

    2016-08-01

    In this methodological article, we examine participatory methods in depth to demonstrate how these methods can be adopted for quality improvement (QI) projects in health care. We draw on existing literature and our QI initiatives in the Department of Veterans Affairs to discuss the application of photovoice and guided tours in QI efforts. We highlight lessons learned and several benefits of using participatory methods in this area. Using participatory methods, evaluators can engage patients, providers, and other stakeholders as partners to enhance care. Participant involvement helps yield actionable data that can be translated into improved care practices. Use of these methods also helps generate key insights to inform improvements that truly resonate with stakeholders. Using participatory methods is a valuable strategy to harness participant engagement and drive improvements that address individual needs. In applying these innovative methodologies, evaluators can transcend traditional approaches to uniquely support evaluations and improvements in health care. © The Author(s) 2015.

  3. Organizing and delivering case management services: lessons from the National Long Term Care Channeling Demonstration.

    Science.gov (United States)

    Christianson, J B; Applebaum, R; Carcagno, G; Phillips, B

    1988-01-01

    This article discusses issues relating to the design and internal administration of a case-management agency for community based home care for the elderly. Included in the article are issues relating to screening procedures, assessment and case management activities, cost controls, automated management information systems, and personnel matters. The analysis is based on the experience of the National Long Term Care Demonstration ("Channeling") which established and evaluated ten case management projects nationwide under federal funding.

  4. Examining the need assessment process by identifying the need profiles of elderly care recipients in the Ten-year Long-Term Care Project (TLTCP) of Taiwan.

    Science.gov (United States)

    Liu, Li-Fan; Yao, Hui-Ping

    2014-12-01

    To deal with the increasing long-term care (LTC) needs of elderly people in Taiwan, the government launched the Ten-year Long-term Care Project (TLTCP) in 2007, and through the care management system, care plans for those in need were distributed and implemented by care managers according to the single assessment process. Based on the emphasis of linking the right need assessment to the care plan, this study aimed to explore the need profiles of LTC recipients with regard to their health indicators to serve as a validity check on the identified dependency levels and care plans in the current care management system. A model based on latent class analysis (LCA) was used for dealing with the issue of health heterogeneity. LCA provides an empirical method that examines the interrelationships among health indicators and characterizes the underlying set of mutually exclusive latent classes that account for the observed indicators. The analysis included a total of 2901 elderly care recipients in the LTC dataset from a southern city, 1 of the 5 major metropolitan areas in Taiwan. The identified dependency levels of the samples and their care plans in need assessment were compared and discussed. Four need profiles were explored in the LTC dataset. Apart from the low (LD) (32.95%) and moderate dependent groups (MD) (17.48%), there were 2 groups identified among the high-dependency levels, including the severe physical and psychological dependency (SPP) (26.37%) and the comorbidities and severe dependency (CSD) groups (23.20%), which in sum were approximately identified as high dependency (HD) by care managers in the LTC dataset. In addition, the CSD group currently costs more for their care plans on average in LTC services (NT. 277,081.15, approximately 9200 USD) than the SPP group (NT. 244,084.21) and the other groups. Need assessment is a key to success in care management in LTC. The results of this study showed the importance of focusing on multifacet indicators

  5. Alcoholics Anonymous and nursing. Lessons in holism and spiritual care.

    Science.gov (United States)

    McGee, E M

    2000-03-01

    Alcoholic Anonymous (AA) is a worldwide, million-member organization that has assisted countless alcoholics to achieve sobriety through a spiritual program of recovery from alcoholism. Based on spiritual principles known as the "Twelve Steps" and "Twelve Traditions," AA has provided a model for other recovery programs such as Narcotics Anonymous (NA), Gamblers Anonymous (GA), and Sex and Love Addicts Anonymous (SLAA). Recovery in AA appears to involve a process of self-transcendence. In recent years, nursing scholars have increasingly explored the concepts of self-transcendence and spirituality as they apply to nursing theory and practice. This article explores the roots and spiritual dimensions of 12-step recovery programs. It further explores the ways in which theoretical and clinical knowledge about the delivery of spiritual care interventions may be gained from an understanding of AA's spiritual approach to recovery.

  6. Lessons of Three Mile Island for the health care community

    International Nuclear Information System (INIS)

    Wald, N.

    1986-01-01

    The author discusses the key points that we should have learned from the TMI accident. There has to be one responsible decision maker; otherwise conflicting decision increase the stress and anxiety levels. There has to be a realistic appraisal and clear communication of the situation with all of the people involved. Both overoptimistic and overpessimistic views are deleterious in promoting realistic responses from the population at risk. There has to be an action plan on paper that is credible, one which people can believe will work. Adequate time, thought, and resources have to be dedicated to the plan. It is not simply a matter of putting words on paper. Education for radiation emergencies is critically important. All professional (including governors, their staffs, and health care personnel) and the general public must know something about radiation before they are caught in the middle of a crisis

  7. Applying the lessons of high risk industries to health care.

    Science.gov (United States)

    Hudson, P

    2003-12-01

    High risk industries such as commercial aviation and the oil and gas industry have achieved exemplary safety performance. This paper reviews how they have managed to do that. The primary reasons are the positive attitudes towards safety and the operation of effective formal safety management systems. The safety culture provides an important explanation of why such organisations perform well. An evolutionary model of safety culture is provided in which there is a range of cultures from the pathological through the reactive to the calculative. Later, the proactive culture can evolve towards the generative organisation, an alternative description of the high reliability organisation. The current status of health care is reviewed, arguing that it has a much higher level of accidents and has a reactive culture, lagging behind both high risk industries studied in both attitude and systematic management of patient risks.

  8. Evaluation of a multidisciplinary burn care journal club: Lessons learned.

    Science.gov (United States)

    Carta, T; Gawaziuk, J P; Cristall, N; Forbes, L; Logsetty, S

    2018-05-01

    Journal clubs allow discussion of the quality and findings of recent publications. However, journal clubs have not historically been multidisciplinary. Burn care is recognized as a true collaborative care model, including regular multidisciplinary rounds. Since 2011 we have offered a multidisciplinary burn journal club at our institution. We present an evaluation of the factors that have made the sessions successful to facilitate others to commence their own club. At the end of each journal club session participants anonymously completed a structured evaluation. Five-point scales were used to evaluate understanding, meeting objectives, presentation and appropriateness of information. Qualitative questions were asked to identify beneficial factors, suggestions for improvements, ideas for future sessions and feedback for the facilitator. Attendance grew from six to a maximum of 19. Members included physicians, nurses, dieticians, physiotherapists, occupational therapists, social workers, basic scientists and students. Presentations were undertaken by all of these disciplines. Ratings improved steadily over time. Understanding increased from a score of 4.5 to 4.8; meeting objectives from 4 to 4.9; satisfaction with method of presentation from 4.3 to 4.9 and with level of information from 3 to 4.9. Over time, the journal club has evolved to better meet the needs of our team. Successful multidisciplinary journal club implementation requires identification of champions and ongoing evaluation. The success of the journal club has been possible through the engagement of the entire burn team. Champions within each discipline, facilitated discussion and evaluation tools have helped nurture a nonthreatening team based learning environment. Copyright © 2017. Published by Elsevier Ltd.

  9. 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.

  10. Battlefield Tourniquets: Lessons Learned in Moving Current Care Toward Best Care in an Army Medical Department at War.

    Science.gov (United States)

    Kragh, John F; Dubick, Michael A

    2016-01-01

    Bleeding prevention and control by tourniquet use by out-of-hospital caregivers is a major breakthrough in military medicine of current wars. The present review documents developments in tourniquet practices since 2001 among the US military services for aid in improving doctrine, policy, and especially care in wars to come. Tourniquets are an adjunct for resuscitation in self-care and buddy aid and today are issued to all military servicepersons who deploy into a combat zone. In the US Army, virtually every Soldier is trained in first aid tourniquet use; since 2009 they are instructed early and often to use them early and often. Despite substantial knowledge gains among the services in tourniquet use and resulting improvements in casualty survival, current evidence shows persistent difficulties in achieving best care with tourniquet use for individual trauma patients. Nevertheless, contemporary tourniquet use incorporates key lessons learned over the last 14 years of war that include: (1) tourniquet use reliably stops bleeding from limb wounds and prevents mortality in prehospital settings; and (2) brief tourniquet use appears to be safe. These 2 lessons have become so evident that civilian emergency medical systems have begun using them, albeit unevenly. Collection and interpretation of data of casualties with tourniquet use have showed that such intervention has lifesaving benefit through 2 mechanisms: control of both ongoing hemorrhage and shock severity. The next generation of interventions in bleeding control involves developing the skill sets, education, and standards of tourniquet users which may improve hemorrhage control in wars to come.

  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. Amish-Initiated Burn Care Project: Case Report and Lessons Learned in Participatory Research.

    Science.gov (United States)

    Hess, Rosanna F

    2017-03-01

    This case report describes the phases of an Amish Burn Care Project and the lessons learned throughout the process. Data sources to construct the case report included participant observation, interviews, archival documents, and a focus group. The narrative is organized into five phases of a participatory research approach: engagement, formalization, mobilization, maintenance, and expansion. Community-initiated research led to legitimate change, working together for change took time, team members grew in mutual trust and respect for each other, cultural humility brought personal and professional growth, and capacity building took place through mutually supported efforts.

  13. Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

    Directory of Open Access Journals (Sweden)

    Heather E Douglas

    2017-04-01

    Full Text Available Introduction: There is limited evidence of the benefits of information and communication technology (ICT to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

  14. Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider.

    Science.gov (United States)

    Douglas, Heather E; Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

    2017-04-10

    There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients.

  15. Implementing Information and Communication Technology to Support Community Aged Care Service Integration: Lessons from an Australian Aged Care Provider

    Science.gov (United States)

    Georgiou, Andrew; Tariq, Amina; Prgomet, Mirela; Warland, Andrew; Armour, Pauline; Westbrook, Johanna I

    2017-01-01

    Introduction: There is limited evidence of the benefits of information and communication technology (ICT) to support integrated aged care services. Objectives: We undertook a case study to describe carelink+, a centralised client service management ICT system implemented by a large aged and community care service provider, Uniting. We sought to explicate the care-related information exchange processes associated with carelink+ and identify lessons for organisations attempting to use ICT to support service integration. Methods: Our case study included seventeen interviews and eleven observation sessions with a purposive sample of staff within the organisation. Inductive analysis was used to develop a model of ICT-supported information exchange. Results: Management staff described the integrated care model designed to underpin carelink+. Frontline staff described complex information exchange processes supporting coordination of client services. Mismatches between the data quality and the functions carelink+ was designed to support necessitated the evolution of new work processes associated with the system. Conclusions: There is value in explicitly modelling the work processes that emerge as a consequence of ICT. Continuous evaluation of the match between ICT and work processes will help aged care organisations to achieve higher levels of ICT maturity that support their efforts to provide integrated care to clients. PMID:29042851

  16. Global Lessons In Frugal Innovation To Improve Health Care Delivery In The United States.

    Science.gov (United States)

    Bhatti, Yasser; Taylor, Andrea; Harris, Matthew; Wadge, Hester; Escobar, Erin; Prime, Matt; Patel, Hannah; Carter, Alexander W; Parston, Greg; Darzi, Ara W; Udayakumar, Krishna

    2017-11-01

    In a 2015 global study of low-cost or frugal innovations, we identified five leading innovations that scaled successfully in their original contexts and that may provide insights for scaling such innovations in the United States. We describe common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of health care, and lessons for the implementation and scaling of other innovations. We highlight promising trends in the United States that support adapting these innovations, including growing interest in moving care out of health care facilities and into community and home settings; the growth of alternative payment models and incentives to experiment with new approaches to population health and care delivery; and the increasing use of diverse health professionals, such as community health workers and advanced practice providers. Our findings should inspire policy makers and health care professionals and inform them about the potential for globally sourced frugal innovations to benefit US health care.

  17. Prehospital trauma care reduces mortality. Ten-year results from a time-cohort and trauma audit study in Iraq

    Directory of Open Access Journals (Sweden)

    Murad Mudhafar K

    2012-02-01

    Full Text Available Abstract Background Blunt implementation of Western trauma system models is not feasible in low-resource communities with long prehospital transit times. The aims of the study were to evaluate to which extent a low-cost prehospital trauma system reduces trauma deaths where prehospital transit times are long, and to identify specific life support interventions that contributed to survival. Methods In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents were managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers. The study was conducted with a time-period cohort design. Results 37% of the study patients had serious injuries with Injury Severity Score ≥ 9. The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2. During the ten-year study period trauma mortality was reduced from 17% (95% CI 15 -19 to 4% (95% CI 3.5 - 5, survival especially improving in major trauma victims. In most patients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support measures were sufficient to improve physiological severity indicators. Conclusion In case of long prehospital transit times simple life support measures by paramedics and lay first responders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.

  18. Cancer Care Ontario and integrated cancer programs: portrait of a performance management system and lessons learned.

    Science.gov (United States)

    Cheng, Siu Mee; Thompson, Leslee J

    2006-01-01

    A performance management system has been implemented by Cancer Care Ontario (CCO). This system allows for the monitoring and management of 11 integrated cancer programs (ICPs) across the Province of Ontario. The system comprises of four elements: reporting frequency, reporting requirements, review meetings and accountability and continuous improvement activities. CCO and the ICPs have recently completed quarterly performance review exercises for the last two quarters of the fiscal year 2004-2005. The purpose of this paper is to address some of the key lessons learned. The paper provides an outline of the CCO performance management system. These lessons included: data must be valid and reliable; performance management requires commitments from both parties in the performance review exercises; streamlining performance reporting is beneficial; technology infrastructure which allows for cohesive management of data is vital for a sustainable performance management system; performance indicators need to stand up to scrutiny by both parties; and providing comparative data across the province is valuable. Critical success factors which would help to ensure a successful performance management system include: corporate engagement from various parts of an organization in the review exercises; desire to focus on performance improvement and avoidance of blaming; and strong data management systems. The performance management system is a practical and sustainable system that allows for performance improvement of cancer care services. It can be a vital tool to enhance accountability within the health care system. The paper demonstrates that the performance management system supports accountability in the cancer care system for Ontario, and reflects the principles of the provincial governments commitment to continuous improvement of healthcare.

  19. The Effects of Collaborative Care of Living Animals in Biology Lessons on Students' Relatedness Toward Their Teacher Across Gender

    Science.gov (United States)

    Eckes, Alexander; Großmann, Nadine; Wilde, Matthias

    2018-01-01

    The transition from elementary school to the upper grades can lead to ambiguous feelings toward the new, male teachers. This study investigated whether collaborative animal care in biology lessons affects students' feelings of relatedness toward their biology teachers positively during the first year after the school transition. Four hundred twenty fifth graders (M age = 10.5 years, SD age = 0.6 years) of higher types of tracking participated. We designed one experimental group that involved caring for the living animals to be used in the upcoming lessons, and two control groups. The first control group included lessons with living animals, but did not include prior care of those animals, and the second incorporated neither living animals nor prior care. All groups received biology lessons with the same content. To examine the effects of caretaking, we used an adapted version of the scale "relatedness" (Ryan 1982). In both control groups, boys showed lower relatedness toward female teachers and girls toward male teachers, respectively. Collaborative mice care promoted equal relatedness across all gender combinations among teachers and students.

  20. 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

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

    Science.gov (United States)

    Thompson, Sandra C; Haynes, Emma; Woods, John A; Bessarab, Dawn C; Dimer, Lynette A; Wood, Marianne M; Sanfilippo, Frank M; Hamilton, Sandra J; Katzenellenbogen, Judith M

    2016-01-01

    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. 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. 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. Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their Aboriginal patients and work at multiple levels both outside and

  2. 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

  3. Lessons Learned from the Crew Health Care System (CHeCS) Rack 1 Environmental Control and Life Support (ECLS) Design

    Science.gov (United States)

    Williams, David E.

    2006-01-01

    This paper will provide an overview of the International Space Station (ISS) Environmental Control and Life Support (ECLS) design of the Crew Health Care System (CHeCS) Rack 1 and it will document some of the lessons that have been learned to date for the ECLS equipment in this rack.

  4. Thomas L Petty's lessons for the respiratory care clinician of today.

    Science.gov (United States)

    Pierson, David J

    2014-08-01

    Because of the importance of his original contributions and their practical relevance today, Thomas L Petty (1932-2009) was arguably the most important physician in the history of respiratory care. As much as any single individual, he was responsible for the concept of intensive and multidisciplinary respiratory care. In the 1960s and 1970s, he made key observations and introduced pioneering therapies in the ICU and in the home. He was the first to describe and name ARDS and to show how to use PEEP to treat life-threatening hypoxemia. He was one of the first anywhere to organize a pulmonary rehabilitation program and to show the beneficial effects of long-term oxygen therapy in COPD. Dr Petty emphasized the importance of practical, hands-on respiratory care education for both physicians and non-physicians using a collaborative team approach. He targeted educational activities and practical resources specifically to patients, and he showed how researchers and clinicians could interact responsibly with innovators in industry to the benefit of both. His life and career provide 6 important lessons for respiratory clinicians today and in the future: (1) whatever their roles, RTs and other clinicians in this field need to be experts in its core areas, such as mechanical ventilation, ARDS, and COPD; (2) respiratory care is a team activity: every member is important, and all the members need to communicate well and work together; (3) education needs to be targeted to those in the best position to benefit the patient, including primary care providers and family members; (4) everyone in the field needs to understand the important role of the respiratory care industry and to deal with it responsibly; (5) it must never be forgotten that it is all about the patient; and (6) respiratory care should be exciting and fun. Copyright © 2014 by Daedalus Enterprises.

  5. Ideologies of aid, practices of power: lessons for Medicaid managed care.

    Science.gov (United States)

    Nelson, Nancy L

    2005-03-01

    The articles in this special issue teach valuable lessons based on what happened in New Mexico with the shift to Medicaid managed care. By reframing these lessons in broader historical and cultural terms with reference to aid programs, we have the opportunity to learn a great deal more about the relationship between poverty, public policy, and ideology. Medicaid as a state and federal aid program in the United States and economic development programs as foreign aid provide useful analogies specifically because they exhibit a variety of parallel patterns. The increasing concatenation of corporate interests with state and nongovernmental interests in aid programs is ultimately producing a less centralized system of power and responsibility. This process of decentralization, however, is not undermining the sources of power behind aid efforts, although it does make the connections between intent, planning, and outcome less direct. Ultimately, the devolution of power produces many unintended consequences for aid policy. But it also reinforces the perspective that aid and the need for it are nonpolitical issues.

  6. Transitioning HIV-Positive Adolescents to Adult Care: Lessons Learned From Twelve Adolescent Medicine Clinics.

    Science.gov (United States)

    Tanner, Amanda E; Philbin, Morgan M; DuVal, Anna; Ellen, Jonathan; Kapogiannis, Bill; Fortenberry, J Dennis

    2016-01-01

    To maximize positive health outcomes for youth with HIV as they transition from youth to adult care, clinical staff need strategies and protocols to help youth maintain clinic engagement and medication adherence. Accordingly, this paper describe transition processes across twelve clinics within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) to provide lessons learned and inform the development of transition protocols to improve health outcomes as youth shift from adolescent to adult HIV care. During a large multi-method Care Initiative program evaluation, three annual visits were completed at each site from 2010-2012 and conducted 174 semi-structured interviews with clinical and program staff (baseline n=64, year 1 n=56, year 2=54). The results underscore the value of adhering to recent American Academy of Pediatrics (AAP) transition recommendations, including: developing formal transition protocols, preparing youth for transition, facilitating youth's connection to the adult clinic, and identifying necessary strategies for transition evaluation. Transitioning youth with HIV involves targeting individual-, provider-, and system-level factors. Acknowledging and addressing key barriers is essential for developing streamlined, comprehensive, and context-specific transition protocols. Adolescent and adult clinic involvement in transition is essential to reduce service fragmentation, provide coordinated and continuous care, and support individual and community level health. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. "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…

  8. A Primary Care System to Improve Health Care Efficiency: Lessons from Ecuador.

    Science.gov (United States)

    Aldulaimi, Sommer; Mora, Francisco E

    2017-01-01

    Ecuador is a country with few resources to spend on health care. Historically, Ecuador has struggled to find a model for health care that is efficient, effective, and available to all people in the country, even those in underserved and rural communities. In 2000, the Ecuador Ministry of Public Health implemented a new system of health care that used primary care as its platform. Since then, Ecuador has been able to increase its health care efficiency, increasing its ranking from 111 of 211 countries worldwide in 2000, to 20 of 211 countries in 2014. This article briefly reviews the new components of the system implemented in Ecuador and examines the tools used to accomplish this. The discussion also compares and contrasts the Ecuador and US systems, and identifies concepts and policies from Ecuador that could improve the US system. © Copyright 2017 by the American Board of Family Medicine.

  9. 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.

  10. 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. © The Author 2014. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Strategies to enhance price and quality competition in health care: lessons learned from tracking local markets.

    Science.gov (United States)

    Lesser, Cara S; Ginsburg, Paul B

    2006-06-01

    Drawing on observations from tracking changes in local health care markets over the past ten years, this article critiques two Federal Trade Commission and Department of Justice recommendations to enhance price and quality competition. First, we take issue with the notion that consumers, acting independently, will drive greater competition in health care markets. Rather we suggest an important role remains for trusted agents who can analyze inherently complex price and quality information and negotiate on consumers' behalf. With aggregated information identifying providers who deliver cost-effective care, consumers would be better positioned to respond to financial incentives about where to seek care and thereby drive more meaningful competition among providers to reduce costs and improve quality. Second, we take issue with the FTC/DOJ recommendation to provide more direct subsidies to prevent distortions in competition. In the current political environment, it is not practical to provide direct subsidies for all of the unfunded care that exists in health care markets today; instead, some interference with competition may be necessary to protect cross subsidies. Barriers can be reduced, though, by revising pricing policies that have resulted in marked disparities in the relative profitability of different services.

  12. 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.

  13. [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.

  14. Developing a pediatric palliative care service in a large urban hospital: challenges, lessons, and successes.

    Science.gov (United States)

    Edlynn, Emily S; Derrington, Sabrina; Morgan, Helene; Murray, Jennifer; Ornelas, Beatriz; Cucchiaro, Giovanni

    2013-04-01

    We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. We examined the hiring process of personnel and marketing strategies, a clinical database facilitated ongoing quality review and identified trends, and a survey project assessed provider satisfaction and how referring physicians used the palliative care service. The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.

  15. Health Care for Older Adults in Uganda: Lessons for the Developing World.

    Science.gov (United States)

    Tam, Wai Jia; Yap, Philip

    2017-06-01

    Approximately two-thirds of the world's older adults live in developing nations. By 2050, as many as 80% of such older people will live in low- and middle-income countries. In sub-Saharan Africa alone, the number of individuals aged 60 and older is projected to reach 163 million. Despite this demographic wave, the majority of Africa has limited access to qualified geriatric health care. 3 Although foreign aid and capacity-building efforts can help to close this gap over time, it is likely that failure to understand the unique context of Africa's older adults, many of whom are marginalized, will lead to inadequacies in service delivery and poor health outcomes. 4 As the need for culturally competent care of older adults gains recognition in the developed world, research in geriatric care in developing countries should progress in tandem. 4 By examining the multidimensional challenges that an older woman with the human immunodeficiency virus (HIV) in rural Uganda faces, this article makes contextualized policy recommendations for older adults in Africa and provides lessons for the developing world. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  16. Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.

    Science.gov (United States)

    Goyder, Clare R; Jones, Caroline H D; Heneghan, Carl J; Thompson, Matthew J

    2015-12-01

    Because of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area. To ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these. Secondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK. Two datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. Learning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed. Learning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors. © British Journal of General Practice 2015.

  17. The road to patient experience of care measurement: lessons from the United States.

    Science.gov (United States)

    Zimlichman, Eyal; Rozenblum, Ronen; Millenson, Michael L

    2013-09-17

    Patient-centered care has become an increasing priority in the United States and plays a prominent role in recent healthcare reforms. One way the country has managed to advance patient-centered care is through establishment of a family of national patient experience surveys (the Consumer Assessment of Healthcare Providers and Systems Plans (CAHPS). CAHPS is publicly reported for several types of providers and was recently tied to hospital reimbursement. This is part of a trend over the last two decades that has shifted provider-patient relationships from a traditional paternal approach to customer service and then to clinical partnership. The health care system in Israel, however, is still struggling to overcome barriers to change in this area. While community based biannual patient experience surveys are conducted by the Myers-JDC-Brookdale Institute, there is no comprehensive national approach to measuring the patient experience across a broad range of settings. Only recently did the Israeli Ministry of Health take its first steps to include patient experience as a dimension of health care quality.In its current position, Israel should learn from the U.S. experience with policies promoting patient-centered care, and specifically the impact on clinical services of measuring the patient experience. Looking at what has happened in the United States, we suggest three main lessons. First, there is a need for a set of national patient experience surveys that would be publicly reported and eventually tied to provider reimbursement. Secondly, the national survey tools should be customized to the unique characteristics of Israeli society and draw from recent research on patient-centeredness to include new and important domains such as patient activation and shared decision-making. Finally, newer technological approaches should be explored with the aim of increasing response rates and the timeliness and usefulness of the surveys.

  18. Ten Demands of Improved Usability in eHealth and Some Progress - Co-Creation by Health and Social Care Professionals.

    Science.gov (United States)

    Scandurra, Isabella; Liljequist, David

    2016-01-01

    Current healthcare organizations often do not accomplish the intended effects of their eHealth systems due to inadequate usability. Commissioned by the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish health and social care has been analysed from the perspective of their professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, nine workshops were held where health informatics researchers guided staff from different care organizations, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents ten demands that Swedish health and social care professionals find imperative to prioritize. The study emphasizes that development of eHealth systems must be integrated into the care practice improvement process and iteratively evaluated regarding usability.

  19. Enhancing and Adapting Treatment Foster Care: Lessons Learned in Trying to Change Practice.

    Science.gov (United States)

    Murray, Maureen M; Southerland, Dannia; Farmer, Elizabeth M; Ballentine, Kess

    2010-01-01

    Evidence-based practices to improve outcomes for children with severe behavioral and emotional problems have received a great deal of attention in children's mental health. Therapeutic Foster Care (TFC), a residential intervention for youth with emotional or behavioral problems, is one of the few community-based programs that is considered to be evidence-based. However, as for most treatment approaches, the vast majority of existing programs do not deliver the evidence-based version. In an attempt to fill this gap and improve practice across a wide range of TFC agencies, we developed an enhanced model of TFC based on input from both practice and research. It includes elements associated with improved outcomes for youth in "usual care" TFC agencies as well as key elements from Chamberlain's evidence-based model. The current manuscript describes this "hybrid" intervention - Together Facing the Challenge - and discusses key issues in implementation. We describe the sample and settings, highlight key implementation strategies, and provide "lessons learned" to help guide others who may wish to change practice in existing agencies.

  20. [Psychosocial care following the firework disaster in Enschede; the lessons from the Bijlmer airline disaster].

    Science.gov (United States)

    Gersons, B P R; Huijsman-Rubingh, R R R; Olff, M

    2004-07-17

    When the psychosocial-care scheme for victims of the firework explosion in Enschede, the Netherlands (2000) was set up, lessons learned from the Bijlmer airline disaster (Amsterdam 1992) were put into practice. The aftermath of this incident showed that psychological and physical health problems can still occur many years later. The main failure of the aftercare of the Bijlmer disaster lay in the coordination of aid and the monitoring of health problems. In Enschede steps were taken to redress these problems. An information and advice centre (IAC) was set up to monitor the well-being of the victims, and to provide them with information and, where necessary, assistance. It is responsible for limiting the effects of the disaster. A total of 13,000 people have consulted the IAC. A residents' association was formed. This gave the victims a common voice during the process of attempting to restore normality in their lives. A specialized mental health-care unit was founded to treat disaster-related disorders using evidence-based treatments. So far approximately 1,300 people have consulted this body. A longitudinal study has been set up to map the consequences of the disaster and to advise aid organizations. This will also give information on the extent to which these methods have been able to limit the long-term consequences.

  1. 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

  2. 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.

  3. 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.

  4. [Engineering aspects of seismic behavior of health-care facilities: lessons from California earthquakes].

    Science.gov (United States)

    Rutenberg, A

    1995-03-15

    The construction of health-care facilities is similar to that of other buildings. Yet the need to function immediately after an earthquake, the helplessness of the many patients and the high and continuous occupancy of these buildings, require that special attention be paid to their seismic performance. Here the lessons from the California experience are invaluable. In this paper the behavior of California hospitals during destructive earthquakes is briefly described. Adequate structural design and execution, and securing of nonstructural elements are required to ensure both safety of occupants, and practically uninterrupted functioning of equipment, mechanical and electrical services and other vital systems. Criteria for post-earthquake functioning are listed. In view of the hazards to Israeli hospitals, in particular those located along the Jordan Valley and the Arava, a program for the seismic evaluation of medical facilities should be initiated. This evaluation should consider the hazards from nonstructural elements, the safety of equipment and systems, and their ability to function after a severe earthquake. It should not merely concentrate on safety-related structural behavior.

  5. 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.

  6. Primary health care lessons from the northeast of Brazil: the Agentes de Saúde Program.

    Science.gov (United States)

    Cufino Svitone, E; Garfield, R; Vasconcelos, M I; Araujo Craveiro, V

    2000-05-01

    Market-led economic reforms are usually viewed as being in conflict with government-stimulated socioeconomic development for disadvantaged groups. Nevertheless, Ceará, a poor state in the Northeast of Brazil, has since 1987 pursued both of those strategies simultaneously. One part of that approach has been a program of nurse-directed auxiliary health workers serving about 5 million people--almost all the persons outside the capital city and half of those in the capital. The system requires that the auxiliaries, called agentes de saúde, live in the local communities that they serve. The health agents visit each home once a month to carry out a small number of priority health activities. While health agent positions are in high demand, the minimum-wage salary that the agents receive makes up only a small portion of the state budget. A key aspect of the system is timely and comprehensive information, which is based on agent visits and is managed by trained nurses. Since the health agents system was launched, there has been a rapid decline in infant mortality, a rapid rise in immunization, identification of bottlenecks limiting the utilization of other medical resources, and timely interventions in times of crisis. The health agents system has combined administrative decentralization with financial centralization during a period of electoral democratization. The system has strengthened Ceará's commitment to primary care even as market-oriented changes have reduced the overall role of government. The Ceará program is being copied throughout the Northeast and other regions of Brazil. The key role that nurses play in the Ceará program in organizing and leading a system of basic primary care in poor neighborhoods and rural areas may provide useful lessons for other countries. In addition, Ceará does not have many of the favorable characteristics of other countries that have successfully invested in primary health care. Ceará thus represents a more achievable model

  7. 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.

  8. Contributions of COPD, asthma, and ten comorbid conditions to health care utilization and patient-centered outcomes among US adults with obstructive airway disease.

    Science.gov (United States)

    Murphy, Terrence E; McAvay, Gail J; Allore, Heather G; Stamm, Jason A; Simonelli, Paul F

    2017-01-01

    Among persons with obstructive airway disease, the relative contributions of chronic obstructive pulmonary disease (COPD), asthma, and common comorbid conditions to health care utilization and patient-centered outcomes (PCOs) have not been previously reported. We followed a total of 3,486 persons aged ≥40 years with COPD, asthma, or both at baseline, from the Medical Expenditure Panel Survey (MEPS) cohorts enrolled annually from 2008 through 2012 for 1 year. MEPS is a prospective observational study of US households recording self-reported COPD, asthma, and ten medical conditions: angina, arthritis, cancer, coronary heart disease, cognitive impairment, diabetes, hypertension, lung cancer, myocardial infarction, and stroke/transient ischemic attack. We studied the separate contributions of these conditions to health care utilization (all-cause and respiratory disease hospitalization, any emergency department [ED] visit, and six or more outpatient visits) and PCOs (seven or more days spent in bed due to illness, incident loss of mobility, and incident decline in self-perceived health). COPD made the largest contributions to all-cause and respiratory disease hospitalization and ED visits, while arthritis made the largest contribution to outpatient health care. Arthritis and COPD, respectively, made the greatest contributions to the PCOs. COPD made the largest and second largest contributions to health care utilization and PCOs among US adults with obstructive airway disease. The twelve medical conditions collectively accounted for between 52% and 61% of the health care utilization outcomes and between 53% and 68% of the PCOs. Cognitive impairment, diabetes, hypertension, and stroke also made significant contributions.

  9. How can health care organisations make and justify decisions about risk reduction? Lessons from a cross-industry review and a health care stakeholder consensus development process

    International Nuclear Information System (INIS)

    Sujan, Mark A.; Habli, Ibrahim; Kelly, Tim P.; Gühnemann, Astrid; Pozzi, Simone; Johnson, Christopher W.

    2017-01-01

    Interventions to reduce risk often have an associated cost. In UK industries decisions about risk reduction are made and justified within a shared regulatory framework that requires that risk be reduced as low as reasonably practicable. In health care no such regulatory framework exists, and the practice of making decisions about risk reduction is varied and lacks transparency. Can health care organisations learn from relevant industry experiences about making and justifying risk reduction decisions? This paper presents lessons from a qualitative study undertaken with 21 participants from five industries about how such decisions are made and justified in UK industry. Recommendations were developed based on a consensus development exercise undertaken with 20 health care stakeholders. The paper argues that there is a need in health care to develop a regulatory framework and an agreed process for managing explicitly the trade-off between risk reduction and cost. The framework should include guidance about a health care specific notion of acceptable levels of risk, guidance about standardised risk reduction interventions, it should include regulatory incentives for health care organisations to reduce risk, and it should encourage the adoption of an approach for documenting explicitly an organisation's risk position. - Highlights: • Empirical description of industry perceptions on making risk reduction decisions. • Health care consensus development identified five recommendations. • Risk concept should be better integrated into safety management. • Education and awareness about risk concept are required. • Health systems need to start a dialogue about acceptable levels of risk.

  10. 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.

  11. 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

  12. Contributions of COPD, asthma, and ten comorbid conditions to health care utilization and patient-centered outcomes among US adults with obstructive airway disease

    Directory of Open Access Journals (Sweden)

    Murphy TE

    2017-08-01

    Full Text Available Terrence E Murphy,1 Gail J McAvay,1 Heather G Allore,1 Jason A Stamm,2 Paul F Simonelli2 1Department of Internal Medicine, Section of Geriatrics, Yale University School of Medicine, New Haven, CT, USA; 2Department of Internal Medicine, Section of Thoracic Medicine, Geisinger Medical Center, Danville, PA, USA Background: Among persons with obstructive airway disease, the relative contributions of chronic obstructive pulmonary disease (COPD, asthma, and common comorbid conditions to health care utilization and patient-centered outcomes (PCOs have not been previously reported.Methods: We followed a total of 3,486 persons aged ≥40 years with COPD, asthma, or both at baseline, from the Medical Expenditure Panel Survey (MEPS cohorts enrolled annually from 2008 through 2012 for 1 year. MEPS is a prospective observational study of US households recording self-reported COPD, asthma, and ten medical conditions: angina, arthritis, cancer, coronary heart disease, cognitive impairment, diabetes, hypertension, lung cancer, myocardial infarction, and stroke/transient ischemic attack. We studied the separate contributions of these conditions to health care utilization (all-cause and respiratory disease hospitalization, any emergency department [ED] visit, and six or more outpatient visits and PCOs (seven or more days spent in bed due to illness, incident loss of mobility, and incident decline in self-perceived health.Results: COPD made the largest contributions to all-cause and respiratory disease hospitalization and ED visits, while arthritis made the largest contribution to outpatient health care. Arthritis and COPD, respectively, made the greatest contributions to the PCOs.Conclusion: COPD made the largest and second largest contributions to health care utilization and PCOs among US adults with obstructive airway disease. The twelve medical conditions collectively accounted for between 52% and 61% of the health care utilization outcomes and between 53

  13. Delivery of Type 2 diabetes care in low- and middle-income countries: lessons from Lima, Peru.

    Science.gov (United States)

    Cardenas, M K; Miranda, J J; Beran, D

    2016-06-01

    The health system's response is crucial to addressing the increasing burden of diabetes, particularly that affecting low- and middle-income countries. This study aims to assess the facilitators and barriers that help or hinder access to care for people with diabetes in Peru. We used a survey tool to design and collect qualitative and quantitative data from primary and secondary sources of information at different levels of the health system. We performed 111 interviews in Lima, the capital city of Peru, with patients with diabetes, healthcare providers and healthcare officials. We applied the six building blocks framework proposed by the World Health Organization in our analysis. We found low political commitment, as well as several barriers that directly affect access to medicines, regular laboratory check-ups and follow-up appointments for diabetes, especially at the primary healthcare level. Three major system-level barriers were identified: (1) the availability of information at different healthcare system levels that affects several processes in the healthcare provision; (2) insufficient financial resources; and (3) insufficient human resources trained in diabetes management. Despite an initial political commitment by the Peruvian government to improve the delivery of diabetes care, there exist several key limitations that affect access to adequate diabetes care, especially at the primary healthcare level. In a context in which various low- and middle-income countries are aiming to achieve universal health coverage, this study provides lessons for the implementation of strategies related to diabetes care delivery. © 2016 Diabetes UK.

  14. 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

  15. Primary care and addiction treatment: lessons learned from building bridges across traditions.

    Science.gov (United States)

    Stanley, A H

    1999-01-01

    A primary care unit combined with residential addiction treatment allows patients with addictive disease and chronic medical or psychiatric problems to successfully complete the treatment. These are patients who would otherwise fail treatment or fail to be considered candidates for treatment. Health care providers should have a background in primary care and have the potential to respond professionally to clinical problems in behavioral medicine. Ongoing professional training and statistical quality management principles can maintain morale and productivity. Health education is an integral part of primary care. The costs of such concurrent care when viewed in the context of the high societal and economic costs of untreated addictive disease and untreated chronic medical problems are low. The principles used to develop this primary care unit can be used to develop health care units for other underserved populations. These principles include identification of specific health care priorities and continuity of rapport with the target population and with addiction treatment staff.

  16. Lessons Learned From the Development and Parameterization of a Computer Simulation Model to Evaluate Task Modification for Health Care Providers.

    Science.gov (United States)

    Kasaie, Parastu; David Kelton, W; Ancona, Rachel M; Ward, Michael J; Froehle, Craig M; Lyons, Michael S

    2018-02-01

    Computer simulation is a highly advantageous method for understanding and improving health care operations with a wide variety of possible applications. Most computer simulation studies in emergency medicine have sought to improve allocation of resources to meet demand or to assess the impact of hospital and other system policies on emergency department (ED) throughput. These models have enabled essential discoveries that can be used to improve the general structure and functioning of EDs. Theoretically, computer simulation could also be used to examine the impact of adding or modifying specific provider tasks. Doing so involves a number of unique considerations, particularly in the complex environment of acute care settings. In this paper, we describe conceptual advances and lessons learned during the design, parameterization, and validation of a computer simulation model constructed to evaluate changes in ED provider activity. We illustrate these concepts using examples from a study focused on the operational effects of HIV screening implementation in the ED. Presentation of our experience should emphasize the potential for application of computer simulation to study changes in health care provider activity and facilitate the progress of future investigators in this field. © 2017 by the Society for Academic Emergency Medicine.

  17. Landscape care of urban vacant properties and implications for health and safety: Lessons from photovoice.

    Science.gov (United States)

    Sampson, Natalie; Nassauer, Joan; Schulz, Amy; Hurd, Kathleen; Dorman, Cynthia; Ligon, Khalil

    2017-07-01

    Care of vacant properties in urban environments is of particular interest to planners and residents alike. We report on a photovoice project completed by community leaders, researchers, and residents in two Detroit neighborhoods experiencing longtime systemic disinvestment. Participants photographed and discussed examples of care in a series of three focus groups in each neighborhood. Analyses highlight how acts of landscape care and visible cues to care contribute to changes in physical and social environments, and explore various links to health. We suggest theoretical and practical applications of residents' perspectives on landscape care and identify implications for well-being and neighborhood stability. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Gentry, Sarah; Badrinath, Padmanabhan

    2017-03-06

    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.

  19. Promoting Local Ownership: Lessons Learned from Process of Transitioning Clinical Mentoring of HIV Care and Treatment in Ethiopia

    Directory of Open Access Journals (Sweden)

    Getnet M. Kassie

    2018-02-01

    Full Text Available IntroductionFocus on improving access and quality of HIV care and treatment gained acceptance in Ethiopia through the work of the International Training and Education Center for Health. The initiative deployed mobile field-based teams and capacity building teams to mentor health care providers on clinical services and program delivery in three regions, namely Tigray, Amhara, and Afar. Transitioning of the clinical mentoring program (CMP began in 2012 through capacity building and transfer of skills and knowledge to local health care providers and management.ObjectiveThe initiative explored the process of transitioning a CMP on HIV care and treatment to local ownership and documented key lessons learned.MethodsA mixed qualitative design was used employing focus group discussions, individual in-depth interviews, and review of secondary data. The participants included regional focal persons, mentors, mentees, multidisciplinary team members, and International Training and Education Center for Health (I-TECH staff. Three facilities were selected in each region. Data were collected by trained research assistants using customized guides for interviews and with data extraction format. The interviews were recorded and fully transcribed. Open Code software was used for coding and categorizing the data.ResultsA total of 16 focus group discussions and 20 individual in-depth interviews were conducted. The critical processes for transitioning a project were: establishment of a mentoring transition task force, development of a roadmap to define steps and directions for implementing the transition, and signing of a memorandum of understanding (MOU between the respective regional health bureaus and I-TECH Ethiopia to formalize the transition. The elements of implementation included mentorship and capacity building, joint mentoring, supportive supervision, review meetings, and independent mentoring supported by facility-based mechanisms: multidisciplinary team

  20. Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design.

    Science.gov (United States)

    Hartzler, Andrea L; Chaudhuri, Shomir; Fey, Brett C; Flum, David R; Lavallee, Danielle

    2015-01-01

    The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients-physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT). We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery. Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs. Our work illustrates a range of engagement methods guided by human-centered principles and design recommendations for optimizing PRO Dashboards for patient

  1. Integrating Patient-Reported Outcomes into Spine Surgical Care through Visual Dashboards: Lessons Learned from Human-Centered Design

    Science.gov (United States)

    Hartzler, Andrea L.; Chaudhuri, Shomir; Fey, Brett C.; Flum, David R.; Lavallee, Danielle

    2015-01-01

    Introduction: The collection of patient-reported outcomes (PROs) draws attention to issues of importance to patients—physical function and quality of life. The integration of PRO data into clinical decisions and discussions with patients requires thoughtful design of user-friendly interfaces that consider user experience and present data in personalized ways to enhance patient care. Whereas most prior work on PROs focuses on capturing data from patients, little research details how to design effective user interfaces that facilitate use of this data in clinical practice. We share lessons learned from engaging health care professionals to inform design of visual dashboards, an emerging type of health information technology (HIT). Methods: We employed human-centered design (HCD) methods to create visual displays of PROs to support patient care and quality improvement. HCD aims to optimize the design of interactive systems through iterative input from representative users who are likely to use the system in the future. Through three major steps, we engaged health care professionals in targeted, iterative design activities to inform the development of a PRO Dashboard that visually displays patient-reported pain and disability outcomes following spine surgery. Findings: Design activities to engage health care administrators, providers, and staff guided our work from design concept to specifications for dashboard implementation. Stakeholder feedback from these health care professionals shaped user interface design features, including predefined overviews that illustrate at-a-glance trends and quarterly snapshots, granular data filters that enable users to dive into detailed PRO analytics, and user-defined views to share and reuse. Feedback also revealed important considerations for quality indicators and privacy-preserving sharing and use of PROs. Conclusion: Our work illustrates a range of engagement methods guided by human-centered principles and design

  2. Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned.

    Science.gov (United States)

    Slusher, Tina M; Kiragu, Andrew W; Day, Louise T; Bjorklund, Ashley R; Shirk, Arianna; Johannsen, Colleen; Hagen, Scott A

    2018-01-01

    Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs) remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU) and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

  3. Pediatric Critical Care in Resource-Limited Settings—Overview and Lessons Learned

    Directory of Open Access Journals (Sweden)

    Tina M. Slusher

    2018-03-01

    Full Text Available Pediatric critical care is an important component of reducing morbidity and mortality globally. Currently, pediatric critical care in low middle-income countries (LMICs remains in its infancy in most hospitals. The majority of hospitals lack designated intensive care units, healthcare staff trained to care for critically ill children, adequate numbers of staff, and rapid access to necessary medications, supplies and equipment. In addition, most LMICs lack pediatric critical care training programs for healthcare providers or certification procedures to accredit healthcare providers working in their pediatric intensive care units (PICU and high dependency areas. PICU can improve the quality of pediatric care in general and, if properly organized, can effectively treat the severe complications of high burden diseases, such as diarrhea, severe malaria, and respiratory distress using low-cost interventions. Setting up a PICU in a LMIC setting requires planning, specific resources, and most importantly investment in the nursing and permanent medical staff. A thoughtful approach to developing pediatric critical care services in LMICs starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built on in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease pediatric morbidity and mortality in the context of public health goals as we reach toward the sustainable development goals.

  4. Lessons learned from testing the quality cost model of Advanced Practice Nursing (APN) transitional care.

    Science.gov (United States)

    Brooten, Dorothy; Naylor, Mary D; York, Ruth; Brown, Linda P; Munro, Barbara Hazard; Hollingsworth, Andrea O; Cohen, Susan M; Finkler, Steven; Deatrick, Janet; Youngblut, JoAnne M

    2002-01-01

    To describe the development, testing, modification, and results of the Quality Cost Model of Advanced Practice Nurses (APNs) Transitional Care on patient outcomes and health care costs in the United States over 22 years, and to delineate what has been learned for nursing education, practice, and further research. The Quality Cost Model of APN Transitional Care. Review of published results of seven randomized clinical trials with very low birth-weight (VLBW) infants; women with unplanned cesarean births, high risk pregnancies, and hysterectomy surgery; elders with cardiac medical and surgical diagnoses and common diagnostic related groups (DRGs); and women with high risk pregnancies in which half of physician prenatal care was substituted with APN care. Ongoing work with the model is linking the process of APN care with the outcomes and costs of care. APN intervention has consistently resulted in improved patient outcomes and reduced health care costs across groups. Groups with APN providers were rehospitalized for less time at less cost, reflecting early detection and intervention. Optimal number and timing of postdischarge home visits and telephone contacts by the APNs and patterns of rehospitalizations and acute care visits varied by group. To keep people well over time, APNs must have depth of knowledge and excellent clinical and interpersonal skills that are the hallmark of specialist practice, an in-depth understanding of systems and how to work within them, and sufficient patient contact to effect positive outcomes at low cost.

  5. Five-year forward view: lessons from emergency care at the extremes of age.

    Science.gov (United States)

    Minhas, J S; Minhas, D; Coats, T; Banerjee, J; Roland, D

    2018-03-01

    Objective The progressive rise in demand on NHS emergency care resources is partly attributable to increases in attendances of children and older people. A quality gap exists in the care provision for the old and the young. The Five Year Forward View suggested new models of care but that the "answer is not one-size-fits-all". This article discusses the urgent need for person-centred outcome measures to bridge the gap that exists between demand and provision. Design This review is based on evidence gathered from literature searching across several platforms using a variety of search terms to account for the obvious heterogeneity, drawing on key 'think-tank' evidence. Settings Qualitative and quantitative studies examining approaches to caring for individuals at the extremes of age. Participants Individuals at the extremes of age (infants and older people). Main Outcome Measures Understanding similarities and disparities in the care of individuals at the extremes of age in an emergency and non-emergency context. Results There exists several similarities and disparities in the care of individuals at the extremes of age. The increasing burden of health disease on the economy must acknowledge the challenges that exist in managing patients in emergency settings at the extremes of age and build systems to acknowledge the traits these individuals exhibit. Conclusion Commissioners of services must optimise the models of care delivery by appreciating the similarities and differences between care requirements in these two large groups seeking emergency care.

  6. Designing Effective Interactions for Concordance around End-of-Life Care Decisions: Lessons from Hospice Admission Nurses

    Directory of Open Access Journals (Sweden)

    Carey Candrian

    2017-04-01

    choice patients make to forego aggressive treatment measures when they enroll in hospice. In a literal sense, to enroll in hospice means to bring in support for end-of-life care. It means to identify the need for expertise around symptom management at end-of-life, and agree to having a care team come and manage someone’s physical, psychosocial, and/or spiritual needs. As with all care, hospice can be stopped if it is no longer considered appropriate. To uncover the communication tensions undergirding a hospice admission interaction, we use Street’s ecological theory of patient-centered communication to analyze a case exemplar of a hospice admission interaction. This analysis reveals diverse points of struggle within hospice decision-making processes around hospice care and the need for communication techniques that promote trust and acceptance of end-of-life care. Lessons learned from talking about hospice care can inform other quality initiatives around communication and informed decision-making in the context of advance care planning, palliative care, and end-of-life care.

  7. Investing in Low-Wage Workers: Lessons from Family Child Care in Rhode Island

    Science.gov (United States)

    Roder, Anne; Seavey, Dorie

    2006-01-01

    While child care is one of the fastest growing occupations in the country, most employment in this field is precarious and low-wage. Investing in Low-Wage Workers profiles the Day Care Justice Co-op, a group of largely Latina and African American women living and working in some of Rhode Island's poorest communities. Determined to improve family…

  8. 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.

  9. Case-mix payment for nursing home care: lessons from Maryland.

    Science.gov (United States)

    Feder, J; Scanlon, W

    1989-01-01

    Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.

  10. Patient perspectives of care in a regionalised trauma system: lessons from the Victorian State Trauma System.

    Science.gov (United States)

    Gabbe, Belinda J; Sleney, Jude S; Gosling, Cameron M; Wilson, Krystle; Hart, Melissa J; Sutherland, Ann M; Christie, Nicola

    2013-02-18

    To explore injured patients' experiences of trauma care to identify areas for improvement in service delivery. Qualitative study using in-depth, semi-structured interviews, conducted from 1 April 2011 to 31 January 2012, with 120 trauma patients registered by the Victorian State Trauma Registry and the Victorian Orthopaedic Trauma Outcomes Registry and managed at the major adult trauma services (MTS) in Victoria. Emergent themes from patients' experiences of acute, rehabilitation and post-discharge care in the Victorian State Trauma System (VSTS). Patients perceived their acute hospital care as high quality, although 3s with communication and surgical management delays were common. Discharge from hospital was perceived as stressful, and many felt ill prepared for discharge. A consistent emerging theme was the sense of a lack of coordination of post-discharge care, and the absence of a consistent point of contact for ongoing management. Most patients' primary point of contact after discharge was outpatient clinics at the MTS, which were widely criticised because of substantial delays in receiving an appointment, prolonged waiting times, limited time with clinicians, lack of continuity of care and inability to see senior clinicians. This study highlights perceived 3s in the patient care pathway in the VSTS, especially those relating to communication, information provision and post-discharge care. Trauma patients perceived the need for a single point of contact for coordination of post-discharge care.

  11. A Policy Guide on Integrated Care (PGIC: Lessons Learned from EU Project INTEGRATE and Beyond

    Directory of Open Access Journals (Sweden)

    Liesbeth Borgermans

    2017-09-01

    Full Text Available Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012–2016 and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

  12. A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond.

    Science.gov (United States)

    Borgermans, Liesbeth; Devroey, Dirk

    2017-09-25

    Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012-2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.

  13. 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

  14. 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.

  15. Privatization of Health Care Provision in a Transition Economy: Lessons From the Republic of Macedonia

    National Research Council Canada - National Science Library

    Nordyke, Robert

    2000-01-01

    ...) under a World Bank credit. The RAND Corporation was under contract to provide technical assistance to the Government of Macedonia on aspects of the health sector financial reforms for primary health care (PHC...

  16. Diabetes self-care: lessons from research on the family and broader contexts.

    Science.gov (United States)

    Anderson, Barbara J

    2003-04-01

    The foundation of diabetes management is the self-care behavior of the patient. All of the systems within which the person with diabetes interacts, as well as the media and broader social and cultural values, affect this self-care behavior. In this article I focus on recent research that has examined the link between relationships in the patient's intimate network (i.e., family and close friends) and in the patient's exchange network (i.e., patient-provider relationship, Internet support). The goal of this review is to identify relational targets associated with self-care behaviors that are potentially modifiable within the diabetes medical care setting. Evidence-based suggestions are made for points of intervention entry, and areas for future research are explored.

  17. 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

  18. The next generation Internet and health care: a civics lesson for the informatics community.

    Science.gov (United States)

    Shortliffe, E H

    1998-01-01

    The Internet provides one of the most compelling examples of the way in which government research investments can, in time, lead to innovations of broad social and economic impact. This paper reviews the history of the Internet's evolution, emphasizing in particular its relationship to medical informatics and to the nation's health-care system. Current national research programs are summarized and the need for more involvement by the informatics community and by federal health-care agencies is emphasized.

  19. A European late starter: lessons from the history of reform in Irish health care.

    Science.gov (United States)

    Wren, Maev-Ann; Connolly, Sheelah

    2017-12-26

    The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.

  20. An Australian casemix classification for palliative care: lessons and policy implications of a national study.

    Science.gov (United States)

    Eagar, Kathy; Gordon, Robert; Green, Janette; Smith, Michael

    2004-04-01

    To provide a nontechnical discussion of the development of a palliative care casemix classification and some policy implications of its implementation. 3866 palliative care patients who, in a three month period, had 4596 episodes of care provided by 58 palliative care services in Australia and New Zealand. A detailed clinical and service utilization profile was collected on each patient with staff time and other resources measured on a daily basis. A statistical summary of the clinical variables was compiled as the first stage of the analysis. Palliative care phase was found to be a good predictor of resource use, with patients fairly evenly distributed across the five categories. Clients treated in an inpatient setting had poorer function and higher symptom severity scores than those treated in an ambulatory setting, a result that is not surprising in this Australian setting. Implementation of the resultant AN-SNAP classification has been proceeding since 1998 in some Australian jurisdictions. The development and implementation of a classification such as AN-SNAP provides the possibility of having a consistent approach to collecting palliative care data in Australia as well as a growing body of experience on how to progressively improve the classification over time.

  1. Protecting healthcare workers in an acute care environment during epidemics: lessons learned from the SARS outbreak

    Directory of Open Access Journals (Sweden)

    John Casken

    2011-01-01

    Full Text Available During the 2002-2003 the SARS outbreak resulted in 8,450 illnesses and 812 deaths. Out of these documented cases 1706 were among healthcare workers (HCWsThe purpose of this paper is to focus on and examine the details of infection control (IC measures and which of these measures appear to be the most effective in stopping disease spread. Historically, HCWs have had poor compliance with the use of IC measures prior to the SARS outbreak. A number of lessons were learned from the SARS epidemic that should be incorporated into healthcare institutions policies and procedures. They include the following: an emphasis on the correct and immediate use of IC measures; an increased focus on HCWs recognizing early perceived threats; healthcare institutions should mandate routine in-house education with periodic updates on IC measures; administrators need to acknowledge and encourage role models among staff; engineeringcontrols should be put in place to protect staff from pathogens; and finally, there should be clear and constant communication between administration and staff.

  2. Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

    Science.gov (United States)

    Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

    2014-02-01

    Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.

  3. 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.

  4. Characteristics of health care organizations associated with learning and development: lessons from a pilot study.

    Science.gov (United States)

    Nyström, Monica

    2009-01-01

    Characteristics of health care organizations associated with an ability to learn from experiences and to develop and manage change were explored in this study. Understanding of these characteristics is necessary to identify factors influencing success in learning from the past and achieving future health care quality objectives. A literature review of the quality improvement, strategic organizational development and change management, organizational learning, and microsystems fields identified 20 organizational characteristics, grouped under (a) organizational systems, (b) key actors, and (c) change management processes. Qualitative methods, using interviews, focus group reports, and archival records, were applied to find associations between identified characteristics and 6 Swedish health care units externally evaluated as delivering high-quality care. Strong support for a characteristic was defined as units having more than 4 sources describing the characteristic as an important success factor. Eighteen characteristics had strong support from at least 2 units. The strongest evidence was found for the following: (i) key actors have long-term commitment, provide support, and make sense of ambiguous situations; (ii) organizational systems encourage employee commitment, participation, and involvement; and (iii) change management processes are employed systematically. Based on the results, a new model of "characteristics associated with learning and development in health care organizations" is proposed.

  5. Management commitments and primary care: another lesson from Costa Rica for the world?

    Science.gov (United States)

    Soors, Werner; De Paepe, Pierre; Unger, Jean-Pierre

    2014-01-01

    Maintained dedication to primary care has fostered a public health delivery system with exceptional outcomes in Costa Rica. For more than a decade, management commitments have been part of Costa Rican health reform. We assessed the effect of the Costa Rican management commitments on access and quality of care and on compliance with their intended objectives. We constructed seven hypotheses on opinions of primary care providers. Through a mixed qualitative and quantitative approach, we tested these hypotheses and interpreted the research findings. Management commitments consume an excessive proportion of consultation time, inflate recordkeeping, reduce comprehensiveness in primary care consultations, and induce a disproportionate consumption of hospital emergency services. Their formulation relies on norms in need of optimization, their control on unreliable sources. They also affect professionalism. In Costa Rica, management commitments negatively affect access and quality of care and pose a threat to the public service delivery system. The failures of this pay-for-performance-like initiative in an otherwise well-performing health system cast doubts on the appropriateness of pay-for-performance for health systems strengthening in less advanced environments.

  6. The economics of choice: lessons from the U.S. health‐care market

    Science.gov (United States)

    Hanoch, Yaniv; Rice, Thomas

    2011-01-01

    Abstract 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. PMID:21122041

  7. 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.

  8. 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.

  9. 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

  10. PIMA Point of Care CD4+ Cell Count Machines in Remote MNCH Settings: Lessons Learned from Seven Districts in Zimbabwe

    Science.gov (United States)

    Mtapuri-Zinyowera, Sekesai; Chiyaka, Edward T.; Mushayi, Wellington; Musuka, Godfrey; Naluyinda-Kitabire, Florence; Mushavi, Angella; Chikwasha, Vasco

    2013-01-01

    An evaluation was commissioned to generate evidence on the impact of PIMA point-of-care CD4+ count machines in maternal and new-born child health settings in Zimbabwe; document best practices, lessons learned, challenges, and recommendations related to scale up of this new technology. A mixed methodology approach that included 31 in-depth interviews with stakeholders involved in procurement, distribution, and use of the POC machines was employed. Additionally, data was also abstracted from 207 patient records from 35 sites with the PIMA POC CD4+ count machines and 10 other comparative sites without the machine. A clearer training strategy was found to be necessary. The average time taken to initiate clients on antiretroviral treatment (ART) was substantially less, 15 days (IQR-1-149) for sites with a PIMA POC machine as compared to 32.7 days (IQR-1-192) at sites with no PIMA POC machine. There was general satisfaction because of the presence of the PIMA POC CD4+ count machine at sites that also initiated ART. PMID:24847177

  11. A data infrastructure for the assessment of health care performance: lessons from the BRIDGE-health project.

    Science.gov (United States)

    Bernal-Delgado, Enrique; Estupiñán-Romero, Francisco

    2018-01-01

    The integration of different administrative data sources from a number of European countries has been shown useful in the assessment of unwarranted variations in health care performance. This essay describes the procedures used to set up a data infrastructure (e.g., data access and exchange, definition of the minimum common wealth of data required, and the development of the relational logic data model) and, the methods to produce trustworthy healthcare performance measurements (e.g., ontologies standardisation and quality assurance analysis). The paper ends providing some hints on how to use these lessons in an eventual European infrastructure on public health research and monitoring. Although the relational data infrastructure developed has been proven accurate, effective to compare health system performance across different countries, and efficient enough to deal with hundred of millions of episodes, the logic data model might not be responsive if the European infrastructure aims at including electronic health records and carrying out multi-cohort multi-intervention comparative effectiveness research. The deployment of a distributed infrastructure based on semantic interoperability, where individual data remain in-country and open-access scripts for data management and analysis travel around the hubs composing the infrastructure, might be a sensible way forward.

  12. 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.

  13. 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.

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

    NARCIS (Netherlands)

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

    2013-01-01

    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

  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. 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

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

    Science.gov (United States)

    Hernández, Carme; Alonso, Albert; Garcia-Aymerich, Judith; Grimsmo, Anders; Vontetsianos, Theodore; García Cuyàs, Francesc; Altes, Anna Garcia; Vogiatzis, Ioannis; Garåsen, Helge; Pellise, Laura; Wienhofen, Leendert; Cano, Isaac; Meya, Montserrat; Moharra, Montserrat; Martinez, Joan Ignasi; Escarrabill, Juan; Roca, Josep

    2015-01-01

    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. 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). 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. The project demonstrated: (i) Sustainability of training effects over time in chronic patients with obstructive pulmonary disease (p 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.

  18. 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.

  19. 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

  20. 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. © 2016 World Obesity.

  1. 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. © 2010 Blackwell Publishing Ltd.

  2. Challenges in the care of clients with established cardiovascular disease: lessons learned from Australian community pharmacists.

    Directory of Open Access Journals (Sweden)

    Hanni P Puspitasari

    Full Text Available As primary healthcare professionals, community pharmacists have both opportunity and potential to contribute to the prevention and progression of chronic diseases. Using cardiovascular disease (CVD as a case study, we explored factors that influence community pharmacists' everyday practice in this area. We also propose a model to best illustrate relationships between influencing factors and the scope of community pharmacy practice in the care of clients with established CVD.In-depth, semi-structured interviews were conducted with 21 community pharmacists in New South Wales, Australia. All interviews were audio-recorded, transcribed ad verbatim, and analysed using a "grounded-theory" approach.Our model shows that community pharmacists work within a complex system and their practice is influenced by interactions between three main domains: the "people" factors, including their own attitudes and beliefs as well as those of clients and doctors; the "environment" within and beyond the control of community pharmacy; and outcomes of their professional care. Despite the complexity of factors and interactions, our findings shed some light on the interrelationships between these various influences. The overarching obstacle to maximizing the community pharmacists' contribution is the lack of integration within health systems. However, achieving better integration of community pharmacists in primary care is a challenge since the systems of remuneration for healthcare professional services do not currently support this integration.Tackling chronic diseases such as CVD requires mobilization of all sources of support in the community through innovative policies which facilitate inter-professional collaboration and team care to achieve the best possible healthcare outcomes for society.

  3. 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.

  4. Lessons from interprofessional e-learning: piloting a care of the elderly module.

    Science.gov (United States)

    Juntunen, Anitta; Heikkinen, Eija

    2004-08-01

    Educating health care professionals is a key issue in the provision of quality healthcare services. Interprofessional education has been suggested as a means of meeting this challenge. Four Finnish polytechnics providing education for nurses, social workers and physiotherapists wished to develop the content and methods of teaching the care of the elderly by collaboratively creating and implementing an interprofessional module of 15 European Credit Transfer units, using e-learning. This paper examines the planning and assessment of the impact of the pilot module. The web-based environment eminently suited teaching interprofessional care of the elderly. It supported content and methodological development and renewal of the module. It enabled discussion and collaboration between nursing, social work and rehabilitation teachers and students from the Polytechnics which are located in different parts of Finland. However, it became evident during the pilot that the most crucial challenges of the web-based pedagogy were in the ability of the teacher to supervise, support and motivate students and the organisation of interprofessional learning offered by collaborating institutions.

  5. 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.

  6. 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.

  7. 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.

    Science.gov (United States)

    Gregory, Michael

    2015-01-01

    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.

  8. 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.

  9. 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

  10. 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

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

    Science.gov (United States)

    Wodchis, Walter P; Dixon, Anna; Anderson, Geoff M; Goodwin, Nick

    2015-01-01

    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. 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. 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. 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. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Pharmacotherapeutic management of chronic noncancer pain in primary care: lessons for pharmacists

    Directory of Open Access Journals (Sweden)

    Jouini G

    2014-03-01

    Full Text Available Ghaya Jouini,1–3 Manon Choinière,3,4 Elisabeth Martin,2,3 Sylvie Perreault,1,5 Djamal Berbiche,2,3 David Lussier,6–8 Eveline Hudon,2,3,9 Lyne Lalonde1–3,101Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; 2Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, Quebec, Canada; 3Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM, Montreal, Quebec, Canada; 4Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 5Sanofi-Aventis Endowment Research Chair in Optimal Drug Use, Université de Montréal, Montreal, Quebec, Canada; 6Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada; 7Division of Geriatric Medicine and Alan-Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada; 8Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 9Department of Family Medicine and Emergency, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada; 10Sanofi-Aventis Endowment Research Chair in Ambulatory Pharmaceutical Care, Université de Montréal and Centre de santé et de services sociaux de Laval, Quebec, CanadaPurpose: Describe the pharmacotherapeutic management of primary-care patients with chronic noncancer pain, assess their satisfaction with pain treatment, and identify the determinants of their satisfaction.Methods: A cohort study was conducted in Quebec (Canada. Patients reporting chronic noncancer pain with an average pain intensity of at least 4 on a 0–10 scale (10= worst possible pain and having an active analgesic prescription from a primary-care physician were recruited. They completed a telephone interview and a self-administered questionnaire to document their pain, emotional well-being, satisfaction with treatment, and barriers/beliefs/attitudes about pain and its treatment. Information

  17. 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

  18. How primary care reforms influenced health indicators in Manisa district in Turkey: Lessons for general practitioners.

    Science.gov (United States)

    Cevik, Celalettin; Sozmen, Kaan; Kilic, Bulent

    2018-12-01

    Turkish health reforms began in 2003 and brought some significant changes in primary care services. Few studies in Turkey compare the shift from health centres (HC) to family physicians (FP) approach, which was initiated by reforms. This study compares health status indicators during the HC period before reforms (2003-2007) and the FP period after reforms (2008-2012) in Turkey. This study encompasses time series data consisting of the results of a 10-year assessment (2003-2012) in Manisa district. All the data were obtained electronically and by month. The intersection points of the regression curves of these two periods and the beta coefficients were compared using segmented linear regression analysis. The mean number of follow-up per person/year during the HC period in infants (10.5), pregnant women (6.6) and women (1.8) was significantly higher than the mean number of follow-up during the FP period in infants (6.7), pregnant women (5.6) and women (0.9). Rates of BCG and measles vaccinations were significantly higher during the FP period; however, rates of HBV and DPT were same. The mean number of outpatient services per person/year during the FP period (3.3) was significantly higher than HC period (2.8). Within non-communicable diseases, no difference was detected for hypertension prevalence. Within communicable diseases, there was no difference for rabies suspected bites but acute haemorrhagic gastroenteritis significantly decreased. The infant mortality rate and under five-year child mortality rate significantly increased during the FP period. Primary care services should be reorganized and integrated with public health services.

  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. © 2013 John Wiley & Sons Ltd.

  20. Commentary: narrative lessons from a Nigerian novelist: implications for medical education and care.

    Science.gov (United States)

    Zarconi, Joseph

    2012-08-01

    In her TED Talk entitled "The danger of a single story," Nigerian novelist Chimamanda Adichie shares stories about her life that illustrate the natural human tendency to interpret the lives of others in the context of what she describes as narrowly constructed and often stereotypical "single stories." These single-story views often portray others as wholly different from those constructing the stories, thereby diminishing the possibilities for genuine human connection. Referencing Adichie's talk, the author describes the narrative dissonance that so often distances patients from their physicians. He illustrates the dangers to patients that can result from single-story caregiving by physicians, sharing an example from his own experience in which unnecessary harm came to his patient because of his own single-story thinking. The author argues that these single-story dangers must be openly and consciously addressed in the training of doctors to counteract the tendency for their clinical and educational experiences to inculcate single stories by which physicians come to interpret their patients. He offers suggestions as to why single-story thinking arises in clinical practice and how to mitigate these forces in medical education. The author concludes by contending that the education of physicians, and caring for the sick, should be aimed at preserving the dignity of those being served, and he argues for an "equal humanity" model of the patient-physician relationship that engages patients in all dimensions of their multiple stories.

  1. HIPs at Ten

    Science.gov (United States)

    Kuh, George; O'Donnell, Ken; Schneider, Carol Geary

    2017-01-01

    2017 is the anniversary of the introduction of what are now commonly known as high-impact practices (HIPs). Many of the specific activities pursued under the HIPs acronym have been around in some form for decades, such as study abroad, internships, and student-faculty research. It was about ten years ago that, after conferring HIPs at Ten with…

  2. 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. ©Birgitte Noergaard, Marianne Sandvei, Nina Rottmann, Helle Johannessen, Uffe Wiil, Thomas Schmidt, Susanne S Pedersen. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 17.05.2017.

  3. Residential care for abandoned children and their integration into a family-based setting in Uganda: lessons for policy and programming.

    Science.gov (United States)

    Walakira, Eddy J; Ochen, Eric A; Bukuluki, Paul; Alllan, Sue

    2014-01-01

    This article describes a model of care for abandoned and neglected infants in need of urgent physical, social, and medical support as implemented by the Child's i Foundation, an international, nongovernmental organization operating in Uganda. The model discounts the need for long-term care of young children within institutions and challenges the basis for intercountry adoption. Underpinned by the essentials of care continuum provided under the Uganda National Alternative Care Framework (Ministry of Gender, Labour and Social Development, 2012), the model emphasizes the need to effect the reintegration of the separated child within the family of his or her birth, or locally organize foster care or adoption. Highlighting policy and programming lessons, the model showcases a holistic approach to the problem and puts emphasis on interventions that are protective, promotional, and transformational and the use of a community-oriented approach. The model offers guidance to both government and nongovernment actors in addressing the problems of child neglect and abandonment through the implementation of the alternative care framework. © 2014 Michigan Association for Infant Mental Health.

  4. The first ten years: achievements and challenges of the Brazilian program of universal access to HIV/AIDS comprehensive management and care, 1996-2006.

    Science.gov (United States)

    Hacker, Mariana A; Kaida, Angela; Hogg, Robert S; Bastos, Francisco I

    2007-01-01

    A review was carried out of papers published between 1996 and 2006, documenting the introduction of highly active anti-retroviral therapy (HAART) in Brazil. Papers indexed in the MEDLINE and SciELO databases were retrieved using different combinations of keywords related to the management and care of AIDS in the post-HAART era: opportunistic diseases and co-infections, adherence to therapy, survival in the pre- and post-HAART eras, adverse events and side-effects, emergence and possible transmission of resistant viral strains, metabolic and cardiovascular disorders, and issues related to access to care and equity. The review documents the dramatic changes in HIV/AIDS disease progression in the post-HAART era, including an increase in survival and quality of life and a pronounced decrease in the episodes of opportunistic diseases. Notwithstanding such major achievements, new challenges have emerged, including slow evolving co-infections (such as hepatitis C, metabolic and cardiovascular disorders), the emergence of viral resistance, with consequences at the individual level (virological failure) and the community level (primary/secondary resistance at the population level), and impacts on the cost of new therapeutic regimens.

  5. Ten years incidence of natural rubber latex sensitization and symptoms in a prospective cohort of health care workers using non-powdered latex gloves 2000-2009.

    Science.gov (United States)

    Larese Filon, Francesca; Bochdanovits, Letizia; Capuzzo, Chiara; Cerchi, Roberto; Rui, Francesca

    2014-07-01

    To assess the incidence of sensitization and gloves-related symptoms in 10-year follow-up in a group of health care workers (9,660 person-years) using non-powdered latex gloves from 2000 to 2009 and to examine related factors. We studied 2,053 health care workers in Trieste Hospitals by means of skin prick test for latex extract, patch tests and medical examinations. We report the incidence of latex sensitization among workers using non-powdered latex gloves. The incidence of latex sensitization, rhinitis, asthma, urticaria, irritant and allergic contact dermatitis were 1.0; 0.12; 0.21; 0.72; 2.39 and 2.50 cases per 1,000 person-years, respectively. Respiratory symptoms and urticaria were positively related with latex sensitization (OR = 8.0; 95 % CL 1.27-48.6), with common allergic respiratory symptoms (OR = 4.19; 95 % CL 1.04-16.8) and with familial atopy (OR = 4.47; 95 % CL 1.1-17.9). The incidence of latex sensitization and latex-related symptoms were very low but subjects with allergic symptoms related to common allergens are at higher risk. The use of non-latex gloves is suggested for them.

  6. Chernobyl ten years after

    International Nuclear Information System (INIS)

    1996-01-01

    The accident in the fourth reactor plant in Chernobyl in Ukraine occurred ten years years ago, caused the death of 31 people while the health consequences have turned out to be difficult to assess. This review describes the accident, its consequences and effects to health, studies carried out at the present state as well as the comparison with the other accidents and disaster. (author)

  7. 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:

  8. 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…

  9. 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.

  10. 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

  11. [Ten-year evolution of mechanical ventilation in acute respiratory failure in the hematogical patient admitted to the intensive care unit].

    Science.gov (United States)

    Belenguer-Muncharaz, A; Albert-Rodrigo, L; Ferrandiz-Sellés, A; Cebrián-Graullera, G

    2013-10-01

    A comparison was made between invasive mechanical ventilation (IMV) and noninvasive positive pressure ventilation (NPPV) in haematological patients with acute respiratory failure. A retrospective observational study was made from 2001 to December 2011. A clinical-surgical intensive care unit (ICU) in a tertiary hospital. Patients with hematological malignancies suffering acute respiratory failure (ARF) and requiring mechanical ventilation in the form of either IMV or NPPV. Analysis of infection and organ failure rates, duration of mechanical ventilation and ICU and hospital stays, as well as ICU, hospital and mortality after 90 days. The same variables were analyzed in the comparison between NPPV success and failure. Forty-one patients were included, of which 35 required IMV and 6 NPPV. ICU mortality was higher in the IMV group (100% vs 37% in NPPV, P=.006). The intubation rate in NPPV was 40%. Compared with successful NPPV, failure in the NPPV group involved more complications, a longer duration of mechanical ventilation and ICU stay, and greater ICU and hospital mortality. Multivariate analysis of mortality in the NPPV group identified NPPV failure (OR 13 [95%CI 1.33-77.96], P=.008) and progression to acute respiratory distress syndrome (OR 10 [95%CI 1.95-89.22], P=.03) as prognostic factors. The use of NPPV reduced mortality compared with IMV. NPPV failure was associated with more complications. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  12. Hepatitis B and C virus prevalence in couples attending an in vitro fertilization clinic in a tertiary care hospital in Saudi Arabia: comparison with ten years earlier.

    Science.gov (United States)

    Albadran, Asma; Hibshi, Ali; Saeed, Bahjat; Coskun, Serdar; Awartani, Khalid Arab

    2017-01-01

    Viral hepatitis B (HBV) and C (HCV) are a major public health problem in Saudi Arabia. Recent data has indicated a major reduction in viral hepatitis prevalence in Saudi population. However, there is limited data for infertile Saudi couples. To determine the prevalence of HCV and HBV attending an in vitro fertilization (IVF) clinic in Saudi Arabia between 2012 and 2015 to compare with the prevalence 10 years earlier in the same center. Retrospective prevalence study. Tertiary care center in Riyadh. Data on the prevalence of HBV and HCV was collected on all couples seen at the IVF unit between 2002-2005 and 2012-2015. Prevalence of HBV and HCV. In 4442 patients during 2002-2005 and 5747 patients during 2012-2015, the prevalence of HBV was significantly less in 2012-2015 compared with 2002-2005 (1.67% [97 patients] vs 4.7% [210 patients], P < .0001), respectively, but HCV prevalence was similar for the two periods (0.7% for both periods) (P=.887). The hepatitis B seroprevalence rate was higher in males compared to females during 2002-2005 (6.3% vs 3.1%) (P < .0001) and 2012-2015 (2.4% vs 1.1% ) (P < .0001), respectively. The significant drop in HBV prevalence was most likely due to the introduction of the vaccination program in 1989, while reasons for HCV prevalence remaining unchanged are unclear. No data on confounding factors that may have affected the prevalence.

  13. Caring communities as collective learning process: findings and lessons learned from a participatory research project in Austria.

    Science.gov (United States)

    Wegleitner, Klaus; Schuchter, Patrick

    2018-04-01

    By now, the public health end-of-life care approach is well established and has induced diverse initiatives-subsumed under the concept of compassionate or caring communities-to engage the community in supporting vulnerable, dying people and their beloved ones. In the light of a participatory research project our paper examines the question: what are the deeper ideas behind caring communities and what constitutes a caring community? A multi-level analysis based on (I) qualitative research with focus groups and interviews with community members within the project; (II) the reflection of the role of participatory research in caring community initiatives, and (III) the meta-analysis of an international expert workshop, which allowed to discuss our experiences and insights in the light of international caring community models and expertise. Our analysis of qualities ("ingredients") of a caring community, from the perspective of community members, highlighted the importance of the co-creation of supportive care relationships in the local care web, through everyday life solidarity in the neighbourhood, appreciating and exchanging the wisdom of care, and also marked the role of professionals as enablers. Participatory research in caring community developments has the potential to engage and empower citizens, and to interlink existential care-stories with questions about the structural and political environments of appropriate end-of-life care. The caring community movement and public health end-of-life care has to maintain their critical potential against the commercialization and fragmentation of care (services), but also without "romanticizing" communities. Prospective caring community progresses need (I) an ecological health-promotion framework for action and (II) social learning processes along the existential experiences and the wisdom of community members, complementing each other. Organizing existential-political care dialogues can contribute to an ethic of caring

  14. Powers of ten

    CERN Document Server

    1979-01-01

    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 idea for the film appears to have come from the 1957 book Cosmic View by Kees Boeke. 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 pow...

  15. Smoking cessation counseling for Asian immigrants with serious mental illness: using RE-AIM to understand challenges and lessons learned in primary care-behavioral health integration.

    Science.gov (United States)

    Saw, Anne; Kim, Jin; Lim, Joyce; Powell, Catherine; Tong, Elisa K

    2013-09-01

    Engagement in modifiable risk behaviors, such as tobacco use, substantially contributes to early mortality rates in individuals with serious mental illness (SMI). There is an alarmingly high prevalence of tobacco use among subgroups of Asian Americans, such as immigrants and individuals with SMI, yet there are no empirically supported effective smoking cessation interventions that have been tailored to meet the unique cultural, cognitive, and psychological needs of Asian immigrants with SMI. In this article, we share the experiences of clinicians in the delivery of smoking cessation counseling to Asian American immigrants with SMI, in the context of an Asian-focused integrated primary care and behavioral health setting. Through a qualitative analysis of clinician perspectives organized with the RE-AIM framework, we outline challenges, lessons learned, and promising directions for delivering smoking cessation counseling to Asian American immigrant clients with SMI.

  16. The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model.

    Science.gov (United States)

    Moore, Julia E; Grouchy, Michelle; Graham, Ian D; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E

    2016-05-01

    Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. Funded projects have been sustained (76% reported full sustainability) and spread to over 200 new sites. Lessons learned include the following: assess readiness, develop tailored implementation materials, consider characteristics of implementation supports, protect champion time and consider evaluation feasibility. Copyright © 2016 Longwoods Publishing.

  17. Engaging stakeholders: lessons from the use of participatory tools for improving maternal and child care health services.

    Science.gov (United States)

    Ekirapa-Kiracho, Elizabeth; Ghosh, Upasona; Brahmachari, Rittika; Paina, Ligia

    2017-12-28

    Effective stakeholder engagement in research and implementation is important for improving the development and implementation of policies and programmes. A varied number of tools have been employed for stakeholder engagement. In this paper, we discuss two participatory methods for engaging with stakeholders - participatory social network analysis (PSNA) and participatory impact pathways analysis (PIPA). Based on our experience, we derive lessons about when and how to apply these tools. This paper was informed by a review of project reports and documents in addition to reflection meetings with the researchers who applied the tools. These reports were synthesised and used to make thick descriptions of the applications of the methods while highlighting key lessons. PSNA and PIPA both allowed a deep understanding of how the system actors are interconnected and how they influence maternal health and maternal healthcare services. The findings from the PSNA provided guidance on how stakeholders of a health system are interconnected and how they can stimulate more positive interaction between the stakeholders by exposing existing gaps. The PIPA meeting enabled the participants to envision how they could expand their networks and resources by mentally thinking about the contributions that they could make to the project. The processes that were considered critical for successful application of the tools and achievement of outcomes included training of facilitators, language used during the facilitation, the number of times the tool is applied, length of the tools, pretesting of the tools, and use of quantitative and qualitative methods. Whereas both tools allowed the identification of stakeholders and provided a deeper understanding of the type of networks and dynamics within the network, PIPA had a higher potential for promoting collaboration between stakeholders, likely due to allowing interaction between them. Additionally, it was implemented within a participatory action

  18. Primary care-based multifaceted, interdisciplinary medical educational intervention for patients with systolic heart failure: lessons learned from a cluster randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Schellberg Dieter

    2009-08-01

    Full Text Available Abstract Background Chronic (systolic heart failure (CHF is a common and disabling condition. Adherence to evidence-based guidelines in primary care has been shown to improve health outcomes. The aim was to explore the impact of a multidisciplinary educational intervention for general practitioners (GPs (Train the trainer = TTT on patient and performance outcomes. Methods This paper presents the key findings from the trial and discusses the lessons learned during the implementation of the TTT trial. Primary care practices were randomly assigned to the TTT intervention or to the control group. 37 GPs (18 TTT, 19 control were randomised and 168 patients diagnosed with ascertained CHF (91 TTT, 77 control were enrolled. GPs in the intervention group attended four meetings addressing clinical practice guidelines and pharmacotherapy feedback. The primary outcome was patient self-reported quality of life at seven months, using the SF-36 Physical Functioning scale. Secondary outcomes included other SF-36 scales, the Kansas City Cardiomyopathy Questionnaire (KCCQ, total mortality, heart failure hospital admissions, prescribing, depressive disorders (PHQ-9, behavioural change (European Heart Failure Self-Care Behaviour Scale, patient-perceived quality of care (EUROPEP and improvement of heart failure using NT-proBNP-levels. Because recruitment targets were not achieved an exploratory analysis was conducted. Results There was high baseline achievement in both groups for many outcomes. At seven months, there were no significant mean difference between groups for the primary outcome measure (-3.3, 95%CI -9.7 to 3.1, p = 0.30. The only difference in secondary outcomes related to the prescribing of aldosterone antagonists by GPs in the intervention group, with significant between group differences at follow-up (42 vs. 24%, adjusted OR = 4.0, 95%CI 1.2–13; p = 0.02. Conclusion The intervention did not change the primary outcome or most secondary outcomes

  19. Primary care-based multifaceted, interdisciplinary medical educational intervention for patients with systolic heart failure: lessons learned from a cluster randomised controlled trial.

    Science.gov (United States)

    Peters-Klimm, Frank; Campbell, Stephen; Müller-Tasch, Thomas; Schellberg, Dieter; Gelbrich, Goetz; Herzog, Wolfgang; Szecsenyi, Joachim

    2009-08-13

    Chronic (systolic) heart failure (CHF) is a common and disabling condition. Adherence to evidence-based guidelines in primary care has been shown to improve health outcomes. The aim was to explore the impact of a multidisciplinary educational intervention for general practitioners (GPs) (Train the trainer = TTT) on patient and performance outcomes. This paper presents the key findings from the trial and discusses the lessons learned during the implementation of the TTT trial. Primary care practices were randomly assigned to the TTT intervention or to the control group. 37 GPs (18 TTT, 19 control) were randomised and 168 patients diagnosed with ascertained CHF (91 TTT, 77 control) were enrolled. GPs in the intervention group attended four meetings addressing clinical practice guidelines and pharmacotherapy feedback. The primary outcome was patient self-reported quality of life at seven months, using the SF-36 Physical Functioning scale. Secondary outcomes included other SF-36 scales, the Kansas City Cardiomyopathy Questionnaire (KCCQ), total mortality, heart failure hospital admissions, prescribing, depressive disorders (PHQ-9), behavioural change (European Heart Failure Self-Care Behaviour Scale), patient-perceived quality of care (EUROPEP) and improvement of heart failure using NT-proBNP-levels. Because recruitment targets were not achieved an exploratory analysis was conducted. There was high baseline achievement in both groups for many outcomes. At seven months, there were no significant mean difference between groups for the primary outcome measure (-3.3, 95%CI -9.7 to 3.1, p = 0.30). The only difference in secondary outcomes related to the prescribing of aldosterone antagonists by GPs in the intervention group, with significant between group differences at follow-up (42 vs. 24%, adjusted OR = 4.0, 95%CI 1.2-13; p = 0.02). The intervention did not change the primary outcome or most secondary outcomes. Recruitment targets were not achieved and the under

  20. 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. Copyright 2014, SLACK Incorporated.

  1. Integrating cultural values, beliefs, and customs into pregnancy and postpartum care: lessons learned from a Hawaiian public health nursing project.

    Science.gov (United States)

    Mayberry, L J; Affonso, D D; Shibuya, J; Clemmens, D

    1999-06-01

    Determining the elements of culturally competent health care is an important goal for nurses. This goal is particularly integral in efforts to design better preventive health care strategies for pregnant and postpartum women from multiple cultural and ethnic backgrounds. Learning about the values, beliefs, and customs surrounding health among the targeted groups is essential, but integrating this knowledge into the actual health care services delivery system is more difficult. The success of a prenatal and postpartum program developed for native Hawaiian, Filipino, and Japanese women in Hawaii has been attributed to the attention on training, direct care giving, and program monitoring participation by local cultural and ethnic healers and neighborhood leaders living in the community, with coordination by public health nurses. This article profiles central design elements with examples of specific interventions used in the Malama Na Wahine or Caring for Pregnant Women program to illustrate a unique approach to the delivery of culturally competent care.

  2. Ten practical lessons for an effective radon risk communication program

    International Nuclear Information System (INIS)

    Fisher, A.; Johnson, F.R.

    1990-01-01

    Those responsible for state and local radon programs often express frustration about the small share of homes that have been tested for radon, and the small share of those with high readings that have been mitigated. Several recent studies have examined how well alternative ways of communicating about radon's risk have accomplished the goals of motivating appropriate testing and mitigation. Unfortunately, the results of these studies have not reached practitioners. This paper is for them. It summarizes the practical implications that are most crucial for planning and implementing an effective radon risk communication program--a program that will motivate people to test for radon and mitigate when radon levels are high, without unduly alarming those whose radon levels are low

  3. Process and impact evaluation of the Romp & Chomp obesity prevention intervention in early childhood settings: lessons learned from implementation in preschools and long day care settings.

    Science.gov (United States)

    de Silva-Sanigorski, Andrea M; Bell, Andrew C; Kremer, Peter; Park, Janet; Demajo, Lisa; Smith, Michael; Sharp, Sharon; Nichols, Melanie; Carpenter, Lauren; Boak, Rachel; Swinburn, Boyd

    2012-06-01

    The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children's dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention. Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups. The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs. These results provide confidence that obesity prevention interventions in children's settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health

  4. Improving homeless persons’ utilization of primary care : Lessons to be learned from an outreach programme in The Netherlands

    NARCIS (Netherlands)

    Elissen, A.M.J.; van Raak, A.J.A.; Derck, E.W.C.C.; Vrijhoef, H.J.M.

    2013-01-01

    Faced with rising homelessness, countries around the world are in need of innovative approaches to caring for those without shelter, who, more often than not, suffer from severe health problems. We conducted a case study of an innovative Dutch Primary Care for the Homeless (PCH) programme to gain

  5. Improving multiple health risk behaviors in primary care: lessons from the Prescription for Health Common Measures, Better Outcomes (COMBO) study.

    Science.gov (United States)

    Fernald, Douglas H; Dickinson, L Miriam; Froshaug, Desireé B; Balasubramanian, Bijal A; Holtrop, Jodi Summers; Krist, Alex H; Glasgow, Russell E; Green, Larry A

    2012-01-01

    Four health behaviors--smoking, risky drinking, physical inactivity, and unhealthy diets--contribute substantially to health care burden and are common among primary care patients. However, there is insufficient evidence to recommend broadly brief interventions to address all 4 of these in frontline primary care. This study took advantage of a multinetwork initiative to reflect on health behavior outcomes and the challenges of using a common set of measures to assess health behavior-change strategies for multiple health behaviors in routine primary care practice. Standardized, brief practical health behavior and quality of life measures used across 7 practice-based research networks (PBRNs) with independent primary care interventions in 54 primary care practices between August 2005 and December 2007 were analyzed. Mixed-effects longitudinal models assessed whether intervention patients improved diet, physical activity, smoking, alcohol consumption, and unhealthy days over time. Separate analyses were conducted for each intervention. Of 4463 adults, 2199 had follow-up data, and all available data were used in longitudinal analyses. Adjusting for age, race/ethnicity, education, and baseline body mass index where available, diet scores improved significantly in 5 of 7 networks (P practically in PBRNs testing diverse strategies to improve behaviors; however, variations in implementation, instrumentation performance, and some features of study design overwhelmed potential cross-PBRN comparisons. For common measures to be useful for comparisons across practices or PBRNs, greater standardization of study designs and careful attention to practicable implementation strategies are necessary.

  6. Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care

    Science.gov (United States)

    Huygens, Martine Wilhelmina Johanna; Schoenmakers, Tim M; Oude Nijeweme-D'Hollosy, Wendy; van Velsen, Lex; Vermeulen, Joan; Schoone-Harmsen, Marian; Jansen, Yvonne JFM; van Schayck, Onno CP; Friele, Roland; de Witte, Luc

    2018-01-01

    Background Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. Objective This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. Methods Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. Results The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use

  7. Lessons Learned From a Living Lab on the Broad Adoption of eHealth in Primary Health Care.

    Science.gov (United States)

    Swinkels, Ilse Catharina Sophia; Huygens, Martine Wilhelmina Johanna; Schoenmakers, Tim M; Oude Nijeweme-D'Hollosy, Wendy; van Velsen, Lex; Vermeulen, Joan; Schoone-Harmsen, Marian; Jansen, Yvonne Jfm; van Schayck, Onno Cp; Friele, Roland; de Witte, Luc

    2018-03-29

    Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self

  8. 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.

  9. The ten thousand Kims

    International Nuclear Information System (INIS)

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

    2011-01-01

    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.

  10. Nephrologists' perceptions regarding dialysis withdrawal and palliative care in Europe: lessons from a European Renal Best Practice survey

    NARCIS (Netherlands)

    van Biesen, Wim; van de Luijtgaarden, Moniek W. M.; Brown, Edwina A.; Michel, Jean-Pierre; van Munster, Barbara C.; Jager, Kitty J.; van der Veer, Sabine N.

    2015-01-01

    Background. There is a variation in dialysis withdrawal rates, but reasons for this variation across European countries are largely unknown. We therefore surveyed nephrologists' perceptions of factors concerning dialysis withdrawal and palliative care and explored relationships between these

  11. 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

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

    OpenAIRE

    Turner, Deborah E; Helliwell, Philip S; Woodburn, James

    2007-01-01

    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. Method...

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

    Science.gov (United States)

    Odeyemi, Isaac Ao; Nixon, John

    2013-01-01

    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. 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. 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. 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 and the factors that affect its uptake and equity in different health care systems. The results are anticipated to be helpful in informing how developing countries may utilize PHI to meet the aim of achieving universal health care.

  14. Aboriginal experiences of cancer and care coordination: Lessons from the Cancer Data and Aboriginal Disparities (CanDAD) narratives.

    Science.gov (United States)

    Reilly, Rachel; Micklem, Jasmine; Yerrell, Paul; Banham, David; Morey, Kim; Stajic, Janet; Eckert, Marion; Lawrence, Monica; Stewart, Harold B; Brown, Alex

    2018-04-24

    Aboriginal people with cancer experience worse outcomes than other Australians for a range of complex and interrelated reasons. A younger age at diagnosis, higher likelihood of more advanced cancer or cancer type with poorer prognosis, geographic isolation and cultural and language diversity mean that patient pathways are potentially more complex for Aboriginal people with cancer. In addition, variation in the quality and acceptability of care may influence cancer outcomes. This study sought to understand how care coordination influences Aboriginal people's experiences of cancer treatment. Interviews with 29 Aboriginal patients or cancer survivors, 11 carers and 22 service providers were carried out. Interviews were semi-structured and sought to elicit experiences of cancer and the health-care system. The manifest content of the cancer narratives was entered onto a cancer pathway mapping tool and underlying themes were identified inductively. The practice of cancer care coordination was found to address the needs of Aboriginal patients and their families/carers in 4 main areas: "navigating the health system"; "information and communication"; "things to manage at home"; and "cultural safety". The CanDAD findings indicate that, when the need for cancer care coordination is met, it facilitated continuity of care in a range of ways that may potentially improve cancer outcomes. However, the need remains unmet for many. Findings support the importance of dedicated care coordination to enable Aboriginal people to receive adequate and appropriate patient-centred care, so that the unacceptable disparity in cancer outcomes between Aboriginal and non-Aboriginal people can be addressed. © 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.

  15. Incorporating the Six Core Elements of Health Care Transition Into a Medicaid Managed Care Plan: Lessons Learned From a Pilot Project.

    Science.gov (United States)

    McManus, Margaret; White, Patience; Pirtle, Robin; Hancock, Catina; Ablan, Michael; Corona-Parra, Raquel

    2015-01-01

    This pediatric-to-adult health care transition pilot project describes the process and results of incorporating the "Six Core Elements of Health Care Transition (2.0)" into a Medicaid managed care plan with a group of 35 18-23 year olds who have chronic mental health, developmental, and complex medical conditions. The pilot project demonstrated an effective approach for customizing and delivering recommended transition services. At the start of the 18-month project, the Medicaid plan was at the basic level (1) of transition implementation of the Six Core Elements with no transition policy, member transition readiness assessment results, health care transition plans of care, updated medical summaries, transfer package for the adult-focused provider, and assurance of transfer completion and consumer feedback. At the conclusion of the pilot project, the plan scored at level 3 on each core element. The primary reason for not scoring at the highest level (4) was because the transition elements have not been incorporated into services for all enrollees within the plan. Future efforts in managed care will benefit from starting the transition process much earlier (ages 12-14), expanding the role of nurse care managers and participating pediatric and adult-focused clinicians in transition, and offering payment incentives to clinicians to implement the Six Core Elements of Health Care Transition. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Does mental illness affect consumer direction of community-based care? Lessons from the Arkansas Cash and Counseling program.

    Science.gov (United States)

    Shen, Ce; Smyer, Michael A; Mahoney, Kevin J; Loughlin, Dawn M; Simon-Rusinowitz, Lori; Mahoney, Ellen K

    2008-02-01

    Previous research from the Cash and Counseling Demonstration and Evaluation (CCDE) in Arkansas, New Jersey, and Florida suggests that giving consumers control over their personal care greatly increases their satisfaction and improves their outlook on life. Still, some argue that consumer-directed care may not be appropriate for consumers with intellectual disabilities or mental health diagnoses. This study examined how Cash and Counseling-a new option allowing consumers to manage an individualized budget equivalent to what agencies would have spent on their care-changes the way consumers with mental health diagnoses meet their personal care needs and how that affects their well-being. Using the Arkansas CCDE baseline and the 9-month follow-up data for individuals in the treatment and control groups, we compared and contrasted the experience of elderly consumers with and without mental health diagnoses utilizing logit regression. After examining several outcome measures, including satisfaction with care arrangements and the paid caregiver's reliability and schedule, unmet needs, and satisfaction with the relationship with paid caregivers, this study found evidence that, from the perspective of consumers, the Cash and Counseling program works well for participants with mental health diagnoses. Considering the growing need for long-term-care services and the limited resources available, a consumer-directed option makes sense, and it can be a valuable alternative for persons with mental health needs.

  17. Community of solution for the U.S. health care system: lessons from the U.S. educational system.

    Science.gov (United States)

    Devoe, Jennifer E; Gold, Rachel

    2013-01-01

    The Folsom Group asserts that radical changes are needed to fix the health care system in the United States. The U.S. education system is one potential model to emulate. Could a future health care system-level community of solution be modeled after the U.S. education system? Could community health care services be planned, organized, and delivered at the neighborhood level by district, similar to the structure for delivering public education? Could community health centers, governed by community boards, serve every neighborhood? This essay imagines how U.S. health care system reforms could be designed using our public school system as a roadmap. Our intention is to challenge readers to recognize the urgent need for radical reform in the U.S. health care system, to introduce one potential model for reform, and to encourage creative thinking about other system-level communities of solution that could lead to profound change and improvements in the U.S. health care system.

  18. The state of primary care in the United States of America and lessons for primary care groups in the United Kingdom.

    Science.gov (United States)

    Koperski, M

    2000-04-01

    The health care system of the United States of America (USA) is lavishly funded and those with adequate insurance usually receive excellent attention. However, the system is fragmented and inequitable. Health workers often find it difficult to separate vocational roles from business roles. Care tends to focus on the acute rather than the chronic, on 'episodes of illness' rather than 'person-centred' care, on short-term fixes rather than long-term approaches, on scientific/technical solutions rather than discourse or the 'art of healing', and on individual health rather than population health. The majority of US doctors are trained in the 'hightech' hospital paradigm and there is no equivalent of the United Kingdom (UK) general practitioner (GP), who lies at the hub of a primary health care team (PHCT) and who is charged with taking a long-term view, co-ordinating health care for individual patients, and acting as patient advocate without major conflicting financial incentives. However, primary care groups/trusts (PCGs) could learn from US management and training techniques, case management, NHS Direct equivalents, and the effects of poorly developed PHCTs. PCGs could develop the UK's own version of utilisation management. A cash-limited, unified budget within an underfunded National Health Service poses threats to general practice. In both the USA and the UK, primary care is a prominent tool in new attempts at cost control. PCGs offer the opportunity of better integration with public health and social services, but threaten GPs' role as independent advocates by giving them a rationing role. Managed care has forced a similar role onto our US counterparts with consequent public displeasure and professional disillusion. UK GPs will have to steer a careful course if they are to avoid a similar fate.

  19. 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

  20. Electronic health records and technical assistance to improve quality of primary care: Lessons for regional extension centers.

    Science.gov (United States)

    Boas, Samuel J; Bishop, Tara F; Ryan, Andrew M; Shih, Sarah C; Casalino, Lawrence P

    2014-07-01

    In 2009, the American Recovery and Reinvestment Act apportioned $643 million for a Health Information Technology Extension Program, which established Regional Extension Centers (RECs) to support the implementation and use of electronic health records (EHRs). Little is known, however, about how RECs should assist in EHR implementation and how they should structure ongoing support. The purpose of this paper is to describe physicians' experiences with the Primary Care Information Project (PCIP), an REC run by the New York City Department of Health and Mental Hygiene. We interviewed 17 physicians enrolled in PCIP to understand the role of the EHRon quality of care and their experience with technical assistance from PCIP. All physicians stated that they felt that the EHR improved the quality of care they delivered to their patients particularly because it helped them track patients. All the physicians found technical assistance helpful but most wanted ongoing assistance months or years after they adopted the EHR. © 2013 Published by Elsevier Inc.

  1. Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative.

    Science.gov (United States)

    Harvey, Gill; Oliver, Kathryn; Humphreys, John; Rothwell, Katy; Hegarty, Janet

    2015-02-01

    Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ∼ 30% were estimated to have suboptimal management according to Public Health Observatory analyses. An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ∼ 2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care.

  2. Linking communities to formal health care providers through village health teams in rural Uganda: lessons from linking social capital.

    Science.gov (United States)

    Musinguzi, Laban Kashaija; Turinawe, Emmanueil Benon; Rwemisisi, Jude T; de Vries, Daniel H; Mafigiri, David K; Muhangi, Denis; de Groot, Marije; Katamba, Achilles; Pool, Robert

    2017-01-11

    Community-based programmes, particularly community health workers (CHWs), have been portrayed as a cost-effective alternative to the shortage of health workers in low-income countries. Usually, literature emphasises how easily CHWs link and connect communities to formal health care services. There is little evidence in Uganda to support or dispute such claims. Drawing from linking social capital framework, this paper examines the claim that village health teams (VHTs), as an example of CHWs, link and connect communities with formal health care services. Data were collected through ethnographic fieldwork undertaken as part of a larger research program in Luwero District, Uganda, between 2012 and 2014. The main methods of data collection were participant observation in events organised by VHTs. In addition, a total of 91 in-depth interviews and 42 focus group discussions (FGD) were conducted with adult community members as part of the larger project. After preliminary analysis of the data, we conducted an additional six in-depth interviews and three FGD with VHTs and four FGD with community members on the role of VHTs. Key informant interviews were conducted with local government staff, health workers, local leaders, and NGO staff with health programs in Luwero. Thematic analysis was used during data analysis. The ability of VHTs to link communities with formal health care was affected by the stakeholders' perception of their roles. Community members perceive VHTs as working for and under instructions of "others", which makes them powerless in the formal health care system. One of the challenges associated with VHTs' linking roles is support from the government and formal health care providers. Formal health care providers perceived VHTs as interested in special recognition for their services yet they are not "experts". For some health workers, the introduction of VHTs is seen as a ploy by the government to control people and hide its inability to provide health

  3. A Study in Critical Listening Using Eight to Ten Year Olds in an Analysis of Commercial Propaganda Emanating from Television.

    Science.gov (United States)

    Cook, Jimmie Ellis

    Selected eight to ten year old Maryland children were used in this study measuring the effect of lessons in becoming aware of propaganda employed by commercial advertisers in television programs. Sixteen 45-minute lessons directed to the propaganda techniques of Band Wagon, Card Stacking, Glittering Generalities, Name Calling, Plain Folks,…

  4. In Madagascar, Use Of Health Care Services Increased When Fees Were Removed: Lessons For Universal Health Coverage.

    Science.gov (United States)

    Garchitorena, Andres; Miller, Ann C; Cordier, Laura F; Ramananjato, Ranto; Rabeza, Victor R; Murray, Megan; Cripps, Amber; Hall, Laura; Farmer, Paul; Rich, Michael; Orlan, Arthur Velo; Rabemampionona, Alexandre; Rakotozafy, Germain; Randriantsimaniry, Damoela; Gikic, Djordje; Bonds, Matthew H

    2017-08-01

    Despite overwhelming burdens of disease, health care access in most developing countries is extremely low. As governments work toward achieving universal health coverage, evidence on appropriate interventions to expand access in rural populations is critical for informing policies. Using a combination of population and health system data, we evaluated the impact of two pilot fee exemption interventions in a rural area of Madagascar. We found that fewer than one-third of people in need of health care accessed treatment when point-of-service fees were in place. However, when fee exemptions were introduced for targeted medicines and services, the use of health care increased by 65 percent for all patients, 52 percent for children under age five, and over 25 percent for maternity consultations. These effects were sustained at an average direct cost of US$0.60 per patient. The pilot interventions can become a key element of universal health care in Madagascar with the support of external donors. Project HOPE—The People-to-People Health Foundation, Inc.

  5. Creating community collaboration to improve the care of patients with high blood pressure: lessons from Rochester, New York.

    Science.gov (United States)

    Bisognano, John D; Speranza, Paul S; Becker, Lawrence M; Norwood, Wade S; Bradley, Al; Nazar, Michael D; Beckman, Howard B

    2012-03-01

    Over the past two years, the business community of Monroe County, which includes Rochester, New York, has been engaging in a collaborative to improve outcomes for people with high blood pressure. As the employers examined the costs of care in the community, they recognized two important factors. First, the costs of care for the uninsured, the underinsured, and the Medicare population influence the business community's cost of care. Second, trying to redesign care just for their employees alone was not effective. This project is unique in that the stimulus and funding for community-wide action comes from the business community. They saw beyond the often unsuccessful short-term cost reduction programs and joined with a community-focused organization, the Finger Lakes Health Systems Agency, to construct a multi-year, multi-faceted intervention designed to encourage practice redesign and an invigorated community commitment to partnership and accountability. This report describes the process to date and hopefully will stimulate conversations about mechanisms to encourage similar collaboration within other communities. © 2012 Wiley Periodicals, Inc.

  6. 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

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

    Science.gov (United States)

    Turner, Deborah E; Helliwell, Philip S; Woodburn, James

    2007-11-06

    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. 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. 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 guided intra-articular steroid injection

  8. Caring Practices, Energy Regulation and the Use of Ready to Use Foods in the Management of Moderate Malnutrition: Lessons from the Developed World

    International Nuclear Information System (INIS)

    Wright, Charlotte; Mutoro, Antonina; Garcia, Ada

    2014-01-01

    Full text: Aims: This paper aims to consider how developed world evidence on weight faltering (failure to thrive) and energy regulation could inform treatment programmes for moderate malnutrition. Lesson from the UK: In the UK, weight faltering (failure to thrive) caused by mild to moderate undernutrition occurs in around 2% of infants. Research with such children has revealed that many have individual characteristics of low appetite and fussy eating that predispose them to undernutrition, but that after a structured assessment and advice from their health visitor, their weight gain can be improved. Infants and toddlers show substantial energy regulation and tend to eat less following intake of high energy drinks . This may be why the use of high energy milks and food supplements in the UK tends to be associated with delayed intake of solids and worsening eating behavior, but not improved growth. This partly reflects the difficulty of diagnosing moderate acute malnutrition (MAM), since any single threshold tends to also identify constitutionally short or slim children. Application to the developing world: The recent introduction of new high-energy ready to use therapeutic foods (RUTF) has greatly improved the care of severely malnourished children, but there may be risks in the use of such foods when used in MAM, with children who may have low appetite drive or simply be constitutionally short. The possibly adverse effects include: • Reduced intake of the normal diet due to energy regulation, leading to more coercive and aversive feeding behavior by carers. • Displacement of breast milk • Delayed acquisition of solid feeding skills • Loss of opportunity to improve family feeding skills • Energy gap when supplements withdrawn. Conclusions: Trials of the use of RUTF in the management of moderate malnutrition need to consider short term harms and long term efficacy, not just short-term gains in weight and should be compared to interventions that target

  9. 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

  10. 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.

  11. An enquiry based on a standardised questionnaire into knowledge, awareness and preferences concerning the care of familial hypercholesterolaemia among primary care physicians in the Asia-Pacific region: the "Ten Countries Study".

    Science.gov (United States)

    Pang, Jing; Hu, Miao; Lin, Jie; Miida, Takashi; Nawawi, Hapizah M; Park, Jeong Euy; Wu, Xue; Ramli, Anis S; Kim, Ngoc Thanh; Kwok, See; Gonzalez-Santos, Lourdes E; Su, Ta-Chen; Truong, Thanh Huong; Soran, Handrean; Yamashita, Shizuya; Tomlinson, Brian; Watts, Gerald F

    2017-10-25

    To determine physicians' knowledge, awareness and preferences regarding the care of familial hypercholesterolaemia (FH) in the Asia-Pacific region. A formal questionnaire was anonymously completed by physicians from different countries/regions in the Asia-Pacific. The survey sought responses relating to general familiarity, awareness of management guidelines, identification (clinical characteristics and lipid profile), prevalence and inheritance, extent of elevation in risk of cardiovascular disease (CVD) and practice on screening and treatment. Practising community physicians from Australia, Japan, Malaysia, South Korea, Philippines, Hong Kong, China, Vietnam and Taiwan were recruited to complete the questionnaire, with the UK as the international benchmark. An assessment and comparison of the knowledge, awareness and preferences of FH among physicians in 10 different countries/regions. 1078 physicians completed the questionnaire from the Asia-Pacific region; only 34% considered themselves to be familiar with FH. 72% correctly described FH and 65% identified the typical lipid profile, with a higher proportion of physicians from Japan and China selecting the correct FH definition and lipid profile compared with those from Vietnam and Philippines. However, less than half of the physician were aware of national or international management guidelines; this was significantly worse than physicians from the UK (35% vs 61%, pcountry-specific guidelines and extensive work in FH education and awareness programmes are imperative to improve the care of FH in the region. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. An enquiry based on a standardised questionnaire into knowledge, awareness and preferences concerning the care of familial hypercholesterolaemia among primary care physicians in the Asia-Pacific region: the “Ten Countries Study”

    Science.gov (United States)

    Pang, Jing; Hu, Miao; Lin, Jie; Miida, Takashi; Nawawi, Hapizah M; Park, Jeong Euy; Wu, Xue; Ramli, Anis S; Kim, Ngoc Thanh; Kwok, See; Gonzalez-Santos, Lourdes E; Su, Ta-Chen; Truong, Thanh Huong; Soran, Handrean; Yamashita, Shizuya; Tomlinson, Brian; Watts, Gerald F

    2017-01-01

    Objective To determine physicians’ knowledge, awareness and preferences regarding the care of familial hypercholesterolaemia (FH) in the Asia-Pacific region. Setting A formal questionnaire was anonymously completed by physicians from different countries/regions in the Asia-Pacific. The survey sought responses relating to general familiarity, awareness of management guidelines, identification (clinical characteristics and lipid profile), prevalence and inheritance, extent of elevation in risk of cardiovascular disease (CVD) and practice on screening and treatment. Participants Practising community physicians from Australia, Japan, Malaysia, South Korea, Philippines, Hong Kong, China, Vietnam and Taiwan were recruited to complete the questionnaire, with the UK as the international benchmark. Primary outcome An assessment and comparison of the knowledge, awareness and preferences of FH among physicians in 10 different countries/regions. Results 1078 physicians completed the questionnaire from the Asia-Pacific region; only 34% considered themselves to be familiar with FH. 72% correctly described FH and 65% identified the typical lipid profile, with a higher proportion of physicians from Japan and China selecting the correct FH definition and lipid profile compared with those from Vietnam and Philippines. However, less than half of the physician were aware of national or international management guidelines; this was significantly worse than physicians from the UK (35% vs 61%, p<0.001). Knowledge of prevalence (24%), inheritability (41%) and CVD risk (9%) of FH were also suboptimal. The majority of the physicians considered laboratory interpretative commenting as being useful (81%) and statin therapy as an appropriate cholesterol-lowering therapy (89%) for FH management. Conclusions The study identified important gaps, which are readily addressable, in the awareness and knowledge of FH among physicians in the region. Implementation of country-specific guidelines and

  13. Cultivating engaged leadership through a learning collaborative: lessons from primary care renewal in Oregon safety net clinics.

    Science.gov (United States)

    McMullen, Carmit K; Schneider, Jennifer; Firemark, Alison; Davis, James; Spofford, Mark

    2013-01-01

    The aim of this study was to explore how learning collaboratives cultivate leadership skills that are essential for implementing patient-centered medical homes (PCMHs). We conducted an ethnographic evaluation of a payor-incentivized PCMH implementation in Oregon safety net clinics, known as Primary Care Renewal. Analyses primarily drew on in-depth interviews with organizational leaders who were involved in the initiative. We solicited perspectives on the history, barriers, facilitators, and other noteworthy factors related to the implementation of PCMH. We reviewed and summarized transcripts and created and applied a coding dictionary to identify emergent leadership themes. We reviewed field notes from clinic site visits and observations of learning collaborative activities for additional information on the role of engaged leadership. Interview data suggested that organizations followed a similar, sequential process of Primary Care Renewal implementation having 2 phases-inspiration and implementation-and that leaders needed and learned different leadership skills in each phase. Leaders reported that collaborative learning opportunities were critical for developing engaged leadership skills during the inspiration phase of transformation. Facilitative and modeling aspects of engaged leadership were most important for codesigning a vision and plan for change. Adaptive leadership skills became more important during the implementation phase, when specific operational and management skills were needed to foster standardization and spread of the Primary Care Renewal initiative throughout participating clinics. The PCMH has received much attention as a way to reorganize and potentially improve primary care. Documenting steps and stages for cultivating leaders with the vision and skills to transform their organizations into PCMHs may offer a useful roadmap to other organizations considering a similar transformation.

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

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    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

  15. Do Lessons Learned in a Training Intervention on Web-Based Health Care Resources Diffuse to Nonexposed Members in the Primary Care Setting? A Comparative Study

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    Homa, Karen; Schifferdecker, Karen E.; Reed, Virginia A.

    2009-01-01

    Objective The Internet offers a significant information resource for health professionals. A strategy to improve the use of these resources is for health care providers and staff to receive specific training. The aim of this study was to determine whether those who attended an Internet health care resource training intervention transferred knowledge and skills to others in the practice. Methods Twenty-four primary care practices participated in the study in which 64 providers and staff attended a training intervention and 288 did not. A preintervention questionnaire that assessed knowledge, skill, and Internet usage was compared with a postintervention questionnaire. The main effect of interest in the linear model was the group by time interaction term, to determine whether knowledge and skill improved for both groups. Results There were 41 attendees and 222 nonattendees that completed both pre- and postintervention questionnaires. There were 9 variables that showed a possible diffusion pattern, in which both attendees and nonattendees improved between pre- and postintervention. Overall, the training intervention seemed to have impacted knowledge and skills of the respondents and also reported improvements in the clinical area of patient education, but frequency of use for most Web resources for medical decision making did not improve. Conclusion An improvement strategy that depends on a training intervention for a few members in a practice may not necessarily transfer relative to all aspects of patient care. PMID:19020403

  16. Music lessons: what musicians can teach doctors (and other health professionals).

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    Davidoff, Frank

    2011-03-15

    Medicine is a learned profession, but clinical practice is above all a matter of performance, in the best and deepest sense of the word. Because music is, at its core, a pure distillate of real-time performance, musicians are in an excellent position to teach us about better ways to become and remain expert performers in health care and ways for our teachers and mentors to help us do that. Ten features of the professionalization of musicians offer us lessons on how the clinical practice of medicine might be learned, taught, and performed more effectively.

  17. Herding: a new phenomenon affecting medical decision-making in multiple sclerosis care? Lessons learned from DIScUTIR MS.

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    Saposnik, Gustavo; Maurino, Jorge; Sempere, Angel P; Ruff, Christian C; Tobler, Philippe N

    2017-01-01

    Herding is a phenomenon by which individuals follow the behavior of others rather than deciding independently on the basis of their own private information. A herding-like phenomenon can occur in multiple sclerosis (MS) when a neurologist follows a therapeutic recommendation by a colleague even though it is not supported by best practice clinical guidelines. Limited information is currently available on the role of herding in medical care. The objective of this study was to determine the prevalence (and its associated factors) of herding in the management of MS. We conducted a study among neurologists with expertise in MS care throughout Spain. Participants answered questions regarding the management of 20 case scenarios commonly encountered in clinical practice and completed 3 surveys and 4 experimental paradigms based on behavioral economics. The herding experiment consisted of a case scenario of a 40-year-old woman who has been stable for 3 years on subcutaneous interferon and developed a self-limited neurological event. There were no new magnetic resonance imaging (MRI) lesions. Her neurological examination and disability scores were unchanged. She was advised by an MS neurologist to switch from interferon to fingolimod against best practice guidelines. Multivariable logistic regression analysis was conducted to evaluate factors associated with herding. Out of 161 neurologists who were invited to participate, 96 completed the study (response rate: 60%). Herding was present in 75 (78.1%), having a similar prevalence in MS experts and general neurologists (68.8% vs 82.8%; P =0.12). In multivariate analyses, the number of MS patients seen per week was positively associated with herding (odds ratio [OR] 1.08, 95% CI 1.01-1.14). Conversely, physician's age, gender, years of practice, setting of practice, or risk preferences were not associated with herding. Herding was a common phenomenon affecting nearly 8 out of 10 neurologists caring for MS patients. Herding may

  18. Successful Deployment of High Flow Nasal Cannula in a Peruvian Pediatric Intensive Care Unit Using Implementation Science—Lessons Learned

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    Katie R. Nielsen

    2018-04-01

    Full Text Available Acute lower respiratory infections are the leading cause of death outside the neonatal period for children less than 5 years of age. Widespread availability of invasive and non-invasive mechanical ventilation in resource-rich settings has reduced mortality rates; however, these technologies are not always available in many low- and middle-income countries due to the high cost and trained personnel required to implement and sustain their use. High flow nasal cannula (HFNC is a form of non-invasive respiratory support with growing evidence for use in pediatric respiratory failure. Its simple interface makes utilization in resource-limited settings appealing, although widespread implementation in these settings lags behind resource-rich settings. Implementation science is an emerging field dedicated to closing the know-do gap by incorporating evidence-based interventions into routine care, and its principles have guided the scaling up of many global health interventions. In 2016, we introduced HFNC use for respiratory failure in a pediatric intensive care unit in Lima, Peru using implementation science methodology. Here, we review our experience in the context of the principles of implementation science to serve as a guide for others considering HFNC implementation in resource-limited settings.

  19. Multi-Disciplinary Stroke Care in Developing Countries – Lessons from the Wessex-Ghana Stroke Partnership

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    Louise Johnson

    2017-11-01

    Full Text Available Stroke disease in Ghana has been of increasing concern since the mid to late 20th century, in association with the increasing westernisation of diet and lifestyle [1]. Two thirds of world-wide mortality cases from stroke occur in sub-Saharan Africa [2], and in the Ghanaian capital city region of Accra, stroke is now attributed as the second largest cause of death [1]. The burden of stroke in sub-Saharan Africa is significant [3]. Experts recommend a three-prong approach to dealing with the burden of non-communicable disease (NCD: epidemiological surveillance; primary prevention (preventing disease in healthy populations; and secondary prevention (preventing complications and improving quality of life in affected communities [4]. This paper outlines the development of a specialist stroke service in Accra, Ghana. This work therefore broadly relates to the secondary prevention aspect, achieved through the development of a dedicated and specialised stroke service. Whilst this project took place in Ghana, the learning could be applied to the development of a stroke service in any resource poor setting, such as South Sudan. Indeed, because the focus is on establishing the fundamentals of organised stroke care, the principles are also entirely relevant to more developed health care systems.

  20. Herding: a new phenomenon affecting medical decision-making in multiple sclerosis care? Lessons learned from DIScUTIR MS

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    Saposnik G

    2017-01-01

    Full Text Available Gustavo Saposnik,1–3 Jorge Maurino,4 Angel P Sempere,5 Christian C Ruff,2 Philippe N Tobler2 1Division of Neurology, Department of Medicine, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada; 2Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Zurich, Switzerland; 3Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada; 4Neuroscience Area, Medical Department, Roche Farma, Madrid, 5Department of Neurology, Hospital General Universitario de Alicante, Alicante, Spain Purpose: Herding is a phenomenon by which individuals follow the behavior of others rather than deciding independently on the basis of their own private information. A herding-like phenomenon can occur in multiple sclerosis (MS when a neurologist follows a therapeutic recommendation by a colleague even though it is not supported by best practice clinical guidelines. Limited information is currently available on the role of herding in medical care. The objective of this study was to determine the prevalence (and its associated factors of herding in the management of MS.Methods: We conducted a study among neurologists with expertise in MS care throughout Spain. Participants answered questions regarding the management of 20 case scenarios commonly encountered in clinical practice and completed 3 surveys and 4 experimental paradigms based on behavioral economics. The herding experiment consisted of a case scenario of a 40-year-old woman who has been stable for 3 years on subcutaneous interferon and developed a self-limited neurological event. There were no new magnetic resonance imaging (MRI lesions. Her neurological examination and disability scores were unchanged. She was advised by an MS neurologist to switch from interferon to fingolimod against best practice guidelines. Multivariable logistic regression analysis was conducted to evaluate factors associated with herding

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

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    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.

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

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    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.

  3. Cognitive and Other Strategies to Mitigate the Effects of Fatigue. Lessons from Staff Physicians Working in Intensive Care Units.

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    Henrich, Natalie; Ayas, Najib T; Stelfox, Henry T; Peets, Adam D

    2016-09-01

    Fatigue is common among physicians and adversely affects their performance. To identify strategies that attending physicians use when fatigued to maintain clinical performance in the intensive care unit (ICU). We conducted a qualitative study using focus groups and structured interviews of attending ICU physicians working in academic centers in Canada. In three focus group meetings, we engaged a total of 11 physicians to identify strategies used to prevent and cope with fatigue. In the focus groups, 21 cognitive strategies were identified and classified into 9 categories (minimizing number of tasks, using techniques to improve retention of details, using a structured approach to patient care, asking for help, improving opportunities for focusing, planning ahead, double-checking, adjusting expectations, and modulating alertness). In addition, various lifestyle strategies were mentioned as important in preventing fatigue (e.g., protecting sleep before call, adequate exercise, and limiting alcohol). Telephone interviews were then conducted (n = 15 physicians) with another group of intensivists. Structured questions were asked about the strategies identified in the focus groups that were most useful during ICU activities. In the interviews, the most useful and frequently used strategies were prioritizing tasks that need to be done immediately and postponing tasks that can wait, working systematically, using a structured approach, and avoiding distractions. ICU physicians reported using a variety of deliberate cognitive and lifestyle strategies to prevent and cope with fatigue. Given the low cost and intuitive nature of the majority of these strategies, further investigations should be done to better characterize their effectiveness in improving performance.

  4. Promoting Business and Entrepreneurial Awareness in Health Care Professionals: Lessons From Venture Capital Panels at Medicine 2.0 Conferences

    Science.gov (United States)

    Patel, Jigar; Eysenbach, Gunther

    2014-01-01

    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. PMID:25100579

  5. 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.

  6. Methodological challenges in evaluating health care financing equity in data-poor contexts: lessons from Ghana, South Africa and Tanzania.

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    Borghi, Josephine; Ataguba, John; Mtei, Gemini; Akazili, James; Meheus, Filip; Rehnberg, Clas; Di, McIntyre

    2009-01-01

    Measurement of the incidence of health financing contributions across socio-economic groups has proven valuable in informing health care financing reforms. However, there is little evidence as to how to carry out financing incidence analysis (FIA) in lower income settings. We outline some of the challenges faced when carrying out a FIA in Ghana, Tanzania and South Africa and illustrate how innovative techniques were used to overcome data weaknesses in these settings. FIA was carried out for tax, insurance and out-of-pocket (OOP) payments. The primary data sources were Living Standards Measurement Surveys (LSMS) and household surveys conducted in each of the countries; tax authorities and insurance funds also provided information. Consumption expenditure and a composite index of socioeconomic status (SES) were used to assess financing equity. Where possible conventional methods of FIA were applied. Numerous challenges were documented and solution strategies devised. LSMS are likely to underestimate financial contributions to health care by individuals. For tax incidence analysis, reported income tax payments from secondary sources were severely under-reported. Income tax payers and shareholders could not be reliably identified. The use of income or consumption expenditure to estimate income tax contributions was found to be a more reliable method of estimating income tax incidence. Assumptions regarding corporate tax incidence had a huge effect on the progressivity of corporate tax and on overall tax progressivity. LSMS consumption categories did not always coincide with tax categories for goods subject to excise tax (e.g., wine and spirits were combined, despite differing tax rates). Tobacco companies, alcohol distributors and advertising agencies were used to provide more detailed information on consumption patterns for goods subject to excise tax by income category. There was little guidance on how to allocate fuel levies associated with 'public transport' use

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

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    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

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

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    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.

  9. Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program.

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    Lawn, Sharon; Zabeen, Sara; Smith, David; Wilson, Ellen; Miller, Cathie; Battersby, Malcolm; Masman, Kevin

    2017-08-24

    Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health's Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P=0.037) and complex needs (Pmanage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia's health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self

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

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    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

  11. 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

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    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

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

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    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.

  13. Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England.

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    Checkland, Kath; Coleman, Anna; McDermott, Imelda; Segar, Julia; Miller, Rosalind; Petsoulas, Christina; Wallace, Andrew; Harrison, Stephen; Peckham, Stephen

    2013-09-01

    The current reorganisation of the English NHS is one of the most comprehensive ever seen. This study reports early evidence from the development of clinical commissioning groups (CCGs), a key element in the new structures. To explore the development of CCGs in the context of what is known from previous studies of GP involvement in commissioning. Case study analysis from sites chosen to provide maximum variety across a number of dimensions, from September 2011 to June 2012. A case study analysis was conducted using eight detailed qualitative case studies supplemented by descriptive information from web surveys at two points in time. Data collection involved observation of a variety of meetings, and interviews with key participants. Previous research shows that clinical involvement in commissioning is most effective when GPs feel able to act autonomously. Complicated internal structures, alongside developing external accountability relationships mean that CCGs' freedom to act may be subject to considerable constraint. Effective GP engagement is also important in determining outcomes of clinical commissioning, and there are a number of outstanding issues for CCGs, including: who feels 'ownership' of the CCG; how internal communication is conceptualised and realised; and the role and remit of locality groups. Previous incarnations of GP-led commissioning have tended to focus on local and primary care services. CCGs are keen to act to improve quality in their constituent practices, using approaches that many developed under practice-based commissioning. Constrained managerial support and the need to maintain GP engagement may have an impact. CCGs are new organisations, faced with significant new responsibilities. This study provides early evidence of issues that CCGs and those responsible for CCG development may wish to address.

  14. Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults.

    Science.gov (United States)

    Gibson, William; Wand, Benedict M; O'Connell, Neil E

    2017-09-14

    Neuropathic pain, which is due to nerve disease or damage, represents a significant burden on people and society. It can be particularly unpleasant and achieving adequate symptom control can be difficult. Non-pharmacological methods of treatment are often employed by people with neuropathic pain and may include transcutaneous electrical nerve stimulation (TENS). This review supersedes one Cochrane Review 'Transcutaneous electrical nerve stimulation (TENS) for chronic pain' (Nnoaham 2014) and one withdrawn protocol 'Transcutaneous electrical nerve stimulation (TENS) for neuropathic pain in adults' (Claydon 2014). This review replaces the original protocol for neuropathic pain that was withdrawn. To determine the analgesic effectiveness of TENS versus placebo (sham) TENS, TENS versus usual care, TENS versus no treatment and TENS in addition to usual care versus usual care alone in the management of neuropathic pain in adults. We searched CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, Web of Science, PEDro, LILACS (up to September 2016) and various clinical trials registries. We also searched bibliographies of included studies for further relevant studies. We included randomised controlled trials where TENS was evaluated in the treatment of central or peripheral neuropathic pain. We included studies if they investigated the following: TENS versus placebo (sham) TENS, TENS versus usual care, TENS versus no treatment and TENS in addition to usual care versus usual care alone in the management of neuropathic pain in adults. Two review authors independently screened all database search results and identified papers requiring full-text assessment. Subsequently, two review authors independently applied inclusion/exclusion criteria to these studies. The same review authors then independently extracted data, assessed for risk of bias using the Cochrane standard tool and rated the quality of evidence using GRADE. We included 15 studies with 724 participants. We found a

  15. ABACC ten years applying safeguards

    International Nuclear Information System (INIS)

    Palacios, Elias

    2001-01-01

    The Argentinian-Brazilian Agency for Accounting and Control of nuclear special materials has been in operations for ten years. The rational behind the creation and the work performed by the Agency during the last decade is described. (author)

  16. 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

  17. Collaborations for leadership in applied health research and care: lessons from the theory of communities of practice.

    Science.gov (United States)

    Kislov, Roman; Harvey, Gill; Walshe, Kieran

    2011-06-23

    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. 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. 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 and organisational learning. Achieving the aims of the

  18. 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.

  19. Transcutaneous electrical nerve stimulation (TENS) for pain management in labour

    Science.gov (United States)

    Dowswell, Therese; Bedwell, Carol; Lavender, Tina; Neilson, James P

    2014-01-01

    Background Transcutaneous nerve stimulation (TENS) has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. TENS machines are frequently operated by women, which may increase a sense of control in labour. Objectives To assess the effects of TENS on pain in labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 April 2011) and reference lists of retrieved papers. Selection criteria Randomised controlled trials comparing women receiving TENS for pain management in labour versus routine care, alternative non-pharmacological methods of pain relief, or placebo devices. We included all types of TENS machines. Data collection and analysis Two review authors assessed for inclusion all trials identified by the search strategy, carried out data extraction and assessed risk of bias. We have recorded reasons for excluding studies. Main results Seventeen trials with 1466 women contribute data to the review. Thirteen examined TENS applied to the back, two to acupuncture points, and two to the cranium. Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (average risk ratio 0.41, 95% confidence interval 0.31 to 0.54; measured in two studies). The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia there was no evidence that it reduced pain. There was no consistent evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and babies. No

  20. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour.

    Science.gov (United States)

    Dowswell, Therese; Bedwell, Carol; Lavender, Tina; Neilson, James P

    2009-04-15

    Transcutaneous nerve stimulation (TENS) has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. The TENS unit is frequently operated by women, which may increase sense of control in labour. To assess the effects of TENS on pain in labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008). Randomised controlled trials comparing women receiving TENS for pain relief in labour versus routine care, alternative pharmacological methods of pain relief, or placebo devices. We included all types of TENS machines. Two review authors assessed for inclusion all trials identified by the search strategy, carried out data extraction and assessed risk of bias. We have recorded reasons for excluding studies. The search identified 25 studies; we excluded six and included 19 studies including 1671 women. Fifteen examined TENS applied to the back, two to acupuncture points and two to the cranium. Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32 to 0.55). The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia there was no evidence that it reduced pain. There was no consistent evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and babies. No adverse events were reported. There is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact (either positive or

  1. 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

  2. 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…

  3. 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…

  4. Ten per cent more grain

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1967-08-15

    At a low estimate, ten per cent of stored grain is lost every year to insect pests. In this article, based on a lecture given earlier this year in Switzerland, Dr. Harry E. Goresline, Food Radiation Specialist of the Food and Agriculture Organisation, now assisting the Joint FAO/IAEA Division of Atomic Energy in Food and Agriculture, explains how use of radiation can help to prevent losses and the research which has taken place to ensure its safety

  5. Ten years experience of PR

    International Nuclear Information System (INIS)

    Dobak, Dobroslav

    2002-01-01

    This paper is an effort to summarize the way Slovak Bohunice NPP has gone through since the historical change in the Middle and Eastern European countries. Milestones on the way were: 1989 - change of political system; increasing interest of the public appearance; creation of work capacities - personnel and technical; education/exchange with Western countries; 1994 - establishment of Foreign Affairs and PR Department reporting directly to the NPP manager; application of various approaches, some observed from other countries; creation of utility policy - place of PR in the company; establishment of QA system - description of PR activities, goals, interlinks etc.; annual planning process including activities, finance, education (training). Lessons learned are: the NPP managers were not prepared; the public was not (and still is not) prepared to obtain specific information; education is crucial in opinion winning; simple overtake of methods from others is not always applicable; strategy and feedback are necessary. Special case was the early closure Bohunice V1 NPP

  6. 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...

  7. Ten questions about systems biology

    DEFF Research Database (Denmark)

    Joyner, Michael J; Pedersen, Bente K

    2011-01-01

    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......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...

  8. Ten Thousand Years of Solitude?

    International Nuclear Information System (INIS)

    Benford, G.; Pasqualetti, M.J.

    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

  9. 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.

  10. Ten questions on nuclear wastes

    International Nuclear Information System (INIS)

    Guillaumont, R.; Bacher, P.

    2004-01-01

    The authors give explanations and answers to ten issues related to nuclear wastes: when a radioactive material becomes a waste, how radioactive wastes are classified and particularly nuclear wastes in France, what are the risks associated with radioactive wastes, whether the present management of radioactive wastes is well controlled in France, which wastes are raising actual problems and what are the solutions, whether amounts and radio-toxicity of wastes can be reduced, whether all long life radionuclides or part of them can be transmuted, whether geologic storage of final wastes is inescapable, whether radioactive material can be warehoused over long durations, and how the information on radioactive waste management is organised

  11. 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.

  12. Lessons Learned

    Directory of Open Access Journals (Sweden)

    Amanda Phelan BNS, MSc, PhD

    2015-03-01

    Full Text Available The public health nurses’ scope of practice explicitly includes child protection within their role, which places them in a prime position to identify child protection concerns. This role compliments that of other professions and voluntary agenices who work with children. Public health nurses are in a privileged position as they form a relationship with the child’s parent(s/guardian(s and are able to see the child in its own environment, which many professionals cannot. Child protection in Ireland, while influenced by other countries, has progressed through a distinct pathway that streamlined protocols and procedures. However, despite the above serious failures have occurred in the Irish system, and inquiries over the past 20 years persistently present similar contributing factors, namely, the lack of standardized and comprehensive service responses. Moreover, poor practice is compounded by the lack of recognition of the various interactional processes taking place within and between the different agencies of child protection, leading to psychological barriers in communication. This article will explore the lessons learned for public health nurses practice in safeguarding children in the Republic of Ireland.

  13. Ten years of nuclear power

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1964-08-15

    Ten years have elapsed since the world's first nuclear power station began to supply electricity in Russia, and this in turn marked the end of a twelve year stage following the first controlled nuclear chain reaction at Chicago. These periods mark major stages in the development of atomic energy from the realm of abstract ideas to that of everyday industrial application. They followed a period of fundamental research and laboratory work, culminating in Enrico Fermi's demonstration of a system whereby the forces of the atom could be brought under control. Then it was necessary to find ways and means of using the chain reaction for practical purposes and on an industrial scale. And after this had been shown in 1954 to be technically possible, it had still to be developed into an economic process. The nuclear power station has proved itself from the technical and engineering standpoint. The third phase of development has been to bring it to the stage of being economically competitive with alternative sources of energy, and it would appear that we are now reaching that goal - though more slowly than had been envisaged ten years ago

  14. The Knitting Lesson.

    Science.gov (United States)

    Smith, Pamela

    1987-01-01

    Based on Jean-Francois Millet's 1869 painting, "The Knitting Lesson," this lesson's goal is to introduce students in grades seven through nine to genre (everyday life) painting the nineteenth century. The lesson is also designed to show that some aspects of genre may be timeless. (BSR)

  15. A summary of lessons learned at the Shippingport Station Decommissioning Project (SSDP)

    International Nuclear Information System (INIS)

    Crimi, F.P.; Mullee, G.R.

    1987-10-01

    This paper describes the lessons learned from a management perspective during decommissioning. The lessons learned are presented in a chronological sequence during the life of the project up to the present time. The careful analysis of the lessons learned and the implementation of corresponding actions have contributed toward improving the effectiveness of decommissioning as time progresses. The lessons learned should be helpful in planning future decommissioning projects

  16. 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...

  17. Lessons learned bulletin

    International Nuclear Information System (INIS)

    1994-05-01

    During the past four years, the Department of Energy -- Savannah River Operations Office and the Westinghouse Savannah River Company (WSRC) Environmental Restoration (ER) Program completed various activities ranging from waste site investigations to closure and post closure projects. Critiques for lessons learned regarding project activities are performed at the completion of each project milestone, and this critique interval allows for frequent recognition of lessons learned. In addition to project related lessons learned, ER also performs lessons learned critiques. T'he Savannah River Site (SRS) also obtains lessons learned information from general industry, commercial nuclear industry, naval nuclear programs, and other DOE sites within the complex. Procedures are approved to administer the lessons learned program, and a database is available to catalog applicable lessons learned regarding environmental remediation, restoration, and administrative activities. ER will continue to use this database as a source of information available to SRS personnel

  18. Resolution 1540, ten years on

    International Nuclear Information System (INIS)

    Hautecouverture, Benjamin

    2014-06-01

    Adopted on the 28 April 2004 by the United Nations Security Council under Chapter VII of the UN Charter, Resolution 1540 is a composite tool that was hitherto unprecedented. To recap, States are bound to 'refrain from providing any form of support to non-State actors that attempt to develop, acquire, manufacture, possess, transport, transfer or use nuclear, chemical or biological weapons and their means of delivery' (par. 1), and to prohibit and prevent non-State actors from the aforementioned through 'appropriate and effective' (par. 2,3) legal, judiciary, and administrative means. A Committee was established to which States had to submit a first report outlining the steps 'they have taken or intend to take to implement this resolution' (par. 4). This Committee was initially established for two years and has been regularly renewed since, and its mandate was extended in 2011 for ten years. It is not a surveillance mechanism. Finally, with the aim of remedying difficulties that certain States may experience in implementing the Resolution, 'States in a position to do so' are invited to offer assistance (par. 7). The level of the application of Resolution 1540 was originally based on a delicate three-pronged balance of obligation, good will, and partnership. It is not a matter of designating certain States to the rest of the international community, whilst avoiding that the exercise be limited to the submission of national reports, instead aiming to initiate a dynamic. The wager was a risky one. Ten years on, 90% of UN member States have submitted one or several implementation reports. 170 States and 50 international and regional organisations have taken part in outreach and implementation support events. Whatever quantitative or qualitative conclusions that can be reached, we should continue to promote the Re-solution's universal adoption, and to ensure that the implementation of its provisions is undertaken in a lasting manner, taking account of the national

  19. 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.

  20. Comparison of radiology residency programs in ten countries

    International Nuclear Information System (INIS)

    Willatt, J.M.G.; Mason, A.C.

    2006-01-01

    The purpose of our study was to compare various aspects of radiology training schemes in ten countries. A questionnaire was sent to senior residents in the UK, USA, Canada, Australia, New Zealand, Italy, Egypt, India, Malaysia and Greece. The questions concerned length of training, required pre-training experience, the organization of the training scheme, teaching, resources, stages at which residents can independently perform and report examinations, fellowships, and progression to jobs. A wide variety of training, ranging from highly scheduled programs with detailed aims and objectives, to self-learning occurs across the world. Examinations and assessments are also variable. There are lessons to be learned from varying practices; more exchanges of ideas should be encouraged. In view of the ''internationalization'' of radiology services and the variation in training styles an international qualification for quality assurance purposes may be desirable. (orig.)

  1. 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

  2. Patient safety: lessons learned

    International Nuclear Information System (INIS)

    Bagian, James P.

    2006-01-01

    The traditional approach to patient safety in health care has ranged from reticence to outward denial of serious flaws. This undermines the otherwise remarkable advances in technology and information that have characterized the specialty of medical practice. In addition, lessons learned in industries outside health care, such as in aviation, provide opportunities for improvements that successfully reduce mishaps and errors while maintaining a standard of excellence. This is precisely the call in medicine prompted by the 1999 Institute of Medicine report ''To Err Is Human: Building a Safer Health System.'' However, to effect these changes, key components of a successful safety system must include: (1) communication, (2) a shift from a posture of reliance on human infallibility (hence ''shame and blame'') to checklists that recognize the contribution of the system and account for human limitations, and (3) a cultivation of non-punitive open and/or de-identified/anonymous reporting of safety concerns, including close calls, in addition to adverse events. (orig.)

  3. Capacity-building of the allied health workforce to prevent and control diabetes: Lessons learnt from the National Initiative to Reinforce and Organize General Diabetes Care in Sri Lanka (NIROGI Lanka) project.

    Science.gov (United States)

    Wijeyaratne, Chandrika; Arambepola, Carukshi; Karunapema, Palitha; Periyasamy, Kayathri; Hemachandra, Nilmini; Ponnamperuma, Gominda; Beneragama, Hemantha; de Alwis, Sunil

    2016-04-01

    In 2008, to tackle the exponential rise in the clinical burden of diabetes that was challenging the health systems in Sri Lanka, a shift in focus towards patient-centred care linked with community health promotion was initiated by the National Initiative to Reinforce and Organize General Diabetes Care in Sri Lanka (NIROGI Lanka) project of the Sri Lanka Medical Association. Specific training of "diabetes educator nursing officers" (DENOs), field staff in maternal and child health, footwear technicians, and health promoters from the community, was instituted to improve knowledge, skills and attitudes in the area of control and prevention of diabetes. This article highlights some of the activities carried out to date with the allied health workforce and volunteer community. Specifically, it describes experiences with the DENO programme: the educational and administrative processes adopted, challenges faced and lessons learnt. It also highlights an approach to prevention and management of complications of chronic diabetic foot through training a cohort of prosthetics and orthotics technicians, in the absence of podiatrists, and an initiative to provide low-cost protective footwear. Harnessing the enthusiasm of volunteers - adults and schoolchildren - to address behavioural risk factors in a culturally appropriate fashion has also been a key part of the NIROGI Lanka strategy.

  4. 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.

  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

    such as primary care practices, therapist 2 offices, prisons, schools , and community organizations. Providers working in these various settings have...ment, follow-up care for children prescribed attention deficit hyperactivity disorder ( ADHD ) medication, and mental health utilization (among other

  6. Compactified vacuum in ten dimensions

    International Nuclear Information System (INIS)

    Wurmser, D.

    1987-01-01

    Since the 1920's, theories which unify gravity with the other fundamental forces have called for more than the four observed dimensions of space-time. According to such a theory, the vacuum consists of flat four-dimensional space-time described by the Minkowski metric M 4 and a compactified space B. The dimensions of B are small, and the space can only be observed at distance scales smaller than the present experimental limit. These theories have had serious difficulties. The equations of gravity severely restrict the possible choices for the space B. The allowed spaces are complicated and difficult to study. The vacuum is furthermore unstable in the sense that a small perturbation causes the compactified dimensions to expand indefinitely. There is an addition a semi-classical argument which implies that the compactified vacuum by annihilated by virtual black holes. It follows that a universe with compactified extra dimensions could not have survived to the present. These results were derived by applying the equations of general relativity to spaces of more than four dimensions. The form of these equations was assumed to be unchanged by an increase in the number of dimensions. The authors illustrate the effect of such terms by considering the example B = S 6 where S 6 is the six-dimensional sphere. Only when the extra terms are included is this choice of the compactified space allowed. He explore the effect of a small perturbation on such a vacuum. The ten-dimensional spherically symmetric potential is examined, and I determine conditions under which the formation of virtual black holes is forbidden. The examples M 4 x S 6 is still plagued by the semi-classical instability, but this result does not hold in general. The requirement that virtual black holes be forbidden provides a test for any theory which predicts a compactified vacuum

  7. A Systematic Review on Confidentiality, Disclosure, and Stigma in the United States: Lessons for HIV Care in Pregnancy From Reproductive Genetics.

    Science.gov (United States)

    Wilkinson, Barbara; Arora, Kavita Shah

    2015-01-01

    The fields of HIV care in pregnancy and reproductive genetics have always been 'exceptional' in that patients are highly concerned about the potential for stigma and the corresponding need for privacy and confidentiality. However, the two fields have diverged in how they have addressed these concerns. The systematic review analyzed 61 manuscripts for similarities and differences between the fields of HIV care in pregnancy and reproductive genetics in the United States, with respect to privacy, confidentiality, disclosure, and stigma. The systematic review revealed that the field of HIV care in pregnancy has insufficiently addressed patient concerns about privacy, confidentiality, and stigma compared to the field of reproductive genetics. Failure to adequately protect confidentiality of HIV-positive patients, and failure to reduce stigma associated with HIV testing and treatment are deficiencies in the delivery of care to HIV-positive pregnant woman and barriers to reducing vertical transmission of HIV. Improvements in care and policy should mirror the field of reproductive genetics.

  8. Continuing Care

    Science.gov (United States)

    ... Can’t Grandma Remember My Name? Artwork for Purchase Support Articles Ten Signs of Caregiver Stress Therapeutic ... loved one with Alzheimer’s may be a difficult decision. It is best to make decisions about care ...

  9. Ten years of negotiating rights around maternal health in Uttar Pradesh, India

    Directory of Open Access Journals (Sweden)

    Dasgupta Jashodhara

    2011-12-01

    Full Text Available Abstract Background Preventable maternal mortality and morbidity have been globally recognized as human rights issues. Maternal mortality in India is among the highest in the world, and reflects inequity in access to healthcare: women from certain states as well as poorer women and less literate women appear to be significantly disadvantaged. The government of India has been attempting to improve maternal outcomes through a cash transfer within the National Rural Health Mission to encourage women to come to hospitals for childbirth. Methods This paper reviews documents of the last ten years describing the experiences of a Non-Governmental Organisation, SAHAYOG, in working with a civil society platform, the Healthwatch Forum, to develop ‘rights based’ strategies around maternal health. The paper builds an analysis using recent frameworks on accountability and gendered rights claiming to examine these experiences and draw out lessons regarding rights claiming strategies for poor women. Results The examination of documents over the last ten years indicates defined phases of development in the evolution of SAHAYOG’s understanding and of the shifts in strategy among SAHAYOG and its close allies, and responses by the state. The first three stages depict the deepening of SAHAYOG’s understanding of the manner in which poor and marginalized women negotiate their access to health care; the fourth stage explores a health system intervention and the challenges of working from within civil society in alliance with poor and marginalized women. Conclusion The findings from SAHAYOG’s experiences with poor Dalit women in Uttar Pradesh reveal the elements of social exclusion within the health system that prevent poor and marginalized women from accessing effective lifesaving care. Creating a voice for the most marginalised and carving space for its articulation impacts upon the institutions and actors that have a duty to meet the claims being made

  10. Ten years of negotiating rights around maternal health in Uttar Pradesh, India.

    Science.gov (United States)

    Dasgupta, Jashodhara

    2011-12-16

    Preventable maternal mortality and morbidity have been globally recognized as human rights issues. Maternal mortality in India is among the highest in the world, and reflects inequity in access to healthcare: women from certain states as well as poorer women and less literate women appear to be significantly disadvantaged. The government of India has been attempting to improve maternal outcomes through a cash transfer within the National Rural Health Mission to encourage women to come to hospitals for childbirth. This paper reviews documents of the last ten years describing the experiences of a Non-Governmental Organisation, SAHAYOG, in working with a civil society platform, the Healthwatch Forum, to develop 'rights based' strategies around maternal health. The paper builds an analysis using recent frameworks on accountability and gendered rights claiming to examine these experiences and draw out lessons regarding rights claiming strategies for poor women. The examination of documents over the last ten years indicates defined phases of development in the evolution of SAHAYOG's understanding and of the shifts in strategy among SAHAYOG and its close allies, and responses by the state. The first three stages depict the deepening of SAHAYOG's understanding of the manner in which poor and marginalized women negotiate their access to health care; the fourth stage explores a health system intervention and the challenges of working from within civil society in alliance with poor and marginalized women. The findings from SAHAYOG's experiences with poor Dalit women in Uttar Pradesh reveal the elements of social exclusion within the health system that prevent poor and marginalized women from accessing effective lifesaving care. Creating a voice for the most marginalised and carving space for its articulation impacts upon the institutions and actors that have a duty to meet the claims being made. However, given the accountability deficit, the analysis indicates the importance

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. Ten years of effective multilateralism?

    International Nuclear Information System (INIS)

    Hautecouverture, Benjamin

    2013-12-01

    successes of multilateralism and international law provide security assurances or do they mask the flaws of an insufficiently intrusive system? While the U.S. signaled their defiance under the guidance of John Bolton, European thinking settled on a conclusion with the air of a slogan: yes to multilateralism, providing it is effective. This was to be the cornerstone of the policies to undertake and the instruments to implement to forge a global role for the Union. Its originality is based simultaneously in realism and in a refusal to resort to force as the foremost means of action on the international stage. Another way of defining the 2003 Strategy is a skillful compromise between differing positions to banish the Iraqi 'cacophony' as quickly as possible. Ten years on, it is now time for 'impact assessments' and other 'scorecards' of public policies. In the midst of the Eurozone economic crisis, evaluating a strategy of 'effective multilateralism' is not easy. The Union's bi-annual reports on its implementation have recently begun to try to provide a quantitative analysis that is not entirely convincing (for instance, the number of ratifications of such-and-such an instrument with regard to the budget allocated by the EU to facilitate its universalization, over such-and-such a period). Fundamentally, the 2003 Strategy is essentially beyond this kind of analysis even if it can prove useful. The strength of the European approach consists in establishing a long-term willingness to maintain and strengthen collective security tools approved by the greatest possible number of States. Its weakness is to occasionally confront a strategic reality that is as contradictory as it is stubborn. Effective multilateralism is linked to voluntarism and vows. (author)

  17. 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

    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. 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. 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. 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 intervention.

  18. 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

  19. Correlates of Strengthening Lessons from HIV/AIDS Treatment and Care Services in Ethiopia Perceived Access and Implications for Health System.

    Directory of Open Access Journals (Sweden)

    Bereket Yakob

    Full Text Available Access to healthcare is an important public health concept and has been traditionally measured by using population level parameters, such as availability, distribution and proximity of the health facilities in relation to the population. However, client based factors such as their expectations, experiences and perceptions which impact their evaluations of health care access were not well studied and integrated into health policy frameworks and implementation programs.This study aimed to investigate factors associated with perceived access to HIV/AIDS Treatment and care services in Wolaita Zone, Ethiopia.A cross-sectional survey was conducted on 492 people living with HIV, with 411 using ART and 81 using pre-ART services accessed at six public sector health facilities from November 2014 to March 2015. Data were analyzed using the ologit function of STATA. The variables explored consisted of socio-demographic and health characteristics, type of health facility, type of care, distance, waiting time, healthcare responsiveness, transportation convenience, satisfaction with service, quality of care, financial fairness, out of pocket expenses and HIV disclosure.Of the 492 participants, 294 (59.8% were females and 198 (40.2% were males, with a mean age of 38.8 years. 23.0% and 12.2% believed they had 'good' or 'very good' access respectively, and 64.8% indicated lower ratings. In the multivariate analysis, distance from the health facility, type of care, HIV clinical stage, out of pocket expenses, employment status, type of care, HIV disclosure and perceived transportation score were not associated with the perceived access (PA. With a unit increment in satisfaction, perceived quality of care, health system responsiveness, transportation convenience and perceived financial fairness scores, the odds of providing higher rating of PA increased by 29.0% (p<0.001, 6.0%(p<0.01, 100.0% (p<0.001, 9.0% (p<0.05 and 6.0% (p<0.05 respectively.Perceived quality of

  20. 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.

  1. Africa has unique and urgent barriers to cleft care: lessons from practitioners at the Pan-African Congress on Cleft Lip and Palate.

    Science.gov (United States)

    Adetayo, Oluwaseun; Ford, Rachel; Martin, Mark

    2012-01-01

    The goals of this study were to delineate the protocols employed for managing patients with cleft lip and palate deformities, delineate the challenges facing practitioners and patients, and to determine the patient and physician barriers to cleft care delivery in the region. Survey questionnaires were administered to practitioners attending the second Pan-African Congress on Cleft Lip and Palate (PACCLIP), which took place in Ibadan, Nigeria, West Africa from February 4-7, 2007. The conference included 225 participants, representing 17 African countries Protocols for repair of cleft lip and palate deformities were varied, with Millard's and von Langenbeck's techniques being the preferred approach for the management of cleft lip and palate deformities, respectively. A large proportion of providers have limited access to core cleft care supporting teams, especially speech language pathologists, orthodontists, and audiologists. Several challenging barriers to cleft care were also identified at both the institutional and individual levels and are reported. Geographic separation in Africa presents a similar challenge due to isolationism as it does to surgeons in Europe. Specific to Africa are the increased barriers to care, and economic and financial hardship at various levels. A focus on funding, team building, infrastructural support, and patient education appear to be crucial in improving the care and lives of children with facial clefts in Africa.

  2. Screening and detection of elder abuse: Research opportunities and lessons learned from emergency geriatric care, intimate partner violence, and child abuse.

    Science.gov (United States)

    Beach, Scott R; Carpenter, Christopher R; Rosen, Tony; Sharps, Phyllis; Gelles, Richard

    2016-01-01

    This article provides an overview of elder abuse screening and detection methods for community-dwelling and institutionalized older adults, including general issues and challenges for the field. Then, discussions of applications in emergency geriatric care, intimate partner violence (IPV), and child abuse are presented to inform research opportunities in elder abuse screening. The article provides descriptions of emerging screening and detection methods and technologies from the emergency geriatric care and IPV fields. We also discuss the variety of potential barriers to effective screening and detection from the viewpoint of the older adult, caregivers, providers, and the health care system, and we highlight the potential harms and unintended negative consequences of increased screening and mandatory reporting. We argue that research should continue on the development of valid screening methods and tools, but that studies of perceived barriers and potential harms of elder abuse screening among key stakeholders should also be conducted.

  3. Lesson study i Danmark?

    DEFF Research Database (Denmark)

    Mogensen, Arne

    2009-01-01

    Der beskrives et japansk lesson study forløb, og det diskuteres i hvilket omfang, de gode japanske erfaringer kan overføres til dansk matematikundervisning.......Der beskrives et japansk lesson study forløb, og det diskuteres i hvilket omfang, de gode japanske erfaringer kan overføres til dansk matematikundervisning....

  4. "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…

  5. 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

  6. 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

    Science.gov (United States)

    Young, Taryn; Rohwer, Anke; van Schalkwyk, Susan; Volmink, Jimmy; Clarke, Mike

    2015-01-01

    Background 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. Methods and Findings 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. Conclusions Implementing clinically integrated EBHC curricula

  7. 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. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Restriction on Restraints in the Care for People With Intellectual Disabilities in the Netherlands: Lessons Learned from Australia, UK, and United States

    NARCIS (Netherlands)

    Romijn, A.; Frederiks, B.J.M.

    2012-01-01

    In the Netherlands, physical/mechanical restraints in the care provided to people with intellectual disabilities are still in use, with the case of "Brandon" being a recent and illustrative example. The public debate that this case triggered raised questions concerning the policy proposal in the

  9. Ten steps to successful software process improvement

    Science.gov (United States)

    Kandt, R. K.

    2003-01-01

    This paper identifies ten steps for managing change that address organizational and cultural issues. Four of these steps are critical, that if not done, will almost guarantee failure. This ten-step program emphasizes the alignment of business goals, change process goals, and the work performed by the employees of an organization.

  10. 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...

  11. 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......The article investigates the concept of lessons in IR. By means of a constructivist critique of the 'lessons literature', the article analyses one of the most important of IR lessons: that of Munich. Examining how the Munich lesson came about, the article shows the praxeological nature of lessons...... 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...

  12. Implementing the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle into everyday care: opportunities, challenges, and lessons learned for implementing the ICU Pain, Agitation, and Delirium Guidelines.

    Science.gov (United States)

    Balas, Michele C; Burke, William J; Gannon, David; Cohen, Marlene Z; Colburn, Lois; Bevil, Catherine; Franz, Doug; Olsen, Keith M; Ely, E Wesley; Vasilevskis, Eduard E

    2013-09-01

    other ICU team members. In this study of the implementation of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle in a tertiary care setting, clear factors were identified that both advanced and impeded adoption of this complex intervention that requires interprofessional education, coordination, and cooperation. Focusing on these factors preemptively should enable a more effective and lasting implementation of the bundle and better care for critically ill patients. Lessons learned from this study will also help healthcare providers optimize implementation of the recent ICU pain, agitation, and delirium guidelines, which has many similarities but also some important differences as compared with the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle.

  13. Care at home for elderly – lessons learnt from the Swiss Red Cross “Integrated Home Care” in Eastern Europe/CIS

    OpenAIRE

    Rutschmann, Christine

    2017-01-01

    Introduction: The Swiss Red Cross (SRC) is supporting local partners in Eastern Europe/CIS in developing services to allow elderly a dignified ageing in their homes. SRC promotes integrated medico-social home care services in agreement with the local partners, their strategies and capacities. “Help to self-help” is crucial besides the provision of good quality low cost services, accessible for people in need. In many post-Soviet countries, cooperation between Health and Social Ministries is r...

  14. The Council of Academic Hospitals of Ontario (CAHO) Adopting Research to Improve Care (ARTIC) Program: Reach, Sustainability, Spread and Lessons Learned from an Implementation Funding Model

    OpenAIRE

    Moore, Julia E.; Grouchy, Michelle; Graham, Ian D.; Shandling, Maureen; Doyle, Winnie; Straus, Sharon E.

    2016-01-01

    Despite evidence on what works in healthcare, there is a significant gap in the time it takes to bring research into practice. The Council of Academic Hospitals of Ontario's Adopting Research to Improve Care program addresses this research-to-practice gap by incorporating the following components into its funding program: strategic selection of evidence for implementation, education and training for implementation, implementation supports, executive champions and governance, and evaluation. F...

  15. Using workshops to develop theories of change in five low and middle income countries: lessons from the programme for improving mental health care (PRIME)

    Science.gov (United States)

    2014-01-01

    Background The Theory of Change (ToC) approach has been used to develop and evaluate complex health initiatives in a participatory way in high income countries. Little is known about its use to develop mental health care plans in low and middle income countries where mental health services remain inadequate. Aims ToC workshops were held as part of formative phase of the Programme for Improving Mental Health Care (PRIME) in order 1) to develop a structured logical and evidence-based ToC map as a basis for a mental health care plan in each district; (2) to contextualise the plans; and (3) to obtain stakeholder buy-in in Ethiopia, India, Nepal, South Africa and Uganda. This study describes the structure and facilitator’s experiences of ToC workshops. Methods The facilitators of the ToC workshops were interviewed and the interviews were recorded, transcribed and analysed together with process documentation from the workshops using a framework analysis approach. Results Thirteen workshops were held in the five PRIME countries at different levels of the health system. The ToC workshops achieved their stated goals with the contributions of different stakeholders. District health planners, mental health specialists, and researchers contributed the most to the development of the ToC while service providers provided detailed contextual information. Buy-in was achieved from all stakeholders but valued more from those in control of resources. Conclusions ToC workshops are a useful approach for developing ToCs as a basis for mental health care plans because they facilitate logical, evidence based and contextualised plans, while promoting stakeholder buy in. Because of the existing hierarchies within some health systems, strategies such as limiting the types of participants and stratifying the workshops can be used to ensure productive workshops. PMID:24808923

  16. Human rights and mental health in post-apartheid South Africa: lessons from health care professionals working with suicidal inmates in the prison system.

    Science.gov (United States)

    Bantjes, Jason; Swartz, Leslie; Niewoudt, Pieter

    2017-10-12

    During the era of apartheid in South Africa, a number of mental health professionals were vocal about the need for socio-economic and political reform. They described the deleterious psychological and social impact of the oppressive and discriminatory Nationalist state policies. However, they remained optimistic that democracy would usher in positive changes. In this article, we consider how mental health professionals working in post-apartheid South Africa experience their work. Our aim was to describe the experience of mental health professionals working in prisons who provide care to suicidal prisoners. Data were collected from in-depth semi-structured interviews and were analyzed using thematic content analysis. Findings draw attention to the challenges mental health professionals in post-apartheid South Africa face when attempting to provide psychological care in settings where resources are scarce and where the environment is anti-therapeutic. Findings highlight the significant gap between current policies, which protect prisoners' human rights, and every-day practices within prisons. The findings imply that there is still an urgent need for activism in South Africa, particularly in the context of providing mental health care services in settings which are anti-therapeutic and inadequately resourced, such as prisons.

  17. Lessons learnt from the MAGNET Malawian-German Hospital Partnership: the German perspective on contributions to patient care and capacity development.

    Science.gov (United States)

    Neuhann, Florian; Barteit, Sandra

    2017-07-26

    Malawi is a low-income country with one of the highest HIV prevalence rates worldwide (Kendig et al., Trop Med Health 41:163-170, 2013). The health system depends largely on external funding. Official German development aid has supported health care in Malawi for many years (German Embassy Lilongwe, The German Development Cooperation in Malawi), including placing medical doctors in various departments of the Kamuzu Central Hospital (KCH) in Lilongwe. In 2008, a hospital partnership called MAGNET (Malawi German Networking for Capacity Building in Treatment, Training and Research at KCH) evolved as part of the German ESTHER network. The partnership was abruptly terminated in 2015. We reviewed 35 partnership documents and conducted an online survey of partnership stakeholders to retrospectively assess the hospital partnership based on the Capacity WORKS model of the German Corporation for International Cooperation (GIZ). This model evaluates systems' management and implementation to understand and support the functioning of cooperation within societies. Based on this model, we considered the five success factors for cooperation management: (1) strategy, (2) cooperation, (3) steering, (4) processes, and (5) learning and innovation. In an online survey, we used an adapted version of the partnership evaluation tool by the Centers for Disease Control and Prevention (CDC). From 2008 to 2015, the MAGNET partnership contributed to capacity building and improved patient care in the KCH Medical Department through clinical care, technical support, teaching and trainings, and operations research based on mutually agreed upon objectives. The MAGNET partnership was implemented in three phases during which there were changes in leadership in the Medical Department and the hospital, contractual policies, funder priorities and the competing influences of other actors. Communication and follow up among partners worked best during phases when a German doctor was onsite. The partnership

  18. Palliative Care Leadership Centers Are Key To The Diffusion Of Palliative Care Innovation.

    Science.gov (United States)

    Cassel, J Brian; Bowman, Brynn; Rogers, Maggie; Spragens, Lynn H; Meier, Diane E

    2018-02-01

    Between 2000 and 2015 the proportion of US hospitals with more than fifty beds that had palliative care programs tripled, from 25 percent to 75 percent. The rapid adoption of this high-value program, which is voluntary and runs counter to the dominant culture in US hospitals, was catalyzed by tens of millions of dollars in philanthropic support for innovation, dissemination, and professionalization in the palliative care field. We describe the dissemination strategies of the Center to Advance Palliative Care in the context of the principles of social entrepreneurship, and we provide an in-depth look at its hallmark training initiative, Palliative Care Leadership Centers. Over 1,240 hospital palliative care teams have trained at the Leadership Centers to date, with 80 percent of them instituting palliative care services within two years. We conclude with lessons learned about the role of purposeful technical assistance in promoting the rapid diffusion of high-value health care innovation.

  19. Lessons we are learning: using participatory action research to integrate palliative care, health promotion and public health through the DöBra research program in Sweden.

    Science.gov (United States)

    Tishelman, Carol

    2018-01-01

    Public health and health promotion approaches to end-of-life (EoL) research and care are still rare in Sweden. People remain generally ill-prepared for encounters with death and unable to advocate for quality EoL care; this may be reflected in Sweden's low scores for community engagement in the 2015 Quality of Death index. We have consolidated our endeavours into a cohesive national transdisciplinary research program, DöBra (a pun meaning both 'dying well' and 'awesome' in Swedish). In DöBra, we investigate how culture, the environment and conversation can promote constructive change and support better quality of life and death among the general population, in specific subgroups and in interventions directed to staff caring for dying individuals, their friends and families. DöBra uses ideas from new public health and the Ottawa Charter as umbrella theoretical frameworks and participatory action research as an overarching methodological approach. In DöBra we aim to achieve change in communities in a broad sense. In this interactive workshop, we therefore focus on the particular challenges we encounter in conducting stringent research when trying to catalyse, rather than control, change processes. We will share our ideas, experiences, reflections, tools and approaches as well as results, related to using a variety of strategies to bring together a broad range of stakeholders to co-create experience-based evidence through innovative approaches. We begin by linking theory, research and practice through discussion of the overarching ideas and individual projects, with the second part of the session based on audience engagement with various tools used in DöBra.

  20. 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.

  1. Intensive Education of Health Care Workers Improves the Outcome of Ebola Virus Disease: Lessons Learned from the 2014 Outbreak in Sierra Leone.

    Science.gov (United States)

    Jones-Konneh, Tracey Elizabeth Claire; Murakami, Aya; Sasaki, Hiroyuki; Egawa, Shinichi

    2017-10-01

    The rare and deadly Ebola virus disease (EVD) is caused by Ebola virus (EBOV) infection. The 2014-2015 EVD outbreak in West Africa was unprecedented. Person-to-person transmission of EBOV by direct contact with the body or bodily fluids of an infected person through broken skin or unprotected mucous membrane caused rapid outbreak in communities. Nosocomial infection was the cause of death of many health care workers (HCWs). This paper aims to reveal the importance and effect of intensive education of HCWs when combating an outbreak such as EVD. We compared the curricula of two educational programs and analyzed their effects by the trend of weekly new patients. In September 2014, a three-day training program on infection, prevention and control (IPC) was organized for nurses, but it was not sufficient to achieve good outcome. In December 2014, a newly established National Ebola Training Academy was set up to offer a platform of clinical training modules for frontline Ebola response workers. This academy addressed the training needs of clinicians and hygienists who were working or will work at Ebola treatment centers that were established after the onset of the 2014 outbreak. Increased intensive contents and simulated training at the academy improved HCWs' understanding of EVD, IPC and patient care, which subsequently contributed to the survival of patients. The rapid settlement of the outbreak after introducing the Academy indicates that appropriate intensive education of HCWs is the key activity carried out to control the outbreak of EVD in Sierra Leone.

  2. Vadose Zone Journal: The first ten years

    NARCIS (Netherlands)

    Vrugt, J.A.; Or, D.; Young, M.H.

    2013-01-01

    Celebrating ten years of publication, the authors introduce a special section commemorating the anniversary of Vadose Zone Journal and reviewing the journal’s role in an evolving understanding of vadose zone science.

  3. Ten Leading Causes of Death and Injury

    Science.gov (United States)

    ... Overdose Traumatic Brain Injury Violence Prevention Ten Leading Causes of Death and Injury Recommend on Facebook Tweet Share Compartir ... in Hospital Emergency Departments, United States – 2014 Leading Causes of Death Charts Causes of Death by Age Group 2016 [ ...

  4. Ten key issues in modern flow chemistry.

    Science.gov (United States)

    Wegner, Jens; Ceylan, Sascha; Kirschning, Andreas

    2011-04-28

    Ten essentials of synthesis in the flow mode, a new enabling technology in organic chemistry, are highlighted as flashlighted providing an insight into current and future issues and developments in this field. © The Royal Society of Chemistry 2011

  5. Ten into four won't go

    International Nuclear Information System (INIS)

    Freedman, D.Z.; West, P.C.

    1989-01-01

    It is shown that nontrivial spontaneous compactification of ten-dimensional N = 1 supergravity with or without Yang-Mills matter is not possible unless maximal symmetry (i.e. Lorentz invariance) is violated in the four-dimensional spacetime

  6. 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.

  7. Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India.

    Science.gov (United States)

    Bhojani, Upendra; Kolsteren, Patrick; Criel, Bart; De Henauw, Stefaan; Beerenahally, Thriveni S; Verstraeten, Roos; Devadasan, Narayanan

    2015-01-01

    Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource-constrained settings. To evaluate an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. A quasi-experimental study was conducted in a poor urban neighborhood in South India. Four health facilities delivered the intervention (n=163 diabetes patients) and the four matched facilities served as control (n=154). The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management. Patients were surveyed before and after the 6-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Quantitative data were used to assess the reach of the intervention and its effectiveness on patients' knowledge, practice, healthcare expenditure, and glycemic control through a difference-in-differences analysis. Qualitative data were analyzed thematically to understand adoption, implementation, and maintenance of the intervention. Reach: Of those who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. Adoption: All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard

  8. The Supersymmetric Top-Ten Lists

    OpenAIRE

    Haber, Howard E.

    1993-01-01

    Ten reasons are given why supersymmetry is the leading candidate for physics beyond the Standard Model. Ultimately, the experimental discovery of supersymmetric particles at future colliders will determine whether supersymmetry is relevant for TeV scale physics. The grand hope of supersymmetry enthusiasts is to connect TeV scale supersymmetry with Planck scale physics. The ten most pressing theoretical problems standing in the way of this goal are briefly described.

  9. Lessons Learned From Transitioning PEPFAR Track 1.0 Care and Treatment Programs: Case Studies in Financial Management Capacity Building in Zambia and Botswana.

    Science.gov (United States)

    Kuehn, Chuck; Tidwell, George; Vhugen, Jann; Sharma, Anjali

    2015-01-01

    In 2008, the United States government mandated transition of internationally managed HIV care and treatment programs to local country ownership. Three case studies illustrate the US Health Resources Services Administration's fiscal assessment and technical assistance (TA) processes to strengthen local organizations' capabilities to absorb and manage United States government funding. Review of initial, TA and follow-up reports reveal that the 1 Botswanan and 2 Zambian organizations closed 10 of 17 financial capacity gaps, with Health Resources Services Administration assisting on 2. Zambian organizations requested and absorbed targeted TA on the basis of the consultant's desk review, their finance staff revised fiscal policies and procedures, and accordingly trained other staff. In Botswana, delays in integrating recommendations necessitated on-site TA for knowledge building and role modeling. Organizational maturity may explain differences in responsiveness, ownership, and required TA approaches. Clarifying expectations of capacity building, funding agreement, and nonmonetary donor involvement can help new organizations determine and act on intervening actions.

  10. 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.

  11. A randomized controlled trial of skin care protocols for facial resurfacing: lessons learned from the Plastic Surgery Educational Foundation's Skin Products Assessment Research study.

    Science.gov (United States)

    Pannucci, Christopher J; Reavey, Patrick L; Kaweski, Susan; Hamill, Jennifer B; Hume, Keith M; Wilkins, Edwin G; Pusic, Andrea L

    2011-03-01

    The Skin Products Assessment Research Committee was created by the Plastic Surgery Educational Foundation in 2006. The Skin Products Assessment Research study aims were to (1) develop an infrastructure for Plastic Surgery Educational Foundation-conducted, industry-sponsored research in facial aesthetic surgery and (2) test the research process by comparing outcomes of the Obagi Nu-Derm System versus conventional therapy as treatment adjuncts for facial resurfacing procedures. The Skin Products Assessment Research study was designed as a multicenter, double-blind, randomized, controlled trial. The study was conducted in women with Fitzpatrick type I to IV skin, moderate to severe facial photodamage, and periocular and/or perioral fine wrinkles. Patients underwent chemical peel or laser facial resurfacing and were randomized to the Obagi Nu-Derm System or a standard care regimen. The study endpoints were time to reepithelialization, erythema, and pigmentation changes. Fifty-six women were enrolled and 82 percent were followed beyond reepithelialization. There were no significant differences in mean time to reepithelialization between Obagi Nu-Derm System and control groups. The Obagi Nu-Derm System group had a significantly higher median erythema score on the day of surgery (after 4 weeks of product use) that did not persist after surgery. Test-retest photographic evaluations demonstrated that both interrater and intrarater reliability were adequate for primary study outcomes. The authors demonstrated no significant difference in time to reepithelialization between patients who used the Obagi Nu-Derm System or a standard care regimen as an adjunct to facial resurfacing procedures. The Skin Products Assessment Research team has also provided a discussion of future challenges for Plastic Surgery Educational Foundation-sponsored clinical research for readers of this article.

  12. How transformational learning promotes caring, consultation and creativity, and ultimately contributes to sustainable development: Lessons from the Partnership for Education and Research about Responsible Living (PERL) network

    Science.gov (United States)

    Thoresen, Victoria Wyszynski

    2017-12-01

    Oases of learning which are transformative and lead to significant behavioural change can be found around the globe. Transformational learning has helped learners not only to understand what they have been taught but also to re-conceptualise and re-apply this understanding to their daily lives. Unfortunately, as many global reports indicate, inspirational transformational learning approaches for sustainable development are rare and have yet to become the norm - despite calls for such approaches by several outstanding educators and organisations. This article examines three learning approaches developed by the network of the Partnership for Education and Research about Responsible Living (PERL). These approaches are structured around core elements of transformative learning for sustainable development, yet focus particularly on the ability to care, consult with others and be creative. They seem to depend on the learners' ability to articulate their perceptions of sustainable development in relation to their own values and to identify how these are actualised in their daily life. Together with other core elements of transformative learning, an almost magical (not precisely measurable) synergy then emerges. The intensity of this synergy appears to be directly related to the individual learner's understanding of the contradictions, interlinkages and interdependencies of modern society. The impact of this synergy seems to be concurrent with the extent to which the learner engages in a continual learning process with those with whom he/she has contact. The findings of this study suggest that mainstreaming transformational learning for sustainable development in ways that release the "magic synergy of creative caring" can result in the emergence of individuals who are willing and able to move from "business as usual" towards more socially just, economically equitable, and environmentally sensitive behaviour.

  13. The current state of the science for active self-care complementary and integrative medicine therapies in the management of chronic pain symptoms: lessons learned, directions for the future.

    Science.gov (United States)

    Crawford, Cindy; Lee, Courtney; Buckenmaier, Chester; Schoomaker, Eric; Petri, Richard; Jonas, Wayne

    2014-04-01

    Chronic pain management typically consists of prescription medications or provider-based, behavioral, or interventional procedures which are often ineffective, may be costly, and can be associated with undesirable side effects. Because chronic pain affects the whole person (body, mind, and spirit), patient-centered complementary and integrative medicine (CIM) therapies that acknowledge the patients' roles in their own healing processes have the potential to provide more efficient and comprehensive chronic pain management. Active self-care CIM (ACT-CIM) therapies allow for a more diverse, patient-centered treatment of complex symptoms, promote self-management, and are relatively safe and cost-effective. To date, there are no systematic reviews examining the full range of ACT-CIM used for chronic pain symptom management. A systematic review was conducted, using Samueli Institute's rapid evidence assessment of the literature methodology, to rigorously assess both the quality of the research on ACT-CIM modalities and the evidence for their efficacy and effectiveness in treating chronic pain symptoms. A working group of subject matter experts was also convened to evaluate the overall literature pool and develop recommendations for the use and implementation of these modalities. Following key database searches, 146 randomized controlled trials were included in the review. This article summarizes the current state of the science, lessons learned from the gaps exposed by the review, as well as suggestions for next steps toward translation for the field. Although the review's entire scope is detailed throughout the current Pain Medicine supplement, the authors encourage the use of this report as a guide for future ACT-CIM research. Wiley Periodicals, Inc.

  14. Lessons Learned for Decommissioning Planning

    International Nuclear Information System (INIS)

    Sohn, Wook; Kim, Young-gook; Kim, Hee-keun

    2015-01-01

    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. Supporting aboriginal knowledge and practice in health care: lessons from a qualitative evaluation of the strong women, strong babies, strong culture program.

    Science.gov (United States)

    Lowell, Anne; Kildea, Sue; Liddle, Marlene; Cox, Barbara; Paterson, Barbara

    2015-02-05

    The Strong Women, Strong Babies, Strong Culture Program (the Program) evolved from a recognition of the value of Aboriginal knowledge and practice in promoting maternal and child health (MCH) in remote communities of the Northern Territory (NT) of Australia. Commencing in 1993 it continues to operate today. In 2008, the NT Department of Health commissioned an evaluation to identify enabling factors and barriers to successful implementation of the Program, and to identify potential pathways for future development. In this paper we focus on the evaluation findings related specifically to the role of Aborignal cultural knowledge and practice within the Program. A qualitative evaluation utilised purposive sampling to maximise diversity in program history and Aboriginal culture. Semi-structured, in-depth interviews with 76 participants were recorded in their preferred language with a registered Interpreter when required. Thematic analysis of data was verified or modified through further discussions with participants and members of the evaluation team. Although the importance of Aboriginal knowledge and practice as a fundamental component of the Program is widely acknowledged, there has been considerable variation across time and location in the extent to which these cultural dimensions have been included in practice. Factors contributing to this variation are complex and relate to a number of broad themes including: location of control over Program activities; recognition and respect for Aboriginal knowledge and practice as a legitimate component of health care; working in partnership; communication within and beyond the Program; access to transport and working space; and governance and organisational support. We suggest that inclusion of Aboriginal knowledge and practice as a fundamental component of the Program is key to its survival over more than twenty years despite serious challenges. Respect for the legitimacy of Aboriginal knowledge and practice within health

  16. An outbreak of vancomycin-resistant Enterococcus faecium in an acute care pediatric hospital: Lessons from environmental screening and a case-control study

    Science.gov (United States)

    Drews, Steven J; Richardson, Susan E; Wray, Rick; Freeman, Renee; Goldman, Carol; Streitenberger, Laurie; Stevens, Derek; Goia, Cristina; Kovach, Danuta; Brophy, Jason; Matlow, Anne G

    2008-01-01

    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. OBJECTIVE To report an outbreak investigation and a case-control study to identify risk factors for VRE colonization or infection in hospitalized children. METHODS Screening for VRE cases was performed by culture or polymerase chain reaction. A case-control study of VRE-colonized patients was undertaken. Environmental screening was performed using standard culture and susceptibility methods, with pulsed-field gel electrophoresis to determine relationships between VRE isolates. Statistical analysis was performed using SAS version 9.0 (SAS Institute Inc, USA). RESULTS Thirty-four VRE-positive cases were identified on 10 wards between February 28, 2005, and May 27, 2005. Pulsed-field gel electrophoresis analysis confirmed a single outbreak strain that was also isolated from a video game found on one affected ward. Multivariate analysis identified cephalosporin use as the major risk factor for VRE colonization. CONCLUSIONS In the present study outbreak, VRE colonization was significantly associated with cephalosporin use. Because shared recreational items and environmental surfaces may be colonized by VRE, they warrant particular attention in housekeeping protocols, particularly in pediatric institutions. PMID:19412380

  17. Using Technology to Claim Rights to Free Maternal Health Care: Lessons about Impact from the My Health, My Voice Pilot Project in India.

    Science.gov (United States)

    Dasgupt, Jashodhara; Sandhya, Y K; Lobis, Samantha; Verma, Pravesh; Schaaf, Marta

    2015-12-10

    My Health, My Voice is a human rights-based project that pilots the use of technology to monitor and display online data regarding informal payments for maternal health care in two districts of Uttar Pradesh, India. SAHAYOG, an organization based in Uttar Pradesh, partnered with a grassroots women's forum to inform women about their entitlements, to publicize the project, and to implement a toll-free hotline where women could report health providers' demands for informal payments. Between January 2012 and May 2013, the hotline recorded 873 reports of informal payment demands. Monitoring and evaluation revealed that the project enhanced women's knowledge of their entitlements, as well as their confidence to claim their rights. Anecdotal evidence suggests that health providers' demands for informal payments were reduced in response to the project, although hospital and district officials did not regularly consult the data. The use of technology accorded greater legitimacy among governmental stakeholders. Future research should examine the sustainability of changes, as well as the mechanisms driving health sector responsiveness. Copyright © 2015 Dasgupta et al. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

  18. 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.

  19. Goiania, ten years later. Proceedings of an international conference

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    Following the radiological accident that happened in Goiania, Brazil, in late 1987, the Brazilian National Nuclear Energy Commission (CNEN) was able to turn to the international community for assistance under the terms of the 1986 IAEA sponsored Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency; this marked the first time the convention was invoked. Additionally, to prevent the loss of useful information, CNEN and the IAEA designated a panel of international experts to investigate the causes and consequences of the accident and draw up a comprehensive report, `The Radiological Accident in Goiania`, which the IAEA published in 1988. Under its nuclear safety programme, it is the IAEA`s intention to follow up serious radiological accidents with review and analysis, to document the causes and circumstances and to disseminate conclusions, lessons to be learned and recommendations from which all States may benefit. A decade after the Goiania accident, the CNEN convened the international conference `Goiania, Ten Years Later` in co-operation with the IAEA. The purpose of this conference was to share with the local population and the international community the knowledge gained during this tragic event and in the following years. The conference attracted some 400 participants from 17 countries (Argentina, Austria, Brazil, Canada, Cuba, El Salvador, Estonia, Germany, Israel, Italy, Mexico, Peru, Russian Federation, Spain, Uruguay, United States of America and Venezuela). The present IAEA proceedings contain some 50 papers selected for publication by the editorial committee of the conference Refs, figs, tabs

  20. Goiania, ten years later. Proceedings of an international conference

    International Nuclear Information System (INIS)

    1998-12-01

    Following the radiological accident that happened in Goiania, Brazil, in late 1987, the Brazilian National Nuclear Energy Commission (CNEN) was able to turn to the international community for assistance under the terms of the 1986 IAEA sponsored Convention on Assistance in the Case of a Nuclear Accident or Radiological Emergency; this marked the first time the convention was invoked. Additionally, to prevent the loss of useful information, CNEN and the IAEA designated a panel of international experts to investigate the causes and consequences of the accident and draw up a comprehensive report, 'The Radiological Accident in Goiania', which the IAEA published in 1988. Under its nuclear safety programme, it is the IAEA's intention to follow up serious radiological accidents with review and analysis, to document the causes and circumstances and to disseminate conclusions, lessons to be learned and recommendations from which all States may benefit. A decade after the Goiania accident, the CNEN convened the international conference 'Goiania, Ten Years Later' in co-operation with the IAEA. The purpose of this conference was to share with the local population and the international community the knowledge gained during this tragic event and in the following years. The conference attracted some 400 participants from 17 countries (Argentina, Austria, Brazil, Canada, Cuba, El Salvador, Estonia, Germany, Israel, Italy, Mexico, Peru, Russian Federation, Spain, Uruguay, United States of America and Venezuela). The present IAEA proceedings contain some 50 papers selected for publication by the editorial committee of the conference

  1. 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.

  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. A Web-Disseminated Self-Help and Peer Support Program Could Fill Gaps in Mental Health Care: Lessons From a Consumer Survey

    Science.gov (United States)

    Banschback, Kaitlin; Santorelli, Gennarina D; Constantino, Michael J

    2017-01-01

    mental health care. The results of this survey can be used to inform the design of such interventions. PMID:28104578

  4. Implementation fidelity of self-administered transcutaneous electrical nerve stimulation (TENS) in patients with chronic back pain: an observational study.

    Science.gov (United States)

    Pallett, Edward J; Rentowl, Patricia; Johnson, Mark I; Watson, Paul J

    2014-03-01

    The efficacy of transcutaneous electrical nerve stimulation (TENS) for pain relief has not been reliably established. Inconclusive findings could be due to inadequate TENS delivery and inappropriate outcome assessment. Electronic monitoring devices were used to determine patient compliance with a TENS intervention and outcome assessment protocol, to record pain scores before, during, and after TENS, and measure electrical output settings. Patients with chronic back pain consented to use TENS daily for 2 weeks and to report pain scores before, during, and after 1-hour treatments. A ≥ 30% reduction in pain scores was used to classify participants as TENS responders. Electronic monitoring devices "TLOG" and "TSCORE" recorded time and duration of TENS use, electrical settings, and pain scores. Forty-two patients consented to participate. One of 35 (3%) patients adhered completely to the TENS use and pain score reporting protocol. Fourteen of 33 (42%) were TENS responders according to electronic pain score data. Analgesia onset occurred within 30 to 60 minutes for 13/14 (93%) responders. It was not possible to correlate TENS amplitude, frequency, or pulse width measurements with therapeutic response. Findings from TENS research studies depend on the timing of outcome assessment; pain should be recorded during stimulation. TENS device sophistication might be an issue and parameter restriction should be considered. Careful protocol design is required to improve adherence and monitoring is necessary to evaluate the validity of findings. This observational study provides objective evidence to support concerns about poor implementation fidelity in TENS research.

  5. ANALGETSKI UCINAK TRANSAKUTNE ELEKTRICNE NERVNE STIMULACIJE (TENS)

    OpenAIRE

    ĆURKOVIĆ, B.

    1984-01-01

    Transkutana električna nervna stimulacija. (TENS) danas je široko prihvaćen terapijski postupak za suzbijanje boli. Način njezina djelovanja nije još jasno definiran, premda se većina autora priklanja centralnom mehranizmu smanjenja boli. Rezultati, u literaturi, variraju od nesignifikantno boljeg učinka od placeba do 95°/o dobrog analgetskog djelovanja. U Zavodu za reumatske bolesti i rehabilitaciju Kliničkog bolničkog centra, Zagreb, evaluiran je učinak TENS-a u bolesnika s križ...

  6. Lessons for Teaching Art Criticism.

    Science.gov (United States)

    Barrett, Terry, Ed.; Clark, Gilbert, Ed.

    This collection of lessons is meant to be a practical guide to help teachers engage children in art criticism. The lessons generally follow a similar format. Most suggest an age group but may be modified for use with younger or older students. Several authors suggest variations and extensions for lessons that include studio activities. A broad…

  7. 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)

  8. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.

    Science.gov (United States)

    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

    2008-08-19

    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. Factorial randomised trial. 64 general practices in England. 579 patients with chronic or recurrent low back pain; 144 were randomised to normal care, 147 to massage, 144 to six Alexander technique lessons, and 144 to 24 Alexander technique lessons; half of each of these groups were randomised to exercise prescription. Normal care (control), six sessions of massage, six or 24 lessons on the Alexander technique, and prescription for exercise from a doctor with nurse delivered behavioural counselling. Roland Morris disability score (number of activities impaired by pain) and number of days in pain. Exercise and lessons in the Alexander technique, but not massage, remained effective at one year (compared with control Roland disability score 8.1: massage -0.58, 95% confidence interval -1.94 to 0.77, six lessons -1.40, -2.77 to -0.03, 24 lessons -3.4, -4.76 to -2.03, and exercise -1.29, -2.25 to -0.34). Exercise after six lessons achieved 72% of the effect of 24 lessons alone (Roland disability score -2.98 and -4.14, respectively). Number of days with back pain in the past four weeks was lower after lessons (compared with control median 21 days: 24 lessons -18, six lessons -10, massage -7) and quality of life improved significantly. No significant harms were reported. One to one lessons in the Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons. National Research Register N0028108728.

  9. Elliot Lake uranium mine reclamation, the first ten years

    International Nuclear Information System (INIS)

    Payne, R.A.

    2000-01-01

    In 1989, Rio Algom Limited finalized its plans for the closure and subsequent decommissioning of two of its then three operating mines in Elliot Lake as a result of market conditions. These two mines closed in August 1990. These mine closures had significant impacts. The principal mining operations of Rio Algom at that time were still in Elliot Lake and had been the very foundation of the company for about 40 years. The business impact on the Corporation was regarded as possibly severe. The resultant layoff of over 1,500 long-term, highly qualified, skilled and well-paid employees, a devastating blow to the affected employees and their families, would have a significant financial impact on the municipal economy, particularly as this announcement was seen as the first step in the early closure of all four operating mines in the region. At that time there was little precedence for such a high profile mine closure program and consequently the many unknowns relating to the mine decommissioning process, legislative requirements and society's expectations resulted in a perception of a significant yet ill-defined liability. In this atmosphere of understandable company, stakeholder and public concern, Rio Algom Limited embarked on what has turned out to be a long, rigorous, challenging yet ultimately reasonable and rewarding process of progressive reclamation of all its Elliot Lake mines, some ten in total (nine uranium, one copper). Over the past ten years, reclamation of all ten mines has been successfully completed, some $70 m plus has been expended in direct site reclamation works and the workforce has been reduced from over 2,500 to just 4. After ten years, the focus of attention is now on the long-term care, maintenance, monitoring and reporting required for the decommissioned mine sites, and the accomplishment of this in the best interests of all the stakeholders. (author)

  10. 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.

  11. Kaluza-Klein supergravity in ten dimensions

    International Nuclear Information System (INIS)

    Huq, M.; Namazie, M.A.

    1983-11-01

    We construct a massive version of N=2 supergravity in ten dimensions by compactification of the eleven dimensional, N=1 theory. This theory describes the usual N=2 massless super-multiplet, in addition to which there is an infinite tower of massive, charged N=2 supermultiplets. (author)

  12. 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…

  13. Ten years after the Jali Commission

    African Journals Online (AJOL)

    Ten years have lapsed since the Jali Commission's final report became publicly available, and it is therefore an .... as the 'core business' of the department. This was seen as .... the 2009/10–2013/14 DCS Strategic Plan did the department ...

  14. Czech, Slovak science ten years after split

    CERN Multimedia

    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).

  15. 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...

  16. Top Ten Concerns for Trustees in 1988.

    Science.gov (United States)

    Meyerson, Joel W.

    1988-01-01

    Ten issues most likely to influence institutions this year include tuition policy and financing, capital renewal and replacement, charitable giving, scientific equipment and laboratories, endowment management and spending policy, research funding, corporate contributions, minority enrollment and hiring, debt financing and debt capacity, and cost…

  17. Giant multipole resonances: perspectives after ten years

    International Nuclear Information System (INIS)

    Bertrand, F.E.

    1980-01-01

    Nearly ten years ago evidence was published for the first of the so-called giant multipole resonances, the giant quadrupole resonance. During the ensuing years research in this field has spread to many nuclear physics laboratories throughout the world. The present status of electric giant multipole resonances is reviewed. 24 figures, 1 table

  18. VINKA, ten years on. Main scientific results

    International Nuclear Information System (INIS)

    1979-01-01

    The VINKA facility in the TRITON swimming-pool reactor at Fontenay-aux-Roses allows the irradiation of solids at low temperatures in order to study crystalline defects. After ten years of operation the main scientific results obtained in the fields of creep and growth (chapter I), point defects (chapter II), amorphisation (chapter III) and dechanneling of particles (chapter IV) are summarised [fr

  19. Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults.

    Science.gov (United States)

    Hurlow, Adam; Bennett, Michael I; Robb, Karen A; Johnson, Mark I; Simpson, Karen H; Oxberry, Stephen G

    2012-03-14

    cancer population. The initial review identified two RCTs (64 participants) therefore this review now includes a total of three RCTs (88 participants). These studies were heterogenous with respect to study population, sample size, study design, methodological quality, mode of TENS, treatment duration, method of administration and outcome measures used. In one RCT, there were no significant differences between TENS and placebo in women with chronic pain secondary to breast cancer treatment. In the other RCT, there were no significant differences between acupuncture-type TENS and sham in palliative care patients; this study was underpowered. Despite the one additional RCT, the results of this updated systematic review remain inconclusive due to a lack of suitable RCTs. Large multi-centre RCTs are required to assess the value of TENS in the management of cancer-related pain in adults.

  20. 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…

  1. Ten years of industrial and municipal membrane bioreactor (MBR) systems - lessons from the field.

    Science.gov (United States)

    Larrea, Asun; Rambor, Andre; Fabiyi, Malcolm

    2014-01-01

    The use of membrane bioreactors (MBRs) in activated sludge wastewater treatment has grown significantly in the last decade. While there is growing awareness and knowledge about the application of MBR technology in municipal wastewater treatment, not much information is available on the application of MBRs in industrial wastewater treatment. A comparative study of design data, operating conditions and the major challenges associated with MBR operations in 24 MBR plants treating both municipal and industrial wastewater, built by and/or operated by Praxair, Inc., is presented. Of the 24 MBR systems described, 12 of the plants used high purity oxygen (HPO). By enabling a wide range of food/microorganism ratios and loading conditions in the same system, HPO MBR systems can extend the options available to industrial plant operators to meet the challenges of wide fluctuations in organic loading and footprint limitations. While fouling in industrial MBR systems can be an issue, adequate flux and permeability values can be reliably maintained by the use of good maintenance strategies and effective process controls (pretreatment, cleaning and membrane autopsies).

  2. Consulting the oracle: ten lessons from using the Delphi technique in nursing research.

    Science.gov (United States)

    Keeney, Sinead; Hasson, Felicity; McKenna, Hugh

    2006-01-01

    The aim of this paper was to provide insight into the Delphi technique by outlining our personal experiences during its use over a 10-year period in a variety of applications. As a means of achieving consensus on an issue, the Delphi research method has become widely used in healthcare research generally and nursing research in particular. The literature on this technique is expanding, mainly addressing what it is and how it should be used. However, there is still much confusion and uncertainty surrounding it, particularly about issues such as modifications, consensus, anonymity, definition of experts, how 'experts' are selected and how non-respondents are pursued. This issues that arise when planning and carrying out a Delphi study include the definition of consensus; the issue of anonymity vs. quasi-anonymity for participants; how to estimate the time needed to collect the data, analyse each 'round', feed back results to participants, and gain their responses to this feedback; how to define and select the 'experts' who will be asked to participate; how to enhance response rates; and how many 'rounds' to conduct. Many challenges and questions are raised when using the Delphi technique, but there is no doubt that it is an important method for achieving consensus on issues where none previously existed. Researchers need to adapt the method to suit their particular study.

  3. 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

  4. 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.

    Science.gov (United States)

    Orobaton, Nosakhare; Abegunde, Dele; Shoretire, Kamil; Abdulazeez, Jumare; Fapohunda, Bolaji; Lamiri, Goli; Maishanu, Abubakar; Ganiyu, Akeem; Ndifon, Eric; Gwamzhi, Ringpon; Osborne-Smith, Matthew

    2015-01-01

    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 antenatal care, and

  5. Creating a winning team: lessons from football.

    Science.gov (United States)

    Simons, Sherri Lee

    2005-01-01

    There are tasks best done on an individual basis when caring for a neonate, but the ultimate outcome for infants and their families results from a team effort. Incorporating ten strategies drawn from football can help the NICU manager create and foster effective teamwork.

  6. 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…

  7. Phagocytosis: history's lessons.

    Science.gov (United States)

    Garg, Manish; Chandawarkar, Rajiv Y

    2013-01-01

    The assimilation of lessons from the past is an essential component of education for scientists of tomorrow. These lessons are not easy to find. History books on science are few and usually highly dramatized and biographies of scientists tend to exaggerate the pomp of scientific discovery. Both underplay the hard and laborious work that is integral to any scientific pursuit. Here we illustrate one such example. A century ago, the Nobel Prize in Medicine was awarded to two scientists: Ilya Metchnikoff, a Russian zoologist, for the discovery ofphagocytosis-a cell-mediated ingestion ofmicrobes; and Paul Ehrlich, a distinguished physician-scientist, for discovering a highly antigen-specific serum-derived antibody-based immune defense. These two diametrically opposing views of the host-pathogen interaction set the stage for a strife that led to seminal advancements in immunology. Mirrored in this journey are important lessons for scientists today--ubiquitously as applicable to modern scientific life as they were a century ago. This commentaryhighlights these lessons--a fitting centenary to a well-deserved recognition.

  8. Recycling Lesson Plan

    Science.gov (United States)

    Okaz, Abeer Ali

    2013-01-01

    This lesson plan designed for grade 2 students has the goal of teaching students about the environmental practice of recycling. Children will learn language words related to recycling such as: "we can recycle"/"we can't recycle" and how to avoid littering with such words as: "recycle paper" and/or "don't throw…

  9. Smart Consumer Lesson Plans.

    Science.gov (United States)

    New Jersey Consortium for Consumer Education, Newark.

    Lesson plans are provided for use with different populations of pre-K through senior high school students in four different areas of consumer education. Eight units in advertising are included: A First Look at Ads (pre-K-Grade 3), Don't Judge a Book by Its Cover (Grades 1-3), Fatal Distraction (Junior High), Package Labeling (Junior High), Product…

  10. Data processing potential ten years from now

    International Nuclear Information System (INIS)

    Zajde, C.

    1982-01-01

    What today is still experimental will tomorrow be routine. Use of emission tomography, automatic determination of regions of interest, generalisation of Fourrier phase and amplitude analysis, parametric images these will become routine medical protocols. The next ten years will see a saturation in the field of research and a stabilisation in system development. Equipment renewal will be seen from the same angle as in the automotive industry - more for reasons of wear and tear than for reasons of technical advancement

  11. School Psychologists' Job Satisfaction: Ten Years Later

    OpenAIRE

    Worrell, Travis G.

    2004-01-01

    School Psychologistsâ Job Satisfaction: Ten Years Later (ABSTRACT) This study was designed to replicate nationwide surveys completed in 1982 and 1992. The purpose was to examine and describe the levels of job satisfaction and the relationship between the variables in a national sample of school psychologists belonging to the National Association of School Psychologists (NASP). The sample for this study consisted of respondents who reported being full-time school practitioners. ...

  12. Simplification of the helical TEN2 laser

    Science.gov (United States)

    Krahn, K.-H.

    1980-04-01

    The observation that the helical TEN2 laser can effectively be simplified by giving up the use of decoupling elements as well as by abolishing the segmentation of the electrode structure is examined. Although, as a consequence of this simplification, the operating pressure range was slightly decreased, the output power could be improved by roughly 30%, a result which is attributed to the new electrode geometry exhibiting lower inductance and lower damping losses.

  13. Modification of the 'ten-day rule'

    International Nuclear Information System (INIS)

    Klempfner, G.

    1985-01-01

    In a 1964 decision the National Health and Medical Research Council recommended that radiological examinations of the lower abdomen and pelvis of women of childbearing age should be confined to the 10-day interval following the onset of menstruation. Recent evidence suggests that the first four weeks from the first day of the last menstrual period is not a critically radiosensitive period and consequently strict adherence to the ten-day rule is no longer indicated

  14. Antimicrobial activity of Verbascum macrurum Ten. (Scrophulariaceae).

    Science.gov (United States)

    Guarino, C

    2002-01-01

    The Author presents the results regarding the antibacterial action of extracts of Verbascum macrurum Ten.. The leaves of this species, gathered on the slopes of Mt. Matese, were ground and four extracts were made as follows: with dicholoromethane, ethonol and water (70:30 v/v), water and methanol. The antibacterial activity of each of the samples was tested and it is demonstrated that the extract with the ethanol/water was the most activity one.

  15. 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.

  16. Lessons learnt from the introduction of the contraceptive implant in ...

    African Journals Online (AJOL)

    This article explores the complexities of introducing new contra ... framework[1,2] and other emerging literature, lessons are identified and key .... events and negative user experiences related to inadequate quality of care, which even if ..... completion; CM, JS, NLD: reviewed and assisted with the development of the initial ...

  17. Lecciones de Quechua. Primer Nivel, Segundo Nivel (Quechua Lessons. First Level, Second Level).

    Science.gov (United States)

    Herrero, Joaquin; And Others

    The two volumes comprising this text represent the beginning and intermediate levels of a course in the Quechua language for speakers of Spanish. Based on the "Audio Lingual Materials" format, the ten lessons in the the first volume generally contain: (1) a short dialog and a supplementary vocabulary section or adapted dialog which…

  18. 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.

  19. 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

  20. Novitäten im Breslauer Stadttheater

    OpenAIRE

    Zduniak, Maria

    2017-01-01

    Am Anfang des 20. Jahrhunderts zählte das Breslauer Stadttheater, obwohl mit nur einer kleinen Orchester-Besetzung ausgestattet, zu den bemerkenswerten europäischen Opernbühnen. Es war aufgeschlossen für musikalische Novitäten. Als Beweis dafür sind u.a. die Breslauer Premieren Salome (1906) von Richard Strauss, L\\'Orfeo (1913) von Claudio Monteverdi und die Uraufführung der Oper Eros und Psyche (1917) von Ludomir Różycki zu nennen.

  1. Ten financial management principles for survival.

    Science.gov (United States)

    Cleverley, W O

    1988-03-01

    Financial insolvency is the primary cause of hospital failure. Managers may analyze a hospital's financial statements to anticipate and prevent fiscal problems. Ten measures of fiscal status may be used to evaluate the following: operating profitability nonoperating income equity growth liquidity debt capacity age of facilities revenue generation replacement funds receivables survivability Based on data from the Financial Analysis Service, Catholic hospitals are doing better than other U.S. hospitals in some areas of financial preparedness. In most areas, however, all hospitals suffer by comparison with manufacturers. The 10 principles of solvent and successful operations can help hospitals improve financial resiliency.

  2. 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

  3. Optical spectroscopy of ten extragalactic radiosources

    International Nuclear Information System (INIS)

    Rawlings, S.; Riley, J.M.; Saunders, R.

    1989-01-01

    We present optical spectroscopy of ten objects associated with extra-galactic radiosources, using the University of Hawaii 2.2-m telescope. Redshifts are measured for four radiogalaxies (B20217 + 36A + B, 3C73, 0648 + 19A, 0648 + 19B) and for a galaxy which is probably associated with a double radio-source with highly unusual properties (0951 + 37); existing redshifts are confirmed for two radiogalaxies (4C39.04, 4C40.08); and a tentative redshift of z=2.87 measured for the quasar 3C82. (author)

  4. Audits reveal ten common environmental problems

    International Nuclear Information System (INIS)

    Buys, M.W.

    1992-01-01

    The old saying that open-quotes an ounce of prevention is worth a pound of cureclose quotes rings particularly true in environmental matters in the 1990s. Environmental problems can potentially lead to expensive fines, costly cleanups, negative public relations, and even criminal sanctions against members of the corporation. A recurring pattern of problems has been noted during the performance of environmental disposition, acquisition, and compliance assessments of many different operators in most of the producing states. The ten most common problems found in oilfield audits are discussed here in an effort to enhance the awareness of operators

  5. 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. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. 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

  7. Lessons from Goiania

    International Nuclear Information System (INIS)

    Nazari Alves, R.

    2000-01-01

    The lessons learned from the radiological accident of Goiania in 1987 derived from the observations from the Regulatory Agency which was in charge of the decontamination tasks may be consolidated into four classes: Preventive Actions, characterised as those that aim to minimise the probability of occurrence of a radiological accident; Minimisation of time between the moment of the accident occurrence and the beginning of intervention, in case a radiological accident does occur, despite all preventive measures; Intervention, which is correlated to the type of installation, its geographical location, the social classes involved and their contamination vectors; and Follow up, for which well established rules to allow continuing monitoring of the victims and rebuilding of homes are necessary. The greatest lesson of all was the need for integration of the professionals involved, from all organizations. (author)

  8. Breastfeeding Practices and Barriers to Implementing the Ten Steps to Successful Breastfeeding in Mississippi Hospitals.

    Science.gov (United States)

    Alakaam, Amir; Lemacks, Jennifer; Yadrick, Kathleen; Connell, Carol; Choi, Hwanseok Winston; Newman, Ray G

    2018-05-01

    Mississippi has the lowest rates of breastfeeding in the United States at 6 and 12 months. There is growing evidence that the rates and duration of infant breastfeeding improve after hospitals implement the Ten Steps to Successful Breastfeeding; moreover, the Ten Steps approach is considered the standard model for evaluation of breastfeeding practices in birthplaces. Research aim: This study aimed to examine the implementation level of the Ten Steps and identify barriers to implementing the Ten Steps in Mississippi hospitals. A cross-sectional self-report survey was used to answer the research aim. Nurse managers of the birthing and maternity units of all 43 Mississippi hospitals that provided birthing and maternity care were recruited. A response rate of 72% ( N = 31) was obtained. Implementation of the Ten Steps in these hospitals was categorized as low, partial, moderate, or high. The researcher classified implementation in 29% of hospitals as moderate and in 71% as partial. The hospital level of implementation was significantly positively associated with the hospital delivery rate along with the hospital cesarean section rate per year. The main barriers for the implementation process of the Ten Steps reported were resistance to new policies, limited financial and human resources, and lack of support from national and state governments. Breastfeeding practices in Mississippi hospitals need to be improved. New policies need to be established in Mississippi to encourage hospitals to adopt the Ten Steps policies and practice in the maternity and birthing units.

  9. Lessons Learned from ISS Cooperation

    Science.gov (United States)

    Jolly, C.

    2002-01-01

    Forty years of human spaceflight activities are now culminating in the International Space Station program (ISS). The ISS involves fifteen nations, working together to create a permanently occupied orbital facility that will support scientific and potentially, commercial endeavours. The assembly of the ISS is scheduled to be completed later in this decade, after which it will be operated for at least ten years. At the strategic level, such a complex international project is highly dependent on the fifteen Partners' respective internal politics and foreign policies. On the operational level, Partners still have certain difficulties in issuing and agreeing to common technical procedures. As with almost all aspects of International Space Station cooperation, the Partners are going through a constant learning process, where they have to deal with complex political, legal and operational differences. Intergovernmental Agreement and the Memoranda of Understanding, the instruments forming the legal backbone of the International Space Station cooperation, are still lacking a fair number of arrangements that need to be created for completing and operating the Station. The whole endeavour is also a constant learning process at the operational level, as astronauts, cosmonauts, engineers and technicians on the ground with different cultural and educational backgrounds, learn to work together. One recent Space Shuttle mission to the Station showed the importance of standardising even trivial system components such as packaging labels, as it took the astronauts half a day more than planned to correctly unpack the equipment. This paper will provide a synthesis of some of the main lessons learned during the first few years of International Space Station's lifetime. Important political, legal and operational issues will be addressed and combined. This analysis will provide some guidelines and recommendations for future international space projects, such as an international human

  10. 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.

  11. Module Ten: Transformers; Basic Electricity and Electronics Individualized Learning System.

    Science.gov (United States)

    Bureau of Naval Personnel, Washington, DC.

    The module introduces a very important electrical device, the transformer. The module is divided into six lessons: transformer construction, transformer theory and operation, turns and voltage ratios, power and current, transformer efficiency, and semiconductor rectifiers. Each lesson consists of an overview, a list of study resources, lesson…

  12. What lessons can history teach us about the Charcot foot?

    Science.gov (United States)

    Sanders, Lee J

    2008-01-01

    Regrettably, physicians today receive very little instruction in the history of medicine. Most health care providers have a very limited, contemporary knowledge of the condition that we know of as the Charcot foot. Yet, historical concepts of the pathogenesis and natural history of this condition provide us with important lessons that enhance our understanding, recognition, and management of this rare but debilitating neurogenic arthropathy. It is my belief that knowledge of the history of medicine provides us with a better understanding of present-day issues and clearer vision as we look to the future. This article describes some of the important lessons learned from the history of the Charcot foot.

  13. Flying Lessons for Clinicians: Developing System 2 Practice.

    Science.gov (United States)

    Gregoire, Jerome N; Alfes, Celeste M; Reimer, Andrew P; Terhaar, Mary F

    There is a long history of adopting lessons learned from aviation to improve health care practice. Two of the major practices that have successfully transferred include using a checklist and simulation. Training and simulation technology is currently underdeveloped for nurses and health care providers entering critical care transport. This article describes a pedagogical approach adopted from aviation to develop a new simulation platform and program of research to develop the science of critical care transport nursing education. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  14. Feasibility study of Transcutaneous Electrical Nerve Stimulation (TENS) for cancer bone pain.

    Science.gov (United States)

    Bennett, Michael I; Johnson, Mark I; Brown, Sarah R; Radford, Helen; Brown, Julia M; Searle, Robert D

    2010-04-01

    This multicenter study assessed the feasibility of conducting a phase III trial of transcutaneous electrical nerve stimulation (TENS) in patients with cancer bone pain recruited from palliative care services. Eligible patients received active and placebo TENS for 1 hour at site of pain in a randomized crossover design; median interval between applications 3 days. Responses assessed at 30 and 60 minutes included numerical and verbal ratings of pain at rest and on movement, and pain relief. Recruitment, tolerability, adverse events, and effectiveness of blinding were also evaluated. Twenty-four patients were randomised and 19 completed both applications. The intervention was well tolerated. Five patients withdrew: 3 due to deteriorating performance status, and 2 due to increased pain (1 each following active and placebo TENS). Confidence interval estimation around the differences in outcomes between active and placebo TENS suggests that TENS has the potential to decrease pain on movement more than pain on rest. Nine patients did not consider that a placebo was used; the remaining 10 correctly identified placebo TENS. Feasibility studies are important in palliative care prior to undertaking clinical trials. Our findings suggest that further work is required on recruitment strategies and refining the control arm before evaluating TENS in cancer bone pain. Cancer bone pain is common and severe, and partly mediated by hyperexcitability. Animal studies suggest that Transcutaneous Electrical Nerve Stimulation can reduce hyperalgesia. This study examined the feasibility of evaluating TENS in patients with cancer bone pain in order to optimize methods before a phase III trial. Copyright 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.

  15. Primary health care lessons from the Northeast of Brazil: the Agentes de Saúde Program Lecciones del Nordeste de Brasil sobre la atención primaria de salud: el Programa de Agentes de Salud

    Directory of Open Access Journals (Sweden)

    Ennio Cufino Svitone

    2000-05-01

    Full Text Available Market-led economic reforms are usually viewed as being in conflict with government-stimulated socioeconomic development for disadvantaged groups. Nevertheless, Ceará, a poor state in the Northeast of Brazil, has since 1987 pursued both of those strategies simultaneously. One part of that approach has been a program of nurse-directed auxiliary health workers serving about 5 million people--almost all the persons outside the capital city and half of those in the capital. The system requires that the auxiliaries, called agentes de saúde, live in the local communities that they serve. The health agents visit each home once a month to carry out a small number of priority health activities. While health agent positions are in high demand, the minimum-wage salary that the agents receive makes up only a small portion of the state budget. A key aspect of the system is timely and comprehensive information, which is based on agent visits and is managed by trained nurses. Since the health agents system was launched, there has been a rapid decline in infant mortality, a rapid rise in immunization, identification of bottlenecks limiting the utilization of other medical resources, and timely interventions in times of crisis. The health agents system has combined administrative decentralization with financial centralization during a period of electoral democratization. The system has strengthened Ceará's commitment to primary care even as market-oriented changes have reduced the overall role of government. The Ceará program is being copied throughout the Northeast and other regions of Brazil. The key role that nurses play in the Ceará program in organizing and leading a system of basic primary care in poor neighborhoods and rural areas may provide useful lessons for other countries. In addition, Ceará does not have many of the favorable characteristics of other countries that have successfully invested in primary health care. Ceará thus represents a

  16. Do Lessons in Nature Boost Subsequent Classroom Engagement? Refueling Students in Flight

    Directory of Open Access Journals (Sweden)

    Ming Kuo

    2018-01-01

    Full Text Available Teachers wishing to offer lessons in nature may hold back for fear of leaving students keyed up and unable to concentrate in subsequent, indoor lessons. This study tested the hypothesis that lessons in nature have positive—not negative—aftereffects on subsequent classroom engagement. Using carefully matched pairs of lessons (one in a relatively natural outdoor setting and one indoors, we observed subsequent classroom engagement during an indoor instructional period, replicating these comparisons over 10 different topics and weeks in the school year, in each of two third grade classrooms. Pairs were roughly balanced in how often the outdoor lesson preceded or followed the classroom lesson. Classroom engagement was significantly better after lessons in nature than after their matched counterparts for four of the five measures developed for this study: teacher ratings; third-party tallies of “redirects” (the number of times the teacher stopped instruction to direct student attention back onto the task at hand; independent, photo-based ratings made blind to condition; and a composite index each showed a nature advantage; student ratings did not. This nature advantage held across different teachers and held equally over the initial and final 5 weeks of lessons. And the magnitude of the advantage was large. In 48 out of 100 paired comparisons, the nature lesson was a full standard deviation better than its classroom counterpart; in 20 of the 48, the nature lesson was over two standard deviations better. The rate of “redirects” was cut almost in half after a lesson in nature, allowing teachers to teach for longer periods uninterrupted. Because the pairs of lessons were matched on teacher, class (students and classroom, topic, teaching style, week of the semester, and time of day, the advantage of the nature-based lessons could not be attributed to any of these factors. It appears that, far from leaving students too keyed up to concentrate

  17. Lessons from Fukushima: New Concerns for the Future

    International Nuclear Information System (INIS)

    Matsumura, Akio; Girard, Odile

    2016-01-01

    In this article, the author, former Japanese diplomat, expresses lessons he learned from the catastrophe. He outlines that several aspects of this crisis keep on affecting population's health and environmental safety. He outlines several aspects: experts as well as the public have been looking for technical solutions during the first two weeks, experts knew from the beginning that the crisis was largely beyond the current technical capacities. He states that, without the intervention of experts from different fields, important information would have remained in the government's and public operator's hands rather than been communicated to the public. According to him, the main lesson is that we are now living surrounded by new threats which have been actually present for ten years, and that Fukushima is a matter of new concerns about nuclear plants

  18. Ten years of the Spanish Virtual Observatory

    Science.gov (United States)

    Solano, E.

    2015-05-01

    The main objective of the Virtual Observatory (VO) is to guarantee an easy and efficient access and analysis of the information hosted in astronomical archives. The Spanish Virtual Observatory (SVO) is a project that was born in 2004 with the goal of promoting and coordinating the VO-related activities at national level. SVO is also the national contact point for the international VO initiatives, in particular the International Virtual Observatory Alliance (IVOA) and the Euro-VO project. The project, led by Centro de Astrobiología (INTA-CSIC), is structured around four major topics: a) VO compliance of astronomical archives, b) VO-science, c) VO- and data mining-tools, and d) Education and outreach. In this paper I will describe the most important results obtained by the Spanish Virtual Observatory in its first ten years of life as well as the future lines of work.

  19. Women in Astronomy II: Ten Years After

    Science.gov (United States)

    Sargent, Wallace

    2004-01-01

    The meeting "Women in Astronomy II: Ten Years After" took place at the California Institute of Technology in Pasadena, CA June 27-28, 2003. The meeting was sponsored by the Committee on the Status of Women of the American Astronomical Society and was attended by about 155 participants. The purpose of the meeting was: "To review the current status of women in astronomy, understand their work environment, assess development since the 1992 Baltimore conference, and recommend future actions that will improve the environment for all astronomers." A description of the meeting and its background can be found at http://www.aas.org/%7Ecswa/WIA2003.html. The proceedings are being edited by Profs. Meg Urry (Yale University) and Ran Bagenal (University of Colorado). The principal outcome of WIAII was a series of recommendations, "The Pasadena Recommendations", which have been approved by the AAS Council and which can be found at http://www.aas.org/%7Ecswa/.

  20. Spacelab - Ten years of international cooperation

    Science.gov (United States)

    Bignier, M.; Harrington, J. C.; Sander, M. J.

    1983-01-01

    The history, current status, and future plans of the Spacelab program are reviewed, with a focus on the cooperative relationship between ESA and NASA. The initial decision to undertake the program and the three agreements signed to begin its implementation are examined, and the division of responsibilities and financial contributions is discussed insofar as it affected the management structure. Consideration is given to the major facilities, the 50-mission operational cycle, communications, the currently scheduled activities (through 1985), the prospective later uses, and the ten dedicated discipline laboratories. The importance of continuous mutual support during the planning and development phases is stressed. The program so far is considered a success, in terms of the goals set by the participants and in terms of the resolution of the problems inherent in international technological endeavors.

  1. Ten years of x-ray holography

    International Nuclear Information System (INIS)

    Faigel, G.; Bortel, G.; Tegze, M.; Fadley, C.S.; Simionovici, A.S.

    2007-01-01

    With the appearance of nano-science the role of local methods has become more and more important. Hard x-ray holography based on the inside reference point concept is a local probe of the atomic order in solids. It gives the 3D real space image of atoms without the phase ambiguity inherent to diffraction methods. In this paper a brief description of the basics of hard x-ray holography is given. The last ten years' experimental and evaluation-related developments are reviewed. We also introduce different variants of the method, such as Bremsstrahlung and gamma ray holography (GRH). The power of the method is illustrated by examples. We outline new directions and future possibilities. (authors)

  2. in primary care

    African Journals Online (AJOL)

    Claire van Deventer

    Keywords: child HIV, doctor involvement, primary health care, quality improvement ... expertise increased, PHC facilities are now expected to be able to .... organised patient documentation were revisited. .... Review: what can we learn from quality ... South Pacific: Review of evidence and lessons from an innovative.

  3. The Fernald Closure Project: Lessons Learned

    International Nuclear Information System (INIS)

    Murphy, Cornelius M.; Carr, Dennis

    2008-01-01

    For nearly 37 years, the U.S. Department of Energy site at Fernald - near Cincinnati, Ohio - produced 230,000 metric tons (250,000 short tons) of high-purity, low-enriched uranium for the U.S. Defense Program, generating more than 5.4 million metric tons (6 million short tons) of liquid and solid waste as it carried out its Cold War mission. The facility was shut down in 1989 and clean up began in 1992, when Fluor won the contract to clean up the site. Cleaning up Fernald and returning it to the people of Ohio was a $4.4 billion mega environmental-remediation project that was completed in October 2006. Project evolved through four phases: - Conducting remedial-investigation studies to determine the extent of damage to the environment and groundwater at, and adjacent to, the production facilities; - Selecting cleanup criteria - final end states that had to be met that protect human health and the environment; - Selecting and implementing the remedial actions to meet the cleanup goals; - Executing the work in a safe, compliant and cost-effective manner. In the early stages of the project, there were strained relationships - in fact total distrust - between the local community and the DOE as a result of aquifer contamination and potential health effects to the workers and local residents. To engage citizens and interested stakeholders groups in the decision-making process, the DOE and Fluor developed a public-participation strategy to open the channels of communication with the various parties: site leadership, technical staff and regulators. This approach proved invaluable to the success of the project, which has become a model for future environmental remediation projects. This paper will summarize the history and shares lessons learned: the completion of the uranium-production mission to the implementation of the Records of Decision defining the cleanup standards and the remedies achieved. Lessons learned fall into ten categories: - Regulatory approach with end

  4. Successful replantation in ten-digit amputation.

    Science.gov (United States)

    Kantarci, Umit; Cepel, Selim; Buldu, Halil

    2010-01-01

    Amputations involving ten digits are very rare because of different lengths of the digits. A 34-year-old man working in a printing house presented one hour after guillotine amputation involving all ten digits. Surgery was initiated 80 minutes after admission and took seven hours. Under axillary anesthesia, the operation was performed by two teams each consisting of two microsurgeons and two assistants. Replantation was completed without the use of any skin graft or flap. Fingertip examination showed poor arterial circulation in the second, third, and fourth digits of the left hand after 24 hours of replantation and surgical exploration was performed, during which anastomosis of the ulnar digital artery of the second digit was re-established and a Y-shaped vein graft was placed at the level of the third web to restore revascularization of the third and fourth digits. However, these interventions did not prevent the development of necrosis in the distal segment of the fourth digit which resulted in dry gangrene that required amputation. After 38 months of replantation, radiographic examination showed complete union in all fingers without malunion or damage to the joint surface and about 8 degrees of medial angulation in the proximal phalanx of the fourth digit of the right hand. The patient did not have difficulty in performing daily activities and had a considerably good pinching. Losses of active range of motion of the metacarpophalangeal and interphalangeal joints were within the rage of 10 to 30 degrees in both hands. In the assessment of sensation, static and dynamic two-point discrimination test results were 6.1 mm and 4.0 mm, respectively.

  5. 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)

  6. Bead Game Simulation. Lesson Plan.

    Science.gov (United States)

    Ripp, Ken

    This lesson plan offers students the opportunity to participate in the three basic economic systems (market, command, and tradition). By working in each of the systems, students will internalize the fundamental values present in each system and will gain insights into the basic advantages and disadvantages of each system. The lesson plan provides…

  7. Simple and Practical Efficiency Lessons

    Science.gov (United States)

    Kolpin, Van

    2018-01-01

    The derivation of conditions necessary for Pareto efficient production and exchange is a lesson frequently showcased in microeconomic theory textbooks. Traditional delivery of this lesson is, however, limited in its scope of application and can be unnecessarily convoluted. The author shows that the universe of application is greatly expanded and a…

  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. Lesson Study and History Education

    Science.gov (United States)

    Halvorsen, Anne-Lise; Kesler Lund, Alisa

    2013-01-01

    This article examines the experiences of a group of fifth-grade teachers who used lesson study, a teacher-driven form of professional development, to teach history in a project supported by a Teaching American History Grant. The project addressed the following questions: What does a lesson study cycle for history education look like? What…

  10. 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...

  11. 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.

  12. 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.

  13. 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.

  14. The lessons of SARS in Hong Kong.

    Science.gov (United States)

    Lai, Thomas Sik To; Yu, Wai Cho

    2010-02-01

    Severe acute respiratory syndrome (SARS) is a novel coronavirus infection which broke out in Hong Kong in March 2003. Princess Margaret Hospital was designated to manage this new, mysterious and serious disease. Healthcare workers had to work under extremely stressful and often risky conditions to care for patients. Despite manpower and equipment reinforcements, staff infection occurred as a result of bodily exhaustion, working in an unfamiliar environment and lapses in infection control. Patients suffered even more, not only due to physical discomfort, but also because of the fear of isolation and death away from family and friends. Health authorities learnt their lessons in the outbreak and formulated emergency plans for future infectious disease epidemics. The healthcare infrastructure has been examined and upgraded with regard to intensive care capacity, infection control measures, professional training, manpower deployment, staff facilities, and stockpiling of drugs and personal protective equipment.

  15. 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

  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......The ``old stage'' of The Royal Theatre in Copenhagen-a classical horseshoe theatre with an almost flat audience floor and four balcony levels—is the primary opera and ballet theatre in Denmark. In the early 1980s the orchestra pit was enlarged and its size made flexible. However, in the following...... years this new flexibility caused a formal battle between the orchestra, the singers, and management, because each group had different interests as to how the pit should be configured for each new production. In the 1990s, increased concern about the musicians' hearing and the increase in the popularity...

  17. 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.

  18. 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 ...

  19. 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.

  20. Ten steps to a cooler planet

    International Nuclear Information System (INIS)

    2001-01-01

    The overwhelming scientific consensus is that human activities, especially activities that produce greenhouse gases are accumulating in the atmosphere and are changing the intricate balance that has sustained life on earth for millions of years. The estimate is that in Canada about 35 per cent of the greenhouse gases released to the atmosphere come from personal sources. This booklet provides brief account of the ways that individuals contribute to green house gas emissions and provides some helpful hints on how to reduce this personal contribution to the climate change problem. The ten ways suggested are: (1) use public transport as much as possible, (2) buy smaller cars , (3) use the train instead of flying, make fewer long distance trips by combining business and vacation travel, (4) set the thermostat one degree lower and save 525 kg of carbon dioxide per year, (5) avoid overhousing by choosing a smaller house and by making every square foot count, (6) buy energy efficient appliances, (7) reduce water heater's energy consumption by insulating it, (8) reduce meat intake and buy locally produced food in season, (9) minimize garbage production by reusing and recycling, (10) use green power wherever available and contribute to the development of renewable energy sources

  1. 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.

  2. 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.

  3. Experience and lessons learned in the assessment of safety justifications for experiments mounted in research reactors

    International Nuclear Information System (INIS)

    Cox, R.F.

    1990-01-01

    Some experiments in research reactors are arguably a risky undertaking due to their uncertain outcome. The justifications for such experiments require careful assessment to validate their undertaking. The public, the operators and the installation itself must be safeguarded. Assessment of the potential risk is an acquired skill but in doing so the route can be eased by learning from the lessons experience can teach. This paper, essentially for the usage of safety managers, sets out some of the issues relating to the assessment process gained from our experience over a few tens of years in the assessment of experiments. Many of the conclusions reached may appear all too obvious viewed in retrospect, but they were not necessarily clear at the time. Those organizations setting up assessment teams may find some of the conclusions of value such that their proposed management system can embrace methodologies for assessment that can avoid or lessen the impact of some of the pitfalls we have tried to identify. Failure to recognise some of these points may run the risk of delayed clearances, dilated timescales and cost overruns. It is in the hope of reducing all these penalties that we offer our experiences

  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. "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.

  6. St. Louis FUSRAP Lessons Learned

    International Nuclear Information System (INIS)

    Eberlin, J.; Williams, D.; Mueller, D.

    2003-01-01

    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

  7. The five times ten things everyone should have had in their hands before they are ten and two years old.

    Science.gov (United States)

    Hut, R.; Poot, A.

    2017-12-01

    To train the young ones to become people that make stuff, I present the five times ten things we use a lot that everyone should have used before they are ten and two years old. I will bring at least two times ten of these things and show them live to you! And: I will bring a large paper for you to bring home with those five times ten things on it to put in the hands of your kids!

  8. Transformation of an academic medical center: lessons learned from restructuring and downsizing.

    Science.gov (United States)

    Woodard, B; Fottler, M D; Kilpatrick, A O

    1999-01-01

    This article reviews management literature on health care transformation and describes the processes, including restructuring, job redesign, and downsizing, involved in one academic medical center's experience. The article concludes with lessons learned at each of the stages of the transformation process: planning, implementation, and process continuation. Managerial implications for similar transformation efforts in other health care organizations are suggested.

  9. 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...

  10. Ten years of energy policy in Catalonia

    International Nuclear Information System (INIS)

    Masalles Roman, I.; Marin Sanchez, J.M.; Gurgui Ferrer, A.; Figuerola Perez, E.

    1992-01-01

    Catalonia is located in the north-east corner of Spain, on the Mediterranean coast and bordering with France in the north. It is one of the most industrialized and developed regions of Spain, with a per capita income of 10879 ECU per year (1989), 21.9% higher than the Spanish average. It contributes to 20.3% of the Spanish GDP. Primary energy consumption was 16.5 M toe in 1989, covered by the following sources: 3.5% coal, 51.8% oil, 9.4% natural gas, 3.6% hydro, 30.8% nuclear, 0.1% electrical import/export balance and 0.8% waste residuals. Oil dependence is distorted by the existence of a major petrochemical industry that uses more than 2.6 Mtoe of oil derivatives for non-energy purposes. Final energy demand in 1989 was 8.8 Mtoe, 40.9% for industry, 36.9% for transportation and 22.3% for the domestic and services sector. In the 60's, Catalonia's socio-economic development was accompanied by a spectacular increase in the demand for primary energy: from slightly above 2.5 million toe in 1960 to 5.6 Mtoe ten years later. If this decade can be characterized by a steady increase in the total value of consumption, the 70's also constitute years of major changes in the field of energy on an international scale (the oil crisis) and in politics in the Spanish State. 6 refs., 3 figs., 6 tabs

  11. HYPNOTEACHING IN HISTORY LESSON

    Directory of Open Access Journals (Sweden)

    Agus Budianto

    2017-07-01

    Full Text Available Abstract: Hypnoteaching in History Lesson. Historical learning is a science that can’t be separated in educating the younger generation. Through this lesson, teachers in secondary schools can provide the foundation of nationality through important events in the study of the social sciences. Many of the problems that occur in learning history, such as the boring and make sleepy. Everyone must have heard the term hypnosis, hypnotism, or hypnotherapy. Each person must also have a different view or understanding when hearing these terms. Hypnoteaching is one of the learning methods by using the art of communicating to influence learners. Hypnoteaching is a combination of five teaching-learning methods such as quantum learning, accelerate learning, power teaching, neuro-linguistic programming (NLP and hypnosis. Hypnoteaching can be done using informal hypnosis as well as formal hypnosis. Informal hypnosis is also called indirect hypnosis ie teachers can naturally make the Critical Area learners become no longer critical, through a very persuasive communication pattern. Here's what the teacher can do in Informal hypnosis: (1 get attention; (2 establishing Themes; (3 presenting the structure and regulations; (4 building relationships. If the learners are already comfortable and interested, the next step is to do a formal hypnosis before the lesson begins. Here are the steps that must be done: (1 Induction; (2 Deepening; (3 Deep level test; (4 Suggestion, and; (5 Termination.   Keywords: Historical learning, hypnoteaching, hypnosis, hypnotism, hypnotherapy, history Abstrak: Hipnoteaching dalam Pembelajaran Sejarah. Pelajaran sejarah tidak bisa dihilangkan dalam mendidik para generasi muda. Melalui pembelajaran ini, guru pada sekolah menengah pertama dapat memberikan pondasi rasa nasionalisme melalui peristiwa peristiwa penting dalam pelajaran ilmu pengetahuan social. Masalah yang sering muncul pada pembelajaran ini adalah kebosanan siswa dan

  12. Higher Education ERP: Lessons Learned.

    Science.gov (United States)

    Swartz, Dave; Orgill, Ken

    2001-01-01

    Shares experiences and lessons learned by chief information officers of large universities about enterprise resource planning (ERP). Specifically, provides a framework for approaching an ERP that could save universities millions of dollars. (EV)

  13. lessons from tuberous sclerosis complex

    African Journals Online (AJOL)

    intellectual disability, autism, specific learning disorders) and mental health disorders (e.g. depression, psychosis and anxiety disorders). The first lesson, therefore, is ... of an adolescent with TSC, facial angiofibromas and a presumed fat-poor ...

  14. Lessons of nuclear power

    International Nuclear Information System (INIS)

    Collingridge, D.

    1984-01-01

    In an earlier article the author has argued that the turbulent history of nuclear power in Britain and the USA stems from the technology itself, and has little to do with the very different institutional arrangements made for the new technology in the two countries. Nuclear plant has various features which make its planning extraordinarily difficult. Its long lead time, large unit size, capital intensity and dependence on complex infrastructure combine to ensure that mistakes are likely to be made in planning the technology and that what mistakes do occur are expensive. This article aims to expand on the earlier one in two ways; by looking at the apparent success of the French nuclear programme which seems to run counter to the thesis of the earlier article, and by trying to draw lessons from the earlier analysis for the breeder reactor. (author)

  15. Lessons learned in radiology

    International Nuclear Information System (INIS)

    Goodenough, D.J.

    2001-01-01

    The paper reviews aspects of the history of radiology with the goal of identifying lessons learned, particularly in the area of radiological protection of the patient in diagnostic and interventional radiology, nuclear medicine and radiotherapy. It is pointed out that since the days of Roentgen there has been a need not only to control and quantify the amount of radiation reaching the patient but also to optimize the imaging process to offer the greatest diagnostic benefit within allowable levels of patient dose. To this end, in diagnostic radiology, one finds the development of better films, X rays tubes, grids, screens and processing techniques, while in fluoroscopy, one sees the increased luminance of calcium tungstate. In interventional radiology, one finds an improvement in catheterization techniques and contrast agents. In nuclear medicine, the development of tracer techniques into modern cameras and isotopes such as technetium can be followed. In radiotherapy, one sees the early superficial X rays and radium sources gradually replaced with radon seeds, supervoltage, 60 Co and today's linear accelerators. Along with the incredible advances in imaging and therapeutic technologies comes the growing realization of the potential danger of radiation and the need to protect the patient (as well as physicians, ancillary personnel and the general population) from unnecessary radiation. The important lesson learned is that we must walk a tightrope, balancing the benefits and risks of any technology utilizing radiation to produce the greatest benefits at the lowest acceptable risk. The alternative techniques using non-ionizing radiation will have to be considered as part of the general armamentarium for medical imaging whenever radiation consequences are unacceptable. (author)

  16. 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.

  17. 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)

  18. Lessons learned from accident investigations

    International Nuclear Information System (INIS)

    Zuniga-Bello, P.; Croft, J.R.; Glenn, J.

    1998-01-01

    Accidents in 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 from them. A brief description of some of these accidents is given. Lessons learned from the accidents described are approached bearing in mind: safety culture, quality assurance, human factors, good engineering practice, defence in depth, security of sources, safety assessment and monitoring and verification compliance. (author)

  19. Leading in crisis: lessons for safety leaders.

    Science.gov (United States)

    George, William W; Denham, Charles R; Burgess, L Hayley; Angood, Peter B; Keohane, Carol

    2010-03-01

    The National Quality Forum (NQF) Safe Practices are a group of 34 evidence-based Safe Practices that should be universally used to reduce the risk of harm to patients. Four of these practices specifically address leadership. A recently published book, 7 Lessons for Leading in Crisis, offers practical advice on how to lead in crisis. An analysis of how concepts from the 7 lessons could be applied to the Safe Practices was presented nationally by webinar to assess the audience's reaction to the information. The objective of this article was to present the information and the audience's reaction to it. Recommendations for direct actions that health care leaders can take to accelerate adoption of NQF Safe Practices were presented to health care leaders, followed by an immediate direct survey that used Reichheld's "Net Promoter Score" to assess whether the concepts presented were considered applicable and valuable to the audience. In a separate presentation, the challenges and crises facing nursing leaders were addressed by nursing leaders. Six hundred seventy-four hospitals, with an average of 4.5 participants per hospital, participated in the webinar. A total of 272 safety leaders responded to a survey immediately after the webinar. A Net Promoter Score assessment revealed that 58% of those surveyed rated the value of the information at 10, and 91% scored the value of the webinar to be between 8 and 10, where 10 is considered a strong recommendation that those voting would recommend this program to others. The overwhelmingly high score indicated that the principles presented were important and valuable to this national audience of health care leadership. The 2010 environment of uncertainty and shrinking financial resources poses significant risk to patients and new challenges for leaders at all levels. A values-grounded focus on personal accountability for leading in crisis situations strongly resonates with those interested in or leading patient safety initiatives.

  20. Maternal morbidities affect tens of millions.

    Science.gov (United States)

    Finger, W R

    1994-02-01

    Various separate studies indicate maternal morbidity is more common than had been believed. A Safe Motherhood Survey was conducted in 1993 in the Philippines among 9000 women, as part of efforts to study women's language and perceptions about pregnancy and symptoms of morbidity. In El Salvador, interviews were conducted among 2000 women on morbidity issues. Preliminary results from a Family Health International (FHI) five-country survey of 16,000 women revealed that 7 out of every 10 women reported a health problem related to maternity or chronic conditions stemming from pregnancy or childbirth. Conditions ranged from obstructed labor, complications from unsafe abortions, and bacterial infections, to anemia, hemorrhage, and eclampsia. The quality of care determines whether the health problems are life threatening. Less serious morbidity cases involve fatigue or back pain, which is exacerbated by poor nutrition and hard physical labor. Other reproductive morbidities are sexually transmitted diseases, side effects from contraceptives, and general gynecological problems. The FHI results from Ghana, Indonesia, and Egypt showed 240-300 morbidities for every maternal death; maternal mortality worldwide is estimated at 500,000 annually. A study of fistula (an injury during labor to the vagina and bladder that results in urinary or fecal incontinence) found that Nigerian community norms and limited access to emergency health care were factors. The women reported costs, poor roads, and transportation problems. A study in Ethiopia found that, in an Addis Ababa hospital between 1983-88, 600 fistulas were repaired every year, of which almost 66% occurred at first delivery. A study in Cairo in 1988 found that nearly 6 out of every 10 women reported a prolapsed uterus. Women in the studies were able to talk openly and willingly about their problems, when concepts and language were appropriate and interviewers were trained. A small study in India confirmed the correlation between

  1. Ten Frequently Asked Questions About Veterans’ Transitions: Results of a Decade of RAND Work on Veteran Life

    Science.gov (United States)

    2016-01-01

    no prior civilian work experi- ence and those with injuries or disabilities. As part of their duty to care for the men and women who have served...personal, and cultural fac- tors. Many service members expressed concern that using men - tal health services will negatively affect their military...lesson learned from previous research is how inaccurate many stereotypes about veterans are. For example, the research takes issue with the

  2. Spent Fuel Storage Operation - Lessons Learned

    International Nuclear Information System (INIS)

    2013-12-01

    Experience gained in planning, constructing, licensing, operating, managing and modifying spent fuel storage facilities in some Member States now exceeds 50 years. Continual improvement is only achieved through post-project review and ongoing evaluation of operations and processes. This publication is aimed at collating and sharing lessons learned. Hopefully, the information provided will assist Member States that already have a developed storage capability and also those considering development of a spent nuclear fuel storage capability in making informed decisions when managing their spent nuclear fuel. This publication is expected to complement the ongoing Coordinated Research Project on Spent Fuel Performance Assessment and Research (SPAR-III); the scope of which prioritizes facility operational practices in lieu of fuel and structural components behaviour over extended durations. The origins of the current publication stem from a consultants meeting held on 10-12 December 2007 in Vienna, with three participants from the IAEA, Slovenia and USA, where an initial questionnaire on spent fuel storage was formulated (Annex I). The resultant questionnaire was circulated to participants of a technical meeting, Spent Fuel Storage Operations - Lessons Learned. The technical meeting was held in Vienna on 13-16 October 2008, and sixteen participants from ten countries attended. A consultants meeting took place on 18-20 May 2009 in Vienna, with five participants from the IAEA, Slovenia, UK and USA. The participants reviewed the completed questionnaires and produced an initial draft of this publication. A third consultants meeting took place on 9-11 March 2010, which six participants from Canada, Hungary, IAEA, Slovenia and the USA attended. The meeting formulated a second questionnaire (Annex II) as a mechanism for gaining further input for this publication. A final consultants meeting was arranged on 20-22 June 2011 in Vienna. Six participants from Hungary, IAEA, Japan

  3. Strategic Purchasing in Practice: Comparing Ten European Countries.

    Science.gov (United States)

    Klasa, Katarzyna; Greer, Scott L; van Ginneken, Ewout

    2018-02-05

    Strategic purchasing of health care services is widely recommended as a policy instrument. We conducted a review of literature of material drawn from the European Observatory on Health Systems and Policies Health Systems in Transition series, other European Observatory databases, and selected country-specific literature to augment the comparative analysis by providing the most recent healthcare trends in ten selected countries. There is little evidence of purchasing being strategic according to any of the established definitions. There is little or no literature suggesting that existing purchasing mechanisms in Europe deliver improved population health, citizen empowerment, stronger governance and stewardship, or develop purchaser organization and capacity. Strategic purchasing has not generally been implemented. Policymakers considering adopting strategic purchasing policies should be aware of this systemic implementation problem. Policymakers in systems with strategic purchasing built into policy should not assume that a purchasing system is strategic or that it is delivering any expected objectives. However, there are individual components of strategic purchasing that are worth pursuing and can provide benefits to health systems. Copyright © 2018. Published by Elsevier B.V.

  4. Maternity Nurses' Perceptions of Implementation of the Ten Steps to Successful Breastfeeding.

    Science.gov (United States)

    Cunningham, Emilie M; Doyle, Eva I; Bowden, Rodney G

    The purpose of this study was to determine maternity nurses' perceptions of implementing the Ten Steps to Successful Breastfeeding. An online survey and a focus group were used to evaluate perceptions of maternity nurses of implementing the Ten Steps to Successful Breastfeeding in an urban Texas hospital at the onset of the project initiation. Responses were transcribed and coded using Nvivo software. Thematic analysis was conducted and consensus was reached among the research team to validate themes. Twenty-eight maternity nurses participated. Nurses perceived a number of barriers to implementing the Ten Steps to Successful Breastfeeding including nurse staffing shortages, variations in practice among nurses, different levels of nurse education and knowledge about breastfeeding, lack of parental awareness and knowledge about breastfeeding, culture, and postpartum issues such as maternal fatigue, visitors, and routine required procedures during recovery care that interfered with skin-to-skin positioning. Maternity nurses desired more education about breastfeeding; specifically, a hands-on approach, rather than formal classroom instruction, to be able to promote successful implementation of the Ten Steps. More education on breastfeeding for new mothers, their families, and healthcare providers was recommended. Nurse staffing should be adequate to support nurses in their efforts to promote breastfeeding. Skin-to-skin positioning should be integrated into the recovery period. Hospital leadership support for full implementation and policy adherence is essential. Challenges in implementing the Ten Steps were identified along with potential solutions.

  5. 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.

  6. Metabonomics and Intensive Care

    OpenAIRE

    Antcliffe, D; Gordon, AC

    2016-01-01

    This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

  7. The use of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour: a review of the evidence.

    Science.gov (United States)

    Bedwell, Carol; Dowswell, Therese; Neilson, James P; Lavender, Tina

    2011-10-01

    to assess the effects of transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. studies were identified from a search of the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008). randomised controlled trials comparing women receiving TENS for pain relief in labour vs routine care or placebo devices. All types of TENS machines were included. two review authors assessed all trials identified by the search strategy, carried out data extraction and assessed risk of bias. 14 studies including 1256 women were included: 11 examined TENS applied to the back, two to acupuncture points and one to the cranium. Overall, there was little difference in satisfaction with pain relief or in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32-0.55). The majority of women using TENS would use it again in a future labour. There was no evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and infants. No adverse events were reported. there is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact on other outcomes for mothers or infants. The use of TENS at home in early labour has not been evaluated. Although the guidelines of the National Institute for Health and Clinical Excellence recommend that TENS should not be offered to women in labour, women appear to be choosing it and midwives are supporting them in their choice. Given the absence of adverse effects and the limited evidence base, it seems unreasonable to deny women that choice. More robust studies of effectiveness are needed. Copyright © 2009 Elsevier Ltd. All rights reserved.

  8. 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.

  9. 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.

  10. 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...

  11. Increasing intensity of TENS prevents analgesic tolerance in rats

    Science.gov (United States)

    Sato, Karina L.; Sanada, Luciana S.; Rakel, Barbara A.; Sluka, Kathleen A.

    2012-01-01

    Transcutaneous electrical nerve stimulation (TENS) reduces hyperalgesia and pain. Both low frequency (LF) and high frequency (HF) TENS, delivered at the same intensity (90% motor threshold (MT)) daily, result in analgesic tolerance with repeated use by the 5th day of treatment. Thecurrentstudytestedif 1) increasingintensityby 10% per daypreventsthedevelopmentoftolerance to repeated TENS, and 2) iflowerintensity TENS (50 % MT) produces an equivalentreduction in hyperalgesia when compared to 90% MT TENS. Sprague-Dawley rats with unilateral knee joint inflammation (3% carrageenan) were separated according to the intensity of TENS used: Sham, 50% LF, 50% HF, 90% LF, 90% HF, and increased intensity by 10% per day (LF and HF). The reduced mechanical withdrawal threshold following the induction of inflammation was reversed by application of TENS applied at 90% MT and increasing intensity for the first 4 days. On the 5th day, the groups that received 90% MT intensity showed tolerance. Nevertheless, the group that received an increased intensity on each day still showed a reversal of the mechanical withdrawal threshold with TENS. These results show that the development of tolerance can be delayed by increasing intensity of TENS. PMID:22858165

  12. Didactic Contracts in Realistic Mathematics Education Teaching Practice in Indonesia: A lesson on addition

    DEFF Research Database (Denmark)

    Putra, Zetra Hainul

    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......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...

  13. Supporting teachers' technology integration in lesson plans

    NARCIS (Netherlands)

    Janssen, Noortje

    2017-01-01

    Lesson planning offers rich opportunities for teachers to consider and implement technology in the classroom. This dissertation investigated the design and effectiveness of supplementary information to assist pre-service teachers during the lesson planning process. Based on the Technological,

  14. Value pricing pilot program : lessons learned

    Science.gov (United States)

    2008-08-01

    This "Lessons Learned Report" provides a summary of projects sponsored by the Federal Highway Administration's (FHWA's) Congestion and Value Pricing Pilot Programs from 1991 through 2006 and draws lessons from a sample of projects with the richest an...

  15. Dominating Duffer’s Domain: Lessons for the U.S. Marine corps Information Operations Practitioner

    Science.gov (United States)

    2017-01-01

    has learned 26 hard -won lessons that readers may find useful for the future conduct and planning of IO. The principles espoused here were derived from...to be frank, it wasn’t that hard . I had done the ten-day Intermediate MAGTF (Marine Air Ground Task Force) Information Operations Practitioner...paragraph, with no phases. It was, however, beauti- fully formatted , and the task listing had everything: military deception, electronic warfare, OPSEC

  16. Ten key points for the appropriate use of antibiotics in hospitalised patients: a consensus from the Antimicrobial Stewardship and Resistance Working Groups of the International Society of Chemotherapy

    NARCIS (Netherlands)

    Hara, G. Levy; Kanj, S.S.; Pagani, L.; Abbo, L.; Endimiani, A.; Wertheim, H.F.L.; Amabile-Cuevas, C.; Tattevin, P.; Mehtar, S.; Cardoso, F.; Unal, S.; Gould, I.

    2016-01-01

    The Antibiotic Stewardship and Resistance Working Groups of the International Society for Chemotherapy propose ten key points for the appropriate use of antibiotics in hospital settings. (i) Get appropriate microbiological samples before antibiotic administration and carefully interpret the results:

  17. Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain.

    Science.gov (United States)

    Milne, S; Welch, V; Brosseau, L; Saginur, M; Shea, B; Tugwell, P; Wells, G

    2001-01-01

    Low back pain (LBP) affects a large proportion of the population. Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as an alternative therapy to pharmacological treatments for chronic pain. However, despite its widespread use, the effectiveness of TENS is still controversial. The aim of this systematic review was to determine the efficacy of TENS in the treatment of chronic LBP. We searched MEDLINE, EMBASE, PEDro and the Cochrane Controlled Trials Register up to June 1, 2000. Only randomized controlled clinical trials of TENS for the treatment of patients with a clinical diagnosis of chronic LBP were included. Abstracts were excluded unless further data could be obtained from the authors. Two reviewers independently selected trials and extracted data using predetermined forms. Heterogeneity was tested with Cochran's Q test. A fixed effects model was used throughout for continuous variables, except where heterogeneity existed, in which case, a random effects model was used. Results are presented as weighted mean differences (WMD) with 95% confidence intervals (95% CI), where the difference between the treated and control groups was weighted by the inverse of the variance. Standardized mean differences (SMD) were calculated by dividing the difference between the treated and control by the baseline variance. SMD were used when different scales were used to measure the same concept. Dichotomous outcomes were analyzed with odds ratios. Five trials were included, with 170 subjects randomized to the placebo group receiving sham-TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for acupuncture-like TENS). The schedule of treatments varied greatly between studies ranging from one treatment/day for two consecutive days, to three treatments/day for four weeks. There were no statistically significant differences between the active TENS group when compared to the placebo TENS group for any outcome measures

  18. Lessons from independence

    International Nuclear Information System (INIS)

    Hauptfuhrer, R.R.

    1990-01-01

    The recent history of Oryx provides invaluable lessons for those who plan future energy strategies, relates the author of this paper. When Oryx became an independent oil and gas company, its reserves were declining, its stock was selling below asset values, and the price of oil seemed stuck below $15 per barrel. The message from Oryx management to Oryx employees was: We are in charge of our own destiny. We are about to create our own future. Oryx had developed a new, positive corporate culture and the corporate credit required for growth. This paper points to two basic principles that have guided the metamorphosis in Oryx's performance. The first objective was to improve operational efficiency and to identify the right performance indicators to measure this improvement. It states that the most critical performance indicator for an exploration and production company must be replacement and expansion of reserves at a competitive replacement cost. Oryx has cut its finding costs from $12 to $5 per barrel, while the BP acquisition provided proven reserves at a cost of only $4 per barrel. Another performance indicator measures Oryx's standing in the financial markets

  19. Constellation Program Lessons Learned. Volume 2; Detailed Lessons Learned

    Science.gov (United States)

    Rhatigan, Jennifer; Neubek, Deborah J.; Thomas, L. Dale

    2011-01-01

    These lessons learned are part of a suite of hardware, software, test results, designs, knowledge base, and documentation that comprises the legacy of the Constellation Program. The context, summary information, and lessons learned are presented in a factual format, as known and described at the time. While our opinions might be discernable in the context, we have avoided all but factually sustainable statements. Statements should not be viewed as being either positive or negative; their value lies in what we did and what we learned that is worthy of passing on. The lessons include both "dos" and "don ts." In many cases, one person s "do" can be viewed as another person s "don t"; therefore, we have attempted to capture both perspectives when applicable and useful. While Volume I summarizes the views of those who managed the program, this Volume II encompasses the views at the working level, describing how the program challenges manifested in day-to-day activities. Here we see themes that were perhaps hinted at, but not completely addressed, in Volume I: unintended consequences of policies that worked well at higher levels but lacked proper implementation at the working level; long-term effects of the "generation gap" in human space flight development, the need to demonstrate early successes at the expense of thorough planning, and the consequences of problems and challenges not yet addressed because other problems and challenges were more immediate or manifest. Not all lessons learned have the benefit of being operationally vetted, since the program was cancelled shortly after Preliminary Design Review. We avoid making statements about operational consequences (with the exception of testing and test flights that did occur), but we do attempt to provide insight into how operational thinking influenced design and testing. The lessons have been formatted with a description, along with supporting information, a succinct statement of the lesson learned, and

  20. Granulocyte colony-stimulating factor in toxic epidermal necrolysis (TEN) and Chelsea & Westminster TEN management protocol [corrected].

    Science.gov (United States)

    de Sica-Chapman, A; Williams, G; Soni, N; Bunker, C B

    2010-04-01

    Toxic epidermal necrolysis (TEN) is a rare but life-threatening, allergic drug reaction. Skin blistering with epidermal and mucosal necrolysis with subsequent detachment from an inflamed underlying dermis is a hallmark of the condition. The pathogenesis of TEN is not well understood, accounting for controversies about its management and significant delay in initiating potentially beneficial therapy. There are no management protocols based on a robust evidence base. Prompt recognition of the diagnosis and consensus on early management initiatives are necessary in order to improve outcomes and survival in TEN. To date, TEN management has been directed at arresting the allergic reaction and treating the complications. We have identified a need for specific medical interventions to accelerate wound regeneration. This approach has not previously been adopted in the management of TEN. We observed that in two cases of severe TEN, dramatic re-epithelialization and recovery coincided with the introduction of granulocyte colony-stimulating factor (G-CSF) for neutropenia. We explain how addition of the G-CSF promotes recovery from TEN by enhanced bioregeneration of the damaged tissues through accelerated re-epithelialization. G-CSF has been used for severe neutropenia in TEN, but we recommend and explain why, as in our Chelsea and Westminster protocol, G-CSF should be considered in treating severe TEN irrespective of the severity of neutropenia.

  1. What Happens at the Lesson Start?

    Science.gov (United States)

    Saloviita, Timo

    2016-01-01

    Transitional periods, such as lesson starts, are necessary steps from one activity to another, but they also compete with time for actual learning. The aim of the present study was to replicate a previous pilot study on lesson starts and explore possible disturbances. In total, 130 lesson starts in Finnish basic education in grades 1-9 were…

  2. Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial.

    Science.gov (United States)

    MacPherson, Hugh; Tilbrook, Helen; Richmond, Stewart; Woodman, Julia; Ballard, Kathleen; Atkin, Karl; Bland, Martin; Eldred, Janet; Essex, Holly; Hewitt, Catherine; Hopton, Ann; Keding, Ada; Lansdown, Harriet; Parrott, Steve; Torgerson, David; Wenham, Aniela; Watt, Ian

    2015-11-03

    Management of chronic neck pain may benefit from additional active self-care-oriented approaches. To evaluate clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, nonspecific neck pain. Three-group randomized, controlled trial. (Current Controlled Trials: ISRCTN15186354). U.K. primary care. Persons with neck pain lasting at least 3 months, a score of at least 28% on the Northwick Park Questionnaire (NPQ) for neck pain and associated disability, and no serious underlying pathology. 12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone. NPQ score (primary outcome) at 0, 3, 6, and 12 months (primary end point) and Chronic Pain Self-Efficacy Scale score, quality of life, and adverse events (secondary outcomes). 517 patients were recruited, and the median duration of neck pain was 6 years. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Between-group reductions in NPQ score at 12 months versus usual care were 3.92 percentage points for acupuncture (95% CI, 0.97 to 6.87 percentage points) (P = 0.009) and 3.79 percentage points for Alexander lessons (CI, 0.91 to 6.66 percentage points) (P = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Participant self-efficacy improved for both interventions versus usual care at 6 months (P neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained. Arthritis Research UK.

  3. How the Big Ten West Was Won: Football Recruiting

    Directory of Open Access Journals (Sweden)

    Diehl Kevin A.

    2017-06-01

    Full Text Available The paper analyses the 2017 Big Ten West Division football cycle models recruiting. The top ten recruit scores [(Rivals.com * 100 + [100 (outside surrounding; 75 (surrounding] + extra credit walk-ons (100; 75] allow proper ranking: Iowa, Nebraska, Wisconsin, Northwestern, Illinois, Minnesota, and Purdue.

  4. 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,…

  5. TRANSCUTANEOUS ELECTRICAL NERVE-STIMULATION (TENS) IN RAYNAUDS-PHENOMENON

    NARCIS (Netherlands)

    MULDER, P; DOMPELING, EC; VANSLOCHTERENVANDERBOOR, JC; KUIPERS, WD; SMIT, AJ

    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

  6. Using TENS for pain control: the state of the evidence

    Science.gov (United States)

    Vance, Carol GT; Dailey, Dana L; Rakel, Barbara A; Sluka, Kathleen A

    2014-01-01

    Summary 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. PMID:24953072

  7. 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.

  8. Lessons to be learned from an analysis of ammonium nitrate disasters in the last 100 years

    International Nuclear Information System (INIS)

    Pittman, William; Han, Zhe; Harding, Brian; Rosas, Camilo; Jiang, Jiaojun; Pineda, Alba; Mannan, M. Sam

    2014-01-01

    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

  9. Lessons of nuclear robot history

    International Nuclear Information System (INIS)

    Oomichi, Takeo

    2014-01-01

    Severe accidents occurred at Fukushima Daiichi Nuclear Power Station stirred up people's great expectation of nuclear robot's deployment. However unexpected nuclear disaster, especially rupture of reactor building caused by core meltdown and hydrogen explosion, made it quite difficult to introduce nuclear robot under high radiation environment to cease accidents and dispose damaged reactor. Robotics Society of Japan (RSJ) set up committee to look back upon lessons learned from 50 year's past experience of nuclear robot development and summarized 'Lessons of nuclear robot history', which was shown on the home page website of RSJ. This article outlined it with personal comment. History of nuclear robot developed for inspection and maintenance at normal operation and for specific required response at nuclear accidents was reviewed with many examples at home and abroad for TMI, Chernobyl and JCO accidents. Present state of Fukushima accident response robot's introduction and development was also described with some comments on nuclear robot development from academia based on lessons. (T. Tanaka)

  10. Cultures of the Western World. Grade Ten. Instructional Guide.

    Science.gov (United States)

    West Chester School District, PA.

    This curriculum guide presents nine units for the study of western cultures in the tenth grade. The units contain up to 13 lessons each and comprise a two-semester course. Content includes ancient Greece and Rome, the Middle Ages, the Renaissance and Reformation, Great Britain, France as a case study of revolution, Russia, and nationalism and the…

  11. Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial.

    Science.gov (United States)

    Macedo, L B; Josué, A M; Maia, P H B; Câmara, A E; Brasileiro, J S

    2015-06-01

    To assess the immediate effect of conventional and burst transcutaneous electrical nerve stimulation (TENS) in combination with cryotherapy on pain threshold and tolerance in healthy individuals. Randomised, controlled trial. University laboratory. One hundred and twelve healthy women. Volunteers were allocated at random to seven groups (n=16): (1) control, (2) placebo TENS, (3) conventional TENS, (4) burst TENS, (5) cryotherapy, (6) cryotherapy in combination with burst TENS, and (7) cryotherapy in combination with conventional TENS. Pain threshold and tolerance were measured by applying a pressure algometer at the lateral epicondyle of the humerus, before and after each intervention. The primary outcome measure was pressure pain threshold. A significant increase in pain threshold and tolerance at the 5% level of significance was recorded as follows: burst TENS {pain threshold: mean difference 1.3 [95% confidence interval (CI) 1.4 to 1.2]; pain tolerance: mean difference 3.8 (95% CI 3.9 to 3.7)}, cryotherapy [pain threshold: mean difference 1.3 (95% CI 1.4 to 1.2); pain tolerance: mean difference 1.9 (95% CI 1.8 to 2.0)] and cryotherapy in combination with burst TENS [pain threshold: mean difference 2.6 (95% CI 2.4 to 2.8); pain tolerance: mean difference 4.9 (95% CI 5.0 to 4.8)]. Cryotherapy in combination with burst TENS provided greater analgesia compared with the other groups (Pcryotherapy in combination with burst TENS to reduce induced pain, and suggest a potentiating effect when these techniques are combined. No such association was found between cryotherapy and conventional TENS. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  12. Keynote on lessons from major radiation accidents

    International Nuclear Information System (INIS)

    Ortiz, P.; Oresegun, M.; Wheatley, J.

    2000-01-01

    Generic lessons have been learned from a relatively large number of accidents in the most relevant practices (a set of analysis have been made on about 90 radiotherapy events, 43 industrial radiography and nine from industrial irradiations); more specific lessons have been drawn from in-depth investigations of individual accidents. The body of knowledge is grouped as follows: a) radiotherapy is very unique in that humans (patients) are purposely given very high radiation doses (20-75 Gy) by placing them in the radiation beam or by placing radioactive sources in contact with tissues. Intended deterministic effects are the essence of the normal radiotherapy practice and relatively small deviation from the intended doses, i.e,, slightly higher or lower than intended may cause increased rate of severe complication or reduce probability of cure. Consequences of major accidents have been devastating, affecting tens, even hundreds of patients and causing death (directly or indirectly) to a large number of them; b) accidents involving industrial radiography are the most frequent cause of overexposure to workers (radiographers); c) accidents with industrial irradiators have lower probability of occurrence, however, they are deemed to be fatal, especially when whole body exposure to panoramic gamma irradiators occur; partial body irradiation from industrial or research accelerator beams has led to amputation of hands and legs; d) when control of sources was relinquished ('orphan' sources) this has resulted in severe injuries, in some cases death and widespread contamination of the environment. A tool for further dissemination of lessons will be an international reporting system of unusual radiation events (RADEV), being introduced world-wide. Accidents were rarely due to a single human error or isolated equipment failure. In most cases there was a combination of elements such as: a) unawareness of the potential for an accident, b) poor education, which usually did not

  13. 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.

  14. Overview of lessons learnt

    International Nuclear Information System (INIS)

    Pescatore, C.; Federline, M.; Duncan, A.

    2004-01-01

    During the Tarragona International Seminar the participating high-level specialists had very open and fruitful discussion concerning strategic decommissioning issues. The lessons learnt and possible solutions for future work issues can be found below. Although there appears to be a trend towards early dismantling, there seemed to be general agreement that technical solutions support a wide variety of safe decommissioning approaches. Thus, in terms of decommissioning strategy, it appears that no one size fits all. A flexible regulatory approach is needed in order to recognize the changing operational risks and physical conditions of facilities with time, and to optimise their dismantling. The NEA has released a comprehensive study on decommissioning strategies and costs that indicates world-wide progress. According to this report, over 50% of countries with nuclear facilities have a framework of decommissioning requirements and 60% have defined radioactive waste clearance levels. Up to about 70% of the costs of D and D are attributable to dismantling and waste management. The provisions for safety of the D and D process are closely linked to the availability of the necessary funds as and when required. A number of common factors were defined for successful implementation of decommissioning strategies: i.e. safety, technical feasibility of decommissioning options, risk-informed progression of D and D activities as project proceeds, maintenance of competency and corporate memory throughout project, waste management and disposal capability, financing that suits the scope of the project, a well-defined risk-informed and performance-based regulatory process, and establishment of effective communication with local and regional governments and key stakeholders, particularly personnel, at the earliest opportunity before decommissioning. (author)

  15. COMMUNITY HEALTH & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, ... selected from each of the ten wards in the LGA using multistage sampling technique. ..... Knowledge of HIV/AIDS Insurance Companies in Lagos State.

  16. [Economics] Introductory Lesson (Begin Day One). Lesson Plan.

    Science.gov (United States)

    Lewin, Roland

    This introductory lesson on teaching economics concepts contains sections on the following: purpose; objectives; time; materials needed; and step-by-step classroom procedures. The focus is on the economic problem of scarcity and opportunity costs. Attached is an original skit, "There's no such thing as a free lunch," and a chart that…

  17. Lessons learned related to packaging and transportation

    International Nuclear Information System (INIS)

    Wallen, C.

    1995-01-01

    The use of lessons learned as a tool for learning from past experiences is well established, especially by many organizations within the nuclear industry. Every person has, at some time, used the principles of lessons learned to adopt good work practices based on their own experiences or the experiences of others. Lessons learned can also help to avoid the recurrence of adverse practices, which is often an area that most lessons-learned programs tend to focus on. This paper will discuss how lessons learned relate to packaging and transportation issues and events experienced at Department of Energy (DOE) facilities. It will also discuss the role performed by the Office of Nuclear and Facility Safety's Office of Operating Experience Analysis and Feedback in disseminating lessons learned and operating experience feedback to the DOE complex. The central concept of lessons learned is that any organization should be able to learn from its own experiences and events. In addition, organizations should implement methodologies to scan external environments for lessons learned, to analyze and determine the relevance of lessons learned, and to bring about the necessary changes learned from these experiences. With increased concerns toward facility safety, the importance of utilizing the lessons-learned principles and the establishment of lessons-learned programs can not be overstated

  18. Transcutaneous Electrical Nerve Stimulation (TENS) for the Control of Pain during Rehabilitation Following Total Knee Arthroplasty (TKA): A Randomized, Blinded, Placebo-Controlled Trial

    Science.gov (United States)

    Rakel, Barbara; Zimmerman, M. Bridget; Geasland, Katharine; Embree, Jennie; Clark, Charles R; Noiseux, Nicolas O; Callaghan, John J; Herr, Keela; Walsh, Deirdre; Sluka, Kathleen A

    2014-01-01

    This study evaluated the efficacy of TENS in reducing pain and hyperalgesia and increasing function following total knee arthroplasty (TKA). We hypothesized participants using TENS during rehabilitation exercises would: 1) report significantly lower pain during range-of-motion (ROM) and fast walking but not at rest; 2) have less hyperalgesia; and, 3) have better function than participants receiving Placebo-TENS or Standard Care. We also hypothesized that change in ROM pain would differ based on psychological characteristics (trait anxiety, pain catastrophizing and depression) and treatment group. This prospective, randomized study used intent-to-treat analyses on 317 subjects after primary, unilateral TKA. Assessors, blinded to treatment allocation, measured pain, function (ROM and gait speed), and hyperalgesia (quantitative sensory tests) postoperatively and 6 weeks after surgery. Analgesic intake, anxiety, depression, and pain catastrophizing were also assessed. TENS participants used it 1–2 times/day at 42 mA (on average) and had less pain postoperatively during active knee extension (p=0.019) and fast walking (p=0.006) than Standard Care participants. TENS and Placebo-TENS were not significantly different. TENS participants who scored low on anxiety and pain catastrophizing had a greater reduction in ROM pain at 6 weeks than those scoring high on these factors (p=0.002 and 0.03). Both TENS and Placebo-TENS participants had less postoperative mechanical hyperalgesia (p=0.03 – 0.01) than Standard Care participants. Supplementing pharmacologic analgesia with TENS during rehabilitation exercises reduces movement pain postoperatively but a placebo influence exists and the effect is gone by 6 weeks. Patients with low anxiety and pain catastrophizing may benefit most from TENS. PMID:25270585

  19. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial.

    Science.gov (United States)

    Santana, Licia Santos; Gallo, Rubneide Barreto Silva; Ferreira, Cristine Homsi Jorge; Duarte, Geraldo; Quintana, Silvana Maria; Marcolin, Alessandra Cristina

    2016-01-01

    In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS) relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided? Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis. Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4cm, and without the use of any medications from hospital admission until randomisation. The principal investigator applied TENS to the experimental group for 30minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care. The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided. After the intervention, a significant mean difference in change in pain of 15mm was observed favouring the experimental group (95% CI 2 to 27). The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0hours (95% CI 4.1 to 5.9) longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour. TENS produces a significant decrease in pain during labour and postpones the need for pharmacological analgesia for pain relief. NCT01600495. Copyright © 2015. Published by Elsevier B.V.

  20. Field observations and lessons learned

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, Joh B [Los Alamos National Laboratory

    2010-01-01

    This presentation outlines observations and lessons learned from the Megaports program. It provides: (1) details of field and technical observations collected during LANL field activities at ports around the world and details of observations collected during radiation detections system testing at Los Alamos National Laboratory; (2) provides suggestions for improvement and efficiency; and (3) discusses possible program execution changes for more effective operations.

  1. 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…

  2. 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…

  3. Lessons learned in crisis management.

    Science.gov (United States)

    Olson, Chris

    2014-01-01

    This paper will explore lessons learned following a series of natural and man-made disasters affecting the Massachusetts Mutual Life Insurance Company and/or its subsidiaries. The company employs a team of certified continuity professionals who are charged with overseeing resilience on behalf of the enterprise and leading recovery activities wherever and whenever necessary.

  4. "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…

  5. Machiavelli's "The Prince." [Lesson Plan].

    Science.gov (United States)

    Discovery Communications, Inc., Bethesda, MD.

    Based on Machiavelli's book "The Prince," this lesson plan presents activities designed to help students understand that Machiavelli's enumeration of leadership qualities for a prince has always been controversial; and that leaders and followers may differ in what they identify as the qualities of a good leader. The main activity of the lesson…

  6. Basic safety principles: Lessons learned

    Energy Technology Data Exchange (ETDEWEB)

    Erp, J.B. van [Argonne National Lab., IL (United States)

    1997-09-01

    The presentation reviews the following issues: basic safety principles and lessons learned; some conclusions from the Kemeny report on the accident at TMI; some recommendations from the Kemeny report on the accident at TMI; conclusions and recommendations from the Rogovin report on the accident on TMI; instrumentation deficiencies (from Rogovin report).

  7. Lessons from The Little Prince

    Science.gov (United States)

    Munakata, Mika

    2005-01-01

    To children, The Little Prince by Antoine de Saint-Exupery (1943) may be a mystical story about a traveler among planets. For adults, the story can be appreciated for the lessons it teaches us about what it is like to be a child--and how children may perceive the world of adults. And, for science educators, particularly, The Little Prince…

  8. Basic safety principles: Lessons learned

    International Nuclear Information System (INIS)

    Erp, J.B. van

    1997-01-01

    The presentation reviews the following issues: basic safety principles and lessons learned; some conclusions from the Kemeny report on the accident at TMI; some recommendations from the Kemeny report on the accident at TMI; conclusions and recommendations from the Rogovin report on the accident on TMI; instrumentation deficiencies (from Rogovin report)

  9. The 'Amistad' Case. Lesson Plan.

    Science.gov (United States)

    National Archives and Records Administration, Washington, DC.

    Teaching about the Amistad case provides correlations to the National Standards for History, and Civics and Government. An overview of the events of 1839 is given in this lesson plan. Seven student activities include reading and using primary source documents, writing journal articles, viewing the movie "Amistad," and giving…

  10. Evaluating Eyewitness Reports [Lesson Plan].

    Science.gov (United States)

    2000

    This lesson offers students experience in making historical meaning from eyewitness accounts that present a range of different perspectives. Students begin with a case study in working with alternative reports of a single event: the Great Chicago Fire of 1871. First, they compare two newspaper reports on the fire, then two memoirs of the fire…

  11. Lessons in Contingent, Recursive Humility

    Science.gov (United States)

    Vagle, Mark D.

    2011-01-01

    In this article, the author argues that critical work in teacher education should begin with teacher educators turning a critical eye on their own practices. The author uses Lesko's conception of contingent, recursive growth and change to analyze a lesson he observed as part of a phenomenological study aimed at understanding more about what it is…

  12. 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…

  13. 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)

  14. 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…

  15. Constellation Lessons Learned Executive Summary

    Science.gov (United States)

    Thomas, L. Dale; Neubek, Deb

    2011-01-01

    This slide presentation reviews the lessons learned from the Constellation Program (CxP) and identified several factors that contributed to the inability of the CxP to meet the cost and schedule commitments. The review includes a significant section on the context in which the CxP operated since new programs are likely to experience the same constraints.

  16. EMU Lessons Learned Database

    Science.gov (United States)

    Matthews, Kevin M., Jr.; Crocker, Lori; Cupples, J. Scott

    2011-01-01

    As manned space exploration takes on the task of traveling beyond low Earth orbit, many problems arise that must be solved in order to make the journey possible. One major task is protecting humans from the harsh space environment. The current method of protecting astronauts during Extravehicular Activity (EVA) is through use of the specially designed Extravehicular Mobility Unit (EMU). As more rigorous EVA conditions need to be endured at new destinations, the suit will need to be tailored and improved in order to accommodate the astronaut. The Objective behind the EMU Lessons Learned Database(LLD) is to be able to create a tool which will assist in the development of next-generation EMUs, along with maintenance and improvement of the current EMU, by compiling data from Failure Investigation and Analysis Reports (FIARs) which have information on past suit failures. FIARs use a system of codes that give more information on the aspects of the failure, but if one is unfamiliar with the EMU they will be unable to decipher the information. A goal of the EMU LLD is to not only compile the information, but to present it in a user-friendly, organized, searchable database accessible to all familiarity levels with the EMU; both newcomers and veterans alike. The EMU LLD originally started as an Excel database, which allowed easy navigation and analysis of the data through pivot charts. Creating an entry requires access to the Problem Reporting And Corrective Action database (PRACA), which contains the original FIAR data for all hardware. FIAR data are then transferred to, defined, and formatted in the LLD. Work is being done to create a web-based version of the LLD in order to increase accessibility to all of Johnson Space Center (JSC), which includes converting entries from Excel to the HTML format. FIARs related to the EMU have been completed in the Excel version, and now focus has shifted to expanding FIAR data in the LLD to include EVA tools and support hardware such as

  17. Ten-Competence: Life-Long Competence Development and Learning

    NARCIS (Netherlands)

    Koper, Rob; Specht, Marcus

    2006-01-01

    Koper, R., & Specht, M. (2008). Ten-Competence: Life-Long Competence Development and Learning. In M-A. Cicilia (Ed.), Competencies in Organizational e-learning: concepts and tools (pp. 234-252). Hershey: IGI-Global.

  18. Ten Things Parents Can Do to Prevent Suicide

    Science.gov (United States)

    ... Ribbon Commands Skip to main content Turn off Animations Turn on Animations Our Sponsors Log in | Register Menu Log in | ... teen at risk for suicide . Spend some time reading these ten ways you can help prevent a ...

  19. Simultaneous determination of ten compounds in two main ...

    African Journals Online (AJOL)

    Simultaneous determination of ten compounds in two main medicinal plant parts of Tibetan herb, Pterocephalus hookeri (CB Clarke) Höeck, by ultra-high performance liquid chromatography-photodiode array.

  20. Top Ten Challenges Facing the Next Secretary of Homeland Security

    National Research Council Canada - National Science Library

    2008-01-01

    In an effort to assist with the first Presidential administration transition of the Department of Homeland Security, the Homeland Security Advisory Council has identified ten key challenges that will...