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Sample records for cares settings association

  1. Norovirus epidemiology in community and health care settings and association with patient age, denmark

    DEFF Research Database (Denmark)

    Franck, Kristina T; Fonager, Jannik; Ersbøll, Annette K;

    2014-01-01

    . In community and health care settings, we found an association between infection with GII.4 and increasing age. Norovirus GII.4 predominated in patients ≥60 years of age and in health care settings. A larger proportion of children than adults were infected with NoV GII.3 or GII.P21. Susceptibility to No......Norovirus (NoV) is a major cause of gastroenteritis. NoV genotype II.4 (GII.4) is the predominant genotype in health care settings but the reason for this finding is unknown. Stool samples containing isolates with a known NoV genotype from 2,109 patients in Denmark (patients consulting a general...... practitioner or outpatient clinic, inpatients, and patients from foodborne outbreaks) were used to determine genotype distribution in relation to age and setting. NoV GII.4 was more prevalent among inpatients than among patients in community settings or those who became infected during foodborne outbreaks...

  2. Norovirus epidemiology in community and health care settings and association with patient age, Denmark.

    Science.gov (United States)

    Franck, Kristina T; Fonager, Jannik; Ersbøll, Annette K; Böttiger, Blenda

    2014-07-01

    Norovirus (NoV) is a major cause of gastroenteritis. NoV genotype II.4 (GII.4) is the predominant genotype in health care settings but the reason for this finding is unknown. Stool samples containing isolates with a known NoV genotype from 2,109 patients in Denmark (patients consulting a general practitioner or outpatient clinic, inpatients, and patients from foodborne outbreaks) were used to determine genotype distribution in relation to age and setting. NoV GII.4 was more prevalent among inpatients than among patients in community settings or those who became infected during foodborne outbreaks. In community and health care settings, we found an association between infection with GII.4 and increasing age. Norovirus GII.4 predominated in patients ≥ 60 years of age and in health care settings. A larger proportion of children than adults were infected with NoV GII.3 or GII.P21. Susceptibility to NoV infection might depend on patient age and infecting NoV genotype. Cohort studies are warranted to test this hypothesis.

  3. County-Level Poverty Is Equally Associated with Unmet Health Care Needs in Rural and Urban Settings

    Science.gov (United States)

    Peterson, Lars E.; Litaker, David G.

    2010-01-01

    Context: Regional poverty is associated with reduced access to health care. Whether this relationship is equally strong in both rural and urban settings or is affected by the contextual and individual-level characteristics that distinguish these areas, is unclear. Purpose: Compare the association between regional poverty with self-reported unmet…

  4. Associations between structural quality aspects and process quality in Dutch early childhood education and care settings

    NARCIS (Netherlands)

    Slot, P.L.; Leseman, P.P.M.; Verhagen, J.; Mulder, H.

    2015-01-01

    The relationship between structural quality and process quality in early childhood education and care (ECEC) has been addressed in several studies. However, the findings are not conclusive. The present study was conducted in the Netherlands, which has a strongly regulated mid-quality ECEC system reg

  5. Parental Perceptions of Child Care Quality in Centre-Based and Home-Based Settings: Associations with External Quality Ratings

    Science.gov (United States)

    Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie

    2015-01-01

    The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…

  6. Socioeconomic Factors Associated With Posthospitalization Hospice Care Settings: A 5-Year Perspective.

    Science.gov (United States)

    Kirkendall, Abbie; Shen, Jay J; Greenway, Joseph; Bai, Wenbo

    2016-04-01

    Investigating whether socioeconomic characteristics determine if hospice is received at home or in a medical facility is important to examine, considering most patients prefer to die at home. This study relied upon The State Inpatient Data of Nevada. A total of 19 206 discharges were analyzed from the data set between 2009 and 2013. The results indicate that increasingly patients are being discharged to home and overall socioeconomic characteristics appear to have less of an influence over whether hospice is received at home or in a medical facility. Further research on the perspectives of patients would provide insight into whether patients' preferences or socioeconomic characteristics are more influential on where hospice services are received.

  7. Factors associated with constructive staff-family relationships in the care of older adults in the institutional setting.

    Science.gov (United States)

    Haesler, Emily; Bauer, Michael; Nay, Rhonda

    2006-12-01

    Background  Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives  The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff-family relationships. Search strategy  A literature search was performed using the following databases for the years 1990-2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage

  8. Factors associated with health information exchange system usage in a safety-net ambulatory care clinic setting.

    Science.gov (United States)

    Vest, Joshua R; Gamm, Larry D; Ohsfeldt, Robert L; Zhao, Hongwei; Jasperson, 'Jon Sean

    2012-08-01

    The Meaningful Use criteria promises to make health information exchange (HIE) much more widespread. However, the usage of the information systems made available by existing HIE efforts tends to be very low. This study sought to examine the factors associated with usage of an operational HIE system during ambulatory care visits to safety-net clinics. Overall the HIE system was accessed for 21% of encounters. However, system access took on two distinct forms. In general, usage was more likely for patients with recent emergency department visits and chronic conditions. This study indicates the organizational commitment to engage in HIE does not necessarily mean that the information systems will be always used. In addition, system usage will take on various forms for different reasons. These results reveal considerations for the development, operation and evaluation of HIE efforts.

  9. American Health Care Association

    Science.gov (United States)

    ... Care Association Responds to Ruling on Injunction Delaying CMS Implementation of Arbitration Rule AHCA/NCAL Elects New ... Information Technology Integrity Medicaid Medicare Patient Privacy and Security Survey and Regulatory Therapy Services Workforce Events Calendar ...

  10. Long Term Care Minimum Data Set (MDS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive...

  11. Factors associated with delayed entry into HIV medical care after HIV diagnosis in a resource-limited setting: Data from a cohort study in India

    Directory of Open Access Journals (Sweden)

    Gerardo Alvarez-Uria

    2013-06-01

    Full Text Available Studies from sub-Saharan Africa have shown that a substantial proportion of patients diagnosed with HIV enter into HIV medical care late. However, data from low or middle-income countries outside Africa are scarce. In this study, we investigated risk factors associated with delayed entry into care stratified by gender in a large cohort study in India. 7701 patients were diagnosed with HIV and 5410 entered into care within three months of HIV diagnosis. Nearly 80% entered into care within a year, but most patients who did not enter into care within a year remained lost to follow up or died. Patient with risk factors related to having a low socio-economic status (poverty, being homeless, belonging to a disadvantaged community and illiteracy were more likely to enter into care late. In addition, male gender and being asymptomatic at the moment of HIV infection were factors associated with delayed entry into care. Substantial gender differences were found. Younger age was found to be associated with delayed entry in men, but not in women. Widows and unmarried men were more likely to enter into care within three months. Women belonging to disadvantaged communities or living far from a town were more likely to enter into care late. The results of this study highlight the need to improve the linkage between HIV diagnosis and HIV treatment in India. HIV programmes should monitor patients diagnosed with HIV until they engage in HIV medical care, especially those at increased risk of attrition.

  12. Predictors of community-associated Staphylococcus aureus, methicillin-resistant and methicillin-susceptible Staphylococcus aureus skin and soft tissue infections in primary-care settings.

    Science.gov (United States)

    Lee, G C; Hall, R G; Boyd, N K; Dallas, S D; DU, L C; Treviño, L B; Retzloff, C; Treviño, S B; Lawson, K A; Wilson, J P; Olsen, R J; Wang, Y; Frei, C R

    2016-11-01

    Skin and soft tissue infections (SSTIs) due to Staphylococcus aureus have become increasingly common in the outpatient setting; however, risk factors for differentiating methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) SSTIs are needed to better inform antibiotic treatment decisions. We performed a case-case-control study within 14 primary-care clinics in South Texas from 2007 to 2015. Overall, 325 patients [S. aureus SSTI cases (case group 1, n = 175); MRSA SSTI cases (case group 2, n = 115); MSSA SSTI cases (case group 3, n = 60); uninfected control group (control, n = 150)] were evaluated. Each case group was compared to the control group, and then qualitatively contrasted to identify unique risk factors associated with S. aureus, MRSA, and MSSA SSTIs. Overall, prior SSTIs [adjusted odds ratio (aOR) 7·60, 95% confidence interval (CI) 3·31-17·45], male gender (aOR 1·74, 95% CI 1·06-2·85), and absence of healthcare occupation status (aOR 0·14, 95% CI 0·03-0·68) were independently associated with S. aureus SSTIs. The only unique risk factor for community-associated (CA)-MRSA SSTIs was a high body weight (⩾110 kg) (aOR 2·03, 95% CI 1·01-4·09).

  13. Are decreases in drug use risk associated with reductions in HIV sex risk behaviors among adults in an urban hospital primary care setting?

    Directory of Open Access Journals (Sweden)

    Angela Wangari Walter, PhD, MPH, MSW

    2016-12-01

    Full Text Available Drug use is associated with increased sexual risk behaviors. We examined whether decreases in drug use risk are associated with reduction in HIV-related sex risk behaviors among adults. Data was from a cohort of participants (n = 574 identified by drug use screening in a randomized trial of brief intervention for drug use in an urban primary care setting. Inverse probability of treatment weighted (IPTW logistic regression models were used to examine the relationship between decreases in drug use risk and sex-related HIV risk behavior reduction from study entry to six months. Weights were derived from propensity score modeling of decreases in drug use risk as a function of potential confounders. Thirty seven percent of the study participants (213/574 reported a decrease in drug use risk, and 7% (33/505 reported decreased sex-related HIV risk behavior at the six-month follow-up point. We did not detect a difference in reduction of risky sexual behaviors for those who decreased drug use risk (unadjusted: OR 1.32, 95% CI 0.65–2.70; adjusted OR [AOR] 1.12, 95% CI 0.54–2.36. Adults who screened positive for high drug use risk had greater odds of reducing sex risk behavior in unadjusted analyses OR 3.71, 95% CI 1.81–7.60; but the results were not significant after adjusting for confounding AOR 2.50, 95% CI 0.85–7.30. In this primary care population, reductions in HIV sex risk behaviors have complex etiologies and reductions in drug use risk do not appear to be an independent predictor of them.

  14. Association of over-the-counter pharmaceutical sales with influenza-like-illnesses to patient volume in an urgent care setting.

    Science.gov (United States)

    Liu, Timothy Y; Sanders, Jason L; Tsui, Fu-Chiang; Espino, Jeremy U; Dato, Virginia M; Suyama, Joe

    2013-01-01

    We studied the association between OTC pharmaceutical sales and volume of patients with influenza-like-illnesses (ILI) at an urgent care center over one year. OTC pharmaceutical sales explain 36% of the variance in the patient volume, and each standard deviation increase is associated with 4.7 more patient visits to the urgent care center (p<0.0001). Cross-correlation function analysis demonstrated that OTC pharmaceutical sales are significantly associated with patient volume during non-flu season (p<0.0001), but only the sales of cough and cold (p<0.0001) and thermometer (p<0.0001) categories were significant during flu season with a lag of two and one days, respectively. Our study is the first study to demonstrate and measure the relationship between OTC pharmaceutical sales and urgent care center patient volume, and presents strong evidence that OTC sales predict urgent care center patient volume year round.

  15. Pressure ulcer prevention in care home settings.

    Science.gov (United States)

    Ellis, Michael

    2017-03-31

    Pressure ulcer prevention in the care home setting can be challenging and is often compromised by a lack of access to education and resources. There are measures that have been shown to consistently improve outcomes in pressure ulcer prevention including assessment of the patient and their individual risks, delivery of a consistent plan of care that meets patients' needs, and regular evaluation to identify shortfalls. In addition, there should be a robust approach to investigating events that lead to a person developing a pressure ulcer and that information should be used to improve future practice. Pressure ulcer prevention in care homes is achievable and nurses should all be aware of the necessary measures detailed in this article.

  16. Neuroleptic malignant syndrome associated with haloperidol use in critical care setting: should haloperidol still be considered the drug of choice for the management of delirium in the critical care setting?

    Science.gov (United States)

    Dixit, Deepali; Shrestha, Pranabh; Adelman, Marc

    2013-07-12

    A 48-year-old man was brought to the emergency department because of intoxication. The patient was in respiratory distress, subsequently intubated for airway protection. On hospital day 5, he was diagnosed with delirium. Haloperidol was initiated at 5 mg intravenous every 6 h and titrated up to a dose of 60 mg /day over 5 days. On hospital day 18, his temperature peaked to 107.1°F. Other symptoms included mental status change, muscular rigidity and autonomic dysfunction. Neuroleptic malignant syndrome (NMS) associated with haloperidol was suspected. No other causes for these symptoms were present. Concurrent medications were reviewed and ruled out for possible drug-induced fever. Haloperidol was discontinued and dantrolene and bromocriptine was initiated. The temperature decreased to 102.2°F within 3 h and other symptoms resolved overtime. The temporal relationship between the patient's fever decline with the discontinuation of haloperidol, and improvement with dantrolene and bromocriptine, the diagnosis was believed to be haloperidol-induced NMS.

  17. Identifying and managing patients with delirium in acute care settings.

    Science.gov (United States)

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  18. Toward integrating a common nursing data set in home care to facilitate monitoring outcomes across settings.

    Science.gov (United States)

    Keenan, Gail; Stocker, Julia; Barkauskas, Violet; Treder, Marcy; Heath, Crystal

    2003-01-01

    The purpose of our research is to identify a realistic subset of North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC), and Nursing Interventions Classification (NIC) terms specific to the home care (HC) setting. A subset of 89 NOC outcomes were identified for study in HC through a baseline survey. Three research assistants then observed the care of 258 patients to whom the 89 NOC outcomes applied and recorded the associated NANDA and NIC terms. Follow-up surveys and focus groups were conducted with the nurses and research assistants. There were 81 different NANDA and 226 NIC labels used to describe study patients' care. Only 36 of the 89 NOC labels studied were deemed clinically useful for HC. We found that expert opinion about terminology usage before actual experience under practice conditions is unreliable.

  19. A Profile Approach to Child Care Quality, Quantity, and Type of Setting: Parent Selection of Infant Child Care Arrangements

    Science.gov (United States)

    Sosinsky, Laura Stout; Kim, Se-Kang

    2013-01-01

    Building on prior variable-oriented research which demonstrates the independence of the associations of child care quality, quantity, and type of setting with family factors and child outcomes, the current study identifies four profiles of child care dimensions from the NICHD Study of Early Child Care and Youth Development. Profiles accounted for…

  20. Quality assurance in the ambulatory care setting.

    Science.gov (United States)

    Tyler, R D

    1989-01-01

    One of the most utilitarian developments in the field of quality assurance in health care has been the introduction of industrial concepts of quality management. These concepts, coupled with buyer demand for accountability, are bringing new perspectives to health care quality assurance. These perspectives provide a new view of quality assurance as a major responsibility and strategic opportunity for management; a competitive and marketable commodity; and a method of improving safety, effectiveness, and satisfaction with medical care.

  1. Approach Merotopies and Associated Near Sets

    Directory of Open Access Journals (Sweden)

    James Peters

    2013-04-01

    Full Text Available This article introduces associated near sets of a collection of sets. The proposed approach introduces a means of defining as well as describing an ε-approach merotopy in terms of the members of associated sets of collections that are sufficiently near. A characterization for continuous functions is established using associated near sets. This article also introduces p-containment considered in the context of near sets. An application of the proposed approach is given in terms of digital image classification.

  2. Aesthetics in Asian Child Care Settings.

    Science.gov (United States)

    Honig, Alice S.

    This speech presents observations, made on a trip in June 1976, of the aesthetic environments of children in China, Japan, and Hong Kong. Home, school and day care environments are compared in terms of living and play space, room decor, the presence of art and toys, dramatic play and performance, music, nature and outdoor appreciation, food and…

  3. Emergence of infection control surveillance in alternative health care settings.

    Science.gov (United States)

    Clark, Pamela

    2010-01-01

    During the past decade, health care delivery has undergone enormous changes. The nationwide growth in managed care organizations and the changing methods of provider reimbursement are restructuring the entire health care system. Diversification and integration strategies have blurred historical separations between the activities of hospitals, nursing homes, physicians, and other providers. Services are being offered in and shifting to less costly settings, such as ambulatory clinics, work sites, and homes. Many factors have contributed to the increasing trend of health care delivery outside hospitals. This presentation will provide insight to the management and surveillance of infection prevention in these health care settings.

  4. Client Satisfaction with Delivery Care Service and Associated Factors in the Public Health Facilities of Gamo Gofa Zone, Southwest Ethiopia: In a Resource Limited Setting

    Directory of Open Access Journals (Sweden)

    Rahel Tesfaye

    2016-01-01

    Full Text Available Background. Ensuring patient satisfaction is an important means of secondary prevention of maternal mortality. This study presents findings from a multidimensional study of client satisfaction from the Gamo Gofa Zone in Southwest Ethiopia. Methods. A facility based cross-sectional study using exit interviews was conducted from 2014. Client satisfaction was measured using a survey adopted from the Donabedian quality assessment framework. Thirteen health institutions were randomly sampled of 66 institutions in Gamo Gofa Zone. Logistic regression was used to determine predictors of client satisfaction. Results. The overall satisfaction level of the clients in this study was 79.1% with (95% CI; 75–82. Women attending health centres were more likely satisfied than women attending hospitals (χ2=83.7, df=12, P<0.001. The proportion of women who complained about an unfriendly attitude or unresentful care from health workers was higher in the hospitals (χ2=27.4, df=1, P<0.001. The presence of support persons during child birth improved client satisfaction (AOR = 6.23 95% CI; 2.75–14.1 and women who delivered with caesarean section are four times more likely satisfied than those who deliver vaginally (AOR 3.6 95% CI; 1.44–9.06. Client satisfaction was reduced if the women had to pay for the services (AOR = 0.27 95% CI; 0.09–81. Conclusions. The study shows that overall satisfaction level is good. More emphasis should be put on giving women friendly care, particularly at the hospitals.

  5. Client Satisfaction with Delivery Care Service and Associated Factors in the Public Health Facilities of Gamo Gofa Zone, Southwest Ethiopia: In a Resource Limited Setting.

    Science.gov (United States)

    Tesfaye, Rahel; Worku, Amare; Godana, Wanzahun; Lindtjorn, Bernt

    2016-01-01

    Background. Ensuring patient satisfaction is an important means of secondary prevention of maternal mortality. This study presents findings from a multidimensional study of client satisfaction from the Gamo Gofa Zone in Southwest Ethiopia. Methods. A facility based cross-sectional study using exit interviews was conducted from 2014. Client satisfaction was measured using a survey adopted from the Donabedian quality assessment framework. Thirteen health institutions were randomly sampled of 66 institutions in Gamo Gofa Zone. Logistic regression was used to determine predictors of client satisfaction. Results. The overall satisfaction level of the clients in this study was 79.1% with (95% CI; 75-82). Women attending health centres were more likely satisfied than women attending hospitals (χ (2) = 83.7, df = 12, P < 0.001). The proportion of women who complained about an unfriendly attitude or unresentful care from health workers was higher in the hospitals (χ (2) = 27.4, df = 1, P < 0.001). The presence of support persons during child birth improved client satisfaction (AOR = 6.23 95% CI; 2.75-14.1) and women who delivered with caesarean section are four times more likely satisfied than those who deliver vaginally (AOR 3.6 95% CI; 1.44-9.06). Client satisfaction was reduced if the women had to pay for the services (AOR = 0.27 95% CI; 0.09-81). Conclusions. The study shows that overall satisfaction level is good. More emphasis should be put on giving women friendly care, particularly at the hospitals.

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

    Directory of Open Access Journals (Sweden)

    Cilene Saghabi de Medeiros Silva

    2012-09-01

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

  7. Goal setting: an integral component of effective diabetes care.

    Science.gov (United States)

    Miller, Carla K; Bauman, Jennifer

    2014-08-01

    Goal setting is a widely used behavior change tool in diabetes education and training. Prior research found specific relatively difficult but attainable goals set within a specific timeframe improved performance in sports and at the workplace. However, the impact of goal setting in diabetes self-care has not received extensive attention. This review examined the mechanisms underlying behavioral change according to goal setting theory and evaluated the impact of goal setting in diabetes intervention studies. Eight studies were identified, which incorporated goal setting as the primary strategy to promote behavioral change in individual, group-based, and primary care settings among patients with type 2 diabetes. Improvements in diabetes-related self-efficacy, dietary intake, physical activity, and A1c were observed in some but not all studies. More systematic research is needed to determine the conditions and behaviors for which goal setting is most effective. Initial recommendations for using goal setting in diabetes patient encounters are offered.

  8. Mental health collaborative care and its role in primary care settings.

    Science.gov (United States)

    Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S

    2013-08-01

    Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.

  9. The Influence of Setting on Care Coordination for Childhood Asthma.

    Science.gov (United States)

    Kelly, R Patrick; Stoll, Shelley C; Bryant-Stephens, Tyra; Janevic, Mary R; Lara, Marielena; Ohadike, Yvonne U; Persky, Victoria; Ramos-Valencia, Gilberto; Uyeda, Kimberly; Malveaux, Floyd J

    2015-11-01

    Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings-school district, clinic or health care system, and community-and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team.

  10. Common presentations of elder abuse in health care settings.

    Science.gov (United States)

    Powers, James S

    2014-11-01

    Health care professionals encounter elder abuse in the community and in medical offices, emergency rooms, hospitals, and long-term care facilities. Keen awareness of risk factors for elder abuse and the variety of presentations in different health settings helps promote detection, treatment, and prevention of elder abuse.

  11. Doctoral Clinical Geropsychology Training in a Primary Care Setting

    Science.gov (United States)

    Zweig, Richard A.; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory

    2005-01-01

    Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica,…

  12. Health care priority setting in Norway a multicriteria decision analysis

    NARCIS (Netherlands)

    Defechereux, T.; Paolucci, F.; Mirelman, A.; Youngkong, S.; Botten, G.; Hagen, T.P.; Niessen, L.W.

    2012-01-01

    BACKGROUND: Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and tr

  13. Filipino Arts among Elders in Institutionalized Care Settings

    Science.gov (United States)

    de Guzman, Allan B.; Satuito, James Cyril B.; Satumba, Miko Anne E.; Segui, Diego Rey A.; Serquina, Faith Evelyn C.; Serrano, Lawrence Jan P.; Sevilla, Madelyn D.

    2011-01-01

    The use of traditional art in recreational therapies is unexplored. This paper, thus, attempts to surface the unique power of traditional Filipino arts (TFA) as synergizing lens in capturing the individual and the collective experiences of a select group of Filipino elderly in an institutionalized care setting relative to their feelings of…

  14. Supporting relationships between family and staff in continuing care settings.

    Science.gov (United States)

    Austin, Wendy; Goble, Erika; Strang, Vicki; Mitchell, Agnes; Thompson, Elizabeth; Lantz, Helen; Balt, Linda; Lemermeyer, Gillian; Vass, Kelly

    2009-08-01

    In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family-staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of "Everybody Knows Your Name," "Loss and Laundry," "It's the Little Things That Count," and "The Chasm of Us Versus Them." Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family- staff relationships in traditional continuing care settings in Canada.

  15. [Essential data set's archetypes for nursing care of endometriosis patients].

    Science.gov (United States)

    Spigolon, Dandara Novakowski; Moro, Claudia Maria Cabral

    2012-12-01

    This study aimed to develop an Essential Data Set for Nursing Care of Patients with Endometriosis (CDEEPE), represented by archetypes. An exploratory applied research with specialists' participation that was carried out at Heath Informatics Laboratory of PUCPR, between February and November of 2010. It was divided in two stages: CDEEPE construction and evaluation including Nursing Process phases and Basic Human Needs, and archetypes development based on this data set. CDEEPE was evaluated by doctors and nurses with 95.9% of consensus and containing 51 data items. The archetype "Perception of Organs and Senses" was created to represents this data set. This study allowed identifying important information for nursing practices contributing to computerization and application of nursing process during care. The CDEEPE was the basis for archetype creation, that will make possible structured, organized, efficient, interoperable, and semantics records.

  16. Decentralized health care priority-setting in Tanzania

    DEFF Research Database (Denmark)

    Maluka, Stephen; Kamuzora, Peter; Sebastiån, Miguel San

    2010-01-01

    care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents......Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health...... not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level...

  17. An Expanded Theoretical Framework of Care Coordination Across Transitions in Care Settings.

    Science.gov (United States)

    Radwin, Laurel E; Castonguay, Denise; Keenan, Carolyn B; Hermann, Cherice

    2016-01-01

    For many patients, high-quality, patient-centered, and cost-effective health care requires coordination among multiple clinicians and settings. Ensuring optimal care coordination requires a clear understanding of how clinician activities and continuity during transitions affect patient-centeredness and quality outcomes. This article describes an expanded theoretical framework to better understand care coordination. The framework provides clear articulation of concepts. Examples are provided of ways to measure the concepts.

  18. Palliative care case management in primary care settings: A nationwide survey

    NARCIS (Netherlands)

    Plas, A.G. van der; Deliens, L.; Watering, M. van de; Jansen, W.J.; Vissers, K.C.P.; Onwuteaka-Philipsen, B.D.

    2013-01-01

    BACKGROUND: In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the

  19. Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions.

    Science.gov (United States)

    Apker, Julie; Propp, Kathleen M; Zabava Ford, Wendy S; Hofmeister, Nancee

    2006-01-01

    This study explored how nurses communicate professionalism in interactions with members of their health care teams. Extant research show that effective team communication is a vital aspect of a positive nursing practice environment, a setting that has been linked to enhanced patient outcomes. Although communication principles are emphasized in nursing education as an important component of professional nursing practice, actual nurse interaction skills in team-based health care delivery remain understudied. Qualitative analysis of interview transcripts with 50 participants at a large tertiary hospital revealed four communicative skill sets exemplified by nursing professionals: collaboration, credibility, compassion, and coordination. Study findings highlight specific communicative behaviors associated with each skill set that exemplify nurse professionalism to members of health care teams. Theoretical and pragmatic conclusions are drawn regarding the communicative responsibilities of professional nurses in health care teams. Specific interaction techniques that nurses could use in nurse-team communication are then offered for use in baccalaureate curriculum and organizational in-service education.

  20. Care coordination for patients with complex health profiles in inpatient and outpatient settings.

    Science.gov (United States)

    Berry, Leonard L; Rock, Beth L; Smith Houskamp, Beth; Brueggeman, Joan; Tucker, Lois

    2013-02-01

    Patients with the most complex health profiles consume a disproportionate percentage of health care expenditures, yet often receive fragmented, suboptimal care. Since 2003, Wisconsin-based Gundersen Health has improved the quality of life and reduced the cost burden of patients with complex health profiles with an integrated care coordination program. Those results are consistent with data from the most successful care coordination demonstration projects funded by the Centers for Medicare and Medicaid Services. Specifically, Gundersen's program has been associated with reduced hospital stays, lower costs for inpatients, less use of inpatient services, and increased patient satisfaction. Gundersen's success is rooted in its team-based approach to coordinated care. Teams, led by a subspecialty-trained nurse, have regular, face-to-face contact with patients and their physicians in both inpatient and outpatient settings; involve patients deeply in care-related decisions; access a system-wide electronic medical record database that tracks patients' care; and take a macrolevel view of care-related factors and costs. Gundersen's model offers specific take-home lessons for institutions interested in coordinated care as they design programs aimed at improving quality and lowering costs. This institutional case study provides a window into well-executed care coordination at a large health care system in an era when major changes in health care provision and reimbursement mechanisms are on the horizon.

  1. Cervical cancer screening in primary health care setting in Sudan

    DEFF Research Database (Denmark)

    Ibrahim, Ahmed; Aro, Arja R.; Rasch, Vibeke;

    2012-01-01

    OBJECTIVE: To determine the feasibility of visual inspection with the use of acetic acid (VIA) as a screening method for cervical cancer, an alternative to the Pap smear used in primary health care setting in Sudan, and to compare sensitivity, specificity, positive and negative predictive values....../119 (73.9%) were positive for cervical intraepithelial neoplasia. VIA had higher sensitivity than Pap smear (74.2% versus 72.9%; P = 0.05) respectively. Out of 88 confirmed positive cases, 22 (25.0%) cases were invasive cervical cancer in stage 1, of which 19 versus three were detected by VIA and Pap...... of this study showed that VIA has higher sensitivity and lower specificity compared to Pap smear, but a combination of both tests has greater sensitivity and specificity than each test independently. It indicates that VIA is useful for screening of cervical cancer in the primary health care setting in Sudan...

  2. Treatment of acute burn blisters in unscheduled care settings.

    Science.gov (United States)

    Payne, Sarah; Cole, Elaine

    2012-09-01

    Many patients with minor burns present at emergency departments and urgent care centres, where their management is often undertaken by experienced nurses rather than experts in treating burns. This article describes a small study of the clinical decision making that underpins nurses' management of minor burns in these non-specialist settings. The results suggest that, due to a lack of relevant research, nurses base their decisions on previous experience or expert colleagues' opinions and advice rather than on the evidence.

  3. CD-Based Microfluidics for Primary Care in Extreme Point-of-Care Settings

    Directory of Open Access Journals (Sweden)

    Suzanne Smith

    2016-01-01

    Full Text Available We review the utility of centrifugal microfluidic technologies applied to point-of-care diagnosis in extremely under-resourced environments. The various challenges faced in these settings are showcased, using areas in India and Africa as examples. Measures for the ability of integrated devices to effectively address point-of-care challenges are highlighted, and centrifugal, often termed CD-based microfluidic technologies, technologies are presented as a promising platform to address these challenges. We describe the advantages of centrifugal liquid handling, as well as the ability of a standard CD player to perform a number of common laboratory tests, fulfilling the role of an integrated lab-on-a-CD. Innovative centrifugal approaches for point-of-care in extremely resource-poor settings are highlighted, including sensing and detection strategies, smart power sources and biomimetic inspiration for environmental control. The evolution of centrifugal microfluidics, along with examples of commercial and advanced prototype centrifugal microfluidic systems, is presented, illustrating the success of deployment at the point-of-care. A close fit of emerging centrifugal systems to address a critical panel of tests for under-resourced clinic settings, formulated by medical experts, is demonstrated. This emphasizes the potential of centrifugal microfluidic technologies to be applied effectively to extremely challenging point-of-care scenarios and in playing a role in improving primary care in resource-limited settings across the developing world.

  4. Priority Setting, Cost-Effectiveness, and the Affordable Care Act.

    Science.gov (United States)

    Persad, Govind

    2015-01-01

    The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

  5. Pain management in the acute care setting: Update and debates.

    Science.gov (United States)

    Palmer, Greta M

    2016-02-01

    Pain management in the paediatric acute care setting is underutilised and can be improved. An awareness of the analgesic options available and their limitations is an important starting point. This article describes the evolving understanding of relevant pharmacogenomics and safety data of the various analgesic agents with a focus on agents available in Australia and New Zealand. It highlights the concerns with the use of codeine in children and discusses alternative oral opioids. Key features of oral, parenteral, inhaled and intranasal analgesic agents are discussed, as well as evidence supported use of sweet tasting solutions and non-pharmacological interventions. One of the biggest changes in acute care pain management has been the advent of intranasal fentanyl providing reliable potent analgesia without the need for intravenous access. The article will also address the issue of multimodal analgesia where a single agent is insufficient.

  6. Mental health in humanitarian settings: shifting focus to care systems.

    Science.gov (United States)

    Jordans, Mark J D; Tol, Wietse A

    2013-03-01

    Mental health in low- and middle income countries has received increasing attention. This attention has shifted focus, roughly moving from demonstrating the burden of mental health problems, to establishing an evidence base for interventions, to thinking about care delivery frameworks. This paper reviews these trends specifically for humanitarian settings and discusses lessons learned. Notably, that mental health assessments need to go beyond measuring the impact of traumatic events on circumscribed psychiatric disorders; that evidence for effectiveness of interventions is still too weak and its focus too limited; and that development of service delivery in the context of instable community and health systems should be an area of key priority.

  7. Healthy incentive scheme in the Irish full-day-care pre-school setting.

    LENUS (Irish Health Repository)

    Molloy, C Johnston

    2013-12-16

    A pre-school offering a full-day-care service provides for children aged 0-5 years for more than 4 h\\/d. Researchers have called for studies that will provide an understanding of nutrition and physical activity practices in this setting. Obesity prevention in pre-schools, through the development of healthy associations with food and health-related practices, has been advocated. While guidelines for the promotion of best nutrition and health-related practice in the early years\\' setting exist in a number of jurisdictions, associated regulations have been noted to be poor, with the environment of the child-care facility mainly evaluated for safety. Much cross-sectional research outlines poor nutrition and physical activity practice in this setting. However, there are few published environmental and policy-level interventions targeting the child-care provider with, to our knowledge, no evidence of such interventions in Ireland. The aim of the present paper is to review international guidelines and recommendations relating to health promotion best practice in the pre-school setting: service and resource provision; food service and food availability; and the role and involvement of parents in pre-schools. Intervention programmes and assessment tools available to measure such practice are outlined; and insight is provided into an intervention scheme, formulated from available best practice, that was introduced into the Irish full-day-care pre-school setting.

  8. American Association of Critical-Care Nurses

    Science.gov (United States)

    ... of Certification APRN Resources Education State-of-the-art educational programs provide evidence- based knowledge, directly applicable to practice ... Policy Disclaimer © American Association of Critical-Care Nurses Learn ...

  9. Oral ketamine in the palliative care setting: a review of the literature and case report of a patient with neurofibromatosis type 1 and glomus tumor-associated complex regional pain syndrome.

    Science.gov (United States)

    Soto, Eliezer; Stewart, Douglas R; Mannes, Andrew J; Ruppert, Sarah L; Baker, Karen; Zlott, Daniel; Handel, Daniel; Berger, Ann M

    2012-06-01

    Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to be effective not only for its anesthetic properties but also for the analgesic and opiate-sparing effects. However, data on efficacy and safety of oral ketamine for the treatment of neuropathic or cancer pain syndromes is limited with most of the evidence based on small clinical trials and anecdotal experiences. In this review, we will analyze the clinical data on oral ketamine in the palliative care setting. After an extensive search using five major databases, a total of 19 relevant articles were included. No official clinical guidelines for the use of oral ketamine in this patient population were found. Studies on oral ketamine for cancer and neuropathic pain have shown mixed results which could be partially due to significant differences in hepatic metabolism. In addition, we will include a case report of a 38-year-old female with neurofibromatosis type 1 (NF1) with history of chronic, severe pain in her fingertips secondary to multiple glomus tumors which evolved into CRPS resistant to multiple therapies but responsive to oral ketamine. Based on our experience with oral ketamine, this drug should be administered after an intravenous trial to monitor response and side effects in patients with an adequate functional status. However, patients in the palliative care and hospice setting, especially the one at the end of their lives, may also benefit from oral ketamine even if an intravenous trial is not feasible.

  10. Care priorities- Registered Nurses' clinical daily work in municipal elderly care settings.

    Science.gov (United States)

    Norell, Margaretha; Ziegert, Kristina; Kihlgren, Annica

    2013-06-01

    Common in Swedish elderly home care is that Registered Nurses work independently, and lead the care team without being a part of it. People involved in the care of the patient can be social services, physician, Registered Nurse (RN), nurses in inpatient care and family. In according to current model for nursing documentation RNs interventions is described as participation, information/education, support, environment, general care, training, observation/surveillance, special care drug administration and coordination. Time pressure is perceived as high, but the nurses have the opportunity to influence their daily work situation and make priorities. The purpose of this study was to investigate how RNs prioritise interventions in municipal elderly care settings. A quantitative descriptive method was used for the study. Data were collected during the months of April and October 2004 - 2008, using a web-based form. The nurses filled in patient's type of housing, performed interventions, and if the interventions were delegated. Interventions were described as keywords and were attributed a certain amount of time, calculated in previous time studies. The inclusion criteria were: all patients 80 years of age and older, in a municipality in south-western Sweden, who received some form of health care from a RN, or performed by non-certified staff by delegation. Results indicate that differences in priority could be observed, depending on the patient's gender, or whether the patient was living in independent or sheltered housing. Drug administration was prioritised for female patients, while coordination became a priority for patients living in ordinary housing. Support received the highest priority, regardless if the patient lived in ordinary or sheltered housing. However, it is not entirely clear what support signifies in municipal health care settings, and this issue would therefore require further investigation.

  11. Sedation with dexmedetomidine in the intensive care setting

    Directory of Open Access Journals (Sweden)

    Gerlach AT

    2011-11-01

    Full Text Available Anthony T Gerlach, Claire V Murphy The Ohio State University Medical Center, Ohio State University, Columbus, OH, USA Abstract: Dexmedetomidine is an α-2 agonist that produces sedation and analgesia without compromising the respiratory drive. Use of dexmedetomidine as a sedative in the critically ill is associated with fewer opioid requirements compared with propofol and a similar time at goal sedation compared with benzodiazepines. Dexmedetomidine may produce negative hemodynamic effects including lower mean heart rates and potentially more bradycardia than other sedatives used in the critically ill. Recent studies have demonstrated that dexmedetomidine is safe at higher dosages, but more studies are needed to determine whether the efficacy of dexmedetomidine is dose dependent. In addition, further research is required to define dexmedetomidine's role in the care of delirious critically ill patients, as many, but not all, studies have indicated favorable outcomes. Keywords: dexmedetomidine, sedation, critical care

  12. High Job Demands and Low Job Control Increase Nurses' Professional Leaving Intentions: The Role of Care Setting and Profit Orientation.

    Science.gov (United States)

    Wendsche, Johannes; Hacker, Winfried; Wegge, Jürgen; Rudolf, Matthias

    2016-10-01

    We investigated how two types of care setting (home care and nursing home) and type of ownership (for-profit vs. public/non-profit) of geriatric care services interacted in influencing registered nurses' intention to give up their profession. In prior research, employment in for-profit-organizations, high job demands, and low job control were important antecedents of nurses' intent to leave. However, the impact of care setting on these associations was inconclusive. Therefore, we tested a mediated moderation model predicting that adverse work characteristics would drive professional leaving intentions, particularly in for-profit services and in nursing homes. A representative German sample of 304 registered nurses working in 78 different teams participated in our cross-sectional study. As predicted, lower job control and higher job demands were associated with higher professional leaving intentions, and nurses reported higher job demands in public/non-profit care than in for-profit care, and in nursing homes compared to home care. Overall, RNs in nursing homes and home care reported similar intent to leave, but in for-profit settings only, nurses working in nursing homes reported higher professional leaving intentions than did nurses in home care, which was linked to lower job control in the for-profit nursing home setting, supporting mediated moderation. Taken together, our results indicate that the interplay of care setting and type of ownership is important when explaining nurses' intentions to give up their profession. © 2016 Wiley Periodicals, Inc.

  13. Prevalence of Sarcopenia and Associated Outcomes in the Clinical Setting.

    Science.gov (United States)

    Peterson, Sarah J; Braunschweig, Carol A

    2016-02-01

    Sarcopenia refers to age-associated decrease in muscle mass and function. The condition was originally described in the elderly, but emerging evidence suggests that it is also a concern among the chronically ill nonelderly. Currently there are a number of definitions for diagnosing sarcopenia; however, in the clinical setting, abdominal computed tomography (CT) scans completed for diagnostic purposes can be utilized to identify CT-defined sarcopenia. Recent studies suggest that prevalence of CT-defined sarcopenia is high among chronically ill patients, ranging from 15%-50% in patients with cancer, 30%-45% with liver failure, and 60%-70% for critically ill patients in the intensive care unit. Depleted muscle mass is associated with infectious complications, prolonged duration of mechanical ventilation, longer hospitalization, greater need for rehabilitation care after hospital discharge, and higher mortality. In consideration of the growing population of older adults with multiple comorbidities, more research is needed to identify sarcopenia and develop interventions that are directed at attenuating or reversal muscle loss.

  14. Health care priority setting: principles, practice and challenges

    Directory of Open Access Journals (Sweden)

    Donaldson Cam

    2004-04-01

    Full Text Available Abstract Background Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA. Methods This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries. Results At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care. Conclusion Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated.

  15. The use of spirometry in a primary care setting

    Directory of Open Access Journals (Sweden)

    Elizabeth A Blain

    2009-10-01

    Full Text Available Elizabeth A Blain, Timothy J CraigPenn State Hershey Medical Center, Hershey, PA, USAObjective: To determine the use of spirometry in family practice, internal medicine, and pediatric outpatient settings.Methods: Data were collected from 45 outpatient offices in the central Pennsylvania area via phone survey that asked a set of four questions: 1 Do you have spirometry in your office? 2 Do you use spirometry for asthma patients? 3 In what situation do you use spirometry for? 4 Do you use spirometry more for chronic obstructive pulmonary disease (COPD or asthma? Results: It was found that pediatricians used spirometry 66% of the time, family practitioners 47% of the time, and internal medicine practitioners 60% of the time. Of those who did not use spirometry, 94% stated that they refer to a hospital if they required spirometry and 6% referred to subspecialists if the patient required spirometry. 10% of pediatricians performed the test on each asthma visit, otherwise the others used it only for exacerbations or as a baseline. No internists used spirometry regularly for asthma patients, and 22% used it more for COPD. In family practice only 14% used spirometry routinely at each visit for asthma patients.Conclusions: Pediatricians used spirometry more often in the outpatient setting than other specialists, followed closely by internal medicine physicians. Family practice physicians were the least likely to use spirometry. Multiple barriers seemed to prevent routine use of spirometry, but no one barrier accounted for the majority.Keywords: spirometry, asthma, primary care

  16. Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland

    Science.gov (United States)

    Bähler, Caroline; Signorell, Andri; Reich, Oliver

    2016-01-01

    Background Many efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer at the end-of-life. One of the consequences might be an increased need for hospitalisations at the end-of-life, which goes along with burdensome transitions for patients and higher health care costs for the society. Aim We aimed to examine the health care utilisation in the last six months of life, including transitions between health care settings, in a Swiss adult population. Methods The study population consisted of 11'310 decedents of 2014 who were insured at the Helsana Group, the leading health insurance in Switzerland. Descriptive statistics were used to analyse the health care utilisation by age group, taking into account individual and regional factors. Zero-inflated Poisson regression model was used to predict the number of transitions. Results Mean age was 78.1 in men and 83.8 in women. In the last six months of life, 94.7% of the decedents had at least one consultation; 61.6% were hospitalised at least once, with a mean length of stay of 28.3 days; and nursing home stays were seen in 47.4% of the decedents. Over the same time period, 64.5% were transferred at least once, and 12.9% experienced at least one burdensome transition. Main predictors for transitions were age, sex and chronic conditions. A high density of home care nurses was associated with a decrease, whereas a high density of ambulatory care physicians was associated with an increase in the number of transitions. Conclusions Health care utilisation was high in the last six months of life and a considerable number of decedents were being transferred. Advance care planning might prevent patients from numerous and particularly from burdensome transitions. PMID:27598939

  17. Pseudomonas bronchopulmonary infections in a palliative care setting

    Directory of Open Access Journals (Sweden)

    Naveen Salins

    2015-04-01

    Full Text Available Blood stream infections and pneumonia caused by Pseudomonas aeruginosa is associated with high mortality, especially in an immunocompromised host. A large section of the palliative care patient population has varied forms of compromised immunity due to advanced cancer or cancer treatment, organ failures, chronic autoimmune disorders, degenerative conditions, and acquired immunodeficiency syndrome. The lung is one of the most frequently involved organs in a variety of complications in an immunocompromised host and infection is the most common complication. P. aeruginosa is one of the most common pathogens associated with bronchopulmonary infections in an immunocompromised host. Routine radiological tests like chest X-ray may often be unyielding and an early and a prompt initiation of treatment reduces mortality and morbidity risk.

  18. Establishing research in a palliative care clinical setting: perceived barriers and implemented strategies.

    Science.gov (United States)

    Bullen, Tracey; Maher, Kate; Rosenberg, John P; Smith, Bradley

    2014-02-01

    There are many challenges in developing research projects in research-naïve clinical settings, especially palliative care where resistance to participate in research has been identified. These challenges to the implementation of research are common in nursing practice and are associated with attitudes towards research participation, and some lack of understanding of research as a process to improve clinical practice. This is despite the professional nursing requirement to conduct research into issues that influence palliative care practice. The purpose of this paper is to describe the process of implementing a clinical research project in collaboration with the clinicians of a palliative care community team and to reflect on the strategies implemented to overcome the challenges involved. The challenges presented here demonstrate the importance of proactively implementing engagement strategies from the inception of a research project in a clinical setting.

  19. Transition between care settings at end of life in the Netherlands: results from a nationwide study.

    NARCIS (Netherlands)

    Abarshi, E.; Echteld, M.; Block, L. van den; Donker, G.; Deliens, L.; Onwuteaka-Philipsen, B.

    2009-01-01

    Background: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Objective: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to i

  20. Transition between care settings at end of life in the Netherlands: results from a nationwide study.

    NARCIS (Netherlands)

    Abarshi, E.; Echteld, M.; Block, L. van den; Donker, G.; Deliens, L.; Onwuteaka-Philipsen, B.

    2009-01-01

    Issue/problem: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Aim: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to iden

  1. Developing a Policy for Delegation of Nursing Care in the School Setting

    Science.gov (United States)

    Spriggle, Melinda

    2009-01-01

    School nurses are in a unique position to provide care for students with special health care needs in the school setting. The incidence of chronic conditions and improved technology necessitate care of complex health care needs that had formerly been managed in inpatient settings. Delegation is a tool that may be used by registered nurses to allow…

  2. Personalised medicine: Priority setting and opportunity costs in European public health care systems

    OpenAIRE

    Vollmann, Jochen

    2015-01-01

    “Personalised medicine” is currently attracting considerable attention and raising high hopes and expectations in modern medicine. The term “personalised medicine” denotes the use of genetic or other biomarker information, and it does not focus on a more personal patient-doctor relationship. Furthermore, personalised medicine is associated with ethical problems like priority setting and opportunity costs in solidarity-based public health care systems. Personalised medicine provides modern,...

  3. Challenges Associated With Using Large Data Sets for Quality Assessment and Research in Clinical Settings.

    Science.gov (United States)

    Cohen, Bevin; Vawdrey, David K; Liu, Jianfang; Caplan, David; Furuya, E Yoko; Mis, Frederick W; Larson, Elaine

    2015-08-01

    The rapidly expanding use of electronic records in health-care settings is generating unprecedented quantities of data available for clinical, epidemiological, and cost-effectiveness research. Several challenges are associated with using these data for clinical research, including issues surrounding access and information security, poor data quality, inconsistency of data within and across institutions, and a paucity of staff with expertise to manage and manipulate large clinical data sets. In this article, we describe our experience with assembling a data-mart and conducting clinical research using electronic data from four facilities within a single hospital network in New York City. We culled data from several electronic sources, including the institution's admission-discharge-transfer system, cost accounting system, electronic health record, clinical data warehouse, and departmental records. The final data-mart contained information for more than 760,000 discharges occurring from 2006 through 2012. Using categories identified by the National Institutes of Health Big Data to Knowledge initiative as a framework, we outlined challenges encountered during the development and use of a domain-specific data-mart and recommend approaches to overcome these challenges.

  4. Structure of associated sets to Midy's Property

    CERN Document Server

    Gilberto, García-Pulgarín; Miguel, Velásquez-Soto Juan

    2011-01-01

    Let $b$ be a positive integer greater than 1, $N$ a positive integer relatively prime to $b$, $ |b|_{N}$ the order of $b$ in the multiplicative group $% \\mathbb{U}_{N}$ of positive integers less than $N$ and relatively primes to $% N,$ and $x\\in\\mathbb{U}_{N}$. It is well known that when we write the fraction $\\frac{x}{N}$ in base $b$, it is periodic. Let $d,\\,k$ be positive integers with $% d\\geq2$ and such that $|b|_{N}=kd$ and $\\frac{x}{N}=0.% bar{a_{1}a_{2}...a_{|b|_{N}}}$ with the bar indicating the period and $a_{i}$ are digits in base $b$. We separate the period ${a_{1}a_{2}... a_{|b|_{N}}}$ in $d$ blocks of length $k$ and let $ A_{j}=[a_{(j-1)k+1}a_{(j-1)k+2}...a_{jk}]_{b} $ be the number represented in base $b$ by the $j-th$ block and $% S_{d}(x)=\\sum\\limits_{j=1}^{d}A_{j}$. If for all $x\\in\\mathbb{U}_{N}$, the sum $S_{d}(x)$ is a multiple of $b^{k}-1$ we say that $N$ has the Midy's property for $b$ and $d$. In this work we present some interesting properties of the set of positive integers $d$ such ...

  5. Customer care. Patient satisfaction in the prehospital setting.

    Science.gov (United States)

    Doering, G T

    1998-09-01

    The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew

  6. Health care priority setting in Norway a multicriteria decision analysis

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    Defechereux Thierry

    2012-02-01

    Full Text Available Abstract Background Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. Methods In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. Results The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Conclusions Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.

  7. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives

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    Lim CJ

    2014-01-01

    Full Text Available Ching Jou Lim,1 David CM Kong,1 Rhonda L Stuart2,31Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia; 2Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia; 3Department of Medicine, Monash University, Clayton, VIC, AustraliaAbstract: Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions.Keywords: residential aged care, health care-associated infection, surveillance, multidrug-resistant, antibiotic prescribing, antimicrobial stewardship

  8. Detection of autoantibodies in a point-of-care rheumatology setting.

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    Konstantinov, Konstantin N; Tzamaloukas, Antonios; Rubin, Robert L

    2013-08-01

    Autoimmune rheumatic diseases are common and confront society with serious medical, social, and financial burdens imposed by their debilitating nature. Many autoimmune diseases are associated with a particular set of autoantibodies, which have emerged as highly useful to define and classify disease, predict flares, or monitor efficacy of therapy. However, current practice for monitoring autoantibodies is protracted, labor-intensive, and expensive. This review provides an overview on the value of point-of-care (POC) biosensor technology in the diagnosis and management of patients with autoimmune rheumatic diseases. Real-time measurement of autoantibodies will clearly benefit the rheumatology practice in emergency and urgent care settings, where definitive diagnosis is essential for initiation of correct critical care therapy. Immediate serological information in clinic will provide considerable value for long-term patient care and an opportunity for an instant, result-deduced therapeutic action, avoiding delays and improving compliance, especially in field-based and remote areas. We describe the particular autoantibodies that are useful disease and activity markers and would, therefore, be attractive to POC applications. Already existing biosensors and platforms that show promise for autoantibody testing are summarized and comparatively evaluated. As POC assessment is gaining momentum in several areas of patient care, we propose that rheumatology is poised to benefit from this innovative and affordable technology.

  9. Quality assessment of child care services in primary health care settings of Central Karnataka (Davangere District

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    Rashmi

    2010-01-01

    Full Text Available Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community. Materials and Methods: Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50%, of the service provider. Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. Statistical Analysis: Proportions, Likert′s scale to grade the services and Chi-square. Results: Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother′s education andoutreach educational session . Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. Conclusion: Mothers education was not stressed by service providers. Service providers′ knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average.

  10. Diagnosing binge eating disorder in a primary care setting.

    Science.gov (United States)

    Montano, C Brendan; Rasgon, Natalie L; Herman, Barry K

    2016-01-01

    Binge eating disorder (BED), now recognized as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most prevalent eating disorder. Although nearly half of individuals with BED are obese, BED also occurs in nonobese individuals. Despite the relatively high percentage of weight loss treatment-seeking individuals meeting BED criteria, primary care physicians may not be familiar with or have ever diagnosed BED. Many providers may also have difficulty distinguishing BED as a contributory factor in obesity. This review differentiates BED from other causes of obesity by describing how obese individuals with BED differ from obese individuals without BED and from nonobese individuals with BED in areas including psychopathology, behavior, genetics, physiology, quality of life and productivity. The ways in which health-care providers can identify individuals who may have BED are also highlighted so the proper course of treatment is pursued. Overall, obese individuals with BED demonstrate a number of key characteristics that differentiate them from obese individuals without eating disorders, including increased impulsivity in response to food stimuli with loss of control over eating, resulting in the consumption of more calories. They also experience significant guilt and other negative emotions following a meal. In addition, individuals with BED patients have more psychiatric comorbidity, display more psychopathology, exhibit longer binge durations, consume more meals as snacks during the day and have less dietary restraint compared with individuals with BED who are not obese. However, the differences between individuals with BED who are obese versus not obese are not as prominent. Taken together, the evidence appears to support the conclusion that BED is a unique and treatable neurobehavioral disorder associated with distinct behavioral and psychological profiles and distinct medical and functional outcomes, and that

  11. Marketing: applications in a military health care setting.

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    Roark, G A; Tucker, S L

    1997-08-01

    Military health care leaders must recognize the importance of satisfied consumers. As part of this recognition, the focus of military medicine must change from a coercive-power to a reward-power system. This change highlights the need for business practices such as marketing. Encouraging military health care administrators to learn and understand the applications of the marketing variables will enhance demand management and health care delivery for beneficiaries. This paper describes some applications of marketing variables, informs the military health care administrator about the process of marketing, and describes the utility of marketing in the current paradigm shift in military health care delivery.

  12. Shared caregiving: comparisons between home and child-care settings.

    Science.gov (United States)

    Ahnert, L; Rickert, H; Lamb, M E

    2000-05-01

    The experiences of 84 German toddlers (12-24 months old) who were either enrolled or not enrolled in child care were described with observational checklists from the time they woke up until they went to bed. The total amount of care experienced over the course of a weekday by 35 pairs of toddlers (1 member of each pair in child care, 1 member not) did not differ according to whether the toddlers spent time in child care. Although the child-care toddlers received lower levels of care from care providers in the centers, their mothers engaged them in more social interactions during nonworking hours than did the mothers of home-only toddlers, which suggests that families using child care provided different patterns of care than families not using child care. Child-care toddlers experienced high levels of emotional support at home, although they experienced less prompt responses to their distress signals. Mothers' ages were unrelated to the amounts of time toddlers spent with them, but older mothers initiated more proximity.

  13. A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

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    Chong Mei

    2011-08-01

    Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

  14. The Depression Initiative. Description of a collaborative care model for depression and of the factors influencing its implementation in the primary care setting in the Netherlands

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    Fransina J. de Jong

    2009-06-01

    Full Text Available Background: In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands. Aim: Description of a collaborative care model for major depressive disorder (MDD and of the factors influencing its implementation in the primary care setting in the Netherlands. Data sources: Data collected during the preparation phase of the CC:DIP trial of the Depression Initiative, literature, policy documents, information sheets from professional associations. Results: Factors facilitating the implementation of the collaborative care model are continuous supervision of the care managers by the consultant psychiatrist and the trainers, a supportive web-based tracking system and the new reimbursement system that allows for introduction of a mental health care-practice nurse (MHC-PN in the general practices and coverage of the treatment costs. Impeding factors might be the relatively high percentage of solo-primary care practices, the small percentage of professionals that are located in the same building, unfamiliarity with the concept of collaboration as required for collaborative care, the reimbursement system that demands regular negotiations between each health care provider and the insurance companies and the reluctance general practitioners might feel to expand their responsibility for their depressed patients. Conclusion: Implementation of the collaborative care model in the Netherlands requires extensive training and supervision on micro level, facilitation of reimbursement on meso- and macro level and structural effort to change the treatment culture for chronic mental disorders in the primary care setting.

  15. Teaching Reflective Care in Japanese Early Childhood Settings

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    Hellman, Anette

    2016-01-01

    The purpose of this article is to explore the way preschool teachers teach reflective care in Japan. The article builds on a two-month ethnographic study conducted in Japanese kindergartens and nurseries among children aged 3-6 years. The data were analysed using concepts of age and gender. The results show that care in Japan, in contrast to…

  16. Does health care associated pneumonia really exist?

    Science.gov (United States)

    Lopez, Alejandra; Amaro, Rosanel; Polverino, Eva

    2012-07-01

    The most recent ATS guidelines for nosocomial pneumonia of 2005 describe a new clinical category of patients, Health Care-Associated Pneumonia which includes a number of very heterogeneous conditions possibly associated with a high risk of multi-drug resistant (MDR) infections and of mortality. This paper aims at reviewing the current literature on HCAP and examines the controversial issues of HCAP etiology and outcomes, underlining the need of a profound revision of the HCAP concept in the face of the poor and contrasting scientific evidence supporting its basis.

  17. Setting the Equation: Establishing Value in Spine Care

    Science.gov (United States)

    Resnick, Daniel K.; Tosteson, Anna N. A.; Groman, Rachel F.; Ghogawala, Zoher

    2014-01-01

    Study Design Topic review Objective Describe value measurement in spine care and discuss the motivation for, methods for, and limitations of such measurement. Summary of Background Data Spinal disorders are common and are an important cause of pain and disability. Numerous complimentary and competing treatment strategies are used to treat spinal disorders and the costs of these treatments is substantial and continues to rise despite clear evidence of improved health status as a result of these expenditures. Methods The authors present the economic and legislative imperatives forcing the assessment of value in spine care. The definition of value in health care and methods to measure value specifically in spine care are presented. Limitations to the utility of value judgements and caveats to their use are presented. Results Examples of value calculations in spine care are presented and critiqued. Methods to improve and broaden the measurement of value across spine care are suggested and the role of prospective registries in measuring value is discussed. Conclusions Value can be measured in spine care through the use of appropriate economic measures and patient reported outcomes measures. Value must be interpreted in light of the perspective of the assessor, the duration of the assessment period, the degree of appropriate risk stratification, and the relative value of treatment alternatives. PMID:25299258

  18. Psychiatric morbidity among adult patients in a semi-urban primary care setting in Malaysia

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    Omar Khairani

    2009-06-01

    Full Text Available Abstract Background Screening for psychiatric disorders in primary care can improve the detection rate and helps in preventing grave consequences of unrecognised and untreated psychiatric morbidity. This is relevant to the Malaysian setting where mental health care is now also being provided at primary care level. The aim of this paper is to report the prevalence of psychiatric illness in a semi-urban primary care setting in Malaysia using the screening tool Patient Health Questionnaire (PHQ. Methods This is a cross-sectional study carried out in a semi-urban primary healthcare centre located south of Kuala Lumpur. Systematic random sampling was carried out and a total of 267 subjects completed the PHQ during the study period. Results The proportion of respondents who had at least one PHQ positive diagnosis was 24.7% and some respondents had more than one diagnosis. Diagnoses included depressive illness (n = 38, 14.4%, somatoform disorder (n = 32, 12.2%, panic and anxiety disorders (n = 17, 6.5%, binge eating disorder (n = 9, 3.4% and alcohol abuse (n = 6, 2.3%. Younger age (18 to 29 years and having a history of stressors in the previous four weeks were found to be significantly associated (p = 0.036 and p = 0.044 respectively with PHQ positive scores. Conclusion These findings are broadly similar to the findings of studies done in other countries and are a useful guide to the probable prevalence of psychiatric morbidity in primary care in other similar settings in Malaysia.

  19. Spirometry use: detection of chronic obstructive pulmonary disease in the primary care setting

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    Thomas A Barnes

    2011-01-01

    Full Text Available Thomas A Barnes1, Len Fromer21Department of Cardiopulmonary Sciences, Northeastern University, Boston, MA, USA; 2David Geffen School of Medicine at UCLA, Los Angeles, CA, USAObjective: To describe a practical method for family practitioners to stage chronic obstructive pulmonary disease (COPD by the use of office spirometry.Methods: This is a review of the lessons learned from evaluations of the use of office spirometry in the primary care setting to identify best practices using the most recent published evaluations of office spirometry and the analysis of preliminary data from a recent spirometry mass screening project. A mass screening study by the American Association for Respiratory Care and the COPD Foundation was used to identify the most effective way for general practitioners to implement office spirometry in order to stage COPD.Results: A simple three-step method is described to identify people with a high pre-test probability in an attempt to detect moderate to severe COPD: COPD questionnaire, measurement of peak expiratory flow, and office spirometry. Clinical practice guidelines exist for office spirometry basics for safety, use of electronic peak flow devices, and portable spirometers.Conclusion: Spirometry can be undertaken in primary care offices with acceptable levels of technical expertise. Using office spirometry, primary care physicians can diagnose the presence and severity of COPD. Spirometry can guide therapies for COPD and predict outcomes when used in general practice.Keywords: chronic obstructive pulmonary disease, spirometry, family practice, primary care physician

  20. A managed clinical network for cardiac services: set-up, operation and impact on patient care

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    Karen E. Hamilton

    2005-09-01

    Full Text Available Purpose: To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. Methods: This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Results: Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and ‘bed down’. Its primary “modus operand” was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were

  1. Paediatric emergency and acute care in resource poor settings.

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    Duke, Trevor; Cheema, Baljit

    2016-02-01

    Acute care of seriously ill children is a global public health issue, and there is much scope for improving quality of care in hospitals at all levels in many developing countries. We describe the current state of paediatric emergency and acute care in the least developed regions of low and middle income countries and identify gaps and requirements for improving quality. Approaches are needed which span the continuum of care: from triage and emergency treatment, the diagnostic process, identification of co-morbidities, treatment, monitoring and supportive care, discharge planning and follow-up. Improvements require support and training for health workers and quality processes. Effective training is that which is ongoing, combining good technical training in under-graduate courses and continuing professional development. Quality processes combine evidence-based guidelines, essential medicines, appropriate technology, appropriate financing of services, standards and assessment tools and training resources. While initial emergency treatment is based on common clinical syndromes, early differentiation is required for specific treatment, and this can usually be carried out clinically without expensive tests. While global strategies are important, it is what happens locally that makes a difference and is too often neglected. In rural areas in the poorest countries in the world, public doctors and nurses who provide emergency and acute care for children are revered by their communities and demonstrate daily that much can be carried out with little.

  2. High dependency care in an obstetric setting in the UK.

    Science.gov (United States)

    Saravanakumar, K; Davies, L; Lewis, M; Cooper, G M

    2008-10-01

    Our objective was to establish the utilisation and pattern of high dependency care in a tertiary referral obstetric unit. Data of pregnant or recently pregnant women admitted to the obstetric high dependency unit from 1984 to 2007 were included to evaluate the admission rate. Four years' information of an ongoing prospective audit was collated to identify the indications for admission, maternal monitoring, transfers to intensive care unit, and location of the baby. The overall high dependency unit admission rate is 2.67%, but increased to 5.01% in the most recent 4 years. Massive obstetric haemorrhage is now the most common reason for admission. Invasive monitoring was undertaken in 30% of women. Two-thirds of neonates (66.3%) stayed with their critically ill mothers in the high dependency unit. Transfer to the intensive care unit was needed in 1.4 per 1000 deliveries conducted. We conclude that obstetric high dependency care provides holistic care from midwives, obstetricians and anaesthetists while retaining the opportunity of early bonding with babies for critically ill mothers.

  3. "Who Says What Is Quality?": Setting Quality Standards for Family Child Care

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    Modigliani, Kathy

    2011-01-01

    This article tells the story of the 4-year consensus-building process to design quality standards for the field of family child care. Working with the National Association for Family Child Care, the Family Child Care Project at Wheelock College was funded to create an accreditation system for home-based child care programs using innovative methods…

  4. Primary health care in a paediatric setting — the background

    Directory of Open Access Journals (Sweden)

    D.J. Power

    1979-09-01

    Full Text Available At a recent conference, a definition was drawn up that is most appropriate to the South African situation: “ Primary health care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation, and at a cost that the community and country can afford. It forms an integral part both of the country’s health system of which it is the nucleus, and of the overall social and economic development of the community.”

  5. A Risk Score to Predict Hypertension in Primary Care Settings in Rural India.

    Science.gov (United States)

    Sathish, Thirunavukkarasu; Kannan, Srinivasan; Sarma, P Sankara; Razum, Oliver; Thrift, Amanda Gay; Thankappan, Kavumpurathu Raman

    2016-01-01

    We used the data of 297 participants (15-64 years old) from a cohort study (2003-2010) who were free from hypertension at baseline, to develop a risk score to predict hypertension by primary health care workers in rural India. Age ≥35 years, current smoking, prehypertension, and central obesity were significantly associated with incident hypertension. The optimal cutoff value of ≥3 had a sensitivity of 78.6%, specificity of 65.2%, positive predictive value of 41.1%, and negative predictive value of 90.8%. The area under the receiver operating characteristic curve of the risk score was 0.802 (95% confidence interval = 0.748-0.856). This simple and easy to administer risk score could be used to predict hypertension in primary care settings in rural India.

  6. A NEW ASSOCIATION RULE MINING BASED ON FREQUENT ITEM SET

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    Ms. Sanober Shaikh

    2011-09-01

    Full Text Available In this paper a new mining algorithm is defined based on frequent item set. Apriori Algorithm scans the database every time when it finds the frequent item set so it is very time consuming and at each step it generates candidate item set. So for large databases it takes lots of space to store candidate item set. The defined algorithm scans the database at the start only once and then makes the undirected item set graph. From this graph by considering minimum support it finds the frequent item set and by considering the minimum confidence it generates the association rule. If database and minimum support is changed, the new algorithm finds the new frequent items by scanning undirected item set graph. That is why it’s executing efficiency is improved distinctly compared to traditional algorithm.

  7. Communication Supports in Congregate Residential Care Settings in Ohio

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    Mitchell, Pamela R.

    2009-01-01

    Background: Communication skills are important to the pursuit of increased self-determination in individuals with disabilities. The aim of this investigation was to gather information about communication supports in state-run residential care facilities in Ohio, and to compare findings with a previous investigation on this topic examining such…

  8. How Do Physicians Teach Empathy in the Primary Care Setting?

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    Shapiro, Johanna

    2002-01-01

    Explored how primary care clinician-teachers actually attempt to convey empathy to medical students and residents. Found that they stress the centrality of role modeling in teaching, and most used debriefing strategies as well as both learner- and patient-centered approaches in instructing learners about empathy. (EV)

  9. Applying Kohlberg's Theory of Moral Development in Group Care Settings.

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    Larsen, John A.

    1981-01-01

    Argues that Kohlberg's theory of moral development and his methods of moral education have special relevance to residential treatment because they (1) provide a framework for understanding the moral decision-making process at various levels of development, and (2) encourage child care professionals of any theoretical or clinical persuasion to…

  10. The Burn-Out Syndrome in the Day Care Setting

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    Maslach, Christina; Pines, Ayala

    1977-01-01

    Results of a study of personal job-stress factors among day care center personnel focus on impact of staff-child ratio, working hours, time out, staff meetings and program structure. Recommended institutional changes for prevention of staff "burn-out" involve reduction in amount of direct staff-child contact, development of social-professional…

  11. Management of levofloxacin induced anaphylaxis and acute delirium in a palliative care setting

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    Arunangshu Ghoshal

    2015-01-01

    Full Text Available Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life.

  12. Results of Associated Implication Algebra on a Partial Ordered Set

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Some sufficient and necessary conditions that implication algebra on a partial ordered set is associated implication algebra are obtained, and the relation between lattice H implication algebra and associated implication algebra is discussed. Also, the concept of filter is proposed with some basic properties being studied.

  13. Understanding Nurses’ Information Needs and Searching Behavior in Acute Care Settings

    OpenAIRE

    2005-01-01

    We report the results of a pilot study designed to describe nurses’ information needs and searching behavior in acute care settings. Several studies have indicated that nurses have unmet information needs while delivering care to patients. AIM: Identify the information needs of nurses in acute care settings. METHODS: Nurses at three hospitals were asked to use an information retrieval tool (CPG Viewer). A detailed log of their interactions with the tool was generated. RESULT...

  14. Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings.

    Science.gov (United States)

    Lavin, Mary Ann; Harper, Ellen; Barr, Nancy

    2015-04-14

    The electronic health record (EHR) is a documentation tool that yields data useful in enhancing patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs. Although nurses applaud the EHR, they also indicate dissatisfaction with its design and cumbersome electronic processes. This article describes the views of nurses shared by members of the Nursing Practice Committee of the Missouri Nurses Association; it encourages nurses to share their EHR concerns with Information Technology (IT) staff and vendors and to take their place at the table when nursing-related IT decisions are made. In this article, we describe the experiential-reflective reasoning and action model used to understand staff nurses' perspectives, share committee reflections and recommendations for improving both documentation and documentation technology, and conclude by encouraging nurses to develop their documentation and informatics skills. Nursing issues include medication safety, documentation and standards of practice, and EHR efficiency. IT concerns include interoperability, vendors, innovation, nursing voice, education, and collaboration.

  15. Management of ramsay hunt syndrome in an acute palliative care setting

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    Shrenik Ostwal

    2015-01-01

    Full Text Available Introduction: The Ramsay Hunt syndrome is characterized by combination of herpes infection and lower motor neuron type of facial nerve palsy. The disease is caused by a reactivation of Varicella Zoster virus and can be unrepresentative since the herpetic lesions may not be always be present (zoster sine herpete and might mimic other severe neurological illnesses. Case Report: A 63-year-old man known case of carcinoma of gall bladder with liver metastases, post surgery and chemotherapy with no scope for further disease modifying treatment, was referred to palliative care unit for best supportive care. He was on regular analgesics and other supportive treatment. He presented to Palliative Medicine outpatient with 3 days history of ipsilateral facial pain of neuropathic character, otalgia, diffuse vesciculo-papular rash over ophthalmic and maxillary divisions of left trigeminal nerve distribution of face and ear, and was associated with secondary bacterial infection and unilateral facial edema. He was clinically diagnosed to have Herpes Zoster with superadded bacterial infection. He was treated with tablet Valacyclovir 500 mg four times a day, Acyclovir cream for local application, Acyclovir eye ointment for prophylactic treatment of Herpetic Keratitis, low dose of Prednisolone, oral Amoxicillin and Clindamycin for 7 days, and Pregabalin 150 mg per day. After 7 days of treatment, the rash and vesicles had completely resolved and good improvement of pain and other symptoms were noted. Conclusion: Management of acute infections and its associated complications in an acute palliative care setting improves both quality and length of life.

  16. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings

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    Sen S

    2014-06-01

    Full Text Available Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC models in the inpatient, ambulatory, and community practice settings. Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results: Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications. Additionally, a checklist has been created to assist other pharmacists in developing the pharmacist’s TOC roles in a practice environment or incorporating more TOC elements in their practice setting. Conclusion: Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.

  17. The use of spirometry in a primary care setting

    OpenAIRE

    Elizabeth A Blain; Craig, Timothy J.

    2009-01-01

    Elizabeth A Blain, Timothy J CraigPenn State Hershey Medical Center, Hershey, PA, USAObjective: To determine the use of spirometry in family practice, internal medicine, and pediatric outpatient settings.Methods: Data were collected from 45 outpatient offices in the central Pennsylvania area via phone survey that asked a set of four questions: 1) Do you have spirometry in your office? 2) Do you use spirometry for asthma patients? 3) In what situation do you use spirometry for? 4) Do you use s...

  18. Psychosocial screening and assessment in oncology and palliative care settings

    Directory of Open Access Journals (Sweden)

    Luigi eGrassi

    2015-01-01

    Full Text Available Psychiatric and psychosocial disorders among cancer patients have been reported as a major consequence of the disease and treatment. The problems in applying a pure psychiatric approach have determined the need for structuring more defined methods, including screening for distress and emotional symptoms and a more specific psychosocial assessment, to warrant proper care to cancer patients with psychosocial problems. This review examines some of the most significant issues related to these two steps, screening and assessment of psychosocial morbidity in cancer and palliative care. With regard to this , the many different variables, such as the factors affecting individual vulnerability (e.g. life events, chronic stress and allostatic load, well-being, and health attitudes and the psychosocial correlates of medical disease (e.g. psychiatric disturbances, psychological symptoms, illness behavior, and quality of life which are possibly implicated not only in classical psychiatric disorders but more broadly in psychosocial suffering. Multidimensional tools (e.g. and specific psychosocially oriented interview (e.g. the Diagnostic Criteria for Psychosomatic Research - DCPR represent a way to screen for and assess emotional distress, anxiety and depression, maladaptive coping, dysfunctional attachment, as well as other significant psychosocial dimensions secondary to cancer, such as demoralization and health anxiety. Cross-cultural issues, such as language, ethnicity, race, and religion, are also discussed as possible factors influencing the patients and families perception of illness, coping mechanisms, psychological response to a cancer diagnosis.

  19. High burden of protein-energy malnutrition in Nigeria: beyond the health care setting.

    Science.gov (United States)

    Ubesie, Ac; Ibeziakor, Ns

    2012-01-01

    There is still a high burden of protein-energy malnutrition in Nigeria. The severe forms of the disease are usually associated with high level of mortality even in the tertiary health facilities. To review the cost-effective health promotional strategies at community levels that could aid prevention, early detection, and prompt treatment of protein-energy malnutrition. The strategy used for locating articles used for this review was to search databases like Google, Google scholar, relevant electronic journals from the universities' libraries, including PubMed and Scirus, Medline, Cochrane library and WHO's Hinari. We believe that strategies beyond the health care setting have potential of significantly reducing the morbidity and mortality associated with protein-energy malnutrition in Nigeria.

  20. Risk of Lymphoma and Solid Cancer among Patients with Rheumatoid Arthritis in a Primary Care Setting

    DEFF Research Database (Denmark)

    Andersen, Christen Bertel L; Lindegaard, Hanne Merete; Vestergaard, Hanne;

    2014-01-01

    lymphoproliferative malignancies or solid cancers. These risk estimates did not change when eosinophilia, CRP, and comorbidities were included in the models. CONCLUSIONS: In this large cohort of patients with RA of short or long duration recruited from a primary care resource, RA was not associated with an increased...... risk of lymphoproliferative or solid cancers during 4 years of follow-up, when the models were adjusted for confounders. Blood eosinophilia could not be identified as a mediator of cancer development in the present setting.......BACKGROUND: Several studies have demonstrated an association between rheumatoid arthritis (RA) and lymphoproliferative malignancies, but pathogenic mechanisms remain unclear. We investigated 1) the risk of lymphoproliferative malignancies and solid tumors in adults with RA identified in primary...

  1. Supporting Nutrition in Early Care and Education Settings: The Child and Adult Care Food Program (CACFP)

    Science.gov (United States)

    Stephens, Samuel A.

    2016-01-01

    Child care centers, Head Start programs, and family child care providers serving young children--as well as after school programs and homeless shelters that reach older children, adults, and families--are supported in providing healthy meals and snacks by reimbursements through the Child and Adult Care Food Program (CACFP). Administered by the…

  2. Dimensions and determinants of trust in health care in resource poor settings--a qualitative exploration.

    Directory of Open Access Journals (Sweden)

    Vijayaprasad Gopichandran

    Full Text Available BACKGROUND: Trust in health care has been intensely researched in resource rich settings. Some studies in resource poor settings suggest that the dimensions and determinants of trust are likely to be different. OBJECTIVES: This study was done as a qualitative exploration of the dimensions and determinants of trust in health care in Tamil Nadu, a state in south India to assess the differences from dimensions and determinants in resource rich settings. METHODOLOGY: The participants included people belonging to marginalized communities with poor access to health care services and living in conditions of resource deprivation. A total of thirty five in depth interviews were conducted. The interviews were summarized and transcribed and data were analyzed following thematic analysis and grounded theory approach. RESULTS: The key dimensions of trust in health care identified during the interviews were perceived competence, assurance of treatment irrespective of ability to pay or at any time of the day, patients' willingness to accept drawbacks in health care, loyalty to the physician and respect for the physician. Comfort with the physician and health facility, personal involvement of the doctor with the patient, behavior and approach of doctor, economic factors, and health awareness were identified as factors determining the levels of trust in health care. CONCLUSIONS: The dimensions and determinants of trust in health care in resource poor settings are different from that in resource rich settings. There is a need to develop scales to measure trust in health care in resource poor settings using these specific dimensions and determinants.

  3. The meaning of spiritual care in a pediatric setting.

    Science.gov (United States)

    Dell'Orfano, Shelley

    2002-10-01

    In the previous issue of the Journal of Pediatric Nursing, one type of evidence-based practice (EBP) format was provided for potential nurse scholars who utilize the EBP process [MacPhee, M. (2002). Journal of Pediatric Nursing, 17(4);313-20]. There are, however, many potential formats to present evidence-based clinical practice innovations. I am eager to work with nurses who have been involved in promoting evidence-based nursing practice. The Journal of Pediatric Nursing will use this column as a forum for sharing evidence-based clinical practice innovations, such as case studies, clinical teaching exemplars, and interdisciplinary programs highlighting collaborative practice among nurses and other health care professionals. Please contact me at maura80521@yahoo.com for editorial advice and assistance. The following article is a clinical contribution from a nurse on the Neurosurgery-Rehabilitation Unit of The Children's Hospital, Denver. This evidence-based clinical project evolved from a nurse's recognition of the importance of spiritual care for families of children with serious brain injuries. It is an example of how an EBP formula can facilitate change and innovation. Start with a clinical problem; get help; look to the literature for best research evidence; look to other clinical sources for best practice ideas; evaluate what you have; and make a decision to maintain the status quo, gather more data, or change practice. This clinical project is an example of the collaborative, interdisciplinary nature of EBP, and it is also an example of the collaborative work among differently skilled nurses. In this instance, a clinically based nurse identified a practice problem and recruited a nurse researcher to help design, analyze, and evaluate the findings from an interview study. The results are being implemented via nursing leadership to change practice.

  4. VENTILATOR ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Syed Ali

    2015-12-01

    Full Text Available BACKGROUND Knowledge of the incidence of ventilator-associated pneumonia (VAP and its associated risk factors is imperative for the development and use of more effective preventive measures. METHODOLOGY We conducted a prospective cohort study over a period of 12 months to determine the incidence and the risk factors for development of VAP in critically ill adult patients admitted in intensive care units (ICUs in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, we included 150 patients, on mechanical ventilation for more than 48 hours. VAP was diagnosed according to the current diagnostic criteria. RESULTS The study cohort comprised of 150 patients of various cases of cerebrovascular accident, poisoning, neurological disorders, sepsis and others. VAP was diagnosed when a score of ≥6 was obtained in the clinical pulmonary infection scoring system having six variables and a maximum score of 12. The mean age of the patients was 40 years. Of the 150 patients, 28 patients developed VAP during the ICU stay. The incidence of VAP in our study was 18.8%. The risk factor in our study was decrease in the PaO2/FiO2 ratio, duration of mechanical ventilation, impaired consciousness, tracheostomy, re-intubation, emergency intubation, nasogastric tube, emergency intubation and intravenous sedatives were found to be the specific risk factors for early onset VAP, while tracheostomy and re-intubation were the independent predictors of late-onset VAP, The most predominant organisms in our study was Pseudomonas (39.2%. CONCLUSIONS Knowledge of these risk factors may be useful in implementing simple and effective preventive measures. Precaution during emergency intubation, minimizing the occurrence of reintubation, avoidance of tracheostomy as far as possible, and minimization of sedation. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to

  5. Palliative care for cancer patients in a primary health care setting: Bereaved relatives' experience, a qualitative group interview study

    Directory of Open Access Journals (Sweden)

    Jensen Anders

    2008-01-01

    Full Text Available Abstract Background Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary care setting to explore barriers and facilitators for delivery of good palliative home care. Methods Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results Three main categories of experience were identified: 1 The health professionals' management, where a need to optimize was found. 2 Shared care, which was lacking. 3 The relatives' role, which needs an extra focus. Conclusion Relatives experience insufficient palliative care mainly due to organizational and cultural problems among professionals. Palliative care in primary care in general needs improvement and attention should be drawn to the "professionalization" of the relatives and the need to strike a balance between their needs, wishes and resources in end-of-life care and bereavement.

  6. Patients receiving opioid maintenance treatment in primary care: successful chronic hepatitis C care in a real world setting

    Directory of Open Access Journals (Sweden)

    Seidenberg André

    2013-01-01

    Full Text Available Abstract Background Injection drug users (IDUs represent a significant proportion of patients with chronic hepatitis C (CHC. The low treatment uptake among these patients results in a low treatment effectiveness and a limited public health impact. We hypothesised that a general practitioner (GP providing an opioid maintenance treatment (OMT for addicted patients can achieve CHC treatment and sustained virological response rates (SVR comparable to patients without drug dependency. Methods Retrospective patient record analysis of 85 CHC patients who received OMT for more than 3 months in a single-handed general practice in Zurich from January 1, 2002 through May 31, 2008. CHC treatment was based on a combination with pegylated interferon and ribavirin. Treatment uptake and SVR (undetectable HCV RNA 6 months after end of treatment were assessed. The association between treatment uptake and patient characteristics was investigated by multiple logistic regression. Results In 35 out of 85 CHC patients (52 males with a median (IQR age of 38.8 (35.0-44.4 years, antiviral therapy was started (41.2%. Median duration (IQR of OMT in the treatment group was 55.0 (35.0-110.1 months compared to the group without therapy 24.0 (9.8-46.3 months (p Conclusion In addicted patients a high CHC treatment and viral eradication rate in a primary care setting in Switzerland is feasible. Opioid substitution seems a beneficial framework for CHC care in this “difficult to treat” population.

  7. Association of Continuity of Primary Care and Statin Adherence.

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    James R Warren

    Full Text Available Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR and usual provider continuity index (UPI for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR and 95% confidence interval (CI for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06 for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54.Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.

  8. Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Braun, Lynne T; Grady, Kathleen L; Kutner, Jean S; Adler, Eric; Berlinger, Nancy; Boss, Renee; Butler, Javed; Enguidanos, Susan; Friebert, Sarah; Gardner, Timothy J; Higgins, Phil; Holloway, Robert; Konig, Madeleine; Meier, Diane; Morrissey, Mary Beth; Quest, Tammie E; Wiegand, Debra L; Coombs-Lee, Barbara; Fitchett, George; Gupta, Charu; Roach, William H

    2016-09-13

    The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality of life and is consistent with the patients' values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient- and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient's family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payer-provider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

  9. Feasibility of HIV point-of-care tests for resource-limited settings: challenges and solutions.

    Science.gov (United States)

    Stevens, Wendy; Gous, Natasha; Ford, Nathan; Scott, Lesley E

    2014-09-08

    Improved access to anti-retroviral therapy increases the need for affordable monitoring using assays such as CD4 and/or viral load in resource-limited settings. Barriers to accessing treatment, high rates of loss to initiation and poor retention in care are prompting the need to find alternatives to conventional centralized laboratory testing in certain countries. Strong advocacy has led to a rapidly expanding repertoire of point-of-care tests for HIV. point-of-care testing is not without its challenges: poor regulatory control, lack of guidelines, absence of quality monitoring and lack of industry standards for connectivity, to name a few. The management of HIV increasingly requires a multidisciplinary testing approach involving hematology, chemistry, and tests associated with the management of non-communicable diseases, thus added expertise is needed. This is further complicated by additional human resource requirements and the need for continuous training, a sustainable supply chain, and reimbursement strategies. It is clear that to ensure appropriate national implementation either in a tiered laboratory model or a total decentralized model, clear country-specific assessments need to be conducted.

  10. Palliative care for cancer patients in a primary health care setting:Bereaved relatives' experience, a qualitative group interview study

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde;

    2008-01-01

    Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primar...... improvement and attention should be drawn to the "professionalization" of the relatives and the need to strike a balance between their needs, wishes and resources in end-of-life care and bereavement.......Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary...... care setting to explore barriers and facilitators for delivery of good palliative home care. Methods: Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results: Three main categories of experience were identified: 1) The health professionals' management, where...

  11. Grounded theory of barriers and facilitators to mandated implementation of mental health care in the primary care setting.

    Science.gov (United States)

    Benzer, Justin K; Beehler, Sarah; Miller, Christopher; Burgess, James F; Sullivan, Jennifer L; Mohr, David C; Meterko, Mark; Cramer, Irene E

    2012-01-01

    Objective. There is limited theory regarding the real-world implementation of mental health care in the primary care setting: a type of organizational coordination intervention. The purpose of this study was to develop a theory to conceptualize the potential causes of barriers and facilitators to how local sites responded to this mandated intervention to achieve coordinated mental health care. Methods. Data from 65 primary care and mental health staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after an organizational mandate to provide integrated mental health care in the primary care setting. Results. Standardized referral procedures and communication practices between primary care and mental health were influenced by the organizational factors of resources, training, and work design, as well as provider-experienced organizational boundaries between primary care and mental health, time pressures, and staff participation. Organizational factors and provider experiences were in turn influenced by leadership. Conclusions. Our emergent theory describes how leadership, organizational factors, and provider experiences affect the implementation of a mandated mental health coordination intervention. This framework provides a nuanced understanding of the potential barriers and facilitators to implementing interventions designed to improve coordination between professional groups.

  12. Grounded Theory of Barriers and Facilitators to Mandated Implementation of Mental Health Care in the Primary Care Setting

    Directory of Open Access Journals (Sweden)

    Justin K. Benzer

    2012-01-01

    Full Text Available Objective. There is limited theory regarding the real-world implementation of mental health care in the primary care setting: a type of organizational coordination intervention. The purpose of this study was to develop a theory to conceptualize the potential causes of barriers and facilitators to how local sites responded to this mandated intervention to achieve coordinated mental health care. Methods. Data from 65 primary care and mental health staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after an organizational mandate to provide integrated mental health care in the primary care setting. Results. Standardized referral procedures and communication practices between primary care and mental health were influenced by the organizational factors of resources, training, and work design, as well as provider-experienced organizational boundaries between primary care and mental health, time pressures, and staff participation. Organizational factors and provider experiences were in turn influenced by leadership. Conclusions. Our emergent theory describes how leadership, organizational factors, and provider experiences affect the implementation of a mandated mental health coordination intervention. This framework provides a nuanced understanding of the potential barriers and facilitators to implementing interventions designed to improve coordination between professional groups.

  13. Distraction: an assessment of smartphone usage in health care work settings

    Directory of Open Access Journals (Sweden)

    Gill PS

    2012-08-01

    Full Text Available Preetinder S Gill,1 Ashwini Kamath,2 Tejkaran S Gill31College of Technology, Eastern Michigan University, Ypsilanti, MI, USA; 2School of Information, University of Texas, Austin, TX, USA; 3College of Engineering, University of Michigan, Ann Arbor, MI, USAAbstract: Smartphone use in health care work settings presents both opportunities and challenges. The benefits could be severely undermined if abuse and overuse are not kept in check. This practice-focused research paper examines the current panorama of health software applications. Findings from existing research are consolidated to elucidate the level and effects of distraction in health care work settings due to smartphone use. A conceptual framework for crafting guidelines to regulate the use of smartphones in health care work settings is then presented. Finally, specific guidelines are delineated to assist in creating policies for the use of smartphones in a health care workplace.Keywords: smartphone, health care, distraction, workplace, mobile apps, health informatics

  14. The Emergency Care of Patients With Cancer: Setting the Research Agenda.

    Science.gov (United States)

    Brown, Jeremy; Grudzen, Corita; Kyriacou, Demetrios N; Obermeyer, Ziad; Quest, Tammie; Rivera, Donna; Stone, Susan; Wright, Jason; Shelburne, Nonniekaye

    2016-12-01

    To identify research priorities and appropriate resources and to establish the infrastructure required to address the emergency care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, emergency medicine, and palliative care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the emergency care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative care in the emergency department setting.

  15. Prevalence of peripheral arterial disease in patients with diabetes mellitus in a primary care setting.

    Science.gov (United States)

    Rabia, K; Khoo, E M

    2007-06-01

    The aims of the study were to determine the prevalence of peripheral arterial disease (PAD) in diabetic patients and in different ethnic groups at a primary care setting, and to evaluate risk factors associated with PAD in these diabetic patients. A cross sectional study of 200 diabetic patients over 18 years old who attended a primary care clinic at a teaching hospital in Kuala Lumpur, Malaysia was carried out. Face-to-face interviews were conducted using structured questionnaires for demographic characteristics and risk factors evaluation. Blood pressure measurements, assessment of peripheral neuropathy and ankle brachial pressures were performed. PAD was diagnosed by an ankle brachial pressure index (ABPI) of <0.9 on either leg. The overall prevalence of PAD was 16% in this diabetic population. The prevalence of PAD was 5.8% in Malays, 19.4% in Chinese and 19.8% in Indians. The prevalence of peripheral neuropathy was 41%, foot ulcer 9.5%, and gangrene 3.0%. The presence of foot ulcer was weakly associated with PAD (P=0.052). No significant relationships were found between age, gender, smoking status, duration of diabetes mellitus, hypertension, dyslipidaemia, and PAD. PAD is common in the diabetic population of this study.

  16. Child Care Teachers' Perspectives on Including Children with Challenging Behavior in Child Care Settings

    Science.gov (United States)

    Quesenberry, Amanda C.; Hemmeter, Mary Louise; Ostrosky, Michaelene M.; Hamann, Kira

    2014-01-01

    In this study, 9 teachers from 5 child care centers were interviewed to examine their perceptions on including children with challenging behavior in their classrooms. The findings provide a firsthand view into how child care teachers support children's social and emotional development and address challenging behavior. Results confirm previous…

  17. Fit for purpose? Introducing a rational priority setting approach into a community care setting.

    Science.gov (United States)

    Cornelissen, Evelyn; Mitton, Craig; Davidson, Alan; Reid, Colin; Hole, Rachelle; Visockas, Anne-Marie; Smith, Neale

    2016-06-20

    Purpose - Program budgeting and marginal analysis (PBMA) is a priority setting approach that assists decision makers with allocating resources. Previous PBMA work establishes its efficacy and indicates that contextual factors complicate priority setting, which can hamper PBMA effectiveness. The purpose of this paper is to gain qualitative insight into PBMA effectiveness. Design/methodology/approach - A Canadian case study of PBMA implementation. Data consist of decision-maker interviews pre (n=20), post year-1 (n=12) and post year-2 (n=9) of PBMA to examine perceptions of baseline priority setting practice vis-à-vis desired practice, and perceptions of PBMA usability and acceptability. Findings - Fit emerged as a key theme in determining PBMA effectiveness. Fit herein refers to being of suitable quality and form to meet the intended purposes and needs of the end-users, and includes desirability, acceptability, and usability dimensions. Results confirm decision-maker desire for rational approaches like PBMA. However, most participants indicated that the timing of the exercise and the form in which PBMA was applied were not well-suited for this case study. Participant acceptance of and buy-in to PBMA changed during the study: a leadership change, limited organizational commitment, and concerns with organizational capacity were key barriers to PBMA adoption and thereby effectiveness. Practical implications - These findings suggest that a potential way-forward includes adding a contextual readiness/capacity assessment stage to PBMA, recognizing organizational complexity, and considering incremental adoption of PBMA's approach. Originality/value - These insights help us to better understand and work with priority setting conditions to advance evidence-informed decision making.

  18. Child Care and Mothers' Mental Health: Is High-Quality Care Associated with Fewer Depressive Symptoms?

    Science.gov (United States)

    Gordon, Rachel A.; Usdansky, Margaret L.; Wang, Xue; Gluzman, Anna

    2011-01-01

    Finding high-quality child care may pose financial and logistical challenges and create ongoing emotional strains for some mothers. We use the Study of Early Child Care and Youth Development to ask (a) are child-care settings that mothers select on the basis of their own perceptions of quality rated more highly by independent observers (and more…

  19. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Mansfield Richard J

    2005-02-01

    Full Text Available Abstract Background Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. Methods We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000. Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection were examined. Results Shoulder pain was associated with an injury in one third (33.2% (230/692 of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52 more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202 of visits. An x-ray was performed in 29.0% (164/566 of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound was infrequently performed (6.5%, 37/566. Physiotherapy was ordered in 23.9% (135/566 of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. Conclusion These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.

  20. Quality of Care in the Psychiatric Setting : Perspectives of the Patient, Next of Kin and Care staff

    OpenAIRE

    Schröder, Agneta

    2006-01-01

    The overall aim of this thesis was to describe quality of care from different perspectives in the psychiatric setting, to develop an instrument for measuring quality of care from the in-patient perspective and to use this instrument empirically. A qualitative descriptive design involving a phenomenographic analysis was used in Studies I, III and IV, and a descriptive and comparative design with statistical analysis in Study II. In Study I, 20 patients were interviewed. The results showed that...

  1. Contextualizing an Expanded Definition of Health Literacy among Adolescents in the Health Care Setting

    Science.gov (United States)

    Massey, Philip M.; Prelip, Michael; Calimlim, Brian M.; Quiter, Elaine S.; Glik, Deborah C.

    2012-01-01

    The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and…

  2. Managing Low Back Pain in the Primary Care Setting: The Know-Do Gap

    Directory of Open Access Journals (Sweden)

    N Ann Scott

    2010-01-01

    Full Text Available OBJECTIVE: To ascertain knowledge gaps in the diagnosis and treatment of acute and chronic low back pain (LBP in the primary care setting to prepare a scoping survey for identifying knowledge gaps in LBP management among Alberta’s primary care practitioners, and to identify potential barriers to implementing a multidisciplinary LBP guideline.

  3. An Innovative Model of Integrated Behavioral Health: School Psychologists in Pediatric Primary Care Settings

    Science.gov (United States)

    Adams, Carolyn D.; Hinojosa, Sara; Armstrong, Kathleen; Takagishi, Jennifer; Dabrow, Sharon

    2016-01-01

    This article discusses an innovative example of integrated care in which doctoral level school psychology interns and residents worked alongside pediatric residents and pediatricians in the primary care settings to jointly provide services to patients. School psychologists specializing in pediatric health are uniquely trained to recognize and…

  4. Setting up a health care quality management system in a multidisciplinary clinical research center

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    L. V. Laktionova

    2013-01-01

    Full Text Available The paper discusses the issues of setting up a quality management system in a multidisciplinary specialized clinical research center. It describes the experience with information technologies used in a prophylactic facility to set up effective out- and inpatient health care control. Measures to optimize work under present-day conditions to upgrade the quality of health care are given using the federal health facility as an example.

  5. The sound of spiritual care: music interventions in a palliative care setting.

    Science.gov (United States)

    Tees, Bob; Budd, Jennifer

    2011-01-01

    The article describes how music has been integrated into spiritual and supportive care for palliative care patients at Brantford General Hospital (Ontario). Numerous case examples illustrate how a song or piece of music can play a vital role in the spiritual dimension of end of life care. The article expands the concept of the "living human document" by positing that a life story has an accompanying soundtrack: a musical memory and sensorial attunement that can be energized when music is offered at the bedside. The writers suggest that music provides an alternate spiritual language for patients whether or not they have a religious affiliation.

  6. Volunteers supporting older people in formal care settings in England: personal and local factors influencing prevalence and type of participation.

    Science.gov (United States)

    Hussein, Shereen; Manthorpe, Jill

    2014-12-01

    In the UK context of financial austerity and the promotion of the social responsibility through the concept of the "Big Society," volunteers are becoming a more important part of the labor workforce. This is particularly so in the long-term care (LTC) sector, where both shortages of staff and demands for support are particularly high. This article investigate the levels and profile of contribution of volunteers in the LTC sector using a large national data set, National Minimum Data Set for Social Care, linked to local area levels of rurality and socio-economic status. The analysis shows that volunteer activity in formal care services varies between sectors and service types, with no strong relationship between local area deprivation, unemployment levels, and levels of volunteering. However, some significant association was found with level of rurality. The contribution of volunteers is most evident in provision of counseling, support, advocacy, and advice.

  7. PREVALENCE OF VARIOUS MUSCULOSKELETAL DISORDERS IN CHILD CARE WORKERS IN DAY CARE SETTINGS

    Directory of Open Access Journals (Sweden)

    Mariet Caroline, MPT,

    2014-08-01

    Full Text Available Child care workers are those who take care of children in the absence of their parents. Child care workers are exposed to various kinds of occupational injuries which include infections, sprains and strains, trauma like bites from children, trip falls and noise exposure. The risks of injury among these workers are due to their nature of the job. One of the common occupational risks found in these workers is musculoskeletal injury, it occurs as a result of working in awkward postures such as bending, twisting, lifting and carrying in incorrect positions, which may result in various injuries like strain, sprain and soft tissue ruptures. Workers with poor physical conditioning may tend to undergo these changes very rapidly. The purpose of this study was to find out the prevalence of various musculoskeletal disorders in child care workers who are taking care of the babies. The study was conducted around various day care centres, among 160 women from who were chosen for the study and were given musculoskeletal analysis questionnaires (Nordic musculoskeletal questionnaire , The Questionnaires were evaluated using descriptive statistics, analysed using SPSS and the results were computed in percentage. Following the analysis, it was concluded that low back injury was predominant among 44% of workers followed by 18% with neck pain, 11% of shoulder pain, 9% of knee pain, 7% of elbow, 6% of wrist, 4% of others and surprisingly 1 % had no musculoskeletal complaints.

  8. Peer pressure and public reporting within healthcare setting: improving accountability and health care quality in hospitals.

    Science.gov (United States)

    Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter

    2012-01-01

    In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.

  9. Nurse practitioner organizational climate in primary care settings: implications for professional practice.

    Science.gov (United States)

    Poghosyan, Lusine; Nannini, Angela; Stone, Patricia W; Smaldone, Arlene

    2013-01-01

    The expansion of the nurse practitioner (NP) workforce in primary care is key to meeting the increased demand for care. Organizational climates in primary care settings affect NP professional practice and the quality of care. This study investigated organizational climate and its domains affecting NP professional practice in primary care settings. A qualitative descriptive design, with purposive sampling, was used to recruit 16 NPs practicing in primary care settings in Massachusetts. An interview guide was developed and pretested with two NPs and in 1 group interview with 7 NPs. Data collection took place in spring of 2011. Individual interviews lasted from 30-70 minutes, were audio recorded, and transcribed. Data were analyzed using Atlas.ti 6.0 software by 3 researchers. Content analysis was applied. Three previously identified themes, NP-physician relations, independent practice and autonomy, and professional visibility, as well as two new themes, organizational support and resources and NP-administration relations emerged from the analyses. NPs reported collegial relations with physicians, challenges in establishing independent practice, suboptimal relationships with administration, and lack of support. NP contributions to patient care were invisible. Favorable organizational climates should be promoted to support the expanding of NP workforce in primary care and to optimize recruitment and retention efforts.

  10. Duty to speak up in the health care setting a professionalism and ethics analysis.

    Science.gov (United States)

    Topazian, Rachel J; Hook, C Christopher; Mueller, Paul S

    2013-11-01

    Staff and students working in health care settings are sometimes reluctant to speak up when they perceive patients to be at risk for harm. In this article, we describe four incidents that occurred at our institution (Mayo Clinic). In two of them, health care professionals failed to speak up, which resulted in harm; in the other two, they did speak up, which prevented harm and improved patient care. We analyzed each scenario using the Physician's Charter on Medical Professionalism and prima facie ethics principles to determine whether principles were violated or upheld. We conclude that anyone who works in a health care setting has a duty to speak up when a patient faces harm. We also provide guidance for health care institutions on promoting a culture in which speaking up is encouraged and integrated into routine practice.

  11. Sharing clinical information across care settings: the birth of an integrated assessment system

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    Henrard Jean-Claude

    2009-04-01

    Full Text Available Abstract Background Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific. Methods From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system. Results The rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations. Conclusion This comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training.

  12. Transitions between care settings at the end of life in the Netherlands: results from a nationwide study.

    NARCIS (Netherlands)

    Abarshi, E.; Echteld, M.; Block, L. van den; Donker, G.; Deliens, L.; Onwuteaka-Philipsen, B.

    2010-01-01

    Multiple transitions between care settings in the last phase of life could jeopardize continuity of care and overall end-of-life patient care. Using a mortality follow-back study, we examined the nature and prevalence of transitions between Dutch care settings in the last 3 months of life, and ident

  13. Critical pathways for the management of preeclampsia and severe preeclampsia in institutionalised health care settings

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    Daftari Ashi

    2003-10-01

    Full Text Available Abstract Background Preeclampsia is a complex disease in which several providers should interact continuously and in a coordinated manner to provide proper health care. However, standardizing criteria to treat patients with preeclampsia is problematical and severe flaws have been observed in the management of the disease. This paper describes a set of critical pathways (CPs designed to provide uniform criteria for clinical decision-making at different levels of care of pregnant patients with preeclampsia or severe preeclampsia. Methods Clinicians and researchers from different countries participated in the construction of the CPs. The CPs were developed using the following steps: a Definition of the conceptual framework; b Identification of potential users: primary care physicians and maternal and child health nurses in ambulatory settings; ob/gyn and intensive care physicians in secondary and tertiary care levels. c Structural development. Results The CPs address the following care processes: 1. Screening for preeclampsia, risk assessment and classification according to the level of risk. 2. Management of preeclampsia at primary care clinics. 3. Evaluation and management of preeclampsia at secondary and tertiary care hospitals: 4. Criteria for clinical decision-making between conservative management and expedited delivery of patients with severe preeclampsia. Conclusion Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity worldwide, the expected impact of these CPs is the contribution to improving health care quality in both developed and developing countries. The CPs are designed to be applied in a complex health care system, where different physicians and health providers at different levels of care should interact continuously and in a coordinated manner to provide care to all preeclamptic women. Although the CPs were developed using evidence-based criteria, they could require careful evaluation and

  14. Intervening at the Setting Level to Prevent Behavioral Incidents in Residential Child Care: Efficacy of the CARE Program Model.

    Science.gov (United States)

    Izzo, Charles V; Smith, Elliott G; Holden, Martha J; Norton, Catherine I; Nunno, Michael A; Sellers, Deborah E

    2016-07-01

    The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions.

  15. The Quality of Care Provided to Women with Urinary Incontinence in Two Clinical Settings

    Science.gov (United States)

    Anger, Jennifer T.; Alas, Alexandriah; Litwin, Mark S.; Chu, Stephanie D.; Bresee, Catherine; Roth, Carol P.; Rashid, Rezoana; Shekelle, Paul; Wenger, Neil S.

    2016-01-01

    Purpose Our aim was to test the feasibility of a set of quality-of-care indicators for urinary incontinence (UI) and, at the same time, measure the care provided to women with UI in two different clinical settings. Materials and Methods This was a pilot test of a set of quality-of-care indicators (QIs). This was a pilot test of a set of quality-of-care indicators (QIs). Twenty QIs were previously developed using the RAND Appropriateness method. These QIs were used to measure care received for 137 women with a urinary incontinence (UI) diagnosis in a 120-physician hospital-based multi-specialty medical group (MSG). We also performed an abstraction of 146 patient records from primary care offices in Southern California. These charts were previously used as part of the Assessing Care of Vulnerable Elders Project (ACOVE). As a post-hoc secondary analysis, the two populations were compared with respect to quality, as measured by compliance with the QIs. Results In the ACOVE population, 37.7% of patients with UI underwent a pelvic examination, versus 97.8% in the MSG. Only 15.6% of cases in the MSG and 14.2% in ACOVE (p=0.86) had documentation that pelvic floor exercises were offered. Relatively few women with a body mass index (BMI) of >25 were counseled about weight loss in either population (20.9% MSG vs. 26.1% ACOVE, p=0.76). For women undergoing sling surgery, documentation of counseling about risks was lacking, and only 9.3% of eligible cases (MSG only) had documentation of the risks of mesh. Conclusions QIs are a feasible means to measure the care provided to women with UI. Care varied by population studied, yet deficiencies in care were prevalent in both patient populations studied. PMID:27164512

  16. Health care-associated pneumonia: an evidence-based review.

    Science.gov (United States)

    Attridge, Russell T; Frei, Christopher R

    2011-08-01

    Health care-associated pneumonia is a relatively new classification of pneumonia that includes community-dwelling pneumonia patients having contact with the health care system. Current data indicate that health care-associated pneumonia patients present with more severe disease, are more likely to be infected with drug-resistant pathogens, and suffer increased mortality compared with community-acquired pneumonia patients. Guidelines recommend that these patients receive empiric antibiotics similar to those recommended for nosocomial pneumonia; however, it is not currently known if outcomes are improved when health care-associated pneumonia patients are treated with these therapies. In addition, the individual health care-associated pneumonia risk factors are based on limited data and are a poor predictor of patients likely to be infected with drug-resistant pathogens. Many questions remain on how to most appropriately care for this growing group of pneumonia patients. This review is an evidence-based discussion of current health care-associated pneumonia data, the individual health care-associated pneumonia risk factors, and limitations and additional considerations for the health care-associated pneumonia classification system.

  17. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    Science.gov (United States)

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  18. American Association of Critical-Care Nurses

    Science.gov (United States)

    ... range of topics including regulatory issues, advanced practice, ethics, end-of-life care, legal issues and research. Browse Topics Volunteer Share your nursing expertise as a volunteer, which includes becoming an ...

  19. A qualitative study of nurse practitioner promotion of interprofessional care across institutional settings: Perspectives from different healthcare professionals

    Directory of Open Access Journals (Sweden)

    Christina Hurlock-Chorostecki

    2016-03-01

    Conclusions: Nurse practitioners in acute care hospital and long-term care settings have valued attributes that can promote interprofessional care. Effective strategies to promote interprofessional care emerge from these role attributes. However, the interprofessional relationship type perceived could enhance or impede the contribution of the strategies to interprofessional care promotion.

  20. Risk adjustment methods for Home Care Quality Indicators (HCQIs based on the minimum data set for home care

    Directory of Open Access Journals (Sweden)

    Hirdes John P

    2005-01-01

    Full Text Available Abstract Background There has been increasing interest in enhancing accountability in health care. As such, several methods have been developed to compare the quality of home care services. These comparisons can be problematic if client populations vary across providers and no adjustment is made to account for these differences. The current paper explores the effects of risk adjustment for a set of home care quality indicators (HCQIs based on the Minimum Data Set for Home Care (MDS-HC. Methods A total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA in Manitoba, Canada, gathered data on their clients using the MDS-HC. These assessment data were used to generate HCQIs for each agency and for the two regions. Three types of risk adjustment methods were contrasted: a client covariates only; b client covariates plus an "Agency Intake Profile" (AIP to adjust for ascertainment and selection bias by the agency; and c client covariates plus the intake Case Mix Index (CMI. Results The mean age and gender distribution in the two populations was very similar. Across the 19 risk-adjusted HCQIs, Ontario CCACs had a significantly higher AIP adjustment value for eight HCQIs, indicating a greater propensity to trigger on these quality issues on admission. On average, Ontario had unadjusted rates that were 0.3% higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were, on average, 1.5% lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing, whereby they were more likely to be ranked among the worst performers following risk adjustment. The opposite was true for sites in Ontario. Conclusions Risk adjustment is essential when comparing quality of care across providers when home care agencies provide services to populations with different characteristics. While such adjustment had a relatively small effect for the two regions, it did

  1. Transitions in Care: Medication Reconciliation in the Community Pharmacy Setting After Discharge

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    Staci M. Williams, PharmD

    2013-01-01

    Full Text Available Objective: To assess the feasibility of a workflow process in which pharmacists in an independent community pharmacy group conduct medication reconciliation for patients undergoing transitions in care.Methods: Three workflow changes were made to improve the medication reconciliation process in a group of three independent community pharmacies. Analysis of the process included workflow steps performed by pharmacy staff, pharmacist barriers encountered during the medication reconciliation process, number of medication discrepancies identified, and pharmacist comfort level while performing each medication reconciliation service.Key Findings: Sixty patient medication reconciliation services met the inclusion criteria for the study. Pharmacists were involved in all steps associated with the medication reconciliation workflow, and were the sole performer in four of the steps: verifying discharge medications with the pharmacy medication profile, resolving discrepancies, contacting the prescriber, and providing patient counseling. Pharmacists were least involved in entering medications into the pharmacy management system, performing that workflow step 13% of the time. The most common barriers were the absence of a discharge medication list (24% and patient not present during consultation (11%. A total of 231 medication discrepancies were identified, with an average of 3.85 medication discrepancies per discharge. Pharmacists’ comfort level performing medication reconciliation improved through the 13 weeks of the study.Conclusions: These findings suggest that medication reconciliation for patients discharged from hospitals and long term care facilities can be successfully performed in an independent community pharmacy setting. Because many medication discrepancies were identified during this transition of care, it is highly valuable for community pharmacists to perform medication reconciliation services.

  2. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting

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    Jaishika Seedat

    2016-02-01

    Full Text Available Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23 was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23 was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.

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

    Science.gov (United States)

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

    2010-01-01

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

  4. Costing nursing care: using the clinical care classification system to value nursing intervention in an acute-care setting.

    Science.gov (United States)

    Moss, Jacqueline; Saba, Virginia

    2011-08-01

    The purpose of this study was to combine an established methodology for coding nursing interventions and action types using the Clinical Care Classification System with a reliable formula (relative value units) to cost nursing services. Using a flat per-diem rate to cost nursing care greatly understates the actual costs and fails to address the high levels of variability within and across units. We observed nurses performing commonly executed nursing interventions and recorded these into an electronic database with corresponding Clinical Care Classification System codes. The duration of these observations was used to calculate intervention costs using relative value unit calculation formulas. The costs of the five most commonly executed interventions were nursing care coordination/manage-refer ($2.43), nursing status report/assess-monitor ($4.22), medication treatment/perform-direct ($6.33), physical examination/assess-monitor ($3.20), and universal precautions/perform-direct ($1.96). Future studies across a variety of nursing specialties and units are needed to validate the relative value unit for Clinical Care Classification System action types developed for use with the Clinical Care Classification System nursing interventions as a method to cost nursing care.

  5. Performance of defect-tolerant set-associative cache memories

    Science.gov (United States)

    Frenzel, J. F.

    1991-01-01

    The increased use of on-chip cache memories has led researchers to investigate their performance in the presence of manufacturing defects. Several techniques for yield improvement are discussed and results are presented which indicate that set-associativity may be used to provide defect tolerance as well as improve the cache performance. Tradeoffs between several cache organizations and replacement strategies are investigated and it is shown that token-based replacement may be a suitable alternative to the widely-used LRU strategy.

  6. Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: a qualitative study

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    Holtzer-Goor Kim M

    2013-01-01

    Full Text Available Abstract Background Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders’ perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists. Methods A case study was undertaken in the Rotterdam Eye Hospital (REH using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis. Results Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based glaucoma follow-up unit (GFU. Respondents’ narratives revealed that: the glaucoma specialists’ sense of urgency for task substitution outside the hospital diminished after establishing a GFU that satisfied their professionalization needs; the return on investments were unclear; and reluctant key stakeholders with strong power positions blocked implementation. The window of opportunity that existed for task substitution in person and setting in 1999 closed with the institutionalization of the GFU. Conclusions Transferring the monitoring of stable glaucoma patients to primary care optometrists in Rotterdam did not seem feasible. The main reasons were the lack of agreement on professional boundaries and work domains, the institutionalization of the GFU in the REH, and the absence of an appropriate reimbursement system. Policy makers considering substituting tasks to other professionals should carefully think about the implementation process, especially in a two-step implementation process (substitution in person and in setting such as this case. Involving the substituting professionals early on to ensure all

  7. Social welfare and the Affordable Care Act: is it ever optimal to set aside comparative cost?

    Science.gov (United States)

    Mortimer, Duncan; Peacock, Stuart

    2012-10-01

    The creation of the Patient-Centered Outcomes Research Institute (PCORI) under the Affordable Care Act has set comparative effectiveness research (CER) at centre stage of US health care reform. Comparative cost analysis has remained marginalised and it now appears unlikely that the PCORI will require comparative cost data to be collected as an essential component of CER. In this paper, we review the literature to identify ethical and distributional objectives that might motivate calls to set priorities without regard to comparative cost. We then present argument and evidence to consider whether there is any plausible set of objectives and constraints against which priorities can be set without reference to comparative cost. We conclude that - to set aside comparative cost even after accounting for ethical and distributional constraints - would be truly to act as if money is no object.

  8. Rough Set Model for Discovering Hybrid Association Rules

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    Pandey, Anjana

    2009-01-01

    In this paper, the mining of hybrid association rules with rough set approach is investigated as the algorithm RSHAR.The RSHAR algorithm is constituted of two steps mainly. At first, to join the participant tables into a general table to generate the rules which is expressing the relationship between two or more domains that belong to several different tables in a database. Then we apply the mapping code on selected dimension, which can be added directly into the information system as one certain attribute. To find the association rules, frequent itemsets are generated in second step where candidate itemsets are generated through equivalence classes and also transforming the mapping code in to real dimensions. The searching method for candidate itemset is similar to apriori algorithm. The analysis of the performance of algorithm has been carried out.

  9. Stereotype threat among black and white women in health care settings.

    Science.gov (United States)

    Abdou, Cleopatra M; Fingerhut, Adam W

    2014-07-01

    The first of its kind, the present experiment applied stereotype threat-the threat of being judged by or confirming negative group-based stereotypes-to the health sciences. Black and White women (N = 162) engaged in a virtual health care situation. In the experimental condition, one's ethnic identity and negative stereotypes of Black women specifically were made salient. As predicted, Black women in the stereotype threat condition who were strongly identified as Black (in terms of having explored what their ethnic identity means to them and the role it plays in their lives) reported significantly greater anxiety while waiting to see the doctor in the virtual health care setting than all other women. It is hypothesized that stereotype threat experienced in health care settings is one overlooked social barrier contributing to disparities in health care utilization and broader health disparities among Black women.

  10. Nurse practitioners--where do they belong within the organizational structure of the acute care setting?

    Science.gov (United States)

    el-Sherif, C

    1995-01-01

    Nurse practitioners are expanding their scope of practice and moving into acute care settings. Striving to be part of the nursing organizational structure in the acute care setting will keep NP's practice firmly rooted in nursing theory. Remaining within the nursing realm will enable them to receive support and guidance from their nursing colleagues while advancing the profession through their knowledge and expertise. Within the nursing organizational structure, NPs can become leaders as clinicians and role models. Without the formal support of the nursing organizational structure, the unique skills and contributions nurse practitioners furnish to the profession will be lost, as others will then dictate the NP role and scope of practice within the acute care setting.

  11. The impact of behavioral and mental health risk assessments on goal setting in primary care.

    Science.gov (United States)

    Krist, Alex H; Glasgow, Russell E; Heurtin-Roberts, Suzanne; Sabo, Roy T; Roby, Dylan H; Gorin, Sherri N Sheinfeld; Balasubramanian, Bijal A; Estabrooks, Paul A; Ory, Marcia G; Glenn, Beth A; Phillips, Siobhan M; Kessler, Rodger; Johnson, Sallie Beth; Rohweder, Catherine L; Fernandez, Maria E

    2016-06-01

    Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3-15.8 %, p set goals for six risks (range of differences 3.8-16.6 %, p controls, intervention patients felt clinicians cared more for them and showed more interest in their concerns. Patient-centered health risk assessments improve screening and goal setting.Trial RegistrationClinicaltrials.gov identifier: NCT01825746.

  12. Palliative cancer care ethics: Principles and challenges in the Indian setting

    Directory of Open Access Journals (Sweden)

    Tejaswi Mudigonda

    2010-01-01

    Full Text Available Palliative cancer treatment is a system of care that seeks to relieve suffering in patients with progressive cancer. Given the intractable symptoms with which certain malignancies manifest, palliative care offers a practical approach towards improving the patient′s quality of life. However, there are an array of ethical issues associated with this treatment strategy such as particular methods of pain relief, a reliable assessment of suffering, autonomy, and multi-specialist care. While these principles are important to increase and improve the network of palliative care, the resource-poor Indian environments present numerous barriers for these principles to be practically applied. As the infrastructure of comprehensive cancer centers develop, paralleled with an increase in training of palliative care professionals, significant improvements need to be made in order to elevate the status of palliative cancer care in India.

  13. Using portable negative pressure wound therapy devices in the home care setting

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    Burke JR

    2014-12-01

    Full Text Available Joshua R Burke, Rachael Morley, Mustafa Khanbhai Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK Abstract: Negative pressure wound therapy (NPWT is the continuous or intermittent application of subatmospheric pressure to the surface of a wound that improves the wound environment, accelerates healing, and reduces wound closure time. Since its first documented use, this technology has lent itself to a number of adaptations, most notably, the development of portable devices facilitating treatment in the home care setting. With advancing surgical standards, wound healing is an important rate-limiting factor in early patient discharge and often a major cost of inpatient treatment. The efficacy of NPWT in the home care setting has been investigated through rate of wound closure, time in care, and patient experience. Rate of wound closure is the most appropriate primary end point. Much can be gleaned from patient experience, but the future success of portable NPWT will be measured on time in care and therefore cost effectiveness. However, there is a lack of level 1a evidence demonstrating increased efficacy of portable over inpatient NPWT. The development of portable NPWT is an encouraging innovation in wound care technology, and extending the benefits to the home care setting is both possible and potentially more beneficial. Keywords: portable, negative pressure wound therapy, vacuum-assisted closure, topical negative pressure therapy

  14. Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

    Science.gov (United States)

    Kornhaber, Rachel; Walsh, Kenneth; Duff, Jed; Walker, Kim

    2016-01-01

    Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician–patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients’ experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships. PMID:27789958

  15. Managing disruptive behaviors in the health care setting: focus on obstetrics services.

    Science.gov (United States)

    Rosenstein, Alan H

    2011-03-01

    Disruptive behaviors can have a significant negative impact on staff relationships, communication flow, task responsibility, and team collaboration, all of which can adversely impact patient outcomes of care. Addressing disruptive behaviors in a positive manner by emphasizing the benefits of mutual understanding, shared goals and priorities, and adherence to accepted standards of care will enhance communication flow and improve the process and outcomes of care. This is particularly relevant in the obstetrics setting, where care is delivered over a continuum of time, with multiple different members of the health care team playing a vital role as the patient progresses from labor to delivery. Critical strategies for success include having strong organizational commitment and leadership support, raising provider insight and awareness, implementing appropriate policies and procedures, providing appropriate educational and training programs, and facilitating action-oriented interventional support.

  16. Isolation gowns in health care settings: Laboratory studies, regulations and standards, and potential barriers of gown selection and use

    Science.gov (United States)

    Kilinc Balci, F. Selcen

    2016-01-01

    Although they play an important role in infection prevention and control, textile materials and personal protective equipment (PPE) used in health care settings are known to be one of the sources of cross-infection. Gowns are recommended to prevent transmission of infectious diseases in certain settings; however, laboratory and field studies have produced mixed results of their efficacy. PPE used in health care is regulated as either class I (low risk) or class II (intermediate risk) devices in the United States. Many organizations have published guidelines for the use of PPE, including isolation gowns, in health care settings. In addition, the Association for the Advancement of Medical Instrumentation published a guidance document on the selection of gowns and a classification standard on liquid barrier performance for both surgical and isolation gowns. However, there is currently no existing standard specific to isolation gowns that considers not only the barrier resistance but also a wide array of end user desired attributes. As a result, infection preventionists and purchasing agents face several difficulties in the selection process, and end users have limited or no information on the levels of protection provided by isolation gowns. Lack of knowledge about the performance of protective clothing used in health care became more apparent during the 2014 Ebola epidemic. This article reviews laboratory studies, regulations, guidelines and standards pertaining to isolation gowns, characterization problems, and other potential barriers of isolation gown selection and use. PMID:26391468

  17. Development of a set of process and structure indicators for palliative care: the Europall project

    Directory of Open Access Journals (Sweden)

    Woitha Kathrin

    2012-11-01

    Full Text Available Abstract Background By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs, patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. Methods As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. Results The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. Conclusions We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs.

  18. Recovery-oriented care in acute inpatient mental health settings: an exploratory study.

    Science.gov (United States)

    McKenna, Brian; Furness, Trentham; Dhital, Deepa; Ennis, Garry; Houghton, James; Lupson, Christine; Toomey, Nigel

    2014-07-01

    Australian mental health nurses will need to care with consumers of mental health services, within the domains of recovery. However, in acute inpatient mental health settings, nurses are without a clear description of how to be recovery-oriented. The intent of this qualitative study was to ask nurses to reflect on and describe current practice within acute inpatient services that are not overtly recovery-oriented. Results show that nurses can identify recovery and articulate with pragmatic clarity how to care within a recovery-oriented paradigm. Pragmatic modes of care described by nurses support using "champions" to assist with eventual system transformation in the delivery of mental health services.

  19. Assessing quality of care of elderly patients using the ACOVE quality indicator set: a systematic review.

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    Marjan Askari

    Full Text Available BACKGROUND: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE quality indicators (QIs were developed to assess and improve the care of elderly patients. OBJECTIVES: The purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate the state of quality of care for the reported conditions. METHODS: We systematically searched MEDLINE, EMBASE and CINAHL for English-language studies indexed by February 2010. Articles were included if they used any ACOVE QIs, or adaptations thereof, for assessing the quality of care. Included studies were analyzed and relevant information was extracted. We summarized the results of these studies, and when possible generated an overall conclusion about the quality of care as measured by ACOVE for each condition, in various settings, and for each QI. RESULTS: Seventeen studies were included with 278 QIs (original, adapted or newly developed. The quality scores showed large variation between and within conditions. Only a few conditions showed a stable pass rate range over multiple studies. Overall, pass rates for dementia (interquartile range (IQR: 11%-35%, depression (IQR: 27%-41%, osteoporosis (IQR: 34%-43% and osteoarthritis (IQR: 29-41% were notably low. Medication management and use (range: 81%-90%, hearing loss (77%-79% and continuity of care (76%-80% scored higher than other conditions. Out of the 278 QIs, 141 (50% had mean pass rates below 50% and 121 QIs (44% had pass rates above 50%. Twenty-three percent of the QIs scored above 75%, and 16% scored below 25%. CONCLUSIONS: Quality of care per condition varies markedly across studies. Although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the ACOVE indicators is still relatively low.

  20. Health care professionals' perspectives on barriers to elder abuse detection and reporting in primary care settings.

    Science.gov (United States)

    Schmeidel, Amy N; Daly, Jeanette M; Rosenbaum, Marcy E; Schmuch, Gretchen A; Jogerst, Gerald J

    2012-01-01

    The purpose of this study was to explore health care professionals' perspectives on elder abuse to achieve a better understanding of the problems of reporting and to generate ideas for improving the detection and reporting process. Through a mailed survey, nurses, physicians, and social workers were invited to participate in an interview. Nine nurses, 8 physicians, and 6 social workers were interviewed, and thematic analysis was used to identify the following core themes: preconceptions, assessment, interpretation, systems, and knowledge and education. Participants suggested a reorganization of the external reporting system. More frequent and pragmatic education is necessary to strengthen practical knowledge about elder abuse.

  1. Assessment of Chronic Illness Care with the German version of the ACIC in different primary care settings in Switzerland

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    Zoller Marco

    2010-10-01

    Full Text Available Abstract Background In Switzerland the extent to which patients with chronic illnesses receive care congruent with the Chronic Care Model (CCM is unknown. Methods According to guidelines we translated the Assessment of Chronic Illness Care (ACIC into German (G-ACIC. We tested the instrument in different primary care settings and compared subscales with the original testing. Results Difficulties encountered during the translation process consisted in the difference of health care settings in Switzerland and USA. However initial testing showed the G-ACIC to be a suitable instrument. The average ACIC subscale scores in Swiss managed care (MC-, group (GP- and single handed practices (SP were higher for MC practices than for group- and single handed practices: Organization of the healthcare delivery system: MC mean (m = 6.80 (SD 1.55, GP m = 5.42 (SD 0.99, SP m = 4.60 (SD 2.07; community linkages: MC m = 4.19 (SD 1.47, GP m = 4.83 (SD 1.81, SP m = 3.10 (SD 2.12; self-management support: MC m = 4.96 (SD 1.13, GP m = 4.73 (SD 1.40, SP m = 4.43 (SD 1.34; decision support: MC m = 4.75 (SD 1.06; GP m = 4.20 (SD 0.87, SP m = 3.25 (SD 1.59; delivery system design: MC m = 5.98 (SD 1.61, GP m = 5.05 (SD 2.05, SP m = 3.86 (SD 1.51 and clinical information systems: MC m = 4.34 (SD = 2.49, GP m = 2.06 (SD 1.35, SP m = 3.20 (SD 1.57. Conclusions The G-ACIC is applicable and useful for comparing different health care settings in German speaking countries. Managed care organizations seem to implement the different components of the CCM in a greater extend than group and single handed practices. However, much room exists for further improvement.

  2. Consumer satisfaction with primary care provider choice and associated trust

    Directory of Open Access Journals (Sweden)

    Balkrishnan Rajesh

    2006-10-01

    Full Text Available Abstract Background Development of managed care, characterized by limited provider choice, is believed to undermine trust. Provider choice has been identified as strongly associated with physician trust. Stakeholders in a competitive healthcare market have competing agendas related to choice. The purpose of this study is to analyze variables associated with consumer's satisfaction that they have enough choice when selecting their primary care provider (PCP, and to analyze the importance of these variables on provider trust. Methods A 1999 randomized national cross-sectional telephone survey conducted of United States residential households, who had a telephone, had seen a medical professional at least twice in the past two years, and aged ≥ 20 years was selected for secondary data analyses. Among 1,117 households interviewed, 564 were selected as the final sample. Subjects responded to a core set of questions related to provider trust, and a subset of questions related to trust in the insurer. A previously developed conceptual framework was adopted. Linear and logistic regressions were performed based on this framework. Results Results affirmed 'satisfaction with amount of PCP choice' was significantly (p Conclusion This study confirmed the association of 'satisfaction with amount of PCP choice' with provider trust. Results affirmed 'enough PCP choice' was a strong predictor of provider trust. 'Second opinion on PCP' may indicate distrust in the provider. Data such as 'trust in providers in general' and 'the role of provider performance information' in choice, though import in PCP choice, were not available for analysis and should be explored in future studies. Results have implications for rethinking the relationships among consumer choice, consumer behaviors in making trade-offs in PCP choice, and the role of healthcare experiences in 'satisfaction with amount of PCP choice' or 'provider trust.'

  3. Person-Centered Care in the Home Setting for Parkinson's Disease: Operation House Call Quality of Care Pilot Study.

    Science.gov (United States)

    Hack, Nawaz; Akbar, Umer; Monari, Erin H; Eilers, Amanda; Thompson-Avila, Amanda; Hwynn, Nelson H; Sriram, Ashok; Haq, Ihtsham; Hardwick, Angela; Malaty, Irene A; Okun, Michael S

    2015-01-01

    Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.

  4. Infection Prevention and Control for Ebola in Health Care Settings - West Africa and United States.

    Science.gov (United States)

    Hageman, Jeffrey C; Hazim, Carmen; Wilson, Katie; Malpiedi, Paul; Gupta, Neil; Bennett, Sarah; Kolwaite, Amy; Tumpey, Abbigail; Brinsley-Rainisch, Kristin; Christensen, Bryan; Gould, Carolyn; Fisher, Angela; Jhung, Michael; Hamilton, Douglas; Moran, Kerri; Delaney, Lisa; Dowell, Chad; Bell, Michael; Srinivasan, Arjun; Schaefer, Melissa; Fagan, Ryan; Adrien, Nedghie; Chea, Nora; Park, Benjamin J

    2016-07-08

    The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa underscores the need for health care infection prevention and control (IPC) practices to be implemented properly and consistently to interrupt transmission of pathogens in health care settings to patients and health care workers. Training and assessing IPC practices in general health care facilities not designated as Ebola treatment units or centers became a priority for CDC as the number of Ebola virus transmissions among health care workers in West Africa began to affect the West African health care system and increasingly more persons became infected. CDC and partners developed policies, procedures, and training materials tailored to the affected countries. Safety training courses were also provided to U.S. health care workers intending to work with Ebola patients in West Africa. As the Ebola epidemic continued in West Africa, the possibility that patients with Ebola could be identified and treated in the United States became more realistic. In response, CDC, other federal components (e.g., Office of the Assistant Secretary for Preparedness and Response) and public health partners focused on health care worker training and preparedness for U.S. health care facilities. CDC used the input from these partners to develop guidelines on IPC for hospitalized patients with known or suspected Ebola, which was updated based on feedback from partners who provided care for Ebola patients in the United States. Strengthening and sustaining IPC helps health care systems be better prepared to prevent and respond to current and future infectious disease threats.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

  5. Parametric Rough Sets with Application to Granular Association Rule Mining

    Directory of Open Access Journals (Sweden)

    Xu He

    2013-01-01

    Full Text Available Granular association rules reveal patterns hidden in many-to-many relationships which are common in relational databases. In recommender systems, these rules are appropriate for cold-start recommendation, where a customer or a product has just entered the system. An example of such rules might be “40% men like at least 30% kinds of alcohol; 45% customers are men and 6% products are alcohol.” Mining such rules is a challenging problem due to pattern explosion. In this paper, we build a new type of parametric rough sets on two universes and propose an efficient rule mining algorithm based on the new model. Specifically, the model is deliberately defined such that the parameter corresponds to one threshold of rules. The algorithm benefits from the lower approximation operator in the new model. Experiments on two real-world data sets show that the new algorithm is significantly faster than an existing algorithm, and the performance of recommender systems is stable.

  6. Factors associated with family reunification for children in foster care

    NARCIS (Netherlands)

    López, Mónica; del Valle, Jorge F.; Montserrat, Carme; Bravo, Amaia

    2013-01-01

    In this paper, we analyse reunification processes from family foster care, both kinship and non-kinship, and the variables associated with them in a Spanish sample. Data collection was carried out after a review of child protection and foster care files, and those responsible for the cases were also

  7. Teaching Social Skills to Enhance Work Performance in a Child Care Setting

    Science.gov (United States)

    Gear, Sabra; Bobzien, Jonna; Judge, Sharon; Raver, Sharon A.

    2011-01-01

    Adults with intellectual disabilities face difficulty seeking employment in the community workforce. Using a single-subject design, this study examined the utility of role playing and self-management strategies to enhance work performance by promoting the social skills of a young woman with Down syndrome working in a community child care setting.…

  8. Dignity Versus Dehumanization in Long-Term Care Settings for Older Persons: A Training Outline.

    Science.gov (United States)

    Kampfe, Charlene M.

    This paper describes the types of attitudes and behaviors that might be destructive to an individual's sense of self-worth, and suggests that counselors in long-term care settings face the challenge of changing these. One strategy for counteracting potential dehumanization, offering in-service training to all levels of staff and administrators, is…

  9. Optimising the Collaborative Practice of Nurses in Primary Care Settings Using a Knowledge Translation Approach

    Science.gov (United States)

    Oelke, Nelly; Wilhelm, Amanda; Jackson, Karen

    2016-01-01

    The role of nurses in primary care is poorly understood and many are not working to their full scope of practice. Building on previous research, this knowledge translation (KT) project's aim was to facilitate nurses' capacity to optimise their practice in these settings. A Summit engaging Alberta stakeholders in a deliberative discussion was the…

  10. Creating Discursive Order at the End of Life: The Role of Genres in Palliative Care Settings

    Science.gov (United States)

    Schryer, Catherine; McDougall, Allan; Tait, Glendon R.; Lingard, Lorelei

    2012-01-01

    This article investigates an emerging practice in palliative care: dignity therapy. Dignity therapy is a psychotherapeutic intervention that its proponents assert has clinically significant positive impacts on dying patients. Dignity therapy consists of a physician asking a patient a set of questions about his or her life and returning to the…

  11. User and provider perspectives on emergency obstetric care in a Tanzanian rural setting

    DEFF Research Database (Denmark)

    Sorensen, Bjarke Lund; Nielsen, Birgitte Bruun; Rasch, Vibeke

    2011-01-01

    The aim of this field study was to analyze the main dynamics and conflicts in attending and providing good quality delivery care in a local Tanzanian rural setting. The women and their relatives did not see the problems of pregnancy and birth in isolation but in relation to multiple other problem...... "actantial model is suggested for that purpose....

  12. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives.

    Science.gov (United States)

    Lim, Ching Jou; Kong, David C M; Stuart, Rhonda L

    2014-01-01

    Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of particular concern is the recent emergence of multidrug-resistant organisms among this vulnerable population. Accordingly, antimicrobial stewardship (AMS) programs have started to be introduced into the residential aged care facilities setting to promote judicious antimicrobial use. However, to successfully implement AMS programs, there are unique challenges pertaining to this resource-limited setting that need to be addressed. In this review, we summarize the epidemiology of infections in this population and review studies that explore antibiotic use and prescribing patterns. Specific attention is paid to issues relating to inappropriate or suboptimal antibiotic prescribing to guide future AMS interventions.

  13. Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions.

    Science.gov (United States)

    DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M

    2013-01-01

    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs.

  14. Aplikasi Teori Self-Care Deficit Orem dalam Konteks Tuna Wisma (Studi Literatur (The Application of Orem’s Self Care Deficit in Homeless Setting

    Directory of Open Access Journals (Sweden)

    Megah Andriyani

    2007-07-01

    Full Text Available Homeless health is government and NGO’s responsibilities for creating optimal citizen health status. Homeless is one of community health nursing clients. The Self Care Theory is used in nursing science for giving conceptual framework as a practical guidance and building self care knowledge through research. Orem described self care as a continuing intervention. It was needed and done by adult to be survived, healthy, and wellness. This theory is also used in homeless setting by many experts. This article aims to describe Orem’s Self Care Theory, describe homeless’ self care, and apply Orem’s Self Care Theory in homeless setting.

  15. Patient Communication in Health Care Settings: new Opportunities for Augmentative and Alternative Communication.

    Science.gov (United States)

    Blackstone, Sarah W; Pressman, Harvey

    2016-01-01

    Delivering quality health care requires effective communication between health care providers and their patients. In this article, we call on augmentative and alternative communication (AAC) practitioners to offer their knowledge and skills in support of a broader range of patients who confront communication challenges in health care settings. We also provide ideas and examples about ways to prepare people with complex communication needs for the inevitable medical encounters that they will face. We argue that AAC practitioners, educators, and researchers have a unique role to play, important expertise to share, and an extraordinary opportunity to advance the profession, while positively affecting patient outcomes across the health care continuum for a large number of people.

  16. From the inside out: the engagement of physicians as leaders in health care settings.

    Science.gov (United States)

    Snell, Anita J; Briscoe, Don; Dickson, Graham

    2011-07-01

    Health care delivery must be transformed to manage spiraling costs and preserve quality care. Transforming complex health systems will require the engagement of physicians as leaders in their health care settings, in both formal and informal roles. In this article we explore the experience of physician leader engagement and identify factors operating at the individual, team, and organizational levels related to increased or decreased physician leader engagement. Using an inductive approach, our analysis of the transcribed interviews yielded a rich understanding of what motivates physicians to be engaged as leaders, how they experience engagement, the role of the physician leader, how physicians understand other physicians' engagement, what encourages and discourages their engagement efforts, and the role that education and training has in physician engagement. We conclude by offering strategies that physicians, health care organizations, and educational institutions can implement to increase the engagement of physician leaders.

  17. Exploring staff perceptions on the role of physical environment in dementia care setting.

    Science.gov (United States)

    Lee, Sook Y; Chaudhury, Habib; Hung, Lillian

    2016-07-01

    This study explored staff perceptions of the role of physical environment in dementia care facilities in affecting resident's behaviors and staff care practice. We conducted focus groups with staff (n = 15) in two purposely selected care facilities in Vancouver, Canada. Focus group participants included nurses, care aides, recreation staff, administrative staff, and family. Data analysis revealed two themes: (a) a supportive physical environment contributes positively to both quality of staff care interaction and residents' quality of life and (b) an unsupportive physical environment contributes negatively to residents' quality of life and thereby makes the work of staff more challenging. The staff participants collectively viewed that comfort, familiarity, and an organized space were important therapeutic resources for supporting the well-being of residents. Certain behaviors of residents were influenced by poor environmental factors, including stimulation overload, safety risks, wayfinding challenge, and rushed care This study demonstrates the complex interrelationships among the dementia care setting's physical environment, staff experiences, and residents' quality of life.

  18. Improving Mental Health Access for Low-Income Children and Families in the Primary Care Setting.

    Science.gov (United States)

    Hodgkinson, Stacy; Godoy, Leandra; Beers, Lee Savio; Lewin, Amy

    2017-01-01

    Poverty is a common experience for many children and families in the United States. Children low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span. Despite their high need for mental health services, children and families living in poverty are least likely to be connected with high-quality mental health care. Pediatric primary care providers are in a unique position to take a leading role in addressing disparities in access to mental health care, because many low-income families come to them first to address mental health concerns. In this report, we discuss the impact of poverty on mental health, barriers to care, and integrated behavioral health care models that show promise in improving access and outcomes for children and families residing in the contexts of poverty. We also offer practice recommendations, relevant to providers in the primary care setting, that can help improve access to mental health care in this population.

  19. Best practices of total quality management implementation in health care settings.

    Science.gov (United States)

    Talib, Faisal; Rahman, Zillur; Azam, Mohammed

    2011-01-01

    Due to the growing prominence of total quality management (TQM) in health care, the present study was conducted to identify the set of TQM practices for its successful implementation in healthcare institutions through a systematic review of literature. A research strategy was performed on the selected papers published between 1995 and 2009. An appropriate database was chosen and 15 peer-reviewed research papers were identified through a screening process and were finally reviewed for this study. Eight supporting TQM practices, such as top-management commitment, teamwork and participation, process management, customer focus and satisfaction, resource management, organization behavior and culture, continuous improvement, and training and education were identified as best practices for TQM implementation in any health care setting. The article concludes with a set of recommendations for the future researchers to discuss, develop, and work upon in order to achieve better precision and generalizations.

  20. Strengthening fairness, transparency and accountability in health care priority setting at district level in Tanzania

    Directory of Open Access Journals (Sweden)

    Stephen Maluka

    2011-11-01

    Full Text Available Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting

  1. Trauma-informed care in inpatient mental health settings: a review of the literature.

    Science.gov (United States)

    Muskett, Coral

    2014-02-01

    Trauma-informed care is an emerging value that is seen as fundamental to effective and contemporary mental health nursing practice. Trauma-informed care, like recovery, leaves mental health nurses struggling to translate these values into day-to-day nursing practice. Many are confused about what individual actions they can take to support these values. To date, the most clearly articulated policy to emerge from the trauma-informed care movement in Australia has been the agreement to reduce, and wherever possible, eliminate the use of seclusion and restraint. Confronted with the constant churn of admissions and readmissions of clients with challenging behaviours, and seemingly intractable mental illness, the elimination of seclusion and restraint is seen to be utopian by many mental health nurses in inpatient settings. Is trauma-informed care solely about eliminating seclusion and restraint, or are there other tangible practices nurses could utilize to effect better health outcomes for mental health clients, especially those with significant abuse histories? This article summarizes the findings from the literature from 2000-2011 in identifying those practices and clinical activities that have been implemented to effect trauma-informed care in inpatient mental health settings.

  2. Dire deadlines: coping with dysfunctional family dynamics in an end-of-life care setting.

    Science.gov (United States)

    Holst, Lone; Lundgren, Maren; Olsen, Lutte; Ishøy, Torben

    2009-01-01

    Working in a hospice and being able to focus on individualized, specialized end-of-life care is a privilege for the hospice staff member. However, it also presents the hospice staff with unique challenges. This descriptive study is based upon two cases from an end-of-life care setting in Denmark, where dysfunctional family dynamics presented added challenges to the staff members in their efforts to provide optimal palliative care. The hospice triad--the patient, the staff member and the family member--forms the basis for communication and intervention in a hospice. Higher expectations and demands of younger, more well-informed patients and family members challenge hospice staff in terms of information and communication when planning for care. The inherent risk factors of working with patients in the terminal phase of life become a focal point in the prevention of the development of compassion fatigue among staff members. A series of coping strategies to more optimally manage dysfunctional families in a setting where time is of the essence are then presented in an effort to empower the hospice team, to prevent splitting among staff members, and to improve quality of care.

  3. Guidelines for a palliative approach for aged care in the community setting: a suite of resources

    Directory of Open Access Journals (Sweden)

    David C. Currow

    2012-11-01

    Full Text Available AbstractIn Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary. The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers. The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations

  4. Doctor-patient communication without family is most frequently practiced in patients with malignant tumors in home medical care settings.

    Science.gov (United States)

    Kimura, Takuma; Imanaga, Teruhiko; Matsuzaki, Makoto

    2014-01-01

    Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.

  5. Memory Complaints Associated with Seeking Clinical Care

    Directory of Open Access Journals (Sweden)

    Carolina Pires

    2012-01-01

    Full Text Available Diagnosis of mild cognitive impairment relies on the presence of memory complaints. However, memory complaints are very frequent in healthy people. The objective of this study was to determine the severity and type of memory difficulties presented by elderly patients who seek for clinical help, as compared to the memory difficulties reported by subjects in the community. Assessment of subjective memory complaints was done with the subjective memory complaints scale (SMC. The mini-mental state examination was used for general cognitive evaluation and the geriatric depression scale for the assessment of depressive symptoms. Eight-hundred and seventy-one nondemented subjects older than 50 years were included. Participants in the clinical setting had a higher total SMC score (10.3±4.2 than those in the community (5.1±3.0. Item 3 of the SMC, Do you ever forget names of family members or friends? contributed significantly more to the variance of the total SMC score in the clinical sample (18% as compared to the community sample (11%. Forgetting names of family members or friends plays an important role in subjective memory complaints in the clinical setting. This symptom is possibly perceived as particularly worrisome and likely drives people to seek for clinical help.

  6. Diagnosis and management of acute otitis media in the urgent care setting.

    Science.gov (United States)

    McCracken, George H

    2002-04-01

    The prevalence of otitis media is increasing, which affects health care resource utilization across all segments, including the urgent care setting. One of the greatest challenges in the management of acute otitis media (AOM) is the effective treatment of cases caused by pathogens that are resistant to commonly used antibiotics. Whereas the production of beta-lactamases among strains of Haemophilus influenzae and Moraxella catarrhalis is an important consideration for antimicrobial therapy, the high prevalence of resistance to penicillin and other classes of antibiotics among strains of Streptococcus pneumoniae represents a greater clinical concern. The Centers for Disease Control and Prevention (CDC) recently convened the Drug Resistant S. pneumoniae Therapeutic Working Group to develop evidence-based recommendations for the treatment of AOM in an era of prevalent resistance. The recommendations from this group included amoxicillin as the preferred first-line drug because of the demonstrated activity against penicillin-intermediate and -resistant strains of S. pneumoniae, using higher dosages of up to 90 mg/kg per day in certain settings. For patients in whom initial treatment is unsuccessful after 3 days, the recommended agents included high-dose amoxicillin-clavulanate (for activity against beta-lactamase-producing pathogens), clindamycin, cefuroxime axetil, or 1 to 3 doses of intramuscular ceftriaxone. The principles set forth in these guidelines can assist the therapeutic decisionmaking process for practitioners in the urgent care setting.

  7. Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies.

    Science.gov (United States)

    Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel

    2016-08-01

    Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of quality indicators for community pharmacies and to report their scores over 2012. In subanalyses the score development over 5 years was described for those indicators, that have been surveyed before and remained unchanged. Methods Community pharmacists in the Netherlands were invited in 2013 to provide information for the set of 2012. Quality indicators were mapped by categories relevant for pharmaceutical care and defined for structures, processes and dispensing outcomes. Scores for categorically-measured quality indicators were presented as the percentage of pharmacies reporting the presence of a quality aspect. For numerical quality indicators, the mean of all reported scores was expressed. In subanalyses for those indicators that had been questioned previously, scores were collected from earlier measurements for pharmacies providing their scores in 2012. Multilevel analysis was used to assess the consistency of scores within one pharmacy over time by the intra-class correlation coefficient (ICC). Results For the set in 2012, 1739 Dutch community pharmacies (88 % of the total) provided information for 66 quality indicators in 10 categories. Indicator scores on the presence of quality structures showed relatively high quality levels. Scores for processes and dispensing outcomes were lower. Subanalyses showed that overall indicators scores improved within pharmacies, but this development differed between pharmacies. Conclusions A set of validated quality indicators provided

  8. Televisitation: virtual transportation of family to the bedside in an acute care setting.

    Science.gov (United States)

    Nicholas, Bonnie

    2013-01-01

    Televisitation is the virtual transportation of a patient's family to the bedside, regardless of the patient's location within an acute care setting. This innovation in the Telemedicine Program at Thunder Bay Regional Health Sciences Centre (TBRHSC) in Ontario, Canada, embraces the concept of patient- and family-centered care and has been identified as a leading practice by Accreditation Canada. The need to find creative ways to link patients to their family and friend supports hundreds of miles away was identified more than ten years ago. The important relationship between health outcomes and the psychosocial needs of patients and families has been recognized more recently. TBRHSC's patient- and family-centered model of care focuses on connecting patients with their families. First Nations renal patients with family in remote communities were some of the earliest users of videoconferencing technology for this purpose.

  9. Progressively engaging: constructing nurse, patient, and family relationships in acute care settings.

    Science.gov (United States)

    Segaric, Cheryl Ann; Hall, Wendy A

    2015-02-01

    In this grounded theory study, informed by symbolic interactionism, we explain how nurses, patients, and family members construct relationships in acute care settings, including managing effects of work environments. We recruited participants from 10 acute care units across four community hospitals in a Western Canadian city. From 33 hr of participant observation and 40 interviews with 13 nurses, 17 patients, and 10 family members, we constructed the basic social-psychological process of progressively engaging. Nurses, patients, and family members approached constructing relationships through levels of engagement, ranging from perspectives about "just doing the job" to "doing the job with heart." Progressively engaging involved three stages: focusing on tasks, getting acquainted, and building rapport. Workplace conditions and personal factors contributed or detracted from participants' movement through the stages of the process; with higher levels of engagement, participants experienced greater satisfaction and cooperation. Progressively engaging provides direction for how all participants in care can invest in relationships.

  10. Communicating with culturally and linguistically diverse patients in an acute care setting: nurses' experiences.

    Science.gov (United States)

    Cioffi, R N Jane

    2003-03-01

    Communication with culturally and linguistically diverse (CLD) patients has been shown to be difficult. This study describes nurses' experiences of communicating with CLD patients in an acute care setting. A purposive sample of registered nurses and certified midwives (n=23) were interviewed. Main findings were: interpreters, bilingual health workers and combinations of different strategies were used to communicate with CLD patients; some nurses showed empathy, respect and a willingness to make an effort in the communication process with others showing an ethnocentric orientation. Main recommendations were: prioritising access to appropriate linguistic services, providing nurses with support from health care workers, e.g., bilingual health care workers who are able to provide more in-depth information, increasing nurses' understanding of legal issues within patient encounters, supporting nurses to translate their awareness of cultural diversity into acceptance of, appreciation for and commitment to CLD patients and their families.

  11. Predictors of home death among palliative cancer patients in a primary care setting

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Vedsted, Peter;

      Background: In most western countries, the majority of palliative cancer patients wish to die at home, where GPs are often deeply involved. However, most research focuses on specialised palliative care, which results in a lack of reliable predictors of home death in primary care. Aim: To analyse...... predictors of home death among deceased palliative cancer patients in a primary care setting. Methods: Using Danish registers, we identified 787 deceased cancer patients and sent a questionnaire to their GPs. The questions concerned the GPs' involvement and the duration of the palliative period at home. We......-of-hours, and whether the GP had had contact with the relatives. Results: 350 questionnaires were filled out. In the preliminary analysis we found that even though many patients died in hospital, this group spent nearly as much of their last time at home as the patients who actually died at home. The analysis...

  12. Ethics in the practice of speech-language pathology in health care settings.

    Science.gov (United States)

    Kummer, Ann W; Turner, Jan

    2011-11-01

    ETHICS refers to a moral philosophy or a set of moral principles that determine appropriate behavior in a society. Medical ethics includes a set of specific values that are considered in determining appropriate conduct in the practice of medicine or health care. Because the practice of medicine and medical speech-language pathology affects the health, well-being, and quality of life of individuals served, adherence to a code of ethical conduct is critically important in the health care environment. When ethical dilemmas arise, consultation with a bioethics committee can be helpful in determining the best course of action. This article will help to define medical ethics and to discuss the six basic values that are commonly considered in discussions of medical ethics. Common ethical mistakes in the practice of speech-language pathology will be described. Finally, the value of a bioethics consultation for help in resolving complex ethical issues will be discussed.

  13. The predictive value of selected job rewards on occupational therapists' job satisfaction in ambulatory care settings.

    Science.gov (United States)

    Painter, J; Akroyd, D; Wilson, S; Figuers, C

    1995-01-01

    Using a perceived reward model of overall job satisfaction, this study utilized a correlational research design with multiple regression analysis to determine the predictive power of extrinsic rewards and intrinsic rewards, collectively and individually, as determinants of overall job satisfaction among registered occupational therapists (OTR) working full-time in ambulatory care settings. The intrinsic rewards (task involvement and task autonomy), collectively and individually, were perceived to be significant overall job satisfaction determinants. General working conditions was the only significant extrinsic reward. Given the demand for OTRs in ambulatory care settings, a better understanding of factors that influence overall job satisfaction among OTRs could prove beneficial in developing appropriate recruitment and retention job design strategies.

  14. Exploring the mealtime experience in residential care settings for older people: an observational study.

    Science.gov (United States)

    Barnes, Sarah; Wasielewska, Anna; Raiswell, Christine; Drummond, Barbara

    2013-07-01

    Improving the mealtime experience in residential care can be a major facilitator in improving care, well-being and QoL. Evidence suggests that, despite guidance on the subject of food, nutrition and hydration, there are still concerns. Although there is a range of methods to research and assess the quality of food provision, there is a challenge in capturing the experiences of those residents who are unable or unwilling to describe their feelings and experiences because of frailty, impaired communication or other vulnerability. The aim of this exploratory study was to capture and describe individual residents' mealtime experience. In spring 2011, a small-scale, observational study was carried out in seven dining settings in four residential care homes in Manchester. An adapted dementia care mapping tool was used alongside field notes. Observations showed two major differences in the way the mealtimes were organised: 'pre-plated' and 'family-style' (where either bowls of food are placed in the centre of the table or food is served directly from a hotplate by a chef). These two styles of service are discussed in relation to the emerging themes of 'task versus resident-centred mealtimes', 'fostering resident independence' and 'levels of interaction'. Although improving mealtimes alone is not enough to improve quality of life in care homes, findings showed that relatively small changes to mealtime delivery can potentially have an impact on resident well-being in these homes. Observation is a useful method of engaging residents in care settings for older people who may not otherwise be able to take part in research.

  15. Composing a core set of performance indicators for public mental health care: a modified Delphi procedure.

    Science.gov (United States)

    Lauriks, Steve; de Wit, Matty A S; Buster, Marcel C A; Arah, Onyebuchi A; Klazinga, Niek S

    2014-09-01

    Public mental health care (PMHC) systems are responsible for the wellbeing of vulnerable groups that cope with complex psychosocial problems. This article describes the development of a set of performance indicators that are feasible, meaningful, and useful to assess the quality of the PMHC system in Amsterdam, the Netherlands. Performance indicators were selected from an international inventory and presented to stakeholders of the PMHC system in a modified Delphi procedure. Characteristics of indicators were judged individually, before consensus on a core set was reached during a plenary discussion. Involving stakeholders at early stages of development increases support for quality assessment.

  16. Extending the ABCDE bundle to the post-intensive care unit setting.

    Science.gov (United States)

    Balas, Michele; Buckingham, Rose; Braley, Tami; Saldi, Sarah; Vasilevskis, Eduard E

    2013-08-01

    A recently proposed interprofessional, evidence-based, multicomponent approach to mitigating the effects of intensive care unit (ICU)-acquired delirium and weakness has the potential to radically transform the way care is delivered to older adults requiring sedation, mechanical ventilation, or both. The Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle empowers members of the interdisciplinary ICU team to implement the best available evidence regarding mechanical ventilation, sedation, weakness, and delirium in a safe, effective, and patient-centered manner. Considering that critically ill older adults are cared for in a number of different settings during the course of hospitalization and recovery, the purpose of this article is to explore the rationale and possible benefits of extending the ABCDE bundle into the post-ICU setting. We provide a case study that illustrates how ABCDE bundle adoption could be the key to improving the quality of care provided to seriously ill older adults in the ICU and beyond.

  17. Motivation of volunteers to work in palliative care setting: A qualitative study

    Directory of Open Access Journals (Sweden)

    M A Muckaden

    2016-01-01

    Full Text Available Background: Volunteers are an integral part of the palliative care services in the Tata Memorial Hospital, Mumbai, Maharashtra, India. These volunteers are an important resource for the department. Thus, it is necessary for the department to determine what motivates these volunteers to continue to work in the setting, acknowledge them and direct efforts toward retaining them and giving them opportunities to serve to the best of their desire and abilities. Aims: The current study aimed at understanding the motivation of volunteers to work in palliative care, to identify the challenges they face and also the effect of their work on their self and relationships. Methodology: In-depth interviews were conducted using semistructured interview guide to study above mentioned aspects. Themes were identified and coding was used to analyze the data. Results: The results suggested that the basic motivation for all the volunteers to work in a palliative care setting is an inherent urge, a feeling of need to give back to the society by serving the sick and the suffering. Other motivating factors identified were team spirit, comfort shared, warm and respectful treatment by the team, satisfying nature of work, experience of cancer in the family, and aligned values and beliefs. Some intrinsic rewards mentioned by volunteers were joy of giving, personal growth, enriching experiences, and meaningful nature of work. Conclusion: The study attempted to improve opportunities of working for these volunteers. Although limited in scope, it offers insight for future research in the area of volunteerism in palliative care setup.

  18. COSTS OF THE HEALTH CARE IN RUSSIA ASSOCIATED WITH SMOKING

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    A. V. Kontsevaya

    2011-01-01

    Full Text Available Aim. To analyze costs of health care in Russia associated with smoking in 2009. Material and methods. Cardiovascular diseases, cancers and chronic obstructive pulmonary diseases (COPD were included in the analysis. Calculation was performed on the basis of the relative risks of diseases associated with smoking, and obtained from foreign surveys, official statistics on morbidity and health system resources expenditure, and costs of health-seeking in line with state program of guaranteed free medical care.  Results. In 2009 total costs of the health care system associated with smoking exceeded RUR 35.8 bln. It corresponded to 0.1% of gross domestic product in Russia in 2009. The costs structure was the following: hospitalization – RUR 26.2 bln, emergency calls – RUR 1.4 bln, and outpatient health-seeking – RUR 8.2 bln. Costs of outpatient pharmacotherapy were not included into analysis because of lack of baseline data needed for calculations. Cardiovascular diseases caused 62% of the health care costs associated with smoking, cancers – 20.2%, and COPD – 17.8%. Conclusion. The smoking in Russia is associated with significant health care costs. It makes needed resources investment in preventive programs to reduce smoking prevalence.

  19. Improper sharp disposal practices among diabetes patients in home care settings: Need for concern?

    OpenAIRE

    Anindo Majumdar; Jayaprakash Sahoo; Gautam Roy; Sadishkumar Kamalanathan

    2015-01-01

    In the recent years, outbreaks of blood-borne infections have been reported from assisted living facilities, which were traced back to improper blood glucose monitoring practices. Needle-stick injuries have been implicated in many such cases. This directly raises concerns over sharp disposal practices of diabetic patients self-managing their condition in home care settings. With India being home to a huge diabetic population, this issue, if neglected, can cause substantial damage to the healt...

  20. Gestalt therapy approaches with aggressive children in a day care setting

    OpenAIRE

    Maxey, Win

    1987-01-01

    This research study was designed to evaluate whether or not Gestalt therapy approaches could be used effectively when intervening with aggressive acts in a day care setting. Five focus children were observed at timed intervals as to whether or not they were aggressive, how the caretaker intervened, and how the children responded to the caretaker intervention. After a baseline of aggressive acts was established, caretakers were trained to use Gestalt therapy interventio...

  1. Child-care chaos and teachers' responsiveness: The indirect associations through teachers' emotion regulation and coping.

    Science.gov (United States)

    Jeon, Lieny; Hur, Eunhye; Buettner, Cynthia K

    2016-12-01

    Teachers in early child-care settings are key contributors to children's development. However, the role of teachers' emotional abilities (i.e., emotion regulation and coping skills) and the role of teacher-perceived environmental chaos in relation to their responsiveness to children are understudied. The current study explored the direct and indirect associations between teachers' perceptions of child-care chaos and their self-reported contingent reactions towards children's negative emotions and challenging social interactions via teachers' emotional regulation and coping strategies. The sample consisted of 1129 preschool-aged classroom teachers in day care and public pre-K programs across the US. We first found that child-care chaos was directly associated with teachers' non-supportive reactions after controlling for multiple program and teacher characteristics. In addition, teachers in more chaotic child-care settings had less reappraisal and coping skills, which in turn, was associated with lower levels of positive responsiveness to children. Teachers reporting a higher degree of chaos used more suppression strategies, which in turn, was associated with teachers' non-supportive reactions and fewer expressive encouragement reactions to children's emotions. Results of this exploratory study suggest that it is important to prepare teachers to handle chaotic environments with clear guidelines and rules. In order to encourage teachers' supportive responses to children, intervention programs are needed to address teachers' coping and emotion regulation strategies in early childhood education.

  2. Multifactorial control and treatment intensity of type-2 diabetes in primary care settings in Catalonia

    Directory of Open Access Journals (Sweden)

    Montasell Montserrat

    2010-03-01

    Full Text Available Abstract Background Many studies on diabetes have demonstrated that an intensive control of glycaemia and the main associated risk factors (hypertension, dislipidaemia, obesity and smoking reduce cardiovascular morbi-mortality. Different scientific societies have proposed a multifactorial approach to type 2 diabetes. The objective of this study was to identify the degree of control of glycosylated haemoglobin (HbA1c and of cardiovascular risk factors in type 2 diabetic patients, using the GedapS 2004 guidelines, and to analyse the type and intensity of drug treatment. Methods This cross-sectional, multicentre, epidemiological study was conducted in a primary care setting in Vallès Occidental South, Catalonia. Data were collected of 393 patients aged 18 and above who were diagnosed with diabetes mellitus type 2. Biodemographic and clinical data, cardiovascular risk factors, associated cardiovascular disease, and treatment were assessed. Descriptive and multivariable analysis with logistic regression was realized. Results A total of 392 patients with a mean age of 66.8 years (SD = 10.6 (45.4% male patients were analyzed. The duration of diabetes was 8.4 years (SD = 7.6. The degree of multifactorial control of risk factors was only 2.6%, although in more than 50% individual cardiovascular risk factor was controlled, except for LDL cholesterol (40.6% and systolic blood pressure (29.6%. Furthermore, only 13.0% of subjects had an optimal BMI, 27.5% an optimal waist circumference. Treatment for diabetes was prescribed in 82.7% of patients, for hypertension 70.7%, for dyslipidaemia 47.2% and 40.1% were taking antiplatelets. Conclusion Over 50% of type 2 diabetic patients presented optimal control of the majority of individual cardiovascular risk factors, although the degree of multifactorial control of diabetes was insufficient (2.6% and should be improved. Drug treatment can be intensified using a larger number of combinations, particularly in

  3. Pharmaceutical care issues identified by pharmacists in patients with diabetes, hypertension or hyperlipidaemia in primary care settings

    Directory of Open Access Journals (Sweden)

    Chua Siew

    2012-11-01

    Full Text Available Abstract Background The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. Methods This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. Results Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%, insufficient awareness and knowledge about disease condition and medication (20.4%, adverse drug reactions (15.6%, therapeutic failure (13.9%, drug-choice problems (9.5% and dosing problems (3.4%. Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52% were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2% was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended. Conclusions This study

  4. Preventing Obesity among Preschool Children: How Can Child-Care Settings Promote Healthy Eating and Physical Activity? Research Synthesis

    Science.gov (United States)

    Larson, Nicole; Ward, Dianne; Neelon, Sara Benjamin; Story, Mary

    2011-01-01

    Child-care settings provide numerous opportunities to promote healthy eating and physical activity behaviors among preschool children. The majority of U.S. children are placed in some form of non-parental care during their preschool years. While approximately 15 percent of preschool children are primarily cared for by their relatives, most…

  5. Performance of the measures of processes of care for adults and service providers in rehabilitation settings

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    Bamm EL

    2015-06-01

    Full Text Available Elena L Bamm,1 Peter Rosenbaum,1,2 Seanne Wilkins,1 Paul Stratford11School of Rehabilitation Science, 2CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, CanadaIntroduction: In recent years, client-centered care has been embraced as a new philosophy of care by many organizations around the world. Clinicians and researchers have identified the need for valid and reliable outcome measures that are easy to use to evaluate success of implementation of new concepts.Objective: The current study was developed to complete adaptation and field testing of the companion patient-reported measures of processes of care for adults (MPOC-A and the service provider self-reflection measure of processes of care for service providers working with adult clients (MPOC-SP(A.Design: A validation studySettings: In-patient rehabilitation facilities.Main outcome measures: MPOC-A and measure of processes of care for service providers working with adult clients (MPOC-SP(A.Results: Three hundred and eighty-four health care providers, 61 patients, and 16 family members completed the questionnaires. Good to excellent internal consistency (0.71–0.88 for health care professionals, 0.82–0.90 for patients, and 0.87–0.94 for family members, as well as moderate to good correlations between domains (0.40–0.78 for health care professionals and 0.52–0.84 for clients supported internal reliability of the tools. Exploratory factor analysis of the MPOC-SP(A responses supported the multidimensionality of the questionnaire.Conclusion: MPOC-A and MPOC-SP(A are valid and reliable tools to assess patient and service-provider accounts, respectively, of the extent to which they experience, or are able to provide, client-centered service. Research should now be undertaken to explore in more detail the relationships between client experience and provider reports of their own behavior.Keywords: client-centered care, service evaluation, MPOC, models of

  6. FACTORS ASSOCIATED WITH WOMEN'S HEALTH CARE DECISION-MAKING AUTONOMY: EMPIRICAL EVIDENCE FROM NIGERIA.

    Science.gov (United States)

    Osamor, Pauline; Grady, Christine

    2017-02-10

    Women's decision-making autonomy has been poorly studied in most developing countries. The few existing studies suggest that it is closely linked to women's socio-demographic characteristics and the social settings in which they live. This study examined Nigerian women's perceived decision-making autonomy about their own health care using nationally representative data from the 2013 Nigerian Demographic and Health Survey. The study sample consisted of 27,135 women aged 15-49 years who lived with their husbands/partners. Responses to questions about who usually makes decisions about the respondent's health care were analysed. Factors associated with women's health care decision-making were investigated using logistic regression models. Only 6.2% of the women reported making their own decisions about health care. For most women (61.1%), this decision was made by their husband/partner alone and 32.7% reported joint decision-making with their husband/partner. Factors independently associated with decision-making by the woman included: geographical region, rural/urban residence, age, education, religion, wealth index, occupation, home ownership and husband's occupation. A strong association between women making their own health care decision was seen with region of residence (χ 2=3221.48, pwomen from the South West region were 8.3 times more likely to make their own health care decisions than women from the North West region. Factors that were significantly associated with joint health care decision-making were also significantly associated with decision-making by the woman alone. The study found that individual-level factors were significantly associated with Nigerian women's decision-making autonomy, as well as other factors, in particular geographic region. The findings provide an important perspective on women's health care decision-making autonomy in a developing country.

  7. Psychiatric services in primary care settings: a survey of general practitioners in Thailand

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    Saipanish Ratana

    2006-07-01

    Full Text Available Abstract Background General Practitioners (GPs in Thailand play an important role in treating psychiatric disorders since there is a shortage of psychiatrists in the country. Our aim was to examine GP's perception of psychiatric problems, drug treatment and service problems encountered in primary care settings. Methods We distributed 1,193 postal questionnaires inquiring about psychiatric practices and service problems to doctors in primary care settings throughout Thailand. Results Four hundred and thirty-four questionnaires (36.4% were returned. Sixty-seven of the respondents (15.4% who had taken further special training in various fields were excluded from the analysis, giving a total of 367 GPs in this study. Fifty-six per cent of respondents were males and they had worked for 4.6 years on average (median = 3 years. 65.6% (SD = 19.3 of the total patients examined had physical problems, 10.7% (SD = 7.9 had psychiatric problems and 23.9% (SD = 16.0 had both problems. The most common psychiatric diagnoses were anxiety disorders (37.5%, alcohol and drugs abuse (28.1%, and depressive disorders (29.2%. Commonly prescribed psychotropic drugs were anxiolytics and antidepressants. The psychotropic drugs most frequently prescribed were diazepam among anti-anxiety drugs, amitriptyline among antidepressant drugs, and haloperidol among antipsychotic drugs. Conclusion Most drugs available through primary care were the same as what existed 3 decades ago. There should be adequate supply of new and appropriate psychotropic drugs in primary care. Case-finding instruments for common mental disorders might be helpful for GPs whose quality of practice was limited by large numbers of patients. However, the service delivery system should be modified in order to maintain successful care for a large number of psychiatric patients.

  8. Reporting new cases of anaemia in primary care settings in Crete, Greece: a rural practice study

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    Lionis Christos

    2012-04-01

    Full Text Available Abstract Background Early diagnosis of anaemia represents an important task within primary care settings. This study reports on the frequency of new cases of anaemia among patients attending rural primary care settings in Crete (Greece and to offer an estimate of iron deficiency anaemia (IDA frequency in this study group. Methods All patients attending the rural primary health care units of twelve general practitioners (GPs on the island of Crete for ten consecutive working days were eligible to participate in this study. Hemoglobin (Hb levels were measured by portable analyzers. Laboratory tests to confirm new cases of anaemia were performed at the University General Hospital of Heraklion. Results One hundred and thirteen out of 541 recruited patients had a low value of Hb according to the initial measurement obtained by the use of the portable analyzer. Forty five (45.5% of the 99 subjects who underwent laboratory testing had confirmed anaemia. The mean value of the Hb levels in the group with confirmed anaemia, as detected by the portable analyzer was 11.1 g/dl (95% Confidence Interval (CI from 10.9 to 11.4 and the respective mean value of the Hb levels obtained from the full blood count was 11.4 g/dl (95% CI from 11.2 to 11.7 (P = 0.01. Sixteen out of those 45 patients with anaemia (35.6% had IDA, with ferritin levels lower than 30 ng/ml. Conclusion Keeping in mind that this paper does not deal with specificity or sensitivity figures, it is suggested that in rural and remote settings anaemia is still invisible and point of care testing may have a place to identify it.

  9. [Concepts associated to systematization of nursing care in Brazilian journals].

    Science.gov (United States)

    Fuly, Patrícia Dos Santos Claro; Leite, Joséte Luzia; Lima, Suzinara Beatriz Soares

    2008-01-01

    This study is a research that has as objective analyze the bibliographical production about the Systematization of Nursing Care in order to discuss concepts associated to the subject. Were analyzed books and national articles published in the database of the Virtual Library in Health, Medline, Lilacs and Scielo, in the period of January of 2000 to January of 2008. Were analyzed 11 articles, having been identified three distinct kind of thought to define concepts associated to Systematization of Nursing Care. Such fact aims for the difficulty of theoretical and pratical articulation, evidenced by the conflicts existing in the literature.

  10. Investigation of Ventilator Associated Pneumoniae in Intensive Care Patients

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    Hakan Tağrıkulu,

    2016-04-01

    Full Text Available Objective: Mechanical ventilator associated pneumonia is a serious infection occurred frequently in intensive care units and associated with high mortality. In this study we aimed to investigate the incidence of ventilator associated pneumonia, the duration of mechanical ventilation, length of intensive care unit stay, complication occurrence and mortality rates on patients undergoing mechanical ventilation for more than 48 hours. Material and Method: Two hundred twenty patients were included in the study. Demographic data at the time of the admission to intensive care unit (age, sex, height, weight and body mass index, intensive care admission diagnosis and systemic diseases were all recorded. The clinical pulmonary infection score was used for ventilator associated pneumonia diagnosis. Antibiotic usage, duration of stay in intensive care unit, duration of mechanical ventilation stay and mortality were all recorded. Results: Ventilator-associated pneumonia was detected in 51.36% (n=113 of the 220 patients. Clinical pulmonary infection score was found as 8.04±1.03 in patients with ventilator-associated pneumonia and 1.75±1.88 in non- ventilatorassociated pneumonia patients (p=0.001. Higher age was detected in ventilator-associated pneumonia group (58±12.79 years and 51.37±15.87 years, p=0.001. Also hypertension and diabetes mellitus were observed more frequently (p=0.001. Development of enteral nutrition in patients with ventilator-associated pneumonia were significantly higher than those of parenterally fed patients (enteral: by 36.4% and 25.5% p=0.006; parenteral: 25% and 19.1%, p=0.042. The length of stay in intensive care unit (12.38±5.81 and 10.79±5.91 days, p=0.045, duration of mechanical ventilation (9.67±4.84 days and 6.7±3.87 days, p=0.001 and mortality rates (24.5% and 15.5% p=0.019 were significantly higher in the ventilator-associated pneumonia group. Conclusion: Ventilator-associated pneumonia increases the duration of

  11. Linking Cultural Competence to Functional Life Outcomes in Mental Health Care Settings.

    Science.gov (United States)

    Michalopoulou, Georgia; Falzarano, Pamela; Butkus, Michael; Zeman, Lori; Vershave, Judy; Arfken, Cynthia

    2014-01-01

    Minorities in the United States have well-documented health disparities. Cultural barriers and biases by health care providers may contribute to lower quality of services which may contribute to these disparities. However, evidence linking cultural competency and health outcomes is lacking. This study, part of an ongoing quality improvement effort, tested the mediation hypothesis that patients' perception of provider cultural competency indirectly influences patients' health outcomes through process of care. Data were from patient satisfaction surveys collected in seven mental health clinics (n=94 minority patients). Consistent with our hypothesis, patients' perception of clinicians' cultural competency was indirectly associated with patients' self-reported improvements in social interactions, improvements in performance at work or school, and improvements in managing life problems through the patients' experience of respect, trust, and communication with the clinician. These findings indicate that process of care characteristics during the clinical encounter influence patients' perceptions of clinicians' cultural competency and affect functional outcomes.

  12. Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study

    Science.gov (United States)

    Montes de Oca, Maria; Aguirre, Carlos; Lopez Varela, Maria Victorina; Laucho-Contreras, Maria E; Casas, Alejandro; Surmont, Filip

    2016-01-01

    Background COPD, asthma, and asthma–COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. Objectives To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma–COPD overlap. Methods COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma–COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Results Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma–COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma–COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. Conclusion COPD, asthma, and asthma–COPD overlap increase the prevalence of

  13. The Effectiveness of Nutritional Screening in Hospital and Primary Care Settings: a Systematic Review

    Directory of Open Access Journals (Sweden)

    A Rashidian

    2005-10-01

    Full Text Available Objectives: To determine the effectiveness of nutritional screening programmes in improving quality of care and patient outcomes compared with usual care. Methods: Searches were performed on MEDLINE, EMBASE, CINHAL, the Cochrane database, and Current Controlled Trials. Due to the assumed scarcity of high quality evidence, interventional studies in hospital or primary care settings with adequate reporting and comparisons were considered as eligible. Team members met after reviewing the papers. Decisions on inclusion or exclusion of papers were made when all agreed. Two reviewers independently extracted data from included studies. Results: 705 abstracts were considered and thirty full-text papers were ordered and reviewed. Following further review of the extracted data two papers met the inclusion criteria. One was a clustered randomized study of 26 general practices to evaluate the effectiveness of screening for elderly ailments including malnutrition. It concluded nutritional screening did not improve referral to dieticians, detection of nutritional problems, or patients’ quality of life. This study was underpowered for evaluating the effectiveness of nutritional screening. A non-randomized controlled before-after study of four hospital wards concluded that intervention improved weight recording, but not referral to dieticians or care at the mealtime of at risk patients. Discussion: Very few studies assess the effectiveness of nutritional screening with relevant outcomes and acceptable quality. The available evidence does not support systematic application of screening tools to hospital, or general practice patients. Given the current level of interest and political support for nutritional screening, further studies are urgently required.

  14. [Nurse-led in Primary Health Care setting: a well-timed and promising organizational innovation].

    Science.gov (United States)

    Torres-Ricarte, Marc; Crusat-Abelló, Ernest; Peñuelas-Rodríguez, Silvia; Zabaleta-del-Olmo, Edurne

    2015-01-01

    At present, the severe economic crisis along with the increasing prevalence of chronic diseases is leading to different countries to consider updating their Primary Health Care (PHC) services in order to make them more efficient and reduce health inequalities. To that end, various initiatives are being carried out, such as the provision of Nurse-led services and interventions. The purpose of this article is to present the available knowledge, controversies and opportunities for Nurse-led initiatives in the setting of PHC. Nurse- led interventions or health services in PHC have proven to be equal or more effective than usual care in disease prevention, the routine follow-up of patients with chronic conditions, and first contact care for people with minor illness. However, as there are only a few health economic evaluation studies published their efficiency is still potential. In conclusion, the Nurse-led care could be an innovative organizational initiative with the potential to provide an adequate response to the contemporary health needs of the population, as well as an opportunity for the nursing profession and for PHC and health systems in general.

  15. Generalized anxiety and mixed anxiety-depression: association with disability and health care utilization.

    Science.gov (United States)

    Roy-Byrne, P P

    1996-01-01

    Generalized anxiety and mixed anxiety-depression have received less attention than the major mood and anxiety disorders ith respect to their possible effects in increasing disability and health care utilization. A review of recent studies, however, indicates that these conditions are prevalent in primary care medical settings and are associated with significant social and occupational disability. Generalized anxiety disorder is also one of the most common diagnoses seen in patients presenting with medically unexplained somatic complaints such as chest pain, irritable bowel symptoms, and hyperventilation and in patients prone to overutilize health care services in general. It is poorly recognized by primary care physicians, possibly due to its chronicity, which may limit the ability of symptoms to "stand out" and be easily detected. However, it is disproportionately present in "high utilizer" samples found to be particularly "frustrating" to their physicians and is accompanied by a high rate of personality disorders, suggesting that maladaptive personality traits and styles of interaction in such patients may also contribute to underrecognition of symptoms by primary care physicians. These preliminary associations between generalized anxiety disorder/mixed anxiety-depression and both disability and increased health care utilization need to be confirmed with carefully designed and controlled studies.

  16. The Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs.

    Science.gov (United States)

    Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy

    2016-07-15

    As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs.

  17. Performance of a Blood Glucose Monitoring System in a Point-of-Care Setting.

    Science.gov (United States)

    Ottiger, Cornelia; Gygli, Nicole; Huber, Andreas R; Fernandez-Tresguerres, Beatriz; Pardo, Scott; Petruschke, Thorsten

    2016-07-01

    This study assesses and demonstrates that CONTOUR® XT-BGMS (CXT-BGMS) complies with the requirements of the German (RiliBÄK) and Swiss (QUALAB) quality control guidelines for point-of-care testing (POCT) and fulfills the ISO15197:2013 accuracy limits criteria under the routine conditions of a hospital point-of care setting. This single-center study was conducted in Switzerland using 105 venous blood samples from hospitalized patients. Each sample was tested in comparison to the hexokinase reference method. Compliance with POCT guidelines was assessed by daily BGMS measurements using control solutions. Accuracy of CXT-BGMS according to ISO limits was 98.41%. All control measurements were within the limits defined by RiliBÄK (within ± 11% of target values and root mean square error [RMSE] within RMSE limits), and QUALAB (within ± 10% of target values).

  18. Performance of a Blood Glucose Monitoring System in a Point-of-Care Setting

    Science.gov (United States)

    Ottiger, Cornelia; Gygli, Nicole; Huber, Andreas R.; Fernandez-Tresguerres, Beatriz; Pardo, Scott; Petruschke, Thorsten

    2016-01-01

    This study assesses and demonstrates that CONTOUR® XT-BGMS (CXT-BGMS) complies with the requirements of the German (RiliBÄK) and Swiss (QUALAB) quality control guidelines for point-of-care testing (POCT) and fulfills the ISO15197:2013 accuracy limits criteria under the routine conditions of a hospital point-of care setting. This single-center study was conducted in Switzerland using 105 venous blood samples from hospitalized patients. Each sample was tested in comparison to the hexokinase reference method. Compliance with POCT guidelines was assessed by daily BGMS measurements using control solutions. Accuracy of CXT-BGMS according to ISO limits was 98.41%. All control measurements were within the limits defined by RiliBÄK (within ± 11% of target values and root mean square error [RMSE] within RMSE limits), and QUALAB (within ± 10% of target values). PMID:26989068

  19. "Collaboration technology": a case study of innovation in order set and clinical care standardization.

    Science.gov (United States)

    Yount, Brian; McNamara, Timothy

    2008-11-06

    Effective standardization of clinical processes, which is a growing priority for healthcare provider organizations and networks, requires effective teamwork among clinicians and staff from multidisciplinary backgrounds--often from geographically dispersed facilities--to reach consensus on care practices. Yet, most healthcare provider organizations have no precedence or tools for managing large-scale, sustained, collaborative activities. This presentation explores the human and social implications of technology. It specifically addresses healthcare collaboration and describes how innovative collaboration management technologies can be used in the healthcare industry to accelerate care standardization, order set standardization and other initiatives necessary for successful computerized provider order entry and electronic health record deployments. These topics are explored through presentation of a survey of healthcare executives and a case study of an advanced collaboration application that was adapted and deployed in a partnership between a large healthcare provider organization and a commercial developer of document management and collaboration management technologies.

  20. Negative pressure wound therapy technologies for chronic wound care in the home setting: A systematic review.

    Science.gov (United States)

    Rhee, Susan M; Valle, M Frances; Wilson, Lisa M; Lazarus, Gerald; Zenilman, Jonathan M; Robinson, Karen A

    2015-01-01

    The use of negative pressure wound therapy (NPWT) is increasing in both the inpatient and outpatient settings. We conducted a systematic review on the efficacy and safety of NPWT for the treatment of chronic wounds in the home setting. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature, up to June 2014. Two independent reviewers screened search results. Seven studies met our criteria for inclusion. Six of the studies compared NPWT devices to other wound care methods and one study compared two different NPWT technologies. Data were limited by variability in the types of comparator groups, methodological limitations, and poor reporting of outcomes. We were unable to draw conclusions about the efficacy or safety of NPWT for the treatment of chronic wounds in the home setting due to the insufficient evidence. Consensus is needed on the methods of conducting and reporting wound care research so that future studies are able inform decisions about the use of NPWT in the home environment for chronic wounds.

  1. Exacerbations and health care resource utilization in patients with airflow limitation diseases attending a primary care setting: the PUMA study

    Directory of Open Access Journals (Sweden)

    Montes de Oca M

    2016-12-01

    Full Text Available Maria Montes de Oca,1 Carlos Aguirre,2 Maria Victorina Lopez Varela,3 Maria E Laucho-Contreras,1 Alejandro Casas,2 Filip Surmont4 1Service of Pneumology, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela; 2Colombian Pneumological Foundation, Bogotá, Colombia; 3Universidad de la República, Facultad de Medicina, Hospital Maciel, Montevideo, Uruguay; 4Medical Affairs, AstraZeneca Latin America, Coral Gables, FL, USA Background: COPD, asthma, and asthma–COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs or specialists. Little information is available regarding this in the primary care setting. Objectives: To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma–COPD overlap. Methods: COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%; asthma–COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Results: Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively

  2. Interdisciplinary diabetes care teams operating on the interface between primary and specialty care are associated with improved outcomes of care: findings from the Leuven Diabetes Project

    Directory of Open Access Journals (Sweden)

    Mathieu Chantal

    2009-10-01

    Full Text Available Abstract Background Type 2 diabetes mellitus is a complex, progressive disease which requires a variety of quality improvement strategies. Limited information is available on the feasibility and effectiveness of interdisciplinary diabetes care teams (IDCT operating on the interface between primary and specialty care. A first study hypothesis was that the implementation of an IDCT is feasible in a health care setting with limited tradition in shared care. A second hypothesis was that patients who make use of an IDCT would have significantly better outcomes compared to non-users of the IDCT after an 18-month intervention period. A third hypothesis was that patients who used the IDCT in an Advanced quality Improvement Program (AQIP would have significantly better outcomes compared to users of a Usual Quality Improvement Program (UQIP. Methods This investigation comprised a two-arm cluster randomized trial conducted in a primary care setting in Belgium. Primary care physicians (PCPs, n = 120 and their patients with type 2 diabetes mellitus (n = 2495 were included and subjects were randomly assigned to the intervention arms. The IDCT acted as a cornerstone to both the intervention arms, but the number, type and intensity of IDCT related interventions varied depending upon the intervention arm. Results Final registration included 67 PCPs and 1577 patients in the AQIP and 53 PCPs and 918 patients in the UQIP. 84% of the PCPs made use of the IDCT. The expected participation rate in patients (30% was not attained, with 12,5% of the patients using the IDCT. When comparing users and non-users of the IDCT (irrespective of the intervention arm and after 18 months of intervention the use of the IDCT was significantly associated with improvements in HbA1c, LDL-cholesterol, an increase in statins and anti-platelet therapy as well as the number of targets that were reached. When comparing users of the IDCT in the two intervention arms no significant differences

  3. [Specialised early rehabilitation of brain injury performed in an intensive care setting].

    Science.gov (United States)

    Daugaard, Morten; Nielsen, Lars Hedemann

    2013-12-09

    In Denmark, early rehabilitation of acquired head injuries is centralised in two centres, each covering half the country as uptake area. The Regional Hospital Hammel Neurocenter (HN), which covers the western half of Denmark, traditionally receives patients for rehabilitation after discharge from the intensive care unit (ICU). In collaboration with the Regional Hospital in Silkeborg HN now offers early rehabilitation in Silkeborg's ICU setting to patients with acquired brain injury. This preliminary study discusses whether the collaboration facilitates rehabilitation at an earlier state than previously.

  4. Prophylaxis and treatment of invasive candidiasis in the intensive care setting.

    Science.gov (United States)

    Ostrosky-Zeichner, L

    2004-10-01

    The term "invasive candidiasis" encompasses a group of infections of increasing relevance in the intensive care setting. Prophylaxis is an attractive strategy when dealing with diseases of high prevalence, morbidity, and mortality. The success of prophylaxis is determined by the selection of a population at high risk and the use of the safest and most effective drug. Although risk factors for this disease are known, risk assessment strategies need to be developed to predict a high likelihood of disease so that targeted prophylaxis can be offered. Recent advances in antifungal therapy, such as development of the azoles and echinocandins, have resulted in excellent prophylactic and therapeutic choices for the management of this problem.

  5. Health care-associated hepatitis C virus infection.

    Science.gov (United States)

    Pozzetto, Bruno; Memmi, Meriam; Garraud, Olivier; Roblin, Xavier; Berthelot, Philippe

    2014-12-14

    Hepatitis C virus (HCV) is a blood-borne pathogen that has a worldwide distribution and infects millions of people. Care-associated HCV infections represented a huge part of hepatitis C burden in the past via contaminated blood and unsafe injections and continue to be a serious problem of public health. The present review proposes a panorama of health care-associated HCV infections via the three mode of contamination that have been identified: (1) infected patient to non-infected patient; (2) infected patient to non-infected health care worker (HCW); and (3) infected HCW to non infected patient. For each condition, the circumstances of contamination are described together with the means to prevent them. As a whole, the more important risk is represented by unsafe practices regarding injections, notably with the improper use of multidose vials used for multiple patients. The questions of occupational exposures and infected HCWs are also discussed. In terms of prevention and surveillance, the main arm for combating care-associated HCV infections is the implementation of standard precautions in all the fields of cares, with training programs and audits to verify their good application. HCWs must be sensitized to the risk of blood-borne pathogens, notably by the use of safety devices for injections and good hygiene practices in the operating theatre and in all the invasive procedures. The providers performing exposed-prone procedures must monitor their HCV serology regularly in order to detect early any primary infection and to treat it without delay. With the need to stay vigilant because HCV infection is often a hidden risk, it can be hoped that the number of people infected by HCV via health care will decrease very significantly in the next years.

  6. Loss of relational continuity of care in schizophrenia: associations with patient satisfaction and quality of care

    Science.gov (United States)

    Sanatinia, Rahil; Cowan, Violet; Barnicot, Kirsten; Zalewska, Krysia; Shiers, David; Cooper, Stephen J.

    2016-01-01

    Background Users of mental health service are concerned about changes in clinicians providing their care, but little is known about their impact. Aims To examine associations between changes in staff, and patient satisfaction and quality of care. Method A national cross-sectional survey of 3379 people aged 18 or over treated in secondary care for schizophrenia or schizoaffective disorder. Results Nearly 41.9% reported at least one change in their key worker during the previous 12 months and 10.5% reported multiple changes. Those reporting multiple changes were less satisfied with their treatment and less likely to report having a care plan, knowing how to obtain help when in a crisis or to have had recommended physical health assessments. Conclusions Frequent changes in staff providing care for people with psychosis are associated with poorer quality of care. Greater efforts need to be made to protect relational continuity of care for such patients. Declaration of interest M.J.C. was co-chair of the expert advisory group on the NICE quality standard on Service User Experience in Adult Mental Health. S.J.C. has previously been a member of the Health and Social Care Board Northern Ireland Formulary Committee. D.S. received a speaker’s fee from Janssen Cilag in 2011. He is a topic expert on NICE guideline for psychosis and schizophrenia in children and young people and a board member of National Collaborating Centre for Mental Health. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:27713834

  7. Gaining entry-level clinical competence outside of the acute care setting.

    Science.gov (United States)

    Lordly, Daphne; Taper, Janette

    2008-01-01

    Traditionally, an emphasis has been placed on dietetic interns' attainment of entry-level clinical competence in acute care facilities. The perceived risks and benefits of acquiring entry-level clinical competence within long-term and acute care clinical environments were examined. The study included a purposive sample of recent graduates and dietitians (n=14) involved in an integrated internship program. Study subjects participated in in-depth individual interviews. Data were thematically analyzed with the support of data management software QSR N6. Perceived risks and benefits were associated with receiving clinical training exclusively in either environment; risks in one area surfaced as benefits in the other. Themes that emerged included philosophy of care, approach to practice, working environment, depth and breadth of experience, relationships (both client and professional), practice outcomes, employment opportunities, and attitude. Entry-level clinical competence is achievable in both acute and long-term care environments; however, attention must be paid to identified risks. Interns who consider gaining clinical competence exclusively in one area can reduce risks and better position themselves for employment in either practice area by incorporating an affiliation in the other area into their internship program.

  8. Skill set or mind set? Associations between health literacy, patient activation and health.

    Directory of Open Access Journals (Sweden)

    Samuel G Smith

    Full Text Available OBJECTIVE: There is ongoing debate on whether health literacy represents a skill-based construct for health self-management, or if it also more broadly captures personal 'activation' or motivation to manage health. This research examines 1 the association between patient activation and health literacy as they are most commonly measured and 2 the independent and combined associations of patient activation and health literacy skills with physical and mental health. METHODS: A secondary analysis of baseline cross-sectional data from the LitCog cohort of older adults was used. Participants (n = 697 were recruited from multiple US-based health centers. During structured face-to-face interviews, participants completed the Test of Functional Health Literacy in Adults (TOFHLA, the Patient Activation Measure (PAM, the SF-36 physical health summary subscale, and Patient Reported Outcomes Measurement Information Service (PROMIS short form subscales for depression and anxiety. RESULTS: The relationship between health literacy and patient activation was weak, but significant (r = 0.11, p<0.01. In models adjusted for participant characteristics, lower health literacy was associated with worse physical health (β = 0.13, p<0.001 and depression (β = -0.16, p<0.001. Lower patient activation was associated with worse physical health (β = 0.19, p<0.001, depression (β = -0.27, p<0.001 and anxiety (β-0.24, p<0.001. CONCLUSIONS: The most common measures of health literacy and patient activation are weakly correlated with each other, but also independently correlated with health outcomes. This suggests health literacy represents a distinct skill-based construct, supporting the Institute of Medicine's definition. Deficits in either construct could be useful targets for behavioral intervention.

  9. Aplikasi Teori Self-Care Deficit Orem dalam Konteks Tuna Wisma (Studi Literatur) (The Application of Orem’s Self Care Deficit in Homeless Setting)

    OpenAIRE

    Megah Andriyani

    2007-01-01

    Homeless health is government and NGO’s responsibilities for creating optimal citizen health status. Homeless is one of community health nursing clients. The Self Care Theory is used in nursing science for giving conceptual framework as a practical guidance and building self care knowledge through research. Orem described self care as a continuing intervention. It was needed and done by adult to be survived, healthy, and wellness. This theory is also used in homeless setting by many exp...

  10. Systematic quality monitoring for specialized palliative care services: development of a minimal set of wuality indicators for palliative care study (QPAC).

    NARCIS (Netherlands)

    Leemans, K.; Deliens, L.; Block, L. van den; Stichele, R. Vander; Francke, A.L.; Cohen, J.

    2016-01-01

    Background: A feasibility evaluation of a comprehensive quality indicator set for palliative care identified the need for a minimal selection of these indicators to monitor quality of palliative care services with short questionnaires for the patients, caregivers, and family carers. Objectives: To d

  11. Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings.

    Science.gov (United States)

    Udo, Tomoko; White, Marney A; Lydecker, Janet L; Barnes, Rachel D; Genao, Inginia; Garcia, Rina; Masheb, Robin M; Grilo, Carlos M

    2016-05-01

    This study examined racial differences in eating-disorder psychopathology, eating/weight-related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating-disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients.

  12. Smokers' attitudes and behaviors related to consumer demand for cessation counseling in the medical care setting.

    Science.gov (United States)

    Weber, Deanne; Wolff, Lisa S; Orleans, Tracy; Mockenhaupt, Robin E; Massett, Holly A; Vose, Kathryn Kahler

    2007-05-01

    This study describes a new segmentation strategy exploring smokers' interest levels in counseling in the medical care setting in order to understand how public health communications can be designed to increase consumer demand for cessation services within this population. A subsample of 431 smokers from a large, nationally representative mail survey was analyzed and categorized into three cessation-demand groups: Low demand (LD), medium demand (MD), and high demand (HD). HD smokers were most likely to be heavy smokers, to make quitting a high priority, and to have self-efficacy in quitting. MD and LD smokers were less likely than HD smokers to have been told to quit smoking by a health care provider in the past or to believe that counseling is effective. The first step in the regression analysis revealed that age, cigarettes smoked per month, whether smokers were currently trying to quit, and whether they were ever told to quit smoking by their health care provider accounted for 21% of the variance in smokers' interest in smoking cessation counseling, F(4, 234) = 16.49, pconsumer demand for cessation counseling.

  13. Management of hemichorea hemiballismus syndrome in an acute palliative care setting

    Directory of Open Access Journals (Sweden)

    Anuja Damani

    2015-01-01

    Full Text Available Hemichorea hemiballismus (HCHB is a rare and debilitating presentation of hyperglycemia and subcortical stroke. Early identification, proper assessment and management of HCHB can lead to complete symptom relief. We describe a case of HCHB presenting to a palliative care setting. A 63-year-old diabetic and hypertensive lady, with history of ovarian cancer presented to Palliative Medicine outpatient clinic with two days history of right HCHB. Blood investigations and brain imaging showed high blood sugar levels and lacunar subcortical stroke. Blood sugar levels were controlled with human insulin and Aspirin. Clopidogrel and Atorvastatin were prescribed for the management of lacunar stroke. HCHB reduced markedly post-treatment, leading to significant reduction in morbidity and improvement in quality of life. The symptoms completely resolved within one week of starting the treatment and the patient was kept on regular home and outpatient follow up for further monitoring. Acute palliative care (APC approach deals with the management of comorbidities and their complications along with supportive care. Prompt assessment and management of such complications lead to better patient outcomes.

  14. Management of hemichorea hemiballismus syndrome in an acute palliative care setting.

    Science.gov (United States)

    Damani, Anuja; Ghoshal, Arunangshu; Salins, Naveen; Deodhar, Jayita; Muckaden, Mary Ann

    2015-01-01

    Hemichorea hemiballismus (HCHB) is a rare and debilitating presentation of hyperglycemia and subcortical stroke. Early identification, proper assessment and management of HCHB can lead to complete symptom relief. We describe a case of HCHB presenting to a palliative care setting. A 63-year-old diabetic and hypertensive lady, with history of ovarian cancer presented to Palliative Medicine outpatient clinic with two days history of right HCHB. Blood investigations and brain imaging showed high blood sugar levels and lacunar subcortical stroke. Blood sugar levels were controlled with human insulin and Aspirin. Clopidogrel and Atorvastatin were prescribed for the management of lacunar stroke. HCHB reduced markedly post-treatment, leading to significant reduction in morbidity and improvement in quality of life. The symptoms completely resolved within one week of starting the treatment and the patient was kept on regular home and outpatient follow up for further monitoring. Acute palliative care (APC) approach deals with the management of comorbidities and their complications along with supportive care. Prompt assessment and management of such complications lead to better patient outcomes.

  15. Collegial relationship breakdown: a qualitative exploration of nurses in acute care settings.

    Science.gov (United States)

    Cowin, Leanne S

    2013-01-01

    Poor collegial relations can cause communication breakdown, staff attrition and difficulties attracting new nursing staff. Underestimating the potential power of nursing team relationships means that opportunities to create better working environments and increase the quality of nursing care can be missed. Previous research on improving collegiality indicates that professionalism and work satisfaction increases and that staff attrition decreases. This study explores challenges, strengths and strategies used in nursing team communication in order to build collegial relationships. A qualitative approach was employed to gather nurses experiences and discussion of communication within their nursing teams and a constant comparison method was utilised for data analysis. A convenience sampling technique was employed to access both Registered Nurses and Enrolled Nurses to partake in six focus groups. Thirty mostly female nurses (ratio of 5:1) participated in the study. Inclusion criteria consisted of being a nurse currently working in acute care settings and the exclusion criteria included nursing staff currently working in closed specialty units (i.e. intensive care units). Results revealed three main themes: (1) externalisation and internalisation of nursing team communication breakdown, (2) the importance of collegiality for retention of nurses and (3) loss of respect, and civility across the healthcare workplace. A clear division between hierarchies of nurses was apparent in how nursing team communication was delivered and managed. Open, respectful and collegial communication is essential in today's dynamic and complex health environments. The nurses in this study highlighted how important nursing communication can be to work motivation and how leadership fosters teamwork.

  16. Behavioral health screening in urban primary care settings: construct validity of the PSC-17.

    Science.gov (United States)

    Kostanecka, Anna; Power, Thomas; Clarke, Angela; Watkins, Marley; Hausman, Cheryl L; Blum, Nathan J

    2008-04-01

    The Pediatric Symptom Checklist-17 (PSC-17) is a brief form of the Pediatric Symptom Checklist that is designed to screen for behavioral health problems in primary care settings. It has been proposed to have three subscales: externalizing, internalizing, and attention problems. In the context of developing a behavioral health screening program in an inner-city primary care practice, we evaluated the construct validity of the PSC-17. A total of 331 families with children between 4 and 12 years of age who were seen for well-child care during the study were invited to complete the PSC-17 and 320 families (96.5%) did so. A confirmatory factor analysis was performed and the Comparative Fit Index and root mean square error of approximation fit statistics were calculated to determine whether the data fit the proposed three-factor model. We found that although the PSC-17 contained three subscales, several items did not load predominantly on the subscale that they were proposed to measure. Specifically, although the five items on the internalizing subscale loaded only on this subscale, only four of the seven externalizing items loaded exclusively on the externalizing subscale, and only two of the five attention items loaded exclusively on the attention problems subscale. Clinicians using the PSC-17 in urban low-income communities should recognize that the externalizing and attention problems subscales of the PSC-17 may not be valid measures of these dimensions of child behavior in this population.

  17. Improving the availability of emergency obstetric care in conflict-affected settings.

    Science.gov (United States)

    Krause, S K; Meyers, J L; Friedlander, E

    2006-01-01

    This paper describes an emergency obstetric care (EmOC) project implemented by the Reproductive Health Response in Conflict (RHRC) Consortium in 12 conflict-affected settings in nine countries from 2000-2005 with funding and technical support from Columbia University's Mailman School of Public Health Averting Maternal Death and Disability (AMDD) programme. The overall goal of the project was to reduce maternal morbidity and mortality in select conflict-affected settings by improving the availability of EmOC. Another aim of the project was to institutionalize EmOC within RHRC Consortium agencies by modelling how to improve the availability of basic and comprehensive EmOC at clinics and hospitals. The specific project purpose was to increase the availability of EmOC in select conflict-affected settings. The project demonstrated that a great deal more can and should be done by humanitarian workers to improve the availability of basic and comprehensive emergency obstetric services in conflict-affected settings.

  18. A point-of-care PCR test for HIV-1 detection in resource-limited settings.

    Science.gov (United States)

    Jangam, Sujit R; Agarwal, Abhishek K; Sur, Kunal; Kelso, David M

    2013-04-15

    A low-cost, fully integrated sample-to-answer, quantitative PCR (qPCR) system that can be used for detection of HIV-1 proviral DNA in infants at the point-of-care in resource-limited settings has been developed and tested. The system is based on a novel DNA extraction method, which uses a glass fiber membrane, a disposable assay card that includes on-board reagent storage, provisions for thermal cycling and fluorescence detection, and a battery-operated portable analyzer. The system is capable of automated PCR mix assembly using a novel reagent delivery system and performing qPCR. HIV-1 and internal control targets are detected using two spectrally separated fluorophores, FAM and Quasar 670. In this report, a proof-of-concept of the platform is demonstrated. Initial results with whole blood demonstrate that the test is capable of detecting HIV-1 in blood samples containing greater than 5000 copies of HIV-1. In resource-limited settings, a point-of-care HIV-1 qPCR test would greatly increase the number of test results that reach the infants caregivers, allowing them to pursue anti-retroviral therapy.

  19. Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting

    Directory of Open Access Journals (Sweden)

    Andrew M. Harrison

    2017-03-01

    Full Text Available Background Electronic Health Record (EHR-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored. Objective To test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system. Study Design In one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview. Results The alert acknowledgement rate from the severe sepsis alert system was 3% (N = 148 and 51% (N = 156 from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min (N = 5 and median 2 min (N = 80 from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers. Conclusion Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting.

  20. Trying to cope with everyday life—Emotional support in municipal elderly care setting

    Directory of Open Access Journals (Sweden)

    Margaretha Norell Pejner

    2012-12-01

    Full Text Available Emotional support is considered to be important to older patients because it is a contributing factor to experiencing good health and it has been shown that it can prevent depression after a hip fracture. Opinions differ on whether emotional support falls within the field of nursing, and studies also show that nurses in an elderly home care setting fail when it comes to giving emotional support. The aim of this study was to explore reasons for registered nurses to give emotional support to older patients in a municipal home care setting. The study was conducted using Grounded Theory. Data collection was carried out through interviews with 16 registered nurses. The inclusion criteria were emotional support given to patients aged 80 years and above living in ordinary or sheltered housing and who were in need of help from both the home help service and registered nurses. The results show that the main concern of emotional support was “Trying to relieve the patient from their emotions so they are able to cope with everyday life.” This core category illustrates how registered nurses tried to support the patients’ own strength, so that they were able to move forward. Registered nurses consider that they could support the patients because they give them access to, or could create access to, their emotions, but there were also times when they felt helplessness and as a result, consciously opted out. The results also indicate that registered nurses were keen to give emotional support. To develop patient-centered elderly care, more knowledge of emotional support and the elderly's need for this support is required.

  1. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

    Science.gov (United States)

    Cheong, Chin Yee; Tan, Jane An Qi; Foong, Yi-Lin; Koh, Hui Mien; Chen, Denise Zhen Yue; Tan, Jessie Joon Chen; Ng, Chong Jin; Yap, Philip

    2016-01-01

    Background/Aims The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation. PMID:27489560

  2. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

    Directory of Open Access Journals (Sweden)

    Chin Yee Cheong

    2016-06-01

    Full Text Available Background/Aims: The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT programme on mood and engagement in older patients with delirium and/or dementia (PtDD in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods: Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4 were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy on 3 consecutive days: day 1 (control condition without music and days 2 and 3 (with CMT. Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES and Observed Emotion Rating Scale (OERS. Results: Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01 in MPES and pleasure and general alertness (Z = 3.188,p = 0.01 in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014. Negative engagement (Z = 2.582, p = 0.01 and affect (Z = 2.004, p = 0.045 were both lower during CMT compared to no music. Conclusion: These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation.

  3. Point-of-Care Diagnostics in Low-Resource Settings and Their Impact on Care in the Age of the Noncommunicable and Chronic Disease Epidemic.

    Science.gov (United States)

    Weigl, Bernhard H; Neogi, Tina; McGuire, Helen

    2014-06-01

    The emergence of point-of-care (POC) diagnostics specifically designed for low-resource settings coupled with the rapid increase in need for routine care of patients with chronic diseases should prompt reconsideration of how health care can be delivered most beneficially and cost-effectively in developing countries. Bolstering support for primary care to provide rapid and appropriate integrated acute and chronic care treatment may be a possible solution. POC diagnostics can empower local and primary care providers and enable them to make better clinical decisions. This article explores the opportunity for POC diagnostics to strengthen primary care and chronic disease diagnosis and management in a low-resource setting (LRS) to deliver appropriate, consistent, and integrated care. We analyze the requirements of resource-appropriate chronic disease care, the characteristics of POC diagnostics in LRS versus the developed world, the many roles of diagnostics in the care continuum in LRS, and the process and economics of developing LRS-compatible POC diagnostics.

  4. Care Coordination Associated with Improved Timing of Newborn Primary Care Visits.

    Science.gov (United States)

    Goyal, Neera K; Hall, Eric S; Kahn, Robert S; Wexelblatt, Scott L; Greenberg, James M; Samaan, Zeina M; Brown, Courtney M

    2016-09-01

    Objective Despite practice recommendations that all newborns be examined within 3-5 days after discharge, many are not seen within this timeframe. Our objective was to determine the association between care coordination and timing of newborn follow-up. Methods This retrospective study evaluated 6251 newborns from eight maternity hospitals who scheduled a primary care appointment at one of two academic pediatric practices over 3.5 years. Two programs were sequentially implemented: (1) newborn discharge coordination, and (2) primary care intake coordination. Primary outcome was days between discharge and follow-up, dichotomized as ≤ or >5 days. Number of rescheduled appointments and loss to follow-up were also assessed. Adjusted relative risks (RR) and odds ratios (OR) were determined by piecewise generalized linear and logistic regression. Results Among 5943 newborns with a completed visit, 52.9 % were seen within 5 days of discharge (mean 6.7 days). After multivariable adjustment, the pre-exposure period (8 months) demonstrated a downward monthly trend in completing early follow-up (RR 0.93, p coordinator implementation and roughly 33 % after primary care coordinator implementation. The latter was also associated with a 13 % monthly decrease in odds of loss to follow-up (OR 0.87, p Care coordination increases adherence among low income families to recommended newborn follow-up after birth hospitalization.

  5. Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association.

    Science.gov (United States)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric; Capuano, Frederic; Claeys, Marc J; Danchin, Nicolas; Fox, Keith Aa; Huber, Kurt; Iakobishvili, Zaza; Lettino, Maddalena; Quinn, Tom; Rubini Gimenez, Maria; Bøtker, Hans E; Swahn, Eva; Timmis, Adam; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zeymer, Uwe; Bueno, Hector

    2017-02-01

    Evaluation of quality of care is an integral part of modern healthcare, and has become an indispensable tool for health authorities, the public, the press and patients. However, measuring quality of care is difficult, because it is a multifactorial and multidimensional concept that cannot be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons for the choice for each measure.

  6. Closed-set-based Discovery of Representative Association Rules Revisited

    CERN Document Server

    Balcázar, José L

    2010-01-01

    The output of an association rule miner is often huge in practice. This is why several concise lossless representations have been proposed, such as the "essential" or "representative" rules. We revisit the algorithm given by Kryszkiewicz (Int. Symp. Intelligent Data Analysis 2001, Springer-Verlag LNCS 2189, 350-359) for mining representative rules. We show that its output is sometimes incomplete, due to an oversight in its mathematical validation, and we propose an alternative complete generator that works within only slightly larger running times.

  7. Novos anticoagulantes em cuidados intensivos New anticoagulants in critical care settings

    Directory of Open Access Journals (Sweden)

    Uri Adrian Prync Flato

    2011-03-01

    prevention of secondary acute coronary syndrome. Antithrombotic agents such as Aspirin, clopidogrel, vitamin K antagonists and fondaparinux, an indirect Factor Xa inhibitor, are already incorporated into our clinical practice. New small-molecule, selective Factor Xa and thrombin inhibitors that simultaneously inhibit free plasma and clot-associated factor activities have received considerable attention recently. These new oral anticoagulants are in various phases of clinical development. dabigatran, rivaroxaban and apixaban are in more advanced phases of clinical development and are already available in a number of countries. This review article highlights the studies describing the use of these three anticoagulants in an intensive care setting.

  8. Within prisons, is there an association between the quantity of prenatal care and infant birthweight?

    Science.gov (United States)

    Howard, David L; Strobino, Donna; Sherman, Susan; Crum, Rosa

    2008-07-01

    There is still controversy surrounding the effectiveness of prenatal care in reducing low birthweight. In addition, very few studies have assessed the relationship between prenatal care and infant birthweight among pregnant women within the prison system. We sought to ascertain whether there is an association between the quantity of prenatal care and infant birthweight among pregnant women within such a setting. We examined the prison medical records of 147 infants born to women delivering at term (37-41 weeks of gestation) between 1 January 2002 and 31 December 2004 who were incarcerated during pregnancy in Texas state prisons. Linear regression was used to evaluate the association between the number of prison prenatal care visits and infant birthweight while adjusting for potential confounders (age, gravidity, maternal education, maternal race, history of substance use, history of alcohol use, history of tobacco use and the presence of any chronic disease). We also adjusted for the interaction between the gestational age at admission to prison and the number of prison prenatal care visits. There was a statistically significant 120.5 g increase in adjusted mean birthweight with each additional prison prenatal care visit (P = 0.001) among study infants whose mothers entered prison during the first trimester. This trend was not observed among women who came in after the first trimester. There appears to be a positive association between the amount of prison prenatal care and infant birthweight among incarcerated pregnant women delivering at term, but this association appears to be limited to women entering prison during the first trimester of pregnancy.

  9. Individual and Area Level Factors Associated with Prenatal, Delivery, and Postnatal Care in Pakistan.

    Science.gov (United States)

    Budhwani, Henna; Hearld, Kristine Ria; Harbison, Hanne

    2015-10-01

    This research examines individual and area level factors associated with maternal health care utilization in Pakistan. The 2012-2013 Pakistan Demographic and Health Surveys data was used to model five outcomes: prenatal care within the first trimester, four plus prenatal visits, birth attendance by a skilled attendant, birth in a medical facility, and receipt of postnatal care. Less than half of births were to mothers receiving prenatal care in the first trimester, and approximately 57 % had trained personnel at delivery. Over half were born to mothers who received postnatal care. Evidence was found to support the positive effect of individual level variables, education and wealth, on the utilization of maternal health care across all five measures. Although, this study did not find unilateral differences between women residing in rural and urban settings, rural women were found to have lower odds of utilizing prenatal services as compared to mothers in urban environments. Additionally, women who cited distance as a barrier, had lower odds of receiving postnatal health care, but still engaged in prenatal services and often had a skilled attendant present at delivery. The odds of utilizing prenatal care increased when women resided in an area where prenatal utilization was high, and this variability was found across measures across provinces. The results found in this paper highlight the uneven progress made around improving prenatal, delivery, and postnatal care in Pakistan; disparities persist which may be attributed to factors both at the individual and community level, but may be addressed through a consorted effort to change national policy around women's health which should include the promotion of evidence based interventions such as incentivizing health care workers, promoting girls' education, and improving transportation options for pregnant women and recent mothers with the intent of ultimately lowering the Maternal Mortality Rate as recommended in the U

  10. Can diabetes management be safely transferred to practice nurses in a primary care setting? A randomised controlled trial

    NARCIS (Netherlands)

    Houweling, Sebastiaan T.; Kleefstra, Nanne; van Hateren, Kornelis J. J.; Groenier, Klaas H.; Meyboom-de Jong, Betty; Bilo, Henk J. G.

    2011-01-01

    Aims and objectives. To determine whether the management of type 2 diabetes mellitus in a primary care setting can be safely transferred to practice nurses. Background. Because of the increasing prevalence of type 2 diabetes mellitus and the burden of caring for individual patients, the demand type

  11. Institutional Care of Children in Low- and Middle-Income Settings: Challenging the Conventional Wisdom of Oliver Twist

    OpenAIRE

    Braitstein, Paula

    2015-01-01

    Whether institutions or extended families are better suited to care for orphans depends on the specific circumstances. Reported rates of traumatic experiences among orphans and vulnerable children are high in both institutions and extended families; improving the quality of care for such children should be the paramount priority in all settings.

  12. Factors Associated with American Indian Cigarette Smoking in Rural Settings

    Directory of Open Access Journals (Sweden)

    Karabi Nandy

    2011-03-01

    Full Text Available Introduction: This paper reports on the prevalence, factors and patterns of cigarette smoking among rural California American Indian (AI adults. Methods: Thirteen Indian health clinic registries formed the random household survey sampling frame (N = 457. Measures included socio-demographics, age at smoking initiation, intention to quit, smoking usage, smoking during pregnancy, health effects of smoking, suicide attempts or ideation, history of physical abuse, neglect and the role of the environment (smoking at home and at work. Statistical tests included Chi Square and Fisher’s Exact test, as well as multiple logistic regression analysis among never, former, and current smokers. Results: Findings confirm high smoking prevalence among male and female participants (44% and 37% respectively. American Indians begin smoking in early adolescence (age 14.7. Also, 65% of current smokers are less than 50% Indian blood and 76% of current smokers have no intention to quit smoking. Current and former smokers are statistically more likely to report having suicidal ideation than those who never smoked. Current smokers also report being neglected and physically abused in childhood and adolescence, are statistically more likely to smoke ½ pack or less (39% vs. 10% who smoke 1+ pack, smoke during pregnancy, and have others who smoke in the house compared with former and never smokers. Conclusion: Understanding the factors associated with smoking will help to bring about policy changes and more effective programs to address the problem of high smoking rates among American Indians.

  13. Teamwork or interdepartmental cooperation: which is more important in the health care setting?

    Science.gov (United States)

    Carson, K D; Carson, P P; Yallapragada, R; Roe, C W

    2001-06-01

    A survey of 75 nursing department employees was conducted to assess the relative importance of across-department and within-team cooperation on workplace outcomes. As compared with within-team cooperation, across-department cooperation is more positively associated with procedural justice, interpersonal justice, satisfaction with supervisor feedback, supervisory rating, job satisfaction, and organizational commitment. Across-department cooperation is more negatively associated with role ambiguity, role conflict, role overload, job tension, and job withdrawal intentions. No significant correlational differences are noted for either distributive justice or politics. Type of cooperation also was analyzed using hierarchical regression, and more variance was explained in across-department cooperation than within-team cooperation by organizational variables. Based on these results, it may be more important for the health care manager to attend to issues of interdepartmental cooperation rather than to internal team dynamics.

  14. Child-care attendance and common morbidity: evidence of association in the literature and questions of design

    Directory of Open Access Journals (Sweden)

    Barros Aluísio J. D.

    1999-01-01

    Full Text Available Papers on child-care attendance as a risk factor for acute respiratory infections and diarrhea were reviewed. There was great variety among the studies with regard to the design, definition of exposure and definition of outcomes. All the traditional epidemiological study designs have been used. The studies varied in terms of how child-care attendance in general was defined, and for different settings. These definitions differed especially in relation to the minimum time of attendance required. The outcomes were also defined and measured in several different ways. The analyses performed were not always appropriate, leading to sets of results of uneven quality, and composed of different measures of association relating different exposures and outcomes, that made summarizing difficult. Despite that, the results reported were remarkably consistent. Only two of the papers reviewed failed to show some association between child-care attendance and increased acute respiratory infections, or diarrhea. On the other hand, the magnitude of the associations reported varied widely, especially for lower respiratory infections. Taken together, the studies so far published provide evidence that children attending child-care centers, especially those under three years of age, are at a higher risk of upper respiratory infections, lower respiratory infections, and diarrhea. The studies were not consistent, however, in relation to attendance at child-care homes. Children in such settings were sometimes similar to those in child-care centers, sometimes similar to those cared for at home, and sometimes presented an intermediate risk.

  15. A cluster randomized trial evaluating electronic prescribing in an ambulatory care setting

    Directory of Open Access Journals (Sweden)

    Quan Sherman

    2007-10-01

    Full Text Available Abstract Background Medication errors, adverse drug events and potential adverse drug events are common and serious in terms of the harms and costs that they impose on the health system and those who use it. Errors resulting in preventable adverse drug events have been shown to occur most often at the stages of ordering and administration. This paper describes the protocol for a pragmatic trial of electronic prescribing to reduce prescription error. The trial was designed to overcome the limitations associated with traditional study design. Design This study was designed as a 65-week, cluster randomized, parallel study. Methods The trial was conducted within ambulatory outpatient clinics in an academic tertiary care centre in Ontario, Canada. The electronic prescribing software for the study is a Canadian electronic prescribing software package which provides physician prescription entry with decision support at the point of care. Using a handheld computer (PDA the physician selects medications using an error minimising menu-based pick list from a comprehensive drug database, create specific prescription instructions and then transmit the prescription directly and electronically to a participating pharmacy via facsimile or to the physician's printer using local area wireless technology. The unit of allocation and randomization is by 'week', i.e. the system is "on" or "off" according to the randomization scheme and the unit of analysis is the prescription, with adjustment for clustering of patients within practitioners. Discussion This paper describes the protocol for a pragmatic cluster randomized trial of point-of-care electronic prescribing, which was specifically designed to overcome the limitations associated with traditional study design. Trial Registration This trial has been registered with clinicaltrials.gov (ID: NCT00252395

  16. Information for Government Agencies about Specific Environmental Health Issues in Child-Care Settings

    Science.gov (United States)

    research on child care environmental health issues, identify key state and regional healthy child care organizations for partnerships, and see how other states are addressing child care environmental health issues.

  17. Innovation and transformation in California's safety net health care settings: an inside perspective.

    Science.gov (United States)

    Lyles, Courtney R; Aulakh, Veenu; Jameson, Wendy; Schillinger, Dean; Yee, Hal; Sarkar, Urmimala

    2014-01-01

    Health reform requires safety net settings to transform care delivery, but how they will innovate in order to achieve this transformation is unknown. Two series of key informant interviews (N = 28) were conducted in 2012 with leadership from both California's public hospital systems and community health centers. Interviews focused on how innovation was conceptualized and solicited examples of successful innovations. In contrast to disruptive innovation, interviewees often defined innovation as improving implementation, making incremental changes, and promoting integration. Many leaders gave examples of existing innovative practices to meeting their diverse patient needs, such as patient-centered approaches. Participants expressed challenges to adapting quickly, but a desire to partner together. Safety net systems have already begun implementing innovative practices supporting their key priority areas. However, more support is needed, specifically to accelerate the change needed to succeed under health reform.

  18. Health care needs of older people living permanently in a residential home setting in Gauteng

    Directory of Open Access Journals (Sweden)

    MM Chabeli

    2003-09-01

    Full Text Available This article reviews some of the prevailing health needs of elderly people living permanently in a residential old age home. A qualitative, exploratory and descriptive design was employed. Twenty-one black elderly people were purposively selected to participate in a focus group interview session for the purpose of describing their perception of their health care needs. From descriptive content analysis, three main data sets emerged, namely physical health needs, unmet psychological needs and the need for a healthy social relationship. Recommendations to deal with these health needs were made based on the empirical data supported by literature. Measures of trustworthiness were ensured as described by Lincoln and Guba (1985:316-327.

  19. Patient Abuse in the Health Care Setting: The Nurse as Patient Advocate.

    Science.gov (United States)

    Albina, Julie K

    2016-01-01

    Incidents of verbal and physical patient abuse in health care settings continue to occur, with some making headline news. Nurses have a professional and ethical responsibility to advocate for their patients when incidents of abuse occur. Tolerating or ignoring inappropriate behaviors occurs for multiple reasons, including ignorance, fear of retaliation, the need for peer acceptance, and concerns for personal advancement. Nurses need to reflect on their biases before they can truly respect patients' autonomy. Through the examination of reported cases of patient abuse, the need for a change in hospital culture becomes evident. The primary steps in eliminating patient abuse are opening communication, providing education, establishing competency, eliminating tolerance of unacceptable behavior, and creating a code of mutual respect. A change in culture to one of mutual respect and dignity for staff members and patients will lead to the best outcomes for all involved.

  20. Identifying the factors influencing minority language use in health care education settings: a European perspective.

    Science.gov (United States)

    Roberts, G W; Paden, L

    2000-07-01

    The recent enhanced status of many minority languages across the European Community has led to increasing demands for their use within the public sector. This is particularly evident in health care, where, in circumstances of stress and vulnerability, denying opportunities for clients to communicate in their preferred language may place them at a personal disadvantage and compromise their health chances. In view of the exclusion of many minority languages from the public domain over the years, their re-introduction demands adaptations to health care education programmes in order to promote language sensitivity in practice. Before embarking on developments which establish such languages within the professional sphere, valuable insight may be gained by examining their current use in practice education. Furthermore, comparing their use across language communities enables the sharing of common experiences and furthers opportunities for developing networks across Europe. This paper describes an ethnographic study of the use, within midwifery education, of the Welsh language in north Wales, the Catalan language in Barcelona and the Irish language in Western Ireland. Semi-structured interviews were conducted with key lecturers, clinical mentors and students across the three communities in order to determine patterns of language use within a range of learning environments. Focus groups were also held in order to confirm the findings. The data reveal many commonalities in terms of language use across the three settings and important factors are identified which support the use of minority languages in practice education. The findings are invaluable for guiding future bilingual initiatives across health care education programmes.

  1. Experiences with developing and implementing a virtual clinic for glaucoma care in an NHS setting

    Directory of Open Access Journals (Sweden)

    Kotecha A

    2015-10-01

    Full Text Available Aachal Kotecha,1,2 Alex Baldwin,1 John Brookes,1 Paul J Foster1,2 1Glaucoma Service, Moorfields Eye Hospital National Health Service Foundation Trust, 2NIHR BRC, Moorfields Eye Hospital, NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, UK Background: This article describes the development of a virtual glaucoma clinic, whereby technicians collect information for remote review by a consultant specialist.Design and Methods: This was a hospital-based service evaluation study. Patients suitable for the stable monitoring service (SMS were low-risk patients with “suspect”, “early”-to-“moderate” glaucoma who were deemed stable by their consultant care team. Three technicians and one health care assistant ran the service. Patients underwent tests in a streamlined manner in a dedicated clinical facility, with virtual review of data by a consultant specialist through an electronic patient record.Main outcome measure: Feasibility of developing a novel service within a UK National Health Service setting and improvement of patient journey time within the service were studied.Results: Challenges to implementation of virtual clinic include staffing issues and use of information technology. Patient journey time within the SMS averaged 51 minutes, compared with 92 minutes in the glaucoma outpatient department. Patient satisfaction with the new service was high.Conclusion: Implementing innovation into existing services of the National Health Service is challenging. However, the virtual clinic showed an improved patient journey time compared with that experienced within the general glaucoma outpatient department. There exists a discrepancy between patient management decisions of reviewers, suggesting that some may be more risk averse than others when managing patients seen within this model. Future work will assess the ability to detect progression of disease in this model compared with the general

  2. The treatment of depressed chinese americans using qigong in a health care setting: a pilot study.

    Science.gov (United States)

    Yeung, Albert; Slipp, Lauren E; Jacquart, Jolene; Fava, Maurizio; Denninger, John W; Benson, Herbert; Fricchione, Gregory L

    2013-01-01

    Background. This pilot study examined the feasibility and efficacy of providing Qigong treatment in a health center to Chinese Americans with major depressive disorder (MDD). Methods. Fourteen Chinese Americans with MDD were enrolled, and they received a 12-week Qigong intervention. The key outcome measurement was the 17-item Hamilton Rating Scale for Depression (HAM-D17); the Clinical Global Impressions-Severity (CGI-S) and -Improvement (CGI-I), the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), and the Multidimensional Scale of Perceived Social Support (MSPSS) were also administered. Positive response was defined as a decrease of 50% or more on the HAM-D17, and remission was defined as HAM-D17 ≤ 7. Patients' outcome measurements were compared before and after the Qigong intervention. Results. Participants (N = 14) were 64% female, with a mean age of 53 (±14). A 71% of participants completed the intervention. The Qigong intervention resulted in a positive treatment-response rate of 60% and a remission rate of 40% and statistically significant improvement, as measured by the HAM-D17, CGI-S, CGI-I, Q-LES-Q-SF, and the family support subscale of the MSPSS. Conclusions. The Qigong intervention provided at a health care setting for the treatment of primary care patients with MDD is feasible. Further studies with larger sample sizes are warranted.

  3. The Treatment of Depressed Chinese Americans Using Qigong in a Health Care Setting: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Albert Yeung

    2013-01-01

    Full Text Available Background. This pilot study examined the feasibility and efficacy of providing Qigong treatment in a health center to Chinese Americans with major depressive disorder (MDD. Methods. Fourteen Chinese Americans with MDD were enrolled, and they received a 12-week Qigong intervention. The key outcome measurement was the 17-item Hamilton Rating Scale for Depression (HAM-D17; the Clinical Global Impressions-Severity (CGI-S and -Improvement (CGI-I, the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF, and the Multidimensional Scale of Perceived Social Support (MSPSS were also administered. Positive response was defined as a decrease of 50% or more on the HAM-D17, and remission was defined as HAM-D17 ≤ 7. Patients' outcome measurements were compared before and after the Qigong intervention. Results. Participants (N=14 were 64% female, with a mean age of 53 (±14. A 71% of participants completed the intervention. The Qigong intervention resulted in a positive treatment-response rate of 60% and a remission rate of 40% and statistically significant improvement, as measured by the HAM-D17, CGI-S, CGI-I, Q-LES-Q-SF, and the family support subscale of the MSPSS. Conclusions. The Qigong intervention provided at a health care setting for the treatment of primary care patients with MDD is feasible. Further studies with larger sample sizes are warranted.

  4. Acupuncture in the Inpatient Acute Care Setting: A Pragmatic, Randomized Control Trial

    Directory of Open Access Journals (Sweden)

    Jeannette Painovich

    2012-01-01

    Full Text Available Purpose. To evaluate the acceptance and effectiveness of acupuncture in a hospital setting. Methods. This 18-month pragmatic randomized controlled trial used a two-tiered consent process for all patients admitted to the acute care unit by study physician groups. The primary study comparison was between those randomized (using biased-coin randomization after initial consent to be offered acupuncture or not. The primary outcome was length of stay (LOS. Other measures include costs, self-reported anxiety, depression, health status, and patient satisfaction. Results. Of the 383 patients consented to the study, 253 were randomized to be offered acupuncture, and 130 were not offered acupuncture. Of those offered acupuncture, 173 (69% accepted and received daily acupuncture. On average, patients offered acupuncture had longer LOSs (4.9 versus 4.1 days than those not offered acupuncture (=.047. Adjustment for diagnosis and severity mix reduced this difference and its significance (=.108. No other significant differences in outcomes were found. Patients who were more anxious (=.000 or depressed (=.017 at admission tended to more often accept acupuncture when offered. Conclusion. Acupuncture is accepted by a majority of hospitalized acute care patients. However, it did not reduce LOS in this already short-stay population.

  5. Improper sharp disposal practices among diabetes patients in home care settings: Need for concern?

    Directory of Open Access Journals (Sweden)

    Anindo Majumdar

    2015-01-01

    Full Text Available In the recent years, outbreaks of blood-borne infections have been reported from assisted living facilities, which were traced back to improper blood glucose monitoring practices. Needle-stick injuries have been implicated in many such cases. This directly raises concerns over sharp disposal practices of diabetic patients self-managing their condition in home care settings. With India being home to a huge diabetic population, this issue, if neglected, can cause substantial damage to the health of the population and a marked economic loss. This article discusses the sharp disposal practices prevalent among diabetes patients, the importance of proper sharp disposal, barriers to safe disposal of sharps, and the options available for doing the same. For adopting an environmentally safe wholesome approach, disposal of plastics generated as a result of diabetes self-care at home is important as well. The article also looks at the possible long-term solutions to these issues that are sustainable in an Indian context.

  6. Shared decision making in health care settings: a role for social work.

    Science.gov (United States)

    Peterson, K Jean

    2012-01-01

    Shared decision making (SDM) is a process integral to social work practice, one where the provider/professional and the consumer/patient discuss treatment alternatives based on patient values and life circumstances and make a shared decision about whether and how to proceed with treatment. Evidence-based medicine suggests that for many health conditions, having the choice of several effective treatment options is not uncommon. In these cases treatment should be based on what is best for the individual, since many factors influence an individual's treatment preference, including the psychological, social, cultural, and spiritual history she/he brings to the medical encounter; a history that has long been ignored in somatic health care. This article develops the argument that medical social workers possess the professional knowledge and skill base to provide decisional coaching, and implementing SDM in primary care settings. Of particular importance are the values that guide professional social work practice, including client self-determination, which is the basis of SDM, and the ability to maintain neutrality.

  7. Assessment of Patient Safety Culture in Primary Health Care Settings in Kuwait

    Directory of Open Access Journals (Sweden)

    Maha Mohamed Ghobashi

    2014-01-01

    Full Text Available Background Patient safety is critical component of health care quality. We aimed to assess the awareness of primary healthcare staff members about patient safety culture and explore the areas of deficiency and opportunities for improvement concerning this issue.Methods: This descriptive cross sectional study surveyed 369 staff members in four primary healthcare centers in Kuwait using self-administered “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of respondents was 276 participants (response rate = 74.79%.Results: Five safety dimensions with lowest positivity (less than 50% were identified and these are; the non – punitive response to errors, frequency of event reporting, staffing, communication openness, center handoffs and transitions with the following percentages of positivity 24%, 32%, 41%, 45% and 47% respectively. The dimensions of highest positivity were teamwork within the center’s units (82% and organizational learning (75%.Conclusion: Patient safety culture in primary healthcare settings in Kuwait is not as strong as improvements for the provision of safe health care. Well-designed patient safety initiatives are needed to be integrated with organizational policies, particularly the pressing need to address the bioethical component of medical errors and their disclosure, communication openness and emotional issues related to them and investing the bright areas of skillful organizational learning and strong team working attitudes.    

  8. Factors associated with maternal death in an intensive care unit

    Science.gov (United States)

    Saintrain, Suzanne Vieira; de Oliveira, Juliana Gomes Ramalho; Saintrain, Maria Vieira de Lima; Bruno, Zenilda Vieira; Borges, Juliana Lima Nogueira; Daher, Elizabeth De Francesco; da Silva Jr, Geraldo Bezerra

    2016-01-01

    Objective To identify factors associated with maternal death in patients admitted to an intensive care unit. Methods A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. Results A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). Conclusion The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death. PMID:28099637

  9. Clowning in Health Care Settings: The Point of View of Adults

    Directory of Open Access Journals (Sweden)

    Alberto Dionigi

    2016-08-01

    Full Text Available Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar, with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia, observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1 clown intervention induces positive emotions, thereby enhancing the patient’s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2 clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3 few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research.

  10. Clowning in Health Care Settings: The Point of View of Adults.

    Science.gov (United States)

    Dionigi, Alberto; Canestrari, Carla

    2016-08-01

    Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient's well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research.

  11. Introduction: priority setting, equitable access and public involvement in health care.

    Science.gov (United States)

    Weale, Albert; Kieslich, Katharina; Littlejohns, Peter; Tugendhaft, Aviva; Tumilty, Emma; Weerasuriya, Krisantha; Whitty, Jennifer A

    2016-08-15

    Purpose - The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in prioritization decisions by discussing the conceptualization, scope and rationales of PPI in priority setting that inform the special issue. Design/methodology/approach - The paper employs a mixed-methods approach in that it provides a literature review and a conceptual discussion of the common themes emerging in the field of PPI and health priority setting. Findings - The special issue focuses on public participation that is collective in character, in the sense that the participation relates to a social, not personal, decision and is relevant to whole groups of people and not single individuals. It is aimed at influencing a decision on public policy or legal rules. The rationales for public participation can be found in democratic theory, especially as they relate to the social and political values of legitimacy and representation. Originality/value - The paper builds on previous definitions of public participation by underlining its collective character. In doing so, it develops the work by Parry, Moyser and Day by arguing that, in light of the empirical evidence presented in this issue, public participatory activities such as protests and demonstrations should no longer be labelled unconventional, but should instead be labelled as "contestatory participation". This is to better reflect a situation in which these modes of participation have become more conventional in many parts of the world.

  12. Clowning in Health Care Settings: The Point of View of Adults

    Science.gov (United States)

    Dionigi, Alberto; Canestrari, Carla

    2016-01-01

    Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient’s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research. PMID:27547261

  13. Microbial contamination of mobile phones in a health care setting in Alexandria, Egypt

    Directory of Open Access Journals (Sweden)

    Selim, Heba Sayed

    2015-02-01

    Full Text Available Aim: This study aimed at investigating the microbial contamination of mobile phones in a hospital setting. Methods: Swab samples were collected from 40 mobile phones of patients and health care workers at the Alexandria University Students’ Hospital. They were tested for their bacterial contamination at the microbiology laboratory of the High Institute of Public Health. Quantification of bacteria was performed using both surface spread and pour plate methods. Isolated bacterial agents were identified using standard microbiological methods. Methicillin-resistant was identified by disk diffusion method described by Bauer and Kirby. Isolated Gram-negative bacilli were tested for being extended spectrum beta lactamase producers using the double disk diffusion method according to the Clinical and Laboratory Standards Institute recommendations.Results: All of the tested mobile phones (100% were contaminated with either single or mixed bacterial agents. The most prevalent bacterial contaminants were methicillin-resistant and coagulase-negative staphylococci representing 53% and 50%, respectively. The mean bacterial count was 357 CFU/ml, while the median was 13 CFU/ml using the pour plate method. The corresponding figures were 2,192 and 1,720 organisms/phone using the surface spread method. Conclusions: Mobile phones usage in hospital settings poses a risk of transmission of a variety of bacterial agents including multidrug-resistant pathogens as methicillin-resistant . The surface spread method is an easy and useful tool for detection and estimation of bacterial contamination of mobile phones.

  14. After-school supervision and adolescent cigarette smoking: contributions of the setting and intensity of after-school self-care.

    Science.gov (United States)

    Mott, J A; Crowe, P A; Richardson, J; Flay, B

    1999-02-01

    This paper looks at the independent contributions of the setting and the intensity of after-school self-care to the cigarette smoking behaviors of 2352 ninth graders. We controlled for a variety of correlates of adolescent cigarette smoking that have not been accounted for in existing research. Results indicated that the intensity of the self-care experience was significantly associated with adolescent smoking behavior irrespective of the typical setting of the adolescents' after-school activities. Our findings also indicated that a nonpermissive parenting style, family rule-setting about cigarettes, and especially, in absentia parental monitoring may reduce the likelihood of cigarette smoking among latchkey and nonlatchkey adolescents alike. However, latchkey youth were not any more sensitive to these aspects of parenting than other adolescents. This is consistent with the notion that targeting these aspects of the home lives of all adolescents has the potential to reduce smoking behaviors among latchkey as well as nonlatchkey children.

  15. Managers' practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings.

    Science.gov (United States)

    Berkman, Lisa F; Buxton, Orfeu; Ertel, Karen; Okechukwu, Cassandra

    2010-07-01

    An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work-family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work-family balance score of manager openness and creativity in dealing with employee work-family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work-family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work-family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work-family score. Managers' attitudes and practices may affect employee health, including sleep duration and CVD risk.

  16. Role of clevidipine butyrate in the treatment of acute hypertension in the critical care setting: a review

    Directory of Open Access Journals (Sweden)

    Ahmed S Awad

    2010-06-01

    Full Text Available Ahmed S Awad, Michael E GoldbergDepartment of Anesthesiology, Cooper University Hospital, UMDNJ-Robert Wood Johnson Medical School, Camden Campus, Camden, New Jersey, USAAbstract: Acutely elevated blood pressure in the critical care setting is associated with a higher risk of acute end-organ damage (eg, myocardial ischemia, stroke, and renal failure and perioperative bleeding. Urgent treatment and careful blood pressure control are crucial to prevent significant morbidity. Clevidipine butyrate (Cleviprex™ is an ultrashort-acting, third-generation intravenous calcium channel blocker. It is an arterial-selective vasodilator with no venodilatory or myocardial depressive effects. Clevidipine has an extremely short half-life of approximately 1 minute as it is rapidly metabolized by blood and tissue esterases. These metabolites are then primarily eliminated through urine and fecal pathways. The rapid onset and the short duration of action permit tighter and closer adjustment of the blood pressure than is possible with other intravenous agents.Keywords: calcium channel blocker, antihypertensive medications, end-organ damage, hypertensive crisis, hypertensive urgency

  17. Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited setting

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    Tsima BM

    2016-08-01

    Full Text Available Billy M Tsima,1 Vincent Setlhare,1 Oathokwa Nkomazana2 1Department of Family Medicine and Public Health, 2Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana Background: Botswana’s health care system is based on a primary care model. Various national guidelines exist for specific diseases. However, most of the guidelines address management at a tertiary level and often appear nonapplicable for the limited resources in primary care facilities. An integrated symptom-based guideline was developed so as to translate the Botswana national guidelines to those applicable in primary care. The Botswana Primary Care Guideline (BPCG integrates the care of communicable diseases, including HIV/AIDS and noncommunicable diseases, by frontline primary health care workers.Methods: The Department of Family Medicine, Faculty of Medicine, University of Botswana, together with guideline developers from the Knowledge Translation Unit (University of Cape Town collaborated with the Ministry of Health to develop the guideline. Stakeholder groups were set up to review specific content of the guideline to ensure compliance with Botswana government policy and the essential drug list.Results: Participants included clinicians, academics, patient advocacy groups, and policymakers from different disciplines, both private and public. Drug-related issues were identified as necessary for implementing recommendations of the guideline. There was consensus by working groups for updating the essential drug list for primary care and expansion of prescribing rights of trained nurse prescribers in primary care within their scope of practice. An integrated guideline incorporating common symptoms of diseases seen in the Botswana primary care setting was developed.Conclusion: The development of the BPCG took a broad consultative approach with buy in from relevant stakeholders. It is anticipated that implementation of the BPCG will translate into better

  18. Assessing Quality of Care of Elderly Patients Using the ACOVE Quality Indicator Set: A Systematic Review

    NARCIS (Netherlands)

    Askari, M.; Wierenga, P.C.; Eslami, S.; Medlock, S.; de Rooij, S.E.; Abu-Hanna, A.

    2011-01-01

    Background: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients. Objectives: The purpose of this review is to summarize studi

  19. HIV transmission in the dental setting and the HIV-infected oral health care professional: workshop 1C.

    LENUS (Irish Health Repository)

    Flint, S R

    2011-04-01

    This workshop addressed two important issues: first, the global evidence of HIV transmission from health care provider to patient and from patient to health care provider in the general health care environment and the dental practice setting; second, in the era of highly active antiretroviral therapy, whether oral health care professionals living with HIV pose a risk of transmission to their patients and whether standard infection control is adequate to protect both the patient and the oral health care professional in dental practice. The workshop culminated in a general discussion and the formulation of a consensus statement from the participating delegates, representing more than 30 countries, on the criteria under which an HIV-infected oral health care professional might practice dentistry without putting patients at risk. This consensus statement, the Beijing Declaration, was agreed nem con.

  20. The lived experience of giving spiritual care: a phenomenological study of nephrology nurses working in acute and chronic hemodialysis settings.

    Science.gov (United States)

    Deal, Belinda; Grassley, Jane S

    2012-01-01

    The purpose of this study was to explore the lived experiences of nephrology nurses giving spiritual care in acute and chronic hemodialysis settings. Ten nurses were interviewed. Five themes were identified: a) drawing close, b) drawing from the well of my spiritual resources, c), sensing the pain of spiritual distress, d) lacking resources to give spiritual care, and e) giving spiritual care is like diving down deep. The study findings suggest that patients and nurses draw close during the giving of spiritual care, that nurses have spiritual resources they use to prepare for and give spiritual care, and that giving spiritual care can have an emotional cost. These findings have implications for nursing practice, nursing education, and nursing research.

  1. Linking Emotional Labor, Public Service Motivation, and Job Satisfaction: Social Workers in Health Care Settings.

    Science.gov (United States)

    Roh, Chul-Young; Moon, M Jae; Yang, Seung-Bum; Jung, Kwangho

    2016-01-01

    This study examines the determinants of emotional laborers'--social workers in health care organizations--job satisfaction and their public service motivation in using a structural equation model and provides empirical evidence regarding what contributes to job satisfaction or burnout in these workers. Among several latent variables, this study confirmed that false face significantly decreases the job satisfaction of social worker and is positively associated with burnout. In addition, commitment to public interest increases social workers' job satisfaction significantly. This study has implications for the management of emotional labor. By educating emotional laborers to reappraise situations to increase their job satisfaction and avoid burnout, reappraisal training and education are expected to result in increases in positive emotions and decreases in negative emotions, and to improve employees' performance in their organizations.

  2. A comparison of human elements and nonhuman elements in private health care settings: customers' perceptions and expectations.

    Science.gov (United States)

    Mohd Suki, Norazah; Chwee Lian, Jennifer Chiam; Suki, Norbayah Mohd

    2009-01-01

    In today's highly competitive health care environment, many private health care settings are now looking into customer service indicators to learn customers' perceptions and determine whether they are meeting customers' expectations in order to ensure that their customers are satisfied with the services. This research paper aims to investigate whether the human elements were more important than the nonhuman elements in private health care settings. We used the internationally renowned SERVQUAL five-dimension model plus three additional dimensions-courtesy, communication, and understanding of customers of the human element-when evaluating health care services. A total of 191 respondents from three private health care settings in the Klang Valley region of Malaysia were investigated. Descriptive statistics were calculated by the Statistical Package for Social Sciences (SPSS) computer program, version 15. Interestingly, the results suggested that customers nowadays have very high expectations especially when it comes to the treatment they are receiving. Overall, the research indicated that the human elements were more important than the nonhuman element in private health care settings. Hospital management should look further to improve on areas that have been highlighted. Implications for management practice and directions for future research are discussed.

  3. A study of automated self-assessment in a primary care student health centre setting.

    Science.gov (United States)

    Poote, Aimee E; French, David P; Dale, Jeremy; Powell, John

    2014-04-01

    We evaluated the advice given by a prototype self-assessment triage system in a university student health centre. Students attending the health centre with a new problem used the automated self-assessment system prior to a face-to-face consultation with the general practitioner (GP). The system's rating of urgency was available to the GP, and following the consultation, the GP recorded their own rating of the urgency of the patient's presentation. Full data were available for 154 of the 207 consultations. Perfect agreement, where both the GP and the self-assessment system selected the same category of advice, occurred in 39% of consultations. The association between the GP assessment and the self-assessment rankings of urgency was low but significant (rho = 0.19, P = 0.016). The self-assessment system tended to be risk averse compared to the GP assessments, with advice for more urgent level of care seeking being recommended in 86 consultations (56%) and less urgent advice in only 8 (5%). This difference in assessment of urgency was significant (P self-assessed and GP-assessed urgency was not associated with symptom site or socio-demographic characteristics of the user. Although the self-assessment system was more risk averse than the GPs, which resulted in a high proportion of patients being triaged as needing emergency or immediate care, the self-assessment system successfully identified a proportion of patients who were felt by the GP to have a self-limiting condition that did not need a consultation. In its prototype form, the self-assessment system was not a replacement for clinician assessment and further refinement is necessary.

  4. [Abuse and neglect of older care recipients in domestic settings - a survey among nurses of in-home care services].

    Science.gov (United States)

    Rabold, S; Görgen, T

    2007-10-01

    Although some anecdotal evidence for the phenomenon of abuse and neglect of community-dwelling older care recipients by in-home care services exists, there is an almost complete lack of data on this topic. In order to determine extent and risk factors of abuse and neglect of older care recipients by nurses, we conducted a self-report study among in-home care workers in the German city of Hanover. A total of 503 nurses took part in the study; the response rate was 43.3%. Nearly 40% of all respondents reported having abused or neglected at least one patient within the last 12 months. Psychological abuse/verbal aggression and neglect were most common. Serious problem behavior could be predicted by patients' aggressive behavior, the number of clients suffering from dementia, subjects' use of alcohol as a means of alleviating work-related stress, and nurses' general judgments of quality of care delivered by the respective in-home service. The results of this study show that the problem of abuse and neglect of care recipients is not limited to nursing homes and care by family members. Findings point at opportunities for prevention and accentuate the need for further research in this field.

  5. Reducing Barriers to Care in the Office-Based Health Care Setting for Children With Autism.

    Science.gov (United States)

    Bultas, Margaret W; McMillin, Stephen Edward; Zand, Debra H

    2016-01-01

    The purpose of this survey-design research study was to evaluate the usefulness of a researcher-developed tool designed to improve office-based health care services and to assess the barriers and resources affecting office-based health care services for children with autism spectrum disorder. Fifty-four health care providers (HCPs) and 59 parents participated in the study. HCPs reported child behaviors, communication, and fears as barriers to providing care, whereas parents reported child behavior, sensory issues, and feelings of a disconnect with the HCP as barriers. HCPs identified the parent as a key resource. Parent-identified resources included provider adaptations to the patient, including slowing down the delivery of care and environmental adaptations to the office. In addition, both HCPs and parents indicated that the researcher-developed tool would be useful in reducing barriers during the HCE. Reducing barriers and improving health care interactions during delivery of care for children with autism spectrum disorder has the potential to improve health outcomes.

  6. Medication prescribing errors in a pediatric inpatient tertiary care setting in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abolfotouh Mostafa A

    2011-08-01

    Full Text Available Abstract Background Medication errors (MEs are among the most common types of medical errors and one of the most common and preventable causes of iatrogenic injuries. The aims of the present study were; (i to determine the incidence and types of medication prescribing errors (MPEs, and (ii to identify some potential risk factors in a pediatric inpatient tertiary care setting in Saudi Arabia. Findings A five-week retrospective cohort study identified medication errors in the general pediatric ward and pediatric intensive care unit (PICU at King Abdulaziz Medical City (KAMC through the physical inspection of physician medication orders and reviews of patients' files. Out of the 2,380 orders examined, the overall error rate was 56 per 100 medication orders (95% CI: 54.2%, 57.8%. Dose errors were the most prevalent (22.1%. These were followed by route errors (12.0%, errors in clarity (11.4% and frequency errors (5.4%. Other types of errors were incompatibility (1.9%, incorrect drug selection (1.7% and duplicate therapy (1%. The majority of orders (81.8% had one or more abbreviations. Error rates were highest in prescriptions for electrolytes (17.17%, antibiotics (13.72% and bronchodilators (12.97%. Medication prescription errors occurred more frequently in males (64.5%, infants (44.5% and for medications with an intravenous route of administration (50.2%. Approximately one third of the errors occurred in the PICU (33.9%. Conclusions The incidence of MPEs was significantly high. Large-scale prospective studies are recommended to determine the extent and outcome of medication errors in pediatric hospitals in Saudi Arabia.

  7. Experiences of nurses working in a rural primary health-care setting in Mopani district, Limpopo Province

    Directory of Open Access Journals (Sweden)

    MP Mohale

    2008-09-01

    Full Text Available Professional nurses working in rural, primary health-care settings are experiencing burnout due to serious shortages of personnel. This is exacerbated by the brain drain of nurses leaving the country. Rural settings are resource constrained in terms of personnel and equipment. This results in dissatisfaction among nurses due to the unbearable working conditions which result in stress and frustration. A qualitative, explorative, descriptive study was conducted to explore and describe the experiences of nurses working in a rural primary health-care setting in the greater Letaba sub district in Limpopo Province. Purposive sampling was used to identify the participants. Data was collected in the form of in-depth interviews. The study revealed that nurses working in primary health-care settings were experiencing emotional and physical strain as a result of the shortage of human resources. It was recommended that policies that meet the health-care needs of rural communities be developed, and that strategies to retain professional nurses in primary health-care settings be formulated.

  8. Distinct Salmonella Enteritidis lineages associated with enterocolitis in high-income settings and invasive disease in low-income settings.

    Science.gov (United States)

    Feasey, Nicholas A; Hadfield, James; Keddy, Karen H; Dallman, Timothy J; Jacobs, Jan; Deng, Xiangyu; Wigley, Paul; Barquist Barquist, Lars; Langridge, Gemma C; Feltwell, Theresa; Harris, Simon R; Mather, Alison E; Fookes, Maria; Aslett, Martin; Msefula, Chisomo; Kariuki, Samuel; Maclennan, Calman A; Onsare, Robert S; Weill, François-Xavier; Le Hello, Simon; Smith, Anthony M; McClelland, Michael; Desai, Prerak; Parry, Christopher M; Cheesbrough, John; French, Neil; Campos, Josefina; Chabalgoity, Jose A; Betancor, Laura; Hopkins, Katie L; Nair, Satheesh; Humphrey, Tom J; Lunguya, Octavie; Cogan, Tristan A; Tapia, Milagritos D; Sow, Samba O; Tennant, Sharon M; Bornstein, Kristin; Levine, Myron M; Lacharme-Lora, Lizeth; Everett, Dean B; Kingsley, Robert A; Parkhill, Julian; Heyderman, Robert S; Dougan, Gordon; Gordon, Melita A; Thomson, Nicholas R

    2016-10-01

    An epidemiological paradox surrounds Salmonella enterica serovar Enteritidis. In high-income settings, it has been responsible for an epidemic of poultry-associated, self-limiting enterocolitis, whereas in sub-Saharan Africa it is a major cause of invasive nontyphoidal Salmonella disease, associated with high case fatality. By whole-genome sequence analysis of 675 isolates of S. Enteritidis from 45 countries, we show the existence of a global epidemic clade and two new clades of S. Enteritidis that are geographically restricted to distinct regions of Africa. The African isolates display genomic degradation, a novel prophage repertoire, and an expanded multidrug resistance plasmid. S. Enteritidis is a further example of a Salmonella serotype that displays niche plasticity, with distinct clades that enable it to become a prominent cause of gastroenteritis in association with the industrial production of eggs and of multidrug-resistant, bloodstream-invasive infection in Africa.

  9. A global health delivery framework approach to epilepsy care in resource-limited settings.

    Science.gov (United States)

    Cochran, Maggie F; Berkowitz, Aaron L

    2015-11-15

    The Global Health Delivery (GHD) framework (Farmer, Kim, and Porter, Lancet 2013;382:1060-69) allows for the analysis of health care delivery systems along four axes: a care delivery value chain that incorporates prevention, diagnosis, and treatment of a medical condition; shared delivery infrastructure that integrates care within existing healthcare delivery systems; alignment of care delivery with local context; and generation of economic growth and social development through the health care delivery system. Here, we apply the GHD framework to epilepsy care in rural regions of low- and middle-income countries (LMIC) where there are few or no neurologists.

  10. Collaborative care in real-world settings: barriers and opportunities for sustainability

    Science.gov (United States)

    Sanchez, Katherine

    2017-01-01

    Patient-centered care and self-management of chronic disease are optimally characterized by distinct adjunct services such as education, and support for the behavioral and psychosocial elements of managing disease. The collaborative care model for the treatment of depression and anxiety in primary care includes the integration of a behavioral health specialist, in collaboration with the primary care provider, and psychiatric consultation to effectively screen and treat common mental health problems. Dissemination and sustainability of the model have encountered numerous barriers across systems of care. This article represents a discussion of the key barriers to collaborative care and offers a discussion of opportunities for dissemination and sustainability of the model.

  11. Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review.

    Directory of Open Access Journals (Sweden)

    Catharina J van Oostveen

    Full Text Available BACKGROUND: Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and inherent costs. The aim of this study was to ascertain which patient-related characteristics or models can predict the need for medical and nursing care in general hospital settings. METHODS: We systematically searched MEDLINE, Embase, Business Source Premier and CINAHL. Pre-defined eligibility criteria were used to detect studies that explored patient characteristics and health status parameters associated to the use of hospital care services for hospitalized patients. Two reviewers independently assessed study relevance, quality with the STROBE instrument, and performed data analysis. RESULTS: From 2,168 potentially relevant articles, 17 met our eligibility criteria. These showed a large variety of factors associated with the use of hospital care services; models were found in only three studies. Age, gender, medical and nursing diagnoses, severity of illness, patient acuity, comorbidity, and complications were the characteristics found the most. Patient acuity and medical and nursing diagnoses were the most influencing characteristics. Models including medical or nursing diagnoses and patient acuity explain the variance in the use of hospital care services for at least 56.2%, and up to 78.7% when organizational factors were added. CONCLUSIONS: A larger variety of factors were found to be associated with the use of hospital care services. Models that explain the extent to which hospital care services are used should contain patient characteristics, including patient acuity, medical or nursing diagnoses, and organizational and staffing characteristics, e.g., hospital size, organization of care, and the size and skill mix of staff. This would

  12. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

    Science.gov (United States)

    Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective.

  13. The association between physical activity, sedentary behavior, sleep, and body mass index z-scores in different settings among toddlers and preschoolers

    OpenAIRE

    Kuzik, Nicholas; Carson, Valerie

    2016-01-01

    Background Physical activity, sedentary behavior, and sleep are all movement behaviors that range on a continuum from no or low movement, to high movement. Consistent associations between movement behaviors and adiposity indicators have been observed in school-age children. However, limited information exists in younger children. Since approximately 50 % of Canadian children ≤5 years of age attend non-parental care, movement behaviors within and outside of the child care setting are important...

  14. Evaluation of a Professional Practice Model in the Ambulatory Care Setting

    Science.gov (United States)

    2014-03-10

    patient satisfaction , nurse -sensitive indicators of quality care as measured by...Project Number: N10-C04 Aim one Evaluate levels of nursing and patient satisfaction in ambulatory care clinics following implementation of a...Clarke, S.P., Sloane, D., Lake, E.T., Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing

  15. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    Science.gov (United States)

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

    2010-10-01

    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.

  16. Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

    Directory of Open Access Journals (Sweden)

    Arthur Kwizera

    2015-01-01

    Full Text Available Aim. Delirium is common among mechanically ventilated patients in the intensive care unit (ICU. There are little data regarding delirium among mechanically ventilated patients in Africa. We sought to determine the burden of delirium and associated factors in Uganda. Methods. We conducted a multicenter prospective study among mechanically ventilated patients in Uganda. Eligible patients were screened daily for delirium using the confusional assessment method (CAM-ICU. Comparisons were made using t-test, chi-squares, and Fisher’s exact test. Predictors were assessed using logistic regression. The level of statistical significance was set at P<0.05. Results. Of 160 patients, 81 (51% had delirium. Median time to onset of delirium was 3.7 days. At bivariate analysis, history of mental illness, sedation, multiorgan dysfunction, neurosurgery, tachypnea, low mean arterial pressure, oliguria, fevers, metabolic acidosis, respiratory acidosis, anaemia, physical restraints, marital status, and endotracheal tube use were significant predictors. At multivariable analysis, having a history of mental illness, sedation, respiratory acidosis, higher PEEP, endotracheal tubes, and anaemia predicted delirium. Conclusion. The prevalence of delirium in a young African population is lower than expected considering the high mortality. A history of mental illness, anaemia, sedation, endotracheal tube use, and respiratory acidosis were factors associated with delirium.

  17. Resistant Hypertension and Obstructive Sleep Apnea in the Primary-Care Setting

    Directory of Open Access Journals (Sweden)

    M. Demede

    2011-01-01

    Full Text Available We ascertained the prevalence of resistant hypertension (RH among blacks and determined whether RH patients are at greater risk for obstructive sleep apnea (OSA than hypertensives. Method. Data emanated from Metabolic Syndrome Outcome Study (MetSO, a study investigating metabolic syndrome among blacks in the primary-care setting. Sample of 200 patients (mean age = 63 ± 13 years; female = 61% with a diagnosis of hypertension provided subjective and clinical data. RH was defined using the JNC 7and European Society guidelines. We assessed OSA risk using the Apnea Risk Evaluation System ARES, defining high risk as a total ARES score ≥6. Results. Overall, 26% met criteria for RH and 40% were at high OSA risk. Logistic regression analysis, adjusting for effects of age, gender, and medical co morbidities, showed that patients with RH were nearly 2.5 times more likely to be at high OSA risk, relative to those with hypertension (OR = 2.46, 95% CI: 1.03–5.88, P<.05. Conclusion. Our findings show that the prevalence of RH among blacks fell within the range of RH for the general hypertensive population (3–29%. However, patients with RH were at significantly greater risk of OSA compared to patients with hypertension.

  18. Use of the interRAI CHESS scale to predict mortality among persons with neurological conditions in three care settings.

    Directory of Open Access Journals (Sweden)

    John P Hirdes

    Full Text Available BACKGROUND: Persons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions. METHODS: Survival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940, complex continuing care hospitals/units (n = 88,721, and nursing homes (n = 185,309 in seven Canadian provinces/territories. RESULTS: CHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings. CONCLUSIONS: CHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection.

  19. Examining change in cortisol patterns during the 10-week transition to a new child-care setting.

    Science.gov (United States)

    Bernard, Kristin; Peloso, Elizabeth; Laurenceau, Jean-Philippe; Zhang, Zhiyong; Dozier, Mary

    2015-01-01

    The transition to out-of-home child care brings a number of challenges for children, including complex peer interactions and extended separations from parents. Children often show a midmorning to afternoon rise in cortisol on child-care days, compared to the typical diurnal decline seen at home. Changes in cortisol were examined in a wide age range of children (N = 168; 1.2 months to 8 years, M = 3.27 years) during the 10-week transition to a new child-care setting. Structural equation modeling using latent change scores showed that children experienced an increase in the cortisol rise at child care across the 10-week transition. Furthermore, child age moderated the difference between home- and child-care cortisol patterns. Findings are placed in a developmental context, and potential implications and future directions are discussed.

  20. The ethical leadership challenge: creating a culture of patient- and family-centered care in the hospital setting.

    Science.gov (United States)

    Piper, Llewellyn E

    2011-01-01

    The growing number of medical errors and resulting preventable deaths in hospitals presents an ethical dilemma that must be addressed by health care leaders and managers. These medical errors and deaths raise questions about safety and quality issues resulting in rising public mistrust and patient dissatisfaction. Many of these medical errors and deaths could have been avoided by including the patient and family in the care. The ethical challenge for leadership is creating a culture of patient- and family-centered care as a means to improve quality, safety, patient satisfaction, and public trust. This article addresses ways to improve safety, quality, patient satisfaction, and cost and thereby reduce medical errors and deaths by implementing a patient- and family-centered care culture. The first critical step for improvement is for hospital leaders and managers to answer the ethical call to create a culture centered on patient- and family-centered care in the hospital setting.

  1. Clinical care for severe influenza and other severe illness in resource-limited settings: the need for evidence and guidelines.

    Science.gov (United States)

    Ortiz, Justin R; Jacob, Shevin T; West, T Eoin

    2013-09-01

    The 2009 influenza A (H1N1) pandemic highlighted the importance of quality hospital care of the severely ill, yet there is evidence that the impact of the 2009 pandemic was highest in low- and middle-income countries with fewer resources. Recent data indicate that death and suffering from seasonal influenza and severe illness in general are increased in resource-limited settings. However, there are limited clinical data and guidelines for the management of influenza and other severe illness in these settings. Life-saving supportive care through syndromic case management is used successfully in high-resource intensive care units and in global programs such as the Integrated Management of Childhood Illness (IMCI). While there are a variety of challenges to the management of the severely ill in resource-limited settings, several new international initiatives have begun to develop syndromic management strategies for these environments, including the World Health Organization's Integrated Management of Adult and Adolescent Illness Program. These standardized clinical guidelines emphasize syndromic case management and do not require high-resource intensive care units. These efforts must be enhanced by quality clinical research to provide missing evidence and to refine recommendations, which must be carefully integrated into existing healthcare systems. Realizing a sustainable, global impact on death and suffering due to severe influenza and other severe illness necessitates an ongoing and concerted international effort to iteratively generate, implement, and evaluate best-practice management guidelines for use in resource-limited settings.

  2. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer

    Science.gov (United States)

    Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.

    2015-01-01

    Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553

  3. Creative solutions for severe dementia with BPSD: a case of art therapy used in an inpatient and residential care setting.

    Science.gov (United States)

    Peisah, C; Lawrence, G; Reutens, S

    2011-08-01

    Behavioral and psychological symptoms of dementia (BPSD) are common, distressing and compromise care. Their diverse etiology necessitates targeted, individualized treatment. We present a case of an 82-year-old with severe dementia and BPSD, and with limited response to a range of pharmacological and non-pharmacological treatments. Individualized art therapy was developed in an inpatient setting using felt material cut into shapes and coloring with stencils and pre-drawn line drawings utilizing preserved skills of coloring, while supporting frontal-executive and language deficits. The activity was replicable and carried over to the residential care setting and supported by family and professional carers.

  4. Behavioral interventions for office-based care: interventions in the family medicine setting.

    Science.gov (United States)

    Larzelere, Michele McCarthy

    2014-03-01

    The practice of family medicine includes the care of many patients with mental health or behavior change needs. Patients in mild to moderate distress may benefit from brief interventions performed in the family physician's office. Patients in more extreme distress may be helped by referral to behavioral health clinicians for short-term or open-ended therapies. Electronic therapy programs and bibliotherapy are also useful resources. The transition to the patient-centered medical home model may allow for more widespread integration of behavioral health care clinicians into primary care, in person and through telemental health care. Integrated care holds the promise of improved access, greater effectiveness of behavioral health service provision, and enhanced efficiency of primary care for patients with behavioral health care needs.

  5. Making Meaningful Improvements to Direct Care Worker Training Through Informed Policy: Understanding How Care Setting Structure and Culture Matter.

    Science.gov (United States)

    Kemeny, M Elizabeth; Mabry, J Beth

    2015-10-09

    Well-intentioned policy governing the training of direct care workers (DCWs) who serve older persons, in practice, may become merely a compliance issue for organizations rather than a meaningful way to improve quality of care. This study investigates the relationships between best practices in DCW training and the structure and culture of long term support service (LTSS) organizations. Using a mixed-methods approach to analyzing data from 328 licensed LTSS organizations in Pennsylvania, the findings suggest that public policy should address methods of training, not just content, and consider organizational variations in size, training evaluation practices, DCW integration, and DCW input into care planning. Effective training also incorporates support for organizations and supervisors as key aspects of DCWs' learning and working environment.

  6. Identifying and Intervening with Substance-Using Women Exposed to Intimate Partner Violence: Phenomenology, Comorbidities, and Integrated Approaches Within Primary Care and Other Agency Settings

    Science.gov (United States)

    Gilbert, Louisa; El-Bassel, Nabila; Resnick, Heidi S.; Noursi, Samia

    2015-01-01

    Abstract Substance use and/or disorders (SUDs) have been identified as a significant correlate of intimate partner violence (IPV) exposure and present complex issues that intersect with the topography of IPV, attendant mental health, and physical co-morbidities and may pose barriers to primary care- and other agency-based screening and intervention efforts. Despite substantial research indicating significantly higher rates of all types and severity of IPV victimization among women with SUDs and bidirectional associations between partner or self-use of drugs or alcohol and IPV victimization, effective screening, brief interventions, coordinated systems of care, and treatment approaches to address these co-occurring problems remain very limited. We integrated select research examining the intersection of IPV victimization and SUDs and several comorbidities that have significant public health impact and provided recommendations for scaling up targeted interventions to redress these co-occurring problems among women in primary, emergency, and other care settings. PMID:25554915

  7. Epidemiology, Diagnosis, and Treatment of HIV-Associated Non-Hodgkin Lymphoma in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Matthew Ulrickson

    2012-01-01

    Full Text Available Lymphoma was a common complication of HIV infection in the pre-antiretroviral era, and the incidence of HIV-associated lymphoma has dropped dramatically since the introduction of combination antiretroviral therapy (cART in resource-rich regions. Conversely, lymphoma is an increasingly common complication of HIV infection in resource-limited settings where the prevalence of HIV infection is high. Relatively little is known, however, about the true incidence and optimal treatment regimens for HIV-associated lymphoma in resource-poor regions. We review the epidemiology, diagnosis, and treatment of HIV-associated non-Hodgkin lymphoma in developing nations and highlight areas for further research that may benefit care in both settings. Examples include risk modification and dose modification of chemotherapy based on HIV risk factors, improving our understanding of the current burden of disease through national cancer registries, and developing cost-effective hematopathological diagnostic strategies to optimize care delivery and maximize use of available chemotherapy.

  8. Knowledge of Critical Care Provider on Prevention of Ventilator Associated Pneumonia

    Directory of Open Access Journals (Sweden)

    Passang Chiki Sherpa

    2014-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP continues to be an important cause of morbidity and mortality in ventilated patient. Prevention of VAP in critically ill patient is significant concern for health care team in intensive care units (ICUs. Knowledge on prevention of VAP would have a significant impact on patient outcome. Aims and Objectives: To assess knowledge on prevention of VAP in critical care providers and to find the association between knowledge on prevention of VAP and educational qualification and years of experience in ICUs. Settings and Design: The study was conducted in 5 different ICUs of Kasturba Hospital, Manipal, and using descriptive study design. Material and Methods: The study involved a purposive sample of 138 critical care providers. Critical care providers who were willing to participate in the study were included. Tools on demographic proforma and self-administered structured knowledge questionnaire on prevention of VAP were developed and content validity was established. The reliability of the tools was established.The data was categorized and analyzed by using descriptive and inferential statistics. The SPSS 16.0 version was used for the analysis of the study. Result: Majority 89.1% of the participant were 20-29 years, 63% unmarried 51.4% had completed diploma course and majority 81.2% were from nursing discipline. The study revealed that only 55.80% of subjects were having adequate knowledge on prevention of VAP based on median score. There was no significant association between knowledge score and educational qualification (÷²=0, p=0.833, years of experience in ICU (÷²= 2.221, p=0.329.

  9. Striving to promote male involvement in maternal health care in rural and urban settings in Malawi - a qualitative study

    Directory of Open Access Journals (Sweden)

    Kululanga Lucy I

    2011-12-01

    Full Text Available Abstract Background Understanding the strategies that health care providers employ in order to invite men to participate in maternal health care is very vital especially in today's dynamic cultural environment. Effective utilization of such strategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care. This paper examines and describes the strategies that were used by different health care facilities to invite husbands to participate in maternal health care in rural and urban settings of southern Malawi. Methods The data was collected through in-depth interviews from sixteen of the twenty health care providers from five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health centres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured interview guide was used to collect data from health care providers with the aim of understanding strategies they used to invite men to participate in maternal health care. Results Four main strategies were used to invite men to participate in maternal health care. The strategies were; health care provider initiative, partner notification, couple initiative and community mobilization. The health care provider initiative and partner notification were at health facility level, while the couple initiative was at family level and community mobilization was at village (community level. The community mobilization had three sub-themes namely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to significantly influence behaviour change for male participation in maternal health care is discussed. Conclusion Strategies to invite men to participate in maternal health care were at health facility, family and community levels. The couple strategy was most appropriate but was mostly used by educated and city

  10. Small primary care practices face four hurdles--including a physician-centric mind-set--in becoming medical homes.

    Science.gov (United States)

    Nutting, Paul A; Crabtree, Benjamin F; McDaniel, Reuben R

    2012-11-01

    Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.

  11. Setting-up nurse-led pilot clinics for the management of non-communicable diseases at primary health care level in resource-limited settings of Africa

    Directory of Open Access Journals (Sweden)

    Jean-Claude Mbanya

    2009-10-01

    Full Text Available BACKGROUND: This article describes the setting-up process for nurse-led pilot clinics for the management of four chronic diseases: asthma, type 2 diabetes mellitus, epilepsy and hypertension at the primary health care level in urban and rural Cameroon. METHODS: The Biyem-Assi urban and the Bafut rural health districts in Cameroon served as settings for this study. International and local guidelines were identified and adapted to the country's; circumstances. Training and follow-up tools were developed and nurses trained by experienced physicians in the management of the four conditions. Basic diagnostic and follow-up materials were provided and relevant essential drugs made available. RESULTS: Forty six nurses attended six training courses. By the second year of activity, three and four clinics were operational in the urban and the rural areas respectively. By then, 925 patients had been registered in the clinics. This represented a 68.5% increase from the first year. While the rural clinics relied mainly on essential drugs for their prescriptions, a prescription pattern combining generic and proprietary drugs was observed in the urban clinics. CONCLUSION: In the quest for cost-effective health care for NCD in sub-Saharan Africa, rethinking health workforce and service delivery has relevance. Nurse-led clinics, algorithm driven service delivery stands as alternatives to overcome the shortage of trained physicians and other issues relating to access to care.

  12. Implementation of latent tuberculosis screening in HIV care centres: evaluation in a low tuberculosis incidence setting.

    Science.gov (United States)

    Wyndham-Thomas, C; Schepers, K; Dirix, V; Mascart, F; Van Vooren, J-P; Goffard, J-C

    2016-03-01

    The screening and treatment of latent tuberculosis infection (LTBI) to prevent active tuberculosis (TB) is recommended by the WHO in all HIV-infected patients. The aim of this study was to evaluate its implementation within Belgium's HIV care. A multiple-choice questionnaire was sent to 55 physicians working in the country's AIDS reference centres. Response rate reached 62%. Only 20% screened all their HIV-infected patients for LTBI. Screening methods used and their interpretation vary from one physician to another. The main barriers to the implementation of LTBI screening and treatment, as perceived by the participants, are lack of sensitivity of screening tools, risks associated with polypharmacy and toxicity of treatment. The poor coverage of LTBI screening reported here and the inconsistency in methods used raises concern. However, this was not unexpected as, in low-TB incidence countries, who, when and how to screen for LTBI remains unclear and published guidelines show important disparities. Recently, a targeted approach in which only HIV-infected patients at highest risk of TB are screened has been suggested. Such a strategy would limit unnecessary exposure to LTBI treatment. This methodology was approved by 80% of the participants and could therefore achieve greater coverage. Its clinical validation is still pending.

  13. Perspectives on the Role of Fospropofol in the Monitored Anesthesia Care Setting

    Directory of Open Access Journals (Sweden)

    Joseph V. Pergolizzi

    2011-01-01

    Full Text Available Monitored anesthesia care (MAC is a safe, effective, and appropriate form of anesthesia for many minor surgical procedures. The proliferation of outpatient procedures has heightened interest in MAC sedation agents. Among the most commonly used MAC sedation agents today are benzodiazepines, including midazolam, and propofol. Recently approved in the United States is fospropofol, a prodrug of propofol which hydrolyzes in the body by alkaline phosphatase to liberate propofol. Propofol liberated from fospropofol has unique pharmacological properties, but recently retracted pharmacokinetic (PK and pharmacodynamic (PD evaluations make it difficult to formulate clear conclusions with respect to fospropofol's PK/PD properties. In safety and efficacy clinical studies, fospropofol demonstrated dose-dependent sedation with good rates of success at doses of 6.5 mg/kg along with good levels of patient and physician acceptance. Fospropofol has been associated with less pain at injection site than propofol. The most commonly reported side effects with fospropofol are paresthesia and pruritus. Fospropofol is a promising new sedation agent that appears to be well suited for MAC sedation, but further studies are needed to better understand its PK/PD properties as well its appropriate clinical role in outpatient procedures.

  14. Primary care physical therapy in people with fibromyalgia: opportunities and boundaries within a monodisciplinary setting.

    Science.gov (United States)

    Nijs, Jo; Mannerkorpi, Kaisa; Descheemaeker, Filip; Van Houdenhove, Boudewijn

    2010-12-01

    Despite the fact that people with fibromyalgia syndrome (FMS) frequently are seen by primary care physical therapists, guidelines for the management of FMS are based primarily on outcomes from multidisciplinary and tertiary care treatment studies. Few data addressing the treatment of patients with FMS in primary care currently are available. The evidence-based guidelines on the management of FMS are based, in part, on evidence from studies examining physical therapy treatment components alone (eg, aerobic exercise, education). Thus, the recommendations can be applied to primary care physical therapy. Primary care physical therapy for patients with FMS should include education, aerobic exercise, and strengthening exercise. For other treatment components such as passive treatments, activity management, and relaxation, less evidence currently is available to advocate their use in primary care physical therapy. Superior results are to be expected when various treatment components are combined.

  15. Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting - A nationwide initiative

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra S; Lange, Peter; Thomsen, Reimar W

    2017-01-01

    -ever outpatient contact for COPD during 2008-2012 (N = 23,741). Adjusted year-specific relative risks (RR) of fulfilling all relevant process performance measures was compared according to ethnicity, education, income, employment, and cohabitation using Poisson regression. RESULTS: Quality of care improved...... during the study period. CONCLUSION: A systematic quality improvement initiative including regular audits, knowledge sharing, and detailed disease-specific recommendations for care improvement may increase the overall quality of care and considerably modify the substantial socioeconomic inequalities...

  16. Treatment evolution after COPD diagnosis in the UK primary care setting.

    Directory of Open Access Journals (Sweden)

    Keele E Wurst

    Full Text Available RATIONALE: To assess the treatment progression during the 24 months following a formal diagnosis of chronic obstructive pulmonary disease (COPD in the UK primary care setting. METHODS: A retrospective cohort of newly diagnosed COPD patients was identified in the Clinical Practice Research Datalink (CPRD from 1/1/2008 until 31/12/2009. Maintenance therapy prescribed within the first 3 months of diagnosis and in the subsequent 3-month intervals for 24 months were analyzed. Treatment classes included long-acting β2-agonists (LABAs, long-acting muscarinic antagonists (LAMAs, inhaled corticosteroids (ICSs, and respective combinations. At each 3-month interval, discontinuation, switching, addition, and stepping down patterns were analyzed cumulatively for the first 12 months and over the 24-month of follow-up. RESULTS: A total of 3199 patients with at least one prescription of a maintenance therapy at baseline and during 4th-6th month interval were included in the analysis. At diagnosis (0-3 months, the most frequently prescribed maintenance therapy was LABA+ICS (43%, followed by LAMA (24% and LABA+LAMA+ICS (23%. Nearly half the patients (LABA-50%, LAMA-43% starting on a monobronchodilator had additions to their treatment in 24 months. Compared to other medications, patients starting on a LAMA were most likely to escalate to triple therapy in 24 months. Nearly one-fourth of the patients prescribed triple therapy at baseline stepped down to LABA+ICS (25% or LAMA (31% within 24 months. CONCLUSION: Disease progression is evident over the 24 months after COPD diagnosis, as more patients were prescribed additional maintenance therapy in the 24-month period compared to baseline. The changes in therapy suggest that it is difficult to achieve a consistently improved COPD disease state.

  17. Agenda Setting During Follow-Up Encounters in a University Primary Care Outpatient Clinic.

    Science.gov (United States)

    Rey-Bellet, Sarah; Dubois, Julie; Vannotti, Marco; Zuercher, Marili; Faouzi, Mohamed; Devaud, Karen; Rodondi, Nicolas; Rodondi, Pierre-Yves

    2016-07-13

    At the beginning of the medical encounter, clinicians should elicit patients' agendas several times using open-ended questions. Little is known, however, about how many times physicians really solicit a patient's agenda during follow-up encounters. The objective was to analyze the number of agenda solicitations by physicians, of agendas initiated by physicians, and of patients' spontaneous agendas during the beginning and the entire encounter. We analyzed 68 videotaped follow-up encounters at a university primary care outpatient clinic. The number of different types of agenda setting was searched for and analyzed using negative binomial regression or logistic regression models. Physicians solicited agendas a mean ± SD of 0.8 ± 0.7 times/patient during the first 5 minutes and 1.7 ± 1.2 times/patient during the entire encounter. Physicians in 32.4% of encounters did not solicit the patient agenda, and there were never more than two physician's solicitations during the first 5 minutes. The mean number of physician's solicitations of the patients' agenda was 42% lower among female physicians during the first 5 minutes and 34% lower during the entire encounter. The number of agendas initiated by physicians was 1.2 ± 1.2/patient during the beginning and 3.2 ± 2.3/patient during the entire encounter. In 58.8% of the encounters, patients communicated their agendas spontaneously. There were twice as many patient spontaneous agendas (IRR = 2.12, p = .002) with female physicians than with males. This study showed that agenda solicitation with open-ended questions in follow-up encounters does not occur as often as recommended. There is thus a risk of missing new agendas or agendas that are important to the patient.

  18. Cerebral microdialysis for protein biomarker monitoring in the neurointensive care setting

    Directory of Open Access Journals (Sweden)

    Lars Tomas Hillered

    2014-12-01

    Full Text Available Cerebral microdialysis (MD was introduced as a neurochemical monitoring tool in the early 1990s and is currently well established for the sampling of low molecular weight biomarkers of energy metabolic perturbation and cellular distress in the neurointensive care (NIC setting. There is now a growing interest in MD for intracerebral sampling of protein biomarkers of secondary injury mechanisms in acute traumatic and neurovascular brain injury in the NIC community. The initial enthusiasm over the opportunity to sample protein biomarkers with high molecular weight cut-off (MWCO MD catheters has dampened somewhat with the emerging realization of inherent problems with this methodology including protein adhesion, protein-protein interaction and biofouling, leading to unstable MD catheter performance (i.e. fluid recovery and extraction efficiency. This review will focus on the results of a multidisciplinary collaborative effort, within the Uppsala Berzelii Centre for Neurodiagnostics during the past several years, to study the features of the complex process of high MWCO MD for protein biomarkers. This research has led to new methodology showing robust in vivo performance with optimized fluid recovery and improved extraction efficiency, allowing for more accurate biomarker monitoring. In combination with evolving analytical methodology allowing for multiplex biomarker analysis in ultra-small MD samples a new opportunity opens up for high-resolution temporal mapping of secondary injury cascades, such as neuroinflammation and other cell injury reactions directly in the injured human brain. Such data may provide an important basis for improved characterization of complex injuries, e.g. traumatic and neurovascular brain injury, and help in defining targets and treatment windows for neuroprotective drug development

  19. An Approach to Associative Retrieval through the Theory of Fuzzy Sets

    Science.gov (United States)

    Sachs, Wladimir

    1976-01-01

    The theory of fuzzy sets is used to provide a rigorous formulation of the problem of associative retrieval. This formulation suggests the idea of using fuzzy clustering to organize data for retrieval. (Author)

  20. Pediatric asthma severity score is associated with critical care interventions

    Science.gov (United States)

    Maue, Danielle K; Krupp, Nadia; Rowan, Courtney M

    2017-01-01

    AIM To determine if a standardized asthma severity scoring system (PASS) was associated with the time spent on continuous albuterol and length of stay in the pediatric intensive care unit (PICU). METHODS This is a single center, retrospective chart review study at a major children’s hospital in an urban location. To qualify for this study, participants must have been admitted to the PICU with a diagnosis of status asthmaticus. There were a total of 188 participants between the ages of two and nineteen, excluding patients receiving antibiotics for pneumonia. PASS was calculated upon PICU admission. Subjects were put into one of three categories based on PASS: ≤ 7 (mild), 8-11 (moderate), and ≥ 12 (severe). The groups were compared based on different variables, including length of continuous albuterol and PICU stay. RESULTS The age distribution across all groups was similar. The median length of continuous albuterol was longest in the severe group with a duration of 21.5 h (11.5-27.5), compared to 15 (7.75-23.75) and 10 (5-15) in the moderate and mild groups, respectively (P = 0.001). The length of stay was longest in the severe group, with a stay of 35.6 h (22-49) compared to 26.5 (17-30) and 17.6 (12-29) in the moderate and mild groups, respectively (P = 0.001). CONCLUSION A higher PASS is associated with a longer time on continuous albuterol, an increased likelihood to require noninvasive ventilation, and a longer stay in the ICU. This may help safely distribute asthmatics to lower and higher levels of care in the future.

  1. Associations Between Family Ratings on Experience With Care and Clinical Quality-of-Care Measures for Nursing Home Residents.

    Science.gov (United States)

    Li, Yue; Li, Qinghua; Tang, Yi

    2016-02-01

    Several states are currently collecting and publicly reporting nursing home resident and/or family member ratings of experience with care in an attempt to improve person-centered care in nursing homes. Using the 2008 Maryland nursing home family survey reports and other data, this study performed both facility- and resident-level analyses, and estimated the relationships between family ratings of care and several long-term care quality measures (pressure ulcers, overall and potentially avoidable hospitalizations, and mortality) after adjustment for resident characteristics. We found that better family evaluations of overall and specific aspects of care may be associated with reduced rates of risk-adjusted measures at the facility level (range of correlation coefficients: -.01 to -.31). Associations of overall experience ratings tended to persist after further adjustment for common nursing home characteristics such as nurse staffing levels. We conclude that family ratings of nursing home care complement other types of performance measures such as risk-adjusted outcomes.

  2. Is Performance in Task-Cuing Experiments Mediated by Task Set Selection or Associative Compound Retrieval?

    Science.gov (United States)

    Forrest, Charlotte L. D.; Monsell, Stephen; McLaren, Ian P. L.

    2014-01-01

    Task-cuing experiments are usually intended to explore control of task set. But when small stimulus sets are used, they plausibly afford learning of the response associated with a combination of cue and stimulus, without reference to tasks. In 3 experiments we presented the typical trials of a task-cuing experiment: a cue (colored shape) followed,…

  3. Malnutrition: The Importance of Identification, Documentation, and Coding in the Acute Care Setting

    Science.gov (United States)

    Kyle, Greg; Itsiopoulos, Catherine; Naunton, Mark; Luff, Narelle

    2016-01-01

    Malnutrition is a significant issue in the hospital setting. This cross-sectional, observational study determined the prevalence of malnutrition amongst 189 adult inpatients in a teaching hospital using the Patient-Generated Subjective Global Assessment tool and compared data to control groups for coding of malnutrition to determine the estimated unclaimed financial reimbursement associated with this comorbidity. Fifty-three percent of inpatients were classified as malnourished. Significant associations were found between malnutrition and increasing age, decreasing body mass index, and increased length of stay. Ninety-eight percent of malnourished patients were coded as malnourished in medical records. The results of the medical history audit of patients in control groups showed that between 0.9 and 5.4% of patients were coded as malnourished which is remarkably lower than the 52% of patients who were coded as malnourished from the point prevalence study data. This is most likely to be primarily due to lack of identification. The estimated unclaimed annual financial reimbursement due to undiagnosed or undocumented malnutrition based on the point prevalence study was AU$8,536,200. The study found that half the patients were malnourished, with older adults being particularly vulnerable. It is imperative that malnutrition is diagnosed and accurately documented and coded, so appropriate coding, funding reimbursement, and treatment can occur. PMID:27774317

  4. PalliPA: How can general practices support caregivers of patients at their end of life in a home-care setting? A study protocol.

    NARCIS (Netherlands)

    Hermann, K.; Boelter, R.; Engeser, P.; Szecsenyi, J.; Campbell, S.M.; Peters-Klimm, F.

    2012-01-01

    BACKGROUND: The care of patients with a life-threatening, progressive and far advanced illness in a home-care setting requires appropriate individual care and requires the active support of family caregivers. General practice teams are usually the primary care givers and first contact and are best p

  5. Drug-adherence questionnaires not valid for patients taking blood-pressure-lowering drugs in a primary health care setting.

    NARCIS (Netherlands)

    Steeg, N. van de; Sielk, M.; Pentzek, M.; Bakx, C.; Altiner, A.

    2009-01-01

    PURPOSE: To validate two established questionnaires [Morisky and Medication Adherence Report Scale (MARS-5)] for the measurement of medical adherence of patients treated with antihypertensive drugs in primary care in Germany. SETTING: General practitioners (GPs) and their patients in North Rhine-Wes

  6. Health Care Workers and Researchers Traveling to Developing-World Clinical Settings: Disease Transmission Risk and Mitigation

    Science.gov (United States)

    2010-01-01

    specific health care-related risks (needlestick, hemorrhagic fever viruses, severe viral respiratory disease, and tuberculosis ), with suggestions...specific Japanese encephalitis virus (parts of South and Southeast Asia) Meningococcal ( meningitis belt of Africa) Yellow fever (parts of Africa...indicated in certain settings, such as direct contact with sources of avian influenza [39]. DRUG-RESISTANT TUBERCULOSIS In general, tuberculosis is a

  7. Clinical Profile of Children and Adolescents Attending the Behavioural Paediatrics Unit OPD in a Tertiary Care Set up

    Science.gov (United States)

    Jayaprakash, R.

    2012-01-01

    Background: There are limited studies on the clinical profile of children attending child guidance clinic under Paediatric background. Aims: To study clinical profile of Children & adolescents attending the Behavioural Paediatrics Unit (BPU) OPD under department of Paediatrics in a tertiary care set up. Methods: Monthly average turnover in the…

  8. Current Practices for Training Staff to Accommodate Youth with Special Health Care Needs in the 4-H Camp Setting

    Science.gov (United States)

    Mouton, Lauren; Bruce, Jacklyn

    2013-01-01

    The theory of inclusion is the foundation for the study reported here; inclusion is a focus not only of formal education, but also of nonformal educational settings such as 4-H. Ideally, 4-H camps are designed to serve youth of all backgrounds and abilities. By accommodating youth with special health care needs, 4-H camps are effectively meeting…

  9. Factors associated with reproductive health care utilization among Ghanaian women

    Directory of Open Access Journals (Sweden)

    Doku David

    2012-11-01

    Full Text Available Abstract Background This study investigates factors determining the timing of antenatal care (ANC visit and the type of delivery assistant present during delivery among a national representative sample of Ghanaian women. Method Data for the study was drawn from the women questionnaire (N=4,916 of the 2008 Ghana Demographic and Health Survey among 15–49-years-old women. Multivariate logistic regression analysis was used to explore factors determining the type of delivery assistance and timing of ANC visit for live births within five years prior to the survey. Results Majority of Ghanaian women attended ANC visit (96.5% but many (42.7% did so late (after the first trimester, while 36.5% had delivery without the assistance of a trained personnel (30.6% or anyone (5.9%. Age (OR=1.5, CI=1.1-1.9, OR for 25-34-year-olds compared to 15-24-year-olds, religion (OR=1.8, CI=1.2-2.8, OR for Christians versus Traditional believers wealth index (OR=2.6, CI=1.7-3.8, OR for the richest compared to the poorest were independently associated with early ANC visit. Likewise, age, place of residence, education and partner’s education were associated with having a delivery assisted by a trained assistant. Also, Christians (OR=1.8, CI=1.1-3.0 and Moslems (OR=1.9, CI=1.1-3.3 were more likely to have trained delivery assistants compared to their counterparts who practised traditional belief. Furthermore, the richer a woman the more likely that she would have delivery assisted by a trained personnel (OR=8.2, CI= 4.2-16.0, OR for the richest in comparison to the poorest. Conclusions Despite the relatively high antenatal care utilisation among Ghanaian women, significant variations exist across the socio-demographic spectrum. Furthermore, a large number of women failed to meet the WHO recommendation to attend antenatal care within the first trimester of pregnancy. These findings have important implications for reducing maternal mortality ratio by three-quarters by the

  10. Trends in length of hospice care from 1996 to 2007 and the factors associated with length of hospice care in 2007: findings from the National Home and Hospice Care Surveys.

    Science.gov (United States)

    Sengupta, Manisha; Park-Lee, Eunice; Valverde, Roberto; Caffrey, Christine; Jones, Adrienne

    2014-06-01

    Using the National Home and Hospice Care Surveys, we examined trends in length of hospice care from 1996 to 2007 and the factors associated with length of care in 2007. Results suggest that the increasing average lengths of care over time reflect the increase in the longest duration of care. For-profit ownership is associated with hospice care received for over a year.

  11. Decolonization in Prevention of Health Care-Associated Infections.

    Science.gov (United States)

    Septimus, Edward J; Schweizer, Marin L

    2016-04-01

    Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent for S. aureus nasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well as Candida. Conversely, triclosan use is discouraged, and topical

  12. Illness perceptions in relation to experiences of contemporary cancer care settings among colorectal cancer survivors and their partners.

    Science.gov (United States)

    Johansson, Ann-Caroline; Axelsson, Malin; Berndtsson, Ina; Brink, Eva

    2014-01-01

    Illness is constituted by subjective experiences of symptoms and their psychosocial consequences. Illness perceptions concern people's lay beliefs about understandings and interpretation of a disease and expectations as to disease outcome. Our knowledge about illness perceptions and coping in relation to the cancer care context among persons with colorectal cancer (CRC) and their partners is incomplete. The aim of the present study was to explore illness perceptions in relation to contemporary cancer care settings among CRC survivors and partners. The present research focused on illness rather than disease, implying that personal experiences are central to the methodology. The grounded theory method used is that presented by Kathy Charmaz. The present results explore illness perceptions in the early recovery phase after being diagnosed and treated for cancer in a contemporary cancer care setting. The core category outlook on the cancer diagnosis when quickly informed, treated, and discharged illustrates the illness perceptions of survivors and partners as well as the environment in which they were found. The cancer care environment is presented in the conceptual category experiencing contemporary cancer care settings. Receiving treatment quickly and without waiting was a positive experience for both partners and survivors; however partners experienced the information as massive and as causing concern. The period after discharge was being marked by uncertainty and loneliness, and partners tended to experience non-continuity in care as more problematic than the survivor did. The results showed different illness perceptions and a mismatch between illness perceptions among survivors and partners, presented in the conceptual category outlook on the cancer diagnosis. One illness perception, here presented among partners, focused on seeing the cancer diagnosis as a permanent life-changing event. The other illness perception, here presented among survivors, concentrated on

  13. Depression, anxiety and stress symptoms among diabetics in Malaysia: a cross sectional study in an urban primary care setting

    OpenAIRE

    Kaur, Gurpreet; Tee, Guat Hiong; Ariaratnam, Suthahar; Krishnapillai, Ambigga S; China, Karuthan

    2013-01-01

    Background Diabetes mellitus is a highly prevalent condition in Malaysia, increasing from 11.6% in 2006 to 15.2% in 2011 among individuals 18 years and above. Co-morbid depression in diabetics is associated with hyperglycemia, diabetic complications and increased health care costs. The aims of this study are to determine the prevalence and predictors of depression, anxiety and stress symptoms in Type II diabetics attending government primary care facilities in the urban area of Klang Valley, ...

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

    Science.gov (United States)

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

    2016-01-01

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

  15. Medication errors in outpatient setting of a tertiary care hospital: classification and root cause analysis

    Directory of Open Access Journals (Sweden)

    Sunil Basukala

    2015-12-01

    Conclusions: Learning more about medication errors may enhance health care professionals' ability to provide safe care to their patients. Hence, A focus on easy-to-use and inexpensive techniques for medication error reduction should be used to have the greatest impact. [Int J Basic Clin Pharmacol 2015; 4(6.000: 1235-1240

  16. A methodological proposal to research patients’ demands and pre-test probabilities using paper forms in primary care settings

    Directory of Open Access Journals (Sweden)

    Gustavo Diniz Ferreira Gusso

    2013-04-01

    Full Text Available Objective: The purpose of this study is to present a methodology for assessing patients’ demands and calculating pre-test probabilities using paper forms in Primary Care. Method: Most developing countries do not use Electronic Health Records (EHR in primary care settings. This makes it difficult to access information regarding what occurs within the health center working process. Basically, there are two methodologies to assess patients’ demands and problems or diagnosis stated by doctors. The first is based on single attendance at each appointment, while the second is based on episodes of care; the latter deals with each problem in a longitudinal manner. The methodology developed in this article followed the approach of confronting the ‘reason for the appointment’ and ‘the problem registered’ by doctors. Paper forms were developed taking this concept as central. All appointments were classified by the International Classification of Primary Care (ICPC. Discussion: Even in paper form, confrontation between ‘reason for the appointment’ and ‘problem registered’ is useful for measuring the pre-test probabilities of each problem-based appointment. This approach can be easily reproduced in any health center and enables a better understanding of population profile. Prevalence of many illnesses and diseases are not known in each reality, and studies conducted in other settings, such as secondary and tertiary care, are not adequate for primary health care. Conclusion: This study offers adequate technology for primary health care workers that have potential to transform each health center into a research-led practice, contributing directly to patient care.

  17. Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality

    Directory of Open Access Journals (Sweden)

    Neelima Ranjan

    2014-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is the most common nosocomial infection diagnosed in the intensive care unit (ICU and in spite of advances in diagnostic techniques and management it remains a common cause of hospital morbidity and mortality. Objective: The primary objective of the following study is to determine the incidence, various risk factors and attributable mortality associated with VAP and secondary objective is to identify the various bacterial pathogens causing VAP in the ICU. Materials and Methods: This prospective observational study was carried out over a period of 1 year. VAP was diagnosed using the clinical pulmonary infection score. Endotracheal aspirate (ETA and bronchoalveolar lavage (BAL samples of suspected cases of VAP were collected from ICU patients and processed as per standard protocols. Statistical Analysis: Fisher′s exact test was applied when to compare two or more set of variables were compared. Results: The incidence of VAP in our study was 57.14% and the incidence density of VAP was 31.7/1000 ventilator days. Trauma was the commonest underlying condition associated with VAP. The incidence of VAP increased as the duration of mechanical ventilation increased and there was a total agreement in bacteriology between semi-quantitative ETAs and BALs in our study. The overall mortality associated with VAP was observed to be 48.33%. Conclusions: The incidence of VAP was 57.14%. Study showed that the incidence of VAP is directly proportional to the duration of mechanical ventilation. The most common pathogens causing VAP were Acinetobacter spp. and Pseudomonas aeruginosa and were associated with a high fatality rate.

  18. Well-Being With Objects: Evaluating a Museum Object-Handling Intervention for Older Adults in Health Care Settings.

    Science.gov (United States)

    Thomson, Linda J M; Chatterjee, Helen J

    2016-03-01

    The extent to which a museum object-handling intervention enhanced older adult well-being across three health care settings was examined. The program aimed to determine whether therapeutic benefits could be measured objectively using clinical scales. Facilitator-led, 30 to 40 min sessions handling and discussing museum objects were conducted in acute and elderly care (11 one-to-ones), residential (4 one-to-ones and 1 group of five), and psychiatric (4 groups of five) settings. Pre-post measures of psychological well-being (Positive Affect and Negative Affect Schedule) and subjective wellness and happiness (Visual Analogue Scales) were compared. Positive affect and wellness increased significantly in acute and elderly and residential care though not psychiatric care whereas negative affect decreased and happiness increased in all settings. Examination of audio recordings revealed enhanced confidence, social interaction, and learning. The program allowed adults access to a museum activity who by virtue of age and ill health would not otherwise have engaged with museum objects.

  19. Person-Centered Care in the Home Setting for Parkinson’s Disease: Operation House Call Quality of Care Pilot Study

    Directory of Open Access Journals (Sweden)

    Nawaz Hack

    2015-01-01

    Full Text Available Objective. (1 To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson’s disease (PD in a rural setting. (2 To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson’s disease was confirmed using standardized criteria, and the Unified Parkinson’s Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work. One Operation House Call patient has successfully received deep brain stimulation (DBS. Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.

  20. Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study

    Directory of Open Access Journals (Sweden)

    Santosh Ramdurg

    2013-01-01

    Full Text Available Aim: Catatonia is caused by a variety of psychiatric and organic conditions. The onset, clinical profile, and response to treatment may vary depending on the underlying cause. The study is an attempt to explore clinical profile, possible etiological correlates with neurotic/psychotic spectrum illnesses, and response to treatment and outcome in patients of catatonia. Materials and Methods: Retrospective chart analysis by using semistructured data sheet for the analysis of sociodemographic data, clinical profile, precipitating event, and response to treatment in patients with catatonic symptoms admitted to IHBAS (Institute of Human Behaviour and Allied Sciences, New Delhi, India from January 2009 to December 2010 was undertaken. Results: Catatonia was commonly observed in patients with the following profile - late twenties, female, Hindu religion, urban background, and housewives. Psychotic spectrum disorder (57%, N=35 was the most commonly entertained diagnosis and affective disorder (18%, N=11 being the second common. Thirty four percent of the subjects responded to lorazepam treatment and rest required modified electroconvulsive therapy (MECT. Conclusion: Catatonia is more likely to be associated with Schizophrenia and Other Psychotic Disorders in Indian settings. Majority of patients responded to therapy either by lorazepam alone or to its augmentation with modified ECT. The study being a retrospective one, the sample being representative of the treatment seeking group only, and unavailability of the follow up data were the limitations of the study

  1. Early career RNs' perceptions of quality care in the hospital setting.

    Science.gov (United States)

    Cline, Daniel D; Rosenberg, Marie-Claire; Kovner, Christine T; Brewer, Carol

    2011-05-01

    The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.

  2. Nurse-led management of chronic disease in a residential care setting.

    Science.gov (United States)

    Neylon, Julie

    2015-11-01

    Introduction of the advanced nurse practitioner (ANP) role has enabled nurses to develop their clinical knowledge and skills, providing greater service provision and improved access to healthcare services. It can also help with the challenges of providing care to an ageing population in primary care. This article reports on the evaluation of an ANP-led clinic in two residential care homes that provides annual reviews for chronic disease management (CDM). A mixed method approach was used to evaluate the service using clinical data obtained from the electronic patient record system and software and patient satisfaction questionnaires. The number of patients receiving CDM reviews in the homes increased as a result of the clinic. Completed satisfaction questionnaires further demonstrated patients' satisfaction and willingness to engage with the service. The service highlights the ANP's effectiveness in managing residential care home patients with chronic diseases and improving their access to healthcare services.

  3. U.S. Judge's Ruling Sets Up New Battle over Care of Lab Animals.

    Science.gov (United States)

    Burd, Stephen

    1993-01-01

    A federal court decision overturning federal regulations requiring research institutions to present plans for care and use of laboratory animals has renewed debate over laboratory animal welfare. University scientists fear new, stricter Department of Agriculture regulations will result. (MSE)

  4. Professional dilemmas for caregivers in Turkish home care settings in Germany

    OpenAIRE

    2014-01-01

    While calling for culturally sensitive healthcare services in migrant communities, the internation-al nursing literature on intercultural care predominantly describes nursing staff as lacking cultur-al competences and immigrant customers as lacking cleverness to navigate the labyrinths of na-tional healthcare systems. Congruences in language, culture and religion in the customer-caregiver relationship can decisively improve the quality of care. However, they do not automat-ically guarantee sm...

  5. The primary care clinic as a setting for continuing medical education: program description.

    Science.gov (United States)

    Pérez-Cuevas, R; Reyes, H; Guiscafré, H; Juárez-Díaz, N; Oviedo, M; Flores, S; Muñoz, O

    2000-11-14

    The Mexican Institute of Social Security (IMSS) is Mexico's Largest state-financed health care system, providing care to 50 million people. This system comprises 1450 family medicine clinics staffed by 14,000 family physicians, as well as 240 secondary care hospitals and 10 tertiary care medical centres. We developed a program of continuing medical education (CME) for IMSS family physicians. The program had 4 stages, which were completed over a 7-month period: development of clinical guidelines, training of clinical instructors, an educational intervention (consisting of interactive workshops, individual tutorials and peer group sessions), and evaluation of both physicians' performance and patients' health status. The pilot study was conducted in an IMSS family medicine clinic providing care to 45,000 people; 20 family physicians and 4 clinical instructors participated. The 2 main reasons for visits to IMSS family medicine clinics are acute respiratory infections and type 2 diabetes mellitus. Therefore, patients being treated at the clinic for either of these illnesses were included in the study. The sources of data were interviews with physicians and patients, clinical records and written prescriptions. A 1-group pretest-posttest design was used to compare physicians' performance in treating the 2 illnesses of interest. We found that the daily activities of the clinic could be reorganized to accommodate the CME program and that usual provision of health care services was maintained. Physicians accepted and participated actively in the program, and their performance improved over the course of the study. We conclude that this CME strategy is feasible, is acceptable to family physicians and may improve the quality of health care provided at IMSS primary care facilities. The effectiveness and sustainability of the strategy should be measured through an evaluative study.

  6. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives

    OpenAIRE

    Lim CJ; Kong DCM; Stuart RL

    2014-01-01

    Ching Jou Lim,1 David CM Kong,1 Rhonda L Stuart2,31Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia; 2Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia; 3Department of Medicine, Monash University, Clayton, VIC, AustraliaAbstract: Residential aged care facilities are increasingly identified as having a high burden of infection, resulting in subsequent antibiotic use, compounded by the complexity of patient demographics and medical care. Of parti...

  7. Recovery-oriented care in older-adult acute inpatient mental health settings in Australia: an exploratory study.

    Science.gov (United States)

    McKenna, Brian; Furness, Trentham; Dhital, Deepa; Ireland, Susan

    2014-10-01

    Recovery-oriented care acknowledges the unique journey that consumers lead with the aim of regaining control of their lives in order to live a good life. Recovery has become a dominant policy-directed model of many mental health care organizations, but in older-adult acute mental health inpatient settings, nurses do not have a clear description of how to be recovery-oriented. The aims of this study were to determine the extent to which elements of existing nursing practice resemble the domains of recovery-oriented care and provide a baseline understanding of practice in preparation for transformation to recovery-oriented mental health care provision. An exploratory, qualitative research design was used to meet the research aims. A purposive sample of mental health nurses (N = 12) participated in focus groups in three older-adult inpatient settings in Australia. A general inductive approach was used to analyze the qualitative data. The mental health nurses in this study readily discussed aspects of their current practice within the recovery domains. They described pragmatic ways to promote a culture of hope, collaborative partnerships, meaningful engagement, autonomy and self-determination, and community participation and citizenship. Nurses also discussed challenges and barriers to recovery-oriented care in older-adult acute mental health settings. This study identified a reasonable baseline understanding of practice in preparation for transformation to recovery-oriented older-adult mental healthcare provision. A concerted drive focused on recovery education is required to effectively embed a recovery-orientated paradigm into older-adult mental health settings.

  8. Minimum standard guidelines of care on requirements for setting up a laser room

    Directory of Open Access Journals (Sweden)

    Dhepe Niteen

    2009-08-01

    Full Text Available Introduction, definition, rationale and scope: Lasers are now becoming an integral part of dermatological practice in India, with more and more dermatologists starting laser dermatology practice. Lasers, when are used with care, by properly trained operators, in carefully designed environment, can deliver a range of useful aesthetic and dermatologic treatments. Facility: Laser treatment is an office procedure, hence it does not require hospital set-up. The laser room facility requires careful planning keeping in mind safety of both patient and operator, convenience of operating, and optimum handling of costly equipments. The facility should be designed to handle procedures under local anesthesia and sedation. Facilities, staff and equipment to handle any emergencies should be available. Location: A room in existing dermatology clinic can be adequately converted to a laser room. Dimensions of laser room, its door and patient′s table should be such that it should facilitate easy movement of patient, machine trolley, operator and assistant in case of routine procedures and in emergency. Physician Qualification: Any dermatologist with MD or diploma in dermatology can do laser procedures, provided he/ she has acquired necessary skills by virtue of training, observing a competent dermatologist. Such training may be obtained during post graduation or later in specified workshops or courses under a competent dermatologist or at centre which routinely performs such procedures. Electricity and uninterrupted power supply: Laser equipments should be connected to stabilizer or UPS circuits only. Preferably an on line UPS as recommended by the laser company should be installed. Earthing of the equipment is essential to avoid damage to the equipment and electrical shocks to the operator. Sufficient power back up to complete the procedure if power is off midway, is essential. Air-conditioning: Laser machines should be operated in low ambient temperature, with

  9. An exploratory study of interprofessional collaboration in end-of-life decision-making beyond palliative care settings.

    Science.gov (United States)

    Ho, Anita; Jameson, Kim; Pavlish, Carol

    2016-11-01

    As healthcare delivery becomes increasingly interprofessional, it is imperative to identify opportunities for effective collaboration and coordination of care. Drawing on a Canadian qualitative study that adopted a constant comparative method based on the grounded theory approach, we report how healthcare providers' (HCPs) personal experiences and professional roles intersect with system factors in hindering or enhancing their ability to support patients and families in planning for end-of-life (EOL) care. We used a criterion-based sampling strategy and sought HCPs who had direct experience engaging patients and families in complex healthcare decisions on: (1) initiating, withholding, or withdrawing treatment; (2) care planning; and/or (3) discharge planning. Interviews sought to understand what HCPs perceived as individual, (inter)professional, and system factors that might hinder, promote, or enhance support for patients/families. We present four major intersecting themes from in-depth interviews with 28 HCPs across acute, long-term, and community care settings that represent three barriers and one facilitator: discomfort with death and dying, confusion about role responsibility, lack of coordinated care, and importance of interprofessional teamwork. Attending to system power hierarchy, we explore interprofessional strategies to support patients' and families' care experiences and promote team-based decision-making. We recommend an interprofessional team approach to facilitate EOL decision-making across care settings and before death becomes imminent. Increasing educational initiatives and developing tools that focus on interprofessional collaboration may help HCPs to understand each other's roles and perspectives, so that they can work together to provide a more coherent and coordinated approach to EOL decision-making.

  10. Policy options to improve leadership of middle managers in the Australian residential aged care setting: a narrative synthesis

    Directory of Open Access Journals (Sweden)

    Merlyn Teri

    2010-07-01

    Full Text Available Abstract Background The prevalence of both chronic diseases and multi-morbidity increases with longer life spans. As Australia's population ages, the aged care sector is under increasing pressure to ensure that quality aged care is available. Key to responding to this pressure is leadership and management capability within the aged care workforce. A systematic literature review was conducted to inform the policy development necessary for the enhancement of clinical and managerial leadership skills of middle managers within residential aged care. Methods Using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts, 4,484 papers were found. After a seven-tiered culling process, we conducted a detailed review (narrative synthesis of 153 papers relevant to leadership and management development in aged care, incorporating expert and key stakeholder consultations. Results • Positive staff experiences of a manager's leadership are critical to ensure job satisfaction and workforce retention, the provision of quality care and the well-being of care recipients, and potentially a reduction of associated costs. • The essential attributes of good leadership for aged care middle management are a hands-on accessibility and professional expertise in nurturing respect, recognition and team building, along with effective communication and flexibility. However, successful leadership and management outcomes depend on coherent and good organisational leadership (structural and psychological empowerment. • There is inadequate preparation for middle management leadership roles in the aged care sector and a lack of clear guidelines and key performance indicators to assess leadership and management skills. • Theory development in aged care leadership and management research is limited. A few effective generic clinical leadership programs targeting both clinical and managerial leaders exist. However

  11. The Association of Types of Training and Practice Settings with Doctors' Empathy and Patient Enablement among Patients with Chronic Illness in Hong Kong.

    Directory of Open Access Journals (Sweden)

    Frances S K Yu

    Full Text Available The increase in non-communicable disease (NCD is becoming a global health problem and there is an increasing need for primary care doctors to look after these patients although whether family doctors are adequately trained and prepared is unknown.This study aimed to determine if doctors with family medicine (FM training are associated with enhanced empathy in consultation and enablement for patients with chronic illness as compared to doctors with internal medicine training or without any postgraduate training in different clinic settings.This was a cross-sectional questionnaire survey using the validated Chinese version of the Consultation and Relational Empathy (CARE Measure as well as Patient Enablement Instrument (PEI for evaluation of quality and outcome of care. 14 doctors from hospital specialist clinics (7 with family medicine training, and 7 with internal medicine training and 13 doctors from primary care clinics (7 with family medicine training, and 6 without specialist training were recruited. In total, they consulted 823 patients with chronic illness. The CARE Measure and PEI scores were compared amongst doctors in these clinics with different training background: family medicine training, internal medicine training and those without specialist training. Generalized estimation equation (GEE was used to account for cluster effects of patients nested with doctors.Within similar clinic settings, FM trained doctors had higher CARE score than doctors with no FM training. In hospital clinics, the difference of the mean CARE score for doctors who had family medicine training (39.2, SD = 7.04 and internal medicine training (35.5, SD = 8.92 was statistically significant after adjusting for consultation time and gender of the patient. In the community care clinics, the mean CARE score for doctors with family medicine training and those without specialist training were 32.1 (SD = 7.95 and 29.2 (SD = 7.43 respectively, but the difference was not

  12. Health Care Providers’ Attitudes and Practices Regarding the use of Advance Directives in a Military Health Care Setting

    Science.gov (United States)

    2007-11-02

    and skills about advance directives have been cited for low completion rates. Family nurse practitioners ( FNPs ), in both civilian and military settings...receive training on ethical and moral implications of advanced nursing practice. These characteristics make the FNP an ideal candidate for promoting...environment (Hunter et al., 1997). Advanced Nursing Role Family nurse practitioners ( FNPs ) are well suited to initiate conversations concerning end-of-life

  13. An exploration of nursing documentation of pressure ulcer care in an acute setting in Ireland.

    LENUS (Irish Health Repository)

    O Brien, J A Jordan

    2012-02-01

    OBJECTIVE: To explore the nature and quality of documented care planning for pressure ulcers in a large teaching hospital in the Republic of Ireland. METHOD: A mixed method design was used; this encompassed a descriptive survey that retrospectively evaluated nursing records (n=85) in two wards (orthopaedic and care of the older adult) and a focus group (n=13) that explored nurses\\' perspectives of the factors influencing concordance and the quality of nursing documentation. Only records of at-risk patients (Waterlow score of >10) were included. RESULTS: It was identified that 47% (n=40) were assessed as at high or very high risk of developing a pressure ulcer. Fifty-two patients (61%) had a weekly risk assessment, but 25% (n=21) had only one follow-up assessment. Only 45% (n=38) of charts had some evidence of documented care planning, and of those 53% (n=20) had no evidence of implementation of the care plan and 66% (n=25) had no evidence of outcome evaluation. Only 48% (n=41) of this at-risk population was nutritionally assessed. Of patients admitted with and without a pressure ulcer, there was no record of regular positioning in 70% (n=59) and 60% (n=51) respectively. CONCLUSION: Documentation on pressure ulcer care is not standardised and requires development. Conflict of interest: None.

  14. Association Between Endovascular Performance in a Simulated Setting and in the Catheterization Laboratory

    DEFF Research Database (Denmark)

    Räder, Sune B E W; Abildgaard, Ulrik; Jørgensen, Erik;

    2014-01-01

    INTRODUCTION: Simulation-based assessment studies have related simulator performance to clinical experience instead of actual clinical performance. This study validates a novel rating scale for coronary angiography (CA) performance and at the same time explores the association between CA...... in the catheterization laboratory. The correlation between operators' previous clinical experience in CA and CARS scores was R = 0.65 (P = 0.005) in the catheterization laboratory and R = 0.11 (P = 0.353) in the simulated setting. CONCLUSIONS: The association between CA performance in a simulated setting and actual...... performance in a simulated setting and in the catheterization laboratory. METHODS: Ten cardiologists and cardiology residents with varying degrees of CA experience performed 2 CAs in the catheterization laboratory and 2 CAs in a simulated setting. The residents had prior simulator experience opposite...

  15. GLOSSI: a method to assess the association of genetic loci-sets with complex diseases

    Directory of Open Access Journals (Sweden)

    Asmann Yan W

    2009-04-01

    Full Text Available Abstract Background The developments of high-throughput genotyping technologies, which enable the simultaneous genotyping of hundreds of thousands of single nucleotide polymorphisms (SNP have the potential to increase the benefits of genetic epidemiology studies. Although the enhanced resolution of these platforms increases the chance of interrogating functional SNPs that are themselves causative or in linkage disequilibrium with causal SNPs, commonly used single SNP-association approaches suffer from serious multiple hypothesis testing problems and provide limited insights into combinations of loci that may contribute to complex diseases. Drawing inspiration from Gene Set Enrichment Analysis developed for gene expression data, we have developed a method, named GLOSSI (Gene-loci Set Analysis, that integrates prior biological knowledge into the statistical analysis of genotyping data to test the association of a group of SNPs (loci-set with complex disease phenotypes. The most significant loci-sets can be used to formulate hypotheses from a functional viewpoint that can be validated experimentally. Results In a simulation study, GLOSSI showed sufficient power to detect loci-sets with less than 10% of SNPs having moderate-to-large effect sizes and intermediate minor allele frequency values. When applied to a biological dataset where no single SNP-association was found in a previous study, GLOSSI was able to identify several loci-sets that are significantly related to blood pressure response to an antihypertensive drug. Conclusion GLOSSI is valuable for association of SNPs at multiple genetic loci with complex disease phenotypes. In contrast to methods based on the Kolmogorov-Smirnov statistic, the approach is parametric and only utilizes information from within the interrogated loci-set. It properly accounts for dependency among SNPs and allows the testing of loci-sets of any size.

  16. The impact of medical technology on sense of security in the palliative home care setting.

    Science.gov (United States)

    Munck, Berit; Sandgren, Anna

    2017-03-02

    The increase in the use of medical devices in palliative home care requires that patients and next-of-kin feel secure. Therefore, the aim was to describe medical technology's impact on the sense of security for patients, next-of-kin and district nurses. Deductive content analysis was conducted on data from three previous studies, using the theoretical framework 'palliative home care as a secure base'. The use of medical technology was shown to have an impact on the sense of security for all involved. A sense of control was promoted by trust in staff and their competence in managing the technology, which was linked to continuity. Inner peace and being in comfort implied effective symptom relief facilitated by pain pumps and being relieved of responsibility. Health care professionals need to have practical knowledge about medical technology, but at the same time have an awareness of how to create and maintain a sense of security.

  17. Confidentiality Concerns Raised by DNA-Based Tests in the Market-Driven Managed Care Setting

    Energy Technology Data Exchange (ETDEWEB)

    Kotval, Jeroo S.

    2006-07-28

    In a policy climate where incentives to cherry pick are minimized, Managed Care Organizations can implement practices that safeguard medical privacy to the extent that data is protected from falling into the hands of third parties who could misuse it to discriminate. To the extent that these practices have been codified into the regulatory Network of the Health Insurance Portability and Accountability Act (HIPAA) Consumers may be able to rest easy about their genetic data being revealed to third parties who may discriminate. However, there are limitations to the use of policy instruments to prevent the discrimination of an entire genre of clients by market driven managed care organizations. Policy measures, to assure that knowledge of genetic conditions and their future costs would not be used by market driven managed care organizations to implement institutional policies and products that would implicitly discriminate against a genre of clients with genetic conditions, present difficulties.

  18. The management of sickle cell disease in a primary care setting.

    Science.gov (United States)

    Humphreys, José V A

    2012-01-01

    With increasing burdens placed on Primary Care Physicians in the prevention and management of Sickle Cell Disease (SCD), it is imperative that there is some basic understanding of the same. Needless to say, its management is a multifocal, multidisciplinary approach which includes a collaborative effort between patients, family members and the healthcare team. Primary Care Physicians must be familiar with the pathophysiological processes, diagnostic evaluation, and current standard of care, new treatment options, clinical research advances and medical management of sickle hemoglobinopathies and their complications. The guidelines should include new born screening and assessment, accessible medical records for those diagnosed with SCD, system support and prevention, management of complication and crisis periods and home management (dietary and lifestyle modifications).

  19. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    Directory of Open Access Journals (Sweden)

    Travers Catherine M

    2011-10-01

    Full Text Available Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will

  20. Agenda-setting for Canadian caregivers: using media analysis of the maternity leave benefit to inform the compassionate care benefit.

    Science.gov (United States)

    Dykeman, Sarah; Williams, Allison M

    2014-04-24

    The Compassionate Care Benefit was implemented in Canada in 2004 to support employed informal caregivers, the majority of which we know are women given the gendered nature of caregiving. In order to examine how this policy might evolve over time, we examine the evolution of a similar employment insurance program, Canada's Maternity Leave Benefit. National media articles were reviewed (n = 2,698) and, based on explicit criteria, were analyzed using content analysis. Through the application of Kingdon's policy agenda-setting framework, the results define key recommendations for the Compassionate Care Benefit, as informed by the developmental trajectory of the Maternity Leave Benefit. Recommendations for revising the Compassionate Care Benefit are made.

  1. Brief intervention in primary care settings. A primary treatment method for at-risk, problem, and dependent drinkers.

    Science.gov (United States)

    Fleming, M; Manwell, L B

    1999-01-01

    Primary health care providers identify and treat many patients who are at risk for or are already experiencing alcohol-related problems. Brief interventions--counseling delivered by primary care providers in the context of several standard office visits--can be a successful treatment approach for many of these patients. Numerous trials involving a variety of patient populations have indicated that brief interventions can reduce patients' drinking levels, regardless of the patients' ages and gender. In clinical practice, brief interventions can help reduce the drinking levels of nondependent drinkers who drink more than the recommended limits, facilitate therapy and abstinence in patients receiving pharmacotherapy, and enhance the effectiveness of assessment and treatment referral in patients who do not respond to brief interventions alone. Despite the evidence for their usefulness, however, brief interventions for alcohol-related problems have not yet been widely implemented in primary care settings.

  2. The role of the media in agenda setting: the case of long-term care rebalancing.

    Science.gov (United States)

    Miller, Edward Alan; Nadash, Pamela; Goldstein, Rachel

    2015-01-01

    This study investigates the role of print media in state policy agendas in four states-Connecticut, Minnesota, Oregon, and Utah-in rebalancing long-term care away from institutions toward home- and community-based (HCBS) services. Ordinary least squares regression is used to model states' policy agendas, as measured by the proportion of Medicaid long-term care spending on HCBS expenditures and number of rebalancing bills proposed, from 1999 to 2008. Results reveal a relationship between states' rebalancing agendas and the extent of media coverage, and state economic, political, and programmatic characteristics. Findings suggest that media coverage reflects broader shifts in state-level attitudes toward rebalancing.

  3. A practical approach to dementia in the outpatient primary care setting.

    Science.gov (United States)

    Darrow, Mark D

    2015-06-01

    As the population ages, fear of memory loss and potential diagnosis of dementia increases. Primary care providers, with their medical knowledge, familiarity with patients and their loved ones, and knowledge of the community and its resources, are perfectly placed to diagnose and treat commonly presenting types of dementia. As knowledge of the types of dementia and their categorization, presentation, and course has increased, diagnosis and treatment of this problem have become more understandable and amenable to primary care intervention. Diagnosis and work-up use common techniques and studies to assist providers. Treatment and management have evolved over time to include nonpharmacologic or behavioral interventions.

  4. Developing an outpatient wound care clinic in an acute rehabilitation setting.

    Science.gov (United States)

    Sheehan, Diane Dudas; Zeigler, Mary H

    2010-01-01

    People with disability are at high risk for skin breakdown,which requires ongoing prevention and management. An outpatient rehabilitation wound clinic was developed to handle a variety of acute and chronic wounds for this unique population. This article describes how two advanced practice nurses proposed the idea for the wound care clinic and formulated a business plan, which was critical to successfully administering an outpatient wound care service. Essential components of the business plan included the goals, scope of service, professional practice model, benefits, rationale, marketing analysis, predicted volumes, regulatory imperatives, and financial needs.

  5. Venous thromboembolism risk and prophylaxis in the acute hospital care setting: the Irish results of the ENDORSE study.

    LENUS (Irish Health Repository)

    Murphy, O

    2012-05-01

    ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting), is a multinational, cross-sectional survey of venous thromboembolism (VTE) risk prevalence and effective prophylaxis in the acute hospital care setting. Three Irish hospitals enrolled in the study. The American College of Chest Physicians (ACCP) guidelines were employed to evaluate VTE risk and prophylaxis. Of 552 patients, 297 (53.8%) and 255 (46.2%) were categorised as surgical or medical, respectively, with 175 (59%) surgical and 109 (43%) medical patients deemed to be at risk for VTE. Of these, only 112 (64%) and 51 (47%) received recommended VTE prophylaxis, respectively. The results are consistent with those observed in other countries and demonstrate a high prevalence of risk for VTE and a low rate of prophylaxis use, particularly in medical patients. Awareness of VTE guidelines should be an integral component of health policy.

  6. Protocol for a systematic review of preference-based instruments for measuring care-related outcomes and their suitability for the palliative care setting

    Science.gov (United States)

    Al-Janabi, Hareth; Currow, David; Hoefman, Renske; Ratcliffe, Julie

    2016-01-01

    Introduction Despite informal caregivers' integral role in supporting people affected by disease or disability, economic evaluations often ignore the costs and benefits experienced by this group, especially in the palliative setting. The purpose of this systematic review is to identify preference-based instruments for measuring care-related outcomes and provide guidance on the selection of instrument in palliative care economic evaluations. Methods and analysis A comprehensive search of the literature will be conducted from database inception (ASSIA; CINAHL; Cochrane library including DARE, NHS EED, HTA; Econlit; Embase; PsychINFO; PubMed). Published peer-reviewed, English-language articles reporting preference-based instruments for measuring care-related outcomes in any clinical area will be included. One researcher will complete the searches and screen the results for potentially eligible studies. A randomly selected subset of 10% citations will be independently screened by two researchers. Any disagreement will be resolved by consensus among the research team. Subsequently, a supplementary search will identify studies detailing the development, valuation, validation and application of the identified instruments. The degree of suitability of the instruments for palliative economic evaluations will be assessed using criteria in the International Society for Quality of Life Research minimum standards for patient-reported outcome measures, the checklist for reporting valuation studies of multiattribute utility-based instruments and information on the development of the instrument in the palliative setting. A narrative summary of the included studies and instruments will be provided; similarities and differences will be described and possible reasons for variations explored. Recommendations for practice on selection of instruments in palliative care economic analyses will be provided. Ethics and dissemination This is a planned systematic review of published

  7. Use of Health Care Services and Associated Factors among Women.

    Directory of Open Access Journals (Sweden)

    Nader Esmailnasab

    2014-01-01

    Full Text Available To estimate the prevalence and analyze factors associated with both public and private health services utilization in women population in a western district of Iran.A cross-sectional study with 1200 individuals aged 18-49 years carried out in different districts of Sanandaj City, western Iran, in 2012. The main outcome variable was use of health service in the previous 12 months. The in-dependent variables were age, education level, place of residence, marital and pregnancy status, household wealth, oc-cupation and duration time of employment, and rating of quality of health services.The prevalence of public and private health services utilization were 60.8% [95%CI: 57.8, 63.8] and 53.8% [95%CI: 50.8%, 56.8%], respectively (P=0.001. After controlling other investigated factors using logistic regression; the academic educational level (OR=1.36, 95%CI: 1.03, 1.80; OR=1.76, 95%CI: 1.33, 2.33, residents of urban (OR=1.65, 95%CI: 1.10, 2.47; OR=1.60, 95%CI: 1.10, 2.42, pregnancy status (OR=2.38, 95%CI: 1.60, 3.55; OR=2.36, 95%CI: 1.61, 3.47, and high level of quality of health services (OR=1.61, 95%CI: 1.15, 2.27; OR=1.70, 95%CI: 1.20, 2.40 were found to be predictors of utilization of both public and private health care respectively. There was also statistically relation between high level of household wealth (OR=3.01, 95% CI: 2.00, 4.57 and private health services utilization.Prevalence of health services utilization varied according to the individual and social factors of popula-tion studied. Present study emphasizes the need to develop care models that focus on the characteristics and demands of the subjects.

  8. Ventilator Associated Pneumonia in a Military Deployed Setting: The Impact of an Aggressive Infection Control Program

    Science.gov (United States)

    2008-02-01

    A, et al. An outbreak of multi-drug resistant Acinetobacter baumannii -calcoaceticus complex infections in the U.S. military health-care system...resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment. JAMA. 2004;292:3006–3011. 7. Urban C, Segal-Maurer S, Rahal JJ...Considerations in control and treatment of nosocomial infections due to multidrug-resistant Acinetobacter baumannii . Clin Infect Dis. 2003;36:1268–1274. 8

  9. When Care is a "Systematic Route of Torture": Conceptualizing the Violence of Medical Negligence in Resource-Poor Settings.

    Science.gov (United States)

    Heckert, Carina

    2016-12-01

    Descriptions of patient mistreatment fill ethnographic accounts of healthcare in resource-poor settings. Often, anthropologists point to structural factors and the ways that the global political economy produces substandard care. This approach makes it difficult to hold parties accountable when there is blatant disregard for human life on the part of individuals providing care. In this article, I draw on the illness narrative of Magaly Chacón, the first HIV positive individual in Bolivia to file charges of medical negligence after failing to receive care to prevent mother-to-child transmission. Magaly's narrative demonstrates how structural conditions are often used to explain away poor patient outcomes, shifting attention away from and normalizing the symbolic violence that also perpetuates substandard care of marginalized patients. I use Magaly's accusations to interrogate how defining acts of mistreatment as medical negligence can be a productive exercise, even when it is difficult to disentangle structural constraints from blatant acts of negligence. Defining who is negligent in resource-poor settings is not easy, as Magaly's case demonstrates. However, Magaly's case also demonstrates that accusations of negligence themselves can demand accountability and force changes within the local structures that contribute to the systematic mistreatment of marginalized patients.

  10. How patients understand physicians' solicitations of additional concerns: implications for up-front agenda setting in primary care.

    Science.gov (United States)

    Robinson, Jeffrey D; Heritage, John

    2016-01-01

    In the more than 1 billion primary-care visits each year in the United States, the majority of patients bring more than one distinct concern, yet many leave with "unmet" concerns (i.e., ones not addressed during visits). Unmet concerns have potentially negative consequences for patients' health, and may pose utilization-based financial burdens to health care systems if patients return to deal with such concerns. One solution to the problem of unmet concerns is the communication skill known as up-front agenda setting, where physicians (after soliciting patients' chief concerns) continue to solicit patients' concerns to "exhaustion" with questions such as "Are there some other issues you'd like to address?" Although this skill is trainable and efficacious, it is not yet a panacea. This article uses conversation analysis to demonstrate that patients understand up-front agenda-setting questions in ways that hamper their effectiveness. Specifically, we demonstrate that up-front agenda-setting questions are understood as making relevant "new problems" (i.e., concerns that are either totally new or "new since last visit," and in need of diagnosis), and consequently bias answers away from "non-new problems" (i.e., issues related to previously diagnosed concerns, including much of chronic care). Suggestions are made for why this might be so, and for improving up-front agenda setting. Data are 144 videotapes of community-based, acute, primary-care, outpatient visits collected in the United States between adult patients and 20 family-practice physicians.

  11. The influence of tai chi and yoga on balance and falls in a residential care setting: a randomised controlled trial.

    Science.gov (United States)

    Saravanakumar, Padmapriya; Higgins, Isabel Johanna; Van Der Riet, Pamela Jane; Marquez, Jodie; Sibbritt, David

    2014-07-23

    Abstract Falls amongst older people is a global public health concern. Whilst falling is not a typical feature of ageing, older people are more likely to fall. Fall injuries amongst older people are a leading cause of death and disability. Many older people do not do regular exercise so that they lose muscle tone, strength, and flexibility which affect balance and predispose them to falls. The management of falls in residential care settings is a major concern with strategies for prevention and monitoring a focus in this setting. Yoga and tai chi have shown potential to improve balance and prevent falls in older adults. They also have potential to improve pain and quality of life. The aim of this study was to determine the feasibility of conducting a 3-arm RCT with frail older people in a residential care setting to test the hypothesis that a 14 week modified tai chi or yoga program is more effective than usual care activity in improving balance function, quality of life, pain experience and in reducing number of falls. There were no statistically significant differences between the three groups in the occurrence of falls. Yoga demonstrated a slight decrease in fall incidence; quality of life improved for the tai chi group. Only the yoga group experienced a reduction in average pain scores though not statistically significant. The findings of the study suggest it is possible to safely implement modified yoga and tai chi in a residential care setting and evaluate this using RCT design. They show positive changes to balance, pain and quality of life and a high level of interest through attendance amongst the older participants. The results support offering tai chi and yoga to older people who are frail and dependent with physical and cognitive limitations.

  12. Validation of the PHQ-15 for Somatoform Disorder in the Occupational Health Care Setting

    NARCIS (Netherlands)

    de Vroege, Lars; Hoedeman, Rob; Nuyen, Jasper; Sijtsma, Klaas; van der Feltz-Cornelis, Christina M.

    2012-01-01

    Introduction Within the occupational health setting, somatoform disorders are a frequent cause of sick leave. Few validated screening questionnaires for these disorders are available. The aim of this study is to validate the PHQ-15 in this setting. Methods In a cross-sectional study of 236 sickliste

  13. Risk Factors Associated with Children Lost to Care in a State Early Childhood Intervention Program

    Science.gov (United States)

    Giannoni, Peggy P.; Kass, Philip H.

    2010-01-01

    A retrospective cohort study was conducted to identify risk factors associated with children lost to care, and their families, compared to those not lost to care within the California Early Start Program. The cohort included data on 8987 children enrolled in the Early Start Program in 1998. This cohort consisted of 2443 children lost to care, 6363…

  14. Risk of aspiration in care home residents and associated factors

    NARCIS (Netherlands)

    Maarel-Wierink, C.D. van der; Putten, G.J. van der; Visschere, L.M. De; Bronkhorst, E.M.; Baat, C. de; Schols, J.M.

    2015-01-01

    Pneumonia is a prevalent cause of death in care home residents. Dysphagia is a significant risk factor of aspiration pneumonia. The purpose of the current study was to screen for risk of aspiration in care home residents in the Netherlands and assess potential risk factors of aspiration. Five experi

  15. The Language Environment of Toddlers in Center-Based Care versus Home Settings

    Science.gov (United States)

    Murray, Ann D.; Fees, Bronwyn S.; Crowe, Linda K.; Murphy, Molly E.; Henriksen, Amanda L.

    2006-01-01

    Children's language development is significantly affected by the quantity and quality of language input, particularly during infancy and toddlerhood. The purpose of this study was to compare the language environment in an accredited child care program with data collected by Hart and Risley (1995). Fourteen toddlers (mean age 24.4 months) were…

  16. Unmet Needs of Children with Special Health Care Needs in a Specialized Day School Setting

    Science.gov (United States)

    Aruda, Mary M.; Kelly, Mary; Newinsky, Karina

    2011-01-01

    Children with Special Health Care Needs (CSHCN) represent a significant component of the pediatric population. They often present to schools with multiple and increasingly complex health issues, including medical technology dependency. Their daily variation in health status requires close monitoring and communication among caregivers. Limited…

  17. Obesity Prevention Interventions in Early Childhood Education and Care Settings with Parental Involvement: A Systematic Review

    Science.gov (United States)

    Morris, Heather; Skouteris, Helen; Edwards, Susan; Rutherford, Leonie

    2015-01-01

    Partnering early childhood education and care (ECEC) and the home together may be more effective in combating obesogenic risk factors in preschool children. Thus, an evaluation of ECEC obesity prevention interventions with a parental component was conducted, exploring parental engagement and its effect on obesity and healthy lifestyle outcomes. A…

  18. International Female Students' Experiences of Navigating the Canadian Health Care System in a Small Town Setting

    Science.gov (United States)

    Burgess, K.; McKenzie, W.; Fehr, F.

    2016-01-01

    This pilot study explored the international female (IF) students' (n = 17) lived experiences of health care accessibility while studying in a small town in Canada. Analysis guided by a phenomenological method resulted in three major themes--(1) after arriving to attend university, IF students experienced challenges in staying healthy, such as…

  19. Developing a broader approach to management of infection control breaches in health care settings.

    Science.gov (United States)

    Patel, Priti R; Srinivasan, Arjun; Perz, Joseph F

    2008-12-01

    Our experiences with health departments and health care facilities suggest that questions surrounding instrument reprocessing errors and other infection control breaches are becoming increasingly common. We describe an approach to management of these incidents that focuses on risk of bloodborne pathogen transmission and the role of public health and other stakeholders to inform patient notification and testing decisions.

  20. Child Sexual Abuse in Early-Childhood Care and Education Settings

    Science.gov (United States)

    Briggs, Freda

    2014-01-01

    When the author was adviser to the Australian Minister for Education for writing the national Safe Schools Framework (2003), meetings were held with early-childhood care and education administrators from all state, Catholic and independent sectors. Their unexpected message was that educators were facing new problems, those of child sexual abuse in…

  1. Referral for a bariatric surgical consultation: it is time to set a standard of care.

    Science.gov (United States)

    Dixon, John B

    2009-05-01

    Indications for bariatric surgery have been clear for some time and many would say that they are conservative. Unfortunately few eligible candidates seek or are referred for bariatric surgery, with less than 1% currently treated annually. In recent years, the evidence base supporting surgical therapy has strengthened with demonstrable improvements in both safety and efficacy. We now have evidence of remarkable improvements in health, quality of life, and increased life expectancy. There is continued frustration with the poor efficacy of non-surgical therapies and no indication that this is about to change. A caring physician should, as best care, refer the seriously ill morbidly obese patient for a surgical opinion. It is no different from their obligation to adequately manage type-2 diabetes, depression or unstable angina. Currently, even discussion of a surgical referral is optional. It is time we articulated and defined a group of patients where referral for a surgical opinion is no longer merely an option but a physician's responsibility as best care for the patient. It is time to provide leadership towards the delivery of better care for these patients.

  2. Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting.

    Science.gov (United States)

    Gillette, Joyce L.; And Others

    1982-01-01

    Five hundred college students who had used Kent State University's School Health Service were surveyed to determine patient satisfaction with health care services. Overall satisfaction with the services was high, and satisfaction was significantly influenced by patients' perceptions of practitioners' technical competence and by the adequacy of the…

  3. Setting an Example: The Health, Medical Care, and Health-Related Behavior of American Parents.

    Science.gov (United States)

    Zill, Nicholas

    This report details a national survey study of parents, age 54 or younger, living with children under age 18. The study examined parents' physical health status, stress levels and negative feelings, health habits, and access to health care. Findings indicated that one in eight parents reported health problems, with health related to education,…

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

    Directory of Open Access Journals (Sweden)

    Ferrua Marie

    2012-06-01

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

  5. "I Do Feel Like a Scientist at Times": A Qualitative Study of the Acceptability of Molecular Point-Of-Care Testing for Chlamydia and Gonorrhoea to Primary Care Professionals in a Remote High STI Burden Setting.

    Directory of Open Access Journals (Sweden)

    Lisa Natoli

    Full Text Available Point-of-care tests for chlamydia (CT and gonorrhoea (NG could increase the uptake and timeliness of testing and treatment, contribute to improved disease control and reduce reproductive morbidity. The GeneXpert (Xpert CT/NG assay, suited to use at the point-of-care, is being used in the TTANGO randomised controlled trial (RCT in 12 remote Australian health services with a high burden of sexually transmissible infections (STIs. This represents the first ever routine use of a molecular point-of-care diagnostic for STIs in primary care. The purpose of this study was to explore the acceptability of the GeneXpert to primary care staff in remote Australia.In-depth qualitative interviews were conducted with 16 staff (registered or enrolled nurses and Aboriginal Health Workers/Practitioners trained and experienced with GeneXpert testing. Interviews were digitally-recorded and transcribed verbatim prior to content analysis.Most participants displayed positive attitudes, indicating the test was both easy to use and useful in their clinical context. Participants indicated that point-of-care testing had improved management of STIs, resulting in more timely and targeted treatment, earlier commencement of partner notification, and reduced follow up efforts associated with client recall. Staff expressed confidence in point-of-care test results and treating patients on this basis, and reported greater job satisfaction. While point-of-care testing did not negatively impact on client flow, several found the manual documentation processes time consuming, suggesting that improved electronic connectivity and test result transfer between the GeneXpert and patient management systems could overcome this. Managing positive test results in a shorter time frame was challenging for some but most found it satisfying to complete episodes of care more quickly.In the context of a RCT, health professionals working in remote primary care in Australia found the GeneXpert highly

  6. Association between child-care and acute diarrhea: a study in Portuguese children

    Directory of Open Access Journals (Sweden)

    Barros Henrique

    2003-01-01

    Full Text Available OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR and their respective 95% confidence intervals (95% CI, crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]. CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.

  7. Community-acquired, health care-associated, and ventilator-associated pneumonia: three variations of a serious disease.

    Science.gov (United States)

    Scott, Susan S; Kardos, Cynthia B

    2012-09-01

    Pneumonia affects millions of people every year in the United States. Hospital-acquired pneumonia is associated with a mortality rate as high as 50%. Pneumonia is classified according to where it was acquired or by the infecting organism. This article explores the similarities and differences in three types of pneumonia seen routinely in the intensive care unit: community-acquired pneumonia, ventilator-associated pneumonia, and health care-associated pneumonia.

  8. Perceptions of effective relationships in an institutional care setting for older people

    Directory of Open Access Journals (Sweden)

    Vera Roos

    2014-02-01

    Full Text Available Orientation: The relocation of older people to residential facilities has implications for their relationships.Research purpose: This article reports older residents’ perceptions of effective relationships.Motivation for the study: Effective relationships protect against loneliness and depression and contribute to well-being. The facility was identified by a social worker as a showcase for effective relationships, but it was not clear what these consist of.Research approach, design and method: The World Café, a qualitative, participatory action research method, was applied to an economically deprived, urban facility caring for older people in Gauteng, South Africa. Three positively framed questions elicited perceptions from participants (nine men, ten women, aged 65–89. Visual and textual data were obtained and thematically analysed until saturation had been achieved. Themes were then subjected to deductive direct content analysis in terms of Self-Interactional Group Theory (SIGT.Main findings: Older residents perceive care managers as friendly and trustworthy and co-residents as caring. Care managers were seen as flexible, empathetic and congruent leaders and they confirmed residents. Relationships between residents were parallel-defined with relational qualities such as empathy and unconditional acceptance. Residents’ needs for privacy were honoured and they felt confirmed. Group dynamics were underpinned by caring and a stimulating environment provided opportunities for engagement.Practical/managerial implications: Relationships between managers and consumers are facilitated by flexibility, empathy, congruence and unconditional acceptance. Supportive group dynamics develop when people confirm and accept one another. A stimulating environment that encourages continuous and close interpersonal contact contributes to effective relationships.Contribution/value-add: Effective relationships should be understood on different levels.

  9. Audit of acute admissions of COPD: standards of care and management in the hospital setting.

    Science.gov (United States)

    Roberts, C M; Ryland, I; Lowe, D; Kelly, Y; Bucknall, C E; Pearson, M G

    2001-03-01

    Despite publication of several management guidelines for COPD, relatively little is known about standards of care in clinical practice. Data were collected on the management of 1400 cases of acute admission with Chronic Obstructive Pulmonary Disease in 38 UK hospitals to compare clinical practice against the recommended British Thoracic Society standards. Variation in the process of care between the different centres was analysed and a comparison of the management by respiratory specialists and nonrespiratory specialists made. There were large variations between centres for many of the variables studied. A forced expiratory volume in one second measurement was found in only 53% of cases. Of the investigations recommended in the acute management arterial blood gases were performed in 79% (interhospital range 40-100%) of admissions and oxygen was formally prescribed in only 64% (range 9-94%). Of those cases with acidosis and hypercapnia 35% had no further blood gas analysis and only 13% received ventilatory support. Long-term management was also deficient with 246 cases known to be severely hypoxic on admission yet two-thirds had no confirmation that oxygen levels had returned to levels above the requirements for long-term oxygen therapy. Only 30% of current smokers had cessation advice documented. To conclude, the median standards of care observed fell below those recommended by the guidelines. The lowest levels of performance were for patients not under the respiratory specialists, but specialists also have room for improvement. The substantial variation in the process of care between hospitals is strong evidence that it is possible for other centres with poorer performance to improve their levels of care.

  10. CLINICO-EPIDEMIOLOGICAL STUDY OF GENITAL ULCER DISE ASE AT A TERTIARY CARE CENTRE IN AN URBAN SETTING IN INDIA

    Directory of Open Access Journals (Sweden)

    Meetesh

    2013-03-01

    Full Text Available ABSTRACT: BACKGROUND: In developing countries, the proportion with STDs wh o present with genital ulcers is high compared to developed nat ions. AIM: To study clinic-epidemiological profile of cases presenting with genital ulcer diseas e at a tertiary care centre. STUDY SETTINGS: Present study was carried out in Department of skin and VD, Medical College and SSG Hospital Baroda between June 2001 and Feb. 2003 . MATERIAL AND METHODS: A cross sectional study was conducted. Sexually active male or female having genital ulcer with history of exposure in patient or partner. Total 216 cases we re included in the study. Detailed history was taken and was recorded. Inquiries were made reg arding age, educational status, occupation, marital status and details of their compl aints. History of sexual activity was elaborately taken. All the details pertaining to num ber of exposures, last exposure, sexual partners, sexual orientations and condom use were no ted. RESULTS: Most of the case are males i.e.91.5%. 56% cases were married. It includes 53 .7% males and more than 88% females. This implies that the high extramarital transmission occu rs in wives and they bear the consequences of extramarital activity of their husbands. . 63.8 % of unmarried male cases and 51.9% of married male cases had sexual exposure to sex worker s. Along with genital ulcer, the most common associated findings were lymph node enlargeme nt (72..4% and subprepucial discharge (13..6% in males. In females, (35.3% ca ses had vaginal discharge. the commonest ulcerative STD was herpes progenitalis (52.8% follo wed by syphilis (30.5%. CONCLUSION: The present study highlights that the high risk sexu al behavior was present in cases, irrespective of the marital and educational status. Female attendance was very low which may be due to asymptomatic STIs, social financial reason and their dependence on male partners for seeking treatment. KEY WORDS:Genital ulcer disease

  11. An uncommon case of random fire-setting behavior associated with Todd paralysis: A case report

    Directory of Open Access Journals (Sweden)

    Kanehisa Masayuki

    2012-08-01

    Full Text Available Abstract Background The association between fire-setting behavior and psychiatric or medical disorders remains poorly understood. Although a link between fire-setting behavior and various organic brain disorders has been established, associations between fire setting and focal brain lesions have not yet been reported. Here, we describe the case of a 24-year-old first time arsonist who suffered Todd’s paralysis prior to the onset of a bizarre and random fire-setting behavior. Case presentation A case of a 24-year-old man with a sudden onset of a bizarre and random fire-setting behavior is reported. The man, who had been arrested on felony arson charges, complained of difficulties concentrating and of recent memory disturbances with leg weakness. A video-EEG recording demonstrated a close relationship between the focal motor impairment and a clear-cut epileptic ictal discharge involving the bilateral motor cortical areas. The SPECT result was statistically analyzed by comparing with standard SPECT images obtained from our institute (easy Z-score imaging system; eZIS. eZIS revealed hypoperfusion in cingulate cortex, basal ganglia and hyperperfusion in frontal cortex,. A neuropsychological test battery revealed lower than normal scores for executive function, attention, and memory, consistent with frontal lobe dysfunction. Conclusion The fire-setting behavior and Todd’s paralysis, together with an unremarkable performance on tests measuring executive function fifteen months prior, suggested a causal relationship between this organic brain lesion and the fire-setting behavior. The case describes a rare and as yet unreported association between random, impulse-driven fire-setting behavior and damage to the brain and suggests a disconnection of frontal lobe structures as a possible pathogenic mechanism.

  12. The Role of Oral Care in Prevention of Ventilator Associated Pneumonia: A Literature Review

    Directory of Open Access Journals (Sweden)

    H Darvishi Khezri

    2014-02-01

    Full Text Available Introduction: Ventilator-associated pneumonia (VAP is the most common nosocomial infection reported among mechanical ventilation patients in intensive care units(ICU. Ventilator-associated pneumonia is associated with increased morbidity, mortality hospital, length of stay and health care costs. Oral health can be compromised by critical illness and by mechanical ventilation and thus, it deteriorates over time. A relationship exists between oral health status and VAP that is influenced by nursing care. Oropharynx colonization is the main risk factor for the development of VAP. Also dental plaques can provide a habitat for microorganisms responsible for VAP. Oral care in critically ill patients is an important issue and nurses of intensive cares play a key role in preventing VAP. Educations for all nurses of intensive cares should focus on the risk factors for VAP as well as onthe preventive interventions. The aim of the present study was to review the literature focusing on oral care in prevention of VAP.

  13. Gene set enrichment analysis for non-monotone association and multiple experimental categories

    OpenAIRE

    Heinloth Alexandra N; Irwin Richard D; Dai Shuangshuang; Lin Rongheng; Boorman Gary A; Li Leping

    2008-01-01

    Abstract Background Recently, microarray data analyses using functional pathway information, e.g., gene set enrichment analysis (GSEA) and significance analysis of function and expression (SAFE), have gained recognition as a way to identify biological pathways/processes associated with a phenotypic endpoint. In these analyses, a local statistic is used to assess the association between the expression level of a gene and the value of a phenotypic endpoint. Then these gene-specific local statis...

  14. [Prioritizing prescriptions in a ambulatory care setting: a tool to achieve appropriateness of care in public health management].

    Science.gov (United States)

    Semeraro, V; Zantedeschi, E; Pasquarella, A; Guerrera, C; Guasticchi, G

    2012-01-01

    Waiting lists are one of the main Public Health issues within developed countries. To promote appropriateness about General Practitioners' (GPs) prescriptions, during 2009 the project "Priority setting in outpatient prescriptions" in Latium Region has been approved. Regional referees, Latium Public Health Agency managers and advisors, managers and advisors of three Local Public Health Units (LPHUs) within the Latium region and some voluntarily recruited General Practitioners (each one with more than 800 patients enrolled) were included in a team work with the duty to develop the project. During two selected months of 2010, 46 GPs have forwarded overall 2.229 medical prescriptions. The six most numerous prescriptions were picked out and analyzed by the team work. 42% of these prescriptions were identified as belonging to category D of the priority level--"standard", while 42% and 41% of prescriptions bore the expressions of "control" and "diagnostic purpose" respectively. Among these ones, 75% were represented by bilateral mammography, prescribed to women aged between 50 and 69 years: but for those people bilateral mammography is already provided free of charge within the regional program of breast cancer screening, making the routine prescription by their physician a useless duplication, unacceptable in a healthcare system of good quality. Therefore at the conclusion of the project, the team work suggests proper standards be applied by healthcare professionals and GPs to achieve a significant objective: mammography appropriateness prescriptions.

  15. Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901

    Science.gov (United States)

    Luta, Gheorghe; Sheppard, Vanessa; Isaacs, Claudine; Cohen, Harvey J.; Muss, Hyman B.; Yung, Rachel; Clapp, Jonathan D.; Winer, Eric; Hudis, Clifford; Tallarico, Michelle; Wang, Julhy; Barry, William T.; Mandelblatt, Jeanne S.

    2015-01-01

    Purpose Survivorship care plans (SCP) are recommended for all cancer patients and could be especially useful to survivors 65 years and over (“older”). This study examined receipt of SCPs among older breast cancer survivors and whether SCPs were associated with improved patient-reported outcomes. Methods Three hundred and twenty-eight older women diagnosed with invasive, nonmetastatic breast cancer between 2007–2011 were recruited from 78 cooperative-group sites. Participants completed telephone interviews at baseline and 1-year posttreatment. Regression analyses examined SCP receipt (yes/no) and functioning (EORTC-QLQ-C30), cancer worry, and experiences of survivorship care (care coordination, knowledge). Results Only 35 % of women received SCPs. For each 1-year increase in age, there was a 5 % lower odds of receiving an SCP (odds ratio (OR)=0.94, 95 % confidence interval (CI) 0.91–0.98, p=0.007). Besides age, no other factor predicted SCPs. SCP receipt was associated with greater knowledge and understanding of requisite follow-up care (p<0.05); however, functioning was not significantly different among those with vs. without SCPs. Conclusions Receipt of care plans was limited. SCPs improved understanding of breast cancer follow-up care among older survivors, but did not impact functioning one year post-treatment. Implications for Cancer Survivors To impact functioning and salient needs of the growing cohort of older survivors, survivorship care plans likely should be tailored to geriatric-specific issues. To improve functioning, SCP content should expand to include exercise, nutrition, polypharmacy, social support and management of symptom burden from cancer, and other comorbid conditions. To improve follow-up care for cancer survivors, SCPs should delineate shared care roles between oncology and primary care in managing recurrence surveillance, screening, and cancer sequelae. PMID:24917307

  16. Daily associations between anxiety and alcohol use: variation by sustained attention, set shifting, and gender.

    Science.gov (United States)

    Dvorak, Robert D; Simons, Jeffrey S

    2014-12-01

    Many theories of emotion regulation and alcohol use posit that alcohol is consumed as a way to regulate negative mood. However, the literature has conflicting evidence on mood-alcohol use associations. Understanding how individual differences affect mood-alcohol use associations remains an important area of study. Previous research has suggested that cognitive abilities may affect the relationship between mood and alcohol. The current ecological momentary study examined associations between daytime anxious and positive mood and both (a) the likelihood of alcohol use and (b) the intensity of use on drinking nights as a function of sustained attention, set shifting, and gender. Participants (n = 100) completed assessments of sustained attention and set shifting, then carried palmtop computers for 21 days, reporting mood and alcohol use up to 8 times per day. Results showed that positive mood was consistently associated with both likelihood and intensity of alcohol use, but the association between positive mood and alcohol outcomes was not affected by cognitive abilities. Anxious mood was positively associated with the likelihood of drinking for men with high cognitive abilities. Anxious mood was positively associated with intoxication on drinking nights for men with high sustained attention, but inversely associated with intoxication on drinking nights for women with high sustained attention. Results suggest that variation in mood, executive functioning, and gender interact to contribute to observed differences in drinking behavior. These differences may be the result of gender-specific coping strategies in response to negative emotion.

  17. The association between the quality of life and depression of elderly in a nursing home institutional setting

    Directory of Open Access Journals (Sweden)

    Ľubica Ilievová

    2016-12-01

    Conclusions: Obtaining information on depression and the quality of life of elderly in nursing home settings should be introduced as a standard part of nursing activities in order to improve the quality of customer care in the nursing homes.

  18. Quality improvement programme for diabetes care in family practice settings in Dubai.

    Science.gov (United States)

    Khattab, M S; Swidan, A M; Farghaly, M N; Swidan, H M; Ashtar, M S; Darwish, E A; Al Mazrooei, A K; Mohammad, A A

    2007-01-01

    A continuous quality improvement programme for the care of registered diabetes patients was introduced in 16 government-affiliated primary health care centres in Dubai. Quality improvement teams were formed, clinical guidelines and information systems were developed, diabetes nurse practitioners were introduced and a team approach was mobilized. Audits before and after the introduction of the scheme showed significant improvements in rates of recording key clinical indicators and in their outcomes. For example, the proportion of patients with glycosylated haemoglobin levels < 7% increased from 20.6% to 31.7% and with LDL cholesterol < 100 mg/dL increased from 20.8% to 33.6%. Mean systolic blood pressure of registered patients fell from 135.3 mmHg to 133.2 mmHg.

  19. Chronic care management of globesity: promoting healthier lifestyles in traditional and mHealth based settings

    Directory of Open Access Journals (Sweden)

    Gianluca eCastelnuovo

    2015-10-01

    Full Text Available Obesity and being overweight could be real chronic conditions above all if there are other complications such as type 2 diabetes, cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer and various psychosocial and psychopathological disorders,. Due to the multifactorial etiology of obesity, evidence-based interventions to improve weight loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. There are significant limitations in this multidisciplinary chronic care management of obesity, most notably those regarding costs and long-term adherence and efficacy. Programs including eHealth platforms and new technologies could overcome limitations connected to the traditional in-patient chronic care management of obesity, thus providing promising opportunities in enhancing weight reduction and reducing complications in terms of long-term efficacy and effectiveness across clinical, organizational, and economic perspectives.

  20. Evaluation and comparison of health care Work Environment Scale in military settings.

    Science.gov (United States)

    Maloney, J P; Anderson, F D; Gladd, D L; Brown, D L; Hardy, M A

    1996-05-01

    The purpose of this study was to describe health care providers' perceptions of their work environment at a large U.S. Army medical center, and to compare the findings to other military medical centers. The sample (N = 112) consisted of the professional nursing staff working on the nine inpatient units. The Work Environmental Scale (WES) was used to measure perceptions of the workplace relative to gender, position (head nurses, staff nurses, and agency nurses), specialty nursing (intensive care unit [ICU] versus non-ICU), education (MSN, BSN, and ADN), and patterns of differences between the WES subscales of four military medical centers. Results of the study indicate that there were no significant gender differences. Head nurses, non-ICU nurses, and MSN nurses perceived their environment more positively. There were significant differences in the WES subscales between the military hospitals. Implications for nursing using the WES were recommended.

  1. Lung cancer management in limited resource settings: guidelines for appropriate good care.

    Science.gov (United States)

    Macbeth, Fergus R; Abratt, Raymond P; Cho, Kwan H; Stephens, Richard J; Jeremic, Branislav

    2007-02-01

    Lung cancer is a major cause of cancer death worldwide and is becoming an increasing problem in developing countries. It is important that, in countries where health care resources are limited, these resources are used most effectively and cost-effectively. The authors, with the support of the International Atomic Energy Agency, drew on existing evidence-based clinical guidelines, published systematic reviews and meta-analyses, as well as recent research publications, to summarise the current evidence and to make broad recommendations on the non-surgical treatment of patients with lung cancer. Tables were constructed which summarise the different treatment options for specific groups of patients, the increase in resource use for and the likely additional clinical benefit from each option. These tables can be used to assess the cost-effectiveness and appropriateness of different interventions in a particular health care system and to develop local clinical guidelines.

  2. When to say when: responding to a suicide attempt in the acute care setting.

    Science.gov (United States)

    Venkat, Arvind; Drori, Jonathan

    2014-01-01

    Attempted suicide represents a personal tragedy for the patient and their loved ones and can be a challenge for acute care physicians. Medical professionals generally view it as their obligation to aggressively treat patients who are critically ill after a suicide attempt, on the presumption that a suicidal patient lacks decision making capacity from severe psychiatric impairment. However, physicians may be confronted by deliberative patient statements, advanced directives or surrogate decision makers who urge the withholding or withdrawal of life sustaining treatments based on the patient's underlying medical condition or life experience. How acute care providers weigh these expressions of patient wishes versus their own views of beneficence, non-maleficence and professional integrity poses a significant ethical challenge. This article presents a case that exemplifies the medical and ethical tensions that can arise in treating a patient following a suicide attempt and how to approach their resolution.

  3. Assessment of Patient Safety Culture in Primary Health Care Settings in Kuwait

    OpenAIRE

    Maha Mohamed Ghobashi; Hanan Abdel Ghani El-ragehy; Hanan Mosleh Ibrahim; Fatma Abdullah Al-Doseri

    2014-01-01

    Background Patient safety is critical component of health care quality. We aimed to assess the awareness of primary healthcare staff members about patient safety culture and explore the areas of deficiency and opportunities for improvement concerning this issue.Methods: This descriptive cross sectional study surveyed 369 staff members in four primary healthcare centers in Kuwait using self-administered “Hospital Survey on Patient Safety Culture” adopted questionnaire. The total number of resp...

  4. Procalcitonin-guided antibiotic treatment of respiratory tract infections in a primary care setting

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Jensen, Jens Ulrik Stæhr

    2011-01-01

    Clinical signs of infection do not allow for correct identification of bacterial and viral aetiology in acute respiratory infections. A valid tool to assist the clinician in identifying patients who will benefit from antibiotic therapy, as well as patients with a potentially serious infection......, could greatly improve patient care and limit excessive antibiotic prescriptions. Procalcitonin is a new marker of suspected bacterial infection that has shown promise in guiding antibiotic therapy in acute respiratory tract infections in hospitals without compromising patient safety. Procalcitonin...

  5. Managing early childhood obesity in the primary care setting: a behavior modification approach.

    Science.gov (United States)

    Drohan, Samantha H

    2002-01-01

    The purpose of this article is to encourage primary care pediatric nurses to begin behavioral-based obesity treatment efforts as early as the preschool years. By examining the critical periods for obesity development and how the formation of food and activity behaviors interacts with those critical periods during the preschool years, the value of initiating early obesity treatment will be highlighted. Furthermore, the theory of behavior modification is presented and core principles are applied to early childhood weight management efforts.

  6. Fragile X-Associated Disorders (FXD): A Handbook for Families, Health Care Providers, Counselors, and Educators

    Science.gov (United States)

    Fragile X-associated Disorders (FXD) A Handbook for Families, Health Care Providers, Counselors, and Educators For Personal Use Only ... contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Section 1: Genetics of Fragile X-Associated Disorders . . . . . . . . . . . . . . . 2 Case Scenario of a Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...

  7. An appreciative inquiry approach to practice improvement and transformative change in health care settings.

    Science.gov (United States)

    Carter, Caroline A; Ruhe, Mary C; Weyer, Sharon; Litaker, David; Fry, Ronald E; Stange, Kurt C

    2007-01-01

    Amid tremendous changes and widespread dissatisfaction with the current health care system, many approaches to improve practice have emerged; however, their effects on quality of care have been disappointing. This article describes the application of a new approach to promote organizational improvement and transformation that is built upon collective goals and personal motivations, invites participation at all levels of the organization and connected community, and taps into latent creativity and energy. The essential elements of the appreciative inquiry (AI) process include identification of an appreciative topic and acting on this theme through 4 steps: Discovery, Dream, Design, and Destiny. We describe each step in detail and provide a case study example, drawn from a composite of practices, to highlight opportunities and challenges that may be encountered in applying AI. AI is a unique process that offers practice members an opportunity to reflect on the existing strengths within the practice, leads them to discover what is important, and builds a collective vision of the preferred future. New approaches such as AI have the potential to transform practices, improve patient care, and enhance individual and group motivation by changing the way participants think about, approach, and envision the future.

  8. Efficacy of brief interventions in clinical care settings for persons living with HIV.

    Science.gov (United States)

    Lightfoot, Marguerita; Rotheram-Borus, Mary Jane; Comulada, W Scott; Reddy, Vanessa S; Duan, Naihua

    2010-03-01

    Prevention of HIV transmission from patients living with HIV (PLH) is a high national priority and strategies that are easy to implement and sustain to eliminate sexual transmission acts among PLH are needed. We evaluated a brief intervention that focused primarily on the enhancing motivations and encouraging PLH to act in accordance with their values without providing the intensity of the existing evidence-based programs for PLH. Using a quasiexperimental design, six medical clinics in Los Angeles County, CA, were evaluated across three intervention conditions: 1) computerized delivery; 2) provider delivery; or 3) standard care. We examined longitudinal changes in patients' reports of the number of HIV-negative (HIV-) or serostatus-unknown sexual partners and the number of unprotected vaginal and anal sex acts. Among 566 PLH, PLH in the computerized delivery condition reported a significant decrease in the number of HIV-/unknown sexual partners compared with the provider delivery and standard care conditions and a significant decrease in the number of unprotected sex acts in comparison to the standard care condition. Computerized motivational interventions delivered in waiting rooms at medical clinics may be an efficient strategy to reduce unprotected sex acts among PLH.

  9. Health care in a unique setting: applying emergency medicine at music festivals

    Directory of Open Access Journals (Sweden)

    McQueen C

    2012-09-01

    Full Text Available Carl McQueen,1 Charlotte Davies21The Air Ambulance Service, Coventry, Warwickshire, 2Yorkshire Deanery, Yorkshire, UKAbstract: The last 25 years has seen an explosion in the popularity of outdoor music festivals, especially in the UK. Coupled with this has been the development of the trend for major sporting events that were once confined to stadia to be accompanied by mass gatherings of spectators and fans in "fan parks" and public places. The majority of music festivals and sporting events are considered to be mass gatherings, using the popular definition of more than 1000 people in one place.1 Despite the increasing popularity of music festivals and other mass gathering events, there is a lack of scientifically robust data concerning the provision of medical care in these circumstances. Published studies are almost exclusively retrospective reviews or case studies of the care provided at individual events. Prospective studies analyzing the role of medical professionals and the quality of care provided at mass gathering events are extremely rare. This literature review aims to summarize the current literature and provide an opportunity to identify new and exciting avenues for research into this unique field.Keywords: emergency medicine, mass gatherings, festivals, training, governance

  10. Disclosing intimate partner violence to health care clinicians - What a difference the setting makes: A qualitative study

    Directory of Open Access Journals (Sweden)

    Finley Erin

    2008-07-01

    Full Text Available Abstract Background Despite endorsement by national organizations, the impact of screening for intimate partner violence (IPV is understudied, particularly as it occurs in different clinical settings. We analyzed interviews of IPV survivors to understand the risks and benefits of disclosing IPV to clinicians across specialties. Methods Participants were English-speaking female IPV survivors recruited through IPV programs in Massachusetts. In-depth interviews describing medical encounters related to abuse were analyzed for common themes using Grounded Theory qualitative research methods. Encounters with health care clinicians were categorized by outcome (IPV disclosure by patient, discovery evidenced by discussion of IPV by clinician without patient disclosure, or non-disclosure, attribute (beneficial, unhelpful, harmful, and specialty (emergency department (ED, primary care (PC, obstetrics/gynecology (OB/GYN. Results Of 27 participants aged 18–56, 5 were white, 10 Latina, and 12 black. Of 59 relevant health care encounters, 23 were in ED, 17 in OB/GYN, and 19 in PC. Seven of 9 ED disclosures were characterized as unhelpful; the majority of disclosures in PC and OB/GYN were characterized as beneficial. There were no harmful disclosures in any setting. Unhelpful disclosures resulted in emotional distress and alienation from health care. Regardless of whether disclosure occurred, beneficial encounters were characterized by familiarity with the clinician, acknowledgement of the abuse, respect and relevant referrals. Conclusion While no harms resulted from IPV disclosure, survivor satisfaction with disclosure is shaped by the setting of the encounter. Clinicians should aim to build a therapeutic relationship with IPV survivors that empowers and educates patients and does not demand disclosure.

  11. End of life care policy for the dying: Consensus position statement of indian association of palliative care

    Directory of Open Access Journals (Sweden)

    Stanley C Macaden

    2014-01-01

    Full Text Available Purpose: To develop an End of Life Care (EOLC Policy for patients who are dying with an advanced life limiting illness. To improve the quality of care of the dying by limiting unnecessary therapeutic medical interventions, providing access to trained palliative care providers, ensuring availability of essential medications for pain and symptom control and improving awareness of EOLC issues through education initiatives. Evidence: A review of Country reports, observational studies and key surveys demonstrates that EOLC in India is delivered ineffectively, with a majority of the Indian population dying with no access to palliative care at end of life and essential medications for pain and symptom control. Limited awareness of EOLC among public and health care providers, lack of EOLC education, absent EOLC policy and ambiguous legal standpoint are some of the major barriers in effective EOLC delivery. Recommendations: Access to receive good palliative and EOLC is a human right. All patients are entitled to a dignified death. Government of India (GOI to take urgent steps towards a legislation supporting good EOLC, and all hospitals and health care institutions to have a working EOLC policy Providing a comprehensive care process that minimizes physical and non physical symptoms in the end of life phase and ensuring access to essential medications for pain and symptom control Palliative care and EOLC to be part of all hospital and community/home based programs Standards of palliative and EOLC as established by appropriate authorities and Indian Association of Palliative Care (IAPC met and standards accredited and monitored by national and international accreditation bodies All health care providers with direct patient contact are urged to undergo EOLC certification, and EOLC training should be incorporated into the curriculum of health care education.

  12. Knowledge and Practice of Diabetic Foot Care in an InPatient Setting at a Tertiary Medical Center

    Directory of Open Access Journals (Sweden)

    AR Muhammad-Lutfi

    2014-11-01

    Full Text Available Good knowledge and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputation. This study is conducted to assess patients’ knowledge and compliance of diabetic foot care. A cross sectional study performed on patients who were admitted to HSNZ from the 1st September 2013 to 30th April 2014 for diabetic foot infections. They were interviewed with a questionnaire of 15 ‘yes’ or ‘no’ questions on foot care knowledge and practice. Score of 1 was given for each ‘yes’ answer. The level of knowledge and practice, whether good or poor, was determined based on the median score of each category. The result was tested using a chi-square test in SPSS version 17. A total of 157 patients were included in this study with a mean age of 56.33 years (31-77. There were 72 male (45.9% and 85 female (54.1% patients with the majority of them being Malays (154 patients, 98.1%. Majority of the patients (58% had poor foot care knowledge while 97 patients (61.8% had poor diabetic foot care practice as compared to the median score. Based on the chi square test of relatedness, there was no significant association between knowledge and practice with any of the variables. In conclusion, the majority of patients admitted for diabetic foot infections had poor knowledge and practice of diabetic foot care. Education regarding foot care strategies should be emphasized and empowered within the diabetic population

  13. Health information technology and quality of health care: strategies for reducing disparities in underresourced settings.

    Science.gov (United States)

    Millery, Mari; Kukafka, Rita

    2010-10-01

    Health information technology (health IT) has potential for facilitating quality improvement and reducing quality disparities found in underresourced settings (URSs). With this systematic literature review, complemented by key informant interviews, the authors sought to identify evidence regarding health IT and quality outcomes in URSs. The review included 105 peer-reviewed studies (2004-2009) in all settings. Only 15 studies included URSs, and 8 focused on URSs. Based on literature across settings, most evidence was available for quality impact of order entry, clinical decision support systems, and computerized reminders. Study designs were predominantly quasi-experimental (37%) or descriptive (35%); 90% of the studies focused on the microsystem level of quality improvement, indicating a need for expanding research into patient experience and organizational and environmental levels. Key informants highlighted organizational partnerships and health IT champions and emphasized that for health IT to have an impact on quality, there must be an organizational culture of quality improvement.

  14. Key components of effective collaborative goal setting in the chronic care encounter.

    Science.gov (United States)

    Bigi, Sarah

    2014-01-01

    Collaborative goal setting in patient-provider communication with chronic patients is the phase in which--after collecting the data regarding the patient's health--it is necessary to make a decision regarding the best therapy and behaviors the patient should adopt until the next encounter. Although it is considered a pivotal phase of shared decision making, there remain a few open questions regarding its components and its efficacy: What are the factors that improve or impede agreement on treatment goals and strategies?; What are the 'success conditions' of collaborative goal setting?; How can physicians effectively help patients make their preferences explicit and then co-construct with them informed preferences to help them reach their therapeutic goals? Using the theoretical framework of dialogue types, an approach developed in the field of Argumentation Theory, it will be possible to formulate hypotheses on the success conditions' and effects on patient commitment of collaborative goal setting.

  15. Is the job satisfaction of primary care team members associated with patient satisfaction?

    Science.gov (United States)

    Szecsenyi, Joachim; Goetz, Katja; Campbell, Stephen; Broge, Bjoern; Reuschenbach, Bernd; Wensing, Michel

    2011-06-01

    BACKGROUND Previous research has shown a correlation between physician job satisfaction and patient satisfaction with quality of care, but the connection between job satisfaction of other primary care team members and patient satisfaction is yet unclear. OBJECTIVE To evaluate whether there is an association between patient satisfaction and job satisfaction of the members of patient care teams. DESIGN The study was based on data from the European Practice Assessment and used an observational design. SETTING 676 primary care practices in Germany. PARTICIPANTS 47 168 patients, 676 general practitioners (practice principals), 305 physician colleagues (trainees and permanently employed physicians) and 3011 non-physician practice members (nurses, secretaries). MAIN OUTCOME MEASURES Patient evaluation was measured using the 23-item EUROPEP questionnaire. Job satisfaction was measured using the 10-item Warr-Cook-Wall job satisfaction scale and further items relating to practice structure. Bivariate correlations were applied in which factors of patient satisfaction and practice structure were compared with physicians and non-physicians satisfaction. RESULTS Patient satisfaction correlates positively with the general job satisfaction of the non-physician (r=0.25, p<0.01) and no significant correlation was found for the general job satisfaction of practice principals and physician colleagues. Patients' satisfaction with the practice organisation correlates positively with the general job satisfaction of the non-physicians (r=0.30, p<0.01) and their view of practice structure (r=0.29, p<0.01). CONCLUSIONS The correlation between non-physician team member satisfaction and patient satisfaction was higher than the correlation between satisfaction of physicians and patients. Patients seem to be sensitive to aspects of practice structure.

  16. Candida colonization in preterm babies admitted to neonatal intensive care unit in the rural setting

    Directory of Open Access Journals (Sweden)

    Mendiratta D

    2006-01-01

    Full Text Available Purpose: Candida colonization in neonates results in significant morbidity and mortality. The purpose of this study was to determine colonization of Candida spp. in preterm babies and identify the risk factors. Methods: Swabs from oral, rectum, groin and umblicus of 103 preterm and 100 term neonates were obtained within 24 hours of birth, day three, day five, day seven and thereafter every week till the neonate was admitted in the neonatal intensive care unit (NICU. Swabs were also collected from the mother′s vagina prior to delivery. Twice every month, air of the NICU was sampled by settle plate and swabs were collected from the hands of health care workers and inanimate objects of NICU. Identification and speciation was done by standard methods. Antibiotic sensitivity was studied against amphotericin B, ketoconazole and fluconazole by disk diffusion method. Results: Colonization with Candida was significantly higher in preterms. Earliest colonization was of oral mucosa and 77.1% of the preterms had colonised at various sites by the first week of life. Significant risk factors in colonized versus non-colonized preterms were male sex, longer duration of rupture of membranes (DROM, administration of steroids and antibiotics and vaginal colonization of mothers, whereas those in preterms versus terms were low birth weight and gestational age. C. albicans was the commonest species, both in the colonized preterms (45.9% and vagina of mothers. Resistance was seen to fluconazole and ketoconazole only. No Candida spp. was isolated from health care personnel or environment. Conclusions: Colonization of preterms by Candida is a significant problem in NICU and the significant risk factors observed in colonized preterms were male sex, longer DROM, administration of steroids and antibiotics and vaginal colonization of mothers.

  17. Profile of patients attending psychogeriatric clinic in a tertiary care setting

    Directory of Open Access Journals (Sweden)

    Suresh Neethu

    2016-01-01

    Full Text Available Background: Proportion of elderly is increasing among the total population of Kerala, and mental health problems of this group are unique. Objectives: To assess the clinical and sociodemographic profile of patients attending Psychogeriatric Clinic in a tertiary care center and to study the correlation of sociodemographic and clinical variables with psychiatric diagnoses in this population. Materials and Methods: A retrospective chart review of patients, who attended the Psychogeriatric Clinic of a tertiary care center over a period of 1 year, was done. The Institutional Ethics Committee discussed and waived clearance for the review. Results: There were 85 cases with a mean age of 69.5 years (standard deviation-7.36. Majority of them were females (56.5% and belonged to low socioeconomic status (52.9%. Comorbid physical illnesses were seen in 76.5% cases. Diagnoses were made by Junior Residents in Psychiatry and confirmed by a qualified psychiatrist, as per International Classification of Diseases-10 criteria. The most common psychiatric diagnosis was organic mental disorders (24.7%, which included dementias, delirium, and organic mood disorders. This was followed by bipolar affective disorders (22.4%, schizophrenia and related disorders (20.0%, depressive and anxiety disorders (17.6% and mental and behavioral disorders due to substance use (2.4%. Occurrence of organic psychiatric disorders showed positive correlation with age (Spearman's ρ =0.253, P = 0.02 and occurrence of hypertension (ρ =0.222, P = 0.04. Conclusions: Organic psychiatric disorders are more common in elderly patients attending a tertiary care center. Comorbid physical illnesses are seen in more than three-fourths of this population. Organic psychiatric disorders are seen more commonly with increasing age and occurrence of hypertension.

  18. Prevalence and Risk Factors Associated with Precancerous Cervical Cancer Lesions among HIV-Infected Women in Resource-Limited Settings

    Directory of Open Access Journals (Sweden)

    Peter Memiah

    2012-01-01

    Full Text Available Objective. To assess the prevalence and identified associated risk factors for precancerous cervical cancer lesions among HIV-infected women in resource-limited settings in Kenya. Methods. HIV-infected women attending the ART clinic at the Nazareth Hospital ART clinic between June 2009 and September 2010. Multivariate logistic regression model with odds ratios and 95% confidence intervals (CI were estimated after controlling for important covariates. Result. A total of 715 women were screened for cervical cancer. The median age of the participants was 40 years (range 18–69 years. The prevalence of precancerous lesions (CINI, CINII, CIN III, ICC was 191 (26.7%. After controlling for other variables in logistic regression analysis, cervical precancerous lesions were associated with not being on ART therapy; whereby non-ART were 2.21 times more likely to have precancerous lesions than ART patients [(aOR=2.21, 95% CI (1.28–3.83]. Conclusion. The prevalence of precancerous cervical lesions was lower than other similar settings. It is recommended that cancer screening of HIV-infected women should be an established practice. Availability and accessibility of these services can be done through their integration into HIV. Prompt initiation of HAART through an early enrollment into care has an impact on reducing the prevalence and progression of cervical precancerous lesions.

  19. Human resource management strategies for the retention of nurses in acute care settings in hospitals in Australia.

    Science.gov (United States)

    Hogan, Pamela; Moxham, Lorna; Dwyer, Trudy

    2007-04-01

    It is paramount that there is an adequate nursing workforce supply for now and in the future, to achieve equitable and quality health outcomes and consumer access to healthcare, regardless of geographic location. Nursing forms the largest body of employees in the health care system, spanning all segments of care. A shortage of nurses, particularly in the acute care settings in hospitals, jeopardizes the provision of quality health care to consumers. This article provides a literature review of Australian State and Federal Government reports into nurse retention. All reports discuss staff turnover rates; the average age of nurses; enrolment numbers in nursing courses; workloads; nursing workforce shortfalls and the effect on the work environment; leadership and management styles; organizational culture; change management; the mobility of nursing qualifications both locally and internationally and the critical need to value nurses. Then why has the situation of nurse retention not improved? Possible reasons for the continued nurse shortage and the promise of strategic HRM in addressing nurse retention are discussed.

  20. Outpatient costs in pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting

    Directory of Open Access Journals (Sweden)

    Bosmans Judith E

    2012-02-01

    Full Text Available Abstract Background To assess differences in outpatient costs among pharmaceutically treated diabetes patients with and without a diagnosis of depression in a Dutch primary care setting. Methods A retrospective case control study over 3 years (2002-2004. Data on 7128 depressed patients and 23772 non-depressed matched controls were available from the electronic medical record system of 20 general practices organized in one large primary care organization in the Netherlands. A total of 393 depressed patients with diabetes and 494 non-depressed patients with diabetes were identified in these records. The data that were extracted from the medical record system concerned only outpatient costs, which included GP care, referrals, and medication. Results Mean total outpatient costs per year in depressed diabetes patients were €1039 (SD 743 in the period 2002-2004, which was more than two times as high as in non-depressed diabetes patients (€492, SD 434. After correction for age, sex, type of insurance, diabetes treatment, and comorbidity, the difference in total annual costs between depressed and non-depressed diabetes patients changed from €408 (uncorrected to €463 (corrected in multilevel analyses. Correction for comorbidity had the largest impact on the difference in costs between both groups. Conclusions Outpatient costs in depressed patients with diabetes are substantially higher than in non-depressed patients with diabetes even after adjusting for confounders. Future research should investigate whether effective treatment of depression among diabetes patients can reduce health care costs in the long term.

  1. TeleWound care – providing remote wound assessment and treatment in the home care setting: current status and future directions

    Directory of Open Access Journals (Sweden)

    Santamaria N

    2013-11-01

    Full Text Available Nick Santamaria,1 Suzanne Kapp2 1University of Melbourne and Melbourne Health, Royal Melbourne Hospital, Melbourne, VIC, Australia; 2Royal District Nursing Service Institute, Melbourne, VIC, Australia Abstract: The use of wound telemedicine systems in the home care environment has been expanding for the last decade. These systems can generally be grouped into two main types: store and forward systems and video conference type systems; additionally, there are also hybrid systems available that include elements of both. Evidence to date suggests that these systems provide significant benefits to patients, clinicians, and to the health care system generally. Reductions in resource use, visit substitution, costs, and high patient and clinician satisfaction have been reported; however, there is a lack of integration with existing health care technology and no clearly defined technical or clinical standards as yet. Similarly, the legalities associated with wound telemedicine and remote consultation remain unclear. As wound telemedicine systems continue to evolve and be deployed in different locations, there remains significant potential to harness their power to benefit patients being treated at home. Keywords: telemedicine, home care, e-health

  2. A needs assessment of the number of comprehensive addiction care physicians required in a Canadian setting.

    LENUS (Irish Health Repository)

    McEachern, Jasmine

    2016-05-13

    Medical professionals adequately trained to prevent and treat substance use disorders are in short supply in most areas of the world. Whereas physician training in addiction medicine can improve patient and public health outcomes, the coverage estimates have not been established. We estimated the extent of the need for medical professionals skilled in addiction medicine in a Canadian setting.

  3. How to develop a program to increase influenza vaccine uptake among workers in health care settings?

    NARCIS (Netherlands)

    Looijmans-van den Akker, I.; Hulscher, M.E.; Verheij, T.J.M.; Riphagen-Dalhuisen, J.; van Delden, J.J.M.; Hak, E.

    2011-01-01

    Background: Apart from direct protection and reduced productivity loss during epidemics, the main reason to immunize healthcare workers (HCWs) against influenza is to provide indirect protection of frail patients through reduced transmission in healthcare settings. Because the vaccine uptake among H

  4. How to develop a program to increase influenza vaccine uptake among workers in health care settings?

    NARCIS (Netherlands)

    Looijmans-van den Akker, I.; Hulscher, M.E.J.L.; Verheij, T.J.; Riphagen-Dalhuisen, J.; Delden, J.J.M. van; Hak, E.

    2011-01-01

    BACKGROUND: Apart from direct protection and reduced productivity loss during epidemics, the main reason to immunize healthcare workers (HCWs) against influenza is to provide indirect protection of frail patients through reduced transmission in healthcare settings. Because the vaccine uptake among H

  5. Cutaneous adverse drug reaction profile in a tertiary care out patient setting in Eastern India

    Directory of Open Access Journals (Sweden)

    Abanti Saha

    2012-01-01

    Conclusions: Cutaneous adverse drug reaction profile in this study is similar in many ways to studies conducted earlier in India. Incidence of life-threatening reactions like SJS-TEN was higher compared with studies conducted abroad. Reaction time and lesion patterns are helpful in identifying an offending drug in the setting of multiple drug therapy.

  6. Factors influencing patients seeking oral health care in the oncology dental support clinic at an urban university dental school setting.

    Science.gov (United States)

    Corrigan, Dale M; Walker, Mary P; Liu, Ying; Mitchell, Tanya Villalpando

    2014-01-01

    The purpose of this study was to identify predictors and/or factors associated with medically compromised patients seeking dental care in the oncology dental support clinic (ODSC) at the University of Missouri-Kansas City (UMKC) School of Dentistry. An 18-item survey was mailed to 2,541 patients who were new patients to the clinic from 2006 to 2011. The response rate was approximately 18% (n = 450). Analyses included descriptive statistics of percentages/frequencies as well as predictors based on correlations. Fifty percent of participants, 100 females and 119 males, identified their primary medical diagnosis as cancer. Total household income (p dental care (p dental health. Perceived overall health (p < .001) also had a significant association with cancer status and the need for organ transplants. This study provided the ODSC at UMKC and other specialty clinics with vital information that can contribute to future planning efforts.

  7. Opportunity costs associated with caring for older Mexican-Americans.

    Science.gov (United States)

    Brown, H Shelton; Herrera, Angelica P; Angel, Jacqueline L

    2013-09-01

    Long-term care use among older Mexican-Americans is poorly understood, despite the adverse effects on health and economic disadvantage in this vulnerable population. This study examines gender-based risk of long-term care use in 628 women and 391 men, age 70 and over in the 2000-2001 and 2004-2005 waves of the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Logistic regression models are employed to assess the impact of the opportunity cost implications of family support (kin availability and co-residence) relative to health care needs (quality-adjusted life years (QALY) weighted scores and functional limitations) on women's risk of entry into a nursing home. A small percentage (~5%) of men and women had entered a long-term care facility. Women had lower weights for QALY weights and greater disability than men, but on average were more likely to live with or in closer proximity to an adult child. Higher disability rates (p long-term care use.

  8. General and URTI-specific antibiotic prescription rates in a Malaysian primary care setting.

    Science.gov (United States)

    Teng, C L; Achike, F I; Phua, K L; Norhayati, Y; Nurjahan, M I; Nor, A H; Koh, C N

    2004-11-01

    Antibiotic prescribing by primary care doctors has received renewed interest due to the continuing emergence of antibiotic resistance and the attendant cost to healthcare. We examined the antibiotic prescribing rate in relation to selected socio-demographic characteristics of the prescribers at the Seremban Health Clinic, a large public primary care clinic, designated for teaching, in the state of Negeri Sembilan, Malaysia. Data were obtained from: (1) retrospective review of prescriptions for the month of June 2002 and (2) a questionnaire survey of prescribers. A total of 10667 prescriptions were reviewed. The overall antibiotic prescribing rate was 15%; the rate (16%) was higher for the general Outpatient Department (OPD) than the 3% for the Maternal & Child Health Clinic (MCH). The antibiotic prescription rates for upper respiratory tract infection (URTI) were 26% and 16%, respectively, for the OPD and MCH. Half of all the antibiotic prescriptions were for URTI making prescribing for URTI an appropriate target for educational intervention. The URTI-specific antibiotic prescription rate did not correlate with the prescribers' intention to specialise, patient load, perceived patient's expectation for an antibiotic, or the score for knowledge of streptococcal tonsillitis. Prescribing behaviours and record-keeping practices requiring correction were identified.

  9. Point-of-care testing for HIV in an Irish prison setting: results from three major Irish prisons.

    Science.gov (United States)

    Bannan, Ciaran L; Lynch, Pamela A; Conroy, Emmett P; O'Dea, Siobhan; Surah, Saloni; Betts-Symonds, Graham; Lyons, Fiona E

    2016-10-01

    HIV is more prevalent in the prison population compared to the general population. Prison inmates are at an increased risk of blood-borne infections. Considerable stigma has been documented amongst inmates with HIV infection. In collaboration with the schools, healthcare facilities, prison authorities and inmate Irish Red Cross groups in Wheatfield, Cloverhill and Mountjoy prisons in Dublin, Ireland, the Department of Genito Urinary Medicine and Infectious Diseases at St James' Hospital in Dublin developed a campaign for raising awareness of HIV, educating inmates about HIV and tackling HIV stigma. Following this campaign, large-scale point-of-care testing for HIV was offered over a short period. In total, 741 inmates were screened for HIV. One inmate tested positive for HIV. We experienced a large number of invalid test results, requiring formal laboratory serum testing, and a small number of false positive results. Large-scale point-of-care testing in the Irish prison setting is acceptable and achievable.

  10. Microscopy, culture, and sensitive management of uncomplicated urinary tract infections in adults in the primary care setting.

    Science.gov (United States)

    Sivathasan, Niroshan; Rakowski, Krzysztof R

    2011-06-01

    The high prevalence of urinary tract infections (UTIs) places a significant burden on healthcare systems. Clinicians may over-manage the issue, and there is great variability in practice, with economic- and resource- implications. Up to 40% of patients with a suspected UTI do not have an infection. Using PubMed (Medline) to shortlist relevant papers in English from the last 30 years, and further sub-selection to include only uncomplicated UTIs in adults in primary care, we reviewed the literature pertaining to uncomplicated UTIs, and how it should be managed efficiently in the primary care setting. In general practice, there is no advantage to routinely request microscopy and culture of urine samples in the presence of an appropriate history and urinalysis reagent-strip testing. If antibiotics are required, then a 3-day course shall suffice. Larger epidemiological studies focusing on more susceptible sub-populations may provide better guidance for discriminatory factors to produce an algorithm for treatment.

  11. Cognitive behavioral treatment for older adults with generalized anxiety disorder. A therapist manual for primary care settings.

    Science.gov (United States)

    Stanley, Melinda A; Diefenbach, Gretchen J; Hopko, Derek R

    2004-01-01

    At least four academic clinical trials have demonstrated the utility of cognitive behavior therapy (CBT) for older adults with generalized anxiety disorder (GAD). These data may not generalize, however, to more heterogeneous and functionally impaired patients and the medical settings in which they typically receive care. A recent pilot project suggested the potential benefits of a new version of CBT for GAD among older patients in primary care. The manual developed and tested in this pilot project is presented here. Treatment components include motivation and education, relaxation skills, cognitive therapy, problem-solving-skills training, exposure exercises, and sleep-management-skills training. Procedures are designed to be administered flexibly to maximize attention to individual patient needs. Examples of session summaries, patient handouts, and homework forms are provided.

  12. A population-based model for priority setting across the care continuum and across modalities

    Directory of Open Access Journals (Sweden)

    Mortimer Duncan

    2006-03-01

    Full Text Available Abstract Background The Health-sector Wide (HsW priority setting model is designed to shift the focus of priority setting away from 'program budgets' – that are typically defined by modality or disease-stage – and towards well-defined target populations with a particular disease/health problem. Methods The key features of the HsW model are i a disease/health problem framework, ii a sequential approach to covering the entire health sector, iii comprehensiveness of scope in identifying intervention options and iv the use of objective evidence. The HsW model redefines the unit of analysis over which priorities are set to include all mutually exclusive and complementary interventions for the prevention and treatment of each disease/health problem under consideration. The HsW model is therefore incompatible with the fragmented approach to priority setting across multiple program budgets that currently characterises allocation in many health systems. The HsW model employs standard cost-utility analyses and decision-rules with the aim of maximising QALYs contingent upon the global budget constraint for the set of diseases/health problems under consideration. It is recognised that the objective function may include non-health arguments that would imply a departure from simple QALY maximisation and that political constraints frequently limit degrees of freedom. In addressing these broader considerations, the HsW model can be modified to maximise value-weighted QALYs contingent upon the global budget constraint and any political constraints bearing upon allocation decisions. Results The HsW model has been applied in several contexts, recently to osteoarthritis, that has demonstrated both its practical application and its capacity to derive clear evidenced-based policy recommendations. Conclusion Comparisons with other approaches to priority setting, such as Programme Budgeting and Marginal Analysis (PBMA and modality-based cost

  13. Opportunity costs associated with caring for older Mexican-Americans

    OpenAIRE

    Brown, H. Shelton; Herrera, Angelica P.; Angel, Jacqueline L.

    2013-01-01

    Long-term care use among older Mexican-Americans is poorly understood, despite the adverse effects on health and economic disadvantage in this vulnerable population. This study examines gender-based risk of long-term care use in 628 women and 391 men, age 70 and over in the 2000-01 and 2004-05 waves of the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Logistic regression models are employed to assess the impact of the opportunity cost implications of family suppor...

  14. Clowning in Health Care Settings: The Point of View of Adults

    OpenAIRE

    Alberto Dionigi; Carla Canestrari

    2016-01-01

    Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), w...

  15. The influence of heart disease on characteristics, quality of life, use of health resources, and costs of COPD in primary care settings

    Directory of Open Access Journals (Sweden)

    Hernandez-Barrera Valentín

    2010-02-01

    Full Text Available Abstract Background To evaluate the influence of heart disease on clinical characteristics, quality of life, use of health resources, and costs of patients with COPD followed at primary care settings under common clinical practice conditions. Methods Epidemiologic, observational, and descriptive study (EPIDEPOC study. Patients ≥ 40 years of age with stable COPD attending primary care settings were included. Demographic, clinical characteristics, quality of life (SF-12, seriousness of the disease, and treatment data were collected. Results were compared between patients with or without associated heart disease. Results A total of 9,390 patients with COPD were examined of whom 1,770 (18.8% had heart disease and 78% were males. When comparing both patient groups, significant differences were found in the socio-demographic characteristics, health profile, comorbidities, and severity of the airway obstruction, which was greater in patients with heart disease. Differences were also found in both components of quality of life, physical and mental, with lower scores among those patients with heart disease. Higher frequency of primary care and pneumologist visits, emergency-room visits and number of hospital admissions were observed among patients with heart diseases. The annual total cost per patient was significantly higher in patients with heart disease; 2,937 ± 2,957 vs. 1,749 ± 2,120, p Conclusion Patients with COPD plus heart disease had greater disease severity and worse quality of life, used more healthcare resources and were associated with greater costs compared to COPD patients without known hearth disease.

  16. Setting the pace for VISION 2020 in Ghana: the case of Bawku Eye Care Programme

    Directory of Open Access Journals (Sweden)

    Michael Ekuoba Gyasi

    2006-09-01

    Full Text Available IntroductionGhana is a west African country bordered on the south by the Atlantic Ocean, and the north, east, and west by the Republics of Burkina Faso, Togo, and Ivory Coast respectively. It has a population of 20,771,382. Prevalence of blindness is estimated at one per cent. It currently has 52 ophthalmologists and 216 ophthalmic nurses (National Eye Care Secretariat, with nearly half of the ophthalmologists (19 located in the national capital and its environs. The health sector attracted 7.9 per cent of government budget in 2002 and 12.3 per cent in the 2006 budget. Currently there is a comprehensive national health insurance policy being implemented that covers most of the common eye operations done in the country.

  17. An improved predictive association rule based classifier using gain ratio and T-test for health care data diagnosis

    Indian Academy of Sciences (India)

    M Nandhini; S N Sivanandam

    2015-09-01

    Health care data diagnosis is a significant task that needs to be executed precisely, which requires much experience and domain-knowledge. Traditional symptoms-based disease diagnosis may perhaps lead to false presumptions. In recent times, Associative Classification (AC), the combination of association rule mining and classification has received attention in health care applications which desires maximum accuracy. Though several AC techniques exist, they lack in generating quality rules for building efficient associative classifier. This paper aims to enhance the accuracy of the existing CPAR (Classification based on Predictive Association Rule) algorithm by generating quality rules using Gain Ratio. Mostly, health care applications deal with high dimensional datasets. Existence of high dimensions causes unfair estimates in disease diagnosis. Dimensionality reduction is commonly applied as a preprocessing step before classification task to improve classifier accuracy. It eliminates redundant and insignificant dimensions by keeping good ones without information loss. In this work, dimensionality reductions by T-test and reduct sets (or simply reducts) are performed as preprocessing step before CPAR and CPAR using Gain Ratio (CPAR-GR) algorithms. An investigation was also performed to determine the impact of T-test and reducts on CPAR and CPAR-GR. This paper synthesizes the existing work carried out in AC, and also discusses the factors that influence the performance of CPAR and CPAR-GR. Experiments were conducted using six health care datasets from UCI machine learning repository. Based on the experiments, CPAR-GR with T-test yields better classification accuracy than CPAR.

  18. A novel educational programme to improve knowledge regarding health care-associated infection and hand hygiene.

    Science.gov (United States)

    Fitzpatrick, Maureen; Everett-Thomas, Ruth; Nevo, Igal; Shekhter, Ilya; Rosen, Lisa F; Scheinman, Stephen R; Arheart, Kristopher L; Birnbach, David J

    2011-06-01

    Lack of hand hygiene by health-care workers is the most significant cause of health care-associated infection. This programme was designed to make health-care workers want to wash their hands, to change their knowledge regarding hand hygiene and health care-associated infection, and influence practice. Improvement between pre- and post-test scores was statistically significant. Compliance is a multifactorial problem that involves knowledge and behaviour. Educational awareness and frequent reminders are critical to maintain high rates of hand hygiene compliance.

  19. Role Domains of Knowledge Brokering: A Model for the Health Care Setting.

    Science.gov (United States)

    Glegg, Stephanie M; Hoens, Alison

    2016-04-01

    Knowledge brokering is a strategy to support collaborations and partnerships within and across clinical, research, and policy worlds to improve the generation and use of research knowledge. Knowledge brokers function in multiple roles to facilitate the use of evidence by leveraging the power of these partnerships. The application of theory can provide clarity in understanding the processes, influences, expected mechanisms of action, and desired outcomes of knowledge brokering. Viewing knowledge brokering from the perspective of its role domains can provide a means of organizing these elements to advance our understanding of knowledge brokering. The objectives of this special interest article are (1) to describe the context for knowledge brokering in health care, (2) to provide an overview of knowledge translation theories applied to knowledge brokering, and (3) to propose a model outlining the role domains assumed in knowledge brokering. The Role Model for Knowledge Brokering is composed of 5 role domains, including information manager, linking agent, capacity builder, facilitator, and evaluator. We provide examples from the literature and our real-world experience to demonstrate the application of the model. This model can be used to inform the practice of knowledge brokering as well as professional development and evaluation strategies. In addition, it may be used to inform theory-driven research examining the effectiveness of knowledge brokering on knowledge generation and translation outcomes in the health care field, as well as on patient health outcomes.Video Abstract is available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A126).

  20. Recovery-oriented care in a secure mental health setting: "striving for a good life".

    Science.gov (United States)

    McKenna, Brian; Furness, Trentham; Dhital, Deepa; Park, Malcolm; Connally, Fiona

    2014-01-01

    Recovery-oriented care acknowledges the unique journey of the consumer to regain control of his or her life in order to live a good life. Recovery has become a dominant policy-directed model of mental health service delivery. Even services that have traditionally been institutional and custodial have been challenged to embrace a recovery-oriented model. The aim of this qualitative study was to provide a description of service delivery in a secure in-patient mental health service, which has developed a self-professed recovery-oriented model of service delivery. An in-depth case study of the secure in-patient service using an exploratory research design was undertaken to meet the aim of this study. Qualitative data was gathered from interviews with consumers and staff (n = 15) and a focus group with carers (n = 5). Data were analyzed using a content analysis approach. Ethical approval for the study was obtained. The stakeholders readily described the secure service within recovery domains. They described a common vision; ways to promote hope and autonomy; examples of collaborative partnership which enhanced the goal of community integration; a focus on strength-based, holistic care; and the management of risk by taking calculated risks. Discrepancies in the perceptions of stakeholders were determined. This case study research provides a demonstrable example of recovery-in-action in one secure mental health service in Australia. It is intended to assist mental health services and clinicians seeking guidance in developing strategies for building and maintaining partnerships with consumers and carers in order for secure services to become truly recovery-oriented.

  1. Knowledge, attitude and practice of pediatric critical care nurses towards pain: Survey in a developing country setting

    Directory of Open Access Journals (Sweden)

    P J Mathew

    2011-01-01

    Full Text Available Background : Nurses′ knowledge, sensitivity and attitudes about pain in children and its management affect their response and therefore management of pediatric pain. Children in critical care units undergo more painful procedures than those in general wards. Aims : To study the knowledge, attitude and practice of nursing personnel catering to critically ill children in a developing country. Settings and Design : Prospective questionnaire-based survey. Materials and Methods : The survey was carried out in a tertiary care teaching hospital on nursing personnel in three pediatric/neonatal intensive care units. The domains studied were: i. Training and experience, ii. Knowledge of pediatric pain, iii. Individual attitude towards pain in children, iv. Personal practice(s for pain alleviation, v. Pain assessment, and vi. Non-pharmacological measures adopted. Statistical Analysis : Descriptive statistics and logistic regression. Results : Of the 81 nursing personnel working in the three critical care units, 56 (69.1% responded to the questionnaire. Only one-third of them had received formal training in pediatric nursing. Fifty percent of the respondents felt that infants perceive less pain than adults. Training in pediatric nursing was a significant contributing factor in the domain of knowledge (P=0.03. Restraint and distraction were the common modalities employed to facilitate painful procedures. Scientific approaches like eutectic mixture of local anesthetic and the judicious use of sedatives were not adopted routinely. Observing a child′s face and posture were widely used parameters to assess pain (83%. None of the three critical care areas used a scoring system to assess pain. Conclusions : There are several lacunae in the knowledge and practice of nurses in developing countries which need to be improved by training.

  2. Using hybrid associative classifier with translation (HACT for studying imbalanced data sets

    Directory of Open Access Journals (Sweden)

    Laura Cleofas Sánchez

    2012-04-01

    Full Text Available Class imbalance may reduce the classifier performance in several recognition pattern problems. Such negative effect is more notable with least represented class (minority class Patterns. A strategy for handling this problem consisted of treating the classes included in this problem separately (majority and minority classes to balance the data sets (DS. This paper has studied high sensitivity to class imbalance shown by an associative model of classification: hybrid associative classifier with translation (HACT; imbalanced DS impact on associative model performance was studied. The convenience of using sub-sampling methods for decreasing imbalanced negative effects on associative memories was analysed. This proposal’s feasibility was based on experimental results obtained from eleven real-world datasets.

  3. Decreased health care quality associated with emergency department overcrowding.

    Science.gov (United States)

    Miró, O; Antonio, M T; Jiménez, S; De Dios, A; Sánchez, M; Borrás, A; Millá, J

    1999-06-01

    The objective of this study was to assess the influence of overcrowding on health care quality provided by emergency departments (ED). The study was carried out in an urban, university tertiary care hospital. All patients seen at the internal medicine unit (IMU) of the ED who returned during the following 72 hours, and those who died in the ED rooms were included in the study. During a consecutive period of 2 years (104 weeks), we prospectively quantified the number of weekly visits, revisits and deaths. We calculated revisit and mortality rates (in respect of percentage of all visited patients) for each week. Correlation between the number of weekly visits, and revisit and mortality rates was assessed using a simple linear regression model. We consigned 81,301 visits, 1137 revisits and 648 deaths; mean (+/- SD) number of weekly visits, revisits and deaths were 782 (68), 10.93 (3.97) and 6.23 (3.04) respectively; weekly revisit rate was 1.40% (0.48%) and weekly mortality rate was 0.79% (0.36%). We observed a significant, positive correlation between mortality rates and weekly number of visits (p = 0.01). Although a similar trend was also found for revisit rates, such an increase did not reach statistical significance (p = 0.06). It is concluded that since revisit and mortality rates constitute good health care quality markers, present data demonstrate that ED overcrowding implies a decrease in the health care quality provided by it.

  4. Is performance in task-cuing experiments mediated by task set selection or associative compound retrieval?

    Science.gov (United States)

    Forrest, Charlotte L D; Monsell, Stephen; McLaren, Ian P L

    2014-07-01

    Task-cuing experiments are usually intended to explore control of task set. But when small stimulus sets are used, they plausibly afford learning of the response associated with a combination of cue and stimulus, without reference to tasks. In 3 experiments we presented the typical trials of a task-cuing experiment: a cue (colored shape) followed, after a short or long interval, by a digit to which 1 of 2 responses was required. In a tasks condition, participants were (as usual) directed to interpret the cue as an instruction to perform either an odd/even or a high/low classification task. In a cue + stimulus → response (CSR) condition, to induce learning of mappings between cue-stimulus compound and response, participants were, in Experiment 1, given standard task instructions and additionally encouraged to learn the CSR mappings; in Experiment 2, informed of all the CSR mappings and asked to learn them, without standard task instructions; in Experiment 3, required to learn the mappings by trial and error. The effects of a task switch, response congruence, preparation, and transfer to a new set of stimuli differed substantially between the conditions in ways indicative of classification according to task rules in the tasks condition, and retrieval of responses specific to stimulus-cue combinations in the CSR conditions. Qualitative features of the latter could be captured by an associative learning network. Hence associatively based compound retrieval can serve as the basis for performance with a small stimulus set. But when organization by tasks is apparent, control via task set selection is the natural and efficient strategy.

  5. The Role of Oral Care in Prevention of Ventilator Associated Pneumonia: A Literature Review

    OpenAIRE

    H Darvishi Khezri

    2014-01-01

    Introduction: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection reported among mechanical ventilation patients in intensive care units(ICU). Ventilator-associated pneumonia is associated with increased morbidity, mortality hospital, length of stay and health care costs. Oral health can be compromised by critical illness and by mechanical ventilation and thus, it deteriorates over time. A relationship exists between oral health status and VAP that is influenced by ...

  6. Individual and contextual-level factors associated with continuity of care for adults with schizophrenia.

    Science.gov (United States)

    Fontanella, Cynthia A; Guada, Joseph; Phillips, Gary; Ranbom, Lorin; Fortney, John C

    2014-09-01

    This retrospective cohort study examined rates of conformance to continuity of care treatment guidelines and factors associated with conformance for persons with schizophrenia. Subjects were 8,621 adult Ohio Medicaid recipients, aged 18-64, treated for schizophrenia in 2004. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Outcome measures captured four dimensions of continuity of care: (1) regularity of care; (2) transitions; (3) care coordination, and (4) treatment engagement. Multilevel modeling was used to assess the association between individual and contextual-level variables and the four continuity of care measures. The results indicated that conformance rates for continuity of care for adults with schizophrenia are below recommended guidelines and that variations in continuity of care are associated with both individual and contextual-level factors. Efforts to improve continuity of care should target high risk patient groups (racial/ethnic minorities, the dually diagnosed, and younger adults with early onset psychosis), as well as community-level risk factors (provider supply and geographic barriers of rural counties) that impede access to care.

  7. The Association between Freedom of Choice and Effectiveness of Home Care Services

    Directory of Open Access Journals (Sweden)

    Marina Steffansson

    2016-03-01

    Full Text Available Objectives: The aim of this paper is to study home care clients’ freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. Methods: A structured postal survey was conducted among regular home care clients ('n' = 2096 aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients’ subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. Results: As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Conclusion: Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients’ opinions and to thereby improve the effectiveness of home care services.

  8. Associations between perceived chronic care quality, perceived patient centeredness, and illness representations among persons with diabetes.

    Science.gov (United States)

    Thomas, Joseph; Iyer, Neeraj N; Collins, William B

    2014-01-01

    Patient beliefs about their illness can motivate behaviors consistent with good disease management. Perceived high-quality chronic care would be expected to increase likelihood of having such beliefs. Associations between perceived quality of chronic care and illness representations, and associations between patient centeredness and illness representations were assessed among persons with diabetes. A mail survey of diabetic patients visiting a multispecialty physician network serving urban and suburban populations in a large midwestern city was conducted. The Patient Assessment of Chronic Illness Care-5A questionnaire was used to assess perceived chronic care quality and patient centeredness. The Brief Illness Perception Questionnaire was used to assess illness representations. Of 500 mailed surveys, 89 completed surveys were returned. The sample consisted mostly of retirees (61%), Whites (81%), and women (60%). Higher perceived chronic care quality was associated with better disease understanding of diabetes (0.24, p = .05). Patients reporting higher patient centeredness (or lower patient-centeredness scores) indicated better disease understanding (-0.26, p = .04) and those reporting higher patient centeredness (or lower patient-centeredness scores) perceived less impact of illness (0.29, p = .02). Chronic care quality as defined in the Chronic Care Model and consistency of chronic care with patient expectations (patient centeredness) was associated with illness representations favorable for good self-care management.

  9. Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting

    Directory of Open Access Journals (Sweden)

    Cucalón José M

    2006-02-01

    analyses. After multivariate adjustments, age, male gender, smoking, high total cholesterol, high HDL/LDL ratio, diabetes and overweight remained strongly associated with risk. Relative risks for hypertension in women and for diabetes in men did not reach statistical significance. Conclusion Despite high prevalence of vascular risk factors, incidence rates were lower than those reported for other countries and other periods, but similar to those reported in the few population-based studies in Spain. Effect measures of vascular risk factors were mainly as reported worldwide and support the hypothesis that protective factors not considered in this study must exist as to explain low rates. This study shows the feasibility of conducting epidemiological cohort studies in primary-care settings.

  10. Maternal health in resource-poor urban settings: how does women's autonomy influence the utilization of obstetric care services?

    Directory of Open Access Journals (Sweden)

    Ezeh Alex C

    2009-06-01

    Full Text Available Abstract Background Despite various international efforts initiated to improve maternal health, more than half a million women worldwide die each year as a result of complications arising from pregnancy and childbirth. This research was guided by the following questions: 1 How does women's autonomy influence the choice of place of delivery in resource-poor urban settings? 2 Does its effect vary by household wealth? and 3 To what extent does women's autonomy mediate the relationship between women's education and use of health facility for delivery? Methods The data used is from a maternal health study carried out in the slums of Nairobi, Kenya. A total of 1,927 women (out of 2,482 who had a pregnancy outcome in 2004–2005 were selected and interviewed. Seventeen variable items on autonomy were used to construct women's decision-making, freedom of movement, and overall autonomy. Further, all health facilities serving the study population were assessed with regard to the number, training and competency of obstetric staff; services offered; physical infrastructure; and availability, adequacy and functional status of supplies and other essential equipment for safe delivery, among others. A total of 25 facilities were surveyed. Results While household wealth, education and demographic and health covariates had strong relationships with place of delivery, the effects of women's overall autonomy, decision-making and freedom of movement were rather weak. Among middle to least poor households, all three measures of women's autonomy were associated with place of delivery, and in the expected direction; whereas among the poorest women, they were strong and counter-intuitive. Finally, the study showed that autonomy may not be a major mediator of the link between education and use of health services for delivery. Conclusion The paper argues in favor of broad actions to increase women's autonomy both as an end and as a means to facilitate improved

  11. Interventions for the prevention of catheter associated urinary tract infections in intensive care units: An integrative review.

    Science.gov (United States)

    Galiczewski, Janet M

    2016-02-01

    Catheter associated urinary tract infections (CAUTIs) put an unnecessary burden on patients and health care systems. The purpose of this integrative review was to examine existing evidence on preventative interventions and protocols currently implemented in intensive care units (ICUs) and the impact they have on CAUTI rates and patient outcomes. This review analysed 14 research articles obtained from electronic databases and included adult patients with urinary catheters in an ICU setting. Evidence demonstrated interventions that included criteria for catheter use, daily review of catheter necessity and discontinuation of catheter prior to day seven were successful in decreasing CAUTI rates. This review provides a scientific basis for the effectiveness of these interventions and protocols. Identification and use of interventions with the greatest positive impact on CAUTI rates are an asset to healthcare professional caring for patients with indwelling catheters and nurse clinicians developing policies.

  12. A taxonomy for community-based care programs focused on HIV/AIDS prevention, treatment, and care in resource-poor settings.

    Science.gov (United States)

    Rachlis, Beth; Sodhi, Sumeet; Burciul, Barry; Orbinski, James; Cheng, Amy H Y; Cole, Donald

    2013-04-16

    Community-based care (CBC) can increase access to key services for people affected by HIV/AIDS through the mobilization of community interests and resources and their integration with formal health structures. Yet, the lack of a systematic framework for analysis of CBC focused on HIV/AIDS impedes our ability to understand and study CBC programs. We sought to develop taxonomy of CBC programs focused on HIV/AIDS in resource-limited settings in an effort to understand their key characteristics, uncover any gaps in programming, and highlight the potential roles they play. Our review aimed to systematically identify key CBC programs focused on HIV/AIDS in resource-limited settings. We used both bibliographic database searches (Medline, CINAHL, and EMBASE) for peer-reviewed literature and internet-based searches for gray literature. Our search terms were 'HIV' or 'AIDS' and 'community-based care' or 'CBC'. Two co-authors developed a descriptive taxonomy through an iterative, inductive process using the retrieved program information. We identified 21 CBC programs useful for developing taxonomy. Extensive variation was observed within each of the nine categories identified: region, vision, characteristics of target populations, program scope, program operations, funding models, human resources, sustainability, and monitoring and evaluation strategies. While additional research may still be needed to identify the conditions that lead to overall program success, our findings can help to inform our understanding of the various aspects of CBC programs and inform potential logic models for CBC programming in the context of HIV/AIDS in resource-limited settings. Importantly, the findings of the present study can be used to develop sustainable HIV/AIDS-service delivery programs in regions with health resource shortages.

  13. Secondary prevention in patients with coronary heart diseases: what factors are associated with health status in usual primary care?

    Directory of Open Access Journals (Sweden)

    Dominik Ose

    Full Text Available BACKGROUND: For patients with coronary heart diseases a substantial part of secondary prevention is delivered in primary care. Along with the growing importance of prevention, health-related quality of life (HRQoL is an indicator of patient-centered care that has gained increased attention. Different approaches for reorganization in primary care have been associated with improvements in HRQoL. However, these are often results of complex interventions. Evidence on aspects concerning usual primary care that actually have an impact on HRQoL remains scarce. Therefore, this observational study aimed to identify factors which are associated with HRQoL in usual primary care at practice and patient-level. METHODS: This observational study was conducted in eight European countries. We were able to match data from survey instruments for 3505 patients with coronary heart disease (CHD in 228 practices. A multilevel analysis was performed to identify associations of EQ-5D scores at patient and practice-level. RESULTS: After dropping patients with missing information, our cohort consisted of 2656 patients. In this sample, 30.5% were female and the mean age was 67.5 years (SD 10.1. The final model included a total set of 14 potential explanatory variables. At practice-level no variable was associated with EQ-5D. At patient-level, lower education (r = -0.0381, p<0.0001, female gender (r = -0.0543, p<0.0001 and a higher number of other conditions (r = -0.0340, p<0.0001, had a strong negative effect on HRQoL. Strong positive associations with HRQoL were found for a good medication adherence (Morisky (r = 0.0195, p<0.0001 and more positive evaluations of physicians' clinical behavior (r = 0.0282, p = 0.002. In terms of HRQoL no differences between single-handed and group practices exist. CONCLUSION: The results of our study suggest that a better patient-physician relationship rather than organization of CHD care is associated with higher HRQOL in the primary

  14. Identifying the barriers to conducting outcomes research in integrative health care clinic settings - a qualitative study

    Directory of Open Access Journals (Sweden)

    Findlay-Reece Barbara

    2010-01-01

    Full Text Available Abstract Background Integrative health care (IHC is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a further study in 2008, to explore the reasons why IHC clinics are not conducting outcomes research and to identify strategies for conducting successful in-house outcomes research programs. The results of the latter study are reported here. Methods A total of 25 qualitative interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews. Results Barriers identified by participants fell into four categories: organizational culture, organizational resources, organizational environment and logistical challenges. Cultural challenges relate to the philosophy of IHC, organizational leadership and practitioner attitudes and beliefs. Participants also identified significant issues relating to their organization's lack of resources such as funding, compensation, infrastructure and partnerships/linkages. Environmental challenges such as the nature of a clinic's patient population and logistical issues such as the actual implementation of a research program and the applicability of research data also posed challenges to the conduct of research. Embedded research leadership, integration of personal and professional values about research, alignment of research activities and clinical workflow processes are some of the factors identified by participants that support IHC clinics' ability to conduct outcomes research. Conclusions Assessing and enhancing the broader

  15. An update on the association between setting quantified road safety targets and road fatality reduction.

    Science.gov (United States)

    Allsop, Richard E; Sze, N N; Wong, S C

    2011-05-01

    This note is intended to rectify estimates provided in a previous paper (Wong et al., 2006) of the short-term effectiveness in terms of road fatality reduction of the setting of quantified road safety targets using data from 14 OECD countries during the period 1980-1999. This work is important in measuring the association between target setting and road safety improvement, because such targets are intended to serve as a useful tool to motivate timely road safety measures by the road authorities and others. The estimates to be rectified were based on before-and-after analysis using a comparison group of countries for each country that had set a target. This note first provides a correction to the qualification test for the inclusion of a country in any particular comparison group. It then presents the numerical effects of this correction on the estimates of the effectiveness of setting quantified road safety targets, both in individual countries and across the whole group of countries that set targets in the relevant period. Finally, impacts on the findings of the previous paper are discussed, with the conclusion that the changes in those of the numerical estimates that are affected do not alter the main message of the paper.

  16. Ervaringen met ontwikkelingsgerichte zorg voor te vroeg geboren kinderen in een Nederlandse setting [Experience with developmental care for children born preterm in a Dutch setting

    NARCIS (Netherlands)

    Pal, S.M. van der; Walther, F.J.

    2008-01-01

    Objective and design. The Leiden Developmental Care Project explored the effects of the basic elements of developmental care (DC: the use of incubator covers and nests) and the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) with individual behavior observations for very pr

  17. Illness beliefs of Chinese American immigrants with major depressive disorder in a primary care setting.

    Science.gov (United States)

    Chen, Justin A; Hung, Galen Chin-Lun; Parkin, Susannah; Fava, Maurizio; Yeung, Albert S

    2015-02-01

    Underutilization of mental health services in the U.S. is compounded among racial/ethnic minorities, especially Chinese Americans. Culturally based illness beliefs influence help-seeking behavior and may provide insights into strategies for increasing utilization rates among vulnerable populations. This is the first large descriptive study of depressed Chinese American immigrant patients' illness beliefs using a standardized instrument. 190 depressed Chinese immigrants seeking primary care at South Cove Community Health Center completed the Explanatory Model Interview Catalogue, which probes different dimensions of illness beliefs: chief complaint, labeling of illness, stigma perception, causal attributions, and help-seeking patterns. Responses were sorted into categories by independent raters and results compared to an earlier study at the same site and using the same instrument. Contrary to prior findings that depressed Chinese individuals tend to present with primarily somatic symptoms, subjects were more likely to report chief complaints and illness labels related to depressed mood than physical symptoms. Nearly half reported they would conceal the name of their problem from others. Mean stigma levels were significantly higher than in the previous study. Most subjects identified psychological stress as the most likely cause of their problem. Chinese immigrants' illness beliefs were notable for psychological explanations regarding their symptoms, possibly reflecting increased acceptance of Western biomedical frameworks, in accordance with recent research. However, reported stigma regarding these symptoms also increased. As Asian American immigrant populations increasingly accept psychological models of depression, stigma may become an increasingly important target for addressing disparities in mental health service utilization.

  18. Removal of bio-aerosols by water flow on surfaces in health-care settings

    Science.gov (United States)

    Yu, Han; Li, Yuguo

    2016-11-01

    Hand hygiene is one of the most important and efficient measures to prevent infections, however the compliance with hand hygiene remains poor especially for health-care workers. To improve this situation, the mechanisms of hand cleansing need to be explored and a detailed study on the adhesion interactions for bio-aerosols on hand surfaces and the process during particles removal by flow is significant for more efficient methods to decrease infections. The first part of presentation will focus on modelling adhesion interactions between particles, like bacteria and virus, and hand surfaces with roughness in water environment. The model presented is based on the DLVO and its extended theories. The removal process comes next, which will put forward a new model to describe the removal of particles by water flow. In this model, molecular dynamics is combined with particle motion and the results by the model will be compared with experiment results and existed models (RnR, Rock & Roll). Finally, possible improvement of the study and future design of experiments will be discussed.

  19. Misdiagnosis of hemifacial spasm is a frequent event in the primary care setting

    Directory of Open Access Journals (Sweden)

    Alberto R. M. Martinez

    2014-02-01

    Full Text Available Primary hemifacial spasm (HFS is characterized by irregular and involuntary contraction of the muscles innervated by the ipsilateral facial nerve. Treatment controls symptoms and improves quality of life (QoL. Objective : Evaluate the initial diagnosis and treatment of HFS prior to referral to a tertiary center. Method : We interviewed through a standard questionnaire 66 patients currently followed in our center. Results : Mean age: 64.19±11.6 years, mean age of symptoms onset: 51.9±12.5 years, male/female ratio of 1:3. None of the patients had a correct diagnosis in their primary care evaluation. Medication was prescribed to 56.8%. Mean time from symptom onset to botulinum toxin treatment: 4.34 ±7.1 years, with a 95% satisfaction. Thirty percent presented social embarrassment due to HFS. Conclusion : Despite its relatively straightforward diagnosis, all patients had an incorrect diagnosis and treatment on their first evaluation. HFS brings social impairment and the delay in adequate treatment negatively impacts QoL.

  20. Ventilator-associated pneumonia: A persistent healthcare problem in Indian Intensive Care Units!

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    Ashu Sara Mathai

    2016-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is the most common nosocomial infection acquired by patients in the Intensive Care Unit (ICU. However, there are scarce clinical data, particularly from Indian ICUs on the occurrence of this infection. Aims: To collect data on the incidence, microbiological profile, and outcomes of patients with VAP. Settings and Design: Tertiary level, medical-surgical ICU; prospective, observational study. Subjects and Methods: All patients who were mechanically ventilated for >48 h in the ICU during the study were enrolled. VAP was diagnosed according to the Centre for Disease Control (CDC criteria. Results: A total of 95 (38% patients developed VAP infections, an incidence of 40.1 VAP infections/1000 mechanical ventilation days. These were predominantly caused by Gram-negative organisms, especially the Acinetobacter species (58 isolates, 53.2%. Many of the VAP-causing isolates (27.3% demonstrated multidrug resistance. Patients with VAP infections experienced a significantly longer ICU stay (13 days [Interquartile Range (IQ range = 10-21] vs. 6 days [IQ = 4-8], P 60 years and those with higher Acute Physiology and Chronic Health Evaluation II scores at admission had significantly greater mortality rates if they acquired a VAP infection (P = 0.010. Conclusions: VAP continues to be a major threat to patients who are admitted for mechanical ventilation into the critical care unit, emphasizing the urgent need for infection control measures.

  1. The Where is Norovirus Control Lost (WINCL) Study: an enhanced surveillance project to identify norovirus index cases in care settings in the UK and Ireland

    Science.gov (United States)

    Wilson, Jennie; Haig, Caroline E; McCowan, Colin; Leanord, Alistair; Loveday, Heather

    2015-01-01

    Background: Norovirus outbreaks have a significant impact on all care settings; little is known about the index cases from whom these outbreaks initiate. Aim: To identify and categorise norovirus outbreak index cases in care settings. Methods: A mixed-methods, multi-centre, prospective, enhanced surveillance study identified and categorised index cases in acute and non-acute care settings. Results: From 54 participating centres, 537 outbreaks were reported (November 2013 to April 2014): 383 (71.3%) in acute care facilities (ACF); 115 (21.4%) in residential or care homes (RCH) and 39 (7.3%) in other care settings (OCS). Index cases were identified in 424 (79%) outbreaks. Of the 245 index cases who were asymptomatic on admission and not transferred within/into the care setting, 123 (50%) had been an inpatient/resident for 4 days. Four themes emerged: missing the diagnosis, care service under pressure, delay in outbreak control measures and patient/resident location and proximity. Conclusion: The true index case is commonly not identified as the cause of a norovirus outbreak with at least 50% of index cases being misclassified. Unrecognised norovirus cross-transmission occurs frequently suggesting that either Standard Infection Control Precautions (SICPs) are being insufficiently well applied, and or SICPs are themselves are insufficient to prevent outbreaks.

  2. Who Shall Not Be Treated: Public Attitudes on Setting Health Care Priorities by Person-Based Criteria in 28 Nations.

    Science.gov (United States)

    Rogge, Jana; Kittel, Bernhard

    2016-01-01

    The principle of distributing health care according to medical need is being challenged by increasing costs. As a result, many countries have initiated a debate on the introduction of explicit priority regulations based on medical, economic and person-based criteria, or have already established such regulations. Previous research on individual attitudes towards setting health care priorities based on medical and economic criteria has revealed consistent results, whereas studies on the use of person-based criteria have generated controversial findings. This paper examines citizens' attitudes towards three person-based priority criteria, patients' smoking habits, age and being the parent of a young child. Using data from the ISSP Health Module (2011) in 28 countries, logistic regression analysis demonstrates that self-interest as well as socio-demographic predictors significantly influence respondents' attitudes towards the use of person-based criteria for health care prioritization. This study contributes to resolving the controversial findings on person-based criteria by using a larger country sample and by controlling for country-level differences with fixed effects models.

  3. Incidence of neuralgic amyotrophy (Parsonage Turner syndrome in a primary care setting--a prospective cohort study.

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    Nens van Alfen

    Full Text Available Neuralgic amyotrophy is considered a rare peripheral nervous system disorder but in practice seems grossly under recognized, which negatively affects care for these patients. In this study we prospectively counted the one-year incidence rate of classic neuralgic amyotrophy in a primary care setting.In a prospective cohort study during the year 2012 we registered all new cases of neck, shoulder or arm complaints from two large primary care centers serving a population of 14,118. Prior to study, general practitioners received a short training on how to diagnose classic neuralgic amyotrophy. Neuralgic amyotrophy was defined according to published criteria irrespective of family history. Only patients with a classic phenotype were counted as definite cases. After inclusion, patients with suspected neuralgic amyotrophy who had not yet seen a neurologist were offered neurologic evaluation for diagnostic confirmation.Of the 492 patients identified with new onset neck, shoulder or arm complaints, 34 were suspected of having neuralgic amyotrophy. After neurologic evaluation the diagnosis was confirmed in 14 patients. This amounts to a one-year incidence rate for classic neuralgic amyotrophy of 1 per 1000.Our findings suggest that neuralgic amyotrophy is 30-50 times more common than previously thought. Unawareness of the disorder and its clinical presentation seems the most likely explanation for this difference. An incidence rate of 1 per 1000 and the long-term sequelae many patients suffer warrant more vigilance in diagnosing the disorder, to pave the way for timely treatment and prevent complications.

  4. Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research.

    Science.gov (United States)

    Zaforteza, Concha; Gastaldo, Denise; Moreno, Cristina; Bover, Andreu; Miró, Rosa; Miró, Margalida

    2015-12-01

    This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained.

  5. Sleep Patterns and Sleep Problems Among Preschool and School-Aged Group Children in a Primary Care Setting

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    M Mohammadi

    2007-06-01

    Full Text Available Objective: To describe sleep patterns and sleep problems among preschool and school aged group children in a primary care setting in Iran. Material & Methods: This cross sectional study was conducted in two primary care pediatric clinics in Tehran from March 2006 to September 2006.Findings: Sleep patterns of 215 children studied (101 were in preschool age group; 2-6 years old, and 114 were in primary school age group; 7-12 years old. Sleep problems were common in study group, as follows: bedtime problems 21.05%-56.44%, excessive daytime sleepiness 26.73%-42.98%, awakening during the night 13.86%-32.46%, regularity and duration of sleep 17.54%-27.72%, sleep-disordered breathing 10.53%-17.82%.Conclusion: These high frequencies of sleep problems in children explains the importance and burden of sleep disorders in children  which unfortunately are not noticed by primary care providers in Iran and inadequate attention to them may have negative consequences on a host of functional domains, including mood, behavior, school performance, and health outcomes.

  6. Pneumococcal Vaccination Guidance for Post-Acute and Long-Term Care Settings: Recommendations From AMDA's Infection Advisory Committee.

    Science.gov (United States)

    Nace, David A; Archbald-Pannone, Laurie R; Ashraf, Muhammad S; Drinka, Paul J; Frentzel, Elizabeth; Gaur, Swati; Mahajan, Dheeraj; Mehr, David R; Mercer, William C; Sloane, Philip D; Jump, Robin L P

    2017-02-01

    Efforts at preventing pneumococcal disease are a national health priority, particularly in older adults and especially in post-acute and long-term care settings The Advisory Committee on Immunization Practices recommends that all adults ≥65 years of age, as well as adults 18-64 years of age with specific risk factors, receive both the recently introduced polysaccharide-protein conjugate vaccine against 13 pneumococcal serotypes as well as the polysaccharide vaccine against 23 pneumococcal serotypes. Nursing facility licensure regulations require facilities to assess the pneumococcal vaccination status of each resident, provide education regarding pneumococcal vaccination, and administer the appropriate pneumococcal vaccine when indicated. Sorting out the indications and timing for 13 pneumococcal serotypes and 23 pneumococcal serotypes administration is complex and presents a significant challenge to healthcare providers. Here, we discuss the importance of pneumococcal vaccination for older adults, detail AMDA-The Society for Post-Acute and Long-Term Care Medicine (The Society)'s recommendations for pneumococcal vaccination practice and procedures, and offer guidance to postacute and long-term care providers supporting the development and effective implementation of pneumococcal vaccine policies.

  7. Association Between the Safe Delivery App and Quality of Care and Perinatal Survival in Ethiopia

    DEFF Research Database (Denmark)

    Lund, Stine; Boas, Ida Marie; Bedesa, Tariku

    2016-01-01

    facilities. Analyses were performed based on the intention-to-treat principle. Interventions: Health care workers in intervention facilities received a smartphone with the SDA. The SDA is a training tool in emergency obstetric and neonatal care that uses visual guidance in animated videos with clinical......Importance: Health apps in low-income countries are emerging tools with the potential to improve quality of health care services, but few apps undergo rigorous scientific evaluation. Objective: To determine the effects of the safe delivery app (SDA) on perinatal survival and on health care workers......’ knowledge and skills in neonatal resuscitation. Design, Setting, and Participants: In a cluster-randomized clinical trial in 5 rural districts of Ethiopia, 73 health care facilities were randomized to the mobile phone intervention or to standard care (control). From September 1, 2013, to February 1, 2015...

  8. Association between pneumonia and oral care in nursing home residents.

    Science.gov (United States)

    El-Solh, Ali A

    2011-06-01

    Pneumonia remains the leading cause of death in nursing home residents. The accumulation of dental plaque and colonization of oral surfaces and dentures with respiratory pathogens serves as a reservoir for recurrent lower respiratory tract infections. Control of gingivitis and dental plaques has been effective in reducing the rate of pneumonia but the provision of dental care for institutionalized elderly is inadequate, with treatment often sought only when patients experience pain or denture problems. Direct mechanical cleaning is thwarted by the lack of adequate training of nursing staff and residents' uncooperativeness. Chlorhexidine-based interventions are advocated as alternative methods for managing the oral health of frail older people; however, efficacy is yet to be demonstrated in randomized controlled trials. Development and maintenance of an oral hygiene program is a critical step in the prevention of pneumonia. While resources may be limited in long-term-care facilities, incorporating oral care in daily routine practice helps to reduce systemic diseases and to promote overall quality of life in nursing home residents.

  9. Knowledge of primary health care and career choice at primary health care settings among final year medical students - challenges to human resources for health in Vietnam.

    Science.gov (United States)

    Giang, Kim Bao; Minh, Hoang Van; Hien, Nguyen Van; Ngoc, Nguyen Minh; Hinh, Nguyen Duc

    2015-01-01

    There is a shortage of medical doctors in primary health care (PHC) settings in Vietnam. Evidence about the knowledge medical students have about PHC and their career decision-making is important for making policy in human resources for health. The objective of this study was to analyse knowledge and attitudes about PHC among medical students in their final year and their choice to work in PHC after graduation. A cross-sectional study was conducted among 400 final year general medical students from Hanoi Medical University. Self-administered interviews were conducted. Key variables were knowledge, awareness of the importance of PHC and PHC career choices. Descriptive and analytic statistics were performed. Students had essential knowledge of the concept and elements of PHC and were well aware of its importance. However, only one-third to one half of them valued PHC with regard to their professional development or management opportunities. Less than 1% of students would work at commune or district health facilities after graduation. This study evidences challenges related to increasing the number of medical doctors working in PHC settings. Immediate and effective interventions are needed to make PHC settings more attractive and to encourage medical graduates to start and continue a career in PHC.

  10. The cost of changing physical activity behaviour: evidence from a "physical activity pathway" in the primary care setting

    Directory of Open Access Journals (Sweden)

    Bull Fiona C

    2011-05-01

    Full Text Available Abstract Background The 'Physical Activity Care Pathway' (a Pilot for the 'Let's Get Moving' policy is a systematic approach to integrating physical activity promotion into the primary care setting. It combines several methods reported to support behavioural change, including brief interventions, motivational interviewing, goal setting, providing written resources, and follow-up support. This paper compares costs falling on the UK National Health Service (NHS of implementing the care pathway using two different recruitment strategies and provides initial insights into the cost of changing physical activity behaviour. Methods A combination of a time driven variant of activity based costing, audit data through EMIS and a survey of practice managers provided patient-level cost data for 411 screened individuals. Self reported physical activity data of 70 people completing the care pathway at three month was compared with baseline using a regression based 'difference in differences' approach. Deterministic and probabilistic sensitivity analyses in combination with hypothesis testing were used to judge how robust findings are to key assumptions and to assess the uncertainty around estimates of the cost of changing physical activity behaviour. Results It cost £53 (SD 7.8 per patient completing the PACP in opportunistic centres and £191 (SD 39 at disease register sites. The completer rate was higher in disease register centres (27.3% vs. 16.2% and the difference in differences in time spent on physical activity was 81.32 (SE 17.16 minutes/week in patients completing the PACP; so that the incremental cost of converting one sedentary adult to an 'active state' of 150 minutes of moderate intensity physical activity per week amounts to £ 886.50 in disease register practices, compared to opportunistic screening. Conclusions Disease register screening is more costly than opportunistic patient recruitment. However, additional costs come with a higher

  11. Humor as a Communication Strategy in Provider-Patient Communication in a Chronic Care Setting.

    Science.gov (United States)

    Schöpf, Andrea C; Martin, Gillian S; Keating, Mary A

    2015-12-30

    Humor is a potential communication strategy to accomplish various and potentially conflicting consultation goals. We investigated humor use and its reception in diabetes consultations by analyzing how and why humor emerges and its impact on the interaction. We did this by using an interactional sociolinguistics approach. We recorded 50 consultations in an Irish diabetes setting. Analysis of the humor events drew on framework analysis and on concepts from Conversation Analysis and pragmatics. The study also comprised interviews using tape-assisted recall. We identified 10 humor functions and two umbrella functions. A key finding is that most humor is relationship-protecting humor initiated by patients, that is, they voice serious messages and deal with emotional issues through humor. Our findings imply that patients' and providers' awareness of indirect communication strategies needs to be increased. We also recommend that researchers employ varied methods to adequately capture the interactive nature of humor.

  12. A systematic review of financial incentives given in the health care setting

    DEFF Research Database (Denmark)

    Molema, Claudia C.M.; Wendel-Vos, G.C Wanda; Pujik, Lisanne

    2016-01-01

    of them were screened on in- and exclusion criteria based on the full-text publication. Results: Three studies were included in the review. Two studies have combined a financial incentive with nutrition classes or motivational interviewing. One of which provided a free membership to a sports facility...... was to provide insight in the effectiveness of financial incentives used for promoting physical activity in the healthcare setting. Methods: A systematic literature search was performed in three databases: Medline, EMBASE and SciSearch. In total, 1395 papers published up until April 2015 were identified. Eleven...... and the other one provided vouchers each for one episode of aerobic activities at a local leisure center or swimming pool. The third study provided a schedule for exercise sessions. None of the studies addressed the preferences of their target population with regard to financial incentives. Despite some short...

  13. A systematic review of financial incentives given in the health care setting

    DEFF Research Database (Denmark)

    Molema, Claudia C.M.; Wendel-Vos, G.C Wanda; Pujik, Lisanne;

    2016-01-01

    Introduction: A substantial amount of the western population is inactive according to current physical activity guidelines, which is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The objective of this review...... was to provide insight in the effectiveness of financial incentives used for promoting physical activity in the healthcare setting. Methods: A systematic literature search was performed in three databases: Medline, EMBASE and SciSearch. In total, 1395 papers published up until April 2015 were identified. Eleven...... and the other one provided vouchers each for one episode of aerobic activities at a local leisure center or swimming pool. The third study provided a schedule for exercise sessions. None of the studies addressed the preferences of their target population with regard to financial incentives. Despite some short...

  14. Improving clinical research and cancer care delivery in community settings: evaluating the NCI community cancer centers program

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    Fennell Mary L

    2009-09-01

    Full Text Available Abstract Background In this article, we describe the National Cancer Institute (NCI Community Cancer Centers Program (NCCCP pilot and the evaluation designed to assess its role, function, and relevance to the NCI's research mission. In doing so, we describe the evolution of and rationale for the NCCCP concept, participating sites' characteristics, its multi-faceted aims to enhance clinical research and quality of care in community settings, and the role of strategic partnerships, both within and outside of the NCCCP network, in achieving program objectives. Discussion The evaluation of the NCCCP is conceptualized as a mixed method multi-layered assessment of organizational innovation and performance which includes mapping the evolution of site development as a means of understanding the inter- and intra-organizational change in the pilot, and the application of specific evaluation metrics for assessing the implementation, operations, and performance of the NCCCP pilot. The assessment of the cost of the pilot as an additional means of informing the longer-term feasibility and sustainability of the program is also discussed. Summary The NCCCP is a major systems-level set of organizational innovations to enhance clinical research and care delivery in diverse communities across the United States. Assessment of the extent to which the program achieves its aims will depend on a full understanding of how individual, organizational, and environmental factors align (or fail to align to achieve these improvements, and at what cost.

  15. The prevalence of skin tears in the acute care setting in Singapore.

    Science.gov (United States)

    Chang, Yee Y; Carville, Keryln; Tay, Ai C

    2016-10-01

    Skin tears appear to be a hidden and extensive problem despite an increased focus in the literature on skin tear epidemiology, prevention strategies and management modalities. Currently, there has been no report of skin tear epidemiology published in Singapore. The aim of the present study was to pilot the methodology by WoundWest at one of the tertairy hospitals in Singapore. The secondary objective was to determine the prevalence and current nursing management of skin tears within two selected acute medical wards in the hospital. A point prevalence survey was conducted within the two medical wards. Six registered nurses acted as the surveyors and underwent pre-survey education. Inter-rater reliability testing was conducted. Surveyors were paired and performed skin examinations on all available patients in the two wards. Data were collected on age, gender, skin tear anatomical locations, their Skin Tear Audit Research categories, dressings used on identified skin tears and related documentation. A total of 144 (98%) patients consented to skin inspections. Findings demonstrated a skin tear prevalence of 6·2%; all skin tears were found to be hospital-acquired and located on the extremities. Most (78%) were in the age range of 70-89 years. There was a dearth in nursing documentation of the skin tears identified and their management. The findings suggested that nurses were lacking in the knowledge of skin tears, and documentation, if available, was not consistent. There is an urgent clinical need for the implementation of a validated skin tear classification tool; standardised protocols for skin tear prevention and management; and a comprehensive skin tear educational programme for hospital care staff. Quarterly hospital-wide skin tear prevalence surveys are also needed to evaluate improvement strategies.

  16. Psychoeducative groups help control type 2 diabetes in a primary care setting

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    Miguel Ángel Cervantes Cuesta

    2013-04-01

    Full Text Available Introduction: The purpose of this study is to measure the impact of a psychoeducational group intervention in diabetes using glycosylated haemoglobin (HbA1c, the body mass index (BMI and cardiovascular risk factors (CVRF compared with conventional educational measures provided individually. Methods: A quasi-experimental study (pre/post-intervention with a non-equivalent control group was conducted, including 72 type 2 individuals with diabetes (mean data: age 63.08 years, HbA1C 6.98%, BMI 30.48 kg/m². The beneficial effect of psychoeducational group therapy in the study group (PGT was compared with conventional diabetes education in the control group (CG. Results: The PGT had a higher mean HbA1c reduction (-0.51 ± 1.7 vs. -0.06 ± 0.53%, p 0.003, met the objectives of optimal control of HbA1c to a higher degree (80% vs. 48%, p 0.005 and greater mean weight reduction (-1.93 ± 3.57 vs. 0.52 ± 1.73 kg, p 0002 than the CG.A significant improvement in total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure was achieved in PGT (all p < 0.05. Conclusions: PGT patients achieved a significant improvement in HbA1C, BMI and CVRF, and outperformed the conventional diabetes education group in achieving the optimal diabetes control objectives. Structural changes in the assistance programs should be considered to introduce these more efficient therapies for diabetes education in primary care.

  17. A pilot randomized trial of technology-assisted goal setting to improve physical activity among primary care patients with prediabetes.

    Science.gov (United States)

    Mann, Devin M; Palmisano, Joseph; Lin, Jenny J

    2016-12-01

    Lifestyle behavior changes can prevent progression of prediabetes to diabetes but providers often are not able to effectively counsel about preventive lifestyle changes. We developed and pilot tested the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) program to enhance primary care providers' counseling about behavior change for patients with prediabetes. Primary care providers in two urban academic practices and their patients with prediabetes were recruited to participate in the ADAPT study, an unblinded randomized pragmatic trial to test the effectiveness of the ADAPT program, including a streamlined electronic medical record-based goal setting tool. Providers were randomized to intervention or control arms; eligible patients whose providers were in the intervention arm received the ADAPT program. Physical activity (the primary outcome) was measured using pedometers, and data were gathered about patients' diet, weight and glycemic control. A total of 54 patients were randomized and analyzed as part of the 6-month ADAPT study (2010-2012, New York, NY). Those in the intervention group showed an increase total daily steps compared to those in the control group (+ 1418 vs - 598, p = 0.007) at 6 months. There was also a trend towards weight loss in the intervention compared to the control group (- 1.0 lbs. vs. 3.0 lbs., p = 0.11), although no change in glycemic control. The ADAPT study is among the first to use standard electronic medical record tools to embed goal setting into realistic primary care workflows and to demonstrate a significant improvement in prediabetes patients' physical activity.

  18. Water-based adhesives with tailored hydrophobic association: dilution resistance and improved setting behavior.

    Science.gov (United States)

    Dundua, Alexander; Landfester, Katharina; Taden, Andreas

    2014-11-01

    Hydrophobic association and stimuli-responsiveness is a powerful tool towards water-based adhesives with strongly improved properties, which is demonstrated based on the example of hydrophobically modified alkali-soluble latexes (HASE) with modulated association. Their rheological properties are highly tunable due to the hydrophobic domains that act as physical crosslinking sites of adjustable interaction strength. Ethanol, propanol, and butanol are used as water-soluble model additives with different hydrophobicity in order to specifically target the association sites and impact the viscoelastic properties and stimuli-responsiveness. The rheological and mechanical property response upon dilution with water can be tailored, and dilution-resistant or even dilution-thickening systems are obtained. The investigations are of high importance for water-based adhesives, as our findings provide insight into general structure-property relationships to improve their setting behavior, especially upon contact with wet substrates.

  19. Factors associated with the continuum of care of HIV-infected patients in Belgium

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    Dominique Van Beckhoven

    2014-11-01

    Full Text Available Introduction: We studied factors associated with the continuum of HIV care in Belgium. Methods: Data of the national registration of new HIV diagnosis and of the national cohort of HIV-infected patients in care were combined to obtain estimates of and factors related with proportions of HIV-infected patients in each step of the continuum of care from diagnosis to suppressed viral load (VL. Factors associated with ignorance of HIV seropositivity were analyzed among patients co-infected with HIV and STI in the Belgian STI sentinel surveillance network. Associated factors were identified by multivariate logistic regression. Results: Among 4038 individuals diagnosed with HIV between 2007 and 2010, 90.3% were linked to care. Of 11684 patients in care in 2010, 90.8% were retained in care up to the following year, 88.3% of those were on ART, of whom 95.3% had suppressed VL (<500 cp/ml (Figure 1. In multivariate analyses, factors associated with ignoring HIV+ status were being younger (p<0.001, being heterosexual compared to MSM, and of a region of origin other than Belgium, Sub-Saharan Africa and Europe. Non-Belgian regions of origin were associated with lower entry and retention in care (p<0.001 for both. Preoperative HIV testing was associated with lower entry in care (p=0.003. MSM had a higher retention in care (p<0.001, whilst IDU had lower retention (p=0.004. Low CD4 at first clinical contact and clinical reasons for HIV testing were independently associated with being on ART (p<0.001 for both; whilst prenatal HIV diagnosis was associated with lower proportion on ART (p=0.016 and lower proportion with suppressed VL among those on ART (p=0.005. Older age was associated with both being on ART and having suppressed VL among those on ART (p=0.007 and p<0.001 respectively, independently of time since HIV diagnosis (Table 1. Conclusions: Regions of origin and risk groups (MSM/heterosexual/IDU are the main factors associated with ignorance of HIV

  20. Core Measures for Congestive Heart Failure in a Tertiary Care Setting in Pakistan

    Science.gov (United States)

    Zafar, Rizwan; Haris, Muhammad; Shabbir, Muhammad Usman; Ghazanfar, Haider; Malik, Sarah A; Khalid, Tehreem; Abbas, Ali H; Saleem, Asad A

    2016-01-01

    Purpose: Heart failure presents a huge burden for individual patients and the healthcare system as a whole. This study aims to assess the adherence to these core measures as identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)/ American Heart Association (AHA) by physicians of Pakistan. Materials and Methodology: We conducted a cross-sectional study in Shifa International Hospital, Islamabad, Pakistan from the period of April 2013 to April 2016. Patients with a primary diagnosis of heart failure were drawn from a coding section of hospital’s record department. Data was evaluated to assess how strictly doctors were following core measures identified by JCAHO/AHA for the given diagnosis. Inclusion criteria for this study were patients ≥ 17 years of age and patients with a primary diagnosis of heart failure according to New York Heart Association (NYHA) classification. Patients with congenital anomalies and structural heart wall problems, like sarcoidosis, hemochromatosis, and amyloidosis, were excluded from the study. Results: Mean ejection fraction (EF) was found to be 27.23 ± 11.72 percent. Symptoms assessment of heart failure was done in 16/421 (3.8%) patients according to NYHA classification and in 405/421 (96.2%) patients according to outpatient-based heart failure assessment based on physician's experience other than NYHA classification. Left ventricle ejection fraction (LVEF) was assessed in 411/421 (97%) patients. Out of these, 336/411 (81.7%) patients had EF < 40%. Mean EF was found to be significantly higher in females as compared to males (p < 0.001). Three hundred and thirty-six out of 411 (81.7%) patients with EF < 40% needed angiotensin converting enzyme inhibitors (ACEi) and beta-blocker (BB) prescriptions. ACEi were prescribed only to 230/336 (68.7%) patients and 248/336 (73.8%) patients were given BB with documented contraindication to ACEi and BB in 7.36% and 17% patients, respectively. There was no

  1. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting

    Directory of Open Access Journals (Sweden)

    Fischer Michael

    2007-03-01

    Full Text Available Abstract Background The aim of this study was to assess the effectiveness of homeopathy compared to conventional treatment in acute respiratory and ear complaints in a primary care setting. Methods The study was designed as an international, multi-centre, comparative cohort study of non-randomised design. Patients, presenting themselves with at least one chief complaint: acute (≤ 7 days runny nose, sore throat, ear pain, sinus pain or cough, were recruited at 57 primary care practices in Austria (8, Germany (8, the Netherlands (7, Russia (6, Spain (6, Ukraine (4, United Kingdom (10 and the USA (8 and given either homeopathic or conventional treatment. Therapy outcome was measured by using the response rate, defined as the proportion of patients experiencing 'complete recovery' or 'major improvement' in each treatment group. The primary outcome criterion was the response rate after 14 days of therapy. Results Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H and 720 conventional (C treatment. The majority of patients in both groups reported their outcome after 14 days of treatment as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing. In the per-protocol set (H: 576 and C: 540 patients similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019. Further subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C: 84.5% and adults (H: 85.6%; C: 86.6%. The unadjusted odds ratio (OR of the primary outcome criterion was 1.40 (0.89–2.22 in children and 0.92 (0.63–1.34 in adults. Adjustments for demographic differences at baseline did not significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon homeopathic

  2. Practical aspects of inhaler use in the management of chronic obstructive pulmonary disease in the primary care setting

    Directory of Open Access Journals (Sweden)

    Yawn BP

    2012-07-01

    Full Text Available Barbara P Yawn,1 Gene L Colice,2 Rick Hodder3,*1Department of Research, Olmsted Medical Center, Rochester, MN, USA; 2Department of Pulmonary, Critical Care, and Respiratory Services, Washington Hospital Center, Washington, DC, USA; 3Divisions of Pulmonary and Critical Care, University of Ottawa, Ottawa, Canada*Professor Rick Hodder has sadly passed away recentlyAbstract: Sustained bronchodilation using inhaled medications in moderate to severe chronic obstructive pulmonary disease (COPD grades 2 and 3 (Global Initiative for Chronic Obstructive Lung Disease guidelines has been shown to have clinical benefits on long-term symptom control and quality of life, with possible additional benefits on disease progression and longevity. Aggressive diagnosis and treatment of symptomatic COPD is an integral and pivotal part of COPD management, which usually begins with primary care physicians. The current standard of care involves the use of one or more inhaled bronchodilators, and depending on COPD severity and phenotype, inhaled corticosteroids. There is a wide range of inhaler devices available for delivery of inhaled medications, but suboptimal inhaler use is a common problem that can limit the clinical effectiveness of inhaled therapies in the real-world setting. Patients' comorbidities, other physical or mental limitations, and the level of inhaler technique instruction may limit proper inhaler use. This paper presents information that can overcome barriers to proper inhaler use, including issues in device selection, steps in correct technique for various inhaler devices, and suggestions for assessing and monitoring inhaler techniques. Ensuring proper inhaler technique can maximize drug effectiveness and aid clinical management at all grades of COPD.Keywords: COPD, inhaler technique, bronchodilator, clinical management

  3. Associations between DNA methylation and schizophrenia-related intermediate phenotypes - a gene set enrichment analysis.

    Science.gov (United States)

    Hass, Johanna; Walton, Esther; Wright, Carrie; Beyer, Andreas; Scholz, Markus; Turner, Jessica; Liu, Jingyu; Smolka, Michael N; Roessner, Veit; Sponheim, Scott R; Gollub, Randy L; Calhoun, Vince D; Ehrlich, Stefan

    2015-06-03

    Multiple genetic approaches have identified microRNAs as key effectors in psychiatric disorders as they post-transcriptionally regulate expression of thousands of target genes. However, their role in specific psychiatric diseases remains poorly understood. In addition, epigenetic mechanisms such as DNA methylation, which affect the expression of both microRNAs and coding genes, are critical for our understanding of molecular mechanisms in schizophrenia. Using clinical, imaging, genetic, and epigenetic data of 103 patients with schizophrenia and 111 healthy controls of the Mind Clinical Imaging Consortium (MCIC) study of schizophrenia, we conducted gene set enrichment analysis to identify markers for schizophrenia-associated intermediate phenotypes. Genes were ranked based on the correlation between DNA methylation patterns and each phenotype, and then searched for enrichment in 221 predicted microRNA target gene sets. We found the predicted hsa-miR-219a-5p target gene set to be significantly enriched for genes (EPHA4, PKNOX1, ESR1, among others) whose methylation status is correlated with hippocampal volume independent of disease status. Our results were strengthened by significant associations between hsa-miR-219a-5p target gene methylation patterns and hippocampus-related neuropsychological variables. IPA pathway analysis of the respective predicted hsa-miR-219a-5p target genes revealed associated network functions in behavior and developmental disorders. Altered methylation patterns of predicted hsa-miR-219a-5p target genes are associated with a structural aberration of the brain that has been proposed as a possible biomarker for schizophrenia. The (dys)regulation of microRNA target genes by epigenetic mechanisms may confer additional risk for developing psychiatric symptoms. Further study is needed to understand possible interactions between microRNAs and epigenetic changes and their impact on risk for brain-based disorders such as schizophrenia.

  4. Polypharmacy in older adults: Association Rule and Frequent-Set Analysis to evaluate concomitant medication use.

    Science.gov (United States)

    Held, Fabian; Le Couteur, David G; Blyth, Fiona M; Hirani, Vasant; Naganathan, Vasi; Waite, Louise M; Seibel, Markus J; Handelsman, David J; Cumming, Robert G; Allore, Heather G; Gnjidic, Danijela

    2017-02-01

    The aim of this study was to apply Association Rule and Frequent-Set analysis, and novel means of data visualisation to ascertain patterns of medication use and medication combinations contributing to medication group clusters according to geriatric syndrome status in older adults. Participants were community-dwelling men (aged ≥70 years, n=1686), Sydney, Australia. Medication exposure was categorised at medication class level and data were analysed according to geriatric syndrome status (presence of at least one syndrome including frailty, falls, cognitive impairment and urinary incontinence). Association Rule and Frequent-Set analysis were performed to identify "interesting" patterns of medication combinations that occur together. This analysis involves advanced computer algorithms that investigated all possible combinations of medications in the dataset in order to identify those which are observed more or much less frequently than expected. Frequent-Set Analysis demonstrated one unexpected medication combination, antiulcer and antidiabetic medications (3.5% of participants) in the overall population (n=1687). Frequency of medication combinations was similar in participants with (n=666) and without (n=1020) geriatric syndromes. Among participants with geriatric syndromes, the most frequent combinations included antigout with lipid-lowering agents (5.7%) followed by angiotensin II and diuretics combination (22%). This novel methodology can be used to detect common medication combinations overall by data visualisation, and against specific adverse drug reactions such as geriatric syndromes. This methodology may be a valuable pharmacovigilance approach to monitor large databases for the safety of medications.

  5. The career goals of nurses in some health care settings in Gauteng

    Directory of Open Access Journals (Sweden)

    K Jooste

    2005-09-01

    Full Text Available In nursing, purposeful career planning is essential if nurse practitioners want to make the right decisions about their work in order to strive towards and accomplish a meaningful quality of working life. Nurses should identify their career goals to be able to investigate their different career opportunities in their field of interest and direct their work according to a work strategy for years ahead. The purpose of this study was to explore and describe the career goals of post-basic nursing students with the aim of describing management strategies to guide the future career of post-basic nursing students in climbing the career ladder effectively and obtaining their set career goals. An explorative, descriptive, qualitative design was selected where the researcher worked inductively to explore and describe the needs (goals and future planned actions of the participants regarding their career management as viewed for a period of five years. The researcher purposively and conveniently identified the sample as all the postbasic nursing students, namely 250 students, who were registered for the first, second and third year of nursing management courses in that period at a South African residential university. Two structured, open questions were developed. Each participant received the questions in writing and was asked to answer them. The QSR NUD*IST program was used for the qualitative management (categorization of data. The results of the research questions related to five categories, namely becoming empowered, being promoted, being educated and professionally developed, partaking in research and taking up new projects.

  6. Sexual dysfunction with the use of antidepressants in a tertiary care mental health setting - a retrospective case series

    Directory of Open Access Journals (Sweden)

    Kingshuk Lahon

    2011-01-01

    Full Text Available Sexual dysfunction affects patients′ quality of life. It can occur secondary to physical or mental disorders, substance abuse and treatment with prescription drugs like antidepressants. We wanted to study the prevalence of sexual dysfunction associated with antidepressant use in the psychiatric unit of a tertiary care hospital and assess for causality, severity and preventability. We did a retrospective data collection from case records of patients on antidepressants from the Psychiatry outpatient clinic of a tertiary care teaching hospital during the period 1 st January 2006 to 31 st December 2006, excluding those with complaints of sexual dysfunction prior to treatment. Data are presented as a case series. Documented adverse events were subjected to analysis for causality, severity and preventability using Naranjo′s, modified Hartwig and Siegel and modified Schumock and Thornton′s Preventability scales respectively. Out of 169 patients, four patients developed sexual dysfunction (2.36% associated with duloxetine, mirtazapine, trazodone and sertraline. We observed a possible causal relationship of mild to moderately severe ADR (sexual dysfunction which was not preventable. Prevalence of antidepressant associated sexual dysfunction was lower than quoted in Western literature probably due to the retrospective nature of our study design. Active monitoring and intervention can greatly improve the quality of life and compliance to treatment.

  7. On the Basis of the Elderly Care Settings%论老年监护设置依据

    Institute of Scientific and Technical Information of China (English)

    刘清生; 黄燕香

    2016-01-01

    老年监护设置不同于未成年人监护设置,设置依据是老年监护设置的前提条件,却为学界所忽视。对监护设置历史的追溯可以发现,监护设置依据自古包括智能和体能两因素,近现代国家民法中也多有体现。不同于未成年人体能和智能增长“从无到有”的过程,老年人因衰老而导致的体能与智能减损是一个“从有到无”的过程,年龄无法成为设置老年监护的直接依据。智能或体能减损致老年人无法“正常化”生活是老年监护设置的合理标准。%The academic research on elderly care is not based on the actual needs of the elderly individuals,which does not really deals with the issue of how to set elderly care. From the historical retrospective,we know that the system of guardianship settings is based on the factors of intelligent mental health and physical condition,stated in the laws of the modern countries. Because of the process of aging caused by physical and mental impairments,age can not be the basis of elderly guardianship basis. The weakening of mental and physical abilities should be the standards for elderly guardianship settings.

  8. Prevalence and Risk Factors of Antenatal Depression among Omani Women in a Primary Care Setting; Cross-sectional study

    Directory of Open Access Journals (Sweden)

    Mohammed Al-Azri

    2016-02-01

    Full Text Available Objectives: This study aimed to identify the prevalence of antenatal depression and the risk factors associated with its development among Omani women. No previous studies on antenatal depression have been conducted in Oman. Methods: This descriptive cross-sectional study was carried out between January and November 2014 in Muscat, Oman. Pregnant Omani women ≥32 gestational weeks who were attending one of 12 local primary care health centres in Muscat for routine antenatal care were invited to participate in the study (n = 986. An Arabic version of the validated self-administered Edinburgh Postnatal Depression Scale questionnaire was used to measure antenatal depression. A cut-off score of ≥13 was considered to indicate probable depression. Results: A total of 959 women participated in the study (response rate: 97.3%. Of these, 233 were found to have antenatal depression (24.3%. A bivariate analysis showed that antenatal depression was associated with unplanned pregnancies (P = 0.010, marital conflict (P = 0.001 and a family history of depression (P = 0.019. The adjusted odds ratio (OR after logistic multivariate regression analysis showed that antenatal depression was significantly associated with unplanned pregnancies (OR: 1.37; 95% confidence interval [CI]: 1.02–1.86 and marital conflict (OR: 13.83; 95% CI: 2.99–63.93. Conclusion: The prevalence of antenatal depression among the studied Omani women was high, particularly in comparison to findings from other Arab countries. Thus, antenatal screening for depression should be considered in routine primary antenatal care. Couples should also be encouraged to seek psychological support should marital conflicts develop during pregnancy.

  9. Setting the research agenda for improving health care in musculoskeletal disorders.

    Science.gov (United States)

    Buchbinder, Rachelle; Maher, Chris; Harris, Ian A

    2015-10-01

    Despite a substantial contribution to the global burden of disease, musculoskeletal conditions are under-represented in clinical research, and that which is performed is often wasteful and lacking clinical relevance. Even clinically relevant musculoskeletal research might not lead to timely or adequate changes in clinical practice and associated improvements in patient outcomes. The formulation of clinical recommendations alone is usually insufficient to bring about changes in practice patterns. Research exploring how to improve the translation of evidence-based recommendations into practice, as well as the identification and removal of barriers to practice change, is necessary in order for the promise of musculoskeletal research to be realized in improved health outcomes. These goals can be achieved by improvements in the coordination of research activities, the resourcing and allocation of funding, and the involvement of clinicians and patients.

  10. A SEU-protected cache memory-based on variable associativity of sets

    Energy Technology Data Exchange (ETDEWEB)

    Zarandi, Hamid Reza [Department of Computer Engineering, Sharif University of Technology, P.O. Box 11365-9517, Tehran (Iran, Islamic Republic of)]. E-mail: zarandi@ce.sharif.edu; Miremadi, Seyed Ghassem [Department of Computer Engineering, Sharif University of Technology, P.O. Box 11365-9517, Tehran (Iran, Islamic Republic of)]. E-mail: miremadi@sharif.edu

    2007-11-15

    SRAM cache memories suffer from single event upset (SEU) faults induced by energetic particles such as neutron and alpha particles. To protect these caches, designers often use error detection and correction codes, which typically provide single-bit error detection and even correction. However, these codes have low error detection capability or incur significant performance penalties. In this paper, a protected cache scheme based on the variable associativity of sets is presented. In this scheme, cache space is divided into sets of different sizes with variable tag field lengths. The other remained bits of tags are used for protecting the tag using a new protection code. This leads to protect the cache without compromising performance and area with respect to the similar one, fully associative cache. The scheme provides high SEU detection coverage as well as high performance. Moreover, reliability and mean-time-to-failure (MTTF) equations are derived and estimated. The results obtained from fault injection experiments and several trace files from SPEC2000 reveal that the proposed scheme exhibits a good performance near to fully associative cache but can detect high percent of SEU faults.

  11. Testing feasibility and reliability of a set of quality indicators to evaluate the organization of palliative care across Europe: a pilot study in 25 countries

    NARCIS (Netherlands)

    Woitha, K.; Hasselaar, J.G.; Beek, K.; Ahmed, N.; Jaspers, B.; Hendriks, J.C.M.; Radbruch, L.; Vissers, K.; Engels, Y.M.

    2015-01-01

    BACKGROUND: A well-organized palliative care service is a prerequisite for offering good palliative care. Reliable and feasible quality indicators are needed to monitor the quality of their organization. AIM: To test feasibility and reliability of a previously developed set of quality indicators in

  12. CANNABIS USE AND ASSOCIATED HARMS AMONG SCHIZOPHRENIA PATIENTS IN A NGERIAN CLINICAL SETTING: A CASE CONTROL STUDY

    Directory of Open Access Journals (Sweden)

    Victor Lasebikan

    2016-08-01

    Full Text Available Aim: The overall aim of this study was to determine the prevalence of cannabis use among patients with schizophrenia with associated levels of harm in a Nigerian clinical setting.Method: In this case-control study, consecutive 150 patients with schizophrenia were matched by age and gender with an equal number of patients that utilized the general outpatient department of the State Hospital, Ring Road Ibadan.The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST was used to obtain prevalence of cannabis use and level of health risk as determined by the ASSIST score. The Positive and Negative Syndrome Scale (PANSS was used to determine the severity of psychosis. Results: Prevalence of cannabis use among the cases was 10.0% and 2.7% among the control group, p = 0.03. Mean ASSIST score was significantly higher among the cases compared with the control, p < 0.001. Respondents of male gender and those who were not married were significantly more likely to be cannabis users among patients with schizophrenia, p < 0.001, p < 0.02 respectively. Conclusion: Cannabis use was prevalent among patients with schizophrenia and was associated with health risks. Thus, routine screening for cannabis use and brief intervention is suggested to be integrated into care for adolescents and adults with schizophrenia.

  13. Treatment of Hip Dislocations and Associated Injuries: Current State of Care.

    Science.gov (United States)

    Beebe, Michael J; Bauer, Jennifer M; Mir, Hassan R

    2016-07-01

    Hip dislocations, most often caused by motor vehicle accidents or similar high-energy trauma, traverse a large subset of distinct injury patterns. Understanding these patterns and their associated injuries allows surgeons to provide optimal care for these patients both in the early and late postinjury periods. Nonoperative care requires surgeons to understand the indications. Surgical care requires the surgeon to understand the benefits and limitations of several surgical approaches. This article presents the current understanding of hip dislocation treatment, focusing on anatomy, injury classifications, nonoperative and operative management, and postinjury care.

  14. Beyond main effects of gene-sets: Harsh parenting moderates the association between a dopamine gene-set and child externalizing behavior

    OpenAIRE

    Windhorst, D.A.; Mileva, V.R.; Rippe, R.C.A.; Tiemeier, H; Jaddoe, V. W. V.; Verhulst, F. C.; IJzendoorn, van, M.H.; Bakermans, M.J.

    2016-01-01

    Abstract Background In a longitudinal cohort study, we investigated the interplay of harsh parenting and genetic variation across a set of functionally related dopamine genes, in association with children's externalizing behavior. This is one of the first studies to employ gene‐based and gene‐set approaches in tests of Gene by Environment (G × E) effects on complex behavior. This approach can offer an important alternative or complement to candidate gene and genome‐wide environmental interact...

  15. Beyond main effects of gene‐sets: harsh parenting moderates the association between a dopamine gene‐set and child externalizing behavior

    OpenAIRE

    2016-01-01

    Abstract Background In a longitudinal cohort study, we investigated the interplay of harsh parenting and genetic variation across a set of functionally related dopamine genes, in association with children's externalizing behavior. This is one of the first studies to employ gene‐based and gene‐set approaches in tests of Gene by Environment (G × E) effects on complex behavior. This approach can offer an important alternative or complement to candidate gene and genome‐wide environmental interact...

  16. Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings

    Directory of Open Access Journals (Sweden)

    Ploeg Jenny

    2008-02-01

    Full Text Available Abstract Background Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community settings. Methods A naturalistic study with a prospective, before and after design documented the implementation of six newly developed nursing best practice guidelines (asthma, breastfeeding, delirium-dementia-depression (DDD, foot complications in diabetes, smoking cessation and venous leg ulcers. Eleven health care organisations were selected for a one-year project. At each site, clinical resource nurses (CRNs worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities (i.e. education sessions, policy review. Process and patient outcomes were assessed by chart audit (n = 681 pre-implementation, 592 post-implementation. Outcomes were also assessed for four of six topics by in-hospital/home interviews (n = 261 pre-implementation, 232 post-implementation and follow-up telephone interviews (n = 152 pre, 121 post. Interviews were conducted with 83/95 (87% CRN's, nurses and administrators to describe recommendations selected, strategies used and participants' perceived facilitators and barriers to guideline implementation. Results While statistically significant improvements in 5% to 83% of indicators were observed in each organization, more than 80% of indicators for breastfeeding, DDD and smoking cessation did not change. Statistically significant improvements were found in > 50% of indicators for asthma (52%, diabetes foot care (83% and venous leg ulcers (60%. Organizations with > 50% improvements reported two unique implementation strategies which included hands-on skill practice sessions for nurses and the development of new patient education materials. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack

  17. Assessing temporal associations between environmental factors and malaria morbidity at varying transmission settings in Uganda

    Directory of Open Access Journals (Sweden)

    Ruth Kigozi

    2016-10-01

    Full Text Available Abstract Background Environmental factors play a major role in transmission of malaria given their relationship to both the development and survival of the mosquito and parasite. The associations between environmental factors and malaria can be used to inform the development of early warning systems for increases in malaria burden. The objective of this study was to assess temporal relationships between rainfall, temperature and vegetation with malaria morbidity across three different transmission settings in Uganda. Methods Temporal relationships between environmental factors (weekly total rainfall, mean day time temperature and enhanced vegetation index series and malaria morbidity (weekly malaria case count data and test positivity rate series over the period January 2010–May 2013 in three sites located in varying malaria transmission settings in Uganda was explored using cross-correlation with pre-whitening. Sites included Kamwezi (low transmission, Kasambya (moderate transmission and Nagongera (high transmission. Results Nagongera received the most rain (30.6 mm and experienced, on average, the highest daytime temperatures (29.8 °C per week. In the study period, weekly TPR and number of malaria cases were highest at Kasambya and lowest at Kamwezi. The largest cross-correlation coefficients between environmental factors and malaria morbidity for each site was 0.27 for Kamwezi (rainfall and cases, 0.21 for Kasambya (vegetation and TPR, and −0.27 for Nagongera (daytime temperature and TPR. Temporal associations between environmental factors (rainfall, temperature and vegetation with malaria morbidity (number of malaria cases and TPR varied by transmission setting. Longer time lags were observed at Kamwezi and Kasambya compared to Nagongera in the relationship between rainfall and number of malaria cases. Comparable time lags were observed at Kasambya and Nagongera in the relationship between temperature and malaria morbidity. Temporal

  18. Evaluation of an innovative communication technology in an acute care setting.

    Science.gov (United States)

    Vandenkerkhof, Elizabeth G; Hall, Susan; Wilson, Rosemary; Gay, Ann; Duhn, Lenora

    2009-01-01

    Wireless technology in healthcare has been associated with communication-related improvements in workflow; however, there are barriers to adoption. The purpose of this study was to assess perceptions and attitudes of staff toward the use of a wireless communication device (Vocera, Vocera Communications, Inc., San Jose, CA) and to compare communication patterns before and after implementation. A pretest-posttest quasi-experimental design and the Theory of Planned Behavior were used. Attitudes, subjective norms, and perceived control explained 25% of the variation in behavioral intent before and 45% of the variation in behavioral intent after Vocera implementation. The time for key communication activities was reduced by 25% overall. On average, each nurse engaged in these activities 16.2 times a day before Vocera and 11.6 times a day with Vocera. This study provides evidence that introduction of novel communication technology must account for user attitudes before implementation. Vocera improved "hand-off" communication, was perceived to be of benefit, and has the potential to improve patient safety and work environments. This may also translate to reduction in healthcare resources.

  19. Identifying genetic marker sets associated with phenotypes via an efficient adaptive score test

    KAUST Repository

    Cai, T.

    2012-06-25

    In recent years, genome-wide association studies (GWAS) and gene-expression profiling have generated a large number of valuable datasets for assessing how genetic variations are related to disease outcomes. With