Sample records for center practices survey

  1. Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey

    International Nuclear Information System (INIS)

    Hrbacek, Jan; Mishra, Kavita K.; Kacperek, Andrzej; Dendale, Remi; Nauraye, Catherine; Auger, Michel; Herault, Joel; Daftari, Inder K.; Trofimov, Alexei V.; Shih, Helen A.; Chen, Yen-Lin E.; Denker, Andrea; Heufelder, Jens; Horwacik, Tomasz; Swakoń, Jan; Hoehr, Cornelia; Duzenli, Cheryl; Pica, Alessia; Goudjil, Farid; Mazal, Alejandro


    Purpose: To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs. Methods and Materials: Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow. Results: Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post–radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers. Conclusions: The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades

  2. Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey

    Energy Technology Data Exchange (ETDEWEB)

    Hrbacek, Jan, E-mail: [Center for Proton Therapy, Paul Scherrer Institute, Villigen (Switzerland); Mishra, Kavita K. [Ocular Tumor Proton Therapy Program, University of California San Francisco, San Francisco, California (United States); Kacperek, Andrzej [National Proton Therapy Centre, Clatterbridge Cancer Centre, Bebington (United Kingdom); Dendale, Remi; Nauraye, Catherine; Auger, Michel [Centre de Protonthérapie d' Orsay, Institut Curie, Orsay (France); Herault, Joel [Centre Lacassagne, Nice (France); Daftari, Inder K. [Ocular Tumor Proton Therapy Program, University of California San Francisco, San Francisco, California (United States); Trofimov, Alexei V.; Shih, Helen A.; Chen, Yen-Lin E. [F. H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Denker, Andrea [Protons for Therapy, Helmholtz-Zentrum Berlin, Berlin (Germany); Heufelder, Jens [BerlinProtonen am HZB, Charité – Universitätsmedizin Berlin, Berlin (Germany); Horwacik, Tomasz; Swakoń, Jan [Institute of Nuclear Physic, Polish Academy of Sciences, Krakow (Poland); Hoehr, Cornelia; Duzenli, Cheryl [BC Cancer Agency – TRIUMF, Vancouver (Canada); Pica, Alessia [Center for Proton Therapy, Paul Scherrer Institute, Villigen (Switzerland); Goudjil, Farid; Mazal, Alejandro [Centre de Protonthérapie d' Orsay, Institut Curie, Orsay (France); and others


    Purpose: To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs. Methods and Materials: Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow. Results: Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post–radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers. Conclusions: The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades

  3. Live defibrillation in simulation-based medical education--a survey of simulation center practices and attitudes. (United States)

    Turban, Joseph W; Peters, Deborah P; Berg, Benjamin W


    Resuscitation from cardiac arrhythmia, requiring cardioversion/defibrillation is a common simulation training scenario. Use of live defibrillation enhances simulation fidelity but is not without risk. This survey was conducted to describe the prevalence of live defibrillation use during training scenarios in healthcare simulation centers, and when used, if safety training was required before using live defibrillation. A convenience sample of attendees at the 7th annual International Meeting on Simulation in Healthcare (January 2007) was surveyed using a closed-ended 23-item survey instrument. Survey domains included responder and simulation center demographics, simulation center defibrillation safety policies, and attitudes toward defibrillation practices in simulation training environments. Fifty-seven individuals representing 39 simulation centers returned surveys, 29 of which were in the United States. Live defibrillation was used in 35 of the 39 centers (90%). A defibrillation safety training policy was in effect at 14 of 39 centers (36%). Formal training before using live defibrillation was considered necessary by 48 of 55 responders (87%). Forty-eight of 54 responders (89%) strongly agreed or agreed with the statement, "I feel using live defibrillation plays an important role in simulation-based education." Although most responders consider use of live defibrillation important and believe formal defibrillator safety training should be conducted before use, only about one third of the centers had a training policy in effect. It remains to be determined whether safety training before the use of live defibrillation during simulation-based education increases user safety.

  4. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. (United States)

    Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E; Rogers, Ann E


    To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through "on the job" training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap.

  5. Donor-recipient human leukocyte antigen matching practices in vascularized composite tissue allotransplantation: a survey of major transplantation centers. (United States)

    Ashvetiya, Tamara; Mundinger, Gerhard S; Kukuruga, Debra; Bojovic, Branko; Christy, Michael R; Dorafshar, Amir H; Rodriguez, Eduardo D


    Vascularized composite tissue allotransplant recipients are often highly sensitized to human leukocyte antigens because of multiple prior blood transfusions and other reconstructive operations. The use of peripheral blood obtained from dead donors for crossmatching may be insufficient because of life support measures taken for the donor before donation. No study has been published investigating human leukocyte antigen matching practices in this field. A survey addressing human leukocyte antigen crossmatching methods was generated and sent to 22 vascularized composite tissue allotransplantation centers with active protocols worldwide. Results were compiled by center and compared using two-tailed t tests. Twenty of 22 centers (91 percent) responded to the survey. Peripheral blood was the most commonly reported donor sample for vascularized composite tissue allotransplant crossmatching [78 percent of centers (n=14)], with only 22 percent (n=4) using lymph nodes. However, 56 percent of the 18 centers (n=10) that had performed vascularized composite tissue allotransplantation reported that they harvested lymph nodes for crossmatching. Of responding individuals, 62.5 percent (10 of 16 individuals) felt that lymph nodes were the best donor sample for crossmatching. A slight majority of vascularized composite tissue allotransplant centers that have performed clinical transplants have used lymph nodes for human leukocyte antigen matching, and centers appear to be divided on the utility of lymph node harvest. The use of lymph nodes may offer a number of potential benefits. This study highlights the need for institutional review board-approved crossmatching protocols specific to vascularized composite tissue allotransplantation, and the need for global databases for sharing of vascularized composite tissue allotransplantation experiences.

  6. A cross Canada survey of sperm banking practices in pediatric oncology centers. (United States)

    Chong, Amy Lee; Gupta, Abha; Punnett, Angela; Nathan, Paul C


    Childhood cancer survivors have identified fertility preservation as a major concern. Sperm banking is an established fertility preservation option in pubertal males. We sought to describe current practices in Canadian pediatric oncology programs, and to identify perceived barriers to sperm banking for male adolescents. A questionnaire was developed to (1) describe current sperm banking practices and facilities; (2) report on the utilization of sperm banking; and (3) identify barriers to sperm banking and possible solutions to improve current practices. A healthcare professional with an interest in fertility preservation within each institution was approached to participate in the study. Fifteen of 16 institutions participated, 2 have fertility preservation teams. Only one has written guidelines or adolescent focused educational material. Over 2 years, 50/262 (19%) adolescents in 12 institutions successfully banked a specimen. In 11 of these, additional information was available: of 85/172 (49%) adolescents offered the option to bank, 38/85 (45%) subsequently attempted. Reported barriers to sperm banking included the pressure to start therapy and restricted banking hours. Formal education of healthcare providers in fertility preservation practices, provision of financial support for families, and an adolescent focused approach were identified as important initiatives to improve sperm banking. There is a disparity in current sperm banking practices in Canada and at present, financial support, and improving knowledge translation among professionals and patients may improve the rates of banking. Copyright © 2010 Wiley-Liss, Inc.

  7. A synopsis on current practice in the diagnosis and management of patients with Turner syndrome in Turkey: A survey of 18 pediatric endocrinology centers* (United States)

    Uçar, Ahmet; Abacı, Ayhan; Pirgon, Özgür; Dündar, Bumin; Tütüncüler, Filiz; Çatlı, Gönül; Anık, Ahmet; Kılınç Uğurlu, Aylin; Büyükgebiz, Atilla


    A comprehensive survey was conducted courtesy of the Turkish Turner study group to evaluate the shortcomings of clinical care in patients with Turner syndrome (TS) in Turkey. A structured questionnaire prepared by the Turner study group in Turkey, which covers relevant aspects of the care of patients with TS, was sent to all pediatric endocrinology centers. Eighteen centers (41%) returned the questionnaire. In the majority of the centers, diagnostic genetic testing, screening for Y chromosomal material, protocols regarding the timing and posology of growth hormone (GH) and estrogen, thrombophilia screening, fertility information, and screening for glucose intolerance, thyroid, and coeliac diseases in patients with TS were in line with the current consensus. Thirteen centers (72.2%) performed GH stimulation tests. Only four centers (22.2%) used oxandrolone in patients with TS with very short stature. The majority of the centers relied on bone age and breast development to assess estrogen adequacy, though together with variable combinations of oestrogen surrogates. Two centers (11.1%) reported performing serum estradiol measurements. Eight centers (44.4% ) routinely conducted cardiac/thoracic aorta magnetic resonance imaging. Screening for hearing, dental, and ophthalmologic problems were performed by thirteen (72.2%), six (33.3%), and ten (55.6 %) centers, respectively. Psychiatric assessments were made by four centers (22.2%) at diagnosis, with only one center (5.6% ) requiring annual reassessments. Although we found some conformity between the current consensus and practice of the participating centers in Turkey regarding TS, further improvements are mandatory in the multi-disciplinary approach to address co-morbidities, which if unrecognized, may be associated with reduced quality of life, and even mortality.

  8. Infection prevention and control practice for Crimean-Congo hemorrhagic fever-A multi-center cross-sectional survey in Eurasia. (United States)

    Fletcher, Tom E; Gulzhan, Abuova; Ahmeti, Salih; Al-Abri, Seif S; Asik, Zahide; Atilla, Aynur; Beeching, Nick J; Bilek, Heval; Bozkurt, Ilkay; Christova, Iva; Duygu, Fazilet; Esen, Saban; Khanna, Arjun; Kader, Çiğdem; Mardani, Masoud; Mahmood, Faisal; Mamuchishvili, Nana; Pshenichnaya, Natalia; Sunbul, Mustafa; Yalcin, Tuğba Y; Leblebicioglu, Hakan


    Crimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers. Evaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia. A cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016. Twenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23). Staff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP&C practice at individual units in endemic areas, as part of national quality assurance programs.

  9. Aphasia centers in North America: a survey. (United States)

    Simmons-Mackie, Nina; Holland, Audrey L


    There is a growing trend toward dedicated programs designed to improve the lives of people with aphasia and their families. We are referring to these programs collectively as "aphasia centers." These programs purportedly differ from more traditional medically based aphasia rehabilitation. However, there is no directory of aphasia centers and no definition of what constitutes such a program. Therefore, an online survey was designed to identify and describe aphasia centers in the United States and Canada. A 37-question survey was posted online via SurveyMonkey. An introductory letter was distributed by electronic mail to a listserv and mailing lists of programs associated with aphasia. Potential respondents who considered themselves an aphasia center were asked to complete the survey. A total of 33 survey responses were analyzed, and descriptive data were compiled resulting in a description of the following aspects of aphasia centers: demographic information, mission, admission and discharge policies, assessment practices, program logistics, staffing patterns, marketing, funding, and services offered. In addition, a qualitative analysis of written text responses revealed the following key themes that appear to characterize the responding programs: services that differ from traditional aphasia rehabilitation; a sense of community; a holistic focus on quality of life, psychosocial well-being, participation, and social support; the centrality of group interaction; and variety/intensity of services. © Thieme Medical Publishers.

  10. Medical Simulation Practices 2010 Survey Results (United States)

    McCrindle, Jeffrey J.


    Medical Simulation Centers are an essential component of our learning infrastructure to prepare doctors and nurses for their careers. Unlike the military and aerospace simulation industry, very little has been published regarding the best practices currently in use within medical simulation centers. This survey attempts to provide insight into the current simulation practices at medical schools, hospitals, university nursing programs and community college nursing programs. Students within the MBA program at Saint Joseph's University conducted a survey of medical simulation practices during the summer 2010 semester. A total of 115 institutions responded to the survey. The survey resus discuss overall effectiveness of current simulation centers as well as the tools and techniques used to conduct the simulation activity

  11. Survey commission of the Manche center

    International Nuclear Information System (INIS)


    The subjects discussed during the Survey commission of the storage center of the Manche CSCM, held in october 2001, are presented in this document. They deal with the site survey, the maintenance facilities realized on this installations, the tritium survey in the water and the CSCM operating. (A.L.B.)

  12. Center for astrophysics redshift survey

    International Nuclear Information System (INIS)

    Davis, M.; Huchra, J.; Latham, D.


    Major advances in the art of redshift measurements have improved the obtainable accuracy to better than 30 km/s. It is now posible to obtain a redshift for almost any galaxy brighter than 15th magnitude on a 60-inch telescope in 60 minutes or less. These advances were utilized in an observation program initiated in the spring of 1978. This program represents a survey of radial velocities for all 2400 galaxies brighter than 14.5 at high galactic latitude in the northern hemisphere. The obtained data set has been employed as a basis for a derivation of a good measure of the local mean mass density. In addition, information was obtained concerning the overdensity and the dynamics of the local supercluster, and an analysis was conducted of the dynamics of groups and clusters of galaxies within the sample volume. 16 references

  13. Frequency of adoption of practice management guidelines at trauma centers (United States)

    Sobrino, Justin; Barnes, Sunni A.; Dahr, Nadine; Kudyakov, Rustam; Berryman, Candice; Nathens, Avery B.; Hemmila, Mark R.; Neal, Melanie


    Evidence-based management guidelines have been shown to improve patient outcomes, yet their utilization by trauma centers remains unknown. This study measured adoption of practice management guidelines or protocols by trauma centers. A survey of 228 trauma centers was conducted over 1 year; 55 completed the survey. Centers were classified into three groups: noncompliant, partially compliant, and compliant with adoption of management protocols. Characteristics of compliant centers were compared with those of the other two groups. Most centers were Level I (58%) not-for-profit (67%) teaching hospitals (84%) with a surgical residency (74%). One-third of centers had an accredited fellowship in surgical critical care (37%). Only one center was compliant with all 32 management protocols. Half of the centers were compliant with 14 of 32 protocols studied (range, 4 to 32). Of the 21 trauma center characteristics studied, only two were independently associated with compliant centers: use of physician extenders and daily attending rounds (both P < .0001). Adoption of management guidelines by trauma centers is inconsistent, with wide variations in practices across centers. PMID:23814383

  14. Applied technology center business plan and market survey (United States)

    Hodgin, Robert F.; Marchesini, Roberto


    Business plan and market survey for the Applied Technology Center (ATC), computer technology transfer and development non-profit corporation, is presented. The mission of the ATC is to stimulate innovation in state-of-the-art and leading edge computer based technology. The ATC encourages the practical utilization of late-breaking computer technologies by firms of all variety.

  15. Patient perception and the barriers to practicing patient-centered communication: A survey and in-depth interview of Chinese patients and physicians. (United States)

    Ting, Xu; Yong, Bao; Yin, Liang; Mi, Tian


    To investigate patient perceptions of patient-centered communication (PCC) in doctor-patient consultations and explore barriers to PCC implementation in China. This study was conducted in public teaching hospital in Guiyang, Guizhou, China. In Phase 1, patient attitudes to PCC were quantitatively assessed in 317 outpatients using modified Patient-Practitioner Orientation Scale (PPOS). In Phase 2, we conducted in-depth interviews with 20 outpatients to explore their views on PCC and expose potential barriers to PCC implementation. Participants communicated "patient-centered" preferences, particularly with regard to their doctors' empathy, communication skills, time and information sharing. Patients were more concerned about doctors exhibiting caring perspective than power sharing. Younger and highly educated patients were more likely to prefer PCC and highly educated patients paid more attention to power sharing. Several factors including inadequate time for PCC resulting from doctors' high patient-load, doctor-patient communication difficulties and excessive treatment due to inappropriate medical payment system affected PCC implementation in China. Patients expressed moderate enthusiasm for PCC in China. They expressed strong preferences concerning physician respect for patient perspective, but less concern for power sharing. Government should improve health care system by implementing PCC in daily healthcare practice to improve patient awareness and preferences. Copyright © 2016. Published by Elsevier Ireland Ltd.

  16. Marketing the academic medical center group practice. (United States)

    Eudes, J A; Divis, K L


    From a marketing perspective, there are many differences between private and academic medical center (AMC) group practices. Given the growing competition between the two, write John Eudes and Kathy Divis, it is important for the AMC group practice to understand and use these differences to develop a competitive market advantage.

  17. A survey of ampullectomy practices

    Institute of Scientific and Technical Information of China (English)

    Stacy B Menees; Philip Schoenfeld; Hyungjin Myra Kim; Grace H Elta


    AIM: To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS: An anonymous survey was mailed to 79 expert biliary endoscopists to assess ampullectomy practices. RESULTS: Forty six (58%) biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years (± 8.6). Endoscopists performed an average of 1.1 (± 0.8) ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was "always" utilized by 67% of respondents vs "sometimes" in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% "always" and 37% "sometimes" performed it prior to resection. Fifty three percent reported "never" performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy (OR = 10.9; P = 0.09). Participants overwhelmingly favored "always" placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection (23%). Argon plasma coagulation was the favored adjunct modality (83%) for removal of residual adenomatous tissue. Practitioners uniformly (100%) preferred follow-up examination to be within 6 mo post-ampullectomy. CONCLUSION: Among biliary experts, there is less variation in ampullectomy practices than is reflected in the literature.

  18. 78 FR 14549 - National Contact Center; Information Collection; National Contact Center Customer Evaluation Survey (United States)


    ...] National Contact Center; Information Collection; National Contact Center Customer Evaluation Survey AGENCY... National Contact Center customer evaluation surveys. In this request, the previously approved surveys have... several months. These temporary surveys will allow the National Contact Center to compare its customer...

  19. Survey on current hydrotherapy use among North American burn centers. (United States)

    Davison, Peter G; Loiselle, Frederick B; Nickerson, Duncan


    The authors have reviewed hydrotherapy practices in North American burn centers and described the epidemiology of hydrotherapy-associated nosocomial infections. A web-based survey was distributed to the directors of all burn care facilities listed by the American Burn Association. Questions addressed aspects of practice, including the method, additives, disposable liners, decontamination practices, nosocomial pathogens, and perceptions regarding the "ideal" method of hydrotherapy. The response rate was 44%, 59 of 142 centers, or 827 of 1900 beds. Hydrotherapy is regularly used by 83% of centers. Among these centers, 10% use exclusively immersion hydrotherapy (IH), 54% use exclusively shower cart hydrotherapy (SCH), and 35% use a combination of IH and SCH. Disposable liners are used at 80% of centers. Tap water alone is used by 51% of centers, 27% add detergent, 16% chlorhexidine, and 7% povidone-iodine. The majority of centers (57%) do not routinely culture their hydrotherapy equipment, 20% culture weekly, 7% monthly, and 17% less than once per month. Directors believe that Pseudomonas aeruginosa, methicillin-sensitive Staphylococcus aureus, and methicillin-resistant S. aureus are the most common nosocomial pathogens, followed by Acinetobacter species and Candida albicans. The relative frequency of occurrence of the first three pathogens did not vary with regard to the hydrotherapy method used. Given the opportunity to redesign, 45% of burn unit directors would implement SCH only, 42% a combination of SCH and IH, 2% exclusively IH, and 11% no hydrotherapy or bedside irrigation only. The prevalence of hydrotherapy use at North American burn centers has decreased since 1990 (83% vs 95%), yet continues to be used at the majority of centers. The use of IH has also declined (55% vs 81%). The trend away from the exclusive use of IH will likely continue, because more centers incorporate showering methods.

  20. Teleradiology for a family practice center

    International Nuclear Information System (INIS)

    Franken, E.A.; Driscoll, C.E.; Berbaum, K.S.; Smith, W.L.; Sato, Y.; Kao, S.C.; Steinkraus, L.


    This study evaluated the role of teleradiology (TR) in providing radiology consultation to a family practice center. All radiographs obtained in the center over a 5-month period were read twice independently: once by TR and once with the original radiograph. Accuracy was comparable for TR and plain films, with an average error rate of 7%. Effect of the radiologist's consultation on the family practitioner was substantial, causing changes in the confidence of diagnosis in over half of cases, and in treatment or prognosis in others. The immediate TR report tended to have a greater impact than the late consultation. The authors conclude that TR offers an acceptable mechanism for radiologic consultation

  1. Precision surveying the principles and geomatics practice

    CERN Document Server

    Ogundare, John Olusegun


    A comprehensive overview of high precision surveying, including recent developments in geomatics and their applications This book covers advanced precision surveying techniques, their proper use in engineering and geoscience projects, and their importance in the detailed analysis and evaluation of surveying projects. The early chapters review the fundamentals of precision surveying: the types of surveys; survey observations; standards and specifications; and accuracy assessments for angle, distance and position difference measurement systems. The book also covers network design and 3-D coordinating systems before discussing specialized topics such as structural and ground deformation monitoring techniques and analysis, mining surveys, tunneling surveys, and alignment surveys. Precision Surveying: The Principles and Geomatics Practice: * Covers structural and ground deformation monitoring analysis, advanced techniques in mining and tunneling surveys, and high precision alignment of engineering structures *...

  2. Findings from Survey Administered to Weatherization Training Centers

    Energy Technology Data Exchange (ETDEWEB)

    Conlon, Brian [Univ. of Tennessee, Knoxville, TN (United States); Tonn, Bruce Edward [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)


    This report summarizes results of a survey administered to directors of weatherization training centers that receive funding from the U.S. Department of Energy. The survey presents results related to questions on training offered and future plans.

  3. Hospitalization in Parkinson disease: a survey of National Parkinson Foundation Centers

    NARCIS (Netherlands)

    Chou, K.L.; Zamudio, J.; Schmidt, P.; Price, C.C.; Parashos, S.A.; Bloem, B.R.; Lyons, K.E.; Christine, C.W.; Pahwa, R.; Bodis-Wollner, I.; Oertel, W.H.; Suchowersky, O.; Aminoff, M.J.; Malaty, I.A.; Friedman, J.H.; Okun, M.S.


    OBJECTIVES: To explore current practices and opinions regarding hospital management of Parkinson disease (PD) patients in specialized PD Centers. METHODS: Fifty-one out of 54 National Parkinson Foundation (NPF) Centers worldwide completed an online survey regarding hospitalization of PD patients.

  4. Nuclear energy center site survey reactor plant considerations

    International Nuclear Information System (INIS)


    The Energy Reorganization Act of 1974 required the Nuclear Regulatory Commission (NRC) to make a nuclear energy center site survey (NECSS). Background information for the NECSS report was developed in a series of tasks which include: socioeconomic inpacts; environmental impact (reactor facilities); emergency response capability (reactor facilities); aging of nuclear energy centers; and dry cooled nuclear energy centers

  5. Practical boundary surveying legal and technical principles

    CERN Document Server

    Gay, Paul


    This guide to boundary surveying provides landowners, land surveyors, students and others with the necessary foundation to understand boundary surveying techniques and the common legal issues that govern boundary establishment.  Boundary surveying is sometimes mistakenly considered a strictly technical discipline with simple and straightforward technical solutions.  In reality, boundary establishment is often a difficult and complex matter, requiring years of experience and a thorough understanding of boundary law.  This book helps readers to understand the challenges often encountered by boundary surveyors and some of the available solutions. Using only simple and logically explained mathematics, the principles and practice of boundary surveying are demystified for those without prior experience, and the focused coverage of pivotal issues such as easements and setting lot corners will aid even licensed practitioners in untangling thorny cases. Practical advice on using both basic and advanced instruments ...

  6. A practice-centered intervention to increase screening for domestic violence in primary care practices

    Directory of Open Access Journals (Sweden)

    Palla Shana L


    Full Text Available Abstract Background Interventions to change practice patterns among health care professionals have had mixed success. We tested the effectiveness of a practice centered intervention to increase screening for domestic violence in primary care practices. Methods A multifaceted intervention was conducted among primary care practice in North Carolina. All practices designated two individuals to serve as domestic violence resources persons, underwent initial training on screening for domestic violence, and participated in 3 lunch and learn sessions. Within this framework, practices selected the screening instrument, patient educational material, and content best suited for their environment. Effectiveness was evaluated using a pre/post cross-sectional telephone survey of a random selection of female patients from each practice. Results Seventeen practices were recruited and fifteen completed the study. Baseline screening for domestic violence was 16% with a range of 2% to 49%. An absolute increase in screening of 10% was achieved (range of increase 0 to 22%. After controlling for clustering by practice and other patient characteristics, female patients were 79% more likely to have been screened after the intervention (OR 1.79, 95% CI 1.43–2.23. Conclusion An intervention that allowed practices to tailor certain aspects to fit their needs increased screening for domestic violence. Further studies testing this technique using other outcomes are needed.

  7. Survey of radiological safety in dental practice

    Energy Technology Data Exchange (ETDEWEB)

    Gill, J R [UKAEA Health and Safety Branch, London; Hudson, A P


    A pilot survey of radiological protection in dental practice in Great Britain has been requested by the Health and Safety Executive and is now in progress. The survey should provide more precise data on the use of X-ray equipment. There are approximately 13,000 dentists in Great Britain using X-ray apparatus, and some 600 of these have been selected, on a statistical basis, to be invited to make use of a postal survey over a six month period. The postal survey technique to be used has already been developed as a service following requests from individual dentists. The dentist receives a questionnaire and three initial films to test the timer, then two special cassettes incorporating film and filters. Film badges are worn over a 12 week period by the dentist and by any staff who assist in radiography. Follow-up visits to discuss the survey will be made to one in ten of the selected dentists. The results will give the individual dentists, without cost, assurance of the efficient functioning of their equipment, and advice, should any remedial measures be necessary. Concurrently, the resulting statistics will give an indication of how many, if any, practices fall short of the recommendations of the Code of Practice for the Protection of Persons against Ionizing Radiations arising from Medical and Dental Use. Further action in respect of the Health and Safety at Work Act will be determined in the light of the survey.

  8. A practical guide to surveys and questionnaires. (United States)

    Slattery, Eric L; Voelker, Courtney C J; Nussenbaum, Brian; Rich, Jason T; Paniello, Randal C; Neely, J Gail


    Surveys with questionnaires play a vital role in decision and policy making in society. Within medicine, including otolaryngology, surveys with questionnaires may be the only method for gathering data on rare or unusual events. In addition, questionnaires can be developed and validated to be used as outcome measures in clinical trials and other clinical research architecture. Consequently, it is fundamentally important that such tools be properly developed and validated. Just asking questions that have not gone through rigorous design and development may be misleading and unfair at best; at worst, they can result in under- or overtreatment and unnecessary expense. Furthermore, it is important that consumers of the data produced by these instruments understand the principles of questionnaire design to interpret results in an optimal and meaningful way. This article presents a practical guide for understanding the methodologies of survey and questionnaire design, including the concepts of validity and reliability, how surveys are administered and implemented, and, finally, biases and pitfalls of surveys.

  9. Regional anesthesia practice in China: a survey. (United States)

    Huang, Jeffrey; Gao, Huan


    Neuraxial anesthesia has been widely used in China. Recently, Chinese anesthesiologists have applied nerve stimulator and ultrasound guidance for peripheral nerve blocks. Nationwide surveys about regional anesthesia practices in China are lacking. We surveyed Chinese anesthesiologists about regional anesthesia techniques, preference, drug selections, complications, and treatments. A survey was sent to all anesthesiologist members by WeChat. The respondents can choose mobile device or desktop to complete the survey. Each IP address is allowed to complete the survey once. A total of 6589 members read invitations. A total of 2654 responses were received with fully completed questionnaires, which represented an overall response rate of 40%. Forty-one percent of the respondents reported that more than 50% of surgeries in their hospitals were done under regional anesthesia. Most of the participants used test dose after epidural catheter insertion. The most common drug for test dose was 3-mL 1.5% lidocaine; 2.6% of the participants reported that they had treated a patient with epidural hematoma after neuraxial anesthesia. Most anesthesiologists (68.2%) performed peripheral nerve blocks as blind procedures based on the knowledge of anatomical landmarks. A majority of hospitals (80%) did not stock Intralipid; 61% of the respondents did not receive peripheral nerve block training. The current survey can serve as a benchmark for future comparisons and evaluation of regional anesthesia practices in China. This survey revealed potential regional anesthesia safety issues in China. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Survey of clinical infant lung function testing practices. (United States)

    Peterson-Carmichael, Stacey L; Rosenfeld, Margaret; Ascher, Simon B; Hornik, Christoph P; Arets, H G M; Davis, Stephanie D; Hall, Graham L


    Data supporting the clinical use of infant lung function (ILF) tests are limited making the interpretation of clinical ILF measures difficult. To evaluate current ILF testing practices and to survey users regarding the indications, limitations and perceived clinical benefits of ILF testing. We created a 26-item survey hosted on the European Respiratory Society (ERS) website between January and May 2010. Notifications were sent to members of the ERS, American Thoracic Society and the Asian Pacific Society of Respirology. Responses were sought from ILF laboratory directors and pediatric respirologists. The survey assessed the clinical indications, patient populations, equipment and reference data used, and perceived limitations of ILF testing. We received 148 responses with 98 respondents having ILF equipment and performing testing in a clinical capacity. Centers in North America were less likely to perform ≥50 studies/year than centers in Europe or other continents (13% vs. 41%). Most respondents used ILF data to either "start a new therapy" (78%) or "help decide about initiation of further diagnostic workup such as bronchoscopy, chest CT or serological testing" (69%). Factors reported as limiting clinical ILF testing were need for sedation, uncertainty regarding clinical impact of study results and time intensive nature of the study. Clinical practices associated with ILF testing vary significantly; centers that perform more studies are more likely to use the results for clinical purposes and decision making. The future of ILF testing is uncertain in the face of the limitations perceived by the survey respondents. © 2013 Wiley Periodicals, Inc.

  11. Job satisfaction survey among health centers staff


    Shahnazi, Hossein; Daniali, Seyede Shahrbanoo; Sharifirad, Gholamreza


    Background: Due to the importance of health care organizations with significant responsibility for prevention and care, assessment of job satisfaction among health care staff is essential. Quality of health services will be decreased provided they are not satisfied. Materials and Methods: This study was a cross-sectional analysis of health care staff in Khomeinishahr (centers, buildings, and networks) If they had at least 6 months work experience, they could enter the study. Data included a t...

  12. Survey of licensee control room habitability practices

    International Nuclear Information System (INIS)

    Boland, J.F.; Brookshire, R.L.; Danielson, W.F.; Driscoll, J.W.; Graham, E.D.; McConnell, R.J.; Thompson, V.N.


    This document presents the results of a survey of Licensee control-room-habitability practices. The survey is part of a comprehensive program plan instituted in August 1983 by the NRC to respond to ongoing questions from the Advisory Committee on Reactor Safeguards (ACRS). The emphasis of this survey was to determine by field review the control-room habitability practices at three different plants, one of which is still under construction and scheduled to receive an operating license in 1986. The other two plants are currently operating, having received operating licenses in the mid-1970's and early 1980's. The major finding of this survey is that despite the fact that the latest control-room-habitability systems have become larger and more complex than earlier systems surveyed, the latest systems do not appear to be functionally superior. The major recommendation of this report is to consolidate into a single NRC document, based upon a comprehensive systems engineering approach, the pertinent criteria for control-room-habitability design

  13. Optometry Australia Scope of Practice Survey 2015. (United States)

    Kiely, Patricia M; Cappuccio, Skye; McIntyre, Ellen


    This paper presents results from the inaugural Scope of Practice Survey of Optometry Australia members conducted in October 2015. The survey gathered information related to confidence in detecting and diagnosing key ocular conditions, grading diabetic retinopathy, prescribing scheduled medicines, access to equipment, confidence using equipment, incidence of patients requiring therapeutic management, referral practices and services provided. The survey was developed, piloted, modified and administered to members of Optometry Australia (excluding student and retired members), who had a current email address. Results were collated and analysed using Microsoft Excel. Of the 587 optometrists in clinical practice who responded, 254 (43 per cent) had therapeutic endorsement of registration. The majority of respondents practised in a major city or surrounding suburbs (63 per cent). Independent practice was the most frequently cited practice type (58 per cent). The estimated average number of patients seen in a week was 48; there was a steady decrease in the number of patients per week with increasing age, from 53 for optometrists in their 20s to 27 for optometrists aged over 70. There was very high confidence (over 93 per cent) in ability to grade diabetic retinopathy and diagnose a range of ocular conditions. Confidence in performance of more advanced techniques was higher for endorsed than non-endorsed optometrists. Approximately 12 per cent of patients required a Schedule 4 therapeutic prescription. The most frequently recommended over-the-counter medications were for dry eye for both endorsed and non-endorsed optometrists. The most frequently prescribed Schedule 4 medications were anti-inflammatories. The most challenging conditions to prescribe for were glaucoma, microbial keratitis and uveitis. Approximately one in six therapeutically endorsed optometrists reported unexpected side effects of medications they had prescribed. Information from the survey will guide

  14. Bimodal Programming: A Survey of Current Clinical Practice. (United States)

    Siburt, Hannah W; Holmes, Alice E


    The purpose of this study was to determine the current clinical practice in approaches to bimodal programming in the United States. To be specific, if clinicians are recommending bimodal stimulation, who programs the hearing aid in the bimodal condition, and what method is used for programming the hearing aid? An 11-question online survey was created and sent via email to a comprehensive list of cochlear implant programming centers in the United States. The survey was sent to 360 recipients. Respondents in this study represented a diverse group of clinical settings (response rate: 26%). Results indicate little agreement about who programs the hearing aids, when they are programmed, and how they are programmed in the bimodal condition. Analysis of small versus large implant centers indicated small centers are less likely to add a device to the contralateral ear. Although a growing number of cochlear implant recipients choose to wear a hearing aid on the contralateral ear, there is inconsistency in the current clinical approach to bimodal programming. These survey results provide evidence of large variability in the current bimodal programming practices and indicate a need for more structured clinical recommendations and programming approaches.

  15. Construction practices: Pulse builder survey results

    Energy Technology Data Exchange (ETDEWEB)

    Kadulski, R

    This paper discusses the results of a nationwide builder survey on common building techniques, such as framing, insulation, airtight construction practices, testing for airtightness, windows, furnaces and water heaters, and ventilation. Results indicate that changes in construction were mainly influenced by the R-2000 program. The spread of R-2000 technology is reflected in the use of higher insulation levels than are called for by codes or than is normal practice, sealing of joints, and attention to air and vapour retarders as well as air tight drywall techniques combined with mechanical ventilation systems.

  16. Job satisfaction survey among health centers staff. (United States)

    Shahnazi, Hossein; Daniali, Seyede Shahrbanoo; Sharifirad, Gholamreza


    Due to the importance of health care organizations with significant responsibility for prevention and care, assessment of job satisfaction among health care staff is essential. Quality of health services will be decreased provided they are not satisfied. This study was a cross-sectional analysis of health care staff in Khomeinishahr (centers, buildings, and networks) If they had at least 6 months work experience, they could enter the study. Data included a two-part questionnaire with a standardized questionnaire, demographic variables, and Smith job descriptive index, which is a questionnaire with six domains. Reliability was obtained for each domain and its validity was reported 0.93. The results showed an overall satisfaction score averages 43.55 ± 12.8 (from 100). Job satisfaction score was not significantly different between the sexes. However, within the current attitude toward job satisfaction, men scores was better than women (P = 0.001). Highest score in job satisfaction was related to relationships with colleagues and lowest score was related to the income, benefits, and job promotion. The more the years of work, the less the job satisfaction was. The attitude toward the current job had a direct relationship with income (P = 0.01). There was a significant inverse relationship between educational level and job satisfaction in domains promotion, income, and benefits (P = 0.01). The staff with higher education levels was less satisfied with income and job promotion qualification. Managers should focus on job qualification to increase job satisfaction and improve the quality of work.

  17. The Trauma Center Organizational Culture Survey: development and conduction. (United States)

    Davis, Matthew L; Wehbe-Janek, Hania; Subacius, Haris; Pinto, Ruxandra; Nathens, Avery B


    The Trauma Center Organizational Culture Survey (TRACCS) instrument was developed to assess organizational culture of trauma centers enrolled in the American College of Surgeons Trauma Quality Program (ACS TQIP). The objective is to provide evidence on the psychometric properties of the factors of TRACCS and describe the current organizational culture of TQIP-enrolled trauma centers. A cross-sectional study was conducted by surveying a sampling of employees at 174 TQIP-enrolled trauma centers. Data collection was preceded by multistep survey development. Psychometric properties were assessed by an exploratory factor analysis (construct validity) and the item-total correlations and Cronbach alpha were calculated (internal reliability). Statistical outcomes of the survey responses were measured by descriptive statistics and mixed effect models. The response rate for trauma center participation in the study was 78.7% (n = 137). The factor analysis resulted in 16 items clustered into three factors as described: opportunity, pride, and diversity, trauma center leadership, and employee respect and recognition. TRACCS was found to be highly reliable with a Cronbach alpha of 0.90 in addition to the three factors (0.91, 0.90, and 0.85). Considerable variability of TRACCS overall and factor score among hospitals was measured, with the largest interhospital deviations among trauma center leadership. More than 80% of the variability in the responses occurred within rather than between hospitals. TRACCS was developed as a reliable tool for measuring trauma center organizational culture. Relationships between TQIP outcomes and measured organizational culture are under investigation. Trauma centers could apply TRACCS to better understand current organizational culture and how change tools can impact culture and subsequent patient and process outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Translating person-centered care into practice

    DEFF Research Database (Denmark)

    Zoffmann, Vibeke; Hörnsten, Åsa; Storbækken, Solveig


    OBJECTIVE: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided...... tools. CONCLUSION: Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked. PRACTICE IMPLICATIONS: Professionals must critically consider the context...

  19. An Investigation of Leadership Best Practices and Teacher Morale in Six Community College Child Development Centers in Southern California (United States)

    Fisher, Paula V.


    This study was an investigation of a community college child development centers' leadership best practices and center teacher morale. A review of the literature focused on high and low teacher morale and leadership best practices. This quantitative study was conducted using the survey-design method with an adapted version of the Purdue Teacher…

  20. Results of an Institutional LGBT Climate Survey at an Academic Medical Center. (United States)

    Chester, Sean D; Ehrenfeld, Jesse M; Eckstrand, Kristen L


    The purpose of this study was to characterize the climate and culture experienced by lesbian, gay, bisexual, and transgender (LGBT) employees and students at one large academic medical center. An anonymous, online institutional climate survey was used to assess the attitudes and experiences of LGBT employees and students. There were 42 LGBT and 14 non-LGBT survey participants. Results revealed that a surprisingly large percentage of LGBT individuals experienced pressure to remain "closeted" and were harassed despite medical center policies of non-discrimination. Continuing training, inclusive policies and practices, and the development of mechanisms to address LGBT-specific harassment are necessary for improving institutional climate.

  1. Environmental Survey preliminary report, Pittsburgh Energy Technology Center, Pittsburgh, Pennsylvania

    Energy Technology Data Exchange (ETDEWEB)


    This report presents the preliminary findings from the first phase of the Environmental Survey of the US Department of Energy (DOE) Pittsburgh Energy Technology Center (PETC) conducted December 7--11, 1987. The Survey is being conducted by an interdisciplinary team of environmental specialists, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team specialists are outside experts being supplied by a private contractor. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with PETC. The Survey covers all environmental media and all areas of environmental regulation. It is being performed in accordance with the DOE Environmental Survey Manual. This phase of the Survey involves the review of existing site environmental data, observations of the operations carried on at PETC, and interviews with site personnel. The Survey team developed a Sampling and Analysis (S A) Plan to assist in further assessing certain environmental problems identified during its on-site Survey activities at PETC. The S A Plan will be executed by the Oak Ridge National Laboratory (ORNL). When completed, the Plan's results will be incorporated into the PETC Survey findings for inclusion into the Environmental Survey Summary Report. 64 refs., 23 figs., 29 tabs.

  2. Survey of radiologic practices among dental practitioners

    International Nuclear Information System (INIS)

    Goren, A.D.; Sciubba, J.J.; Friedman, R.; Malamud, H.


    The purpose of this study was to determine the factors that influence and contribute to patient exposure in radiologic procedures performed in the offices of 132 staff members within the dental department of a teaching hospital. A questionnaire was prepared in which data were requested on brands of film used, type of x-ray unit used, processing, and use of leaded apron, cervical shield, and film holder. Offices were also visited to evaluate performance of existing dental x-ray equipment. Both the Dental Radiographic Normalizing and Monitoring Device and the Dental Quality Control Test Tool were evaluated. The average exposure was equivalent to the class D film (220 mR), but only 13% of those surveyed used the faster class E film, which would reduce patient exposure in half. The survey indicates that dentists are not using the newer low-exposure class E film in their practices

  3. Nuclear energy center site survey: fuel cycle studies

    International Nuclear Information System (INIS)


    Background information for the Nuclear Regulatory Commission Nuclear Energy Center Site Survey is presented in the following task areas: economics of integrated vs. dispersed nuclear fuel cycle facilities, plutonium fungibility, fuel cycle industry model, production controls and failure contingencies, environmental impact, waste management, emergency response capability, and feasibility evaluations

  4. Environmental Survey preliminary report, Feed Materials Production Center, Fernald, Ohio

    Energy Technology Data Exchange (ETDEWEB)


    This report presents the preliminary findings from the first phase of the environmental survey of the United States Department of Energy (DOE) Feed Materials Production Center (FMPC), conducted June 16 through 27, 1986. The survey is being conducted by an interdisciplinary team of environmental specialists, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team components are being supplied by a private contractor. The objective of the survey is to identify environmental problems and areas of environmental risk associated with the FMPC. The survey covers all environmental media and all areas of environmental regulation. It is being performed in accordance with the DOE Environmental Survey Manual. This phase of the survey involves the review of existing site environmental data, observations of the operations carried on at FMPC, and interviews with site personnel. The survey team developed a Sampling and Analysis Plan to assist in further assessing certain of the environmental problems identified during its onsite activities. The Sampling and Analysis Plan will be executed by a DOE national laboratory or a support contractor. When completed, the results will be incorporated into the FMPC Environmental Survey Interim Report. The Interim Report will reflect the final determinations of the FMPC survey. 41 refs., 20 figs., 25 tabs.

  5. Environmental Survey preliminary report, Stanford Linear Accelerator Center, Stanford, California

    Energy Technology Data Exchange (ETDEWEB)


    This report presents the preliminary findings from the first phase of the Survey of the US Department of Energy (DOE) Stanford Linear Accelerator Center (SLAC) at Stanford, California, conducted February 29 through March 4, 1988. The Survey is being conducted by an interdisciplinary team of environmental specialists, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team components are being supplied by a private contractor. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with the SLAC. The Survey covers all environmental media and all areas of environmental regulation and is being performed in accordance with the DOE Environmental Survey Manual. This phase of the Survey involves the review of existing site environmental data, observations of the operations at the SLAC, and interviews with site personnel. The Survey team is developing a Sampling and Analysis Plan to assist in further assessing certain of the environmental problems identified during its on-site activities. The Sampling and Analysis Plan will be executed by a DOE National Laboratory or a support contractor. When completed, the results will be incorporated into the Environmental Survey Interim Report for the SLAC facility. The Interim Report will reflect the final determinations of the SLAC Survey. 95 refs., 25 figs., 25 tabs.

  6. Environmental Survey preliminary report, Stanford Linear Accelerator Center, Stanford, California

    International Nuclear Information System (INIS)


    This report presents the preliminary findings from the first phase of the Survey of the US Department of Energy (DOE) Stanford Linear Accelerator Center (SLAC) at Stanford, California, conducted February 29 through March 4, 1988. The Survey is being conducted by an interdisciplinary team of environmental specialists, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team components are being supplied by a private contractor. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with the SLAC. The Survey covers all environmental media and all areas of environmental regulation and is being performed in accordance with the DOE Environmental Survey Manual. This phase of the Survey involves the review of existing site environmental data, observations of the operations at the SLAC, and interviews with site personnel. The Survey team is developing a Sampling and Analysis Plan to assist in further assessing certain of the environmental problems identified during its on-site activities. The Sampling and Analysis Plan will be executed by a DOE National Laboratory or a support contractor. When completed, the results will be incorporated into the Environmental Survey Interim Report for the SLAC facility. The Interim Report will reflect the final determinations of the SLAC Survey. 95 refs., 25 figs., 25 tabs

  7. Groups of galaxies in the Center for Astrophysics redshift survey

    International Nuclear Information System (INIS)

    Ramella, M.; Geller, M.J.; Huchra, J.P.


    By applying the Huchra and Geller (1982) objective group identification algorithm to the Center for Astrophysics' redshift survey, a catalog of 128 groups with three or more members is extracted, and 92 of these are used as a statistical sample. A comparison of the distribution of group centers with the distribution of all galaxies in the survey indicates qualitatively that groups trace the large-scale structure of the region. The physical properties of groups may be related to the details of large-scale structure, and it is concluded that differences among group catalogs may be due to the properties of large-scale structures and their location relative to the survey limits. 28 refs

  8. Best Practices Guide for Energy-Efficient Data Center Design

    Energy Technology Data Exchange (ETDEWEB)

    O. VanGeet: NREL


    This guide provides an overview of best practices for energy-efficient data center design which spans the categories of Information Technology (IT) systems and their environmental conditions, data center air management, cooling and electrical systems, on-site generation, and heat recovery.

  9. Chlamydia and Gonorrhea Screening and Expedited Partner Therapy (EPT) Practices of College Student Health Centers (United States)

    Oswalt, Sara B.; Eastman-Mueller, Heather P.


    Objective: To examine college student health centers' (SHCs) practices related to sexually transmitted disease (STD) screening and treatment over a 5-year period. Participants: College SHCs that completed the ACHA Pap and STI Survey between 2010 and 2014. Methods: Chi-square tests were conducted with Cramer's V providing a measure of association.…

  10. Detecting malingering: a survey of experts' practices. (United States)

    Slick, Daniel J; Tan, Jing E; Strauss, Esther H; Hultsch, David F


    A survey addressing practices of 'expert' neuropsychologists in handling financial compensation claim or personal injury litigation cases was carried out. Potential participants were identified by publication history. Responses were obtained from 24 out of the 39 neuropsychologists who were surveyed. Approximately 79% of the respondents reported using at least one specialized technique for detecting malingering in every litigant assessment. Half stated that they always give specialized tests at the beginning of the assessment. The Rey 15-Item test and the Test of Memory Malingering were the most frequently reported measures. Respondents also reported frequent use of 'malingering' indexes from standard neuropsychological tests. Reported base-rates varied, but the majority of respondents indicated that at least 10% of the litigants they assessed in the last year were definitely malingering. Respondents were split on the practice of routinely giving warnings at the outset of assessments that suboptimal performance may be detected. However, when the client's motivational status was suspect, more than half (58.3%) altered their assessment routine at least on some occasions, by encouraging good effort (70.8%) or administering additional SVTs. A minority directly confronted or warned clients (25%), terminated the examination earlier than planned (16.6%), or contacted the referring attorney immediately (29.2%). Respondents almost always stated some opinion regarding indicators of invalidity in written reports (95%). However, 41.7% rarely used the term 'malingering' and 12.5% never used the term. Most respondents (>80%) instead stated that the test results are invalid, inconsistent with the severity of the injury or indicative of exaggeration. Copyright 2003 National Academy of Neuropsychology

  11. Consumerism: forcing medical practices toward patient-centered care. (United States)

    Ozmon, Jeff


    Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

  12. User-Centered Design in Practice: The Brown University Experience (United States)

    Bordac, Sarah; Rainwater, Jean


    This article presents a case study in user-centered design that explores the needs and preferences of undergraduate users. An analysis of LibQual+ and other user surveys, interviews with public service staff, and a formal American with Disabilities Act accessibility review served as the basis for planning a redesign of the Brown University…

  13. Emergency contraception: A multispecialty survey of clinician knowledge and practices. (United States)

    Batur, Pelin; Cleland, Kelly; McNamara, Megan; Wu, Justine; Pickle, Sarah


    To assess knowledge and provision of emergency contraception (EC), particularly the most effective methods. A web-based survey was distributed to a cross-sectional convenience sample of healthcare providers across specialties treating reproductive-aged women. The survey was sent to 3260 practicing physicians and advanced practice clinicians in 14 academic centers between February 2013 and April 2014. We analyzed responses by provider specialty using multivariable logistic regression. The final sample included 1684 providers (response rate=51.7%). Ninety-five percent of the respondents had heard of levonorgestrel (LNG) EC. Among reproductive health specialists, 81% provide LNG EC in their practice, although only half (52%) had heard of ulipristal acetate (UPA) and very few provide it (14%). The majority in family medicine (69%) and emergency medicine (74%) provide LNG, in contrast to 42% of internists and 55% of pediatricians. However, the more effective methods [UPA and copper intrauterine device (IUD)] were little known and rarely provided outside of reproductive health specialties; 18% of internists and 14% of emergency medicine providers had heard of UPA and 4% provide it. Only 22% of emergency providers and 32% of pediatricians had heard of the copper IUD used as EC. Among reproductive health specialists, only 36% provide copper IUD as EC in their practice. Specialty, provider type and proportion of women of reproductive age in the practice were related to knowledge and provision of some forms of EC. Awareness and provision of the most effective EC methods, UPA and the copper IUD (which are provider dependent), are substantially lower than for LNG EC, especially among providers who do not focus on reproductive health. In our sample of 1684 healthcare providers from diverse specialties who treat reproductive-aged women, knowledge and provision of the most effective forms of EC (UPA and the copper IUD) are far lower than for LNG EC. Women should be offered the

  14. NASA/DOD Aerospace Knowledge Diffusion Research Project. Report No. 36: The Technical Communications Practices of US Aerospace Engineers and Scientists: Results of the Phase 1 NASA Langley Research Center Mail Survey (United States)

    Pinelli, Thomas E.; Barclay, Rebecca O.; Kennedy, John M.


    The U.S. government technical report is a primary means by which the results of federally funded research and development (R&D) are transferred to the U.S. aerospace industry. However, little is known about this information product in terms of its actual use, importance, and value in the transfer of federally funded R&D. To help establish a body of knowledge, the U.S. government technical report is being investigated as part of the NASA/DOD Aerospace Knowledge Diffusion Research Project. In this report, we summarize the literature on technical reports and provide a model that depicts the transfer of federally funded aerospace R&D via the U.S. government technical report. We present results from our investigation of aerospace knowledge diffusion vis-a-vis the U.S. government technical report, and present the results of research that investigated aerospace knowledge diffusion vis-a-vis the technical communications practices of U.S. aerospace engineers and scientists who were assigned to the Research and Technology Group (RTG) at the NASA Langley Research Center in September 1995.

  15. Nuclear Energy Center Site Survey, 1975. Executive summary

    International Nuclear Information System (INIS)


    The Nuclear Energy Center Site Survey is a study of a potential alternative siting approach for nuclear power and fuel-cycle facilities, an approach that would cluster sizable groups of such facilities on a relatively small number of sites. The largest aggregation of reactors on a single site being planned today is four, and this quad is assumed (for comparative study purposes) to be the typical dispersed site by the year 2000. Three basic types of nuclear energy centers are considered: power-plant centers, consisting of 10 to 40 nuclear electric generating units of 1200-megawatt electric capacity each; fuel-cycle centers, consisting of fuel reprocessing plants, mixed-oxide fuel fabrication facilities, and radioactive waste management facilities; and combined centers, containing both power plants and fuel-cycle facilities. The results of the general site-location screening efforts are shown on a United States map that shows the locations of large areas identified as likely to contain suitable candidate sites for power NECs, on the basis of four coarse screening criteria: water resources, seismic activity, population density, and statutory excluded lands

  16. Discussion on emergency aerial survey system for practical use

    International Nuclear Information System (INIS)

    Moriuchi, Shigeru; Nagaoka, Toshi; Sakamoto, Ryuichi; Tsutsumi, Masahiro; Satio, Kimiaki; Amano, Hikaru; Matsunaga, Takeshi; Yanase, Nobuyuki; Kasai, Atsushi


    In 1980, after the occurrence of the TMI-2 accident in the United States, JAERI started the research and development of aerial survey techniques, and completed two prototype aerial survey systems in 1985 for gamma ray survey and for radioactivity monitoring. Following the Chernobyl reactor accident which occured in Soviet Union in 1986, European countries experienced environmental radiological monitoring using their aerial survey systems, and proved the effectiveness of aerial survey in the emergency. This report describes the outline of the prototype survey systems developed at JAERI, and showed the practical survey systems data processing, data analysis and the techniques including data processing, data analysis and the example outputs. Also, this report made some proposals concerning practical construction and the arrangement of the aerial survey equipments and the establishment of organization which takes charge of the practical emergency survey and the routine maintenance, based on our past experience. (author)

  17. Practical implications of neutron survey instrument performance

    International Nuclear Information System (INIS)

    Tanner, R. J.; Bartlett, D. T.; Hager, I. G.; Jones, I. N.; Molinos, C.; Roberts, N. J.; Taylor, G. C.; Thomas, D. J.


    Improvements have been made to the Monte Carlo modelling used to calculate the response of the neutron survey instruments most commonly used in the UK, for neutron energies up to 20 MeV. The improved modelling of the devices includes the electronics and battery pack, allowing better calculations of both the energy and angle dependence of response. These data are used to calculate the response of the instruments in rotationally and fully isotropic, as well as unidirectional fields. Experimental measurements with radionuclide sources and monoenergetic neutron fields have been, and continue to be made, to test the calculated response characteristics. The enhancements to the calculations have involved simulation of the sensitivity of the response to variations in instrument manufacture, and will include the influence of the user and floor during measurements. The practical implications of the energy and angle dependence of response, variations in manufacture, and the influence of the user are assessed by folding the response characteristics with workplace energy and direction distributions. (authors)

  18. Quality Control Practices for Chemistry and Immunochemistry in a Cohort of 21 Large Academic Medical Centers. (United States)

    Rosenbaum, Matthew W; Flood, James G; Melanson, Stacy E F; Baumann, Nikola A; Marzinke, Mark A; Rai, Alex J; Hayden, Joshua; Wu, Alan H B; Ladror, Megan; Lifshitz, Mark S; Scott, Mitchell G; Peck-Palmer, Octavia M; Bowen, Raffick; Babic, Nikolina; Sobhani, Kimia; Giacherio, Donald; Bocsi, Gregary T; Herman, Daniel S; Wang, Ping; Toffaletti, John; Handel, Elizabeth; Kelly, Kathleen A; Albeiroti, Sami; Wang, Sihe; Zimmer, Melissa; Driver, Brandon; Yi, Xin; Wilburn, Clayton; Lewandrowski, Kent B


    In the United States, minimum standards for quality control (QC) are specified in federal law under the Clinical Laboratory Improvement Amendment and its revisions. Beyond meeting this required standard, laboratories have flexibility to determine their overall QC program. We surveyed chemistry and immunochemistry QC procedures at 21 clinical laboratories within leading academic medical centers to assess if standardized QC practices exist for chemistry and immunochemistry testing. We observed significant variation and unexpected similarities in practice across laboratories, including QC frequency, cutoffs, number of levels analyzed, and other features. This variation in practice indicates an opportunity exists to establish an evidence-based approach to QC that can be generalized across institutions.

  19. ILAE survey of neuropsychology practice in pediatric epilepsy surgery evaluation. (United States)

    Berl, Madison M; Smith, Mary Lou; Bulteau, Christine


    To determine the extent to which specific neuropsychological measures are in common use around the world for the assessment of children who are candidates for epilepsy surgery. As part of the work of the International League Against Epilepsy Pediatric Surgical Task Force, a survey was developed and distributed online. The survey consisted of questions related to demographics, training experience, general practice, and specific measures used and at what frequency. Seventy-eight clinicians with an average of 13.5 years of experience from 19 countries responded to the survey; 69% were English-speaking. Pre- and post-neuropsychological evaluations were conducted with a majority of children undergoing surgical resection for epilepsy. There was high consistency (>90%) among the domains evaluated, while consistency rate among specific measures was more variable (range: 0-100%). Consistency rates were also lower among respondents in non-English-speaking countries. For English-speaking respondents, at least one measure within each domain was used by a majority (>75%) of clinicians; 19 specific measures met this criterion. There is consensus of measures used in neuropsychological studies of pediatric epilepsy patients which provides a basis for determining which measures to include in establishing a collaborative data repository to study surgical outcomes of pediatric epilepsy. Challenges include selecting measures that promote collaboration with centers in non-English-speaking countries and providing data from children under age 5.

  20. 78 FR 36784 - Survey of Nanomaterial Risk Management Practices (United States)


    ...-0010, Docket Number NIOSH-265] Survey of Nanomaterial Risk Management Practices AGENCY: National...), Department of Health and Human Services (HHS). ACTION: Proposed NIOSH Survey of Nanomaterial Risk Management... questions addressing risk management practices for ENMs? (5) What should be the maximum amount of time...

  1. Perceptions of community health center impact on private primary care physician practice. (United States)

    Duffrin, Christopher; Jackson, Natalie; Whetstone, Lauren; Cummings, Doyle; Watson, Ricky; Wu, Qiang


    Community health centers (CHCs) were created in the mid-1960s to expand access to care in impoverished and underserved areas. The number of CHC sites has more than tripled in eastern North Carolina from 28 primary care centers in 2000 to 89 in 2010. This study determined the perceptions of physicians on the impact of CHC expansion on the local practice environment. Descriptive statistics and correlations were used to compare responses regarding perceptions and differences between practice characteristics as well as physician ratios by year. Both CHC and private practice physician addresses were mapped using ArcGIS. Surveys were sent to 1422 (461 returns/32.5% response rate) primary care physicians residing in 43 predominantly rural eastern North Carolina counties. A large percentage of the respondents (82.7%) affirmed that they felt neutral or did not view CHCs to be competitors, whereas a minority (17%) did view them to be difficult to compete against. Forty-two percent of private practice respondents disagreed that CHCs offer a wider range of services despite significantly more CHC physicians than private practice respondents indicating that their facility provided basic services. The CHCs were perceived to offer a wider range of services, employ more staff, and have more practice locations than private practices. However, private practice physicians did not perceive CHCs to have a competitive advantage or to unfairly impact their practices, possibly due to inconsistent population growth in relation to the physician retention during the last 10 years.

  2. Comparing Lay Community and Academic Survey Center Interviewers in Conducting Household Interviews in Latino Communities. (United States)

    Chan-Golston, Alec M; Friedlander, Scott; Glik, Deborah C; Prelip, Michael L; Belin, Thomas R; Brookmeyer, Ron; Santos, Robert; Chen, Jie; Ortega, Alexander N


    The employment of professional interviewers from academic survey centers to conduct surveys has been standard practice. Because one goal of community-engaged research is to provide professional skills to community residents, this paper considers whether employing locally trained lay interviewers from within the community may be as effective as employing interviewers from an academic survey center with regard to unit and item nonresponse rates and cost. To study a nutrition-focused intervention, 1035 in-person household interviews were conducted in East Los Angeles and Boyle Heights, 503 of which were completed by lay community interviewers. A chi-square test was used to assess differences in unit nonresponse rates between professional and community interviewers and Welch's t tests were used to assess differences in item nonresponse rates. A cost comparison analysis between the two interviewer groups was also conducted. Interviewers from the academic survey center had lower unit nonresponse rates than the lay community interviewers (16.2% vs. 23.3%; p < 0.01). However, the item nonresponse rates were lower for the community interviewers than the professional interviewers (1.4% vs. 3.3%; p < 0.01). Community interviewers cost approximately $415.38 per survey whereas professional interviewers cost approximately $537.29 per survey. With a lower cost per completed survey and lower item nonresponse rates, lay community interviewers are a viable alternative to professional interviewers for fieldwork in community-based research. Additional research is needed to assess other important aspects of data quality interviewer such as interviewer effects and response error.

  3. Readiness for the Patient-Centered Medical Home: structural capabilities of Massachusetts primary care practices. (United States)

    Friedberg, Mark W; Safran, Dana G; Coltin, Kathryn L; Dresser, Marguerite; Schneider, Eric C


    The Patient-Centered Medical Home (PCMH), a popular model for primary care reorganization, includes several structural capabilities intended to enhance quality of care. The extent to which different types of primary care practices have adopted these capabilities has not been previously studied. To measure the prevalence of recommended structural capabilities among primary care practices and to determine whether prevalence varies among practices of different size (number of physicians) and administrative affiliation with networks of practices. Cross-sectional analysis. One physician chosen at random from each of 412 primary care practices in Massachusetts was surveyed about practice capabilities during 2007. Practice size and network affiliation were obtained from an existing database. Presence of 13 structural capabilities representing 4 domains relevant to quality: patient assistance and reminders, culture of quality, enhanced access, and electronic health records (EHRs). Three hundred eight (75%) physicians responded, representing practices with a median size of 4 physicians (range 2-74). Among these practices, 64% were affiliated with 1 of 9 networks. The prevalence of surveyed capabilities ranged from 24% to 88%. Larger practice size was associated with higher prevalence for 9 of the 13 capabilities spanning all 4 domains (P < 0.05). Network affiliation was associated with higher prevalence of 5 capabilities (P < 0.05) in 3 domains. Associations were not substantively altered by statistical adjustment for other practice characteristics. Larger and network-affiliated primary care practices are more likely than smaller, non-affiliated practices to have adopted several recommended capabilities. In order to achieve PCMH designation, smaller non-affiliated practices may require the greatest investments.

  4. A survey of different regulatory practices

    International Nuclear Information System (INIS)


    Draft survey of legislation governing the licensing of nuclear installations in OECD Member countries prepared by a Sub-Committee on Licensing for the OECD/NEA Committee on the Safety of Nuclear Installations. (author)

  5. Patient-centered Fertility Care: From Theory to Practice

    Directory of Open Access Journals (Sweden)

    Fatemeh Jafarzadeh-Kenarsari


    Full Text Available Background & aim: Healthcare areas, especially fertility care (commonly accompanied with high emotions, as well as long-term and recurring treatment periods could exclusively benefit from patient-centered care (PCC. Despite evident advantages of PCC, this approach has not been practiced as a routine procedure in current clinical environments yet, even in western developed countries. Therefore, this review aimed to evaluate the significance and different aspects of PCC, while emphasizing on patient-centered fertility care, its challenges, and applicable recommendations in this regard. Methods: This narrative review was conducted on 29 relevant medical and clinical papers (published during 1990-2015 collected using various national and international databases (e.g., SID, Magiran, Medlib, Google scholar, Proquest, Pubmed, Wiley, Science direct, and Scopus. Key words and phrases used in this review were “infertility”, “fertility care”, “childlessness”, “patient-centered care”, “patient-centered fertility care” “shared decision-making”, “infertile patient preferences”, and “patient involvement in fertility care”. Results: According to the literature, implementation challenges of patient-centered fertility care were reported as different individual and organizational factors. These factors include lack of professional motivation to change, underestimating the significance of patient-centeredness by healthcare professionals, difficulty in translation of feedback into concrete measures, lack of time and financial resources, insufficient experience of healthcare professionals with regard to identification of needs and preferences of patients, traditional organizational culture, and common misconceptions. Conclusion: Promotion of patient-centered fertility services requires the identification of infertile needs and priorities of individuals, designation of interventional and supportive programs based on sociocultural

  6. Referral Practices Among U.S. Publicly Funded Health Centers That Offer Family Planning Services. (United States)

    Carter, Marion W; Robbins, Cheryl L; Gavin, Loretta; Moskosky, Susan


    Referrals to other medical services are central to healthcare, including family planning service providers; however, little information exists on the nature of referral practices among health centers that offer family planning. We used a nationally representative survey of administrators from 1,615 publicly funded health centers that offered family planning in 2013-14 to describe the use of six referral practices. We focused on associations between various health center characteristics and frequent use of three active referral practices. In the prior 3 months, a majority of health centers (73%) frequently asked clients about referrals at clients' next visit. Under half (43%) reported frequently following up with referral sources to find out if their clients had been seen. A third (32%) of all health centers reported frequently using three active referral practices. In adjusted analysis, Planned Parenthood clinics (adjusted odds ratio 0.55) and hospital-based clinics (AOR 0.39) had lower odds of using the three active referral practices compared with health departments, and Title X funding status was not associated with the outcome. The outcome was positively associated with serving rural areas (AOR 1.39), having a larger client volume (AOR 3.16), being a part of an insurance network (AOR 1.42), and using electronic health records (AOR 1.62). Publicly funded family planning providers were heavily engaged in referrals. Specific referral practices varied widely and by type of care. More assessment of these and other aspects of referral systems and practices is needed to better characterize the quality of care.

  7. Australian survey on current practices for breast radiotherapy. (United States)

    Dundas, Kylie L; Pogson, Elise M; Batumalai, Vikneswary; Boxer, Miriam M; Yap, Mei Ling; Delaney, Geoff P; Metcalfe, Peter; Holloway, Lois


    Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. This survey provides insight into the current radiotherapy practice for breast cancer in Australia. © 2015 The Royal Australian and New Zealand College of Radiologists.

  8. A nationwide survey of patient centered medical home demonstration projects. (United States)

    Bitton, Asaf; Martin, Carina; Landon, Bruce E


    The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Cross-sectional key-informant interviews. Leaders from existing PCMH demonstration projects with external payment reform. We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified--consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.

  9. CEA 1996 survey of accounting policies and practices

    International Nuclear Information System (INIS)

    Constant, M.


    A survey of accounting policies and practices of some of Canada's largest electrical utilities was presented. The first survey was done in 1981 and then updated in 1986, 1991 and 1996. The dominating issues affecting accounting practices in the 1996 survey were regulation versus deregulation, corporate governance, risk management, research and development costs, new ventures, and environmental liabilities. The Survey examined eight areas of accounting concern, among them financial statement concepts, statement of operations, assets, liabilities, equity, special topics, and financial ratios and other statistics

  10. Nuclear Energy Center Site Survey, 1975. Part I. Summary and conclusions

    International Nuclear Information System (INIS)


    The Nuclear Energy Center Site Survey is a study of a potential siting approach for projected power and fuel-cycle facilities that would cluster sizable groups of such facilities on a relatively small number of sites, as contrasted with current dispersed siting practices. Three basic types of nuclear energy centers (NECs) are considered: power-plant centers, involving ten to forty units of 1200-megawatt electric capacity each; fuel-cycle centers, involving fuel reprocessing plants, mixed-oxide fuel fabrication facilities, and high-level and transuranic radioactive waste management facilities, with a capacity corresponding to the fuel throughput of power plants with a total capacity of approximately 50,000 to 300,000 MWe; and combined centers, containing both power plants and fuel cycle facilities in representative possible combinations. Included among the principal issues considered in evaluation of feasibility of nuclear energy centers are dissipation of the waste heat from the power-generating facilities; transmission system design, reliability, and economics; radiological impact; and environmental impact

  11. Ambulatory surgery centers best practices for the 90s. (United States)

    Hoover, J A


    Outpatient surgery will be the driving force in the continued growth of ambulatory care in the 1990s. Providing efficient, high-quality ambulatory surgical services should therefore be a priority among healthcare providers. Arthur Andersen conducted a survey to discover best practices in ambulatory surgical service. General success characteristics of best performers were business-focused relationships with physicians, the use of clinical protocols, patient convenience, cost management, strong leadership, teamwork, streamlined processes and efficient design. Other important factors included scheduling to maximize OR room use; achieving surgical efficiencies through reduced case pack assembly errors and equipment availability; a focus on cost capture rather than charge capture; sound materiel management practices, such as standardization and vendor teaming; and the appropriate use of automated systems. It is important to evaluate whether the best practices are applicable to your environment and what specific changes to your current processes would be necessary to adopt them.

  12. How do you keto? Survey of North American pediatric ketogenic diet centers. (United States)

    Jung, Da Eun; Joshi, Sucheta M; Berg, Anne T


    We surveyed ketogenic diet centers in North America about their practices surrounding the ketogenic diet. An internet survey was disseminated via REDCap(©) to North American ketogenic diet centers identified from the Charlie Foundation and Ketocal(©) websites. Fifty-six centers responded. In addition to physicians, nurses and dieticians, ketogenic teams included social workers (39%), feeding specialists (14%), educational liaisons (4%), psychologists (5%), and pharmacists (36%). A child attending school (2%), non-English speaking family (19%), single-parent family (0%), and oral feeding (6%) were rarely considered barriers. Overall, the diet was considered the first or second (0%), third or fourth (67%), fifth or sixth (29%), and last resort treatment (4%) by centers. It was considered the first or second treatment for GLUT1 disease (86%) and third or fourth for Dravet (63%), West (71%), and Doose (65%) syndromes. Ketogenic diet is no longer a last resort option. Traditional barriers do not influence its use. © The Author(s) 2014.

  13. Belief Control Practices and Organizational Performances: A Survey ...

    African Journals Online (AJOL)

    Belief Control Practices and Organizational Performances: A Survey of Sugar Industry in Kenya. ... employees in the company core values and design of strategic control systems to cope with changing internal and external operating business ...

  14. Informed consent - a survey of doctors' practices in South Africa ...

    African Journals Online (AJOL)

    Informed consent - a survey of doctors' practices in South Africa. ... whether informed consent as envisioned by the law exists in reality. Cross-cultural research is needed to clarify patients' and parents' expectations of informed consent ...

  15. Survey of Current Best Practices for Diving in Contaminated Water

    National Research Council Canada - National Science Library

    Steigleman, W


    .... Navy divers operating in contaminated water. This survey attempted to identify the current best practices and equipment for diving in contaminated water, including personal protective equipment as well as hazard identification, diver training...

  16. A Nationwide Survey of Patient Centered Medical Home Demonstration Projects (United States)

    Bitton, Asaf; Martin, Carina


    Background The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Design Cross-sectional key-informant interviews. Participants Leaders from existing PCMH demonstration projects with external payment reform. Measurements We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. Results A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified—consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Conclusion Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows. Electronic supplementary material The online version of this article (doi:10.1007/s11606-010-1262-8) contains supplementary material, which is available to authorized users. PMID:20467907

  17. 76 FR 4750 - Survey of Information Sharing Practices With Affiliates (United States)


    ... information by means of a Survey to be completed by financial institutions and other persons that are creditors or users of consumer reports. The OTS will use the Survey responses to prepare a report to Congress on the information sharing practices by financial institutions, creditors, or users of consumer...

  18. Survey on radiation practices in Korea

    International Nuclear Information System (INIS)


    This book introduces outline of the survey with title, purpose, target, timing and composition of statistical data, explanation of terms. It consists of three parts about statistical tables. The first part has state of licensed organizations with number of licensed users by category of organizations, utilization by nuclides and by usage purpose and regional distribution of RI using Hospitals and clinics. The second parts deals with production and import with state of production and import, import by category of organizations and by nuclides and annual trend of production and import. The third part includes radiation safety management with collection of radioactive wastes and annual collect of sealed RI wastes.

  19. A Survey of Intravenous Remifentanil Use for Labor Analgesia at Academic Medical Centers in the United States. (United States)

    Aaronson, Jaime; Abramovitz, Sharon; Smiley, Richard; Tangel, Virginia; Landau, Ruth


    Remifentanil is most commonly offered when neuraxial labor analgesia is contraindicated. There is no consensus regarding the optimal administration, dosing strategy, or requirements for maternal monitoring, which may pose a patient safety issue. This exploratory survey evaluated the current practices regarding remifentanil use for labor analgesia at academic centers in the United States. Of 126 obstetric anesthesia directors surveyed, 84 (67%) responded. In 2014 to 2015, an estimated 36% (95% confidence interval: 25.7-46.3) of centers used remifentanil, most of which did so less than 5 times. Some serious maternal and neonatal respiratory complications occurred, emphasizing that clinical protocols and adequate monitoring are key to ensure maternal and neonatal safety.

  20. Rewards and challenges of community health center practice. (United States)

    Cole, Allison M; Chen, Frederick M; Ford, Paul A; Phillips, William R; Stevens, Nancy G


    More than 1100 community health centers (CHCs) in the United States provide primary care to 20 million underserved patients annually. CHCs have struggled to recruit and retain qualified physicians. To understand physicians' work experiences in CHCs and identify major sources of satisfaction and dissatisfaction. Using purposeful sampling, we conducted semistructured interviews with 12 family physicians practicing in CHCs. Interview questions assessed physicians' experiences in CHCs and sources of satisfaction and dissatisfaction. Interview notes were coded and analyzed by 2 investigators using a grounded theory approach to identify key themes. Though family physicians feel tremendous satisfaction from care of underserved patients, they are frustrated with the overwhelming workload they experience. Family physicians also report poor administrative management while working in CHCs. Implementation of the Affordable Care Act, which relies on expansion of CHC services, may be adversely affected by family physicians' frustrations with CHC practice. Further research to explore and potentially improve the CHC work environment may be needed.

  1. Cognitive Assessment Practices: A Survey of School Psychologists (United States)

    Sotelo-Dynega, Marlene; Dixon, Shauna G.


    The present article describes an exploratory study regarding the preferred cognitive assessment practices of current school psychologists. Three hundred and twenty-three school psychologists participated in the survey. The results suggest that the majority of school psychologists endorsed that they base their assessment practices on an underlying…

  2. Dietary practices in isovaleric acidemia: A European survey

    Directory of Open Access Journals (Sweden)

    A. Pinto


    Conclusions: This survey demonstrates wide differences in dietary practice in the management of IVA across European centres. It provides unique dietary data collectively representing European practices in IVA which can be used as a foundation to compare dietary management changes as a consequence of the first E-IMD IVA guidelines availability.

  3. Practical microbiology in schools: a survey of UK teachers. (United States)

    Redfern, James; Burdass, Dariel; Verran, Joanna


    A survey of secondary school teachers investigated practical microbiology in the classroom. The results were heartening (practical microbiology was common), but concerns were expressed regarding equipment, time, cost, and expertise. Microbiologists should engage more with school education to support teachers and maintain the health of microbiology for future generations. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Current State of Agile User-Centered Design: A Survey (United States)

    Hussain, Zahid; Slany, Wolfgang; Holzinger, Andreas

    Agile software development methods are quite popular nowadays and are being adopted at an increasing rate in the industry every year. However, these methods are still lacking usability awareness in their development lifecycle, and the integration of usability/User-Centered Design (UCD) into agile methods is not adequately addressed. This paper presents the preliminary results of a recently conducted online survey regarding the current state of the integration of agile methods and usability/UCD. A world wide response of 92 practitioners was received. The results show that the majority of practitioners perceive that the integration of agile methods with usability/UCD has added value to their adopted processes and to their teams; has resulted in the improvement of usability and quality of the product developed; and has increased the satisfaction of the end-users of the product developed. The top most used HCI techniques are low-fidelity prototyping, conceptual designs, observational studies of users, usability expert evaluations, field studies, personas, rapid iterative testing, and laboratory usability testing.

  5. Anesthesia for thoracic surgery: A survey of middle eastern practice (United States)

    Eldawlatly, Abdelazeem; Turkistani, Ahmed; Shelley, Ben; El-Tahan, Mohamed; Macfie, Alistair; Kinsella, John


    Purpose: The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern (ME) region. Methods: A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic-anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation (OLV), anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Results: Volume-controlled ventilation was favored over pressure-controlled ventilation (62% vs 38% of respondents, Panesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques (P<0.05). Conclusions: Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice. PMID:23162388

  6. Current neurotrauma treatment practice in secondary medical service centers

    International Nuclear Information System (INIS)

    Suehiro, Eiichi; Yoshino, Hiroko; Koizumi, Hiroyasu; Yoneda, Hiroshi; Suzuki, Michiyasu


    Despite neurotrauma treatment practices comprising a significant amount of neurosurgical work for secondary medical service centers, little attention has been placed on neurotrauma cases and evaluation of current neurotrauma treatment practices is limited. Therefore we investigated current neurotrauma practices in our hospital located in a Japanese suburban city. We analyzed 439 patients with traumatic brain injury (TBI) admitted to our hospital between April 2004 and October 2010. Patients were divided into three groups based on the Glasgow Coma Scale (GCS) score on admission: mild TBI (GCS 14-15) in 252 patients (57.4%), moderate TBI (GCS 9-13) in 116 patients (26.4%), and severe TBI (GCS 3-8) in 71 patients (16.2%). Age, gender, alcohol consumption, cause of injury, cranial CT findings, neurosurgical procedure, length of hospital stay, and clinical outcome were analyzed. The average age of the patients was 59.2 years old. Male patients comprised 65%. Alcohol consumption was reported in 81 cases (18.5%), most of them with moderate TBI. Fall (208 cases, 47.4%) was the most frequent cause of injury, followed by traffic accident (115 cases, 26.2%) and high fall (73 cases, 16.6%). Acute subdural hematoma (174 cases, 39.6%) was most frequently seen in cranial CT findings on admission, which significantly increased with severity. A neurosurgical procedure was performed for 70 cases (15.9%), of which 15 (6.0%) were mild TBI and 18 (15.5%) were moderate TBI. The average hospital stay was 20.8 days, which significantly increased with severity. The overall rate of favorable outcome was 82.7%, and mortality was 8.2%; outcome deteriorated with severity. Some mild and moderate TBI cases had deteriorated and required surgery or resulted in death. These findings suggest that cautious treatment is necessary even in mild to moderate TBI cases which are often encountered in secondary medical service centers. (author)

  7. Nurses who work in general medical practices: a Victorian survey. (United States)

    Bonawit, V; Watson, L


    A questionnaire survey of 452 general medical practices in Victoria attracted responses from 277 practices, many of which did not employ nurses. The 93 respondents from 85 practices who were nurses reported that they enjoyed flexible working hours and stable employment. While their main reason for working in GPs' rooms was convenience, the most important aspect of their work was interaction with patients and fellow workers. Sixtyseven percent of nurses thought continuing education in specific skills was necessary for their work, 43% thought a post-registration qualification in community health nursing would be desirable and 47% thought a special interest group of nurses working in medical practices would be useful.

  8. NASA Center for Astronomy Education: Building a Community of Practice (United States)

    Brissenden, Gina; Prather, E. E.; Slater, T. F.; Greene, W. M.; Thaller, M.; Alvidrez, R.


    The NASA Center for Astronomy Education (CAE) is devoted to the professional development of introductory college astronomy instructors teaching at community colleges. The primary goal is building a "community of practice." Evaluation results suggest this community of practice model is effective at improving instructional practices, particularly in settings where instructors feel isolated from their peers. For community college faculty this isolation can be quite real. Many are the only astronomer, if not the only scientist, at their institution. In addition, they may be adjunct instructors who have no office, no institutional email address, nor appear in the campus directory. CAE works to prevent this sense of isolation by building both actual and virtual communities for these instructors, as well as provide actual and virtual professional development opportunities. CAE's major effort is providing multi-tiered "Teaching Excellence Workshops" offered at national and regional venues. Recently added to our workshop offerings is a Tier II, or advanced, workshop for instructors who have attended a previous Teaching Excellence Workshop. The focus of the Tier II workshops is on implementation issues. In addition, we are now also offering a workshop exclusively for post-docs, graduates, and undergraduate students. Ongoing support is offered through the CAE website. Instructors can learn about, and register for, upcoming workshops. They can engage in discussions about educational issues and share best practices with peers using the moderated discussion group Astrolrner@CAE. CAE also provides an updated article "This Month's Teaching Strategy” which is a reflection on teaching strategies discussed in the workshops. Instructors can also find their peers through the online map of US community colleges offering introductory astronomy courses. Lastly, CAE Regional Teaching Exchanges facilitate local, and sustained, community building. CAE is supported by the NASA/JPL Navigator

  9. Double Star Research: A Student-Centered Community of Practice (United States)

    Johnson, Jolyon


    Project and team-based pedagogies are increasingly augmenting lecture-style science classrooms. Occasionally, university professors will invite students to tangentially partcipate in their research. Since 2006, Dr. Russ Genet has led an astronomy research seminar for community college and high school students that allows participants to work closely with a melange of professional and advanced amatuer researchers. The vast majority of topics have centered on measuring the position angles and searations of double stars which can be readily published in the Journal of Double Star Observations. In the intervening years, a collaborative community of practice (Wenger, 1998) formed with the students as lead researchers on their projects with the guidance of experienced astronomers and educators. The students who join the research seminar are often well prepared for further STEM education in college and career. Today, the research seminar involves multile schools in multiple states with a volunteer educator acting as an assistant instructor at each location. These assistant instructors interface with remote observatories, ensure progress is made, and recruit students. The key deliverables from each student team include a published research paper and a public presentation online or in-person. Citing a published paper on scholarship and college applications gives students' educational carreers a boost. Recently the Journal of Double Star Observations published its first special issue of exlusively student-centered research.

  10. Introducing Principles of Land Surveying by Assigning a Practical Project


    Introducing Principles of Land Surveying by Assigning a Practical Project


    A practical project is used in an engineering surveying course to expose sophomore and junior civil engineering students to several important issues related to the use of basic principles of land surveying. The project, which is the design of a two-lane rural highway to connect between two arbitrary points, requires students to draw the profile of the proposed highway along with the existing ground level. Areas of all cross-sections are then computed to enable quantity computations between th...

  11. Teachers' Beliefs, Perceived Practice and Actual Classroom Practice in Relation to Traditional (Teacher-Centered) and Constructivist (Learner-Centered) Teaching (Note 1) (United States)

    Kaymakamoglu, Sibel Ersel


    This study explored the EFL teachers' beliefs, perceived practice and actual classroom practice in relation to Traditional (teacher-centered) and Constructivist (learner-centered) teaching in Cyprus Turkish State Secondary Schools context. For this purpose, semi-structured interviews and structured observations were employed with purposively…

  12. Integrated Pest Management Intervention in Child Care Centers Improves Knowledge, Pest Control, and Practices. (United States)

    Alkon, Abbey; Nouredini, Sahar; Swartz, Alicia; Sutherland, Andrew Mason; Stephens, Michelle; Davidson, Nita A; Rose, Roberta

    To reduce young children's exposure to pests and pesticides, an integrated pest management (IPM) intervention was provided for child care center staff. The 7-month IPM education and consultation intervention was conducted by trained nurse child care health consultants in 44 child care centers in California. IPM knowledge surveys were completed by child care staff, objective IPM assessments were completed by research assistants pre- and postintervention, and activity logs were completed by the nurses. There were significant increases in IPM knowledge for the child care staff who attended workshops. There were reductions in the prevalence of pests and increases in IPM practices at the postintervention compared with the preintervention time point. The nurses consulted an average of 5.4 hours per center. A nurse-led IPM intervention in child care centers can reduce exposure to harmful substances for young children attending child care centers. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  13. Standardization of mapping practices in the British Geological Survey (United States)

    Allen, Peter M.


    Because the British Geological Survey (BGS) has had, since its foundation in 1835, a mandate to produce geological maps for the whole of Great Britain, there is a long history of introducing standard practices in the way rocks and rock units have been named, classified and illustrated on maps. The reasons for the failure of some of these practices are examined and assessed in relation to the needs of computerized systems for holding and disseminating geological information.

  14. A survey of US dental practices' use of social media. (United States)

    Henry, Rachel K; Molnar, Amy; Henry, Jon C


    Social media is becoming the way for businesses, including health care professionals, to communicate with consumers. The study examines the use of social media by dental practices in the US. An electronic survey was sent to 22,682 dentists in the United States. The survey consisted of questions related to the use of social media in the dental practice. Data was analyzed using descriptive statistics and comparisons were made using a Fisher's exact test. A total of 573 responses were received. Social media was used in 52% of dental practices, the most common being Facebook. The use of social media was most commonly for marketing purposes (91%). Dentists younger than 45 years old were more likely to use social media in their practice than dentists 45 years or older (p > 0.001). Dental practices actively use social media for marketing and communication. Many dentists are unsure how to measure the success of social media in their practice. Additional research is needed to measure the success of social media in a dental practice. Social media is a common way practices market and interact with their patients. There are some difficulties in determining what appropriate content for social media is and how to evaluate the success.

  15. Fiscal 1994 report on technological results. Development of fuel cell technology such as urban energy center (Survey for practical development of optical system of decentralized power source for residential use); 1994 nendo toshi energy center nado nenryo denchi gijutsu kaihatsu seika hokokusho. Minseiyo bunsangata dengen saiteki system jitsuyoka kaihatsu chosa

    Energy Technology Data Exchange (ETDEWEB)



    Feasibility study was conducted on the technology for practical application of a several kW class fuel cell for the people's livelihood, particularly, for residential use. The study was made in six areas consisting of study on the present state of technology, conceptual design of a small fuel cell, survey on a promising market, basic concept of cell for residential use, feasibility study on application and on introduction. There is no record of development of the several kW class; while the fuel cell excels in the efficiency of energy utilization and the environmental conservation, its performance greatly deteriorates by start and stop under the present technology. Accordingly, it is a prerequisite that the equipment is for an electric heat combined type and for system interconnection. Also, while it is proper that the cell is phosphate type and that the fuel is natural gas, an innovation is necessary in the technology for reforming the cell and the fuel. The conceptual design revealed the possibility of a power generation system having a generating efficiency of 32%, exhaust heat recovery rate of 30%, and dimension of 75x65x150 cm. On the basis of a feasibility study on the application to the combination of a house and a beauty parlor, an advantage was recognized in the fuel unit cost of 5 yen/meal and the equipment cost of 200-250 thousand yen/kW, with demand estimated for 2.5 million installations nationwide including 950 thousand in natural gas supply districts. (NEDO)

  16. 2009 Center for Army Leadership Annual Survey of Army Leadership (CASAL): Army Education (United States)


    right time, handling pre- education attitudes, and tracking performance gains and career advantages related to academics.  Developing current, relevant...Army Leadership Technical Report 2010-2 2009 CENTER FOR ARMY LEADERSHIP ANNUAL SURVEY OF ARMY LEADERSHIP (CASAL): ARMY EDUCATION ...Joshua Hatfield ICF International John P. Steele Center for Army Leadership June 2010 The Center for Army Leadership An

  17. Leech management before application on patient: a nationwide survey of practices in French university hospitals

    Directory of Open Access Journals (Sweden)

    Delphine Grau


    Full Text Available Abstract Background Leech therapy in plastic/reconstructive microsurgery significantly improves a successful outcome of flap salvage but the drawback is a risk of severe infection that results in a drop of the salvage rates from 70-80% to below 30%. We report the results of a national survey conducted in all the French university hospitals to assess the current extent of use of leech for medical practices in the hospital and to investigate maintenance, delivery practices and prevention of the risk of infection. Methods Data concerning conditions of storage, leech external decontamination, microbiological controls, mode of delivery and antibiotic prophylaxis were collected from all the French university hospitals in practicing leech therapy, on the basis of a standardized questionnaire. Results Twenty-eight of the 32 centers contacted filled the questionnaire, among which 23 practiced leech therapy, mostly with a centralized storage in the pharmacy; 39.1% of the centers declared to perform leech external decontamination and only 2 centers recurrent microbiological controls of the water storage. Leech delivery was mostly nominally performed (56.5%, but traceability of the leech batch number was achieved in only 39.1% of the cases. Only 5 centers declared that a protocol of antibiotic prophylaxis was systematically administered during leech therapy: either quinolone (2, sulfamethoxazole/trimethoprim (2 or amoxicillin/clavulanic acid (1. Conclusions Measures to prevent infectious complications before application to patient have to be better applied and guidelines of good practices are necessary.

  18. Benchmarking surgeon satisfaction at academic health centers: a nationwide comparative survey. (United States)

    Drachman, D A


    Forty-six academic health centers (AHCs) belonging to the University HealthSystem consortium joined forces to compare the efficiency of their surgical services and to identify best practices. In addition to measures of operational performance, surgeon satisfaction with the surgical services provided was measured by using a standardized questionnaire. From hospital records, indicators of the efficiency of surgical services were collected in three main areas: scheduling, preoperative testing and assessment, and the intraoperative process. Responding to a mail questionnaire, a sample of surgeons rated their satisfaction with key aspects of surgical services including scheduling, operating room staff, and equipment/supplies. On the basis of a review of the operational measures and the survey results, high performers were identified. Site visits were made to several of these high performers to uncover the critical factors responsible for their success. The survey revealed distinct variations in surgeon satisfaction across the participating institutions. Numerical benchmarks were obtained for surgeon satisfaction with each key component of surgical services. Scheduling was the most important component of overall surgeon satisfaction, explaining 71% of the variance in the rating of overall satisfaction with surgical services. High operational efficiency and high surgeon satisfaction were not incompatible. Several of the participating institutions were able to achieve both. These results were disseminated to all of the participants at a national meeting as well as in written form. The surgeon satisfaction survey allowed the participants to establish benchmarks for surgeon satisfaction for each key component of the surgical services they receive. The site visits revealed several common characteristics of highly efficient surgical services. Taken by themselves, the participating institutions might have been reluctant to consider adopting these best practices for fear of

  19. Alcohol Service Practices: A Survey of Bar and Restaurant Managers (United States)

    Nederhoff, Dawn M.; Lenk, Kathleen M.; Horvath, Keith J.; Nelson, Toben F.; Ecklund, Alexandra M.; Erickson, Darin J.; Toomey, Traci L.


    Excessive alcohol consumption can result from illegal sales to intoxicated patrons at bars and restaurants. We surveyed bar/restaurant managers about their practices in reducing illegal sales to intoxicated patrons. We found that managers were confident that they could refuse service to intoxicated customers but were less likely to have…

  20. Practicalities of health survey fieldwork research in a resource ...

    African Journals Online (AJOL)

    Cite as: Abimanyi-Ochom J. Practicalities of health survey field work research in a resource limited setting: challenges and ... vided only ART while TASO provided social support in ..... first aid box in case of any minor accident but was limited.

  1. Radiotherapy skin care: A survey of practice in the UK

    International Nuclear Information System (INIS)

    Harris, Rachel; Probst, Heidi; Beardmore, Charlotte; James, Sarah; Dumbleton, Claire; Bolderston, Amanda; Faithfull, Sara; Wells, Mary; Southgate, Elizabeth


    Aim: The primary objective of the survey was to evaluate clinical skin care practice in radiotherapy departments across the United Kingdom. Methods and sample: A questionnaire containing sixty-one questions grouped into eight themed sections was developed and a link to an on-line survey, using the Survey Monkey™ tool, was e-mailed to all radiotherapy department managers in the United Kingdom (N = 67). Each recipient was invited to provide one response per department. Key results: Fifty-four departments responded within the allocated timeframe giving a final response rate of 81%. Products and their use for skin conditions varied and some outdated and unfounded practices were still being used which did not always reflect the current evidence base. The amount of data routinely collected on skin toxicity was limited making it difficult to quantify the extent of skin morbidity following radiotherapy. Conclusion: The survey demonstrated variability in skin care practice in radiotherapy departments across the UK, with limited practice based on evidence or on skin toxicity measurement and monitoring.

  2. 75 FR 72871 - Survey of Information Sharing Practices With Affiliates (United States)


    ... minimize the burden of the information collection on respondents, including through the use of information... completed by financial institutions and other persons that are creditors or users of consumer reports. The Agencies will use the Survey responses to prepare a report to Congress on the information sharing practices...

  3. 75 FR 75725 - Survey of Information Sharing Practices With Affiliates (United States)


    ... to minimize the burden of the information collection on respondents, including through the use of... by financial institutions and other persons that are creditors or users of consumer reports. The OTS will use the Survey responses to prepare a report to Congress on the information sharing practices by...

  4. Management of Periprocedural Anticoagulation: A Survey of Contemporary Practice. (United States)

    Flaker, Greg C; Theriot, Paul; Binder, Lea G; Dobesh, Paul P; Cuker, Adam; Doherty, John U


    Interruption of oral anticoagulation (AC) for surgery or an invasive procedure is a complicated process. Practice guidelines provide only general recommendations, and care of such patients occurs across multiple specialties. The availability of direct oral anticoagulants further complicates decision making and guidance here is limited. To evaluate current practice patterns in the United States for bridging AC, a survey was developed by the American College of Cardiology Anticoagulation Work Group. The goal of the survey was to assess how general and subspecialty cardiologists, internists, gastroenterologists, and orthopedic surgeons currently manage patients who receive AC and undergo surgery or an invasive procedure. The survey was completed by 945 physicians involved in the periprocedural management of AC. The results provide a template for educational and research projects geared toward the development of clinical pathways and point-of-care tools to improve this area of health care. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Normal tension glaucoma management: a survey of contemporary practice. (United States)

    Symes, Richard J; Mikelberg, Frederick S


    The aim of this study was to investigate contemporary practice patterns with respect to normal tension glaucoma (NTG) management and to determine whether the 2 largest NTG trials have influenced ophthalmologists' clinical practice. A survey questionnaire was sent to ophthalmologists via the American Glaucoma Society, the Canadian Glaucoma Society, and the Canadian Ophthalmological Society. The questionnaire was designed to investigate ophthalmologists' usual practice with respect to NTG and the extent to which practice has been influenced by the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Low pressure Glaucoma Treatment Study (LoGTS). In total, 419 ophthalmologists completed the survey. Of these, 264 respondents were glaucoma subspecialists. The survey showed that 95% and 64% of ophthalmologists were familiar with the CNTGS and the LoGTS, respectively. Of the respondents, 70% indicated that they would initiate treatment in mild-to-moderate NTG without waiting for documented disease progression. Of the respondents, 61% of the total surveyed and 50% of the glaucoma subspecialists felt that the LoGTS results had no impact on their usual clinical practice. The first-choice topical drug for NTG was a prostaglandin analogue (88% of respondents) or brimonidine (10% of respondents). Most ophthalmologists treat NTG more aggressively than recommended by the CTNGS protocol. Most ophthalmologists felt that the LoGTS results had no impact on their normal clinical practice. The prostaglandin analogues are, by far, the most popular choice of drug for contemporary management of NTG. Copyright © 2017 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  6. Delineating advanced practice nursing in New Zealand: a national survey. (United States)

    Carryer, J; Wilkinson, J; Towers, A; Gardner, G


    A variety of advanced practice nursing roles and titles have proliferated in response to the changing demands of a population characterized by increasing age and chronic illness. Whilst similarly identified as advanced practice roles, they do not share a common practice profile, educational requirements or legislative direction. The lack of clarity limits comparative research that can inform policy and health service planning. To identify advanced practice roles within nursing titles employed in New Zealand and practice differences between advanced practice and other roles. Replicating recent Australian research, 3255 registered nurses/nurse practitioners in New Zealand completed the amended Advanced Practice Delineation survey tool. The mean domain scores of the predominant advanced practice position were compared with those of other positions. Differences between groups were explored using one-way ANOVA and post hoc between group comparisons. Four nursing position bands were identified: nurse practitioner, clinical nurse specialist, domain-specific and registered nurse. Significant differences between the bands were found on many domain scores. The nurse practitioner and clinical nurse specialist bands had the most similar practice profiles, nurse practitioners being more involved in direct care and professional leadership. Similar to the position of clinical nurse consultant in Australia, those practicing as clinical nurse specialists were deemed to reflect the threshold for advanced practice nursing. The results identified different practice patterns for the identified bands and distinguish the advanced practice nursing roles. By replicating the Australian study of Gardener et al. (2016), this NZ paper extends the international data available to support more evidence-based nursing workforce planning and policy development. © 2017 International Council of Nurses.

  7. Aspirin desensitization in patients undergoing percutaneous coronary intervention: a survey of current practice. (United States)

    Chapman, Andrew R; Rushworth, Gordon F; Leslie, Stephen J


    Aspirin remains the mainstay of anti-platelet therapy in cardiac patients. However, if a patient is allergic to aspirin and dual anti-platelet therapy is indicated - such as with percutaneous coronary intervention (PCI), then there is no clear guidance. One possibility is aspirin desensitization. A variety of protocols exist for the rapid desensitization of patients with aspirin allergy. The aim of this survey was to assess current knowledge and practice regarding aspirin desensitization in the UK. We conducted a UK wide survey of all UK 116 PCI centers and obtained complete responses from 40 (35.4%) centers. Of these, just 7 (17.5%) centers had previously desensitised patients; 29 (87.9%) centers suggested a lack of a local protocol prevented them from desensitizing, with 10 (30.3%) unsure of how to conduct desensitization. Only 5 (12.5%) centers had a local policy for aspirin desensitization although 25 (64.1%) units had a clinical strategy for dealing with aspirin allergy; the majority (72%) giving higher doses of thienopyridine class drugs. In the UK, there appears to be no consistent approach to patients with aspirin allergy. Patients undergoing PCI benefit from dual anti-platelet therapy (including aspirin), and aspirin desensitization in those with known allergy may facilitate this. Sustained effort should be placed on encouraging UK centers to use desensitization as a treatment modality prior to PCI rather than avoiding aspirin altogether.

  8. Outpatient prescription practices in rural township health centers in Sichuan Province, China

    Directory of Open Access Journals (Sweden)

    Jiang Qian


    Full Text Available Abstract Background Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China. Methods This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections. Results The average medication cost per encounter was 16.30 Yuan ($2.59. About 60% of the prescriptions contained Chinese patent medicine (CPM, and almost all prescriptions (98.07% contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections. Conclusions The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the

  9. Survey on the practice of lingual orthodontics in India

    Directory of Open Access Journals (Sweden)

    Sourabh Agrawal


    Full Text Available Aim: Lingual orthodontics provides an esthetic option of orthodontic treatment, especially for the adults. Lingual orthodontics being an important treatment modality requires extensive training and expertise for honest outcomes. In this study, we have composed a questionnaire to obtain the trend in the practice of lingual orthodontics in India. Materials and Methods: A questionnaire was composed of several aspects of lingual orthodontics. The survey instrument was hosted electronically on a secure website, . The survey was optimized for presentation on tablets, mobiles, and laptops, which were the platforms used by participants to take the survey. The survey data were received and saved by the same secure website. Pearson Chi-square test was done using SPSS 17.0 version software to determine the correlation between treatment outcome and the use of laboratory for the initial setup. Results: A total of 248 orthodontists responded to the survey, 70% orthodontists said that they practice lingual orthodontics. Among the orthodontists who practice lingual orthodontics, 71% orthodontists treat extraction and nonextraction cases and 29% treat only nonextraction cases. Forty percent orthodontists said their final finishing of case is good, 16% said that final finishing is average, 26.5% said that final finishing is very good, and only 17.5% said that it is excellent. Statistically significant correlation exists (P = 0.004 between the treatment outcome and use of laboratory for initial setup. Conclusion: Many orthodontists are taking up lingual cases in India. Survey indicates that there is still room for betterment in terms of the final treatment outcome, and many orthodontists feel that there is need of formal training for expertise in lingual orthodontics.

  10. Barriers in the path of yoga practice: An online survey

    Directory of Open Access Journals (Sweden)

    H V Dayananda


    Full Text Available Context: Clinical benefits of yoga have been well explored, but factors contributing to adherence to regular yoga practice are not well studied. Aims: To study the factors influencing adherence to yoga practices on those participants who have completed 1-month Yoga Instructors′ course from a yoga university. Settings and Design: Online survey was conducted on participants who had finished 1-month Yoga Instructors′ course at a yoga university. Materials and Methods: Online survey was conducted using Survey Monkey web portal with response rate of 42.5%. A total of 1355 participants were approached. Demographic items and a checklist of 21 items on a 5-point likert scale were prepared based on traditional yoga texts. A few items to assess modern lifestyle barriers were also included. Statistical Analysis: One-sample proportion test with chi square statistics was used for analysis. Results: Irregularity in lifestyle, family commitments, and occupational commitments are perceived as significant strong barriers. Dullness, excessive talking, strictly adhering to rules, laziness, physical and mental overexertion, fickleness and wandering of mind, unsteadiness of mind, procrastination, and oversleeping are considered as significant barriers of moderate nature. Conclusions: Modern lifestyle is the major challenge for yoga practitioners to adhere to regular practice of yoga. To address this, attention is required in strengthening the lifestyle management and the spiritual dimension of yoga practice as the spiritual component seems to be side-tracked.

  11. Joint CDRH (Center for Devices and Radiological Health) and state quality-assurance surveys in nuclear medicine: Phase 2 - radiopharmaceuticals

    International Nuclear Information System (INIS)

    Hamilton, D.R.; Evans, C.D.


    The report discusses survey results on aspects of the quality assurance of radio-pharmaceuticals from 180 nuclear-medicine facilities in the United States. Data were collected from facilities in 8 states. Demographic information about nuclear-medicine operations and quality-assurance programs was gathered by state radiation-control-program personnel. The data collected from the survey show an incomplete acceptance of quality-assurance practices for radiopharmaceuticals. Most of the facilities in the survey indicated that, because an inferior radiopharmaceutical was prepared so infrequently, they did not believe it was cost-effective to perform extensive quality-assurance testing. The Center for Devices and Radiological Health hopes that the information from the survey will stimulate nuclear-medicine professionals and their organizations to encourage appropriate testing of all radiopharmaceuticals

  12. Variation in esophageal physiology testing in clinical practice: Results from an international survey. (United States)

    Sweis, R; Heinrich, H; Fox, M


    Advances in clinical measurement of esophageal motility and function have improved the assessment of swallowing disorders and reflux symptoms. Variation in data acquisition, analysis, and reporting exists and impacts on diagnosis and management. This study examined variation in esophageal manometry methodology between institutions to establish the status in current practice. A structured survey was distributed through international NGM societies using an Internet-based platform. Questions explored infrastructure, technology, analysis, and reporting. Responses were received from 91 centers from 29 countries. Eighteen (20%) centers used "conventional" manometry, 75 (82%) high-resolution manometry, and 53 (58%) HR impedance manometry. All centers documented motility for single water swallows. The Chicago Classification was applied by 65 (71.4%) centers. In contrast, analysis of EGJ morphology varied widely. Adjunctive testing was often applied: multiple rapid swallows (77%), rapid drink challenge (77%), single solid swallows (63%), and a standard test meal (18%). Of 86 (94.5%) units that offered pH impedance (pH-Z) studies, approximately half (53.5%) performed tests on acid-suppressant medication in patients with a high pretest probability (eg, erosive esophagitis). Most (75.6%) centers manually reviewed every reflux event. Others examined pH-Z data only prior to symptoms. To assess symptom association with reflux events, 73.6% centers analyzed each symptom separately, whereas 29.7% centers pooled symptoms. There is marked variation in the data acquisition, analysis, and reporting of esophageal manometry studies. Further efforts to improve quality and uniformity in testing and reporting are required. This survey provides information upon which best-practice guidelines can be developed. © 2017 John Wiley & Sons Ltd.

  13. Corporate governance survey: A holistic view for altruistic practice

    Directory of Open Access Journals (Sweden)

    Vijaya B. Marisetty


    Full Text Available Taking a holistic approach, this survey paper first reviews the literature on the four pillars of corporate governance, namely, investors, managers, directors, and law and regulation, and then integrates the four components to achieve a unified framework. Attempting to bridge the gap between principles and practice, the paper also incorporates the views of N R Narayana Murthy, founder member of Infosys, one of the most respected corporate governance practice leaders. The emphasis in Infosys, Mr. Murthy revealed, was not on any of the four dimensions but on the value system, ethics and integrity, and the focus on the competition was through better engagement with employees and customers.

  14. Nuclear Energy Center Site Survey, 1975. Part III. Technical considerations

    International Nuclear Information System (INIS)


    Studies of the technical feasibility of nuclear energy centers (NECs) and the comparison between NEC technical feasibility and that of nuclear facilities on dispersed sites are reviewed. The conclusions related to technical feasibility of NEC are summarized. Technical feasibility was found to rest mainly on five major issues: heat dissipation, transmission, facility construction, radiological impact, and environmental impact. Although general conclusions can be reached in these five areas, it is recognized that they are interdependent, and detailed site-by-site analysis will be necessary. Some general conclusions on technical feasibility of NECs are presented, then detailed conclusions derived from the technical evaluation of NECs compared to dispersed site facilities are presented. The findings of this study on each of the five major feasibility issues are then discussed in sequence. The study concludes that nuclear energy centers, as defined herein, are technically feasible

  15. Survey of corporate social responsibility practices in Nigerian manufacturing sector


    Akinyomi, Oladele John


    Based on stakeholders’ theory, this study examined the practice of corporate social responsibility by manufacturing companies in Nigeria. It employed survey research design to study 15 randomly selected companies in the food and beverages sector. A total of 225 questionnaires were administered to collect data. Data analysis revealed that CSR is a familiar concept in the sector as most of the companies do engage in CSR activities regularly. The major areas of focus of the CSR activities includ...

  16. Environmental scan of anal cancer screening practices: worldwide survey results

    International Nuclear Information System (INIS)

    Patel, Jigisha; Salit, Irving E; Berry, Michael J; Pokomandy, Alexandra de; Nathan, Mayura; Fishman, Fred; Palefsky, Joel; Tinmouth, Jill


    Anal squamous cell carcinoma is rare in the general population but certain populations, such as persons with HIV, are at increased risk. High-risk populations can be screened for anal cancer using strategies similar to those used for cervical cancer. However, little is known about the use of such screening practices across jurisdictions. Data were collected using an online survey. Health care professionals currently providing anal cancer screening services were invited to complete the survey via email and/or fax. Information was collected on populations screened, services and treatments offered, and personnel. Over 300 invitations were sent; 82 providers from 80 clinics around the world completed the survey. Fourteen clinics have each examined more than 1000 patients. Over a third of clinics do not restrict access to screening; in the rest, eligibility is most commonly based on HIV status and abnormal anal cytology results. Fifty-three percent of clinics require abnormal anal cytology prior to performing high-resolution anoscopy (HRA) in asymptomatic patients. Almost all clinics offer both anal cytology and HRA. Internal high-grade anal intraepithelial neoplasia (AIN) is most often treated with infrared coagulation (61%), whereas external high-grade AIN is most commonly treated with imiquimod (49%). Most procedures are performed by physicians, followed by nurse practitioners. Our study is the first description of global anal cancer screening practices. Our findings may be used to inform practice and health policy in jurisdictions considering anal cancer screening

  17. Violence Risk Assessment Practices in Denmark: A Multidisciplinary National Survey

    Directory of Open Access Journals (Sweden)

    Nielsen Louise Hjort


    Full Text Available With a quadrupling of forensic psychiatric patients in Denmark over the past 20 years, focus on violence risk assessment practices across the country has increased. However, information is lacking regarding Danish risk assessment practice across professional disciplines and clinical settings; little is known about how violence risk assessments are conducted, which instruments are used for what purposes, and how mental health professionals rate their utility and costs. As part of a global survey exploring the application of violence risk assessment across 44 countries, the current study investigated Danish practice across several professional disciplines and settings in which forensic and high-risk mental health patients are assessed and treated. In total, 125 mental health professionals across the country completed the survey. The five instruments that respondents reported most commonly using for risk assessment, risk management planning and risk monitoring were Broset, HCR-20, the START, the PCL-R, and the PCL:SV. Whereas the HCR-20 was rated highest in usefulness for risk assessment, the START was rated most useful for risk management and risk monitoring. No significant differences in utility were observed across professional groups. Unstructured clinical judgments were reported to be faster but more expensive to conduct than using a risk assessment instrument. Implications for clinical practice are discussed.

  18. Chronic gastritis in China: a national multi-center survey. (United States)

    Du, Yiqi; Bai, Yu; Xie, Pei; Fang, Jingyuan; Wang, Xiaozhong; Hou, Xiaohua; Tian, Dean; Wang, Chengdang; Liu, Yandi; Sha, Weihong; Wang, Bangmao; Li, Yanqing; Zhang, Guoliang; Li, Yan; Shi, Ruihua; Xu, Jianming; Li, Youming; Huang, Minghe; Han, Shengxi; Liu, Jie; Ren, Xu; Xie, Pengyan; Wang, Zhangliu; Cui, Lihong; Sheng, Jianqiu; Luo, Hesheng; Wang, Zhaohui; Zhao, Xiaoyan; Dai, Ning; Nie, Yuqiang; Zou, Yiyou; Xia, Bing; Fan, Zhining; Chen, Zhitan; Lin, Sanren; Li, Zhao-Shen


    Chronic gastritis is one of the most common findings at upper endoscopy in the general population, and chronic atrophic gastritis is epidemiologically associated with the occurrence of gastric cancer. However, the current status of diagnosis and treatment of chronic gastritis in China is unclear. A multi-center national study was performed; all patients who underwent diagnostic upper endoscopy for evaluation of gastrointestinal symptoms from 33 centers were enrolled. Data including sex, age, symptoms and endoscopic findings were prospectively recorded. Totally 8892 patients were included. At endoscopy, 4389, 3760 and 1573 patients were diagnosed to have superficial gastritis, erosive gastritis, and atrophic gastritis, respectively. After pathologic examination, it is found that atrophic gastritis, intestinal metaplasia and dysplasia were prevalent, which accounted for 25.8%, 23.6% and 7.3% of this patient population. Endoscopic features were useful for predicting pathologic atrophy (PLR = 4.78), but it was not useful for predicting erosive gastritis. Mucosal-protective agents and PPI were most commonly used medications for chronic gastritis. The present study suggests non-atrophic gastritis is the most common endoscopic finding in Chinese patients with upper GI symptoms. Precancerous lesions, including atrophy, intestinal metaplasia and dysplasia are prevalent in Chinese patients with chronic gastritis, and endoscopic features are useful for predicting pathologic atrophy.

  19. Chronic gastritis in China: a national multi-center survey (United States)


    Background Chronic gastritis is one of the most common findings at upper endoscopy in the general population, and chronic atrophic gastritis is epidemiologically associated with the occurrence of gastric cancer. However, the current status of diagnosis and treatment of chronic gastritis in China is unclear. Methods A multi-center national study was performed; all patients who underwent diagnostic upper endoscopy for evaluation of gastrointestinal symptoms from 33 centers were enrolled. Data including sex, age, symptoms and endoscopic findings were prospectively recorded. Results Totally 8892 patients were included. At endoscopy, 4389, 3760 and 1573 patients were diagnosed to have superficial gastritis, erosive gastritis, and atrophic gastritis, respectively. After pathologic examination, it is found that atrophic gastritis, intestinal metaplasia and dysplasia were prevalent, which accounted for 25.8%, 23.6% and 7.3% of this patient population. Endoscopic features were useful for predicting pathologic atrophy (PLR = 4.78), but it was not useful for predicting erosive gastritis. Mucosal-protective agents and PPI were most commonly used medications for chronic gastritis. Conclusions The present study suggests non-atrophic gastritis is the most common endoscopic finding in Chinese patients with upper GI symptoms. Precancerous lesions, including atrophy, intestinal metaplasia and dysplasia are prevalent in Chinese patients with chronic gastritis, and endoscopic features are useful for predicting pathologic atrophy. PMID:24502423

  20. Brachytherapy for carcinoma of the cervix: A Canadian survey of practice patterns in a changing era

    International Nuclear Information System (INIS)

    Pearce, Andrew; Craighead, Peter; Kay, Ian; Traptow, Laurel; Doll, Corinne


    Background and purpose: This survey aimed to document practices of Canadian radiation oncologists performing gynecologic brachytherapy for carcinoma of the cervix and to determine what the effect of the phasing-out of LDR after-loading systems from the commercial market is having on practice. Materials and methods: A 26-item questionnaire was developed to survey various aspects of brachytherapy practice to include: number of patients treated, prescription points/volume, dose and fractionation, timing, critical structure delineation, expected changes due to the phasing-out of support for low dose rate systems, and support for the development of national guidelines. A link to a web-based survey collection instrument was emailed to each radiation oncologist in Canada practicing gynecologic brachytherapy. Results: A 67% response rate was achieved in this web-based survey. Radiation oncologists currently using HDR brachytherapy are most commonly delivering 5 fractions of 6 Gy in addition to an EBRT dose of 45 Gy in 25 fractions. The median total dose equivalents to Point A was 82.9 Gy for both early and advanced disease. In response to the announcement by a major vendor that they would be phasing-out service for a popular LDR after-loader, 49% of Canadian radiation oncologists who practice brachytherapy for cervix cancer are changing to an HDR technique with a further 9% changing to a PDR technique. Eighty-six percent of respondents would support the development of national guidelines for cervix brachytherapy in Canada. Conclusions: Variation in practice exists in Canada in brachytherapy for cervix cancer. Many centers are in the process of phasing-out LDR techniques in response to the withdrawal of commercial support for these systems. Support for the development of Canadian national guidelines is high.

  1. The U.S. Geological Survey Astrogeology Science Center (United States)

    Kestay, Laszlo P.; Vaughan, R. Greg; Gaddis, Lisa R.; Herkenhoff, Kenneth E.; Hagerty, Justin J.


    In 1960, Eugene Shoemaker and a small team of other scientists founded the field of astrogeology to develop tools and methods for astronauts studying the geology of the Moon and other planetary bodies. Subsequently, in 1962, the U.S. Geological Survey Branch of Astrogeology was established in Menlo Park, California. In 1963, the Branch moved to Flagstaff, Arizona, to be closer to the young lava flows of the San Francisco Volcanic Field and Meteor Crater, the best preserved impact crater in the world. These geologic features of northern Arizona were considered good analogs for the Moon and other planetary bodies and valuable for geologic studies and astronaut field training. From its Flagstaff campus, the USGS has supported the National Aeronautics and Space Administration (NASA) space program with scientific and cartographic expertise for more than 50 years.

  2. Practice versus politics in Danish day-care centers

    DEFF Research Database (Denmark)

    Clasen, Line; Jensen de López, Kristine M.


    It is essential that early educators in day-care services possess adequate pedagogical tools for supporting children’s communicative development. Early literacy programmes (ELPs) are potential tools. However, studies investigating the effects of ELPs seldom address implementation processes......’ (NNS) political statements on early learning. This study presents results from 18 pre-programme interviews with pedagogues and illustrates their daily practices prior to the ELP implementation. Results suggest that: (1) there is a potential gap between practice and politics concerning Danish practices...... for promoting early learning; and (2) certain aspects related to existing pedagogical practices may be foreseen as potential challenges for the implementation of structured ELPs....

  3. Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study. (United States)

    Sasnett, Bonita; Harris, Susie T; White, Shelly

    Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

  4. Data Center Energy Efficiency Standards in India: Preliminary Findings from Global Practices

    Energy Technology Data Exchange (ETDEWEB)

    Raje, Sanyukta; Maan, Hermant; Ganguly, Suprotim; Singh, Tanvin; Jayaram, Nisha; Ghatikar, Girish; Greenberg, Steve; Kumar, Satish; Sartor, Dale


    Global data center energy consumption is growing rapidly. In India, information technology industry growth, fossil-fuel generation, and rising energy prices add significant operational costs and carbon emissions from energy-intensive data centers. Adoption of energy-efficient practices can improve the global competitiveness and sustainability of data centers in India. Previous studies have concluded that advancement of energy efficiency standards through policy and regulatory mechanisms is the fastest path to accelerate the adoption of energy-efficient practices in the Indian data centers. In this study, we reviewed data center energy efficiency practices in the United States, Europe, and Asia. Using evaluation metrics, we identified an initial set of energy efficiency standards applicable to the Indian context using the existing policy mechanisms. These preliminary findings support next steps to recommend energy efficiency standards and inform policy makers on strategies to adopt energy-efficient technologies and practices in Indian data centers.

  5. Pediatric Hospitalist Comanagement Survey of Clinical and Billing Practices. (United States)

    O'Connor, Katherine M; Zipes, David G; Schaffzin, Joshua K; Rosenberg, Rebecca


    Surgical comanagement is an increasingly common practice in pediatric hospital medicine. Information about the structure and financing of such care is limited. The aim of the researchers for this study was to investigate pediatric hospitalist surgical comanagement models and to assess pediatric hospitalist familiarity with and patterns of billing for surgical patients. We conducted a cross-sectional cohort web-based survey of pediatric hospitalists using the American Academy of Pediatrics' Section on Hospital Medicine listserv. In our study ( N = 133), we found wide variation in our cohort in surgical patient practice management, including program structure, individual billing practices, and knowledge regarding billing practices. Even for pediatric hospitalists with comanagement service agreements between surgeons and pediatric hospitalists, there was no increased awareness or knowledge about reimbursement or billing for surgical patients. This global lack of knowledge in our small but diverse sample suggests that billing resources and training for pediatric hospitalists practicing comanagement of surgical patients are needed. Copyright © 2017 by the American Academy of Pediatrics.

  6. Sexual Violence Screening Practices of Student Health Centers Located on Universities in Florida (United States)

    Halstead, Valerie; Williams, Jessica R.; Gattamorta, Karina; Gonzalez-Guarda, Rosa


    Objective: The purpose of this study is to describe current sexual violence screening practices of student health centers located on universities in Florida. Participants: Institutional level data was collected from 33 student health centers from November 2015 through January 2016. The student health centers were located on public or private…

  7. A Survey of Electronic Serials Managers Reveals Diversity in Practice

    Directory of Open Access Journals (Sweden)

    Laura Costello


    In surveying academic librarians engaged in serials management, the author sought to identify trends and standards in the field, but instead found significant variation in serials budgets and processes amongst the responding libraries. While it is clear that electronic subscriptions are a significant development and now a permanent feature of serials management, decisions to move from print to digital are complex and definitive conclusions about best practices for serials transitions could not be drawn from this study. The survey revealed that institutions have invested in staff and tools for the management of electronic serials, but staffing configurations and tool combinations are also extremely diverse. The author concluded that the lack of standardization in these areas and the disconnect between institution and serials budget size indicated a serials landscape that was highly individualized and customized to each institution’s unique needs.

  8. Cost and Management Accounting Practices: A Survey of Manufacturing Companies

    Directory of Open Access Journals (Sweden)

    Ali UYAR


    Full Text Available The purpose of this study is to explore cost and management accounting practices utilized by manufacturing companies operating in Istanbul, Turkey. The sample of the study consists of 61 companies, containing both small and medium-sized enterprises, and large companies. The data collection methodology of the study is questionnaire survey. The content of the questionnaire survey is based on several previous studies. The major findings of the study are as follows: the most widely used product costing method is job costing; the complexity in production poses as the highest ranking difficulty in product costing; the most widely used three overhead allocation bases are prime costs, units produced, and direct labor cost; pricing decisions is the most important area where costing information is used; overall mean of the ratio of overhead to total cost is 34.48 percent for all industries; and the most important three management accounting practices are budgeting, planning and control, and cost-volume-profit analysis. Furthermore, decreasing profitability, increasing costs and competition, and economic crises are the factors, which increase the perceived importance of cost accounting. The findings indicate that companies perceive traditional management accounting tools still important. However, new management accounting practices such as strategic planning, and transfer pricing are perceived less important than traditional ones. Therefore, companies need to improve themselves in this aspect.

  9. Privacy and Confidentiality Practices In Adolescent Family Planning Care At Federally Qualified Health Centers. (United States)

    Beeson, Tishra; Mead, Katherine H; Wood, Susan; Goldberg, Debora Goetz; Shin, Peter; Rosenbaum, Sara


    The confidentiality of family planning services remains a high priority to adolescents, but barriers to implementing confidentiality and privacy practices exist in settings designed for teenagers who are medically underserved, including federally qualified health centers (FQHCs). A sample of 423 FQHCs surveyed in 2011 provided information on their use of five selected privacy and confidentiality practices, which were examined separately and combined into an index. Regression modeling was used to assess whether various state policies and organizational characteristics were associated with FQHCs' scores on the index. In-depth case studies of six FQHCs were conducted to provide additional contextual information. Among FQHCs reporting on confidentiality, most reported providing written or verbal information regarding adolescents' rights to confidential care (81%) and limiting access to family planning and medical records to protect adolescents' confidentiality (84%). Far fewer reported maintaining separate medical records for family planning (10%), using a security block on electronic medical records to prevent disclosures (43%) or using separate contact information for communications regarding family planning services (50%). Index scores were higher among FQHCs that received Title X funding than among those that did not (coefficient, 0.70) and among FQHCs with the largest patient volumes than among those with the smallest caseloads (0.43). Case studies highlighted how a lack of guidelines and providers' confusion over relevant laws present a challenge in offering confidential care to adolescents. The organizational practices used to ensure adolescent family planning confidentiality in FQHCs are varied across organizations. Copyright © 2016 by the Guttmacher Institute.

  10. Promoting Evidence-Based Practice at a Primary Stroke Center: A Nurse Education Strategy. (United States)

    Case, Christina Anne

    Promoting a culture of evidence-based practice within a health care facility is a priority for health care leaders and nursing professionals; however, tangible methods to promote translation of evidence to bedside practice are lacking. The purpose of this quality improvement project was to design and implement a nursing education intervention demonstrating to the bedside nurse how current evidence-based guidelines are used when creating standardized stroke order sets at a primary stroke center, thereby increasing confidence in the use of standardized order sets at the point of care and supporting evidence-based culture within the health care facility. This educational intervention took place at a 286-bed community hospital certified by the Joint Commission as a primary stroke center. Bedside registered nurse (RN) staff from 4 units received a poster presentation linking the American Heart Association's and American Stroke Association's current evidence-based clinical practice guidelines to standardized stroke order sets and bedside nursing care. The 90-second oral poster presentation was delivered by a graduate nursing student during preshift huddle. The poster and supplemental materials remained in the unit break room for 1 week for RN viewing. After the pilot unit, a pdf of the poster was also delivered via an e-mail attachment to all RNs on the participating unit. A preintervention online survey measured nurses' self-perceived likelihood of performing an ordered intervention based on whether they were confident the order was evidence based. The preintervention survey also measured nurses' self-reported confidence in their ability to explain how the standardized order sets are derived from current evidence. The postintervention online survey again measured nurses' self-reported confidence level. However, the postintervention survey was modified midway through data collection, allowing for the final 20 survey respondents to retrospectively rate their confidence

  11. Bioethics consultation practices and procedures: a survey of a large Canadian community of practice. (United States)

    Greenberg, R A; Anstey, K W; Macri, R; Heesters, A; Bean, S; Zlotnik Shaul, R


    The literature fails to reflect general agreement over the nature of the services and procedures provided by bioethicists, and the training and core competencies this work requires. If bioethicists are to define their activities in a consistent way, it makes sense to look for common ground in shared communities of practice. We report results of a survey of the services and procedures among bioethicists affiliated with the University of Toronto Joint Centre for Bioethics (JCB). This is the largest group of bioethicists working in healthcare organizations in Canada. The results suggest there are many common services and procedures of JCB bioethicists. This survey can serve as a baseline for further exploration of the work of JCB bioethicists. Common practices exist with respect to the domains of practice, individual reporting relationships, service availability within business hours and the education and training of the bioethicist.

  12. Radiological protection survey results about radiodiagnosis protection practices in Cuba

    International Nuclear Information System (INIS)

    Jova S, L.; Morales M, J.A.; Quevedo, J.R.; Medina, J.R.; Naranjo, A.M.; Fornet, O.M.


    In order to identify radiation protection current situation in national X-ray diagnostic practice , the State (cuban) Supervision System for Radiation and Nuclear Safety carried out in 1992 a survey which was planned for projection of future regulatory activities in this field. Survey covers the most important aspects related to radiation protection of occupationally exposed workers, patients and general population. Surveyed sample included a total of 52 X-ray units, sited in 7 dental clinics, 2 polyclinics and 13 hospitals, from 7 provinces of the country. Results showed that the organization of radiation protection in terms of personnel specially designated to carry out surveillance and control activities and level of documentation is deficient. Survey evidenced the general lack of safety and quality culture among technologists and radiologists which is mainly reflected in non regular application of basic patient protection measures (shielding, collimation, use of proper filtration among others) and non regular execution of basic quality inspection of employed radiographic systems. (authors). 4 refs., 1 fig

  13. National Training Center Fort Irwin expansion area aquatic resources survey

    Energy Technology Data Exchange (ETDEWEB)

    Cushing, C.E.; Mueller, R.P.


    Biologists from Pacific Northwest National Laboratory (PNNL) were requested by personnel from Fort Irwin to conduct a biological reconnaissance of the Avawatz Mountains northeast of Fort Irwin, an area for proposed expansion of the Fort. Surveys of vegetation, small mammals, birds, reptiles, amphibians, and aquatic resources were conducted during 1995 to characterize the populations and habitats present with emphasis on determining the presence of any species of special concern. This report presents a description of the sites sampled, a list of the organisms found and identified, and a discussion of relative abundance. Taxonomic identifications were done to the lowest level possible commensurate with determining the status of the taxa relative to its possible listing as a threatened, endangered, or candidate species. Consultation with taxonomic experts was undertaken for the Coleoptera ahd Hemiptera. In addition to listing the macroinvertebrates found, the authors also present a discussion related to the possible presence of any threatened or endangered species or species of concern found in Sheep Creek Springs, Tin Cabin Springs, and the Amargosa River.

  14. Practical methods for radiation survey in nuclear installations

    International Nuclear Information System (INIS)

    Shweikani, R.


    This study is placed to those who are responsible to perform radiation survey in the nuclear installations, especially the beginners. Therefore, it gives a comprehensive view to all-important aspects related to their work starting from the structure of atoms to the practical steps for radiation survey works. So, it clarify how to perform personal monitoring, methods for monitoring surface contamination, methods for measuring radioactivity of gases and radioactive aerosols in air, monitoring radiation doses, measuring radiation influences in workplaces and finally measuring internal exposure of radiation workers in nuclear installations. Finally, The study shows some cases of breaches of radiation protection rules in some American nuclear installations and describes the final results of these breaches. The aim of this is to assure that any breach or ignore to radiation protection principles may produce bad results, and there is no leniency in implementing environmental radiation protection principles. (author)

  15. Four aspects of the scope and quality of family planning services in US publicly funded health centers: Results from a survey of health center administrators. (United States)

    Carter, Marion W; Gavin, Loretta; Zapata, Lauren B; Bornstein, Marta; Mautone-Smith, Nancy; Moskosky, Susan B


    This study aims to describe aspects of the scope and quality of family planning services provided by US publicly funded health centers before the release of relevant federal recommendations. Using nationally representative survey data (N=1615), we describe four aspects of service delivery: family planning services provided, contraceptive methods provided onsite, written contraceptive counseling protocols and youth-friendly services. We created a count index for each issue and used multivariable ordered logistic regression to identify health center characteristics associated with scoring higher on each. Half of the sample received Title X funding and about a third each were a community health center or health department clinic. The vast majority reported frequently providing contraceptive services (89%) and STD services (87%) for women in the past 3 months. Service provision to males was substantially lower except for STD screening. A total of 63% and 48% of health centers provided hormonal IUDs and implants onsite in the past 3 months, respectively. Forty percent of health centers included all five recommended contraceptive counseling practices in written protocols. Of youth-friendly services, active promotion of confidential services was among the most commonly reported (83%); offering weekend/evening hours was among the least (42%). In multivariable analyses, receiving Title X funding, having larger volumes of family planning clients and being a Planned Parenthood clinic were associated with higher scores on most indices. Many services were consistent with the recommendations for providing quality family planning services, but there was room for improvement across domains and health centers types. As assessed in this paper, the scope and quality of these family planning services was relatively high, particularly among Planned Parenthood clinics and Title X-funded centers. However, results point to important areas for improvement. Future studies should assess

  16. Japanese practicing physicians' relationships with pharmaceutical representatives: a national survey.

    Directory of Open Access Journals (Sweden)

    Sayaka Saito

    Full Text Available BACKGROUND: Previous surveys on the relationship between physicians and pharmaceutical representatives (PRs have been of limited quality. The purpose of our survey of practicing physicians in Japan was to assess the extent of their involvement in pharmaceutical promotional activities, physician characteristics that predict such involvement, attitudes toward relationships with PRs, correlations between the extent of involvement and attitudes, and differences in the extent of involvement according to self-reported prescribing behaviors. METHODS AND FINDINGS: From January to March 2008, we conducted a national survey of 2621 practicing physicians in seven specialties: internal medicine, general surgery, orthopedic surgery, pediatrics, obstetrics-gynecology, psychiatry, and ophthalmology. The response rate was 54%. Most physicians met with PRs (98%, received drug samples (85% and stationery (96%, and participated in industry-sponsored continuing medical education (CME events at the workplace (80% and outside the workplace (93%. Half accepted meals outside the workplace (49% and financial subsidies to attend CME events (49%. Rules at the workplace banning both meetings with PRs and gifts predicted less involvement of physicians in promotional activities. Physicians valued information from PRs. They believed that they were unlikely to be influenced by promotional activities, but that their colleagues were more susceptible to such influence than themselves. They were divided about the appropriateness of low-value gifts. The extent of physician involvement in promotional activities was positively correlated with the attitudes that PRs are a valuable source of information and that gifts are appropriate. The extent of such involvement was higher among physicians who prefer to ask PRs for information when a new medication becomes available, physicians who are not satisfied with patient encounters ending only with advice, and physicians who prefer to

  17. Intensive comprehensive aphasia programs: an international survey of practice. (United States)

    Rose, Miranda L; Cherney, Leora R; Worrall, Linda E


    In response to the need to simultaneously address multiple domains of the International Classification of Functioning, Disability and Health (ICF) in aphasia therapy and to incorporate intensive treatment doses consistent with principles of neuroplasticity, a potentially potent treatment option termed intensive comprehensive aphasia programs (ICAPs) has been developed. To conduct an international survey of ICAPs to determine the extent of their use and to explore current ICAP practices. A 32-item online survey was distributed internationally through Survey Monkey between May and August 2012. The survey addressed ICAP staffing, philosophy, values, funding, admission criteria, activities, family involvement, outcome measures, and factors considered important to success. Twelve ICAPs responded: 8 from the United States, 2 from Canada, and 1 each from Australia and the United Kingdom. The majority of ICAPs are affiliated with university programs and are funded through participant self-pay. ICAPs emphasize individualized treatment goals and evidence-based practices, with a focus on applying the principles of neuroplasticity related to repetition and intensity of treatment. On average, 6 people with aphasia attend each ICAP, for 4 days per week for 4 weeks, receiving about 100 hours of individual, group, and computer-based treatment. Speech-language pathologists, students, and volunteers staff the majority of ICAPs. ICAPs are increasing in number but remain a rare service delivery option. They address the needs of individuals who want access to intensive treatment and are interested in making significant changes to their communication skills and psychosocial well-being in a short period of time. Their efficacy and cost-effectiveness require future investigation.

  18. Survey of tritiated oil sources and handling practices

    International Nuclear Information System (INIS)

    Miller, J.M.


    Tritium interactions with oil sources (primarily associated with pumps) in tritium-handling facilities can lead to the incorporation of tritium in the oil and the production of tritiated hydrocarbons. This results in a source of radiological hazard and the need for special handling considerations during maintenance, decontamination, decommissioning and waste packaging and storage. The results of a general survey of tritiated-oil sources and their associated characteristics, handling practices, analysis techniques and waste treatment/storage methods are summarized here. Information was obtained from various tritium-handling laboratories, fusion devices, and CANDU plants. 38 refs., 1 fig

  19. Errors in practical measurement in surveying, engineering, and technology

    International Nuclear Information System (INIS)

    Barry, B.A.; Morris, M.D.


    This book discusses statistical measurement, error theory, and statistical error analysis. The topics of the book include an introduction to measurement, measurement errors, the reliability of measurements, probability theory of errors, measures of reliability, reliability of repeated measurements, propagation of errors in computing, errors and weights, practical application of the theory of errors in measurement, two-dimensional errors and includes a bibliography. Appendices are included which address significant figures in measurement, basic concepts of probability and the normal probability curve, writing a sample specification for a procedure, classification, standards of accuracy, and general specifications of geodetic control surveys, the geoid, the frequency distribution curve and the computer and calculator solution of problems

  20. U.S. Geological Survey Fundamental Science Practices (United States)



    The USGS has a long and proud tradition of objective, unbiased science in service to the Nation. A reputation for impartiality and excellence is one of our most important assets. To help preserve this vital asset, in 2004 the Executive Leadership Team (ELT) of the USGS was charged by the Director to develop a set of fundamental science practices, philosophical premises, and operational principles as the foundation for all USGS research and monitoring activities. In a concept document, 'Fundamental Science Practices of the U.S. Geological Survey', the ELT proposed 'a set of fundamental principles to underlie USGS science practices.' The document noted that protecting the reputation of USGS science for quality and objectivity requires the following key elements: - Clearly articulated, Bureau-wide fundamental science practices. - A shared understanding at all levels of the organization that the health and future of the USGS depend on following these practices. - The investment of budget, time, and people to ensure that the USGS reputation and high-quality standards are maintained. The USGS Fundamental Science Practices (FSP) encompass all elements of research investigations, including data collection, experimentation, analysis, writing results, peer review, management review, and Bureau approval and publication of information products. The focus of FSP is on how science is carried out and how products are produced and disseminated. FSP is not designed to address the question of what work the USGS should do; that is addressed in USGS science planning handbooks and other documents. Building from longstanding existing USGS policies and the ELT concept document, in May 2006, FSP policies were developed with input from all parts of the organization and were subsequently incorporated into the Bureau's Survey Manual. In developing an implementation plan for FSP policy, the intent was to recognize and incorporate the best of USGS current practices to obtain the optimum

  1. Survey of Postdoctorates at FFRDCs: Final Report [Federally Funded Research and Development Centers

    Energy Technology Data Exchange (ETDEWEB)

    Mulrow, Jeri


    The 2009 FFRDC survey collected the total number of postdocs employed by FFRDCs in the United States—categorized by source of support, citizenship, sex, and field of research—as of October 1, 2009. The universe for the 2009 GSS-FFRDC survey was the Master Government List of Federally Funded Research and Development Centers. The 2009 survey also contacted the NIH’s Intramural Research Program because it employs the largest number of postdocs in the federal government. The FFRDC survey collected data via a web instrument. Topics included the type of support the postdocs received (federal and nonfederal), their sex, citizenship, race/ethnicity, and field of research.

  2. A survey on orbital fractures in an educational center

    Directory of Open Access Journals (Sweden)

    Farahvash MR


    Full Text Available "n Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Trauma is the 2nd cause of mortality in Iran, after cardiovascular diseases. In traumatic patients, head and neck and face skeletal fracture is common. The most common facial fracture is mandible fracture and the least common is frontal fracture. Complications due to orbital fracture are more devasting than the other fractures in face."n"nMethods: These descriptive cross sectional studies are designed on 92 patients with orbital fractures in a referral educational trauma center, Imam Khomeini hospital, Tehran, Iran. Sample size was the patients who referred to this hospital with orbital fracture during the ten years period (1986-2000."n"nResults: In this study 74 patients were male and 18 patients were female. Mean age of patients was 30 years. The most common cause of orbital fracture was motor vehicle accident which was seen in 38 patients.46 patients had fracture in left orbit and 44 patients in right. Isolated orbital fracture was seen in 38 patients and 54 patients had concomitant trauma and fracture in the other organs. Management of orbital fracture was reduction of displaced bone fragment and fixation for osteosynthesis. The most common methods for osteosynthesis was

  3. Cytomegalovirus infection management in solid organ transplant recipients across European centers in the time of molecular diagnostics: An ESGICH survey. (United States)

    Navarro, David; San-Juan, Rafael; Manuel, Oriol; Giménez, Estela; Fernández-Ruiz, Mario; Hirsch, Hans H; Grossi, Paolo Antonio; Aguado, José María


    Scant information is available about how transplant centers are managing their use of quantitative molecular testing (QNAT) assays for active cytomegalovirus (CMV) infection monitoring in solid organ transplant (SOT) recipients. The current study was aimed at gathering information on current practices in the management of CMV infection across European centers in the era of molecular testing assays. A questionnaire-based cross-sectional survey study was conducted by the European Study Group of Infections in Immunocompromised Hosts (ESGICH) of the Society of Clinical Microbiology and Infectious Diseases (ESCMID). The invitation and a weekly reminder with a personal link to an Internet service provider ( was sent to transplant physicians, transplant infectious diseases specialists, and clinical virologists working at 340 European transplant centers. Of the 1181 specialists surveyed, a total of 173 responded (14.8%): 73 transplant physicians, 57 transplant infectious diseases specialists, and 43 virologists from 173 institutions located at 23 different countries. The majority of centers used QNAT assays for active CMV infection monitoring. Most centers preferred commercially available real-time polymerase chain reaction (RT-PCR) assays over laboratory-developed procedures for quantifying CMV DNA load in whole blood or plasma. Use of a wide variety of DNA extraction platforms and RT-PCR assays was reported. All programs used antiviral prophylaxis, preemptive therapy, or both, according to current guidelines. However, the centers used different criteria for starting preemptive antiviral treatment, for monitoring systemic CMV DNA load, and for requesting genotypic assays to detect emerging CMV-resistant variants. Significant variation in CMV infection management in SOT recipients still remains across European centers in the era of molecular testing. International multicenter studies are required to achieve commutability of CMV testing and

  4. Occupational Therapists’ Perceived Relevance of Nussbaum’s Central Capabilities to Client-centered Practice

    Directory of Open Access Journals (Sweden)

    Tahmineh Mousavi


    Full Text Available Background: Client-centered practice is highly valued in occupational therapy. Nussbaum’s Capabilities Approach focuses on the individual person and functional autonomy by encompassing 10 functional capabilities that could provide a framework for the systematic implementation of client-centered care. Method: To explore the perceived relevance of Nussbaum’s 10 capabilities with respect to client-centered practice, semi-structured interviews with 14 occupational therapists in British Columbia, Canada, were conducted and thematically analyzed. Results: Nussbaum’s Central Human Functional Capabilities approach provides a broad perspective, encompassing the range of settings of occupational therapy practice. Nussbaum’s 10 capabilities were viewed as being particularly aligned with the established tenets of client-centered practice. Conclusion: Nussbaum’s Capabilities Approach has several compelling attributes for consideration by occupational therapists that warrant further exploration as a novel basis for systematically implementing client-centered care.

  5. Assessing Person-Centered Outcomes in Practice Research: A Latent Transition Profile Framework (United States)

    Thompson, Aaron M.; Macy, Rebecca J.; Fraser, Mark W.


    Advances in statistics provide new methods for analyzing practice data. These advances include person-centered methods (PCMs) that identify subgroups of research participants with similar characteristics. PCMs derive from a frame of reference that is similar to the risk factor perspective in practice. In practice, the delivery of services is often…

  6. Chronic subdural hematoma: A survey of neurosurgeons’ practices in Nigeria (United States)

    Rabiu, Taopheeq B.


    Background: Chronic subdural hematoma (CSDH) is a commonly encountered condition in neurosurgical practice. In Nigeria, a developing country, patients with CSDH are less likely to be diagnosed and treated by surgical drainage early. Aware of the reported variations in neurosurgeons’ practices regarding CSDH in many parts of the world, we sought to determine the current practices of Nigerian neurosurgeons in managing CSDH. Methods: An Internet-based survey was carried out in which all Nigerian neurosurgeons listed in the Nigerian Academy of Neurological Surgeons directory during the July–December 2012 time period were asked to participate. Questions asked in the survey were: (1) Type of treatment used in patients with CSDH, (2) Use of drains postoperatively, (3) Postoperative patient positioning, (4) Postoperative mobilization, (5) Postoperative complications, and (6) Postoperative computed tomography (CT) scan monitoring. Results: Survey information was sent to the 25 practicing neurosurgeons in Nigeria who met the criteria listed above for being included in this study. Each of the 14 neurosurgeons who responded reported that CSDH is often misdiagnosed initially, usually as a stroke having occurred. Once a diagnosis of CSDH was made, the most common method of treatment reported was placement of one or two burr-holes for drainage of the hematoma. Reported, but used in only a few cases, were twist drill craniostomy, craniectomy, and craniotomy. Each neurosurgeon who responded reported irrigation of the subdural space with sterile saline, and in some cases an antibiotic had been added to the irrigation solution. Six of the 14 neurosurgeons left drains in the subdural space for 24-72 hours. Seven neurosurgeons reported positioning patients with their heads elevated 30° during the immediate postoperative period. No neurosurgeon responding reported use of steroids, and only one acknowledged routine use of anticonvulsive medication for patients with CSDH. Only 3 of

  7. Chronic subdural hematoma: A survey of neurosurgeons' practices in Nigeria. (United States)

    Rabiu, Taopheeq B


    Chronic subdural hematoma (CSDH) is a commonly encountered condition in neurosurgical practice. In Nigeria, a developing country, patients with CSDH are less likely to be diagnosed and treated by surgical drainage early. Aware of the reported variations in neurosurgeons' practices regarding CSDH in many parts of the world, we sought to determine the current practices of Nigerian neurosurgeons in managing CSDH. An Internet-based survey was carried out in which all Nigerian neurosurgeons listed in the Nigerian Academy of Neurological Surgeons directory during the July-December 2012 time period were asked to participate. Questions asked in the survey were: (1) Type of treatment used in patients with CSDH, (2) Use of drains postoperatively, (3) Postoperative patient positioning, (4) Postoperative mobilization, (5) Postoperative complications, and (6) Postoperative computed tomography (CT) scan monitoring. Survey information was sent to the 25 practicing neurosurgeons in Nigeria who met the criteria listed above for being included in this study. Each of the 14 neurosurgeons who responded reported that CSDH is often misdiagnosed initially, usually as a stroke having occurred. Once a diagnosis of CSDH was made, the most common method of treatment reported was placement of one or two burr-holes for drainage of the hematoma. Reported, but used in only a few cases, were twist drill craniostomy, craniectomy, and craniotomy. Each neurosurgeon who responded reported irrigation of the subdural space with sterile saline, and in some cases an antibiotic had been added to the irrigation solution. Six of the 14 neurosurgeons left drains in the subdural space for 24-72 hours. Seven neurosurgeons reported positioning patients with their heads elevated 30° during the immediate postoperative period. No neurosurgeon responding reported use of steroids, and only one acknowledged routine use of anticonvulsive medication for patients with CSDH. Only 3 of the 14 neurosurgeons taking part in

  8. Environmental Survey preliminary report, Morgantown Energy Technology Center, Morgantown, West Virginia

    Energy Technology Data Exchange (ETDEWEB)


    This report presents the preliminary findings from the first phase of the Environmental Survey of the US Department of Energy (DOE) Morgantown Energy Technology Center (METC) conducted November 30 through December 4, 1987. In addition, the preliminary findings of the Laramie Project Office (LPO) Survey, which was conducted as part of the METC Survey on January 25 through 29, 1988, are presented in Appendices E and F. The Survey is being conducted by an interdisciplinary team of environmental specialists, led and managed by the Office of Environment, Safety and Health's Office of Environmental Audit. Individual team components are outside experts being supplied by a private contractor. The objective of the Survey is to identify environmental problems and areas of environmental risk associated with METC. The Survey covers all environmental media and all areas of environmental regulation. It is being performed in accordance with the DOE Environmental Survey Manual. The on-site phase of the Survey involves the review of existing site environmental data, observations of the operations carried on at METC, and interviews with site personnel. The Survey team developed a Sampling and Analysis Plan to assist in further assessing certain environmental problems identified during its on-site activities at METC. The Sampling and Analysis Plan will be executed by the Oak Ridge National Laboratory (ORNL). When completed, the results will be incorporated into the METC Environmental Survey Interim Report. The Interim Report will reflect the final determinations of the Survey METC. 60 refs., 28 figs., 43 tabs.

  9. Toward patient-centered, personalized and personal decision support and knowledge management: a survey. (United States)

    Leong, T-Y


    This paper summarizes the recent trends and highlights the challenges and opportunities in decision support and knowledge management for patient-centered, personalized, and personal health care. The discussions are based on a broad survey of related references, focusing on the most recent publications. Major advances are examined in the areas of i) shared decision making paradigms, ii) continuity of care infrastructures and architectures, iii) human factors and system design approaches, iv) knowledge management innovations, and v) practical deployment and change considerations. Many important initiatives, projects, and plans with promising results have been identified. The common themes focus on supporting the individual patients who are playing an increasing central role in their own care decision processes. New collaborative decision making paradigms and information infrastructures are required to ensure effective continuity of care. Human factors and usability are crucial for the successful development and deployment of the relevant systems, tools, and aids. Advances in personalized medicine can be achieved through integrating genomic, phenotypic and other biological, individual, and population level information, and gaining useful insights from building and analyzing biological and other models at multiple levels of abstraction. Therefore, new Information and Communication Technologies and evaluation approaches are needed to effectively manage the scale and complexity of biomedical and health information, and adapt to the changing nature of clinical decision support. Recent research in decision support and knowledge management combines heterogeneous information and personal data to provide cost-effective, calibrated, personalized support in shared decision making at the point of care. Current and emerging efforts concentrate on developing or extending conventional paradigms, techniques, systems, and architectures for the new predictive, preemptive, and

  10. Increasing Student Success in Large Survey Science Courses via Supplemental Instruction in Learning Centers (United States)

    Hooper, Eric Jon; Nossal, S.; Watson, L.; Timbie, P.


    Large introductory astronomy and physics survey courses can be very challenging and stressful. The University of Wisconsin-Madison Physics Learning Center (PLC) reaches about 10 percent of the students in four introductory physics courses, algebra and calculus based versions of both classical mechanics and electromagnetism. Participants include those potentially most vulnerable to experiencing isolation and hence to having difficulty finding study partners as well as students struggling with the course. They receive specially written tutorials, conceptual summaries, and practice problems; exam reviews; and most importantly, membership in small groups of 3 - 8 students which meet twice per week in a hybrid of traditional teaching and tutoring. Almost all students who regularly participate in the PLC earn at least a "C,” with many earning higher grades. The PLC works closely with other campus programs which seek to increase the participation and enhance the success of underrepresented minorities, first generation college students, and students from lower-income circumstances; and it is well received by students, departmental faculty, and University administration. The PLC staff includes physics education specialists and research scientists with a passion for education. However, the bulk of the teaching is conducted by undergraduates who are majoring in physics, astronomy, mathematics, engineering, and secondary science teaching (many have multiple majors). The staff train these enthusiastic students, denoted Peer Mentor Tutors (PMTs) in general pedagogy and mentoring strategies, as well as the specifics of teaching the physics covered in the course. The PMTs are among the best undergraduates at the university. While currently there is no UW-Madison learning center for astronomy courses, establishing one is a possible future direction. The introductory astronomy courses cater to non-science majors and consequently are less quantitative. However, the basic structure

  11. The work of physical education professionals in Family Health Support Centers (NASF: a national survey

    Directory of Open Access Journals (Sweden)

    Sueyla Ferreira da Silva dos Santos


    Full Text Available DOI:   This is a descriptive and quantitative national survey aimed at presenting Health Education practices (HE developed by Physical Education professionals working at NASF in Brazil. Overall, 296 professionals participated in this study, stratified by Brazilian regions and NASF groupings. Electronic interviews were conducted regarding the activities developed at the unity where each NASF professional worked. The main activities reported were gymnastics (40.1%, and walking (29.4%, having as their priority public elderly people (68.8%, groups of hypertensive and diabetic patients (30.9% and young people (48.3%, respectively. The most discussed topics in lectures and orientations was the importance of physical activity (51.4% and the second most cited was the prevention/treatment of comorbities (32.3%. The community spaces most utilized by Physical Education professionals to develop activities were: public squares, community centers and schools in the southeastern and southern regions of Brazil, and religious entities in the northeastern and Midwestern regions. In conclusion, in spite of the diversity of activities developed in different regions of Brazil, there is predominance of traditional Physical Education contents, which reflect the need of permanent education of such professionals to improve the quality of services offered to the community.

  12. Aerial radiological survey of the Feed Materials Production Center and surrounding area, Fernald, Ohio. Date of survey: April 1985

    International Nuclear Information System (INIS)


    An aerial radiological survey was performed over the area surrounding the Feed Materials Production Center, located near Fernald, Ohio, during the period April 24 to 27, 1985. The survey covered a 70-square-kilometer (27-square-mile) area centered on the plant. The highest exposure rates, in excess of 0.35 milliroentgens per hour (mR/h), were inferred from the data measured directly over the plant. This radiation was due to the presence of nuclides which were consistent with normal plant operations. For the remainder of the survey area, the inferred radiation exposure rates, varying from 6 to 12 microroentgens per hour (μR/h), were due to naturally-occurring potassium, uranium, thorium, and daughter products. The reported exposure rate values include an estimated cosmic ray contribution of 3.7μR/h. Ground-based measurements, conducted during the time of the aerial survey, were compared to the aerial results. Pressurized ionization chamber readings and a group of soil samples were acquired at several locations within the survey area. The exposure rate values obtained from these measurements were in agreement with the inferred aerial results. Soil sample results showed several areas just outside the site boundary with slightly elevated amounts of U-238. The levels, however, were well below the detection limit of the aerial system. The only off-site area that showed apparent above background activity in the aerial data was directly west of the storage silos. The symmetric shape of the contours, however, suggests that these elevated levels are due to ''shine'' from material stored on-site in the silos and not to actual off-site contamination. Detailed comparison of the 1985 aerial survey data with a previous survey conducted in 1976 showed no significant change in any area outside the plant boundary. 6 refs., 9 figs., 3 tabs

  13. Experience of Client-centered Practice amongst Danish Occupational Therapists

    DEFF Research Database (Denmark)

    Larsen, Anette Enemark

    A client-centered approach is on the health care agenda in many European countries (1), and amongst these Denmark (2). It is described as the foundation for Occupational Therapy (OT) (3), a code of professional conduct (4,5), and defined as a partnership between client and therapist (3). The goal...... is to empower a client to fulfil his/her occupational roles in a variety of environments, leading to an increase in intervention efficacy and client perception of intervention quality (3). However, it is known to be challenging (1,3). Given the importance of this approach, there has been limited exploration...

  14. Family-centered bereavement practices in Danish intensive care units

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Kaldan, Gudrun; Coombs, Maureen


    : Self-administered computerized cross-sectional nation-wide survey of Danish ICUs. RESULTS: Nurses at 46 of 48 (96%) ICUs in Denmark responded. Bereavement care at the time of patient death included viewing the patient in ICU (100%), and in the hospital mortuary (59%). Information about hospital...... of death, a letter of condolence, a phone call to the family, referral to a priest or clergyman, or referral to other counseling. Although many interventions were common, there were variations within the elements offered. Nurses and physicians were the most consistent health care staff involved...

  15. Typography and layout of technical reports - Survey of current practices (United States)

    Pinelli, T. E.; Cordle, V. M.; Mccullough, R.


    As part of a review of the NASA Langley Research Center scientific and technical information program, 50 technical reports from industry, research institutions, and government agencies were systematically examined and analyzed to determine current usage and practice in regard to (1) typography, including composition method, type style, type size, and margin treatment; (2) graphic design, including layout and imposition of material on the page; and (3) physical media, including paper, ink, and binding methods. The results indicate that approximately 50 percent of the reports were typeset, 70 percent used Roman (serif) type, 80 percent used 10- or 11-point type for text, 60 percent used a ragged right-hand margin, slightly more than half used paragraph indentation, 75 percent used a single-column layout, 65 percent had one or more figures or tables placed perpendicular to (not aligned with) the text, and perfect binding was the most frequently used binding method.

  16. Implementing the patient-centered medical home model for chronic disease care in small medical practices: practice group characteristics and physician understanding. (United States)

    Baxter, Louisa; Nash, David B


    Strengthening primary care may improve health outcomes and restrain spending. The patient-centered medical home (PCMH) model is endorsed as a tool to achieve this. Early evaluations in large group practices demonstrate improvements in some health outcomes. Evidence is lacking from small medical practices that deliver the majority of primary health care. This was a national survey of 200 physicians that explored perceptions of PCMH. There was considerable interest in adoption of the model; however, providing PCMH care was seen as an extension of traditional roles that requires additional reimbursement. No differentiation was made among a variety of payment models to do this. All joint principle components of the model were identified as important: extending access and information technology were the most contentious. There was consensus that PCMH might improve the quality of primary care; however, tension between wider societal benefits and rising costs for individual practices was a challenge to implementation.

  17. TCT-82 Evaluation of Current Practices in Transcatheter Aortic Valve Replacement: The WRITTEN (WoRldwIde TAVR ExperieNce) Survey

    DEFF Research Database (Denmark)

    Nombela-Franco, Luis; Cerrato, Enrico; Nazif, Tamim


    the main areas of consensus and divergence between centers. Methods An online questionnaire was distributed in centers performing TAVR irrespective of the number of procedures and valve type. The questionnaire was divided in 3 main blocks: pre-procedural evaluation, procedural practices and post......-procedural management. Regional experts were recruited to distribute the survey in each country or region. Results The survey was completed by 250 TAVR centers (with a cumulative experience of nearly 70,000 procedures) from 38 different countries. Heart team meetings were regularly scheduled in most (>95%) centers...

  18. Impact of Information Technology, Clinical Resource Constraints, and Patient-Centered Practice Characteristics on Quality of Care

    Directory of Open Access Journals (Sweden)

    JongDeuk Baek


    Full Text Available Objective: Factors in the practice environment, such as health information technology (IT infrastructure, availability of other clinical resources, and financial incentives, may influence whether practices are able to successfully implement the patient-centered medical home (PCMH model and realize its benefits. This study investigates the impacts of those PCMH-related elements on primary care physicians’ perception of quality of care. Methods: A multiple logistic regression model was estimated using the 2004 to 2005 CTS Physician Survey, a national sample of salaried primary care physicians (n = 1733. Results: The patient-centered practice environment and availability of clinical resources increased physicians’ perceived quality of care. Although IT use for clinical information access did enhance physicians’ ability to provide high quality of care, a similar positive impact of IT use was not found for e-prescribing or the exchange of clinical patient information. Lack of resources was negatively associated with physician perception of quality of care. Conclusion: Since health IT is an important foundation of PCMH, patient-centered practices are more likely to have health IT in place to support care delivery. However, despite its potential to enhance delivery of primary care, simply making health IT available does not necessarily translate into physicians’ perceptions that it enhances the quality of care they provide. It is critical for health-care managers and policy makers to ensure that primary care physicians fully recognize and embrace the use of new technology to improve both the quality of care provided and the patient outcomes.

  19. The auditory processing battery: survey of common practices. (United States)

    Emanuel, Diana C


    A survey of auditory processing (AP) diagnostic practices was mailed to all licensed audiologists in the State of Maryland and sent as an electronic mail attachment to the American Speech-Language-Hearing Association and Educational Audiology Association Internet forums. Common AP protocols (25 from the Internet, 28 from audiologists in Maryland) included requiring basic audiologic testing, using questionnaires, and administering dichotic listening, monaural low-redundancy speech, temporal processing, and electrophysiologic tests. Some audiologists also administer binaural interaction, attention, memory, and speech-language/psychological/educational tests and incorporate a classroom observation. The various AP batteries presently administered appear to be based on the availability of AP tests with well-documented normative data. Resources for obtaining AP tests are listed.

  20. International survey of academic library data curation practices

    CERN Document Server


    This survey looks closely at the data curation practices of a sample of research-oriented universities largely from the USA, the UK, Australia and Scandinavia but also including India, South Africa and other countries. The study looks at how major universities are assisting faculty in developing data curation and management plans for large scale data projects, largely in the sciences and social sciences, often as pre-conditions for major grants. The report looks at which departments of universities are shouldering the data curation burden, the personnel involved in the efforts, the costs involved, types of software used, difficulties in procuring scientific experiment logs and other hard to obtain information, types of training offered to faculty, and other issues in large scale data management.

  1. 2009 survey results: surgeon practice patterns regarding arthroscopic surgery. (United States)

    Redfern, John; Burks, Robert


    A survey was conducted to collect information on the surgical management and practice preferences of the audience members at a recent continuing medical education conference. Participants were polled on a variety of surgical topics, and their responses were recorded using a wireless audience response system. The answers were tabulated and are presented in this report. The majority of respondents preferred an arthroscopic repair for rotator cuff tears (52%) and shoulder instability (71%). Most (50%) perform single-row repair; 33% perform double-row repair. For simple knee arthroscopy, most use preoperative antibiotics (85%), no tourniquet (53%), and no chemical anticoagulation or only compression boots (69%). For cruciate ligament reconstruction, the majority preferred only a preoperative antibiotic (67%), no chemical anticoagulation or only compression boots (56%), and single-bundle reconstruction (88%) using a transtibial femoral tunnel (78%). Most (47%) prefer an all inside suture-based meniscus repair device.

  2. Survey on current practices for neurological prognostication after cardiac arrest. (United States)

    Friberg, Hans; Cronberg, Tobias; Dünser, Martin W; Duranteau, Jacques; Horn, Janneke; Oddo, Mauro


    To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Survey on parenting practices among Chinese in Singapore. (United States)

    Poon, W B; Ho, W L C; Yeo, C L


    Cultural, religious and personal factors impact greatly on parenting. This survey aims to identify gaps in knowledge and perception about common parenting issues, with respect to mandarin-speaking Chinese in Singapore. There is an emphasis on first-time parents, who the authors feel may be the group which will require additional education and support on these issues. A 37-item written survey was conducted before a public mandarin-language forum. Our response rate was 67 percent. Only 44 percent felt that paediatricians allocated sufficient time to discuss parenting issues. 99 percent of parents believed that breast milk was better than formula milk and that 93 percent intended to breastfeed. However, the vast majority of respondents thought that breastfeeding should be stopped if jaundice developed, and that sunning was effective in preventing jaundice. Moreover, the majority did not recognise the seriousness of jaundice, prolonged or otherwise. Widespread misconceptions existed about milk formulas, with half of the respondents thinking that it was necessary to change to lactose-free formula once a child developed diarrhoea. The majority also thought that certain milk formulas could help improve IQ. We hope that more comprehensive and accessible parental education will be available to aid in raising awareness of parental practices, and to dispel misconceptions regarding neonatal care.

  4. Physician organization-practice team integration for the advancement of patient-centered care. (United States)

    Wise, Christopher G; Alexander, Jeffrey A; Green, Lee A; Cohen, Genna R


    The patient-centered medical home is being promoted as a cornerstone for transforming primary care. Physician organizations (POs) are playing a more prominent role by facilitating practices' transformation to the patient-centered medical home. Using a framework of organizational integration, we investigated the changing relationship between POs and practices through qualitative interviews. Through increased integration, POs can support both the big picture and day-to-day activities of practice transformation. Most PO-practice unit connections we identified reflected new areas of engagement-competencies that POs were not developing in the past-that are proving integral to the broad-scale practice change of patient-centered medical home implementation.

  5. Survey of domestic food handling practices in New Zealand. (United States)

    Gilbert, S E; Whyte, R; Bayne, G; Paulin, S M; Lake, R J; van der Logt, P


    The purpose of this survey was to obtain information on the domestic meat and poultry handling practices of New Zealanders in order to support the development of quantitative risk models, as well as providing data to underpin food safety campaigns to consumers. A sample of 1000 New Zealand residents, over 18 years of age, were randomly selected from the electoral roll and asked to participate in a national postal food safety study during 2005. Three hundred and twenty six respondents completed and returned questionnaires containing usable answers, and most of these respondents 'always' prepared the main meal within the household. The majority of meat (84.6%) and poultry (62.9%) purchased by New Zealanders was fresh (rather than frozen), and most consumers (94.4%) claimed that the time taken from food selection to reaching their home was 1 h or less. The majority (approximately 64%) of fresh meat and poultry was frozen in the home and the most favoured method of thawing was at room temperature for up to 12 h. The most common time period for storing cooked or raw meat and poultry in domestic refrigerators was up to 2 days. Most survey respondents preferred their meat and poultry to be cooked either medium or well done. The most popular cooking method for chicken was roasting or baking, while most respondents preferred to pan-fry steak/beef cuts, minced beef or sausages/hamburgers. The potential for undercooking was greatest with pan-fried steak with 19.8% of respondents preferring to consume this meat raw or rare. In answer to questions relating to food handling hygiene practices, 52.2% of respondents selected a hand washing sequence that would help prevent cross contamination. However, it was estimated that 41% and 28% of respondents would use knives and kitchen surfaces respectively in a manner that could allow cross contamination. The data in this survey are self-reported and, particularly for the hygiene questions, respondents may report an answer that they

  6. A survey of silage management practices on California dairies. (United States)

    Heguy, J M; Meyer, D; Silva-Del-Río, N


    The aim of the present study was to gather baseline information on corn silage-management practices to develop an outreach curriculum for dairy producers and growers. In spring 2013, dairy producers in the San Joaquin Valley (California) were surveyed on their silage-management practices. Response rate was 14.5% (n=160) and herd size averaged 1,512 milking cows. Harvest date was set solely by the dairy producer (53.4%) or with the assistance of the crop manager, custom chopper, or nutritionist (23.3%). On some dairies (23.3%), the dairy producer delegated the harvest date decision. Most dairies (75.0%) estimated crop dry matter before harvest, and the preferred method was milk line evaluation. Dairy producers were mostly unfamiliar with harvest rate but the number [1 (35.9%), 2 (50.3%), or 3 to 5 (13.8%)] and size [6-row (17.7%), 8-row (67.3%), or 10-row (15.0%)] of choppers working simultaneously was reported. Most dairies used a single packing tractor (68.8%) and weighed every load of fresh chopped corn delivered to the silage pit (62%). During harvest, dry matter (66.9%), particle length (80.4%), and kernel processing (92.5%) were monitored. Most dairies completed filling their largest silage structure in less than 3 d (48.5%) or in 4 to 7 d (30.9%). Silage covering was completed no later than 7 2h after structure completion in all dairies, and was often completed within 24 h (68.8%). Packed forage was covered as filled in 19.6% of dairies. Temporary covers were used on some dairies (51.0%), with filling durations of 1 to 60 d. When temporary covers were not used, structures were filled in no more than 15 d. After structure closure, silage feedout started in 1 to 3 wk (44.4%), 4 to 5 wk (31.4%), or 8 or more wk (24.2%). Future considerations included increasing the silage storage area (55.9%), increasing the number of packing tractors (37.0%), planting brown mid-rib varieties (34.4%), buying a defacer to remove silage (33.1%), and creating drive-over piles (32

  7. International online survey to assess current practice in equine anaesthesia. (United States)

    Wohlfender, F D; Doherr, M G; Driessen, B; Hartnack, S; Johnston, G M; Bettschart-Wolfensberger, R


    Multicentre Confidential Enquiries into Perioperative Equine Fatalities (CEPEF) have not been conducted since the initial CEPEF Phases 1-3, 20 years ago. To collect data on current practice in equine anaesthesia and to recruit participants for CEPEF-4. Online questionnaire survey. An online questionnaire was prepared and the link distributed internationally to veterinarians possibly performing equine anaesthesia, using emails, posters, flyers and an editorial. The questionnaire included 52 closed, semiclosed and open questions divided into 8 subgroups: demographic data, anaesthetist, anaesthesia management (preoperative, technical equipment, monitoring, drugs, recovery), areas of improvements and risks and motivation for participation in CEPEF-4. Descriptive statistics and Chi-squared tests for comparison of categorical variables were performed. A total of 199 questionnaires were completed by veterinarians from 14 different countries. Of the respondents, 43% worked in private hospitals, 36% in private practices and 21% in university teaching hospitals. In 40 institutions (23%) there was at least one diplomate of the European or American colleges of veterinary anaesthesia and analgesia on staff. Individual respondents reported routinely employ the following anaesthesia monitoring modalities: electrocardiography (80%), invasive arterial blood pressures (70%), pulse oximetry (60%), capnography (55%), arterial blood gases (47%), composition of inspired and expired gases (45%) and body temperature (35%). Drugs administered frequently or routinely as part of a standard protocol were: acepromazine (44%), xylazine (68%), butorphanol (59%), ketamine (96%), diazepam (83%), isoflurane (76%), dobutamine (46%), and, as a nonsteroidal anti-inflammatory drug, phenylbutazone (73%) or flunixin meglumine (66%). Recovery was routinely assisted by 40%. The main factors perceived by the respondents to affect outcome of equine anaesthesia were the preoperative health status of the

  8. Utility survey on nuclear power plant siting and nuclear energy centers

    International Nuclear Information System (INIS)

    Cope, D.F.; Bauman, H.F.


    Most of the large U.S. utilities were surveyed by telephone and mail on questions concerning nuclear power plant siting and nuclear energy centers (NECs). The main purpose of the survey was for guidance of ERDA's NEC program. The questions covered the following topics: availability of sites; impact of environmental and other restraints; plans for development of multi-unit sites; interest in NEC development; interest in including fuel-cycle facilities in NECs; and opinions on the roles desired for the state and Federal governments in power plant siting. The main conclusion of the survey was that, while many utilities were considering multiple-unit sites of 2 to 5 units, none were planning larger energy centers at the present time. However, several expressed interest in NECs as a long-range future development

  9. A national survey of emergency pharmacy practice in the United States. (United States)

    Thomas, Michael C; Acquisto, Nicole M; Shirk, Mary Beth; Patanwala, Asad E


    The results of a survey to characterize pharmacy practice in emergency department (ED) settings are reported. An electronic survey was sent to all members of the American Society of Health-System Pharmacists' Emergency Medicine Connect group and the American College of Clinical Pharmacy's Emergency Medicine Practice and Research Network. Approximately 400 nontrainee pharmacy practitioners were invited to participate in the survey, which was open for 30 days. Descriptive statistics were used for all analyses. Two hundred thirty-three responses to the survey that were at least partially completed were received. After the removal of duplicate responses and null records, 187 survey responses were retained. The majority of respondents were from community hospitals (59.6%) or academic medical centers (36.1%). A pharmacist's presence in the ED of more than eight hours per day on weekdays and weekends was commonly reported (68.7% of respondents); 49.4% of institutions provided more than eight hours of coverage daily. Nearly one in three institutions (34.8%) provided no weekend ED staffing. The most frequently reported hours of coverage were during the 1 p.m.-midnight time frame. The distribution of ED pharmacist activities, by category, was as follows (data are median reported time commitments): clinical, 25% (interquartile range [IQR], 15-40%); emergency response, 15% (IQR, 10-20%); order processing, 15% (IQR, 5-25%); medication reconciliation/history-taking, 10% (IQR, 5-25%); teaching, 10% (IQR, 5-15%); administrative, 5% (IQR, 3-10%); and scholarly endeavors, 0% (IQR, 0-5%). Pharmacists from academic and community EDs perform a variety of clinical, educational, and administrative activities. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  10. A Descriptive Study towards Green Computing Practice Application for Data Centers in IT Based Industries

    Directory of Open Access Journals (Sweden)

    Anthony Jnr. Bokolo


    Full Text Available The progressive upsurge in demand for processing and computing power has led to a subsequent upsurge in data center carbon emissions, cost incurred, unethical waste management, depletion of natural resources and high energy utilization. This raises the issue of the sustainability attainment in data centers of Information Technology (IT based industries. Green computing practice can be applied to facilitate sustainability attainment as IT based industries utilizes data centers to provide services to staffs, practitioners and end users. But it is a known fact that enterprise servers utilize huge quantity of energy and incur other expenditures in cooling operations and it is difficult to address the needs of accuracy and efficiency in data centers while yet encouraging a greener application practice alongside cost reduction. Thus this research study focus on the practice application of Green computing in data centers which houses servers and as such presents the Green computing life cycle strategies and best practices to be practiced for better management in data centers in IT based industries. Data was collected through questionnaire from 133 respondents in industries that currently operate their in-house data centers. The analysed data was used to verify the Green computing life cycle strategies presented in this study. Findings from the data shows that each of the life cycles strategies is significant in assisting IT based industries apply Green computing practices in their data centers. This study would be of interest to knowledge and data management practitioners as well as environmental manager and academicians in deploying Green data centers in their organizations.

  11. French Radiotherapy Database: Results of a survey of French radiation oncology centers in 2007

    International Nuclear Information System (INIS)

    Chauvet, B.; Bolla, M.; Eschwege, F.; Lipinski, F.; Mazeron, J.J.; Mornex, F.; Alies-Patin, A.; Weissmann, H.; Bara, C.; Chantome, G.; Fournie, E.; Bourguignon, M.; Estivalet, S.; Faue, P.; Lipinski, F.; Pointreau, Y.


    The second year, the French Radiotherapy Database presents information from French radiation oncology centers. Among 179 centers, 159 have participated (90 %). The number of accelerators increased from 371 to 384 between 2006 and 2007, 11 % of these machines are more than 15 years old. On average, centers are open 50 hours per week for treatment and 9.5 % more for maintenance. The lack of dedicated CT remains a difficulty: 158 from 159 centers have an access to a CT, but only 50 % have a dedicated scanner. There is no progress compared to 2006. The proportion of centers having a MU double calculation system has increased from 51 to 58 %. Two thirds of centers do not implement in vivo dosimetry. The activity is stable around 190 000 treatments per year. Three-dimension conformal radiotherapy is used for more than half of treatments in 77.2 % of private centers and 50 % of public hospitals. Intensity modulated radiotherapy remains rarely used. The number of radiation oncologists and technologists remains stable. The number of radio physicists has increased from 7.6 %. Despite some progress, the difficulties of this speciality persist in France and are equally distributed across all regions, and between private and public centers. In 2009, the French Society for Radiation Oncology and the associated partners will continue this survey, which interest is recognized by both professionals and health administrations. (authors)

  12. "Best practice" for patient-centered communication: a narrative review. (United States)

    King, Ann; Hoppe, Ruth B


    Communicating with patients has long been identified as an important physician competency. More recently, there is a growing consensus regarding the components that define physician-patient communication. There continues to be emphasis on both the need to teach and to assess the communication skills of physicians. This narrative review aims to summarize the work that has been conducted in physician-patient communication that supports the efficacy of good communications skills. This work may also help to define the physician-patient communication skills that need to be taught and assessed. A review of the literature shows it contains impressive evidence supporting positive associations between physician communication behaviors and positive patient outcomes, such as patient recall, patient understanding, and patient adherence to therapy. There is a consensus about what constitutes "best practice" for physician communication in medical encounters: (1) fostering the relationship, (2) gathering information, (3) providing information, (4) making decisions, (5) responding to emotions, and (6) enabling disease- and treatment-related behavior. Evidence supports the importance of communication skills as a dimension of physician competence. Effort to enhance teaching of communication skills to medical trainees likely will require significant changes in instruction at undergraduate and graduate levels, as well as changes in assessing the developing communication skills of physicians. An added critical dimension is faculty understanding of the importance of communication skills, and their commitment to helping trainees develop those skills.

  13. Best Practices for Pressure Ulcer Prevention in the Burn Center. (United States)

    Warner, Julia; Ann Raible, Mary; Hajduk, Gina; Collavo, Jacqueline

    The State of Pennsylvania Hospital Engagement Network, in collaboration with a hospital system in Southwestern Pennsylvania, established a goal of reducing hospital-acquired pressure ulcers by 20%. A 6-month unfavorable trend of nurse-sensitive clinical indicators called for immediate process improvement. A retrospective chart review resulted in identification of predominant risk factors placing the burn patient at high risk for pressure ulcer formation. Implementations of pressure ulcer prevention measures were inconsistent. Nurses demonstrated varied levels of knowledge about products used for prevention. It became imperative to examine processes within the unit and provide nursing with education, access to skin care supplies, and advanced skin/wound care products for maintaining skin integrity. Creation of evidence-based guidelines was necessary to improve patient outcomes. A collaborative team approach influenced nursing and physician awareness of pressure ulcer risk. Evidence-based prevention guidelines were developed, and consistency in early intervention was achieved, supporting our culture of safety. A change in interprofessional collaborative practice and positive trend in pressure ulcer incidence data supports the success of our program.

  14. Nuclear Energy Center Site Survey, 1975. Part II. The U.S. electric power system and the potential role of nuclear energy centers

    International Nuclear Information System (INIS)


    Information related to Nuclear Energy Centers (NEC) in the U.S. is presented concerning the U.S. electric power system today; electricity demand history and forecasts; history and forecasts of the electric utility industry; regional notes; the status, history, and forecasts of the nuclear role; power plant siting problems and practices; nuclear facilities siting problems and practices; origin and evolution of the nuclear energy center concept; conceptualized description of nuclear energy centers; potential role of nuclear energy centers; assumptions, criteria, and bases; typical evolution of a nuclear energy center; and the nuclear fuel cycle

  15. How to Use the School Survey of Practices Associated with High Performance. REL 2016-162 (United States)

    Weinstock, Phyllis; Yumoto, Futoshi; Abe, Yasuyo; Meyers, Coby; Wan, Yinmei


    This report describes and explains how to use the School Survey of Practices Associated with High Performance, which measures the degree to which schools are engaging in practices associated with high performance. State education departments and school districts can use the survey results to identify and describe school practices associated with…

  16. Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance. (United States)

    Johnson, Bill


    Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met.

  17. The Chinese family-centered care survey for adult intensive care unit: A psychometric study. (United States)

    Wang, Wen-Ling; Feng, Jui-Ying; Wang, Chi-Jen; Chen, Jing-Huei


    This study aimed to develop a family-centered care survey for Chinese adult intensive care units and to establish the survey's psychometric properties. Family-centered care (FCC) is widely recognized as an ideal model of care. Few studies have explored FCC perceptions among family members of adult critical care patients in Asian countries, and no Chinese FCC measurement has been developed. An English version of the 3-factor family-centered care survey for adult intensive care units (FCCS-AICU) was translated into Chinese using a modified back translation procedure. Based on the literature review, two additional concepts, information and empowerment, were added to the Chinese FCCS-AICU. The psychometric properties of the Chinese FCCS-AICU were determined with 249 family members from a medical center in Taiwan and were tested for construct and convergent validity, and internal consistency. Both the monolingual and bilingual equivalence tests of the English and Chinese versions of the 3-factor FCCS-AICU were supported. Exploratory factor analysis supported the 5-factor structure of the Chinese FCCS-AICU with a total explained variance of 58.34%. The Chinese FCCS-AICU was correlated with the Chinese Critical Care Family Needs Inventory. Internal consistency, determined by Cronbach's α, for the overall scale was .94. The Chinese FCCS-AICU is a valid and reliable tool for measuring perceptions of FCC by family members of adult intensive care patients within Chinese-speaking communities. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Patient safety in practical nurses' education: A cross-sectional survey of newly registered practical nurses in Canada. (United States)

    VanDenKerkhof, Elizabeth; Sears, Nancy; Edge, Dana S; Tregunno, Deborah; Ginsburg, Liane


    Practical nurses have experienced an increasing scope of practice, including an expectation to care for complex patients and function on interdisciplinary teams. Little is known about the degree to which patient safety principles are addressed in practical nursing education. To examine self-reported patient safety competencies of practical nurses. A cross-sectional online survey (July 2014) and face-to-face interviews (June 2015). Ontario, Canada. Survey participants were practical nurses newly registered with the College of Nurses of Ontario between January 2012 and December 2013. Interview participants were faculty and students in a practical nursing program in Ontario. Survey respondents completed the Health Professional Education in Patient Safety Survey online. Self-reported competencies in various patient safety domains were compared between classroom and clinical settings. Faculty members were interviewed about educational preparation of practical nurses and students were interviewed to provide insight into interpretation of survey questions. The survey response rate was 28.4% (n=1104/3883). Mean domain scores indicated a high level of confidence in patient safety competence (Nurses of Ontario >2years and in those who obtained their education outside of Canada. Faculty believed their approach to teaching and learning instilled a deep understanding of the limits to practical nurse autonomous practice. Practical nurses were confident in what they learned about patient safety in their educational programs. The high degree of patient safety competence may be a true reflection of practical nurses understanding of, and comfort with, the limits of their knowledge and, ultimately, the limits of their individual autonomous practice. Further exploration as to whether the questionnaire requires additional modification for use with practical nurse populations is warranted. However, this study provides the first examination of practical nurses' perspectives and

  19. Survey on Mycoplasma hyopneumoniae gilt acclimation practices in Europe. (United States)

    Garza-Moreno, Laura; Segalés, Joaquim; Pieters, Maria; Romagosa, Anna; Sibila, Marina


    Gilts are considered to play a key role in Mycoplasma hyopneumoniae (M. hyopneumoniae) transmission and control. An effective gilt acclimation program should ideally reduce M. hyopneumoniae shedding at first farrowing, decreasing pre-weaning colonization prevalence and potential respiratory problems in fatteners. However, information on gilt acclimation practices is scarce in Europe . The aim of this study was to identify current acclimation strategies for M. hyopneumoniae in Europe using a questionnaire designed to assess 15 questions focused on gilt replacement status, acclimation strategies and methods used to ascertain its effect. A total of 321 questionnaires (representing 321 farms) were voluntarily completed by 108 veterinarians (from 18 European countries). From these farms, 280 out of 321 (87.2%) were aware of the health status of gilts on arrival. From these 280 farms, 161 (57.5%) introduced M. hyopneumoniae positive replacements. In addition, 249 out of 321 (77.6%) farms applied an acclimation process using different strategies, being M. hyopneumoniae vaccination (145 out of 249, 58.2%) and the combination of vaccine and exposure to sows selected for slaughter (53 out of 249, 21.3%) the most commonly used. Notwithstanding, only 53 out of 224 (23.6%) farms, knowing the M. hyopneumoniae initial status and performing acclimation strategies against it, verified the effect of the acclimation by ELISA (22 out of 53, 41.5%), PCR (4 out of 53, 7.5%) or both (27 out of 53, 50.9%). This study showed that three fourths of the farms represented in this European survey have M. hyopneumoniae acclimation strategies for gilts, and one fifth of them verify to some extent the effect of the process. Taking into account that the assessment of acclimation efficacy could help in optimizing replacement gilt introduction into the breeding herd, it seems these practices for M. hyopneumoniae are still poorly developed in Europe.

  20. Centering Pregnancy and Traditional Prenatal Care: A Comparison of Health Practices


    Shakespear, Kaylynn


    Centering Pregnancy is an alternative method of providing prenatal care with increased education and social support with health assessment in a group setting. This study, a cross-sectional, correlational, convenience-sample design, sought to determine the difference between women who receive prenatal care in Centering Pregnancy prenatal care and those in traditional prenatal care in regards to health behaviors. Adult pregnant women (n = 125) were surveyed from at least 28 weeks gestation. The...

  1. Using a patient survey for marketing a professional health care practice. (United States)

    Solomon, R J


    Small, private, professional health care practices are at a disadvantage when conducting market survey research because they cannot afford to employ or purchase the expensive specialized marketing skills of their larger competitors. The author describes a method that small private practices can use to conduct patient marketing surveys. Survey findings are reported and examples are provided of how the results influenced subsequent marketing decisions. Suggestions are offered to help ensure the success of similar studies in other practices.

  2. Provision and practice of specialist preterm labour clinics: a UK survey of practice. (United States)

    Sharp, A N; Alfirevic, Z


    To identify the current status of specialist preterm labour (PTL) clinic provision and management within the UK. Postal survey of clinical practice. All consultant-led obstetric units within the UK. A questionnaire was sent by post to all 210 NHS consultant-led obstetric units within the UK. Units that had a specialist PTL clinic were asked to complete a further 20 questions defining their protocol for risk stratification and management. Current practice in specialist preterm labour clinics. We have identified 23 specialist clinics; the most common indications for attendance were previous PTL (100%), preterm prelabour rupture of membranes (95%), two large loop excisions of the transformation zone (95%) or cone biopsy (95%). There was significant heterogeneity in the indications for and method of primary treatment for short cervix, with cervical cerclage used in 45% of units, progesterone in 18% of units and Arabin cervical pessary in 5%. A further 23% used multiple treatment modalities in combination. A significant heterogeneity in all topics surveyed suggests an urgent need for networking, more evidence-based guidelines and prospective comparative audits to ascertain the real impact of specialist PTL clinics on the reduction in preterm birth and its sequelae. © 2013 Royal College of Obstetricians and Gynaecologists.

  3. 78 FR 59426 - Board of Veterans Appeals, Veterans Information Office, Voice of the Veteran Call Center Survey... (United States)


    ... Information Office, Voice of the Veteran Call Center Survey; Correction AGENCY: Board of Veterans Appeals... comment on the proposed collection. The department name should read ``Board of Veterans' Appeals (BVA... ``Board of Veterans' Appeals, Veterans Information Office, Voice of the Veterans Call Center Survey''. We...

  4. Physical Activity Practices, Policies and Environments in Washington State Child Care Settings: Results of a Statewide Survey. (United States)

    Tandon, Pooja S; Walters, Kelly M; Igoe, Bridget M; Payne, Elizabeth C; Johnson, Donna B


    Objectives Child care is an important setting for the promotion of physical activity (PA) in early childhood. The purpose of this study was to examine the associations between specific PA environments and recommended practices in child care settings as well as the degree to which child care settings met recommended standards for total PA time. Methods In 2013, all programs licensed to care for children ages 2-5 in WA state were surveyed about their PA related practices. Logistic regression was used to determine odds of meeting best-practice standards for outdoor time and PA. Results The response rate was 45.8 % from centers (692/1511) and 32.1 % from homes (1281/3991). Few programs reported meeting best-practice standards for the amount of time children spend being physically active (centers: 12.1 %, homes: 20.1 %) and outdoor time (centers: 21.8 %, homes: 21.7 %). Programs where children go outside regardless of weather and those reporting more adult-led PA had higher odds of meeting best-practice standards for both PA and outdoor time. Meeting best-practice standards for outdoor time was the strongest predictor of meeting best-practice standards for total PA time [centers: OR 15.9 (9.3-27.2), homes: OR 5.2 (3.8-7.1)]. Conclusions for Practice There is considerable room for improvement in licensed child care settings in WA to meet best-practice standards for young children's outdoor and PA time. Initiatives that create policies and environments encouraging outdoor play and adult-led PA in child care have the potential to increase physical activity in substantial numbers of young children.

  5. Transition of Care Practices from Emergency Department to Inpatient: Survey Data and Development of Algorithm

    Directory of Open Access Journals (Sweden)

    Sangil Lee


    Full Text Available We aimed to assess the current scope of handoff education and practice among resident physicians in academic centers and to propose a standardized handoff algorithm for the transition of care from the emergency department (ED to an inpatient setting. This was a cross-sectional survey targeted at the program directors, associate or assistant program directors, and faculty members of emergency medicine (EM residency programs in the United States (U.S.. The web-based survey was distributed to potential subjects through a listserv. A panel of experts used a modified Delphi approach to develop a standardized algorithm for ED to inpatient handoff. 121 of 172 programs responded to the survey for an overall response rate of 70.3%. Our survey showed that most EM programs in the U.S. have some form of handoff training, and the majority of them occur either during orientation or in the clinical setting. The handoff structure from ED to inpatient is not well standardized, and in those places with a formalized handoff system, over 70% of residents do not uniformly follow it. Approximately half of responding programs felt that their current handoff system was safe and effective. About half of the programs did not formally assess the handoff proficiency of trainees. Handoffs most commonly take place over the phone, though respondents disagree about the ideal place for a handoff to occur, with nearly equivalent responses between programs favoring the bedside over the phone or faceto-face on a computer. Approximately two-thirds of responding programs reported that their residents were competent in performing ED to inpatient handoffs. Based on this survey and on the review of the literature, we developed a five-step algorithm for the transition of care from the ED to the inpatient setting. Our results identified the current trends of education and practice in transitions of care, from the ED to the inpatient setting in U.S. academic medical centers. An algorithm

  6. A Survey of Hygiene Practices of Bakers in Amuwo Odofin Local ...

    African Journals Online (AJOL)

    A Survey of Hygiene Practices of Bakers in Amuwo Odofin Local Government ... pest control, hygiene of personnel, storage and waste management. Important as this strategy is in the food industry, little has been reported on the practice of ...

  7. Trends in Pap test practices and results: An 11-year review of the annual ACHA Pap Test and STI Survey. (United States)

    Eastman-Mueller, Heather P; Oswalt, Sara B


    To conduct a trend analysis of Pap test practices, Pap test results and related women's services and guidelines of college health centers. College health centers who participated in the annual ACHA Pap Test and STI (sexually transmitted infection) Survey years 2004-2014 (n ranged from 127 to 181 depending on year). Descriptive analyses are presented with ANOVAs (Analysis of Variance) and chi-square tests calculated to examine trends over time. The number of Pap tests significantly decreased over time; however, the percentage of normal and HSIL (high-grade squamous intraepithelial lesion) results did not vary. Availability of conventional cytology slides and cryotherapy were significantly associated with year. Over time, college health centers' guidelines related to initiation of Pap testing evolved to consistently conform to national recommendations for cervical screening. The results indicate most college health centers are following the current national guidelines regarding Pap testing for young adult women.

  8. On the practice of ignoring center-patient interactions in evaluating hospital performance. (United States)

    Varewyck, Machteld; Vansteelandt, Stijn; Eriksson, Marie; Goetghebeur, Els


    We evaluate the performance of medical centers based on a continuous or binary patient outcome (e.g., 30-day mortality). Common practice adjusts for differences in patient mix through outcome regression models, which include patient-specific baseline covariates (e.g., age and disease stage) besides center effects. Because a large number of centers may need to be evaluated, the typical model postulates that the effect of a center on outcome is constant over patient characteristics. This may be violated, for example, when some centers are specialized in children or geriatric patients. Including interactions between certain patient characteristics and the many fixed center effects in the model increases the risk for overfitting, however, and could imply a loss of power for detecting centers with deviating mortality. Therefore, we assess how the common practice of ignoring such interactions impacts the bias and precision of directly and indirectly standardized risks. The reassuring conclusion is that the common practice of working with the main effects of a center has minor impact on hospital evaluation, unless some centers actually perform substantially better on a specific group of patients and there is strong confounding through the corresponding patient characteristic. The bias is then driven by an interplay of the relative center size, the overlap between covariate distributions, and the magnitude of the interaction effect. Interestingly, the bias on indirectly standardized risks is smaller than on directly standardized risks. We illustrate our findings by simulation and in an analysis of 30-day mortality on Riksstroke. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

  9. Practical guidelines for developing a smartphone-based survey instrument

    DEFF Research Database (Denmark)

    Ohme, Jakob; de Vreese, Claes Holger; Albæk, Erik

    The increasing relevance of mobile surveys makes it important to gather empirical evidence on designs of such surveys. This research note presents the results of a test study conducted to identify the best set-up for a smartphone-based survey. We base our analysis on a random sample of Danish...

  10. A Glass Ceiling Survey: Benchmarking Barriers and Practices. (United States)

    Morrison, Ann M.; And Others

    This handbook presents findings of a survey that asked human-resources managers to identify current barriers preventing women and people of color from reaching senior management. The survey was sent to 902 human-resources managers at various organizations. A total of 304 surveys were returned, a 34 percent response rate. The managers gave support…

  11. U.S. Geological Survey Virginia and West Virginia Water Science Center (United States)

    Jastram, John D.


    The U.S. Geological Survey (USGS) serves the Nation by providing reliable scientific information to describe and understand the Earth; minimize loss of life and property from natural disasters; manage water, biological, energy, and mineral resources; and enhance and protect our quality of life. In support of this mission, the USGS Virginia and West Virginia Water Science Center works in cooperation with many entities to provide reliable, impartial scientific information to resource managers, planners, and the public.

  12. Internal Quality Control Practices in Coagulation Laboratories: recommendations based on a patterns-of-practice survey. (United States)

    McFarlane, A; Aslan, B; Raby, A; Moffat, K A; Selby, R; Padmore, R


    Internal quality control (IQC) procedures are crucial for ensuring accurate patient test results. The IQMH Centre for Proficiency Testing conducted a web-based survey to gather information on the current IQC practices in coagulation testing. A questionnaire was distributed to 174 Ontario laboratories licensed to perform prothrombin time (PT) and activated partial thromboplastin time (APTT). All laboratories reported using two levels of commercial QC (CQC); 12% incorporate pooled patient plasma into their IQC program; >68% run CQC at the beginning of each shift; 56% following maintenance, with reagent changes, during a shift, or with every repeat sample; 6% only run CQC at the beginning of the day and 25% when the instruments have been idle for a defined period of time. IQC run frequency was determined by manufacturer recommendations (71%) but also influenced by the stability of test (27%), clinical impact of an incorrect test result (25%), and sample's batch number (10%). IQC was monitored using preset limits based on standard deviation (66%), precision goals (46%), or allowable performance limits (36%). 95% use multirules. Failure actions include repeating the IQC (90%) and reporting patient results; if repeat passes, 42% perform repeat analysis of all patient samples from last acceptable IQC. Variability exists in coagulation IQC practices among Ontario clinical laboratories. The recommendations presented here would be useful in encouraging standardized IQC practices. © 2015 John Wiley & Sons Ltd.

  13. [Survey of occupational health practices of foreign-owned companies]. (United States)

    Nakamura, Saki; Maruyama, Takashi; Hasegawa, Kumi; Nagata, Tomohisa; Mori, Koji


    We conducted a survey to clarify the present state of the occupational health practices (OHPs) of foreign-owned companies (FOCs) in Japan. The results reveal more strategic OHPs of FOCs located in Japan as local subsidiaries. Furthermore, the results should contribute to smoother global development of OHPs for international corporations with headquarters (HQs) in Japan. A total of 1,220 FOCs in Japan with at least 50 employees that are listed in Gaishikeikigyo-Soran (Overview of FOCs) 2009 published by Toyo Keizai, Inc. were targeted in our survey. A questionnaire with items concerning the (1) present situation of global and local OHP standards, (2) relationships with overseas HQ, and (3) impressions regarding daily OHPs was sent to a high-ranking person engaged in OHPs at each FOC. We ask about renkei-kan (sense of cooperation with overseas HQ), a positive Japanese word, in order to evaluate preferable relationships between FOCs and their HQs. There were 123 valid responses. Of these, only 50 had indicated the implementation of global standards (GS). Of the OHPs that were mentioned in GS, responses mainly included risk management for occupational diseases. With respect to local standards (LS), responses indicated that individual approaches toward each worker were an area of particular focus. Satisfaction with staff numbers and budget was high, although HQ involvement in staff numbers and budget control was low. Furthermore, 71.5% of respondents had low renkei-kan. We also found correlations among: renkei-kan, GS availability, frequency of reporting to overseas superiors, audit interval, and understanding of OHP organization at HQs. We found FOCs established OHPs independently of HQs and that they were satisfied with the present situation. On the other hand, there are many respondents who do not have positive feelings, renkei-kan, toward their relationships with HQs. OHP staff of FOCs can enhance renkei-kan by making use of GS, identifying key HQ personnel, and

  14. Procedural pain management in Italy: learning from a nationwide survey involving centers of the Italian Association of Pediatric Hematology-Oncology

    Directory of Open Access Journals (Sweden)

    Chiara Po'


    Full Text Available Procedural pain is an important aspect of care in pediatrics, and particularly in pediatric oncology where children often consider this to be the most painful experience during their illness. Best recommended practice to control procedural pain includes both sedative-analgesic administration and non-pharmacological treatments, practiced in an adequate and pleasant setting by skilled staff. A nationwide survey has been conducted among the Italian Centers of Pediatric Hematology-Oncology to register operators’ awareness on procedural pain, state of the art procedural pain management, operators’ opinions about pain control in their center, and possible barriers impeding sedation-analgesia administration. Based on indications in the literature, we discuss the results of the survey to highlight critical issues and suggest future directions for improvement. Future objectives will be to overcome differences depending on size, improve operators’ beliefs about the complexity of pain experience, and promote a global approach to procedural pain.

  15. Diagnosing autism: Contemporaneous surveys of parent needs and paediatric practice. (United States)

    Hennel, Sabine; Coates, Cathy; Symeonides, Christos; Gulenc, Alisha; Smith, Libby; Price, Anna Mh; Hiscock, Harriet


    Concurrence between parents' information needs and clinicians' practice when diagnosing autism is unknown but may influence families' uptake of management and adjustment. We aimed to compare parents' experience and preferences with paediatrician report of (i) diagnosis delivery and (ii) information given at diagnosis and identify types and usefulness of resources accessed by families post-diagnosis. The design used for the study are parent and paediatrician surveys. Participants are parents of children aged 1.5-18 years, diagnosed with autism between 01 January 2010 and 30 September 2012 and their paediatricians who are members of the Australian Paediatric Research Network. Study-designed quantitative and qualitative questions about diagnosis delivery and information given at diagnosis (written and spoken vs. neither) and parent perceived importance and harms of information accessed post-diagnosis. Paediatricians (53/198 (27%)) identified 1127 eligible families, of whom 404 (36%) participated. Parents were more likely to report receiving adequate time to discuss diagnosis than paediatricians (71 vs. 51%). Parents (98%) rated information about accessing allied health professionals and the meaning of diagnosis as most important, yet paediatricians offered written or spoken information about each infrequently (allied health: 22%; diagnosis: 42%). Post-diagnosis, allied health was the most important source of information (83%). Harmful resources conveyed helplessness or non-evidenced-based therapies, but few parents (14%) reported this. Parents want more information than can be conveyed in a single diagnostic consultation. Developing a tailored 'autism action plan' with written materials could improve parents' understanding of and satisfaction with children's autism diagnoses. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  16. Innovative Practices to Sustain and Renew Service and Patient-centered Outcomes (United States)

    Noelke, Nancy


    Background and Objectives: In integrating HeartMath into our culture at Gundersen Health System, we have a shared focus on delivering workshops and sustaining our HeartMath practices through a variety of innovative approaches. This presentation provides examples of our success in keeping the HeartMath practices alive for our staff. Gundersen is a fully integrated delivery system of 6500 employees. More than 700 medical, dental, and associate employees are distributed throughout 41 clinic locations, a 325-bed tertiary medical center, a Level II Trauma Center, Gundersen Medical Foundation, residency and medical education programs, and a clinical research program. Our service area covers 19 counties in three states, Western Wisconsin, Southeast Minnesota and Northeast Iowa. We are a physician-led organization embracing a strong administrative/medical partnership. Three parts of the 2012–2016 strategic plan apply to this initiative: Innovate to achieve service and patient-centered experience outcomes that are best in class (Outstanding Patient Experience); create a culture that embraces a passion for caring and spirit of improvement (Great Place to Work); and engage our staff to create a safe, injury-free, and healing environment for themselves, our patients, and visitors (Great Place to Work). Rollout Method: Between February 2011 and February 2013, more than 1200 employees completed HeartMath training. This initiative started with two staff members becoming HeartMathcertified trainers in January 2011. To promote leadership support for the program, the department chair MDs received HeartMath education in May 2011. Several units were identified to be the first to receive the training. As positive reviews circulated, requests for trainings were received from other departments. These included requests to customize the HeartMath offerings for leadership summits, manager meetings, new leader on-boarding, and physician and associate staff and to offer HeartMath appetizers

  17. Cancer pain management in China: current status and practice implications based on the ACHEON survey

    Directory of Open Access Journals (Sweden)

    Xia Z


    Full Text Available Zhongjun Xia Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, ChinaPurpose: Cancer pain can seriously impact the quality of life (QoL of patients, and optimal management practices are therefore of paramount importance. The ACHEON survey queried physicians and patients from 10 Asian countries/regions to assess current clinical practices in cancer pain management in Asia. This study presents the data obtained for cancer pain management in mainland China, with an emphasis on practices related to opioid drugs.Materials and methods: In several tertiary hospitals across China, 250 patients experiencing cancer pain and 100 physicians were surveyed on questions designed to assess current cancer pain management practices and cancer pain impact on QoL.Results: The patient survey showed that 88% of patients reported moderate-to-severe cancer pain, with a median duration of 6 months. The physician survey showed that medical school/residency training with regard to cancer pain management was inadequate in ~80% of physicians. A total of 80% of physicians and 67.2% of patients reported that pain scale was used during pain assessment; 84% of physicians expressed that physician-perceived pain severity was not completely consistent with actual pain the patient experienced. Of the 147 patients who recalled the medication received, 83.7% were administered opioid prescriptions. Of the 240 patients who received treatment, 43.8% perceived the inadequacy of controlling pain. The primary barriers from physicians perceived to optimal pain management included patients’ fear of side effects (58%, patients’ fear of addiction (53%, patients’ reluctance to report pain (43%, physicians’ reluctance to prescribe (29%, physicians’ inadequacy of pain assessment (27% and excessive regulation of opioid analgesics (47%.Conclusion: Knowledge of cancer pain management should be strengthened among physicians. Quantitative pain assessment and principle-based pain

  18. Best Practices Guide for Energy-Efficient Data Center Design: Revised March 2011 (Brochure)

    Energy Technology Data Exchange (ETDEWEB)


    This guide provides an overview of best practices for energy-efficient data center design which spans the categories of Information Technology (IT) systems and their environmental conditions, data center air management, cooling and electrical systems, on-site generation, and heat recovery. IT system energy efficiency and environmental conditions are presented first because measures taken in these areas have a cascading effect of secondary energy savings for the mechanical and electrical systems. This guide concludes with a section on metrics and benchmarking values by which a data center and its systems energy efficiency can be evaluated. No design guide can offer 'the most energy-efficient' data center design but the guidelines that follow offer suggestions that provide efficiency benefits for a wide variety of data center scenarios.

  19. A transatlantic survey of nutrition practice in acute pancreatitis.

    LENUS (Irish Health Repository)

    Duggan, SN


    Many guidelines exist for the nutritional management of acute pancreatitis; however, little is known regarding current practice. We aimed to investigate feeding practices, including the use of parenteral\\/enteral nutrition.

  20. Are health centers in Thailand ready for health information technology? : a national survey. (United States)

    Kijsanayotin, Boonchai; Speedie, Stuart


    The Thailand universal health care coverage scheme was instituted in 2001 and The Thailand Ministry of Public Health (MOPH) is restructuring its information systems to support this reform. The MOPH anticipates developing computerized health information systems which can provide information for administration tasks and can improve both healthcare delivery and public health services. To achieve these target goals, knowledge about users and organizations is vital. The knowledge of how health center workers currently use information technology (IT), their knowledge of IT, and acceptance of IT are not only beneficial to policy makers but also to system designers and implementers. The primary objective of this study is to learn how health centers in Thailand use IT, the level of basic IT knowledge among their workers, and their acceptance of health IT. We surveyed a random cross sectional sample of 1,607 health centers representing the total of 9,806 in Thailand in 2005. With an 82% response rate, the preliminary results indicate that information technology usage is pervasive in health centers. The respondents showed a moderately high degree of health information technology acceptance with a modest level of basic IT knowledge. There were no differences in degrees of acceptance among the four geographic regions. The mean score of "intention to use IT" was 5.6 on a scale of 7 and the average basic IT knowledge score was 13 out of 20. These results suggests the possibility of project success if the national health center information system projects are developed and implemented.

  1. Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature. (United States)

    Draper, K; Ley, C; Parsonnet, J


    Probiotic use by patients and physicians has dramatically increased over the last decade, although definitive evidence is often lacking for their use. We examined probiotic-prescribing practices among health care providers (HCP) at a tertiary medical centre and compared these practices to clinical guidelines. HCP at the Stanford Medical Center received a survey on probiotic prescribing practices including choice of probiotic and primary indications. A broad overview of the literature was performed. Among 2,331 HCP surveyed, 632 responded. Of the 582 of these who routinely prescribed medications, 61% had recommended probiotic foods or supplements to their patients. Women and gastroenterologists were more likely to prescribe probiotics (odds ratio (OR): 1.5, 95% confidence interval (CI): 1.0-2.1; OR: 3.9, 95% CI: 1.5-10.1, respectively). Among probiotic prescribers, 50% prescribed inconsistently or upon patient request, and 40% left probiotic choice to the patient. Common indications for probiotics, particularly Lactobacillus GG, were prevention and treatment of antibiotic-associated diarrhoea (79 and 66%, respectively). Probiotics were often prescribed for 'general bowel health' or at patient request (27 and 39% of responders, respectively). Most respondents (63%) thought an electronic medical record (EMR) pop-up would change probiotic prescribing patterns. However, a review of published guidelines and large trials found inconsistencies in probiotic indications, dosages and strain selection. Probiotic prescribing is common but lacks consistency, with choice of probiotic frequently left to the patient, even for indications with some strain-specific evidence. Implementation of EMR pop-ups/pocket guides may increase consistency in probiotic prescribing, although the lack of clear and consistent guidelines must first be addressed with large, well-designed clinical trials.

  2. Examining the Challenges of Cadastral Surveying Practice in Zambia

    African Journals Online (AJOL)

    lodging and examination of survey records, cadastral survey standards and regulations. ... African land systems referred to as the 'Evolutionary Theory of Land Rights' (ETLR). The main ... emerge and, once established, to evolve towards individualisation and ..... livelihoods 'What contributions can we make?', DFID, London.

  3. Evaluation of Nutrition and Physical Activity Policies and Practices in Child Care Centers within Rural Communities. (United States)

    Foster, Jaime S; Contreras, Dawn; Gold, Abby; Keim, Ann; Oscarson, Renee; Peters, Paula; Procter, Sandra; Remig, Valentina; Smathers, Carol; Mobley, Amy R


    Although some researchers have examined nutrition and physical activity policies within urban child care centers, little is known about the potentially unique needs of rural communities. Child care centers serving preschool children located within low-income rural communities (n = 29) from seven states (Indiana, Kansas, Michigan, North Dakota, Ohio, South Dakota, and Wisconsin) were assessed to determine current nutrition and physical activity (PA) practices and policies. As part of a large-scale childhood obesity prevention project, the Community Healthy Living Index's previously validated Early Childhood Program Assessment Tool was used to collect data. Descriptive statistical analysis was conducted to identify high-priority areas. Healthy People 2020 and the Academy of Nutrition and Dietetics' recommendations for nutrition and PA policies in child care centers were used as benchmarks. Reports of not fully implementing (nutrition-related policies or practices within rural early child care centers were identified. Centers not consistently serving a variety of fruits (48%), vegetables (45%), whole grains (41%), limiting saturated fat intake (31%), implementing healthy celebration guidelines (41%), involving children in mealtime (62%), and referring families to nutrition assistance programs (24%) were identified. More than one third of centers also had limited structured PA opportunities. Although eligible, only 48% of the centers participated in the Child and Adult Care Food Program. Overall, centers lacked parental outreach, staff training, and funding/resources to support nutrition and PA. These results provide insight into where child care centers within low-income, rural communities may need assistance to help prevent childhood obesity.

  4. Proposing a Center on Aging and Well-Being: Research, Education, and Practice Considerations (United States)

    Lindenbach, Jeannette M.; Jessup-Falcioni, Heather


    This environmental scan aimed to discover research interests and educational needs of faculty, graduate, and undergraduate students to inspire research, education, and practice in the development of a center on aging and well-being for older adults. The scan consisted of a search of university faculty and researchers regarding research on aging; a…

  5. Nutrition and Physical Activity Practices in Childcare Centers versus Family Childcare Homes (United States)

    Natale, Ruby; Page, Monica; Sanders, Lee


    Obesity rates among preschool-aged children have doubled in the past 10 years, and 60% of these children spend the majority of their day in childcare facilities. Few studies have examined the quality of nutrition and physical activity practices in childcare centers as compared to family childcare homes. The purpose of this study is to determine if…

  6. Child Welfare Worker Perception of the Implementation of Family-Centered Practice (United States)

    Michalopoulos, Lynn; Ahn, Haksoon; Shaw, Terry V.; O'Connor, Julia


    Objectives: The purpose of this study was to explore perceptions of Family-Centered Practice (FCP) among child welfare workers who are expected to use FCP principles in their work with children and families. Method: Nine focus groups were conducted among child welfare workers across seven different regions within one state to assess caseworker's…

  7. Identifying the factors influencing practice variation in thrombosis medicine: A qualitative content analysis of published practice-pattern surveys. (United States)

    Skeith, Leslie; Gonsalves, Carol


    Practice variation, the differences in clinical management between physicians, is one reason why patient outcomes may differ. Identifying factors that contribute to practice variation in areas of clinical uncertainty or equipoise may have implications for understanding and improving patient care. To discern what factors may influence practice variation, we completed a qualitative content analysis of all practice-pattern surveys in thrombosis medicine in the last 10years. Out of 2117 articles screened using a systematic search strategy, 33 practice-pattern surveys met eligibility criteria. Themes were identified using constant comparative analysis of qualitative data. Practice variation was noted in all 33 practice-pattern surveys. Contributing factors to variation included lack of available evidence, lack of clear and specific guideline recommendations, past experience, patient context, institutional culture and the perceived risk and benefit of a particular treatment. Additional themes highlight the value placed on expertise in challenging clinical scenarios, the complexity of practice variation and the value placed on minimizing practice variation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Psychology and psychosocial practices: narratives and conceptions of psychologists from the psychosocial care centers

    Directory of Open Access Journals (Sweden)

    Thais Thomé Seni da Silva e Oliveira


    Full Text Available The psychosocial care, current care model in mental health in Brazil, emphasizes interdisciplinary, inter-sectoral and territorial actions. This paper aims to present conceptions of psychologists from the Centers for Psychosocial Care of a city on Parana state, about the psychosocial practices developed in their daily actions. Semi-structured individual interviews and group meetings were conducted, using the technique of Operating Group of Pichón-Rivière. The interviews and groups were recorded, transcribed and qualitatively analyzed. Results point the dichotomy between clinical and psychosocial practices in psychology and the professional identity of the participants tied to traditional clinical psychology model. Some psychosocial practices are gradually being recognized by professionals as legitimate practice of psychology, and could be considered amplified clinic in psychology. It is concluded that for the effectiveness of psychosocial practices, it is essential to improve graduation courses and permanent education strategies for mental health professionals.

  9. Interconnection Structures, Management and Routing Challenges in Cloud-Service Data Center Networks: A Survey

    Directory of Open Access Journals (Sweden)

    Ahmad Nahar Quttoum


    Full Text Available Today’s data center networks employ expensive networking equipments in associated structures that were not designed to meet the increasing requirements of the current large-scale data center services. Limitations that vary between reliability, resource utilization, and high costs are challenging. The era of cloud computing represents a promise to enable large-scale data centers. Computing platforms of such cloud service data centers consist of large number of commodity low-price servers that, with a theme of virtualization on top, can meet the performance of the expensive high-level servers at only a fraction of the price. Recently, the research in data center networks started to evolve rapidly. This opened the path for addressing many of its design and management challenges, these like scalability, reliability, bandwidth capacities, virtual machines’ migration, and cost. Bandwidth resource fragmentation limits the network agility, and leads to low utilization rates, not only for the bandwidth resources, but also for the servers that run the applications. With Traffic Engineering methods, managers of such networks can adapt for rapid changes in the network traffic among their servers, this can help to provide better resource utilization and lower costs. The market is going through exciting changes, and the need to run demanding-scale services drives the work toward cloud networks. These networks that are enabled by the notation of autonomic management, and the availability of commodity low-price network equipments. This work provides the readers with a survey that presents the management challenges, design and operational constraints of the cloud-service data center networks

  10. survey research in practical theology and congregational studies

    African Journals Online (AJOL)

    such as the social, political and economic environment that influence society also affect the ... correlation research is part of a quantitative research methodology and could contribute to ... Another type is qualitative survey that focuses on the ...

  11. A survey of radon properties in underground shopping centers in Hong Kong

    International Nuclear Information System (INIS)

    Yu, K.N.; Young, E.C.M.; Stokes, M.J.; Lo, C.H.


    A number of radon-related properties have been surveyed in underground shopping centers in Hong Kong. These parameters include the radon concentration, the total potential alpha energy concentration of radon progeny, the equilibrium factor and the unattached fraction of radon progeny. The mean values recorded for these were 29.2 ± 7.8 Bq/m 3 , 3.60 ± 1.53 mWL, 0.46 ± 0.16 and 0.05 ± 0.03, respectively. Based on these figures, we have calculated the average radon dose received by employees in an underground shopping center in Hong Kong to be 0.22 mSv/yr, which represents an approximate increase of 8% over the total dose of about 2.7 mSv/yr received by the average person in Hong Kong. (author)

  12. Strategic plan for science-U.S. Geological Survey, Ohio Water Science Center, 2010-15 (United States)



    This Science Plan identifies specific scientific and technical programmatic issues of current importance to Ohio and the Nation. An examination of those issues yielded a set of five major focus areas with associated science goals and strategies that the Ohio Water Science Center will emphasize in its program during 2010-15. A primary goal of the Science Plan is to establish a relevant multidisciplinary scientific and technical program that generates high-quality products that meet or exceed the expectations of our partners while supporting the goals and initiatives of the U.S. Geological Survey. The Science Plan will be used to set the direction of new and existing programs and will influence future training and hiring decisions by the Ohio Water Science Center.

  13. Patient Engagement Practices in Clinical Research among Patient Groups, Industry, and Academia in the United States: A Survey.

    Directory of Open Access Journals (Sweden)

    Sophia K Smith

    Full Text Available Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed.Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions.Survey respondents (n = 179 valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p < .001. Patient group respondents placed higher value in open communications, clear expectations, and detailed contract execution than did non-patient group respondents (all p < .05. Industry and academic respondents more often cited internal bureaucratic processes and reluctance to share information as engagement barriers than did patient group respondents (all p < .01. Patient groups reported that a lack of transparency and understanding of the benefits of collaboration on the part of industry and academia were greater barriers than did non-patient group respondents (all p< .01.Despite reported similarities among approaches to engagement by the three stakeholder groups, key differences exist in perceived barriers and benefits to partnering with patient groups among the

  14. Improving Patient-Centered Care for Young People in General Practice With a Codesigned Screening App: Mixed Methods Study. (United States)

    Webb, Marianne Julie; Wadley, Greg; Sanci, Lena Amanda


    Despite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people's routine health care. The aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people's assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people's acceptance and experience of using a screening app during regular health care. This was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey. The exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (Ptime to ask questions. In all, 86% (73/85) of young people felt the app was a "good idea" and only 1% (1/85) thought it a "bad idea." Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope

  15. A Survey of Optometry Graduates to Determine Practice Patterns. (United States)

    Bleimann, Robert L.; Smith, Lee W.


    A summary of a study of optometry graduates conducted by the Association of Schools and Colleges of Optometry (ASCO) is provided. The data covered aspects of recently graduated O.D.s' experience in obtaining a state license, becoming established in practice, and their practice characteristics. (Author/MLW)

  16. Neonatal circumcision in severe haemophilia: a survey of paediatric haematologists at United States Hemophilia Treatment Centers. (United States)

    Kearney, S; Sharathkumar, A; Rodriguez, V; Chitlur, M; Valentino, L; Boggio, L; Gill, J


    Neonatal circumcision in patients with severe haemophilia has not been well studied. We performed a survey of paediatric haematologists from Hemophilia Treatment Centers (HTC) across the United States to better understand the attitudes toward and management of neonatal circumcision in haemophilia patients. Response rate to our survey was 40% (n = 64/159). Thirty-eight percent of respondents (n = 24) said that they would allow this procedure in the newborn period but in many cases this was against medical advice. The most reported concern regarding neonatal circumcision in haemophilia patients was the risk of development of an inhibitor (n = 25; 39%) followed by the concern for bleeding (n = 22; 34%) and issues related to vascular access in the neonate (n = 11; 17%). All respondents recommended at least one preprocedure dose of factor replacement. Twenty-two percent (n = 14) of respondents did not use more than one dose of factor replacement but 32% (n = 21) used 1-2 postoperative doses. The remainder of paediatric haematologists surveyed recommended between 3-5 (16%; n = 10) and 6-10 (3%, n = 2) additional days postoperatively. There was wide variation in both techniques of circumcision as well as adjuvant haemostatic agents used. Only 22% of respondents said that they had an established protocol for management of circumcision in the newborn haemophilia patient. These survey results highlight the need for evidence-based guidelines regarding the optimal management of circumcision in neonates with severe haemophilia. © 2014 John Wiley & Sons Ltd.

  17. Emergency Contraception: A multi-specialty survey of clinician knowledge and practices (United States)

    Batur, Pelin; Cleland, Kelly; McNamara, Megan; Wu, Justine; Pickle, Sarah


    Objectives To assess knowledge and provision of emergency contraception (EC), particularly the most effective methods. Study Design A web-based survey was distributed to a cross-sectional convenience sample of healthcare providers across specialties treating reproductive-aged women. The survey was sent to 3,260 practicing physicians and advanced practice clinicians in 14 academic centers between February 2013 and April 2014. We analyzed responses by provider specialty using multivariable logistic regression. Results The final sample included 1,684 providers (response rate = 51.7%). Ninety-five percent of the respondents had heard of levonorgestrel (LNG) EC. Among reproductive health specialists, 81% provide levonorgestrel EC in their practice, although only half (52%) had heard of ulipristal acetate (UPA) and very few provide it (14%). The majority in family medicine (69%) and emergency medicine (74%) provide levonorgestrel, in contrast to 42% of internists and 55% of pediatricians. However, the more effective methods (UPA and copper IUD) were little known and rarely provided outside of reproductive health specialties; 18% of internists and 14% of emergency medicine providers had heard of UPA and 4% provide it. Only 22% of emergency providers and 32% of pediatricians had heard of the copper IUD used as EC. Among reproductive health specialists, only 36% provide copper IUD as EC in their practice. Specialty, provider type and proportion of women of reproductive age in the practice were related to knowledge and provision of some forms of EC. Conclusions Awareness and provision of the most effective EC methods, UPA and the copper IUD (which are provider-dependent), are substantially lower than for LNG EC, especially among providers who do not focus on reproductive health. Implications In our sample of 1,684 healthcare providers from diverse specialties who treat reproductive-aged women, knowledge and provision of the most effective forms of emergency contraception

  18. Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for ambulatory surgical centers - Facility (United States)

    U.S. Department of Health & Human Services — A list of ambulatory surgical center ratings for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey....

  19. Toward generally accepted forensic assessment practices among clinical neuropsychologists: a survey of professional practice and common test use. (United States)

    LaDuke, Casey; Barr, William; Brodale, Donald L; Rabin, Laura A


    This study investigated professional practice and common test use among clinical neuropsychologists engaging in forensic assessment.  Doctorate-level psychologists active in the practice of neuropsychology and on the INS and NAN membership listings (n = 502) were surveyed about their demographics, professional practice, and common test use. Participants who reported engaging in forensic practice (n = 255) were further surveyed about their forensic practice. Forensic participants were more likely to be male and Caucasian, and reported higher ages, more years of professional experience, and a higher prevalence of board certification. While characteristics of their professional and forensic practice varied, forensic participants reported spending most of their professional time conducting neuropsychological assessments with adult clients in a private or group practice setting, focusing on civil referrals and civil legal questions involving older adult issues, developmental issues, head injury, and psychiatric issues. Common test use across neuropsychological assessment domains is presented for board-certified forensic participants (n = 77). An examination of these results reveals that the current pattern of test use is similar to the results of a more general survey of neuropsychological test use.  The findings provide insight into the practice of forensic neuropsychological assessment, and further establish the admissibility of neuropsychological evidence in the United States legal system. Results will be useful for clinical neuropsychologists, field leaders, and legal professionals hoping to gain insight into the role of clinical neuropsychology in civil and criminal legal decision-making.

  20. Questionnaire survey of ultrasonography at centers equipped for detailed breast cancer screening

    International Nuclear Information System (INIS)

    Shiraiwa, Misaki; Endo, Tokiko; Morita, Takako; Niwa, Tae; Oiwa, Mikinao; Nishida, Chikako


    To ascertain the current status of ultrasonography in mammographic (MG) screening at centers equipped for detailed examination and to clarify the related issues, a questionnaire was sent to 181 centers, exclusive of those providing only medical check-ups, recognized by the Central Committee for Quality Control of Mammographic Screening in 7 prefectures of Chubu District. Of the 99 centers that returned the questionnaire (response rate, 54.7%), 82 answered ''yes'' to the use of breast ultrasound in clinical practice, in which the actual state of breast ultrasonography was analyzed. Examinations were performed by doctors alone at 24 centers, doctors and non-doctors at 40, and non-doctors alone at 18. Examinations by doctors were performed in doctors' offices at 28 centers, in inspection rooms at 26 and both at 10, frequently as outpatient examinations in 51 centers (79.7%). The mean duration of examination was 9.8 min for the first examination of a symptomatic patient, 7.5 min for follow-up, 9.6 min for the first examination of an asymptomatic patient, and 7.6 min for follow-up. For non-doctors, the respective times were 16.7, 14.4, 14.7, and 14.2 min, respectively. Non-doctors performing examinations alone (87.9%) and with insufficient MG information (50.0%) took a longer time. Frequently, the image was read only by doctors (65.5%), employing static images (93.3%). Qualified specialist doctors and technologists accounted for 16.2%, and the rate of participation in training by the Japan Association of Breast and Thyroid Sonology (JABTS) was 24.7%. Based on the present questionnaire, conditions of breast ultrasonography for mild MG abnormalities still appear to be inadequate. (author)

  1. Embryo transfer practices in the United States: a survey of clinics registered with the Society for Assisted Reproductive Technology. (United States)

    Jungheim, Emily S; Ryan, Ginny L; Levens, Eric D; Cunningham, Alexandra F; Macones, George A; Carson, Kenneth R; Beltsos, Angeline N; Odem, Randall R


    To gain a better understanding of factors influencing clinicians' embryo transfer practices. Cross-sectional survey. Web-based survey conducted in December 2008 of individuals practicing IVF in centers registered with the Society for Assisted Reproductive Technology (SART). None. None. Prevalence of clinicians reporting following embryo transfer guidelines recommended by the American Society for Reproductive Medicine (ASRM), prevalence among these clinicians to deviate from ASRM guidelines in commonly encountered clinical scenarios, and practice patterns related to single embryo transfer. Six percent of respondents reported following their own, independent guidelines for the number of embryos to transfer after IVF. Of the 94% of respondents who reported routinely following ASRM embryo transfer guidelines, 52% would deviate from these guidelines for patient request, 51% for cycles involving the transfer of frozen embryos, and 70% for patients with previously failed IVF cycles. All respondents reported routinely discussing the risks of multiple gestations associated with standard embryo transfer practices, whereas only 34% reported routinely discussing single embryo transfer with all patients. Although the majority of clinicians responding to our survey reported following ASRM embryo transfer guidelines, at least half would deviate from these guidelines in a number of different situations. Copyright (c) 2010 American Society for Reproductive Medicine. All rights reserved.

  2. Decision-Making in Audiology: Balancing Evidence-Based Practice and Patient-Centered Care (United States)

    Clemesha, Jennifer; Lundmark, Erik; Crome, Erica; Barr, Caitlin; McMahon, Catherine M.


    Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices. PMID:28752808

  3. A survey of propofol injection practices reveals poor knowledge of ...

    African Journals Online (AJOL)

    Differences in unsafe practices among anaesthesiologists who had read the guidelines ... employed (private vs. public) and gender; (b) To estimate the .... Private sector. 66% ..... reports from developing or low-income countries have been.

  4. Practice of knowledge management in Prototype and Plant Development Center (PDC)

    International Nuclear Information System (INIS)

    Mohamad Safuan Sulaiman; Rapieh Aminuddin; Rosli Darmawan; Mohd Ashhar Khalid


    As reflecting the evolvement and movement of world economy direction, Malaysia move one step a head towards knowledge based economy (K-Economy). The movement indirectly changes the Malaysian Nuclear Agency (Nuclear Malaysia) environment to contribute to the K-Economy in the field of science and technology. Therefore, the practice of knowledge management is slowly introduced to the Nuclear Malaysia community to support the K-Economy. This paper describes the detail of the practice of knowledge management at macro and micro level in an organization. The Prototype and Plant Development Center(PDC) under the Technical Support Division, Technical Service Program has been chosen to be the case study in implementing the practice of knowledge management in Nuclear Malaysia. The main objective of this paper is to introduce the right practice of Knowledge management in an organization and PDC as among the first case for this purpose. (Author)

  5. Implementation of Patient-Centered Medical Homes in Adult Primary Care Practices. (United States)

    Alexander, Jeffrey A; Markovitz, Amanda R; Paustian, Michael L; Wise, Christopher G; El Reda, Darline K; Green, Lee A; Fetters, Michael D


    There has been relatively little empirical evidence about the effects of patient-centered medical home (PCMH) implementation on patient-related outcomes and costs. Using a longitudinal design and a large study group of 2,218 Michigan adult primary care practices, our study examined the following research questions: Is the level of, and change in, implementation of PCMH associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results indicated that both level and amount of change in practice implementation of PCMH are independently and positively associated with measures of quality of care and use of preventive services, after controlling for a variety of practice, patient cohort, and practice environmental characteristics. Results also indicate that lower overall medical and surgical costs are associated with higher levels of PCMH implementation, although change in PCMH implementation did not achieve statistical significance. © The Author(s) 2015.

  6. Patient-Centered Specialty Practice: Defining the Role of Specialists in Value-Based Health Care. (United States)

    Ward, Lawrence; Powell, Rhea E; Scharf, Michael L; Chapman, Andrew; Kavuru, Mani


    Health care is at a crossroads and under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. However, primary care accounts for only a small portion of total health-care spending, and there is a need for policies and frameworks to support high-quality, cost-efficient care in specialty practices of the medical neighborhood. The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption. Copyright © 2017. Published by Elsevier Inc.

  7. The Survey of Contamination of Platelet Product with Aerobic Bacteria in Isfahan Blood Transfusion Center

    Directory of Open Access Journals (Sweden)

    F Baghban


    Full Text Available Introduction: Although nowadays the risk of transmission of bacterial pathogens through blood transfusion has been decreased, but there is the possibility of transmission of these factors by injection of these kind of products. The purpose of this survey was determination of contamination of platelet products with aerobic bacteria in Isfahan Blood Transfusion Center. Methods: In the spring and summer of 2014, 2000 platelet product samples were examined randomly in 5 months for aerobic bacterial contamination. First, samples were cultured in fluid thioglycollate medium. The bacteria that were grown in this medium were identified by Gram staining and biochemical tests. Then, DNA was extracted from isolated bacteria and PCR was done for 16S rRNA gene. After that the PCR products were sequenced and the bacteria were recognized at the level of species. Results: At this research, 4 contaminated samples were identified. Isolated bacteria were including: Klebsiella pneumoniae 1 case, Staphylococcus aureus 1 case, Staphylococcus epidermidis 1 case and Staphylococcus haemolyticus 1 case.    After sequencing of 16S rRNA gene, the homology was observed 97%, 83%, 99%, and 90% at theses bacteria, respectively. Discussion: According to the results of this research, platelet products may be contaminated with aerobic bacteria. Therefore, providing appropriate conditions in transfusion centers and other therapeutic centers for doing screening tests on platelet products to identifying bacterial contaminations before using of these products seems to be necessary.

  8. Understanding and Predicting Social Media Use Among Community Health Center Patients: A Cross-Sectional Survey (United States)


    Background The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. Objective The aim was to determine the use and factors predicting the use of social media for health care–related purposes among medically underserved primary care patients. Methods A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. Conclusions Understanding use and factors predicting use can increase adoption and utilization of social media for health care–related purposes among underserved patients in community health centers. PMID:25427823

  9. Remotely sensed data available from the US Geological Survey EROS Data Center (United States)

    Dwyer, John L.; Qu, J.J.; Gao, W.; Kafatos, M.; Murphy , R.E.; Salomonson, V.V.


    The Center for Earth Resources Observation Systems (EROS) is a field center of the geography discipline within the US geological survey (USGS) of the Department of the Interior. The EROS Data Center (EDC) was established in the early 1970s as the nation’s principal archive of remotely sensed data. Initially the EDC was responsible for the archive, reproduction, and distribution of black-and-white and color-infrared aerial photography acquired under numerous mapping programs conducted by various Federal agencies including the USGS, Department of Agriculture, Environmental Protection Agency, and NASA. The EDC was also designated the central archive for data acquired by the first satellite sensor designed for broad-scale earth observations in support of civilian agency needs for earth resource information. A four-band multispectral scanner (MSS) and a return-beam vidicon (RBV) camera were initially flown on the Earth Resources Technology Satellite-1, subsequently designated Landsat-1. The synoptic coverage, moderate spatial resolution, and multi-spectral view provided by these data stimulated scientists with an unprecedented perspective from which to study the Earth’s surface and to understand the relationships between human activity and natural systems.

  10. The Counseling Center Assessment of Psychological Symptoms (CCAPS): Merging clinical practice, training, and research. (United States)

    Youn, Soo Jeong; Castonguay, Louis G; Xiao, Henry; Janis, Rebecca; McAleavey, Andrew A; Lockard, Allison J; Locke, Benjamin D; Hayes, Jeffrey A


    The goal of this article is to present information about a standardized multidimensional measure of psychological symptoms, the Counseling Center Assessment of Psychological Symptoms (CCAPS; Locke et al., 2011; Locke, McAleavey, et al., 2012; McAleavey, Nordberg, Hayes, et al., 2012), developed to assess difficulties specific to college students' mental health. We provide (a) a brief review and summary of the psychometric and research support for the CCAPS; (b) examples of the use of the CCAPS for various purposes, including clinical, training, policy, and counseling center advocacy; and (c) implications of the integration of routine outcome monitoring and feedback for the future of training, research, and clinical practice. In particular, the article emphasizes how the assimilation of and symbiotic relationship between research and practice can address the scientist-practitioner gap. (c) 2015 APA, all rights reserved).

  11. Person-Centered Care Practices in Long-Term Care in the Deep South: Consideration of Structural, Market, and Administrator Characteristics. (United States)

    Jacobs, M Lindsey; Snow, A Lynn; Parmelee, Patricia A; Davis, Jullet A


    The purpose of this study was to identify structural, market, and administrator factors of nursing homes that are related to the implementation of person-centered care. Administrators of Medicare/Medicaid-certified nursing homes in the Deep South were invited to complete a standardized survey about their facility and their perceptions and attitudes regarding person-centered care practices (PCCPs). Nursing home structural and market factors were obtained from public websites, and these data were matched with administrator data. Consistent with the resource-based theory of competitive advantage, nursing homes with greater resources and more competition were more likely to implement PCCPs. Implementation of person-centered care was also higher in nursing homes with administrators who perceived culture change implementation to be feasible in their facilities. Given that there is a link between resource availability and adoption of person-centered care, future research should investigate the cost of such innovations.

  12. Organizational dimensions of relationship-centered care. Theory, evidence, and practice. (United States)

    Safran, Dana Gelb; Miller, William; Beckman, Howard


    Four domains of relationship have been highlighted as the cornerstones of relationship-centered health care. Of these, clinician-patient relationships have been most thoroughly studied, with a rich empirical literature illuminating significant linkages between clinician-patient relationship quality and a wide range of outcomes. This paper explores the realm of clinician-colleague relationships, which we define to include the full array of relationships among clinicians, staff, and administrators in health care organizations. Building on a stream of relevant theories and empirical literature that have emerged over the past decade, we synthesize available evidence on the role of organizational culture and relationships in shaping outcomes, and posit a model of relationship-centered organizations. We conclude that turning attention to relationship-centered theory and practice in health care holds promise for advancing care to a new level, with breakthroughs in quality of care, quality of life for those who provide it, and organizational performance.

  13. Best Manufacturing Practices. Report of Survey Conducted at Stafford County Public Schools, Stafford County, VA

    National Research Council Canada - National Science Library


    During the week of August 8, 1994, a Best Manufacturing Practices (BMP) survey was conducted at the Stafford County Public Schools located in Stafford County, Virginia, considered one of the fastest growing counties in the state...

  14. International survey of veterinarians to assess the importance of competencies in professional practice and education

    NARCIS (Netherlands)

    Bok, H.G.; Teunissen, P.W.; Boerboom, T.B.; Rhind, S.M.; Baillie, S.; Tegzes, J.; Annandale, H.; Matthew, S.; Torgersen, A.; Hecker, K.G.; Hardi-Landerer, C.M.; Gomez-Lucia, E.; Ahmad, B.; Muijtjens, A.M.; Jaarsma, D.A.; Vleuten, C.P.M. van der; Beukelen, P. van


    OBJECTIVE: To determine the perceived importance of specific competencies in professional veterinary practice and education among veterinarians in several countries. DESIGN: Survey-based prospective study. SAMPLE: 1,137 veterinarians in 10 countries. PROCEDURES: Veterinarians were invited via email

  15. Knowledge, attitude and practice of family physicians regarding smoking cessation counseling in family practice centers, suez canal university, egypt. (United States)

    Eldein, Hebatallah Nour; Mansour, Nadia M; Mohamed, Samar F


    Family physicians are the first point of medical contact for most patients, and they come into contact with a large number of smokers. Also, they are well suited to offer effective counseling to people, because family physicians already have some knowledge of patients and their social environments. The present study was conducted to assess family physicians' knowledge, attitude and practice of smoking cessation counseling aiming to improve quality of smoking cessation counseling among family physicians. The study was descriptive analytic cross sectional study. It was conducted within family medicine centers. Sample was comprehensive. it included 75 family physicians. They were asked to fill previously validated anonymous questionnaire to collect data about their personal characteristics, knowledge, attitude and practice of smoking cessation counseling, barriers and recommendations of physicians. Equal or above the mean scores were used as cut off point of the best scores for knowledge, attitude and practice. SPSS version 18 was used for data entry and statistical analysis. The best knowledge, attitude and practice scores among family physicians in the study sample were (45.3 %, 93.3% and 44% respectively). Age (P = 0.039) and qualification of family physicians (P = 0.04) were significant variables regarding knowledge scores while no statistically significance between personal characteristics of family physicians and their attitude or practice scores regarding smoking cessation counseling. More than half of the family physicians recommended training to improve their smoking cessation counseling. Favorable attitude scores of family physicians exceed passing knowledge scores or practice scores. Need for knowledge and training are stimulus to design an educational intervention to improve quality of smoking cessation counseling.

  16. Evaluation of non-adherence in patients undergoing dialysis and kidney transplantation: United States transplantation practice patterns survey. (United States)

    Brar, A; Babakhani, A; Salifu, M O; Jindal, R M


    We performed a survey of United States transplantation centers to evaluate practice patterns in the assessment of nonadherence before and after kidney transplantation. An electronically administered, anonymous survey was sent to 181 United Network for Organ Sharing (UNOS) approved transplantation centers in 2012. Seventy-nine centers completed our survey. Of them, 51.3% had a protocol to evaluate medication/dialysis adherence before the listing; most common (36.4%) was the Simplified Medication Adherence Questionnaire. As an alternative to a questionnaire, the most common measure of nonadherence was the number of missed hemodialysis sessions (77.0%). The most common reason for poor adherence to dialysis regimens was difficulty with transportation (81.3%). Also, 94.4% noted the lack of a questionnaire to evaluate adherence to medications but relied on drug levels (73.4%) and self report. Only 12.9% used a questionnaire for the measurement of quality of life (Karnofsky performance scale). Of the participating centers, 27.1% used a formal cognitive testing for potential living donors. A social worker was used by most centers for nonadherent patients. Respondents indicated that patients (in the pretransplantation state) were more compliant with dialysis than with medication regimens. Finally, 37.7% of respondents noted graft failure due to medication nonadherence in 15% to 29% of their patients. There was a significant variability in the methods of screening for nonadherence while the patient was on dialysis, during pretransplantation work up, and during post-transplantation follow-up examinations. We recommend that there should be a standardized technique to evaluate nonadherence to facilitate focused clinical trials to improve adherence. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Survey of the Statewide Impact of Payer Source on Referral of Small Burns to Burn Centers. (United States)

    Penny, Rachel; Coffey, Rebecca; Jones, Larry; Bailey, J Kevin

    It is generally agreed that patients with large burns will be referred to organized burn centers, however, the referral of patients with smaller burns is less certain. A two-part survey was conducted to identify referral patterns for burn patients that meet American Burn Association referral criteria, and any effect insurance type might have on the referral patterns. The emergency departments of our state hospital association's member hospitals were contacted seeking a referral for a fictitious patient with a third-degree scald of the dominant hand. The referral sites were contacted twice, first stating that the patient had commercial insurance, next stating that the patient had Medicaid. Data collected included wait time for an appointment or reasons for denial of an appointment. Of 218 hospitals, 46 were excluded because they did not offer emergency care, and eight because they were listed as burn centers on the American Burn Association website. Of the remaining 164, 119 (73%) would refer to a burn center, 21 (13%) to a plastic surgeon, 10 (6%) to a hand surgeon, 7 (4%) to a wound center, 7 (4%) to another nonburn physician resource. There was no difference in wait time to the first available appointment with regards to insurance type (6.56 ± 4.68 vs 6.53 ± 5.05 days). Our state's referral pattern gives us insight into the regional referral pattern. This information will be used to guide a focused education and communication program to provide better service for the burn victims of our state.

  18. A survey of asthma management practices and implementation of ...

    African Journals Online (AJOL)

    Background: Bronchial asthma is a global health problem that causes significant morbidity and mortality in all age groups. Global Initiative for Asthma (GINA) seeks to standardize the care asthma patients receive. We assessed the knowledge, attitude, and practices of doctors in Umuahia, Southeast Nigeria, regarding ...

  19. Voice Therapy Practices and Techniques: A Survey of Voice Clinicians. (United States)

    Mueller, Peter B.; Larson, George W.


    Eighty-three voice disorder therapists' ratings of statements regarding voice therapy practices indicated that vocal nodules are the most frequent disorder treated; vocal abuse and hard glottal attack elimination, counseling, and relaxation were preferred treatment approaches; and voice therapy is more effective with adults than with children.…

  20. Practices that support coexistence: A survey of Alfalfa growers (United States)

    The alfalfa industry has worked hard to foster the coexistence of genetically-engineered (GE) and conventional alfalfa production by developing a set of best management practices that aim to limit adventitious-presence (AP) of GE traits in conventional seed. The general goal is to minimize transgene...

  1. A Survey of International Practice in University Admissions Testing (United States)

    Edwards, Daniel; Coates, Hamish; Friedman, Tim


    This paper explores how admissions tests are used in different higher education systems around the world. This is a relatively new area of research, despite the fact that admissions processes are a key component of university practices and given the ever increasing globalisation of higher education. This paper shows that aptitude and achievement…

  2. Undergraduate Psychological Writing: A Best Practices Guide and National Survey (United States)

    Ishak, Shaziela; Salter, Nicholas P.


    There is no comprehensive guide for teaching psychological writing, and little is known about how often instructors teach the topic. We present a best practices guide for teaching psychological writing beyond just American Psychological Association style, discuss psychology-specific writing assignments, and examine psychological writing…

  3. LSS-GAC - A LAMOST Spectroscopic Survey of the Galactic Anti-center (United States)

    Liu, X.-W.; Yuan, H.-B.; Huo, Z.-Y.; Deng, L.-C.; Hou, J.-L.; Zhao, Y.-H.; Zhao, G.; Shi, J.-R.; Luo, A.-L.; Xiang, M.-S.; Zhang, H.-H.; Huang, Y.; Zhang, H.-W.


    As a major component of the LAMOST Galactic surveys, the LAMOST Spectroscopic Survey of the Galactic Anti-center (LSS-GAC) will survey a significant volume of the Galactic thin/thick disks and halo in a contiguous sky area of ~3,400 sq.deg., centered on the Galactic anti-center (|b| ~ 3 M stars of all colors, uniformly and randomly selected from (r, g - r) and (r, r - i) Hess diagrams obtained from a CCD imaging photometric survey of ~5,400 sq.deg. with the Xuyi 1.04/1.20 m Schmidt Telescope, ranging from r = 14.0 to a limiting magnitude of r = 17.8 (18.5 for limited fields). The survey will deliver spectral classification, radial velocity (V r) and stellar parameters (effective temperature (T eff), surface gravity (log g) and metallicity [Fe/H]) for millions of Galactic stars. Together with Gaia which will provide accurate distances and tangential velocities for a billion stars, the LSS-GAC will yield a unique data set to study the stellar populations, chemical composition, kinematics and structure of the disks and their interface with the halo, identify streams of debris of tidally disrupted dwarf galaxies and clusters, probe the gravitational potential and dark matter distribution, map the 3D distribution of interstellar dust extinction, search for rare objects (e.g. extremely metal-poor or hyper-velocity stars), and ultimately advance our understanding of the assemblage of the Milky Way and other galaxies and the origin of regularity and diversity of their properties. The survey was initiated in the fall of 2012 and expected to complete in the spring of 2017. Hitherto, about 0.4 M spectra of S/N(λ7450) >= 10 per pixel have been accumulated. In addition, bright nights have been used to target stars brighter than 14 mag and have so far generated over 0.4 M spectra, yielding an excellent sample of local stars to probe the solar neighborhood. LSP3, a set of pipelines tailored to the need of LSS-GAC, for spectral flux-calibration, and radial velocity and stellar

  4. Big game hunting practices, meanings, motivations and constraints: a survey of Oregon big game hunters (United States)

    Suresh K. Shrestha; Robert C. Burns


    We conducted a self-administered mail survey in September 2009 with randomly selected Oregon hunters who had purchased big game hunting licenses/tags for the 2008 hunting season. Survey questions explored hunting practices, the meanings of and motivations for big game hunting, the constraints to big game hunting participation, and the effects of age, years of hunting...

  5. A Survey of Functional Behavior Assessment Methods Used by Behavior Analysts in Practice (United States)

    Oliver, Anthony C.; Pratt, Leigh A.; Normand, Matthew P.


    To gather information about the functional behavior assessment (FBA) methods behavior analysts use in practice, we sent a web-based survey to 12,431 behavior analysts certified by the Behavior Analyst Certification Board. Ultimately, 724 surveys were returned, with the results suggesting that most respondents regularly use FBA methods, especially…

  6. Healthcare waste generation and management practice in government health centers of Addis Ababa, Ethiopia. (United States)

    Tadesse, Menelik Legesse; Kumie, Abera


    Healthcare wastes are hazardous organic and inorganic wastes. The waste disposal management in Addis Ababa city is seen unscientific manner. The waste management practice in the health facilities are poor and need improvement. This study will help different organizations, stakeholders and policy makers to correct and improve the existing situation of healthcare waste legislation and enforcement and training of staff in the healthcare facilities in Addis Ababa. The study aimed to assess the existing generation and management practice of healthcare waste in selected government health centers of Addis Ababa. The cross-sectional study was conducted to quantify waste generation rate and evaluate its management system. The study area was Addis Ababa. The sample size was determined by simple random sampling technique, the sampling procedure involved 10 sub-cities of Addis Ababa. Data were collected using both waste collecting and measuring equipment and check list. The Data was entered by EPI INFO version 6.04d and analyzed by and SPSS for WINDOW version15. The mean (±SD) healthcare waste generation rate was 9.61 ± 3.28 kg/day of which (38%) 3.64 ± 1.45 kg/day was general or non-hazardous waste and (62%) 5.97 ± 2.31 kg/day was hazardous. The mean healthcare waste generation rate between health centers was a significant different with Kurskal-Wallis test (χ2 = 21.83, p-value = 0.009). All health centers used safety boxes for collection of sharp wastes and all health centers used plastic buckets without lid for collection and transportation of healthcare waste. Pre treatment of infectious wastes was not practiced by any of the health centers. All health centers used incinerators and had placenta pit for disposal of pathological waste however only seven out of ten pits had proper covering material. Segregation of wastes at point of generation with appropriate collection materials and pre- treatment of infectious waste before disposal should be practiced

  7. Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Quigley DD


    Full Text Available Denise D Quigley,1 Peter J Mendel,1 Zachary S Predmore,2 Alex Y Chen,3 Ron D Hays41RAND Corporation, Santa Monica, CA, 2RAND Corporation, Boston, MA, 3AltaMed Health Services Corporation, 4Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USAObjective: To describe how practice leaders used Consumer Assessment of Healthcare Providers and Systems (CAHPS® Clinician and Group (CG-CAHPS data in transitioning toward a patient-centered medical home (PCMH.Study design: Interviews conducted at 14 primary care practices within a large urban Federally Qualified Health Center in California.Participants: Thirty-eight interviews were conducted with lead physicians (n=13, site clinic administrators (n=13, nurse supervisors (n=10, and executive leadership (n=2.Results: Seven themes were identified on how practice leaders used CG-CAHPS data for PCMH transformation. CAHPS® was used: 1 for quality improvement (QI and focusing changes for PCMH transformation; 2 to maintain focus on patient experience; 3 alongside other data; 4 for monitoring site-level trends and changes; 5 to identify, analyze, and monitor areas for improvement; 6 for provider-level performance monitoring and individual coaching within a transparent environment of accountability; and 7 for PCMH transformation, but changes to instrument length, reading level, and the wording of specific items were suggested.Conclusion: Practice leaders used CG-CAHPS data to implement QI, develop a shared vision, and coach providers and staff on performance. They described how CAHPS® helped to improve the patient experience in the PCMH model, including access to routine and urgent care, wait times, provider spending enough time and listening carefully, and courteousness of staff. Regular reporting, reviewing, and discussing of patient-experience data alongside other clinical quality and productivity measures at multilevels of the organization was critical in maximizing the

  8. Survey of advanced practice registered nurses disciplinary action. (United States)

    Hudspeth, Randall


    The nursing profession continues to struggle to find the most appropriate approach to credentialing Advanced Practice Registered Nurses (APRNs). One early step in addressing this struggle is determining the incidence of APRN disciplinary actions by boards of nursing. This article presents data from 2003 and 2004 describing the incidence of APRN disciplinary actions by United States boards of nursing. Fifty-one boards of nursing, all members of the National Council of State Boards of Nursing, were asked to report the numbers of APRN discipline cases for 2003 and 2004 which had been resolved, using a tool that differentiated disciplinary cases into four data categories: chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients. Thirty-eight (74.5%) of 51 boards of nursing reported discipline data for a total of 125,882 APRNs showing 688 disciplinary actions were taken during 2003 and 2004. This indicates that APRNs experience a low incidence of discipline related to chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients.

  9. Survey of cognitive rehabilitation practices in the state of Kuwait. (United States)

    Manee, Fahad S; Nadar, Mohammed Sh; Jassem, Zainab; Chavan, Shashidhar Rao


    Background Rehabilitation professionals must be astute at recognizing, assessing, and treating individuals with cognitive deficits. No research is available to examine cognitive rehabilitation practices applied to individuals with neurological conditions in Kuwait. To identify the use of cognitive assessments, the availability of resources, and the barriers to cognitive rehabilitation practices in Kuwait. Methods Face-to-face interviews were conducted with health care professionals working with adult individuals with neurological conditions. These professionals included occupational therapists, speech-language pathologists, psychiatrists, and neurologists. Results The most commonly used cognitive based assessments are MMSE (41%), and MoCA and LOTCA (15.2%). The only clinical assessment used is the Line-Bisection Test (2.2%). The most used occupation-based assessments are FIM (6.5%), COPM (4.3%), the Interest Checklist (2.2%), and the Barthel Index (2.2%). Resources related to cognitive rehabilitation in Kuwait that are unavailable to practitioners include journal clubs (91%), special interest groups (89%), and continuing education programmes (82.6%). Barriers to cognitive rehabilitation practice included lack of sufficient funds for continuing education, lack of time, lack of standardized assessments, and lack of inter-professional teamwork. Conclusion Many adults in Kuwait live with cognitive impairment. There is a need to develop appropriate evidence-based cognitive rehabilitation clinical guidelines in Kuwait.

  10. Management of acute rhinosinusitis in Danish general practice: a survey

    Directory of Open Access Journals (Sweden)

    Hansen JG


    Full Text Available Jens Georg HansenDepartment of Clinical Epidemiology, Aarhus University Hospital and Aalborg Hospital, Aalborg, DenmarkPurpose: To evaluate whether the ongoing debate over diagnostic problems and treatment choices for acute rhinosinusitis has had any influence on the management of the disease.Methods: We randomly selected 300 Danish general practitioners (GPs from the files of the Research Unit for General Practice at Aarhus University. Invitations to participate and a questionnaire were sent to the GPs by mail.Results: A total of 149 (49% GPs answered the questionnaire. When asked about symptoms, the highest priority was given to sinus pain and signs of tenderness. The most frequent examinations were objective examination of the ear-nose-throat (ENT, palpation of the maxillofacial area, and C-reactive protein point-of-care testing (or CRP rapid test. Nearly all GPs prescribed local vasoconstrictors, and in 70% of cases, antibiotics were prescribed. Phenoxymethylpenicillin was the preferred antibiotic. Use of the CRP rapid test, years in practice, or employment in an ENT department did not have a significant impact on the diagnostic certainty and antibiotic prescribing rate.Conclusion: The clinical diagnoses are based on a few symptoms, signs, and the CRP rapid test. Other examinations, including imaging techniques, are seldom used. Phenoxymethylpenicillin is the preferred antibiotic, and the GPs' diagnostic certainty was 70%.Keywords: general practice, acute rhinosinusitis, diagnosis, treatment, antibiotic

  11. Aerial radiological survey of the area surrounding the Feed Materials Production Center, Fernald, Ohio. Dates of surveys, August 1976/May-June 1977

    International Nuclear Information System (INIS)

    Feimster, E.L.


    Two aerial radiological surveys to measure terrestrial gamma radiation were made over an area centered on the United States Department of Energy's Feed Materials Production Center in the city of Fernald, Ohio. The Center is operated by the National Lead Company of Ohio. Gamma ray data were collected from east-west flight lines at 90 m intervals over an area 25 km 2 centered on the plant site. The small Ohio towns of Shandon, Ross, and New Baltimore were surveyed from north-south flight lines at 300 m intervals. Processed data indicated that on-site radioactivity was due primarily to radionuclides currently being handled or processed at the Center. Off-site data showed the radioactivity to be due to naturally occurring radionuclides northeast and south of the site. If the northwest corner of the survey area an unusually high count rate region of airborne radon daughter activity was encountered. This was equivalent to approximately four times the normal background. However, the follow-up survey of 1977 showed this area to be within the background count rate level

  12. Epidemiology of unintentional injuries in childhood: a population-based survey in general practice.

    NARCIS (Netherlands)

    Otters, H.; Schellevis, F.G.; Damen, J.; Wouden, J.C. van der; Suijlekom-Smit, L.W.A.; Koes, B.W.


    This study aimed to assess the incidence of unintentional injuries presented in general practice, and to identify children at risk from experiencing an unintentional injury. We used the data of all 0–17-yearold children from a representative survey in 96 Dutch general practices in 2001. We computed

  13. A National Survey of School Counselor Supervision Practices: Administrative, Clinical, Peer, and Technology Mediated Supervision (United States)

    Perera-Diltz, Dilani M.; Mason, Kimberly L.


    Supervision is vital for personal and professional development of counselors. Practicing school counselors (n = 1557) across the nation were surveyed to explore current supervision practices. Results indicated that 41.1% of school counselors provide supervision. Although 89% receive some type of supervision, only 10.3% of school counselors receive…

  14. An international survey of cleaning and disinfection practices in the healthcare environment. (United States)

    Kenters, Nikki; Gottlieb, Thomas; Hopman, Joost; Mehtar, Shaheen; Schweizer, Marin L; Tartari, Ermira; Huijskens, E G W; Voss, Andreas


    Antimicrobial resistance has become an urgent global health priority. Basic hygiene practices and cleaning and disinfection of the hospital environment are key in preventing pathogen cross-transmission. To our knowledge no studies have assessed the worldwide differences in cleaning and disinfection practices in healthcare facilities. The electronic survey described here was developed in order to evaluate differences in healthcare facility cleaning practices around the world. The International Society of Antimicrobial Chemotherapy (ISAC, formerly ISC), Infection Prevention and Control work group developed a survey with 30 multiple-choice questions. The questions were designed to assess the current cleaning practices in healthcare settings around the world. A total of 110 healthcare professionals, representing 23 countries participated in the online survey. In 96% of the facilities a written cleaning policy was present. Training of cleaning staff occurred in 70% of the facilities at the start of employment. Cleaning practices and monitoring of these practices varied. In summary, the survey enabled assessment and recognition of widely differing global practices in approaches to environmental cleaning and disinfection. Development of guideline recommendations for cleaning and disinfection could improve practices and set minimum standards worldwide. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  15. Practical Child Safety Education in England: A National Survey of the Child Safety Education Coalition (United States)

    Mulvaney, Caroline A.; Watson, Michael C.; Walsh, Patrick


    Objective: To examine the provision of practical safety education by Child Safety Education Coalition (CSEC) organizations in England. Design: A postal survey. Setting: Providers of child practical safety education who were also part of CSEC. Methods: In February 2010 all CSEC organizations were sent a self-completion postal questionnaire which…

  16. National survey by specialty of U.S. physicians' HPV screening practices. (United States)

    McCree, Donna Hubbard; Leichliter, Jami S; Hogben, Matthew; St Lawrence, Janet S


    High-risk types of HPV are the primary cause of cervical cancer. This article reports HPV screening and diagnosis from a survey evaluating community-based physicians' screening, testing, and clinical practices for sexually transmitted diseases. Surveys mailed to physicians (n = 7,300) obtained information on patients they screen for HPV and cases of HPV diagnosed. Seventy percent (70%) of the physicians returned completed surveys. HPV screening was most frequently conducted in female patients by obstetrician/gynecologists and family practice physicians.

  17. Patient satisfaction surveys as a market research tool for general practices. (United States)

    Khayat, K; Salter, B


    Recent policy developments, embracing the notions of consumer choice, quality of care, and increased general practitioner control over practice budgets have resulted in a new competitive environment in primary care. General practitioners must now be more aware of how their patients feel about the services they receive, and patient satisfaction surveys can be an effective tool for general practices. A survey was undertaken to investigate the use of a patient satisfaction survey and whether aspects of patient satisfaction varied according to sociodemographic characteristics such as age, sex, social class, housing tenure and length of time in education. A sample of 2173 adults living in Medway District Health Authority were surveyed by postal questionnaire in September 1991 in order to elicit their views on general practice services. Levels of satisfaction varied with age, with younger people being consistently less satisfied with general practice services than older people. Women, those in social classes 1-3N, home owners and those who left school aged 17 years or older were more critical of primary care services than men, those in social classes 3M-5, tenants and those who left school before the age of 17 years. Surveys and analyses of this kind, if conducted for a single practice, can form the basis of a marketing strategy aimed at optimizing list size, list composition, and service quality. Satisfaction surveys can be readily incorporated into medical audit and financial management.

  18. Survey of (PM2.5 Concentrations in Sari\\'s City Center in 2010

    Directory of Open Access Journals (Sweden)

    Mahmoud Mohammadyan


    Full Text Available Background and purpose: Because of the high traffic flow in the city center in Sari, a walk through survey indicated that the PM2.5 concentrations are likely to be higher than the standards. This study was carried out to determine the level of PM2.5 at the streets' curbsides in the city center in Sari. Materials and Methods: In this cross-sectional study the PM2.5 concentrations were measured in 185 monitoring stations at the curbsides of four main streets in the Sari city  entre. 5550 10-s samples were collected using a real time particle monitor. A questionnaire was used to record air pollution related information and data were analyzed by descriptive statistic and ANOVA tests. Results: Mean of PM2.5 concentration was 83μgm-3 and it was two times more than the national one and EPA recommended 24- hour standard (35μgm-3. This study showed that mean of PM2.5 concentration at the street during traffic rush hours in the morning and evening were higher than those measured in the afternoon. Conclusion: Because of the high concentration of PM2.5 in the Sari’s city centre that resulted in this study, the 24- hour PM2.5 concentrations are likely to be higher than standards in some days in the city centre in Sari. Therefore, monitoring and control of air pollution are recommended in this city.

  19. State of the field survey: spinal cord stimulator use by academic pain medicine practices. (United States)

    Gharibo, Christopher; Laux, Gary; Forzani, Brian R; Sellars, Christopher; Kim, Eric; Zou, Shengping


    The concept of neuromodulation via the use of spinal cord stimulators (SCS) was first established over forty years ago. Since then, its popularity has grown as numerous studies have demonstrated its utility to reduce chronic pain, improve patient function, and reduce long-term health care costs. The aim of this study was to update the pain medicine community on the evolution of SCS practice trends in academic centers. Ninety-three pain medicine fellowship programs in the United States were identified from the Accreditation Council for Graduate Medical Education Website and were contacted to participate in an internet survey. A 37-item questionnaire was inspired by a previous study performed by Fanciullo et al. Questions focused on three main themes regarding SCS clinical application, namely demographics, education, and technical matters. Completed surveys were received from 50 institutions, all of which reported performing SCS interventions. Annual implants ranged from 0 to 150. Fellowship training was cited as the most valuable modality for learning implantation. Nearly all programs reported manufacturer representative participation during SCS procedures, with a minority of program directors discouraging their involvement in fellow education. SCS trials were performed exclusively on an outpatient basis. The average length for trials was 4-7 days. The most common indication for SCS implantation was failed back surgery syndrome, which also had the highest 2-year success rate. Post procedure, patients generally were followed up every 2-4 weeks for device reprogramming, which was performed by company representatives 92% of the time. Standardized SCS training is imperative as the implementation of neuromodulation therapy continues to increase. Wiley Periodicals, Inc.

  20. Nurseries surveyed in Southern California adopt best practices for water quality


    Mangiafico, Salvatore S; Newman, Julie; Mochizuki, Maren; Zurawski, Dale; Merhaut, Donald J.; Faber, Ben


    A variety of good management practices have been recommended to minimize the impact of water runoff from production nurseries. However, studies have not been conducted to gauge which management practices nursery producers are most likely to adopt in response to education and increased government oversight. We surveyed 85 production nurseries in Southern California about their existing practices to limit the impacts of runoff from their facilities. Of these, 65 in Ventura County were resurveye...

  1. U.S. Experience and practices associated with the use of centralized rad waste processing centers

    International Nuclear Information System (INIS)

    Gibson, James D.


    This paper presents the experience and current practices employed within the United States (US) associated with the use of Centralized Rad waste Processing Centers for the processing of Low Level Radioactive Wastes (LLRW). Information is provided on the methods, technologies, and practices employed by Scientific Ecology Group, Inc. (SEG), which is the worlds largest processor of LLRW. SEG processes over 80,000 cubic meters of waste annually and achieves an overall volume reduction of 12 : 1. LLRW processing in the United States is currently performed primarily at Centralized Rad waste Processing Centers, such as SEG's Central Volume Reduction Facility (CVRF) in Oak Ridge, Tennessee. This is primarily due to the superior economical application of advanced waste processing technologies, equipment, and personnel maintained at these centers. Information is provided on how SEG uses supercompaction, incineration, metals recycling, vitrification, and various other waste processing techniques to process both dry and wet wastes from over 90 commercial nuclear power plants, government operated facilities, hospitals, universities, and various small generators of radioactive waste

  2. National survey of CT colonography practice in Ireland

    LENUS (Irish Health Repository)

    Smyth, A.E.


    CT Colonography was first introduced to Ireland in 1999. Our aim of this study is to review current CT Colonography practices in the Republic of Ireland. A questionnaire on CT Colonography practice was sent to all non-maternity adult radiology departments in the Republic of Ireland with a CT scanner. The results are interpreted in the context of the recommendations on CT Colonography quality standards as published by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus statement in the journal of European Radiology in 2013. Thirty centres provide CT Colonography; 21 of which responded (70%). Each centre performs median 90 studies per year; the majority follow accepted patient preparation and image acquisition protocols. Seventy-six percent of the centres repsonded that the majority of patients imaged are symptomatic. Of the 51 consultant radiologists reading CT Colonography, 37 (73%) have attended a CT Colonography course. In 17 (81%) of the centres the studies are single read although 81% of the centres have access to a second radiologist’s opinion. Fourteen (67%) of the centres reported limited access to CT scanner time as the major limiting factor to expanding their service. CT Colonography is widely

  3. The BirthPlace collaborative practice model: results from the San Diego Birth Center Study. (United States)

    Swartz; Jackson; Lang; Ecker; Ganiats; Dickinson; Nguyen


    Objective: The search for quality, cost-effective health care programs in the United States is now a major focus in the era of health care reform. New programs need to be evaluated as alternatives are developed in the health care system. The BirthPlace program provides comprehensive perinatal services with certified nurse-midwives and obstetricians working together in an integrated collaborative practice serving a primarily low-income population. Low-risk women are delivered by nurse-midwives in a freestanding birth center (The BirthPlace), which is one component of a larger integrated health network. All others are delivered by team obstetricians at the affiliated tertiary hospital. Wellness, preventive measures, early intervention, and family involvement are emphasized. The San Diego Birth Center Study is a 4-year research project funded by the U.S. Federal Agency for Health Care Policy and Research (#R01-HS07161) to evaluate this program. The National Birth Center Study (NEJM, 1989; 321(26): 1801-11) described the advantages and safety of freestanding birth centers. However, a prospective cohort study with a concurrent comparison group of comparable risk had not been conducted on a collaborative practice-freestanding birth center model to address questions of safety, cost, and patient satisfaction.Methods: The specific aims of this study are to compare this collaborative practice model to the traditional model of perinatal health care (physician providers and hospital delivery). A prospective cohort study comparing these two health care models was conducted with a final expected sample size of approximately 2,000 birth center and 1,350 traditional care subjects. Women were recruited from both the birth center and traditional care programs (private physicians offices and hospital based clinics) at the beginning of prenatal care and followed through the end of the perinatal period. Prenatal, intrapartum, postpartum and infant morbidity and mortality are being

  4. Survey of Opioid and Barbiturate Prescriptions in Patients Attending a Tertiary Care Headache Center. (United States)

    Minen, Mia T; Lindberg, Kate; Wells, Rebecca E; Suzuki, Joji; Grudzen, Corita; Balcer, Laura; Loder, Elizabeth


    To educate physicians about appropriate acute migraine treatment guidelines by determining (1) where headache patients were first prescribed opioids and barbiturates, and (2) the characteristics of the patient population who had been prescribed opioids and barbiturates. Several specialty societies issued recommendations that caution against the indiscriminate use of opioids or barbiturate containing medications for the treatment of migraine. These medications are still being prescribed in various medical settings and could put headache specialists in a difficult position when patients request these agents. Patients presenting to a headache center comprised of eight physicians were asked to complete a survey that assessed headache types, comorbid conditions, and whether they had ever been prescribed opioids or barbiturates. If they responded affirmatively to the latter question, they were asked about the prescribing doctor, medication effectiveness, and whether they were currently on the medication. Data collection took place over a one month period. Two hundred forty-four patients were given the survey and 218 of these patients completed it. The predominant diagnosis was migraine (83.9%). More than half of the patients reported having been prescribed an opioid (54.8%) or a barbiturate (56.7%). About one fifth were on opioids (19.4%) or barbiturates (20.7%) at the time of completing the survey. Most patients reported being on opioids for more than 2 years (24.6%) or less than one week (32.1%). The reasons most frequently cited for stopping opioids were that the medications did not help (30.9%) or that they saw a new doctor who would not prescribe them (29.4%). Among patients who had previously been on barbiturates, 32.2% had been on these for over 2 years. Most patients (61.8%) stopped barbiturates because they did not find the medication helpful, while 17.6% said they saw a new doctor who would not prescribe them. The physician specialty most frequently cited as

  5. Survey of brachytherapy practice in the United States: a report of the Clinical Research Committee of the American Endocurietherapy Society. (United States)

    Nag, S; Owen, J B; Farnan, N; Pajak, T F; Martinez, A; Porter, A; Blasko, J; Harrison, L B


    To obtain reliable data on the extent of the brachytherapy practice in the United States by conducting a comprehensive survey of all facilities. The Clinical Research Committee of the AES surveyed all 1321 radiation oncology facilities identified in the Patterns of Care Study (PCS) of the American College of Radiology (ACR). Multiple mailings and follow-up were made to obtain a high response rate. Survey responders and nonresponders were compared using chi-square tests. Summary statistics were reported. Of the 1321 facilities, 1054 responded (80%). Hospital-based and larger facilities had a statistically significant higher rate of response. Brachytherapy was being performed at 819 facilities (the median number of procedures = 21-50). Two hundred and two facilities did no brachytherapy. The common isotopes used were 137Cs (705 facilities), 192Ir (585 facilities), 125I (236 facilities), and 131I (194 facilities). The common brachytherapy techniques used were intracavitary (751 facilities), interstitial (536 facilities), intraluminal (310 facilities), and plaques (148 facilities). Remote afterloaded brachytherapy was used at 205 centers as follows: high dose rate (HDR) (164), medium dose rate (MDR) (5), and low dose rate (LDR) (36). Computerized dosimetry was most commonly used (790 facilities), followed by Patterson-Parker (104 facilities) and Quimby (72 facilities). The common sites treated were cervix (701 facilities), endometrium (565 facilities), head and neck (354 facilities), and lung (344 facilities). Data regarding brachytherapy practice has been obtained from a large percentage (80%) of all facilities in the United States. The majority (78-81%) of radiation oncology facilities perform brachytherapy; however, its use is restricted to gynecological implants in many of these centers. The results from this survey will be used to develop a pattern of care study and data registry in brachytherapy.

  6. Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model. (United States)

    Small, Deborah C; Small, Robert M


    Like every healthcare system today, the Cleveland Clinic health system is a combination of medical hospitals, institutes, and services in which the implementation of uniform care methodologies faces significant barriers. The guiding principle of the Cleveland Clinic, 'Patients First,' focuses on the principle of patient- and family-centered care (PFCC) but deliberately lacks details due to the wide scope of care delivered by the organization. The Stanley Shalom Zielony Institute of Nursing Excellence (the Nursing Institute) at the Cleveland Clinic was charged with standardizing nursing practice across a system with 11,000 registered nurses and 800 advanced practice nurses. The challenge involved providing firm direction on delivering PFCC that was appropriate for all clinical disciplines and could be implemented quickly across existing practices and technologies. Successful implementation required full engagement in the concept of PFCC by what the Institute for Healthcare Improvement has termed the 'hearts and minds' of nurses. To achieve these ends, development of a systemwide nursing practice model was initiated. In this article the authors identify the essence of PFCC, consider barriers to PFCC, review their process of developing PFCC, and describe how the Cleveland Clinic health system has implemented a PFCC nursing practice model. In doing so the authors explore how the concept of 'Passion for Nursing' was used to stimulate nurse engagement in PFCC.

  7. Building the Nonuniversity, Tertiary Care Center Hepatobiliary and Pancreatic Surgery Practice: Structural and Financial Considerations. (United States)

    Baker, Erin H; Siddiqui, Imran; Vrochides, Dionisios; Iannitti, David A; Martinie, John B; Rorabaugh, Lauren; Jeyarajah, D Rohan; Swan, Ryan Z


    Early in their careers, many new surgeons lack the background and experience to understand essential components needed to build a surgical practice. Surgical resident education is often devoid of specific instruction on the business of medicine and practice management. In particular, hepatobiliary and pancreatic (HPB) surgeons require many key components to build a successful practice secondary to significant interdisciplinary coordination and a scope of complex surgery, which spans challenging benign and malignant disease processes. In the following, we describe the required clinical and financial components for developing a successful HPB surgery practice in the nonuniversity tertiary care center. We discuss significant financial considerations for understanding community need and hospital investment, contract establishment, billing, and coding. We summarize the structural elements and key personnel necessary for establishing an effectual HPB surgical team. This article provides useful, essential information for a new HPB surgeon looking to establish a surgical practice. It also provides insight for health-care administrators as to the value an HPB surgeon can bring to a hospital or health-care system.

  8. Grading of direct laryngoscopy. A survey of current practice. (United States)

    Cohen, A M; Fleming, B G; Wace, J R


    One hundred and twenty anaesthetists (30 of each grade), from three separate regions, were interviewed as to how they recorded the appearance of laryngeal structures at direct laryngoscopy and about their knowledge of the commonly used numerical grading system. About two-thirds of anaesthetists surveyed (69.2%) used the numerical grading system, but of these, over half could not identify a 'grade 2' laryngoscopic appearance correctly. Of anaesthetists who did not use the numerical method, over half could not correctly state the difference between a 'grade 2' and a 'grade 3' laryngoscopic appearance. Over 40% of anaesthetists stated incorrectly that the grading should be made on the initial view, even when laryngeal pressure had been needed. Junior anaesthetists were more likely to use the numerical method of recording. The results show that there is unacceptable uncertainty and inaccuracy in the use of the numerical grading system by users as well as non-users, which makes the current routine clinical use of the numerical grading system unsatisfactory.

  9. Survey of brachytherapy practice in France in 1995. Definitive results

    International Nuclear Information System (INIS)

    Peiffert, D.; Simon, J.M.; Baillet, F.


    A survey questionnaire was sent to the 189 French departments of radiation Oncology and 166 responded (88%). Ninety-nine departments declared treating patients by brachytherapy and 358 shielded rooms were available. In Low Dose Rate (LDR) 81 departments used Cesium sources (159 after-loaders, 1,060 sources); Iridium wires were used by 84 departments (673 meters used). Only six departments used other elements. Twenty-six departments were equipped with high dose rate after loaders (HDR) all of them also using LDR techniques for most of the patients. A total of 9,160 patients were treated: 7,868 with LDR and 1,292 with HDR. The common sites treated by LDR were utero-vagina (4,300), breast (1,415), head and neck (1,409), skin (610), anorectal (220) and urologic (70). HDR was used for vaginal cuff (628), bronchi (371), oesophagus (232). PDR just started (33 patients) for a feasibility trial. The rate of patients treated by brachytherapy is around 6-8% of the irradiated patients, but the indications vary is each department. The diffusion of the techniques, and new indications should increase the number of patients being treated by brachytherapy. (authors)

  10. Results of the Community Health Applied Research Network (CHARN) National Research Capacity Survey of Community Health Centers. (United States)

    Song, Hui; Li, Vivian; Gillespie, Suzanne; Laws, Reesa; Massimino, Stefan; Nelson, Christine; Singal, Robbie; Wagaw, Fikirte; Jester, Michelle; Weir, Rosy Chang


    The mission of the Community Health Applied Research Network (CHARN) is to build capacity to carry out Patient-Centered Outcomes Research at community health centers (CHCs), with the ultimate goal to improve health care for vulnerable populations. The CHARN Needs Assessment Staff Survey investigates CHCs' involvement in research, as well as their need for research training and resources. Results will be used to guide future training. The survey was developed and implemented in partnership with CHARN CHCs. Data were collected across CHARN CHCs. Data analysis and reports were conducted by the CHARN data coordinating center (DCC). Survey results highlighted gaps in staff research training, and these gaps varied by staff role. There is considerable variation in research involvement, partnerships, and focus both within and across CHCs. Development of training programs to increase research capacity should be tailored to address the specific needs and roles of staff involved in research.

  11. (Re)Centering the discourse and practice of caring labor: The intersection of feminist thought and cooperative childcare


    Matthew, Rebecca Ann


    This research examines a range of differences among for-profit, non-profit, and cooperative childcare centers using cross-sectional survey data obtained from approximately 748 childcare centers and 2,743 staff members throughout Canada (Doherty, Lero, Goelman, LaGrange, & Tougas, 2000). I make use of feminist theories of care to critically analyze the ways in which for-profit, non-profit, and cooperative childcare centers "value" this type of care, as evidenced by several indicators of labor ...

  12. Nine breast angiosarcomas after conservative treatment for breast carcinoma: a survey from French Comprehensive Cancer Centers

    International Nuclear Information System (INIS)

    Marchal, Christian; Weber, Beatrice; Lafontan, Brigitte de; Resbeut, Michel; Mignotte, Herve; Pabot du Chatelard, Pierre; Cutuli, Bruno; Reme-saumon, Monique; Broussier-leroux, Agnes; Chaplain, Gilles; Lesaunier, Francois; Dilhuydy, Jean-Marie; Lagrange, Jean Leon


    Objectives: To conduct a survey of the angiosarcomas developing after breast conservation for carcinoma in the French Cancer Centers, to study the evolution of these cases in detail, and to review literature in an attempt to propose an optimal treatment scheme. Material and Methods: Eleven of the 20 French Cancer Centers agreed to research and retrospectively analyze all angiosarcomas discovered in patients previously treated by conservative treatment. The majority of the patients were node negative, T1N0M0. The mean age of the patients at the time of primary breast cancer treatment was 62.5 years, and 69 years at the diagnosis of the angiosarcoma. Results: During the last two decades, nearly 20,000 patients have been treated conservatively in these 11 centers, and only 9 cases of angiosarcoma were found. The median latency period between the treatment of the breast carcinoma and the diagnosis of the breast angiosarcoma was approximately 74 months, with a range of 57-108 months. Mastectomy was performed as the main treatment of this angiosarcoma. All recurrences after mastectomy for the angiosarcoma appeared within 16 months after the mastectomy. A median time of recurrence was found to be 7.5 months, regardless of the treatment. The angiosarcomas appeared to be very aggressive, and chemotherapy, radiotherapy, and sometimes hyperthermia could only palliate the condition for a short time. After the diagnosis of angiosarcoma, the median survival was 15.5 months, showing a particularly poor prognosis. Only 1 patient of 9 is alive without progressive disease at 32 months after salvage mastectomy for the recurrence of the angiosarcoma. Precise data obtained from 11 centers show that, of 18115 breast carcinomas treated conservatively, only 9 breast angiosarcomas are reported, which represents a prevalence of 5 cases of angiosarcoma per 10,000, which is the same prevalence for primary breast angiosarcomas occurring in healthy breasts. Conclusion: Angiosarcoma developing

  13. Survey of Implementation of Antiemetic Prescription Standards in Indian Oncology Practices and Its Adherence to the American Society of Clinical Oncology Antiemetic Clinical Guideline

    Directory of Open Access Journals (Sweden)

    Vijay Patil


    Full Text Available Purpose: Adherence to international antiemetic prophylaxis guidelines like those of ASCO can result in better control of chemotherapy-induced nausea and vomiting; however, the extent of implementation of such guidelines in India is unknown. Therefore, this survey was planned. Methods: This study was an anonymized cross-sectional survey approved by the ethics committee. Survey items were generated from the clinical questions given in the ASCO guidelines. The survey was disseminated through personal contacts at an oncology conference and via e-mail to various community oncology centers across India. The B1, B2, and B3 domains included questions regarding the optimal antiemetic prophylaxis for high, moderate, and low-minimal emetogenic regimens. Results: Sixty-six (62.9% of 105 responded and 65 centers (98.5% were aware of the published guidelines. The partial, full, and no implementation scores were 92.5%, 4.5%, and 3.0%, respectively. Full implementation was better for the low-minimal emetogenic regimens (34.8% than the highly emetogenic regimens (6.1%. The three most frequent reasons for hampered implementation of ASCO guidelines in routine chemotherapy practice cited by centers were a lack of sensitization (26 centers; 39.4%, lack of national guidelines (12 centers; 18.2%, and lack of administrative support (10 centers; 15.2%. Conclusion: Awareness regarding ASCO antiemetic guidelines is satisfactory in Indian oncology practices; however, there is a need for sensitization of oncologists toward complete implementation of these guidelines in their clinical practice.

  14. A survey of radiology reporting practices in veterinary teaching hospitals

    International Nuclear Information System (INIS)

    Adams, W.M.


    Radiologists from 28 veterinary schools and one private teaching hospital responded to a survey questionnaire focused on diagnostic image reporting. Radiologists at 26 hospitals generated a hard copy report on essentially all imaging studies performed. At 25 hospitals, radiologists dictated and transcriptionists typed all or most reports; radiologists at two institutions typed all or some of their reports. At five hospitals, preliminary and/or final handwritten reports were generated. The range of reports generated per day was <10 to 40 per radiologist on duty. Seven respondents generated reports as films came from the processor and another 12 routinely generated reports the day the studies were completed. Clinician access to a processed report averaged 2 to 4 days after study was completed (reported range: several hours to 7 or more days). Fifteen responding radiologists personally mounted films from storage jackets for a majority of their reporting. Fourteen respondents generated reports from films mounted on motorized or stationary viewers. Nineteen respondents generated reports in a busy viewing area where they were frequently interrupted. Radiologists' impression of clinician and resident satisfaction regarding availability of radiology reports was that they were satisfied or very satisfied at 15 of the 29 hospitals. Five respondents reported that clinicians and residents were not concerned about availability of processed radiology reports. Thirteen radiologists were planning to change their reporting method within the next 2 years. The change most frequently sought (12 respondents) was to decrease turn-around time of reports. Ten radiologists indicated an interest in trying a voice recognition dictation system. The most common reasons given for not planning any changes in radiology reporting in the next 2 years were: limited number of radiologists (8) and 1 ''satisfied as is'' (7). Turn-around of radiology reports at these veterinary institutions averaged 2


    Directory of Open Access Journals (Sweden)

    Nataliya Kushnir


    Full Text Available STEM is one of the most current educational trends, it provides young people training according to information society in the science, technology, engineering and mathematics. The leading ideas are interdisciplinary education by solving real practical problems, project work and cooperation. The state of STEM-education in the world and Ukraine is analyzed. Particular attention is paid robotics that enables to develop programming skills and design, and it is the integrator of all components of STEM. The range of services in robotics, constructors for learning is considered. The experience of STEM-center of Kherson State University is presented

  16. A survey of current clinical practice in permanent and temporary prostate brachytherapy: 2010 update. (United States)

    Buyyounouski, Mark K; Davis, Brian J; Prestidge, Bradley R; Shanahan, Thomas G; Stock, Richard G; Grimm, Peter D; Demanes, D Jeffrey; Zaider, Marco; Horwitz, Eric M


    To help establish patterns of care and standards of care of interstitial permanent low-dose-rate (LDR) and temporary high-dose-rate brachytherapy for prostate cancer and to compare the results with a similar 1998 American Brachytherapy Society (ABS) survey. A comprehensive questionnaire intended to survey specific details of current clinical brachytherapy practice was provided to the participants of the seventh ABS Prostate Brachytherapy School. Responses were tabulated and descriptive statistics are reported. Sixty-five brachytherapy practitioners responded to the survey. Eighty-nine percent (89%) of respondents performed LDR and 49% perform high-dose-rate brachytherapy. The median number of years of experience for LDR brachytherapists increased from 5 to 10 years over the course of the 12 years since the preceding survey. Compared with the first ABS, a smaller proportion of respondents received formal brachytherapy residency training (43% vs. 56%) or formal "hands-on" brachytherapy training (15% vs. 63%). There has been a marked decline in the utilization of the Mick applicator (Mick Radio-Nuclear Instruments, Inc., Mount Vernon, NY, USA) (60% vs. 28%) and an increase in the use of stranded seeds (40% vs. 11%). Compliance with postimplant dosimetry was higher in the 2010 survey. This survey does suggest an evolution in the practice of LDR brachytherapy since 1998 and aids in identifying aspects that require further progress or investigation. ABS guidelines and other practice recommendations appear to impact the practice of brachytherapy. Copyright © 2012 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Curtis Harrison


    Full Text Available 5D BIM – generating cost data via the building information modelling (BIM process- has the potential to be used by quantity surveyors (QSs to streamline their workflows and increase their provision of quality service. Consultant QSs experienced in the use 5D BIM, from the New Zealand office of one large global practice, were interviewed on their perceptions of the benefits of, and barriers to, 5D BIM implementation within their firm. Findings suggest that 5D BIM has numerous benefits over traditional methods, chiefly through the increased efficiency and visualization that BIM provides, along with the rapid identification of design changes. However, realization of these perceived benefits limited to date, due to several barriers hindering 5D BIM implementation: incomplete design and insufficient model object data in the BIM model; a lack of standards to facilitate electronic measurement; legal issues, and a lack of government support. However, participants perceived that 5D BIM implementation will achieve these benefits to a far greater extent in the future. Further research is recommended to identify the BIM skills which QSs will need in the future to reach the full potential of 5D BIM

  18. Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey. (United States)

    Bakhru, Rita N; McWilliams, David J; Wiebe, Douglas J; Spuhler, Vicki J; Schweickert, William D


    Early mobilization (EM) improves outcomes for mechanically ventilated patients. Variation in structure and organizational characteristics may affect implementation of EM practices. We queried intensive care unit (ICU) environment and standardized ICU practices to evaluate organizational characteristics that enable EM practice. We recruited 151 ICUs in France, 150 in Germany, 150 in the United Kingdom, and 500 in the United States by telephone. Survey domains included respondent characteristics, hospital and ICU characteristics, and ICU practices and protocols. We surveyed 1,484 ICU leaders and received a 64% response rate (951 ICUs). Eighty-eight percent of respondents were in nursing leadership roles; the remainder were physiotherapists. Surveyed ICUs were predominantly mixed medical-surgical units (67%), and 27% were medical ICUs. ICU staffing models differed significantly (P equipment were highly variable among respondents. International ICU structure and practice is quite heterogeneous, and several factors (multidisciplinary rounds, setting daily goals for patients, presence of a dedicated physiotherapist, country, and nurse/patient staffing ratio) are significantly associated with the practice of EM. Practice and barriers may be far different based upon staffing structure. To achieve successful implementation, whether through trials or quality improvement, ICU staffing and practice patterns must be taken into account.

  19. Surveys of Current Teaching and Practice for Impressions for Complete Dentures. (United States)

    Hussain, N; Jabbar, H; Hayati, M; Wu, J; Hyde, T P


    The 3 objectives are to assess current preferences for impressions for complete dentures, audit practice and compare practice to current UK teaching. Three surveys where undertaken; a survey of GDPs preferences, an audit of practice and a survey of teaching in UK dental schools. UK Universities advocate border moulded custom trays. In stated preferences, 99% of practitioners used custom trays for private practice; 67% for NHS work. In actual use, the audit found 91% practitioners in private practice used custom trays; in NHS practice 78% did so. The most widely taught materials were silicone (43%), alginate (29%), & zinc oxide eugenol paste (19%). In practitioners stated preferences, 97% of NHS and 53% of private dentists listed alginate as an option; however the audit showed only 74% (NHS) and 52% (private) actually used alginate, with 20% (NHS) and 48% (private) using silicone. Definitive impressions in custom trays are used by GDPs for both private and NHS work; they are universally taught at UK dental schools. Alginate is popular in NHS practice; however, silicone is more widely taught in UK Universities. The use of silicone materials for definitive impressions has increased since 1999. In UK private practice silicone usage is aligned in popularity with alginate. Copyright© 2018 Dennis Barber Ltd.

  20. Teachers' professional development needs and current practices at the Alexander Science Center School (United States)

    Gargus, Gerald Vincent

    This investigation represents an in-depth understanding of teacher professional development at the Alexander Science Center School, a dependent charter museum school established through a partnership between the California Science Center and Los Angeles Unified School District. Three methods of data collection were used. A survey was distributed and collected from the school's teachers, resulting in a prioritized list of teacher professional development needs, as well as a summary of teachers' opinions about the school's existing professional development program. In addition, six key stakeholders in the school's professional development program were interviewed for the study. Finally, documents related to the school's professional development program were analyzed. Data collected from the interviews and documents were used to develop an understand various components of the Alexander Science Center School's professional development program. Teachers identified seven areas that had a high-priority for future professional development including developing skills far working with below-grade-level students, improving the analytical skills of student in mathematics, working with English Language Learners, improving students' overall reading ability levels, developing teachers' content-area knowledge for science, integrating science across the curriculum, and incorporating hands-on activity-based learning strategies to teach science. Professional development needs identified by Alexander Science Center School teachers were categorized based on their focus on content knowledge, pedagogical content knowledge, or curricular knowledge. Analysis of data collected through interviews and documents revealed that the Alexander Science Center School's professional development program consisted of six venues for providing professional development for teachers including weekly "banked time" sessions taking place within the standard school day, grade-level meetings, teacher support

  1. Salvage radiotherapy for macroscopic local recurrences after radical prostatectomy. A national survey on patterns of practice

    Energy Technology Data Exchange (ETDEWEB)

    Dal Pra, Alan [Bern University Hospital, Inselspital Bern, Department of Radiation Oncology, Bern (Switzerland); Panje, Cedric; Glatzer, Markus; Putora, Paul Martin [Kantonsspital St. Gallen, Department of Radiation Oncology, St. Gallen (Switzerland); Zilli, Thomas [Hospitaux Universitaires de Geneve, Department of Radiation Oncology, Geneve (Switzerland); Arnold, Winfried [Luzerner Kantonsspital, Department of Radiation Oncology, Luzerner (Switzerland); Brouwer, Kathrin [Stadtspital Triemli, Department of Radiation Oncology, Zuerich (Switzerland); Garcia, Helena [Universitaetsspital Zuerich, Department of Radiation Oncology, Zuerich (Switzerland); Gomez, Silvia [Kantonsspital Aarau, Department of Radiation Oncology, Aarau (Switzerland); Herrera, Fernanda [Centre Hospitalier Universitaire Vaudois, Department of Radiation Oncology, Lausanne (Switzerland); Kaouthar, Khanfir [Hopital du Valais, Department of Radiation Oncology, Sion (Switzerland); Papachristofilou, Alexandros [Universitaetsspital Basel, Department of Radiation Oncology, Basel (Switzerland); Pesce, Gianfranco [EOC Bellinzona, Department of Radiation Oncology, Bellinzona (Switzerland); Reuter, Christiane [Kantonsspital Muensterlingen, Department of Radiation Oncology, Muensterlingen (Switzerland); Vees, Hansjoerg [Klinik Hirslanden, Department of Radiation Oncology, Zuerich (Switzerland); Zwahlen, Daniel Rudolf [Kantonsspital Graubuenden, Department of Radiation Oncology, Chur (Switzerland); Engeler, Daniel [Kantonsspital St. Gallen, Department of Urology, St. Gallen (Switzerland)


    Although salvage radiotherapy (SRT) for PSA recurrence after radical prostatectomy provides better oncological outcomes when delivered early, in the absence of detectable disease many patients are treated for macroscopic locally recurrent tumors. Due to limited data from prospective studies, we hypothesized an important variability in the SRT management of these patients. Our aim was to investigate current practice patterns of SRT for local macroscopic recurrence after radical prostatectomy. A total of 14 Swiss radiation oncology centers were asked to complete a survey on treatment specifications for macroscopic locally recurrent disease including information on pretherapeutic diagnostic procedures, dose prescription, radiation delivery techniques and androgen deprivation therapy (ADT). Treatment recommendations on ADT were analyzed using the objective consensus methodology. The majority of centers recommended pretreatment magnetic resonance imaging (MRI) of the pelvis and choline positron emission tomography (PET). The median prescribed dose to the prostate bed was 66 Gy (range 65-72 Gy) with a boost to the macroscopic lesion used by 79% of the centers with a median total dose of 72 Gy (range 70-80 Gy). Intensity-modulated rotational techniques were used by all centers and daily cone beam computed tomography (CT) was recommended by 43%. The use of concomitant ADT for any macroscopic recurrence was recommended by 43% of the centers while the remaining centers recommended it only for high-risk disease, which was not consistently defined. We observed a high variability of treatment paradigms when SRT is indicated for macroscopic local recurrences after prostatectomy. These data reflect the need for more standardized approaches and ultimately further research in this field. (orig.) [German] Obwohl die Evidenz fuer eine fruehzeitige Salvage-Radiotherapie (SRT) bei einem PSA-Rezidiv nach radikaler Prostatektomie spricht, werden viele Patienten erst bei einem

  2. What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan. (United States)

    Ie, Kenya; Murata, Akiko; Tahara, Masao; Komiyama, Manabu; Ichikawa, Shuhei; Takemura, Yousuke C; Onishi, Hirotaka


    Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration. Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

  3. Determining the nature of faint X-ray sources from the ASCA Galactic center survey (United States)

    Lutovinov, A. A.; Revnivtsev, M. G.; Karasev, D. I.; Shimansky, V. V.; Burenin, R. A.; Bikmaev, I. F.; Vorob'ev, V. S.; Tsygankov, S. S.; Pavlinsky, M. N.


    We present the results of the the identification of six objects from the ASCA Galactic center and Galactic plane surveys: AX J173548-3207, AX J173628-3141, AX J1739.5-2910, AX J1740.4-2856, AX J1740.5-2937, and AX J1743.9-2846. Chandra, XMM-Newton, and XRT/Swift X-ray data have been used to improve the positions of the optical counterparts to these sources. Thereafter, we have carried out a series of spectroscopic observations of the established optical counterparts at the RTT-150 telescope. Analysis of X-ray and optical spectra as well as photometric measurements in a wide wavelength range based on optical and infrared catalogs has allowed the nature of the program sources to be determined. Two X-ray objects have been detected in the error circle of AX J173628-3141: one is a coronally active G star and the other may be a symbiotic star, a red giant with an accreting white dwarf. Three sources (AX J1739.5-2910, AX J1740.5-2937, AX J1743.9-2846) have turned out to be active G-K stars, presumably RS CVn objects, one (AX J1740.4-2856) is an M dwarf, and another one (AX J173548-3207) most likely a low-mass X-ray binary in its low state. The distances and corresponding luminosities of the sources in the soft X-ray band (0.5-10 keV) have been estimated; analysis of deep INTEGRAL Galactic center observations has not revealed a statistically significant flux at energies >20 keV from any of them.

  4. A Survey of Optometry Graduates to Determine Practice Patterns: Part II: Licensure and Practice Establishment Experiences. (United States)

    Bleimann, Robert L.; Smith, Lee W.


    A summary of Part II of a two-volume study of optometry graduates conducted by the Association of Schools and Colleges of Optometry is presented. Part II includes the analysis of the graduates' licensure and practice establishment experiences. (MLW)

  5. The future of optometric practice? The results of a survey of optometrists and optometry students. (United States)

    Silverman, Morton W; Woodruff, Chris; Hardigan, Patrick C


    There is an apparent increase in the number of private optometry practices that are closing due to a lack of interested buyers. We examined some of the factors that influence the market for optometry practices in a survey of practicing optometrists and third- and fourth-year optometry students. Optometrists in six states, and students at four schools and colleges of optometry, completed a mailed or faxed survey regarding attitudes toward optometric practice, including fair/reasonable compensation for a new optometrist, the value of optometric practices, and preferred mode of practice on graduation. Doctors and students differed significantly in the amount of money they reported as fair/reasonable compensation for a recently graduated optometrist joining a practice. Comparing students to doctors in specific categories of compensation, students chose a higher fair/reasonable compensation compared to doctors. Students were more likely than doctors to choose >$70,000 as fair/reasonable compensation, while doctors were more likely than students to choose $40,000 to $69,000. Doctors tended to overvalue their practices for the purpose of selling the practice when using percentage of gross income as a valuation method. Students' choices for mode of practice changed dramatically from their ideal when taking their current financial situation into consideration. Students were more likely to choose corporate practice as their preferred practice mode when considering their current financial situation than when not restricted. There are many factors that affect the value and marketability of an optometric practice. In order to sell a practice, the owner must consider the effects of the needs and desires of recently graduated optometrists.

  6. The patient-centered medical home: an ethical analysis of principles and practice. (United States)

    Braddock, Clarence H; Snyder, Lois; Neubauer, Richard L; Fischer, Gary S


    The patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient-physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles.

  7. Collections management plan for the U.S. Geological Survey Woods Hole Coastal and Marine Science Center Data Library (United States)

    List, Kelleen M.; Buczkowski, Brian J.; McCarthy, Linda P.; Orton, Alice M.


    The U.S. Geological Survey Woods Hole Coastal and Marine Science Center has created a Data Library to organize, preserve, and make available the field, laboratory, and modeling data collected and processed by Woods Hole Coastal and Marine Science Center staff. This Data Library supports current research efforts by providing unique, historic datasets with accompanying metadata. The Woods Hole Coastal and Marine Science Center’s Data Library has custody of historic data and records that are still useful for research, and assists with preservation and distribution of marine science records and data in the course of scientific investigation and experimentation by researchers and staff at the science center.

  8. Vaccine financing and billing in practices serving adult patients: A follow-up survey. (United States)

    Lindley, Megan C; Hurley, Laura P; Beaty, Brenda L; Allison, Mandy A; Crane, Lori A; Brtnikova, Michaela; Snow, Megan; Bridges, Carolyn B; Kempe, Allison


    Financial concerns are often cited by physicians as a barrier to administering routinely recommended vaccines to adults. The purpose of this study was to assess perceived payments and profit from administering recommended adult vaccines and vaccine purchasing practices among general internal medicine (GIM) and family medicine (FM) practices in the United States. We conducted an interviewer-administered survey from January-June 2014 of practices stratified by specialty (FM or GIM), affiliation (standalone or ≥ 2 practice sites), and level of financial decision-making (independent or larger system level) in FM and GIM practices that responded to a previous survey on adult vaccine financing and provided contact information for follow-up. Practice personnel identified as knowledgeable about vaccine financing and billing responded to questions about payments relative to vaccine purchase price and payment for vaccine administration, perceived profit on vaccination, claim denial, and utilization of various purchasing strategies for private vaccine stocks. Survey items on payment and perceived profit were assessed for various public and private payer types. Descriptive statistics were calculated and responses compared by physician specialty, practice affiliation, and level of financial decision-making. Of 242 practices approached, 43% (n = 104) completed the survey. Reported payment levels and perceived profit varied by payer type. Only for preferred provider organizations did a plurality of respondents report profiting on adult vaccination services. Over half of respondents reported losing money vaccinating adult Medicaid beneficiaries. One-quarter to one-third of respondents reported not knowing about Medicare Part D payment levels for vaccine purchase and vaccine administration, respectively. Few respondents reported negotiating with manufacturers or insurance plans on vaccine purchase prices or payments for vaccination. Practices vaccinating adults may

  9. Pediatric endocrine society survey of diabetes practices in the United States: What is the current state? (United States)

    Guttmann-Bauman, I; Thornton, P; Adhikari, S; Reifschneider, K; Wood, M A; Hamby, T; Rubin, K


    The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. A practical field survey on equipments for physical protection

    International Nuclear Information System (INIS)

    Sekine, T.; Kubortera, H.; Kurihara, H.; Yagi, T.; Shibata, T.; Murajiri, M.


    Full text: Presented in this paper are the results of data-gathering and evaluation tests on equipments for physical protection system, which, considering the trends in relating technologies and changing threat environments, are most likely to be used in future Japanese nuclear facilities. The following tests are carried out as part of this program. (1) Out-door Sensor Test - Bistatic-Microwave Sensor, Buried-line E-field Sensor, E-field Sensor, and Tension-wire Sensor were selected and tested in Detection-Performance Tests and Environmental (False Alarm) tests. Detection-Probability was provided as the results of Detection-Performance Tests (live-intrusion test), in which Detection-Probability was represented as a function of behavior mode of intruders (covert/overt) and the number of intruders. The Detection-Probability in these tests were fairly high, because of laboratory-test-like nature of these test. The correlation between the Detection-Probability and the number of intruders was not significant. In Environmental Test, survey was done to clarify the correlation between False-Alarm rate of the sensors mentioned above and the atmospheric phenomena such as rainfall or direction/velocity of wind. (This work is sponsored by the Science and Technology Agency, Nuclear Safety Bureau (NSB), Office of Physical Protection of Nuclear Material.) (2) ln-door Sensor Test - 2 thermic-ray Sensors (Passive-IR Sensors) were set up in test-chamber for Detection- Probability Test and Environmental (False-Alarm) Test. Detection-Probability higher than 97% (with reliability level of 80%) was recorded in the former test. In the latter test, the detection-sensitivity of the sensor was set to provide 2 levels, 'Standard' and 'High'. In 'Standard' sensitivity test, 8 false alarms were observed during the test, but the analysis of the situation revealed that all of them were caused by imperfect construction of the test-chamber, and no false-alarm, except for once in 'High' sensitivity

  11. Therapist effects on dropout from a college counseling center practice research network. (United States)

    Xiao, Henry; Castonguay, Louis G; Janis, Rebecca A; Youn, Soo Jeong; Hayes, Jeffrey A; Locke, Benjamin D


    Dropout has been a pervasive and costly problem in psychotherapy, particularly for college counseling centers. The present study examined potential predictors of dropout using a large data set (N = 10,147 clients, 481 therapists) that was gathered through a college counseling center practice research network as a replication and extension of recent findings regarding therapist effects on dropout. The final model resulted in a dropout rate of 15.9% and a therapist effect of 9.51% on dropout variance. Therapist demographic variables were investigated, though none were found to be significant. Variables found to be predictive of increased likelihood of dropping out included higher levels of general presenting concerns, alcohol-related distress, and current financial stress. Ultimately, this study showed that therapists may play an important role in the likelihood of client dropout, and that additional research should be conducted to identify additional predictors, particularly at the therapist and center level. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. The economic impact and multiplier effect of a family practice clinic on an academic medical center. (United States)

    Schneeweiss, R; Ellsbury, K; Hart, L G; Geyman, J P


    Academic medical centers are facing the need to expand their primary care referral base in an increasingly competitive medical environment. This study describes the medical care provided during a 1-year period to 6304 patients registered with a family practice clinic located in an academic medical center. The relative distribution of primary care, secondary referrals, inpatient admissions, and their associated costs are presented. The multiplier effect of the primary care clinic on the academic medical center was substantial. For every $1 billed for ambulatory primary care, there was $6.40 billed elsewhere in the system. Each full-time equivalent family physician generated a calculated sum of $784,752 in direct, billed charges for the hospital and $241,276 in professional fees for the other specialty consultants. The cost of supporting a primary care clinic is likely to be more than offset by the revenues generated from the use of hospital and referral services by patients who received care in the primary care setting.

  13. Team composition and chronic disease management within primary healthcare practices in eastern Ontario: an application of the Measuring Organizational Attributes of Primary Health Care Survey. (United States)

    Lukewich, Julia; Edge, Dana S; VanDenKerkhof, Elizabeth; Williamson, Tyler; Tranmer, Joan


    Various organizational-level attributes are being implemented in primary healthcare to improve healthcare delivery. There is a need to describe the distribution and nature of these attributes and explore differences across practices.AimThe aim of this study was to better understand organizational attributes of primary care teams, focusing specifically on team composition, nursing roles, and strategies that support chronic disease management. We employed a cross-sectional survey design. Team composition, nursing roles, availability of health services, and chronic disease management activities were described using the 'Measuring Organizational Attributes of Primary Health Care Survey.'FindingsA total of 76% (n=26 out of 34) of practice locations completed the survey, including family health teams (FHT; n=21) and community health centers (CHC; n=4). Nurse practitioners (NPs) and registered nurses (RNs) were the most common non-physician providers, and CHCs had a greater proportion of non-physician providers than FHTs. There was overlap in roles performed by NPs and RNs, and registered practical nurses engaged in fewer roles compared with NPs and RNs. A greater proportion of FHTs had systematic chronic disease management services for hypertension, depression and Alzheimer's disease compared with CHC practices. The 'Measuring Organizational Attributes of Primary Health Care Survey' was a useful tool to highlight variability in organizational attributes across PHC practices. Nurses are prominent within PHC practices, engaging in a wide range of roles related to chronic disease management, suggesting a need to better understand their contributions to patient care to optimize their roles.

  14. Practices Related to Women's Use of Iodized Salt in the Region of two Primary Health Care Centers in Antalya, Turkey

    Directory of Open Access Journals (Sweden)

    Arzu Akcan


    Full Text Available BACKGROUND: This research was conducted for the purpose of determining the status of women's use of iodized salt, their knowledge about the subject, their habits and practice of using iodized salt. METHODS: The surveys were completed between March 01 and May 20, 2005. A total of 1454 women a random sample were reached for this study in the primarily slum area covered by two public health centers in Antalya. Face to face interviewing on knowledge and practices of women about iodized salt were investigated on 1454 women. Data obtained were loaded on the computer and evaluated using the SPSS program using percentage and Chi square test and Binary Logistic Regression Analysis. Basic descriptive analysis of the data was performed using frequency distributions. RESULTS: Knowledge and practices of women about iodized salt were investigated on 1454 women through face to face interviewing. It was determined that 18.2% of the women knew what iodine was, 23.6% stated that they knew what problems occurred with iodine deficiency, and 7.1% had been diagnosed with goiter. Less than half (48.3% of the women made sure that the salt they bought was iodized, but 69.9 % stated that they used iodized salt in their homes. As the educational level of the women increased their knowledge about iodine, their making sure the salt they bought was iodized, use of iodized salt at home, and storing salt in a closed cupboard increased at significant levels (p<0.001. CONCLUSION: In Antalya province municipality one in three women did not use iodized salt and the majority did not know that errors in its use decreased the effectiveness of iodine. [TAF Prev Med Bull 2008; 7(4.000: 291-296

  15. International survey of methods used in health technology assessment (HTA: does practice meet the principles proposed for good research?

    Directory of Open Access Journals (Sweden)

    Stephens JM


    Full Text Available Jennifer M Stephens,1 Bonnie Handke,2 Jalpa A Doshi3 On behalf of the HTA Principles Working Group, part of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR HTA Special Interest Group (SIG1Pharmerit International, Bethesda, MD, USA; 2Medtronic Neuromodulation, Minneapolis, MN, USA; 3Center for Evidence-Based Practice and Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USAObjective: To describe research methods used internationally in health technology assessment (HTA and health-care reimbursement policies; compare the survey findings on research methods and processes to published HTA principles; and discuss important issues/trends reported by HTA bodies related to current research methods and applications of the HTA process.Methods: Representatives from HTA bodies worldwide were recruited to complete an online survey consisting of 47 items within four topics: (1 organizational information and process, (2 primary HTA methodologies and importance of attributes, (3 HTA application and dissemination, and (4 quality of HTA, including key issues. Results were presented as a comparison of current HTA practices and research methods to published HTA principles.Results: The survey was completed by 30 respondents representing 16 countries in five major regions, Australia (n = 3, Canada (n = 2, Europe (n = 17, Latin America (n = 2, and the United States (n = 6. The most common methodologies used were systematic review, meta-analysis, and economic modeling. The most common attributes evaluated were effectiveness (more commonly than efficacy, cost-effectiveness, safety, and quality of life. The attributes assessed, relative importance of the attributes, and conformance with HTA principles varied by region/country. Key issues and trends facing HTA bodies included standardizing methods for economic evaluations and grading of evidence, lack of evidence

  16. Sample survey methods as a quality assurance tool in a general practice immunisation audit. (United States)

    Cullen, R


    In a multidoctor family practice there are often just too many sets of patients records to make it practical to repeat an audit by census of even an age band of the practice on a regular basis. This paper attempts to demonstrate how sample survey methodology can be incorporated into the quality assurance cycle. A simple random sample (with replacement) of 120 from 580 children with permanent records who were aged between 6 weeks and 2 years old from an Auckland general practice was performed, with sample size selected to give a predetermined precision. The survey was then repeated after 4 weeks. Both surveys were able to be completed within the course of a normal working day. An unexpectedly low level of under 2 years olds that were recorded as not overdue for any immunisations was found (22.5%) with only a modest improvement after a standard telephone/letter catch up campaign. Seventy-two percent of the sample held a group one community services card. The advantages of properly conducted sample surveys in producing useful estimates of known precision without disrupting office routines excessively were demonstrated. Through some attention to methodology, the trauma of a practice census can be avoided.

  17. CHAracteristics of research studies that iNfluence practice: a GEneral survey of Canadian orthopaedic Surgeons (CHANGES): a pilot survey. (United States)

    de Sa, Darren; Thornley, Patrick; Evaniew, Nathan; Madden, Kim; Bhandari, Mohit; Ghert, Michelle


    Evidence Based Medicine (EBM) is increasingly being applied to inform clinical decision-making in orthopaedic surgery. Despite the promotion of EBM in Orthopaedic Surgery, the adoption of results from high quality clinical research seems highly unpredictable and does not appear to be driven strictly by randomized trial data. The objective of this study was to pilot a survey to determine if we could identify surgeon opinions on the characteristics of research studies that are perceived as being most likely to influence clinical decision-making among orthopaedic surgeons in Canada. A 28-question electronic survey was distributed to active members of the Canadian Orthopaedic Association (COA) over a period of 11 weeks. The questionnaire sought to analyze the influence of both extrinsic and intrinsic characteristics of research studies and their potential to influence practice patterns. Extrinsic factors included the perceived journal quality and investigator profiles, economic impact, peer/patient/industry influence and individual surgeon residency/fellowship training experiences. Intrinsic factors included study design, sample size, and outcomes reported. Descriptive statistics are provided. Of the 109 members of the COA who opened the survey, 95 (87%) completed the survey in its entirety. The overall response rate was 11% (95/841). Surgeons achieved consensus on the influence of three key designs on their practices: 1) randomized controlled trials 94 (99%), 2) meta-analysis 83 (87%), and 3) systematic reviews 81 (85%). Sixty-seven percent of surgeons agreed that studies with sample sizes of 101-500 or more were more likely to influence clinical practice than smaller studies (n = design influencing adoption included 1) reputation of the investigators (99%) and 2) perceived quality of the journal (75%). Although study design and sample size (i.e. minimum of 100 patients) have some influence on clinical decision making, surgeon respondents are equally influenced

  18. Consumer participation in quality improvements for chronic disease care: development and evaluation of an interactive patient-centered survey to identify preferred service initiatives. (United States)

    Fradgley, Elizabeth A; Paul, Christine L; Bryant, Jamie; Roos, Ian A; Henskens, Frans A; Paul, David J


    participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again. The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care.

  19. Consumer Participation in Quality Improvements for Chronic Disease Care: Development and Evaluation of an Interactive Patient-Centered Survey to Identify Preferred Service Initiatives (United States)

    Paul, Christine L; Bryant, Jamie; Roos, Ian A; Henskens, Frans A; Paul, David J


    ranging from 82.1%-100.0%. The majority of participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again. Conclusions The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care. PMID:25532217

  20. Pregnancy After Bariatric Surgery: National Survey of Obstetrician's Comfort, Knowledge, and Practice Patterns. (United States)

    Smid, Marcela C; Dotters-Katz, Sarah K; Mcelwain, Cora-Ann; Volckmann, Eric T; Schulkin, Jay; Stuebe, Alison M


    The objective of this study is to survey a nationally representative sample of obstetricians regarding comfort, knowledge, and practice patterns of caring for pregnant women after bariatric surgery. We conducted an online survey of US obstetricians and describe obstetrician's demographics, practice settings, and practice patterns. We assessed respondent's knowledge and recommended practices. We compared provider knowledge by years since completing residency, scope of practice (generalist or specialist), and practice setting (academic setting or other). Statistical significance was set at p < 0.05. A total of 106 completed the survey (response rate of 54%). Respondents had a median age of 47 and median 17 years in practice. Sixty-two percent were generalists. Nearly all of the respondents (94%) had some experience with caring for pregnant women after bariatric surgery and 83% reported feeling "very comfortable" (48%) or "somewhat comfortable" (35%) providing care for this population. Most (74%) were aware of increased risk of small for gestational age after surgery. Only 13% were able to correctly identify all recommended nutritional labs and 20% reported that they "did not know" which labs are recommended. There were no differences in comfort, experience, knowledge, and practice patterns by physician characteristics and practice settings. While most obstetricians are aware of perinatal risks after bariatric surgery, a substantial percentage of obstetricians are unaware of recommended practices regarding nutrition and nutritional monitoring. As bariatric surgery becomes increasingly prevalent among reproductive age women, educational interventions to increase obstetricians' knowledge of optimal care of pregnant women after bariatric surgery are urgently needed.

  1. Ultrasound-Guided Peripheral Intravenous Access in the Emergency Department: Patient-Centered Survey

    Directory of Open Access Journals (Sweden)

    Keith Boniface


    Full Text Available Introduction: To assess characteristics, satisfaction, and disposition of emergency department (ED patients who successfully received ultrasound (US-guided peripheral intravenous (IV access. Methods: This is a prospective observational study among ED patients who successfully received US-guided peripheral IV access by ED technicians. Nineteen ED technicians were taught to use US guidance to obtain IV access. Training sessions consisted of didactic instruction and hands-on practice. The US guidance for IV access was limited to patients with difficult access. After successfully receiving an US-guided peripheral IV, patients were approached by research assistants who administered a 10-question survey. Disposition information was collected after the conclusion of the ED visit by accessing patients’ electronic medical record. Results: In total, 146 surveys were completed in patients successfully receiving US-guided IVs. Patients reported an average satisfaction with the procedure of 9.2 of 10. Forty-two percent of patients had a body mass index (BMI of greater than 30, and 17.8% had a BMI of more than 35. Sixty-two percent reported a history of central venous catheter placement. This patient population averaged 3 ED visits per year in the past year. Fifty-three percent of the patients were admitted. Conclusion: Patients requiring US-guided IVs in our ED are discharged home at the conclusion of their ED visit about half of the time. These patients reported high rates of both difficult IV access and central venous catheter placement in the past. Patient satisfaction with US-guided IVs was very high. These data support the continued use of US-guided peripheral IVs in this patient population. [West J Emerg Med. 2011;12(4:475–477.

  2. Spirituality and spiritual care: a descriptive survey of nursing practices in Turkey. (United States)

    Akgün Şahin, Zümrüt; Kardaş Özdemir, Funda


    Nurses' spiritual care practices have been shown to affect patients' well-being, therefore understanding nurses' spiritual care perceptions and their practices. The aim of this paper is to investigate the nurses' views to practising spiritual care. A descriptive survey of 193 nurses was conducted at a general hospital in Turkey. Data was collected using a demographic questionnaire and The Spirituality and Spiritual Care Rating Scale (SSCRS). The findings of this study revealed that older nurses (pspiritual care (pspiritual care.

  3. Perception on Informed Consent Regarding Nursing Care Practices in a Tertiary Care Center. (United States)

    Paudel, B; Shrestha, G K

    Background Consent for care procedures is mandatory after receipt of adequate information. It maintains patient's rights and autonomy to make thoughtful decisions. Poor communication often leads to poor health quality. Objective To assess hospitalized patients' perception on informed consent regarding nursing care practices in a tertiary care center. Method This is a descriptive cross-sectional study among 113 admitted patients conducted in February 2012 at Dhulikhel Hospital, Nepal. Patients of various wards were selected using purposive non-probability sampling with at least 3 days of hospitalization. Close ended structured questionnaire was used to assess patients' perception on three different areas of informed consent (information giving, opportunity to make decision and taking prior consent). Result Among the participants 71.6% perceived positively regarding informed consent towards nursing care practices with a mean score of 3.32 ± 1.28. Patients' perception on various areas of informed consent viz. information giving, opportunities to make specific decision and taking prior consent were all positive with mean values of 3.43±1.12, 2.88±1.23, 3.65±1.49 respectively. Comparison of mean perception of informed consent with various variables revealed insignificant correlation (p-value >0.05) for age, educational level and previous hospitalization while it was significant (p-value perception on informed consent towards nursing care practices. Communication skills of nurses affect the perception of patients' regardless of age, education level and past experiences.

  4. Creating a Community of Practice: Lessons Learned from the Center for Astronomy Education (Invited) (United States)

    Brissenden, G.


    The Center for Astronomy Education (CAE) is devoted to improving teaching and learning in Astro 101. To accomplish this, a vital part of CAE is our broader community of practice which includes over 1000 instructors, graduate and undergraduate students, and postdocs. It is this greater community of practice that supports each other, helps, and learns from each other beyond what would be possible without it. As our community of practice has grown, we at CAE have learned many lessons about how different facets of CAE can best be used to promote and support our community both as a whole and for individual members. We will discuss the various facets of CAE, such as our online discussion group Astrolrner@CAE ( and its Guest Moderator program, our CAE Regional Teaching Exchange Coordinator program, our CAE Workshop Presenter Apprenticeship Training program, our online This Month’s Teaching Strategy, monthly newsletters, and various types of socializing and networking sessions we hold at national meetings. But more importantly, we will discuss the lessons we’ve learned about what does and does not work in building community within each of these facets.

  5. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. (United States)

    Shippee, Nathan D; Shah, Nilay D; May, Carl R; Mair, Frances S; Montori, Victor M


    To design a functional, patient-centered model of patient complexity with practical applicability to analytic design and clinical practice. Existing literature on patient complexity has mainly identified its components descriptively and in isolation, lacking clarity as to their combined functions in disrupting care or to how complexity changes over time. The authors developed a cumulative complexity model, which integrates existing literature and emphasizes how clinical and social factors accumulate and interact to complicate patient care. A narrative literature review is used to explicate the model. The model emphasizes a core, patient-level mechanism whereby complicating factors impact care and outcomes: the balance between patient workload of demands and patient capacity to address demands. Workload encompasses the demands on the patient's time and energy, including demands of treatment, self-care, and life in general. Capacity concerns ability to handle work (e.g., functional morbidity, financial/social resources, literacy). Workload-capacity imbalances comprise the mechanism driving patient complexity. Treatment and illness burdens serve as feedback loops, linking negative outcomes to further imbalances, such that complexity may accumulate over time. With its components largely supported by existing literature, the model has implications for analytic design, clinical epidemiology, and clinical practice. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Lessons learned from a pharmacy practice model change at an academic medical center. (United States)

    Knoer, Scott J; Pastor, John D; Phelps, Pamela K


    The development and implementation of a new pharmacy practice model at an academic medical center are described. Before the model change, decentralized pharmacists responsible for order entry and verification and clinical specialists were both present on the care units. Staff pharmacists were responsible for medication distribution and sterile product preparation. The decentralized pharmacists handling orders were not able to use their clinical training, the practice model was inefficient, and few clinical services were available during evenings and weekends. A task force representing all pharmacy department roles developed a process and guiding principles for the model change, collected data, and decided on a model. Teams consisting of decentralized pharmacists, decentralized pharmacy technicians, and team leaders now work together to meet patients' pharmacy needs and further departmental safety, quality, and cost-saving goals. Decentralized service hours have been expanded through operational efficiencies, including use of automation (e.g., computerized provider order entry, wireless computers on wheels used during rounds with physician teams). Nine clinical specialist positions were replaced by five team leader positions and four pharmacists functioning in decentralized roles. Additional staff pharmacist positions were shifted into decentralized roles, and the hospital was divided into areas served by teams including five to eight pharmacists. Technicians are directly responsible for medication distribution. No individual's job was eliminated. The new practice model allowed better alignment of staff with departmental goals, expanded pharmacy hours and services, more efficient medication distribution, improved employee engagement, and a staff succession plan.

  7. ALARA and paediatric imaging in radiation therapy: A survey of Canadian paediatric imaging practice

    International Nuclear Information System (INIS)

    Rodgerson, Christine


    Purpose: There is little discussion in the literature regarding paediatric imaging dose reduction with respect to conventional imaging carried out in radiotherapy departments. This is in contrast to diagnostic radiography where dose optimization when imaging children is a very current topic. For this reason Canadian radiotherapy clinics were surveyed to look at paediatric imaging practice, knowledge and perspectives with respect to imaging dose reduction. Method: As this was an exploratory study, a questionnaire was developed and sent to radiation therapy clinics across Canada, via email, to assess knowledge of paediatric imaging and dose reduction initiatives. The questionnaire focus was CT simulation and treatment verification imaging of children. Results: Practice and knowledge of paediatric imaging varied across Canada. Forty percent of clinics reported using paediatric specific protocols for CT simulation and 20% of clinics reported using paediatric specific protocols for treatment verification imaging. There was variation in imaging practices among the clinics that reported treating the most children. The survey results show that while some measures are being taken to reduce paediatric imaging dose in radiation therapy, 46.7% of the respondents felt more could be done. Conclusion: The survey demonstrates interest in dose reduction in radiation therapy imaging as well as differences in current practice and knowledge across Canada. Paediatric imaging dose reduction would appear to be an area of practice that would benefit from more study and development of standards of practice

  8. A Worldwide Survey on Peyronie's Disease Surgical Practice Patterns Among Surgeons. (United States)

    Chung, Eric; Wang, Run; Ralph, David; Levine, Laurence; Brock, Gerald


    Despite published guidelines on Peyronie's disease (PD), there are limited data on actual surgical practice among surgeons. To evaluate the surgical practice patterns in PD among surgeons from different continents and members of various sexual medicine societies. An anonymous survey on various pre-, intra-, and postoperative aspects of PD surgical care was distributed in printed format during International Society of Sexual Medicine meetings and as an online survey to International Society of Sexual Medicine members. 390 surgeons responded to the survey, with great variations in pre-, intra-, and postoperative strategies in PD surgical care. Most surgeons performed fewer than 10 penile plications and 10 graft surgeries per year. Modified Nesbit plication was the preferred option by most surgeons. Surgeons who received fellowship training were more likely to perform autologous than allograft surgery (odds ratio = 1.79, 95% CI = 1.13-2.82, P = .01). The use of penile color duplex ultrasound was inconsistently performed, with higher-volume surgeons (ie, >20 cases operated a year) more likely to use this diagnostic modality (odds ratio = 70.18, 95% CI = 20.99-234.6, P worldwide survey study has the potential to assist in the formation of a new practice guideline and serve as the basis for future prospective multinational studies. This is one of the largest surveys on PD practice and, to our knowledge, the only survey conducted across various sexual medicine societies, with the inclusion of many high-volume and experienced PD surgeons. This also is the 1st study to comprehensively evaluate many key aspects in surgical practice patterns for PD. However, the categorization on the questionnaire used in this survey was not designed to allow for direct comparison given the possibility of some surgeons with dual society memberships, reporting biases, large CIs in outcomes, different patient demographics, and cultural acceptance. There is great variation in surgical

  9. 24/7 in-house intensivist coverage and fellowship education: a cross-sectional survey of academic medical centers in the United States. (United States)

    Diaz-Guzman, Enrique; Colbert, Colleen Y; Mannino, David M; Davenport, Daniel L; Arroliga, Alejandro C


    The objectives of this study were to determine the current staffing models of practice and the frequency of 24/7 coverage in academic medical centers in the United States and to assess the perceptions of critical care trainees and program directors toward these models. A cross-sectional national survey was conducted using an Internet-based survey platform. The survey was distributed to fellows and program directors of 374 critical care training programs in US academic medical centers. We received 518 responses: 138 from program directors (PDs) (37% of 374 programs) and 380 fellow responses. Coverage by a board-certified or board-eligible intensivist physician 24/7 was reported by 33% of PD respondents and was more common among pediatric and surgical critical care programs. Mandatory in-house call for critical care trainees was reported by 48% of the PDs. Mandatory call was also more common among pediatric-critical care programs compared with the rest (P 24/7 coverage would be associated with better patient care in the ICU and improved education for the fellows, although 65% of them believed this model would have a negative impact on trainees' autonomy. Intensivist coverage 24/7 was not commonly used in US academic centers responding to our survey. Significant differences in coverage models among critical care medicine specialties appear to exist. Program director and trainee respondents believed that 24/7 coverage was associated with better outcomes and education but also expressed concerns about the impact of this model on fellows' autonomy.

  10. A survey of digital radiography practice in four South African teaching hospitals: an illuminative study. (United States)

    Nyathi, T; Chirwa, Tf; van der Merwe, Dg


    The purpose of this study was to assess radiographer familiarity and preferences with digital radiography in four teaching hospitals and thereafter make recommendations in line with the migration from screen film to digital radiography. A questionnaire was designed to collect data from either qualified or student radiographers from four teaching hospitals. From the four teaching hospitals, there were a total of 205 potential respondents. Among other things, responses regarding experiences and preferences with digital radiography, quality control procedures, patient dose, advantages and disadvantages of digital radiography were sought. The information collected was based on self-reporting by the participants. The study is exploratory in nature and descriptive statistics were generated from the collected data using Microsoft Excel 2007 and StatsDirect software. Sixty-three out of 205 (31%) radiographers from all the four radiology centers responded to the circulated questionnaire. Only 15% (8) of the qualified radiographers had 4 or more years of experience with digital radiography compared to 68% (36) for the same amount of experience with screen-film radiography. Sixty-one percent (38) of the participants had been exposed to digital radiography during their lectures while at university. A small proportion, 16% (10) of the respondents underwent formal training in quality control procedures on the digital X-ray units they were using. Slightly more than half (55%) of the participants felt it was easier for them to retake an image in digital radiography than in screen film radiography. The results of this survey showed that the participants are familiar with digital radiography and have embraced this relatively new technology as shown by the fact that they can identify both its advantages and disadvantages as applied to clinical practice. However, there are minimal quality control procedures specific to digital radiography being undertaken as such there is need for

  11. Cerebral angioplasty practice at major medical centers in the United States

    International Nuclear Information System (INIS)

    Chaturvedi, S.; St Pierre, M.E.; Bertasio, B.


    Concern has been expressed recently regarding the proliferation of angioplasty and/or stenting of cerebral vessels. However, little is known about the volume of angioplasties being performed or the number of experienced interventionalists. A questionnaire was mailed to directors of accredited radiology residency programs in the United States, to define the level of expertise available at teaching hospitals in terms of angioplasty and/or stenting. Of 200 programs surveyed, 111 responded (56 %). Of 111 program directors 47 (42 %) indicated that cerebral angioplasty was being performed at their center. The greatest experience is currently for angioplasty of post-subarachnoid hemorrhage vasospasm (mean 16 procedures performed) and the least experience for dilation of basilar artery atherosclerosis (mean five procedures performed). The reported stroke and/or death rate in centers performing angioplasty of the extracranial carotid system is 1.5 %. Comparisons with other medical specialties (e. g., cardiologists, neurologists, neurosurgeons) are necessary to determine the full scope of extracranial neurovascular procedures being performed and the corresponding complication rates. (orig.)

  12. Self-Presentation Bias in Surveys of Teachers' Educational Technology Practices (United States)

    Kopcha, Theodore J.; Sullivan, Howard


    This study investigated self-presentation bias in the self-reports of teachers about their practices in six topic areas in educational technology (Instructional Design, Assessment, Learner-Centered Instruction, Curriculum Alignment, Attitudes about Computers, and Use of Computers with Students). Subjects were 50 middle-school teachers. Data were…

  13. Survey of the sevoflurane sedation status in one provincial dental clinic center for the disabled (United States)

    Park, Chang-hyun


    Background Sevoflurane sedation in pediatric and disabled patients has the advantage of faster induction and recovery compared to general anesthesia, as well as minimum influence on the respiratory and cardiovascular functions, and airway protective reflexes. This study aimed to evaluate the clinical efficacy of sevoflurane sedation used in dental treatment at one provincial dental clinic center for the disabled. Methods We investigated patients' gender, age, reasons for undergoing sedation, medication history prior to treatment, duration of anesthesia, treatment length, type of treatment, and yearly patterns, for 387 cases of dental treatment performed using sevoflurane sedation from January 2013 to October 2016. Results We analyzed 387 cases (215 male patients, 172 female patients). Male patients aged 20 year or older accounted for 39.0% of all patients, marking the highest proportion. Patient's lack of cooperation was the most common reason for performing dental sedation. Prosthetic treatment was the most frequently practiced, accounting for 174 treatment cases. The mean lengths of the entire treatment and of the dental procedure were 55.2 min and 39.8 min, respectively. Conclusions Sevoflurane sedation has the advantage of fast anesthesia induction and recovery compared to general anesthesia; therefore, it can be used efficiently to induce anesthesia in pediatric and disabled patients during short dental procedures, enabling stable treatment of these patients. PMID:28879316

  14. Infrastructure of radiation oncology in France: A large survey of evolution of external beam radiotherapy practice

    International Nuclear Information System (INIS)

    Ruggieri-Pignon, Sophie; Pignon, Thierry; Marty, Michel; Rodde-Dunet, Marie-Helene; Destembert, Brigitte; Fritsch, Beatrice


    Purpose: To study the structural characteristics of radiation oncology facilities for France and to examine how technological evolutions had to be taken into account in terms of accessibility and costs. This study was initiated by the three health care financing administrations that cover health care costs for the French population. The needs of the population in terms of the geographic distribution of the facilities were also investigated. The endpoint was to make proposals to enable an evolution of the practice of radiotherapy (RT) in France. Methods and materials: A survey designed by a multidisciplinary committee was distributed in all RT facilities to collect data on treatment machines, other equipment, personnel, new patients, and new treatments. Medical advisors ensured site visits in each facility. The data were validated at the regional level and aggregated at the national level for analysis. Results: A total of 357 machines had been installed in 179 facilities: 270 linear accelerators and 87 cobalt units. The distribution of facilities and megavoltage units per million inhabitants over the country was good, although some disparities existed between areas. It appeared that most megavoltage units had not benefited from technological innovation, because 25% of the cobalt units and 57% of the linear accelerators were between 6 and 15 years old. Computed tomography access for treatment preparation was not sufficient, and complete data management systems were scarce (15% of facilities). Seven centers had no treatment planning system. Electronic portal imaging devices were available in 44.7% of RT centers and in vivo dosimetry in 35%. A lack of physicians and medical physicists was observed; consequently, the workload exceeded the normal standard recommended by the French White Book. Discrepancies were found between the number of patients treated per machine per year in each area (range, 244.5-604). Most treatments were delivered in smaller facilities (61

  15. The retention of health human resources in primary healthcare centers in Lebanon: a national survey. (United States)

    Alameddine, Mohamad; Saleh, Shadi; El-Jardali, Fadi; Dimassi, Hani; Mourad, Yara


    Critical shortages of health human resources (HHR), associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC) sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon. A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory). A total of 755 providers completed the questionnaire (60.5% response rate). Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit. Two out of five respondents indicated likelihood to quit their jobs within the next 1-3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%), better job opportunities outside the country (35.1%) and lack of professional development (33.7%). A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit. The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits and allied health professionals. Particular attention should

  16. The retention of health human resources in primary healthcare centers in Lebanon: a national survey

    Directory of Open Access Journals (Sweden)

    Alameddine Mohamad


    Full Text Available Abstract Background Critical shortages of health human resources (HHR, associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon. Methods A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory. A total of 755 providers completed the questionnaire (60.5% response rate. Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit. Results Two out of five respondents indicated likelihood to quit their jobs within the next 1–3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%, better job opportunities outside the country (35.1% and lack of professional development (33.7%. A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit. Conclusions The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits

  17. A descriptive survey of types, spread and characteristics of substance abuse treatment centers in Nigeria. (United States)

    Onifade, Peter O; Somoye, Edward B; Ogunwobi, Olorunfemi O; Ogunwale, Adegboyega; Akinhanmi, Akinwande O; Adamson, Taiwo A


    Nigeria, the most populous country in Africa and the 8th most populous in the world with a population of over 154 million, does not have current data on substance abuse treatment demand and treatment facilities; however, the country has the highest one-year prevalence rate of Cannabis use (14.3%) in Africa and ranks third in Africa with respect to the one-year prevalence rate of cocaine (0.7%) and Opioids (0.7%) use. This study aimed to determine the types, spread and characteristics of the substance abuse treatment centers in Nigeria. The study was a cross sectional survey of substance abuse treatment centers in Nigeria. Thirty-one units were invited and participated in filling an online questionnaire, adapted from the European Treatment Unit/Program Form (June 1997 version). All the units completed the online questionnaire. A large proportion (48%) was located in the South-West geopolitical zone of the country. Most (58%) were run by Non-Governmental Organizations. Half of them performed internal or external evaluation of treatment process or outcome. There were a total of 1043 for all categories of paid and volunteer staff, with an average of 33 staff per unit. Most of the funding came from charitable donations (30%). No unit provided drug substitution/maintenance therapy. The units had a total residential capacity of 566 beds. New client admissions in the past one year totalled 765 (mean = 48, median = 26.5, min = 0, max = 147) and 2478 clients received services in the non-residential units in the past year. No unit provided syringe exchange services. The study revealed a dearth of substance abuse treatment units (and of funds for the available ones) in a country with a large population size and one of the highest prevalence rates of substance abuse in Africa. The available units were not networked and lacked a directory or an evaluation framework. To provide an environment for effective monitoring, funding and continuous quality improvement, the units need to

  18. A descriptive survey of types, spread and characteristics of substance abuse treatment centers in Nigeria

    Directory of Open Access Journals (Sweden)

    Akinhanmi Akinwande O


    Full Text Available Abstract Background Nigeria, the most populous country in Africa and the 8th most populous in the world with a population of over 154 million, does not have current data on substance abuse treatment demand and treatment facilities; however, the country has the highest one-year prevalence rate of Cannabis use (14.3% in Africa and ranks third in Africa with respect to the one-year prevalence rate of cocaine (0.7% and Opioids (0.7% use. This study aimed to determine the types, spread and characteristics of the substance abuse treatment centers in Nigeria. Methods The study was a cross sectional survey of substance abuse treatment centers in Nigeria. Thirty-one units were invited and participated in filling an online questionnaire, adapted from the European Treatment Unit/Program Form (June 1997 version. Results All the units completed the online questionnaire. A large proportion (48% was located in the South-West geopolitical zone of the country. Most (58% were run by Non-Governmental Organizations. Half of them performed internal or external evaluation of treatment process or outcome. There were a total of 1043 for all categories of paid and volunteer staff, with an average of 33 staff per unit. Most of the funding came from charitable donations (30%. No unit provided drug substitution/maintenance therapy. The units had a total residential capacity of 566 beds. New client admissions in the past one year totalled 765 (mean = 48, median = 26.5, min = 0, max = 147 and 2478 clients received services in the non-residential units in the past year. No unit provided syringe exchange services. Conclusions The study revealed a dearth of substance abuse treatment units (and of funds for the available ones in a country with a large population size and one of the highest prevalence rates of substance abuse in Africa. The available units were not networked and lacked a directory or an evaluation framework. To provide an environment for effective monitoring

  19. A National Longitudinal Survey of Medical Students' Intentions to Practice Among the Underserved. (United States)

    O'Connell, Thomas F; Ham, Sandra A; Hart, Theodore G; Curlin, Farr A; Yoon, John D


    To explore students' intentions to practice in medically underserved areas. In January 2011, 960 third-year medical students from 24 MD-granting U.S. medical schools were invited to participate in a survey on their intention to practice in a medically underserved area. A follow-up survey was sent to participants in September 2011. Covariates included student demographics, medical school characteristics, environmental exposures, work experiences, sense of calling, and religious characteristics. Adjusted response rates were 564/919 (61.4%, first survey) and 474/564 (84.0%, follow-up survey). Among fourth-year medical students, an estimated 34.3% had an intention to practice among the underserved. In multivariate logistic regression modeling, predictors for intentions to practice among the underserved included growing up in an underserved setting (odds ratio [OR] range: 2.96-4.81), very strong sense of calling (OR range: 1.86-3.89), and high medical school social mission score (in fourth year: OR = 2.34 [95% confidence interval (CI), 1.31-4.21]). International experience was associated with favorable change of mind in the fourth year (OR = 2.86 [95% CI, 1.13-7.24]). High intrinsic religiosity was associated with intentions to practice primary care in underserved settings (in fourth year: OR = 2.29 [95% CI = 1.13-4.64]). Growing up in medically underserved settings, work experience in religiously affiliated organizations, very strong sense of calling, and high medical school social mission score were associated with intentions to practice in underserved areas. Lack of formative educational experiences may dissuade students from considering underserved practice.

  20. Exploring the practice of patient centered care: The role of ethnography and reflexivity. (United States)

    Liberati, Elisa Giulia; Gorli, Mara; Moja, Lorenzo; Galuppo, Laura; Ripamonti, Silvio; Scaratti, Giuseppe


    Patient centered care (PCC) is an essential dimension of healthcare systems' mission worldwide and is recognized as an important condition for ensuring the quality of care. Nonetheless, it is also acknowledged that various care providers perceive patient centeredness differently and that there remain several unanswered questions about the aspects of healthcare delivery that are linked to an actual achievement of PCC. In the paper, we categorize the current research on PCC into two streams ("dyadic" and "organizational") and we discuss the strengths and weaknesses of each. Despite their important contributions to healthcare services research, these approaches to PCC do not fully capture the network of practices and relationships constituting patients and providers' experiences within healthcare contexts. Therefore, we propose an alternative interpretation of PCC that integrates insights from "practice theories" and emphasizes the negotiated and local nature of patient centeredness, which is accomplished through the engagement of providers and patients in everyday care practices. To develop such interpretation, we propose a research approach combining ethnographic and reflexive methods. Ethnography can help achieve more nuanced descriptions of what PCC truly encapsulates in the care process by drawing attention to the social and material reality of healthcare contexts. Reflexivity can help disentangle and bring to surface the tacit knowledge spread in everyday care practices and transform it into actionable knowledge, a type of knowledge that may support services improvement toward PCC. We anticipate that such improvement is far from straightforward: an actual achievement of PCC may challenge the interests of different stakeholders and unsettle consolidated habits, hierarchies and power dynamics. This unsettlement, however, can also serve as a necessary condition for engaging in a participative process of internal development. We discuss the outcomes, limitations and

  1. Development, application, and validation of a survey for infectious disease control practices at equine boarding facilities. (United States)

    Kirby, Alanna T; Traub-Dargatz, Josie L; Hill, Ashley E; Kogan, Lori R; Morley, Paul S; Heird, James C


    To develop a questionnaire for self-assessment of biosecurity practices at equine boarding facilities and to evaluate infectious disease control practices in these facilities in Colorado. Cross-sectional study. 64 equine boarding facilities in Colorado. Survey questions were rated according to importance for prevention and containment of equine infectious diseases. Point values (range, 0 to 20) were assigned for possible responses, with greater values given for optimal infection control methods. Questionnaires were mailed to equine boarding facilities in Colorado advertised on the World Wide Web. Survey responses were compared with assessments made by a member of the research team during visits to 30 randomly selected facilities. Agreement among results was analyzed via a kappa test and rated as poor, fair, moderate, substantial, or nearly perfect. Survey responses were received for 64 of 163 (39%) equine boarding facilities. Scores ranged from 106 to 402 points (maximum possible score, 418). Most facilities received better scores for movement and housing of equids than for other sections of the survey. Respondents at 24 of 48 (50%) facilities that routinely received new equids reported isolation of new arrivals. Agreement between self-assessment by survey respondents and evaluation by a member of the research team was determined to be fair to substantial. Most equine boarding facilities have opportunities to improve measures for prevention or containment of contagious diseases (eg, isolation of newly arrived equids and use of written health management protocols). Most self-assessments of infection control practices were accurate.

  2. Education, training, and practice among nordic neuropsychologists. Results from a professional practices survey

    DEFF Research Database (Denmark)

    Norup, A; Egeland, Jens; Løvstad, Marianne


    disability were the most common conditions seen by neuropsychologists. A mean income of 53,277 Euros was found. Neuropsychologists expressed greater job satisfaction than income satisfaction. Significant differences were found between the Nordic countries. Finnish neuropsychologists were younger and worked......OBJECTIVE: To investigate sociodemographic characteristics, clinical and academic training, work setting and salary, clinical activities, and salary and job satisfaction among practicing neuropsychologists in four Nordic countries. METHODS: 890 neuropsychologists from Denmark, Finland, Norway...

  3. Relational coordination is associated with productivity in general practice: a survey and register based study

    DEFF Research Database (Denmark)

    Lundstrøm, Sanne Lykke; Edwards, Kasper; Reventlow, Susanne


    In this paper we investigate the association between relational coordination among the practice team in general practice and number of consultations performed in a general practice per staff, i.e. a proxy of productivity. We measured relational coordination using the Relational Coordination Survey...... and combined the results with register data. We found that relational coordination was statistically significant associated with number of consultation per staff per year. We later divided consultations in to three types: Face-to-face, Email and phone consultations. We found a statistically significant...... associating between relational coordination and with number of face-to-face consultation per staff per year....

  4. Dementia and driving : A survey of clinical practice in aged care assessment teams

    NARCIS (Netherlands)

    Fox, G.K; Withaar, F.K.; Bashford, G.M

    Current clinical practice in Aged Care Assessment Teams (ACATs) in NSW and ACT regarding assessment of fitness to drive in clients with a diagnosis of dementia was examined. Of 42 ACATs with a geriatrician on staff, 38 (90.5%) responded to a telephone survey. Results showed that assessment of driver

  5. Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices. (United States)

    Staveski, Sandra L; Pickler, Rita H; Lin, Li; Shaw, Richard J; Meinzen-Derr, Jareen; Redington, Andrew; Curley, Martha A Q


    The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. Descriptive self-report survey. A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. Pediatric cardiac intensive care clinicians (physicians and nurses). None. One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia. Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

  6. Integrating Art into Science Education: A Survey of Science Teachers' Practices (United States)

    Turkka, Jaakko; Haatainen, Outi; Aksela, Maija


    Numerous case studies suggest that integrating art and science education could engage students with creative projects and encourage students to express science in multitude of ways. However, little is known about art integration practices in everyday science teaching. With a qualitative e-survey, this study explores the art integration of science…

  7. Third and Fourth Grade Teacher's Classroom Practices in Writing: A National Survey (United States)

    Brindle, Mary; Graham, Steve; Harris, Karen R.; Hebert, Michael


    A random sample of teachers in grades 3 and 4 (N = 157) from across the United States were surveyed about their use of evidence-based writing practices, preparation to teach writing, and beliefs about writing. Teachers' beliefs included their efficacy to teach writing, their orientations to teach writing, their attitude about teaching writing, and…

  8. Effect of mailed reminders on the response rate in surveys among patients in general practice

    DEFF Research Database (Denmark)

    Wensing, M; Mainz, Jan; Kramme, O


    Randomized trials were performed in Denmark and The Netherlands to determine the effect of mailed reminders on the response rate in surveys among patients in general practice. In both countries, general practitioners handed out questionnaires to 200 adult patients who came to visit them. An inter...

  9. Complete Denture Impression Techniques Practiced by Private Dental Practitioners: A Survey


    Kakatkar, Vinay R.


    Impression making is an important step in fabricating complete dentures. A survey to know the materials used and techniques practiced while recording complete denture impressions was conducted. It is disheartening to know that 33 % practitioners still use base plate custom trays to record final impressions. 8 % still use alginate for making final impressions. An acceptable technique for recording CD impressions is suggested.

  10. Assessing Violence Risk and Psychopathy in Juvenile and Adult Offenders: A Survey of Clinical Practices (United States)

    Viljoen, Jodi L.; McLachlan, Kaitlyn; Vincent, Gina M.


    This study surveyed 199 forensic clinicians about the practices that they use in assessing violence risk in juvenile and adult offenders. Results indicated that the use of risk assessment and psychopathy tools was common. Although clinicians reported more routine use of psychopathy measures in adult risk assessments compared with juvenile risks…

  11. Social Workers' Orientation toward the Evidence-Based Practice Process: A Dutch Survey (United States)

    van der Zwet, Renske J. M.; Kolmer, Deirdre M. Beneken genaamd; Schalk, René


    Objectives: This study assesses social workers' orientation toward the evidence-based practice (EBP) process and explores which specific variables (e.g. age) are associated. Methods: Data were collected from 341 Dutch social workers through an online survey which included a Dutch translation of the EBP Process Assessment Scale (EBPPAS), along with…

  12. Evidence-Based Speech-Language Pathology Practices in Schools: Findings from a National Survey (United States)

    Hoffman, LaVae M.; Ireland, Marie; Hall-Mills, Shannon; Flynn, Perry


    Purpose: This study documented evidence-based practice (EBP) patterns as reported by speech-language pathologists (SLPs) employed in public schools during 2010-2011. Method: Using an online survey, practioners reported their EBP training experiences, resources available in their workplaces, and the frequency with which they engage in specific EBP…

  13. Survey of Information Literacy Instructional Practices in U.S. Academic Libraries (United States)

    Julien, Heidi; Gross, Melissa; Latham, Don


    An online survey sent to the community of professional librarians in the United States who provide information literacy instruction in academic libraries provided insights into their practices and the challenges they face. Data include current pedagogical methods, client groups of focus, assessment and evaluation, marketing, instructional…

  14. Cardioversion for atrial fibrillation in current European practice : results of the European Heart Rhythm Association survey

    NARCIS (Netherlands)

    Hernandez-Madrid, Antonio; Svendsen, Jesper Hastrup; Lip, Gregory Y. H.; Van Gelder, Isabelle C.; Dobreanu, Dan; Blomstrom-Lundqvist, Carina

    This survey was conducted to provide an insight into the current clinical practice regarding the use of cardioversion for atrial fibrillation (AF) in Europe. Responses were received from 57 centres across Europe, 71.9 of which were university hospitals. For electrical cardioversion, general

  15. International survey of veterinarians to assess the importance of competencies in professional practice and education

    NARCIS (Netherlands)

    Bok, Harold G. J.; Teunissen, Pim W.; Boerboom, Tobias B. B.; Rhind, Susan M.; Baillie, Sarah; Tegzes, John; Annandale, Henry; Matthew, Susan; Torgersen, Anne; Hecker, Kent G.; Härdi-Landerer, Christina M.; Gomez-Lucia, Esperanza; Ahmad, Bashir; Muijtjens, Arno M. M.; Jaarsma, Debbie A. D. C.; van der Vleuten, Cees P. M.; van Beukelen, Peter


    To determine the perceived importance of specific competencies in professional veterinary practice and education among veterinarians in several countries. Survey-based prospective study. 1,137 veterinarians in 10 countries. Veterinarians were invited via email to participate in the study. A

  16. Social workers’ orientation toward the evidence-based practice process : A Dutch survey

    NARCIS (Netherlands)

    van der Zwet, R.J.M.; Beneken Genaamd Kolmer, D.M.; Schalk, R.


    Objectives: This study assesses social workers’ orientation toward the evidence-based practice (EBP) process and explores which specific variables (e.g. age) are associated. Methods: Data were collected from 341 Dutch social workers through an online survey which included a Dutch translation of the

  17. Survey of sterile admixture practices in canadian hospital pharmacies: part 2. More results and discussion. (United States)

    Warner, Travis; Nishi, Cesilia; Checkowski, Ryan; Hall, Kevin W


    The 1996 Guidelines for Preparation of Sterile Products in Pharmacies of the Canadian Society of Hospital Pharmacists (CSHP) represent the current standard of practice for sterile compounding in Canada. However, these guidelines are practice recommendations, not enforceable standards. Previous surveys of sterile compounding practices have shown that actual practice deviates markedly from voluntary practice recommendations. In 2004, the United States Pharmacopeia (USP) published its "General Chapter Pharmaceutical Compounding-Sterile Preparations", which set a more rigorous and enforceable standard for sterile compounding in the United States. To assess sterile compounding practices in Canadian hospital pharmacies and to compare them with current CSHP recommendations and USP chapter standards. An online survey, based on previous studies of sterile compounding practices, the CSHP guidelines, and the chapter standards, was created and distributed to 193 Canadian hospital pharmacies. A total of 133 pharmacies completed at least part of the survey, for a response rate of 68.9%. All respondents reported the preparation of sterile products. Various degrees of deviation from the practice recommendations were noted for virtually all areas of the CSHP guidelines and the USP standards. Low levels of compliance were most notable in the areas of facilities and equipment, process validation, and product testing. Availability in the central pharmacy of a clean room facility meeting or exceeding the criteria of International Organization for Standardization (ISO) class 8 is a requirement of the chapter standards, but more than 40% of responding pharmacies reported that they did not have such a facility. Higher levels of compliance were noted for policies and procedures, garbing requirements, aseptic technique, and handling of hazardous products. The survey methods for this study and results relating to policies, personnel, raw materials, storage and handling, facilities and

  18. Survey of sterile admixture practices in canadian hospital pharmacies: part 1. Methods and results. (United States)

    Warner, Travis; Nishi, Cesilia; Checkowski, Ryan; Hall, Kevin W


    The 1996 Guidelines for Preparation of Sterile Products in Pharmacies of the Canadian Society of Hospital Pharmacists (CSHP) represent the current standard of practice for sterile compounding in Canada. However, these guidelines are practice recommendations, not enforceable standards. Previous surveys of sterile compounding practices have shown that actual practice deviates markedly from voluntary practice recommendations. In 2004, the United States Pharmacopeia (USP) published its "General Chapter Pharmaceutical Compounding-Sterile Preparations", which set a more rigorous and enforceable standard for sterile compounding in the United States. To assess sterile compounding practices in Canadian hospital pharmacies and to compare them with current CSHP recommendations and USP chapter standards. An online survey, based on previous studies of sterile compounding practices, the CSHP guidelines, and the chapter standards, was created and distributed to 193 Canadian hospital pharmacies. A total of 133 pharmacies completed at least part of the survey, for a response rate of 68.9%. All respondents reported the preparation of sterile products. Various degrees of deviation from the practice recommendations were noted for virtually all areas of the CSHP guidelines and the USP standards. Low levels of compliance were most notable in the areas of facilities and equipment, process validation, and product testing. Availability in the central pharmacy of a clean room facility meeting or exceeding the criteria of International Organization for Standardization (ISO) class 8 is a requirement of the chapter standards, but more than 40% of responding pharmacies reported that they did not have such a facility. Higher levels of compliance were noted for policies and procedures, garbing requirements, aseptic technique, and handling of hazardous products. Part 1 of this series reports the survey methods and results relating to policies, personnel, raw materials, storage and handling

  19. Practicing ethnography in migration-related detention centers: A reflexive account. (United States)

    Esposito, Francesca


    Feminist scholars, as well as community psychologists, have advocated the role of reflexive engagement in the research process in order to challenge power relations. Moreover, the liberating potential of storytelling, especially when working with issues of diversity and marginalization, has been stressed. The purpose of this article is to reflect on an ethnographic work underway in the Identification and Expulsion Center-CIE of Ponte Galeria, Rome. How the researcher's identities, values, and experiences, alongside power and privilege, have influenced her positioning in the research setting and the relationships formed with the different setting members is the subject of discussion. In sharing the story of this work, the final intent is to contribute to the joint effort to foster a reflexive community psychology practice incorporating feminist goals and a dialogue about ethnography in community psychology.

  20. The Impact of Knowledge Management Practices on NPP Organizational Performance - Results of a Global Survey

    International Nuclear Information System (INIS)


    The IAEA has been asked by Member States in the 2012 General Conference Resolutions to ''further increase the level of awareness of efforts in managing nuclear knowledge'' and to continue ''to further develop and disseminate guidance and methodologies for planning, designing, and implementing nuclear knowledge management programs''. The present report summarizes the results of empirical research on the relationship between KM practices in nuclear power plants, their impact on the quality of organizational knowledge processes and the resulting effects on the organizational effectiveness of nuclear power plants. It presents the basic findings of the ''IAEA Global Nuclear Power Plant Survey: Investigating the Link Between Knowledge Management Practices and Organizational Performance'', which was conducted in 2010. This benchmark survey of KM practices in nuclear power plants was developed using a standard research methodology. The survey was made available on a global basis to all nuclear power plant sites. Senior operations managers were asked to complete the survey with input, as required, from their plant management team. Data from individual survey responses were treated as confidential, and only aggregate findings were reported. A total of 124 station ''site organizations'' participated in the survey, representing a response rate of approximately 60%. The findings provide empirical evidence of the importance of KM practices in improving the organizational effectiveness of nuclear power plants. They provide information about the current state of the industry with respect to KM practices, illustrating the direct and tangible benefits of implementing such practices and justifying continued or further efforts to ensure that KM programmes and systems are strategically planned and implemented in operating nuclear power plants. The research provides insights into the mechanisms by which KM practices have an impact on organizational effectiveness and provides a basis for

  1. Neural network-based survey analysis of risk management practices in new product development

    DEFF Research Database (Denmark)

    Kampianakis, Andreas N.; Oehmen, Josef


    The current study investigates the applicability of Artificial Neural Networks (ANNs) to analyse survey data on the effectiveness of risk management practices in product development (PD) projects, and its ability to forecast project outcomes. Moreover, this study presents the relations between risk...... Neural Networks. Dataset used is a filtered survey of 291 product development programs. Answers of this survey are used as training input and target output, in pattern recognition two-layer feed forward networks, using various transfer functions. Using this method, relations among 6 project practices...... and 13 outcome metrics were revealed. Results of this analysis are compared with existent results made through statistical analysis in prior work of one of the authors. Future investigation is needed in order to tackle the lack of data and create an easy to use platform for industrial use....

  2. Impact of postgraduate education on advanced practice nurse activity - a national survey. (United States)

    Wilkinson, J; Carryer, J; Budge, C


    There is a wealth of international evidence concerning the contribution post-registration master's level education makes to advancing the discipline of nursing. There are approximately 277 nurse practitioners registered in NZ, but they account for only a small portion of nurses who have undertaken master's level education. The additional contribution these nurses make to the work environment through advanced practice activities has not, hitherto, been documented. To report the extent of advanced practice nurse activity associated with various levels of nursing education in a sample of nurses working in clinical practice in New Zealand. A replication of recent Australian research was done via a national cross-sectional survey of 3255 registered nurses and nurse practitioners in New Zealand using an online questionnaire to collect responses to the amended Advanced Practice Delineation survey tool. In addition, demographic data were collected including position titles and levels of postgraduate education. A positive association was found between postgraduate education at any level and more time spent in advanced practice activities. Independent of level of postgraduate education, the role a nurse holds also effects the extent of involvement in advanced practice activities. There is an additional contribution made to the work environment by nurses with master's level education which occurs even when they are not employed in an advanced practice role. These findings are of significance to workforce policy and planning across the globe as countries work to sustain health services by increasing nursing capacity effectively within available resources. © 2018 International Council of Nurses.

  3. Ontario pharmacists practicing in family health teams and the patient-centered medical home. (United States)

    Dolovich, Lisa


    The patient-centered medical home (PCMH) approach continues to gather momentum in the United States and Canada as a broad approach to reform the delivery of the complete primary care system. The family health team (FHT) model implemented in Ontario, Canada, best mirrors the PCMH approach of the United States. The integration of pharmacists as key members of the health care team providing on-site, in-office coordinated care to FHT patients was included from the start of planning the FHT model and represents a substantial opportunity for pharmacists to realize their professional vision. Several research projects in Canada and elsewhere have contributed to providing evidence to support the integration of pharmacists into primary care practice sites. Two major research programs, the Seniors Medication Assessment Research Trial (SMART) cluster randomized controlled trial and the Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) multipronged demonstration project made substantial contributions to evidence-informed policy decisions supporting the integration of pharmacists into FHTs. These projects can provide useful information to support the integration of pharmacists into the PCMH and to encourage further research to better measure the effect of the pharmacist from the holistic patient-centered perspective.

  4. A Practitioner's Instrument for Measuring Secondary Mathematics Teachers' Beliefs Surrounding Learner-Centered Classroom Practice. (United States)

    Lischka, Alyson E; Garner, Mary

    In this paper we present the development and validation of a Mathematics Teaching Pedagogical and Discourse Beliefs Instrument (MTPDBI), a 20 item partial-credit survey designed and analyzed using Rasch measurement theory. Items on the MTPDBI address beliefs about the nature of mathematics, teaching and learning mathematics, and classroom discourse practices. A Rasch partial credit model (Masters, 1982) was estimated from the pilot study data. Results show that item separation reliability is .96 and person separation reliability is .71. Other analyses indicate the instrument is a viable measure of secondary teachers' beliefs about reform-oriented mathematics teaching and learning. This instrument is proposed as a useful measure of teacher beliefs for those working with pre-service and in-service teacher development.

  5. Survey of diagnostic and treatment practices for multiple sclerosis in Europe. (United States)

    Fernández, O; Delvecchio, M; Edan, G; Fredrikson, S; Gionvannoni, G; Hartung, H-P; Havrdova, E; Kappos, L; Pozzilli, C; Soerensen, P S; Tackenberg, B; Vermersch, P; Comi, G


    Up-to-date information is needed on the extent to which neurologists treating multiple sclerosis (MS) in Europe are integrating rapidly evolving diagnostic criteria, disease-modifying therapies and recommendations for monitoring disease activity into their clinical practice. A steering committee of MS neurologists used a modified Delphi process to develop case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Case-based questions were developed for radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS) and RRMS with breakthrough disease. Multiple sclerosis neurologists from 11 European countries responded to survey 1 (n = 233) and survey 2 (n = 171). Respondents agreed that they would not treat the patients in the RIS or CIS cases but would treat a patient with a relatively mild form of RRMS. Choice of treatment was evenly distributed among first-line injectables and oral treatments for mild RRMS, and moved to second-line treatment as the RRMS case increased in severity. Additional results on RRMS with breakthrough disease are presented. Although there was general agreement on some aspects of treatment, responses to other management and clinical practice questions varied considerably. These results, which reflect current clinical practice patterns, highlight the need for additional MS treatment education and awareness and may help inform the development of MS practice guidelines in Europe. © 2017 EAN.

  6. Gender in clinical neuropsychology: practice survey trends and comparisons outside the specialty. (United States)

    Sweet, Jerry J; Lee, Catherine; Guidotti Breting, Leslie M; Benson, Laura M


    This paper describes gender-related trends within clinical neuropsychology, based primarily on recurrent practice surveys within the specialty and, to a lesser extent, job-related information from medical specialties and the general U.S. labor market. Chronological and cross-sectional analyses of professional practice survey data from 2005, 2010, and 2015 relevant to gender. As is common with survey data, descriptive analysis and independent samples t-tests were conducted. Longitudinal data allowed for examination of gender trends, as well as observations of change and stability of factors associated with gender, over time. Women have become dominant in number in clinical neuropsychology, and also comprise a vast majority of practitioners entering the specialty. Gender differences are noted in professional identity, work status, work settings, types of career satisfaction, and retirement expectations. Women are more likely to identify work environment and personal/family obstacles to aspects of career satisfaction. A gender pay gap was found at all time points and is not narrowing. As is true nationally, multiple factors appear related to the gender pay gap in clinical neuropsychology. Women in neuropsychology are now dominant in number, and their presence is strongly associated with specific practice patterns, such as greater institutional employment, less involvement in forensic practice, and strong involvement in pediatric practice, which may be maintaining the sizeable gender pay gap in neuropsychology. As the proportion of women neuropsychologists continues to increase, flexible work hours, and alternative means of remuneration may be needed to offset current disproportionate family-related responsibilities.

  7. Contingency planning for electronic health record-based care continuity: a survey of recommended practices. (United States)

    Sittig, Dean F; Gonzalez, Daniel; Singh, Hardeep


    Reliable health information technology (HIT) in general, and electronic health record systems (EHRs) in particular are essential to a high-performing healthcare system. When the availability of EHRs are disrupted, alternative methods must be used to maintain the continuity of healthcare. We developed a survey to assess institutional practices to handle situations when EHRs were unavailable for use (downtime preparedness). We used literature reviews and expert opinion to develop items that assessed the implementation of potentially useful practices. We administered the survey to U.S.-based healthcare institutions that were members of a professional organization that focused on collaboration and sharing of HIT-related best practices among its members. All members were large integrated health systems. We received responses from 50 of the 59 (84%) member institutions. Nearly all (96%) institutions reported at least one unplanned downtime (of any length) in the last 3 years and 70% had at least one unplanned downtime greater than 8h in the last 3 years. Three institutions reported that one or more patients were injured as a result of either a planned or unplanned downtime. The majority of institutions (70-85%) had implemented a portion of the useful practices we identified, but very few practices were followed by all organizations. Unexpected downtimes related to EHRs appear to be fairly common among institutions in our survey. Most institutions had only partially implemented comprehensive contingency plans to maintain safe and effective healthcare during unexpected EHRs downtimes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. AAN Epilepsy Quality Measures in clinical practice: a survey of neurologists. (United States)

    Wasade, Vibhangini S; Spanaki, Marianna; Iyengar, Revathi; Barkley, Gregory L; Schultz, Lonni


    Epilepsy Quality Measures (EQM) were developed by the American Academy of Neurology (AAN) to convey standardization and eliminate gaps and variations in the delivery of epilepsy care (Fountain et al., 2011 [1]). The aim of this study was to identify adherence to these measures and other emerging practice standards in epilepsy care. A 15-item survey was mailed to neurologists in Michigan, USA, inquiring about their practice patterns in relation to EQM. One hundred thirteen of the 792 surveyed Michigan Neurologists responded (14%). The majority (83% to 94%) addressed seizure type and frequency, reviewed EEG and MRI, and provided pregnancy counseling to women of childbearing potential. Our survey identified gaps in practice patterns such as counseling about antiepileptic drug (AED) side effects and knowledge about referral for surgical therapy of intractable epilepsy. Statistical significance in the responses on the AAN EQM was noted in relation to number of years in practice, number of epilepsy patients seen, and additional fellowship training in epilepsy. Practice patterns assessment in relation to other comorbidities revealed that although bone health and sudden unexplained death in epilepsy are addressed mainly in patients at risk, depression is infrequently discussed. The findings in this study indicate that additional educational efforts are needed to increase awareness and to improve quality of epilepsy care at various points of health care delivery. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Nurse Practitioner Independent Practice Authority and Mental Health Service Delivery in U.S. Community Health Centers. (United States)

    Yang, Bo Kyum; Trinkoff, Alison M; Zito, Julie Magno; Burcu, Mehmet; Safer, Daniel J; Storr, Carla L; Johantgen, Mary E; Idzik, Shannon


    Little is known about how nurse practitioner independent practice authority (NP-IPA) influences patient care. This study examined the effect of NP-IPA on patterns of mental health-related visits provided by NPs in U.S. community health centers (CHCs). State NP regulatory information was linked to National Ambulatory Medical Care Survey data on NP- and physician-provided visits (N=61,457) in CHCs from 2006 through 2011. The proportion of NP-provided versus physician-provided mental health-related visits in states with NP-IPA was compared with the proportion in states without NP-IPA. The adjusted odds of mental health-related visits in CHCs provided by NPs in states with and without NP-IPA were compared by using multiple logistic regression models while accounting for the complex survey design. Between 2006 and 2011, the odds of NP- versus physician-provided mental health-related visits in CHCs were more than two times greater in states with NP-IPA than in states with no NP-IPA (adjusted odds ratio [OR]= 2.43, 95% confidence interval [CI]=1.12-4.60). In contrast, no significant difference between states with and without NP-IPA was noted in non-mental health-related CHC visits provided by NPs. Among all mental health-related visits, the odds of visits in which psychotropic medications were prescribed by an NP were more than three times higher in states with NP-IPA than in those without NP-IPA (adjusted OR=3.14, CI=1.50-6.54). Compared with physicians, NPs provided proportionally more CHC mental health-related visits in states with NP-IPA than in states without NP-IPA.

  10. Headache after traumatic brain injury: a national survey of clinical practices and treatment approaches. (United States)

    Brown, Allen W; Watanabe, Thomas K; Hoffman, Jeanne M; Bell, Kathleen R; Lucas, Sylvia; Dikmen, Sureyya


    Individuals with headache after traumatic brain injury (TBI) receive care in a wide variety of clinical locations by physicians trained in multiple specialties. To understand current practice patterns and perceptions of treatment issues among clinicians managing headache after TBI. National survey of current clinical practice using a 20-item questionnaire developed by the authors. Survey respondents were members of the Central Nervous System Council list survey of the American Academy of Physical Medicine and Rehabilitation (N = 1782) and the American Headache Society membership (N = 1260). The survey was sent electronically to potential participants and was followed by 2 biweekly reminders. The survey queried the physicians' clinical setting; their use of headache classification systems, headache diaries, checklists, and diagnostic procedures; the pharmacologic and nonpharmacologic treatments prescribed; and headache chronicity and associated symptoms and disorders among their patients with TBI. Completed surveys were received from 193 respondents. The use of standardized classification systems and checklists was commonly reported. Respondents used nonpharmacologic and pharmacologic treatment approaches with similar frequency and modest perceived success rates. A high frequency of headache-associated new sleep and mood disorders was reported. When response differences occurred between practice settings, they reflected a focus on headache diagnosis, classification, and pharmacologic treatment among neurology and specialty headache clinics, whereas a nonpharmacologic approach to management among TBI specialty and general rehabilitation clinicians was more commonly reported. Management strategies for treating headache after TBI vary widely among general and specialty clinical practices. This suggests that additional research is needed that would lead to an increase in the use of established headache classification and the development of standardized management

  11. Radiographer involvement in mammography image interpretation: A survey of United Kingdom practice

    International Nuclear Information System (INIS)

    Culpan, A.M.


    Breast cancer is most often diagnosed using x-ray mammography. Traditionally mammography images have been interpreted and reported by medically qualified practitioners – radiologists. Due to radiologist workforce shortages in recent years some non-medical practitioners, radiographers, now interpret and report mammography images. The aims of this survey were to describe the characteristics and practices of radiographers who interpret and report mammography images in NHS hospitals in the UK, and in particular to establish the extent of their practice beyond low-risk asymptomatic screening cases. This service evaluation demonstrated that UK radiographers are interpreting and reporting images across the full spectrum of clinical indications for mammography including: low-risk population screening, symptomatic, annual surveillance, family history and biopsy/surgical cases. The survey revealed that radiographers are involved in a diverse range of single and double reading practices where responsibility for diagnostic decision making is shared or transferred between radiologists and/or other radiographers. Comparative analysis of sub-group data suggested that there might be differences in the characteristics and practices of radiographers who interpret only low-risk screening mammograms and those who interpret and report a wider range of cases. The findings of this survey provide a platform for further research to investigate how and why the roles and responsibilities of radiographers who interpret and report mammograms vary between organisations, between practitioners and across different examinations. Further research is also needed to explore the implications of variation in practice for patients, practitioners and service providers. - Highlights: • UK radiographers interpret mammograms across the full spectrum of clinical indications. • UK radiographers are involved in a wide range of single/double mammography reading practices. • Characteristics required for

  12. Play and play occupation: a survey of paediatric occupational therapy practice in Ireland

    Directory of Open Access Journals (Sweden)

    Alice Moore


    Full Text Available Purpose - Play occupation has been identified as an essential part of children’s lives, and it subsequently features in paediatric occupational therapy. However, few studies address the current place of play and play occupation in occupational therapy practice. This study aims to address this gap in knowledge by exploring paediatric occupational therapists’ perspectives on the place of play and play occupation in occupational therapy practice in Ireland. Design/methodology/approach - A cross-sectional online survey was conducted to gather data about the current use of play in the occupational therapy for children under 12 years. Convenience sampling and snowball recruitment techniques were used to recruit paediatric occupational therapists. Data were analysed using descriptive statistics and qualitative content analysis. Findings - In total, 65 therapists responded to the survey (estimated response rate, 32%. Results are organised into four sections: demographics and practice context, play assessment practices, use of play in practice and perceived barriers to play-centred practice. Respondents reported that they valued play as a childhood occupation. However, the survey findings identified that the primary focus was on play as a means to an end. Lack of education on play (research, theory and interventions and pressures in the workplace have been identified as barriers to play-centred practice. Research limitations/implications - Findings indicate that there is a mismatch between therapists valuing play as an occupation and how play is used in occupational therapy practice. Unless clarifications are made about play occupation as being different to skills acquisition in childhood, play occupation will continue to get overlooked as an authentic concern of occupation-centred practice. Thus, play as occupation deserves further attention from educators, researchers and practitioners as a means of strengthening occupation-centred practice, in

  13. Science, humanism, judgement, ethics: person-centered medicine as an emergent model of modern clinical practice. (United States)

    Miles, Andrew


    The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patient-centered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies--person-centered healthcare (PCH)--are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities

  14. [Person-centered approach in occupational mental health: theory, research and practice]. (United States)

    Ikemi, A; Kubota, S; Noda, E; Tomita, S; Hayashida, Y


    The objective of this study was to articulate the person-centered approach (PCAp) in theory and in the research and practice of occupational mental health. First, Carl Rogers' person-centered theory was reviewed. Secondly, a study on 1,661 workers was presented in which psychological variables such as fatigue (FG), depression (DP) and anxiety (AX) were found to be negatively correlated with relationship scales concerning the workers' perception of the person-centered attitudes (PCA) of their superiors, the democratic leadership of their superiors (DEM) and the overall activation (ACT) of their worksites. Significant differences in FG, DP and AX were found among workers who perceived of their superiors as having either high or low PCA. Workers who reported that their superiors had high PCA had significantly less FG, DP and AX than those who perceived of their superiors as having low PCA. Similar results were also obtained when high DEM/low DEM and high ACT/low ACT were compared in terms of workers' FG, DP and AX. Thus, the PCA of job superiors was considered to be positively related to the mental health of workers. Thirdly, PCA training in industry was introduced and evaluated. A total of 137 trainees (managers) conducted active listening, a basic skill in the PCAp, and filled out a relationship inventory immediately afterwards, evaluating themselves as listeners and their partners as listeners. A comparison of scores between the first and last sessions of training showed significant increases in empathy, congruence and unconditional positive regard at the last session in both the speakers' version and the listeners' version of the relationship inventory. Cases showing changes in human relations at work as a consequence of PCA training, reported by the trainees and confirmed by an occupational health nurse, were presented. This study showed that PCA, which is positively related to workers' mental health, can increase as a result of training. The implications of

  15. Practice and philosophy of climate model tuning across six US modeling centers

    Directory of Open Access Journals (Sweden)

    G. A. Schmidt


    Full Text Available Model calibration (or tuning is a necessary part of developing and testing coupled ocean–atmosphere climate models regardless of their main scientific purpose. There is an increasing recognition that this process needs to become more transparent for both users of climate model output and other developers. Knowing how and why climate models are tuned and which targets are used is essential to avoiding possible misattributions of skillful predictions to data accommodation and vice versa. This paper describes the approach and practice of model tuning for the six major US climate modeling centers. While details differ among groups in terms of scientific missions, tuning targets, and tunable parameters, there is a core commonality of approaches. However, practices differ significantly on some key aspects, in particular, in the use of initialized forecast analyses as a tool, the explicit use of the historical transient record, and the use of the present-day radiative imbalance vs. the implied balance in the preindustrial era as a target.

  16. Center for Plant Conservation's Best Practice Guidelines for the reintroduction of rare plants

    Institute of Scientific and Technical Information of China (English)

    Joyce Maschinski; Matthew A. Albrecht


    Recent estimates indicate that one-fifth of botanical species worldwide are considered at risk of becoming extinct in the wild. One available strategy for conserving many rare plant species is reintro-duction, which holds much promise especially when carefully planned by following guidelines and when monitored long-term. We review the Center for Plant Conservation Best Reintroduction Practice Guidelines and highlight important components for planning plant reintroductions. Before attempting reintro-ductions practitioners should justify them, should consider alternative conservation strategies, under-stand threats, and ensure that these threats are absent from any recipient site. Planning a reintroduction requires considering legal and logistic parameters as well as target species and recipient site attributes. Carefully selecting the genetic composition of founders, founder population size, and recipient site will influence establishment and population growth. Whenever possible practitioners should conduct rein-troductions as experiments and publish results. To document whether populations are sustainable will require long-term monitoring for decades, therefore planning an appropriate monitoring technique for the taxon must consider current and future needs. Botanical gardens can play a leading role in devel-oping the science and practice of plant reintroduction.

  17. Constraints to connecting children with nature--Survey of U.S. Fish and Wildlife Service employees sponsored by the National Conservation Training Center, Division of Education Outreach (United States)

    Ratz, Joan M.; Schuster, Rudy M.


    The U.S. Fish and Wildlife Service (FWS) names "connecting people with nature" as one of its top six priorities in the online Service Employee Pocket Guide. The National Conservation Training Center (NCTC) took the initiative to identify issues that impede greater progress in addressing constraints to connecting children with nature. The Division of Education Outreach at NCTC formed a working relation with the Policy Analysis and Science Assistance branch of the U.S. Geological Survey to conduct a study on these issues. To meet the objectives of the study, a survey of a sample of FWS employees was conducted. This report includes the description of how the survey was developed and administered, how the data were analyzed, and a discussion of the survey results. The survey was developed based on published literature and incorporated input from two working groups of professionals focused on the issue of connecting children with nature. Although the objective as stated by the FWS is to connect people with nature, the survey primarily focused on connecting children, rather than all people, with nature. The four primary concepts included on the survey were interpretation of how the FWS defined "connection" as part of its mission, perceived success with outreach, constraints to connecting children with nature, and importance of connecting children with nature. The survey was conducted online using KeySurvey© software. The survey was sent to 604 FWS employees. Responses were received from 320 employees. The respondents represented diversity in regions, tenure, wage/grade level, job series, supervisory status, and involvement with education and outreach activities. The key findings of the survey are as follows: * FWS employees believe they as individuals and the agency are successful now and will be more successful in the future in connecting children with nature. * FWS employees believe that there are many outcomes that are relevant to the FWS objective to connect people

  18. The role of the pharmacist in patient-centered medical home practices: current perspectives

    Directory of Open Access Journals (Sweden)

    Lewis NJW


    Full Text Available Nancy JW Lewis,1 Leslie A Shimp,2 Stuart Rockafellow,2 Jeffrey M Tingen,2 Hae Mi Choe,3 Marie A Marcelino21Private consultancy practice, Rochester Hills, MI, USA; 2Clinical, Social and Administrative Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA; 3Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USAAbstract: Patient-centered medical homes (PCMHs are the centerpiece of primary care transformation in the US. They are intended to improve care coordination and communication, enhance health care quality and patient experiences, and lower health care costs by linking patients to a physician-led interdisciplinary health care team. PCMHs are widely supported by health care associations, payers, and employers. Health care accreditation organizations have created performance measures that promote the adoption of PCMH core attributes. Public and private payers are increasingly providing incentives and bonuses related to performance measure status. Evidence-based prescription, medication adherence, medication use coordination, and systems to support medication safety are all necessary components of PCMHs. Pharmacists have unique knowledge and skills that can complement the care provided by other PCMH team members. Their experience in drug therapy assessments, medication therapy management, and population health has documented benefits, both in terms of patient health outcomes and health care costs. Through collaborative care, pharmacists can assist physicians and other prescribers in medication management and thus improve prescriber productivity and patient access to care. Pharmacists are engaged in PCMHs through both employment and contractual arrangements. While some pharmacists serve a unique PCMH, others work within practice networks that serve practices within a geographical area. Financial support for pharmacist-provided services includes university funding, external grant funding

  19. The research-practice relationship in ergonomics and human factors--surveying and bridging the gap. (United States)

    Chung, Amy Z Q; Shorrock, Steven T


    Significant discord has been aired regarding the widening research-practice gap in several disciplines (e.g. psychology, healthcare), especially with reference to research published in academic journals. The research-practice gap has profound and wide-ranging implications for the adequacy of ergonomics and human factors (E/HF) research and the implementation of research findings into practice. However, no substantive research on this issue has been identified in E/HF. Using an online questionnaire, practitioners were asked about their application of scientific research findings published in peer-reviewed journals and to suggest ways to improve research application in practice. A total of 587 usable responses were collected, spanning 46 countries. This article describes some of the key differences and correlations concerning reading, usefulness and barriers to application among respondents, who varied in terms of organisational type, percentage of work time devoted to application vs. research, society membership and experience. Various solutions proposed by the survey respondents on ways to bridge the research-practice gap are discussed. STATEMENT OF RELEVANCE: The relationship between research and practice in E/HF has long been a subject of discussion, with commentators pointing to tension and possible implications for the adequacy of the discipline. Findings from a cross-sectional survey provide ergonomics practitioners' views on research, leading to discussion of strategies for achieving better integration.

  20. Frequency of Yoga Practice Predicts Health: Results of a National Survey of Yoga Practitioners

    Directory of Open Access Journals (Sweden)

    Alyson Ross


    Full Text Available Background. Yoga shows promise as a therapeutic intervention, but relationships between yoga practice and health are underexplored. Purpose. To examine the relationship between yoga practice and health (subjective well-being, diet, BMI, smoking, alcohol/caffeine consumption, sleep, fatigue, social support, mindfulness, and physical activity. Methods. Cross-sectional, anonymous internet surveys distributed to 4307 randomly selected from 18,160 individuals at 15 US Iyengar yoga studios; 1045 (24.3% surveys completed. Results. Mean age 51.7 (± 11.7 years; 84.2% female. Frequency of home practice favorably predicted (P < .001: mindfulness, subjective well-being, BMI, fruit and vegetable consumption, vegetarian status, sleep, and fatigue. Each component of yoga practice (different categories of physical poses, breath work, meditation, philosophy study predicted at least 1 health outcome (P < .05. Conclusions. Home practice of yoga predicted health better than years of practice or class frequency. Different physical poses and yoga techniques may have unique health benefits.

  1. Development of a Survey to Assess the Acceptability of an Innovative Contraception Practice among Rural Pharmacists

    Directory of Open Access Journals (Sweden)

    Michael Wong


    Full Text Available Improved access to effective contraceptive methods is needed in Canada, particularly in rural areas, where unintended pregnancy rates are high and specific sexual health services may be further away. A rural pharmacist may be the most accessible health care professional. Pharmacy practice increasingly incorporates cognitive services. In Canada many provinces allow pharmacists to independently prescribe for some indications, but not for hormonal contraception. To assess the acceptability for the implementation of this innovative practice in Canada, we developed and piloted a survey instrument. We chose questions to address the components for adoption and change described in Rogers’ “diffusion of innovations” theory. The proposed instrument was iteratively reviewed by 12 experts, then focus group tested among eight pharmacists or students to improve the instrument for face validity, readability, consistency and relevancy to community pharmacists in the Canadian context. We then pilot tested the survey among urban and rural pharmacies. 4% of urban and 35% of rural pharmacies returned pilot surveys. Internal consistency on repeated re-phrased questions was high (Cronbach’s Alpha = 0.901. We present our process for the development of a survey instrument to assess the acceptability and feasibility among Canadian community pharmacists for the innovative practice of the independent prescribing of hormonal contraception.

  2. A survey of chiropractors practicing in Germany: practice characteristics, professional reading habits, and attitudes and perceptions toward research

    Directory of Open Access Journals (Sweden)

    Hondras Maria A


    Full Text Available Abstract Background In 2004, a survey conducted by the European Chiropractor's Union among member countries reported that "there appears to be little interest in research among chiropractors in Germany." However, no research has tested this statement. The objective of this study was to explore the attitudes and perceptions of practicing chiropractors in Germany regarding research, to look at their reading and research habits, and to gather demographic and practice data. Methods A questionnaire was developed and distributed among participants at a seminar held by the German Chiropractors' Association in 2005. The questionnaire was mailed to any members of the association who did not attend the seminar. Results A total of 49 (72% of 68 distributed questionnaires were returned. Forty-five (92% respondents stated they would support research efforts in Germany and 15 (31% declared interest in participating in practiced based research. An average of three hours per week were reportedly spent reading scientific literature by 44 (85% respondents. However, few journals listed by respondents were peer-reviewed and indexed; most were newsletters of chiropractic organizations or free publications. Most participants agreed on the importance of research for the profession, but when asked about the most pressing issue for chiropractic in Germany, legislation and recognition of the profession were the dominant themes. Conclusion The results of this survey show that there is a general interest in supporting and participating in research activities among chiropractors practicing in Germany. Next steps could consist of educating practitioners about the resources available to read and interpret the scientific literature and thus further the understanding of research.

  3. Practice nurses' workload, career intentions and the impact of professional isolation: A cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Watt Graham CM


    Full Text Available Abstract Background Practice nurses have a key role within UK general practice, especially since the 2004 GMS contract. This study aimed to describe that role, identify how professionally supported they felt and their career intentions. An additional aim was to explore whether they felt isolated and identify contributory factors. Methods A cross-sectional questionnaire survey in one large urban Scottish Health Board, targeted all practice nurses (n = 329. Domains included demographics, workload, training and professional support. Following univariate descriptive statistics, associations between categorical variables were tested using the chi-square test or chi-square test for trend; associations between dichotomous variables were tested using Fisher's Exact test. Variables significantly associated with isolation were entered into a binary logistic regression model using backwards elimination. Results There were 200 responses (61.0% response rate. Most respondents were aged 40 or over and were practice nurses for a median of 10 years. Commonest clinical activities were coronary heart disease management, cervical cytology, diabetes and the management of chronic obstructive pulmonary disease. Although most had a Personal Development Plan and a recent appraisal, 103 (52.3% felt isolated at least sometimes; 30 (15.5% intended leaving practice nursing within 5 years. Isolated nurses worked in practices with smaller list sizes (p = 0.024 and nursing teams (p = 0.003; were less likely to have someone they could discuss a clinical/professional (p = 0.002 or personal (p Conclusions A significant proportion of practice nurses reported feeling isolated, at least some of the time. They were more likely to be in small practices and more likely to be considering leaving practice nursing. Factors contributing to their isolation were generally located within the practice environment. Providing support to these nurses within their practice setting may help

  4. Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians. (United States)

    Garcia Guerra, Gonzalo; Joffe, Ari R; Cave, Dominic; Duff, Jonathan; Duncan, Shannon; Sheppard, Cathy; Tawfik, Gerda; Hartling, Lisa; Jou, Hsing; Vohra, Sunita


    Despite the fact that almost all critically ill children experience some degree of pain or anxiety, there is a lack of high-quality evidence to inform preferred approaches to sedation, analgesia, and comfort measures in this environment. We conducted this survey to better understand current comfort and sedation practices among Canadian pediatric intensivists. The survey was conducted after a literature review and initial focus groups. The survey was then pretested and validated. The final survey was distributed by email to 134 intensivists from 17 PICUs across Canada using the Research Electronic Data Capture system. The response rate was 73% (98/134). The most commonly used sedation scores are Face, Legs, Activity, Cry, and Consolability (42%) and COMFORT (41%). Withdrawal scores are commonly used (65%). In contrast, delirium scores are used by only 16% of the respondents. Only 36% of respondents have routinely used sedation protocols. The majority (66%) do not use noise reduction methods, whereas only 23% of respondents have a protocol to promote day/night cycles. Comfort measures including music, swaddling, soother, television, and sucrose solutions are frequently used. The drugs most commonly used to provide analgesia are morphine and acetaminophen. Midazolam and chloral hydrate were the most frequent sedatives. Our survey demonstrates great variation in practice in the management of pain and anxiety in Canadian PICUs. Standardized strategies for sedation, delirium and withdrawal, and sleep promotion are lacking. There is a need for research in this field and the development of evidence-based, pediatric sedation and analgesia guidelines.

  5. Summary of the East Africa Training Consortium Biorisk Management Practices and Training Needs Survey

    Energy Technology Data Exchange (ETDEWEB)

    Wilder, Julie; Mancini, Giulio M.; Wakabi, Timothy; Boggs, Susan E.


    A survey was designed to query former Biorisk management (BRM) trainees in the East Africa region about their practices post-training and their perceived future training needs. A subset of those surveyed had been trained as BRM trainers. The survey was conducted to obtain a baseline of BRM practices that can serve as a benchmark for performance monitoring, to identify priorities for future BRM training and to gauge local BRM trainers' abilities to deliver effective training. The survey revealed that less than 50% of the respondents could identify evidence of a BRM system in their institute. Coaching and mentoring by BRM experts was identified as being of highest benefit to enable success as BRM practitioners. Local trainers reached 1538 trainees in the previous year and reported that trainings positively correlated with desired BRM behavior. Acknowledgements The authors wish to sincerely thank all of the former biorisk management trainees in East Africa who agreed to participate in this survey. Their candid and honest input was extremely insightful. We also thank Lora Grainger (06826) and Ben Brodsky (Manager, 06824) for careful and critical review of the report. We are grateful for the financial support of the Defense Threat Reduction Agency, Cooperative Biological Engagement Program.

  6. A survey of Korean medicine doctors' clinical practice patterns for autism spectrum disorder: preliminary research for clinical practice guidelines. (United States)

    Lee, Jihong; Lee, Sun Haeng; Lee, Boram; Yang, In Jun; Chang, Gyu Tae


    The aim of this study was to investigate autism spectrum disorder (ASD) clinical practice patterns of Korean medicine doctors (KMDs) through questionnaire survey. Questionnaires on Korean medicine (KM) treatment for ASD were distributed to 255 KMDs on December 5, 2016. The KMDs were psychiatrists, pediatricians, or general practitioners, who treated patients with ASD. The questionnaire covered items on treatment methods, aims of treatment, KM syndrome differentiation, diagnostic tools, and sociodemographic characteristics. Frequency analysis was conducted to describe the participants and their practices. A total 22.4% KMDs (n = 57/255) completed the questionnaires and 54 KMDs (21.2%) matched the inclusion criteria. The KMDs utilized herbal medicine (27.3%), body acupuncture (17.6%), scalp acupuncture (10.7%), moxibustion (6.4%), and Korean medical psychotherapy (5.9%) to treat ASD. The most commonly prescribed herbal medicine was Yukmijihwang-tang. Forty-eight (88.9%) KMDs responded that they used KM syndrome differentiation. 'Organ system, Qi, Blood, Yin, Yang, Fluid and Humor diagnosis' was most frequently used for syndrome differentiation. ASD was mainly diagnosed based on the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and DSM-5. The present study demonstrated the current status of KMDs' diagnosis and treatment of ASD. In future clinical trials and clinical practice guidelines, these findings will provide meaningful information on the actual practice patterns of KMDs.

  7. Current practice and recommendations in UK epilepsy monitoring units. Report of a national survey and workshop. (United States)

    Hamandi, Khalid; Beniczky, Sandor; Diehl, Beate; Kandler, Rosalind H; Pressler, Ronit M; Sen, Arjune; Solomon, Juliet; Walker, Matthew C; Bagary, Manny


    Inpatient video-EEG monitoring (VEM) is an important investigation in patients with seizures or blackouts, and in the pre-surgical workup of patients with epilepsy. There has been an expansion in the number of Epilepsy Monitoring Units (EMU) in the UK offering VEM with a necessary increase in attention on quality and safety. Previous surveys have shown variation across centres on issues including consent and patient monitoring. In an effort to bring together healthcare professionals in the UK managing patients on EMU, we conducted an online survey of current VEM practice and held a one-day workshop convened under the auspices of the British Chapter of the ILAE. The survey and workshop aimed to cover all aspects of VEM, including pre-admission, consent procedures, patient safety, drug reduction and reinstatement, seizure management, staffing levels, ictal testing and good data recording practice. This paper reports on the findings of the survey, the workshop presentations and workshop discussions. 32 centres took part in the survey and there were representatives from 22 centres at the workshop. There was variation in protocols, procedures and consent processes between units, and levels of observation of monitored patients. Nevertheless, the workshop discussion found broad areas of agreement on points. A survey and workshop of UK epilepsy monitoring units found that some variability in practice is inevitable due to different local arrangements and patient groups under investigation. However, there were areas of clear consensus particularly in relation to consent and patient safety that can be applied to most units and form a basis for setting minimum standards. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  8. Person-centered osteopathic practice: patients' personality (body, mind, and soul) and health (ill-being and well-being). (United States)

    Fahlgren, Elin; Nima, Ali A; Archer, Trevor; Garcia, Danilo


    Background. Osteopathic philosophy and practice are congruent with the biopsychosocial model, a patient-centered approach when treating disease, and the view of the person as a unity (i.e., body, mind, and soul). Nevertheless, a unity of being should involve a systematic person-centered understanding of the patient's personality as a biopsychosociospiritual construct that influences health (i.e., well-being and ill-being). We suggest Cloninger's personality model, comprising temperament (i.e., body) and character (i.e., mind and soul), as a genuine paradigm for implementation in osteopathic practice. As a first step, we investigated (1) the relationships between personality and health among osteopathic patients, (2) differences in personality between patients and a control group, and (3) differences in health within patients depending on the presenting problem and gender. Method. 524 osteopathic patients in Sweden (age mean = 46.17, SD = 12.54, 388 females and 136 males) responded to an online survey comprising the Temperament and Character Inventory and measures of health (well-being: life satisfaction, positive affect, harmony in life, energy, and resilience; ill-being: negative affect, anxiety, depression, stress, and dysfunction and suffering associated to the presenting problem). We conducted two structural equation models to investigate the association personality-health; graphically compared the patients' personality T-scores to those of the control group and compared the mean raw scores using t-tests; and conducted two multivariate analyses of variance, using age as covariate, to compare patients' health in relation to their presenting problem and gender. Results. The patients' personality explained the variance of all of the well-being (R (2) between .19 and .54) and four of the ill-being (R (2) between .05 and .43) measures. Importantly, self-transcendence, the spiritual aspect of personality, was associated to high levels of positive emotions and

  9. A survey of current practice of vascular surgeons in venous disease management. (United States)

    Bush, Ruth L; Gloviczki, Peter


    Acute venous thromboembolism and chronic venous diseases are common conditions that affect a large proportion of the United States population. The diagnosis of venous disease has improved, and the treatment options have rapidly evolved over the past decade. To date, it is unclear to what extent vascular surgeons have become involved in the modern management of venous disorders. This survey was undertaken to explore the current interest and practice of vascular surgeons in the contemporary care of venous disease. A survey was administered via a web-based platform to active and candidate members of the Society for Vascular Surgery (SVS). The survey included 30 questions investigating the characteristics of venous surgeons and scope of venous practice. Open-ended questions were also included for commentary. A total of 1879 surveys were sent to SVS members nationwide, and 385 members participated (response rate of 20.5%). The participants were mostly men (89.6%) with 37.7% practicing in an academic setting and 59.2% in private practice. The respondents treated superficial veins (92.9%) and deep veins (85.8%) in clinical practice, with 89.9% having their own vascular laboratory. A wide spectrum of interventions for superficial (91.9%), deep (85.8%), and perforator veins (52.7% endovenous, 19.4% subfascial endoscopic perforator surgery) are being performed by respondents. Only 26.2% had learned endovenous thermal ablation in their training program; however, over 96% of those performing venous interventions utilized this technique. Overall, the majority (85.5%) devoted 50% or less of practice to venous disorders. Respondents indicated that limitations to expansion of vein practices mainly involved challenges with third party payers, local competition, and existing large volumes of arterial interventions needing to be performed. Despite the widespread incorporation of venous disease into current vascular practices, 66.1% are not members of the American Venous Forum (AVF

  10. Environmental health knowledge and practice survey among secondary schoolchildren in Zaria, Nigeria.


    Ebong, R D


    Knowledge of environmental health was assessed in a sample of 192 students at Ja'afaru Secondary School, Zaria, Nigeria, by means of a questionnaire. A follow-up practice survey was also administered to assess the environmental sanitation of the school and the homes of a subsample of the students. Observations were recorded on the sources of water, the methods of refuse and sewage disposal, and the hygienic condition of the toilets in both the school and the homes surveyed. The findings indic...

  11. John F. Kennedy Space Center, Safety, Reliability, Maintainability and Quality Assurance, Survey and Audit Program (United States)


    This document is the product of the KSC Survey and Audit Working Group composed of civil service and contractor Safety, Reliability, and Quality Assurance (SR&QA) personnel. The program described herein provides standardized terminology, uniformity of survey and audit operations, and emphasizes process assessments rather than a program based solely on compliance. The program establishes minimum training requirements, adopts an auditor certification methodology, and includes survey and audit metrics for the audited organizations as well as the auditing organization.

  12. A state-of-practice survey of policy, plan, and program assessment in Canadian provinces

    International Nuclear Information System (INIS)

    Noble, Bram F.


    Since the introduction of the 1999 Canadian Cabinet Directive on the environmental assessment of policies, plans, and programs (PPPs), higher-order environmental assessment has been receiving increased attention in Canada. However, while practices and systems are advancing at the federal level, there has been very little attention given to recent developments in PPP assessment at the provincial level. This paper presents the results of a Canada-wide survey of PPP assessment principles and practices in 10 Canadian provincial EA jurisdictions. The findings indicate that there exists considerable variability in the provisions for and practice of PPP assessment amongst Canadian provinces, with only Saskatchewan, Ontario, and Quebec identifying recent practice experience. Included amongst the main barriers to effective implementation at the provincial level are the lack of legislative requirements for strategic EA, and the limited understanding of the nature and benefits of higher-order impact assessment

  13. Continuous improvement in the Netherlands: A survey-based study into the current practices of continuous improvement

    NARCIS (Netherlands)

    Middel, H.G.A.; op de Weegh, S.; Gieskes, J.F.B.; Schuring, R.W.


    Continuous Improvement is a well-known and consolidated concept in literature and practice and is considered vital in today¿s business environment. In 2003 a survey, as part of the international CINet survey, has been performed in the Netherlands in order to gain insight into the current practices

  14. A survey of current practices in management of Hirschsprung′s disease in Nigeria

    Directory of Open Access Journals (Sweden)

    Abdulrasheed A. Nasir


    Full Text Available Background: Although there are several modalities of treatment for Hirschsprung′s disease (HD, there are presently no clear guidelines on treatment of the condition by paediatric surgeons in Nigeria. This survey determines the current approach to treatment among Nigerian paediatric surgeons and should help in establishing a consensus and guidelines for care in this and similar setting. Materials and Methods: An online questionnaire was designed using survey Monkey ® to determine current clinical and operative management of patients with HD by consultant paediatric surgeons practicing in the Nigeria. The paediatric surgeons were notified by E-mail, which included a link to the survey on survey Monkey ® . The survey was also administered at the 12 th annual meeting of Association of Paediatric Surgeons of Nigeria in September, 2013, to capture those who did not complete the online survey. Thirty-one paediatric surgeons from 21 different tertiary paediatric surgery centres completed the survey. Results: Sixteen (52% respondents see up to 20% of their patients with HD in the neonatal period. Twenty-six (84% respondents do routine barium enema. Twenty six (84% respondents do full thickness rectal biopsy under general anaesthesia (GA. There was no consistency in operative techniques, with transabominal Swenson′s operation being practiced by 17 (57% respondents and 11 (37% transanal endorectal pull through. 14 (45% do pull through at any age. 12 (39% respondents do more than half of their patient as primary pull through. Conclusion: Full thickness rectal biopsy under GA is still the vogue with variations in the surgical technique for management of Hirshsprung′s disease in Nigeria. Primary pull through procedures is becoming increasingly popular. There′s a need for Paediatric Surgeons in Nigeria to come up with a guideline on management of HD, to guide trainees and other surgeons in the care of these patients.

  15. Nuclear Energy Center Site Survey, 1975. Part V. Resource availability and site screening

    International Nuclear Information System (INIS)


    Resource requirements for nuclear energy centers are discussed and the large land areas which meet these requirements and may contain potential sites for a nuclear energy center (NEC) are identified. Maps of the areas are included that identify seismic zones, river flow rates, and population density

  16. Exposure control practices for administering nitrous oxide: A survey of dentists, dental hygienists, and dental assistants. (United States)

    Boiano, James M; Steege, Andrea L; Sweeney, Marie H


    Engineering, administrative, and work practice controls have been recommended for many years to minimize exposure to nitrous oxide during dental procedures. To better understand the extent to which these exposure controls are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing dentists, dental hygienists and dental assistants. The anonymous, modular, web-based survey was completed by 284 dental professionals in private practice who administered nitrous oxide to adult and/or pediatric patients in the seven days prior to the survey. Use of primary engineering controls (i.e., nasal scavenging mask and/or local exhaust ventilation (LEV) near the patient's mouth) was nearly universal, reported by 93% and 96% of respondents who administered to adult (A) and pediatric (P) patients, respectively. However, adherence to other recommended precautionary practices were lacking to varying degrees, and were essentially no different among those administering nitrous oxide to adult or pediatric patients. Examples of work practices which increase exposure risk, expressed as percent of respondents, included: not checking nitrous oxide equipment for leaks (41% A; 48% P); starting nitrous oxide gas flow before delivery mask or airway mask was applied to patient (13% A; 12% P); and not turning off nitrous oxide gas flow before turning off oxygen flow to the patient (8% A; 7% P). Absence of standard procedures to minimize worker exposure to nitrous oxide (13% of all respondents) and not being trained on safe handling and administration of nitrous oxide (3%) were examples of breaches of administrative controls which may also increase exposure risk. Successful management of nitrous oxide emissions should include properly fitted nasal scavenging masks, supplemental LEV (when nitrous oxide levels cannot be adequately controlled using nasal masks alone), adequate general ventilation, regular

  17. Current Ketamine Practice: Results of the 2016 American Society of Pain Management Nursing Survey on Ketamine. (United States)

    Klaess, Cynthia C; Jungquist, Carla R


    Ketamine is increasingly utilized for a variety of pain management challenges. Audience comments from a ketamine presentation at the 2015 American Society of Pain Management Nursing (ASPMN) Conference reflected wide variation in ketamine practices as well as barriers to use. The goal was to gain a greater understanding of ASPMN member practice patterns and barriers related to ketamine as adjunctive therapy for pain management. A questionnaire survey design was used. Respondents represented 35 states and 2 countries. The participants were 146 respondents from ASPMN membership (1,485 members). The survey was distributed by ASPMN on SurveyMonkey. Practice setting and ketamine administration practices were assessed with areas for comments. Results were reviewed using frequencies to describe responses and formatted into tables. Comments were individually reviewed and grouped into common themes. Administration of ketamine as an analgesic was reported by 63% of respondents. Continuous intravenous ketamine infusions were the most common route of administration (65%); however, wide variability in dosing and length of therapy was reported. A wide variety of practices and challenges related to ketamine utilization were noted. Numerous studies have indicated the analgesic benefits of ketamine in pain management. The lack of practice standardization has created challenges to its consistent use and outcome measurement. Additionally, the off-label use of ketamine for pain management creates its own unique challenges. However, given the current national climate with intense focus on pain management, interdisciplinary practitioners have an ideal opportunity to evaluate ketamine's use in a comprehensive approach to pain management. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  18. Who Justifies Questionable Reporting Practices? Answers from a Representative Survey of Journalists in Germany

    Directory of Open Access Journals (Sweden)

    Philip Baugut


    Full Text Available Based on a secondary analysis of representative survey data of journalists in Germany (n= 1536, this paper draws attention to two variables that are important when it comes to explain whether journalists accept questionable reporting practices, such as paying people to obtain information or using confidential government documents without permission. First, perceived role achievement is important, as journalists who do not feel able to achieve an active role tend to accept questionable reporting practices more often. Second, however, this relationship is only true for journalists having a moderate tendency to the political left. Findings are explained by means of the theory of cognitive dissonance.

  19. Knowledge, Beliefs and Practices Regarding Antiretroviral Medications for HIV Prevention: Results from a Survey of Healthcare Providers in New England.

    Directory of Open Access Journals (Sweden)

    Douglas S Krakower

    Full Text Available Antiretroviral treatment for HIV-infection before immunologic decline (early ART and pre-exposure chemoprophylaxis (PrEP can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited.Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices.Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample, 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01-1.34 and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98-11.2 were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06-1.34, whereas female gender (aOR 0.26, 95% CI 0.10-0.71 was associated with having not

  20. Translating research into practice through user-centered design: An application for osteoarthritis healthcare planning. (United States)

    Carr, Eloise Cj; Babione, Julie N; Marshall, Deborah


    To identify the needs and requirements of the end users, to inform the development of a user-interface to translate an existing evidence-based decision support tool into a practical and usable interface for health service planning for osteoarthritis (OA) care. We used a user-centered design (UCD) approach that emphasized the role of the end-users and is well-suited to knowledge translation (KT). The first phase used a needs assessment focus group (n=8) and interviews (n=5) with target users (health care planners) within a provincial health care organization. The second phase used a participatory design approach, with two small group sessions (n=6) to explore workflow, thought processes, and needs of intended users. The needs assessment identified five design recommendations: ensuring the user-interface supports the target user group, allowing for user-directed data explorations, input parameter flexibility, clear presentation, and provision of relevant definitions. The second phase identified workflow insights from a proposed scenario. Graphs, the need for a visual overview of the data, and interactivity were key considerations to aid in meaningful use of the model and knowledge translation. A UCD approach is well suited to identify health care planners' requirements when using a decision support tool to improve health service planning and management of OA. We believe this is one of the first applications to be used in planning for health service delivery. We identified specific design recommendations that will increase user acceptability and uptake of the user-interface and underlying decision support tool in practice. Our approach demonstrated how UCD can be used to enable knowledge translation. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Data Basin Aquatic Center: expanding access to aquatic conservation data, analysis tools, people and practical answers (United States)

    Osborne-Gowey, J.; Strittholt, J.; Bergquist, J.; Ward, B. C.; Sheehan, T.; Comendant, T.; Bachelet, D. M.


    The world’s aquatic resources are experiencing anthropogenic pressures on an unprecedented scale and aquatic organisms are experiencing widespread population changes and ecosystem-scale habitat alterations. Climate change is likely to exacerbate these threats, in some cases reducing the range of native North American fishes by 20-100% (depending on the location of the population and the model assumptions). Scientists around the globe are generating large volumes of data that vary in quality, format, supporting documentation, and accessibility. Moreover, diverse models are being run at various temporal and spatial scales as scientists attempt to understand previous (and project future) human impacts to aquatic species and their habitats. Conservation scientists often struggle to synthesize this wealth of information for developing practical on-the-ground management strategies. As a result, the best available science is often not utilized in the decision-making and adaptive management processes. As aquatic conservation problems around the globe become more serious and the demand to solve them grows more urgent, scientists and land-use managers need a new way to bring strategic, science-based, and action-oriented approaches to aquatic conservation. The Conservation Biology Institute (CBI), with partners such as ESRI, is developing an Aquatic Center as part of a dynamic, web-based resource (Data Basin; http: that centralizes usable aquatic datasets and provides analytical tools to visualize, analyze, and communicate findings for practical applications. To illustrate its utility, we present example datasets of varying spatial scales and synthesize multiple studies to arrive at novel solutions to aquatic threats.

  2. 2008 HIMSS Survey results: best practices in implementing nursing/interdisciplinary documentation systems. (United States)

    Newbold, Susan K; Kimmel, Kathleen C; O'Steen, Randy; Morgan, Gina Sauls


    Health care organizations are increasingly using computer systems to support nursing care documentation; however, processes used to deploy such systems are widely varied. The purpose of this survey was to understand current practices related to implementation of computerized nursing and interdisciplinary documentation systems with the goal to establish best practice guidelines. In Spring 2007, members from the Healthcare Information Management and Systems Society Nursing Informatics Working Group interviewed a sample of 15 hospitals to solicit information regarding the following processes: leadership activities, clinical transformation processes, project management activities, implementation processes, evaluation metrics, terminology and other standards used, and methods used to facilitate end-user adoption. This poster will report the results of this survey. Implications for Nurses will be discussed. The results are valuable to nursing informatics professionals who plan to implement systems and to their nursing executives responsible for the systems that are implemented.

  3. Older Driver Safety: A Survey of Psychologists' Attitudes, Knowledge, and Practices. (United States)

    Love, Janet; Tuokko, Holly


    Using an online survey, we examined the knowledge, attitudes, and practices with respect to older driver safety concerns of clinical psychologists from across Canada who self-identified as working with at least some drivers over 60 years of age. Eighty-four psychologists completed the survey, and many were aware of the issues relevant to older driver safety, although only about half reported that assessing fitness to drive was an important issue in their practice. The majority (75%) reported that they would benefit from education concerning evaluation of fitness to drive. The primary recommendation emerging from this investigation is to increase efforts to inform and educate psychologists about driving-related assessment and regulatory issues in general, and specifically with respect to older adults. As the population ages, it is of growing importance for all health care providers to understand the influence of mental health conditions-including cognitive impairment and dementia-on driving skills.

  4. Effect of center practices on the choice of the first dialysis modality for children and young adults. (United States)

    Hogan, Julien; Ranchin, Bruno; Fila, Marc; Harambat, Jérome; Krid, Saoussen; Vrillon, Isabelle; Roussey, Gwenaelle; Fischbach, Michel; Couchoud, Cécile


    Peritoneal dialysis (PD) remains the modality of choice in children, but there is no clear evidence to support a better outcome in children treated with PD. We aimed to assess factors that have an impact on the choice of dialysis modality in children and young adults in France and sought to determine the roles of medical factors and center practices. We included all patients aged dialysis modality. We included 806 patients starting RRT in 177 centers, 23 of which were specialized pediatric centers. Six hundred and one patients (74.6 %) started with hemodialysis (HD), whereas 205 (25.4 %) started with PD. A greater probability of PD was found in younger children, whereas starting the treatment in an emergency setting was associated with a low use of PD. We found a significant variability among centers that accounted for 43 % of the total variability. The probability of PD was higher in adult centers and was proportional to the rate of PD in the center. Center practices are a major factor in the choice of dialysis modality. This raises concerns about patient and family choices and to what extent doctors may influence the final decision. Further pediatric studies focusing on children's and parents' wishes are needed to provide care as close as possible to patients' and families' expectations.

  5. Multidisciplinary Views on Applying Explicit and Implicit Motor Learning in Practice: An International Survey.

    Directory of Open Access Journals (Sweden)

    Melanie Kleynen

    Full Text Available A variety of options and techniques for causing implicit and explicit motor learning have been described in the literature. The aim of the current paper was to provide clearer guidance for practitioners on how to apply motor learning in practice by exploring experts' opinions and experiences, using the distinction between implicit and explicit motor learning as a conceptual departure point.A survey was designed to collect and aggregate informed opinions and experiences from 40 international respondents who had demonstrable expertise related to motor learning in practice and/or research. The survey was administered through an online survey tool and addressed potential options and learning strategies for applying implicit and explicit motor learning. Responses were analysed in terms of consensus (≥ 70% and trends (≥ 50%. A summary figure was developed to illustrate a taxonomy of the different learning strategies and options indicated by the experts in the survey.Answers of experts were widely distributed. No consensus was found regarding the application of implicit and explicit motor learning. Some trends were identified: Explicit motor learning can be promoted by using instructions and various types of feedback, but when promoting implicit motor learning, instructions and feedback should be restricted. Further, for implicit motor learning, an external focus of attention should be considered, as well as practicing the entire skill. Experts agreed on three factors that influence motor learning choices: the learner's abilities, the type of task, and the stage of motor learning (94.5%; n = 34/36. Most experts agreed with the summary figure (64.7%; n = 22/34.The results provide an overview of possible ways to cause implicit or explicit motor learning, signposting examples from practice and factors that influence day-to-day motor learning decisions.

  6. HMOs and physician recruiting: a survey of problems and methods among group practice plans.


    Fink, R


    A mail survey was conducted among 69 group practice health maintenance organizations (HMOs) to collect information on the recruiting of primary care physicians and specialists. In reporting on difficulties in recruiting physicians for primary care, the medical directors of HMOs indicated that the greatest problem was locating obstetrician-gynecologists. Among specialists, recruiting for orthopedists was reported as being most difficult, although plans that employ neurologists and anesthesiolo...

  7. Pediatric First Aid Practices in Ghana: A Population-Based Survey. (United States)

    Gyedu, Adam; Mock, Charles; Nakua, Emmanuel; Otupiri, Easmon; Donkor, Peter; Ebel, Beth E


    Children in low- and middle-income countries (LMIC) often receive care outside the formal medical sector. Improving pre-hospital first aid has proven to be highly cost-effective in lowering trauma mortality. Few studies in LMIC have examined home first aid practices for injured children. We conducted a representative population-based survey of 200 caregivers of children under 18 years of age, representing 6520 households. Caregivers were interviewed about their first aid practices and care-seeking behaviors when a child sustained an injury at home. Injuries of interest included burns, lacerations, fractures and choking. Reported practices were characterized as recommended, low-risk, and potentially harmful. For common injuries, 75-96% of caregivers reported employing a recommended practice (e.g., running cool water over a burn injury). However, for these same injuries, 13-61% of caregivers also identified potentially harmful management strategies (e.g., applying sand to a laceration). Choking had the highest proportion (96%) of recommended first aid practice: (e.g., hitting the child's back) and the lowest percent (13%) of potentially harmful practices (e.g., attempting manual removal). Fractures had the lowest percent (75%) of recommended practices (e.g., immediately bringing the child to a health facility). Burns had the highest percent (61%) of potentially harmful practices (e.g., applying kerosene). While most caregivers were aware of helpful first aid practices to administer for a child injury, many parents also described potentially harmful practices or delays in seeking medical attention. As parents are the de facto first responders to childhood injury, there are opportunities to strengthen pre-hospital care for children in LMICs.

  8. Protocol for determining primary healthcare practice characteristics, models of practice and patient accessibility using an exploratory census survey with linkage to administrative data in Nova Scotia, Canada. (United States)

    Marshall, Emily Gard; Gibson, Richard J; Lawson, Beverley; Burge, Frederick


    There is little evidence on how primary care providers (PCPs) model their practices in Nova Scotia (NS), Canada, what services they offer or what accessibility is like for the average patient. This study will create a database of all family physicians and primary healthcare nurse practitioners in NS, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. 3 census surveys of all family physicians, primary care nurse practitioners (ie, PCPs) and their practices in NS will be conducted. The first will be a telephone survey conducted during typical daytime business hours. At each practice, the person answering the telephone will be asked questions about the practice's accessibility and model of care. The second will be a telephone survey conducted after typical daytime business hours to determine what out-of-office services PCP practices offer their patients. The final will be a tailored fax survey that will collect information that could not be obtained in the first 2 surveys plus new information on scope of practice, practice model and willingness to participate in research. Survey data will be linked with billing data from administrative health databases. Multivariate regression analysis will be employed to assess whether access and availability outcome variables are associated with PCP and model of practice characteristics. Negative binomial regression analysis will be employed to assess the association between independent variables from the survey data and health system use outcomes from administrative data. This study has received ethical approval from the Nova Scotia Health Authority and the Health Data Nova Scotia Data Access Committee. Dissemination approached will include stakeholder engagement at local and national levels, conference presentations, peer-reviewed publications and a public website. Published by the BMJ Publishing Group Limited. For permission to

  9. Unpacking prevention capacity: an intersection of research-to-practice models and community-centered models. (United States)

    Flaspohler, Paul; Duffy, Jennifer; Wandersman, Abraham; Stillman, Lindsey; Maras, Melissa A


    Capacity is a complex construct that lacks definitional clarity. Little has been done to define capacity, explicate components of capacity, or explore the development of capacity in prevention. This article represents an attempt to operationalize capacity and distinguish among types and levels of capacity as they relate to dissemination and implementation through the use of a taxonomy of capacity. The development of the taxonomy was informed by the capacity literature from two divergent models in the field: research-to-practice (RTP) models and community-centered (CC) models. While these models differ in perspective and focus, both emphasize the importance of capacity to the dissemination and sustainability of prevention innovations. Based on the review of the literature, the taxonomy differentiates the concepts of capacity among two dimensions: level (individual, organizational, and community levels) and type (general capacity and innovation-specific capacity). The proposed taxonomy can aid in understanding the concept of capacity and developing methods to support the implementation and sustainability of prevention efforts in novel settings.

  10. Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices. (United States)

    Kano, Miria; Silva-Bañuelos, Alma Rosa; Sturm, Robert; Willging, Cathleen E


    Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities. We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps. Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents. This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented. © Copyright 2016 by the American Board of Family Medicine.

  11. A Survey of Rounding Practices in Canadian Adult Intensive Care Units.

    Directory of Open Access Journals (Sweden)

    Jessalyn K Holodinsky

    Full Text Available To describe rounding practices in Canadian adult Intensive Care Units (ICU and identify opportunities for improvement.Mixed methods design. Cross sectional survey of Canadian Adult ICUs (n = 180 with purposefully sampled follow-up interviews (n = 7.Medical directors representing 111 ICUs (62% participated in the survey. Rounding practices varied across ICUs with the majority reporting the use of interprofessional rounds (81% that employed an open (94% and collaborative (86% approach, occurred at the patient's bedside (82%, and started at a standard time (79% and standard location (56%. Most participants reported that patients (83% and family members (67% were welcome to attend rounds. Approximately half of ICUs (48% used tools to facilitate rounds. Interruptions during rounds were reported to be common (i.e., ≥ 1 interruption for ≥ 50% of patients in 46% of ICUs. Four themes were identified from qualitative analysis of participant responses to open-ended survey questions and interviews: multidisciplinarity, patient and family involvement, factors influencing productivity, and teaching and learning.There is considerable variation in current rounding practices in Canadian medical/surgical ICUs. Opportunities exist to improve ICU rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality.

  12. A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs. (United States)

    Martin, Shelly D; Bush, Anneke C; Lynch, Julia A


    Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

  13. Chronic Subdural Hematoma: A Questionnaire Survey of Management Practice in India and Review of Literature. (United States)

    Avanali, Raghunath; Bhadran, Biju; Krishna Kumar, P; Vijayan, Abhishek; Arun, S; Musthafa, Aneeze M; Panchal, Sunil; Gopal, Vinu V


    To identify the current management modalities practiced by neurosurgeons in India for chronic subdural hematoma. A questionnaire was prepared for the survey and sent via e-mail to neurosurgeons. It covered the following aspects of managing chronic subdural hematoma: 1) demographic and institutional details; 2) choice of surgical procedure; 3) surgical adjutants such as placing a subdural drain; 4) pre- and postoperative care; and 5) recurrences and management. Responses obtained were entered in a SPSS data sheet and analyzed. Response rate of the survey was 9.3%. The majority of neurosurgeons (75%) preferred to do burr whole drainage for primary chronic subdural hematoma and also for recurrences. Only one third of routinely placed a subdural drain. Considerable practice variations exist for medical and perioperative management. Bedside twist drill drainage, which is effective and less costly than operative room procedures, has not gained popularity in practice. The present survey points towards the importance of making management guidelines for this common neurosurgical entity. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Secondary EFL School Teachers' Perceptions of CLT Principles and Practices: An Exploratory Survey

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Anani Sarab


    Full Text Available Communicative Language Teaching (CLT is advocated by many applied linguists as a common vehicle to curriculum innovation in many ELT contexts. It represents a change of focus in language teaching from linguistic structures to learners’ need for developing communication skills. In recent years, the Iranian Ministry of Education has introduced the development of a new English curriculum for secondary schools with the aim of establishing the use of communicative activities in language classes. The present study was an attempt to investigate Iranian teachers’ perception of CLT principles and practices through a survey of 75 secondary school teachers in the context of the newly introduced English language curriculum developed based on CLT principles. Based on a combination of quantitative and qualitative data using a semi-structured questionnaire supplemented with interviews with a smaller group of teachers, the results of the survey revealed that a change in classroom arrangements is required before CLT can be practiced in secondary school English classes in Iran. The results also showed that the employment of CLT procedures at the local level is at its beginning stages and might take time to take root. The conclusion is that for the suggested changes in the curriculum to be implemented and realized in English education in Iran, the findings of more comprehensive surveys complemented with observation of teachers’ instructional practices is required to inform the change implementation.

  15. Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California. (United States)

    Lundsberg, Lisbet S; Lee, Henry C; Dueñas, Grace Villarin; Gregory, Kimberly D; Grossetta Nardini, Holly K; Pettker, Christian M; Illuzzi, Jessica L; Xu, Xiao


    To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests. Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04). Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.

  16. Public attitudes toward practice by medical students: a nationwide survey in Japan. (United States)

    Murata, Kyoko; Sakuma, Mio; Seki, Susumu; Morimoto, Takeshi


    It is essential for medical students to interact directly with patients. However, patients may be reluctant to be seen by medical students in settings in which they may also be seen by senior staff. To understand patients' attitudes toward practice by medical students and consider the factors involved in obtaining patients' cooperation, we conducted a nationwide cross-sectional survey. We randomly selected 2,400 adult participants from all over Japan. Trained research assistants inquired about participants' experiences and attitudes toward practice by medical students using a questionnaire. We compared differences in attitudes between participants who were accepting of practice by medical students and those who were not, as well as differences between participants who had experienced practice by a medical student versus those who had not. A total of 1,109 (46%) participants were included in the study. Eleven percent (117/1109) of the participants had experienced practice by a medical student. One fourth of participants were accepting of practice by medical students, and experienced participants were significantly more likely to be accepting of practice by medical students than inexperienced participants (45% vs. 24%, ppractice by medical students among accepting participants with previous experiences included "polite," "kind," and "hard-working." Fifty-nine percent (637/1088) of participants indicated that they would request a senior staff member's supervision when being seen by a medical student. The present nationwide survey suggests that education emphasizing bedside manner may be effective in promoting patients' cooperation of medical students. In addition, providing information to patients about medical students and efforts to increase supervision during clinical clerkship should be emphasized to foster the public's cooperation.

  17. Chest radiography practice in critically ill patients: a postal survey in the Netherlands

    International Nuclear Information System (INIS)

    Graat, Marleen E; Hendrikse, Karin A; Spronk, Peter E; Korevaar, Johanna C; Stoker, Jaap; Schultz, Marcus J


    To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a 'daily-routine chest radiography' ICU. From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy

  18. Survey of Ophthalmologists Regarding Practice Patterns for Dry Eye and Sjogren Syndrome. (United States)

    Bunya, Vatinee Y; Fernandez, Karen B; Ying, Gui-Shuang; Massaro-Giordano, Mina; Macchi, Ilaria; Sulewski, Michael E; Hammersmith, Kristin M; Nagra, Parveen K; Rapuano, Christopher J; Orlin, Stephen E


    To survey ophthalmologists about current practice patterns regarding the evaluation of dry eye patients and referrals for a Sjogren syndrome (SS) workup. An online survey was sent to ophthalmologists affiliated with the Scheie Eye Institute or Wills Eye Hospital using REDCap in August 2015. Descriptive statistics were used to summarize the data. Four hundred seventy-four survey invitations were sent out and 101 (21%) ophthalmologists completed the survey. The common traditional dry eye test performed was corneal fluorescein staining (62%) and the most common newer dry eye test performed was tear osmolarity (18%). Half of respondents (51%) refer fewer than 5% of their dry eye patients for SS workups, with 18% reporting that they never refer any patients. The most common reasons for referrals included positive review of systems (60%), severe dry eye symptoms (51%) or ocular signs (47%), or dry eye that is refractory to treatment (42%). The majority (83%) felt that there is a need for an evidence-based standardized screening tool for dry eye patients to decide who should be referred for evaluation for SS. Ophthalmologists continue to prefer the use of traditional dry eye tests in practice, with the most common test being corneal fluorescein staining. There is an underreferral of dry eye patients for SS workups, which is contributing to the continued underdiagnosis of the disease. Most respondents felt that there was a need for an evidence-based standardized screening tool to decide which dry eye patients should be referred for SS evaluations.

  19. A survey of practice patterns in the use of laryngeal mask by pediatric anesthesiologists. (United States)

    Patel, Anuradha; Clark, Scott R; Schiffmiller, Moshe; Schoenberg, Catherine; Tewfik, George


    Laryngeal mask is frequently the airway device of choice in routine general anesthesia for many procedures in children. Several studies have described the use of laryngeal masks in unconventional situations. This survey was undertaken to assess how laryngeal masks are being used by pediatric anesthesiologists. The 40-question electronic survey using SurveyMonkey™ was sent to 2740 members of the Society for Pediatric Anesthesia (SPA). This survey assessed the age, work environment, types of practice, and training levels, as well as clinical situations in which the practitioners use laryngeal masks across different pediatric age groups. Seven hundred and forty-three (27.1%) responses were obtained. The use of laryngeal mask increased as the patient age increased in nearly every queried situation. The practitioners routinely utilize laryngeal masks in a variety of challenging scenarios, such as in patients with a recent upper respiratory infection, in the difficult airway, remote locations, and long-duration surgeries. A small percentage of pediatric anesthesiologists use laryngeal masks in laparoscopic surgery and prone position procedures. Pediatric anesthesiologists are using laryngeal masks in both routine and challenging/unconventional situations. Although many of the uses for laryngeal masks are not explicitly stated in the manufacturer guidelines, literature and current practice support the use of laryngeal masks in several of these scenarios. © 2015 John Wiley & Sons Ltd.

  20. [Estimating child mortality using the previous child technique, with data from health centers and household surveys: methodological aspects]. (United States)

    Aguirre, A; Hill, A G


    2 trials of the previous child or preceding birth technique in Bamako, Mali, and Lima, Peru, gave very promising results for measurement of infant and early child mortality using data on survivorship of the 2 most recent births. In the Peruvian study, another technique was tested in which each woman was asked about her last 3 births. The preceding birth technique described by Brass and Macrae has rapidly been adopted as a simple means of estimating recent trends in early childhood mortality. The questions formulated and the analysis of results are direct when the mothers are visited at the time of birth or soon after. Several technical aspects of the method believed to introduce unforeseen biases have now been studied and found to be relatively unimportant. But the problems arising when the data come from a nonrepresentative fraction of the total fertile-aged population have not been resolved. The analysis based on data from 5 maternity centers including 1 hospital in Bamako, Mali, indicated some practical problems and the information obtained showed the kinds of subtle biases that can result from the effects of selection. The study in Lima tested 2 abbreviated methods for obtaining recent early childhood mortality estimates in countries with deficient vital registration. The basic idea was that a few simple questions added to household surveys on immunization or diarrheal disease control for example could produce improved child mortality estimates. The mortality estimates in Peru were based on 2 distinct sources of information in the questionnaire. All women were asked their total number of live born children and the number still alive at the time of the interview. The proportion of deaths was converted into a measure of child survival using a life table. Then each woman was asked for a brief history of the 3 most recent live births. Dates of birth and death were noted in month and year of occurrence. The interviews took only slightly longer than the basic survey

  1. Knowledge, attitudes, practices, and barriers related to research utilization: a survey among pharmacists in Malaysia. (United States)

    Tan, Sin Yee; Hatah, Ernieda


    Background Research utilization is part of evidence-based practice referring to the process of reviewing and critiquing scientific research and applying the findings to one's own clinical practice. Many studies on research utilization have been conducted with doctors and nurses, but to our knowledge, none have been investigated amongst pharmacists. Objective To assess research utilization and its barriers among pharmacists and identify potential influencing factors. Setting Malaysia. Methods This cross-sectional survey was administered online and by mail to a convenient sample of pharmacists working in hospitals, health clinics, and retail pharmacies in rural and urban areas. Main outcome measure Pharmacists' research utilization knowledge, attitudes, and practices. Results Six hundred surveys were mailed to potential respondents, and 466 were returned (77.7% response rate). Twenty-eight respondents completed the survey online. The respondents' research utilization knowledge, attitudes, and practices were found to be moderate. Research utilization was associated with respondents' knowledge and attitude scores (P < 0.001). When factors related to research utilization were modelled, higher educational level was associated with higher level of research utilization (P < 0.001) while less involvement in journal clubs, more years of service (3-7 years and more than 7 years) were associated with low and moderate research utilization, respectively. The main reported barrier to research utilization was lack of sufficient authority to change patient care procedures. Conclusion Pharmacists' research utilization knowledge, attitudes, and practices can be improved by encouraging pharmacists to pursue higher degrees, promoting active participation in institutions' journal clubs, and introducing senior clinical pharmacist specialization.

  2. Energy Survey of Eisenhower Army Medical Center, Fort Gordon, Augusta, Georgia. Volume 2. Appendices

    National Research Council Canada - National Science Library


    ...) including low cost/no cost ECO's and perform complete evaluations of each. Energy equipment replacement projects already underway, approved, or planned by the Medical Center staff will be factored into the evaluations...

  3. History of the Fort Collins Science Center, U.S. Geological Survey (United States)

    O'Shea, Thomas J. (compiler)


    The U.S. Geological Survey’s Fort Collins Science Center ("the Center") has been a nucleus of research, technology development, and associated scientific activities within the Department of the Interior for more than 30 years. The Center’s historical activities are deeply rooted in federal biological resources research and its supporting disciplines, particularly as they relate to the needs of the U.S. Department of the Interior and its resource management agencies. The organizational framework and activities of the Center have changed and adapted over the years in response to shifts in the scientific issues and challenges facing the U.S. Department of the Interior and with the development of new strategies to meet these challenges. Thus, the history of the Center has been dynamic.

  4. Advising Practices: A Survey of Self-Access Learner Motivations and Preferences

    Directory of Open Access Journals (Sweden)

    Leander S. Hughes, Nathan P. Krug, and Stacey L. Vye


    Full Text Available Based on queries from students who frequently visit the English Resource Center (ERC at Saitama University, this research team set out to examine what motivational factors encourage ERC attendees to participate for an extended period of time in the Center on a regular basis. Initial indications are that social collaborative learning amongst peers at the Center is the most significant long-term motivational factor for students to become involved with learning English in the ERC. More specifically, this study explores factors that encourage these learners to become regular and perhaps more autonomous center participants in terms of advising practices such as (a what factors led students to their initial discovery of ERC, (b what inspired that very first visit, (c what encouraged learners to continue to attend the Center on a regular basis, (d what attendees value about the ERC, and finally (e what might be done to ensure that greater support is provided for students who come to the ERC for the first time.

  5. Graduate Management Project: An Evaluation of the Johns Hopkins Outpatient Surgery Center Patient Satisfaction Survey

    National Research Council Canada - National Science Library

    Evan, Barry


    .... Customer or patient satisfaction is a widely accepted measure of quality. Numerous organizations use satisfaction surveys as the foundation for organizational improvement and the Johns Hopkins Health System is no different...

  6. Survey of Equipment Quality Control in Radiotherapy Centers in Croatia: First Results

    International Nuclear Information System (INIS)

    Jurkovic, S.; Diklic, A.; Smilovic Radojcic, Dj.; Svabic, M.; Kasabasic, M.; Ivkovic, A.; Faj, D.


    Implementation of advanced radiation therapy techniques into clinical practice has a huge influence on tumour control as well as normal tissue sparing. Introduction of Conformal Radiation Therapy (CRT) and Intensity Modulated Radiation Therapy (IMRT) into clinical practice results in precise 'tailoring' of dose distributions and according to that in reduction of irradiated volumes. This is not possible without, for the application of advanced radiation therapy techniques constructed, linear accelerators. They must be very precise, well tuned and maintained. In this way the milestone of radiation therapy quality assurance programme is machine quality control (QC). First step in development of quality control programme is existence of written QC protocols. The survey of existence of written QC protocols showed the lack of written protocols for QC procedures in Croatian radiotherapy departments. In this way regular implementation of the procedures are usually left to the conscience of the medical physicists. In the IAEA granted projects CRO6008 and RER9093, we harmonized existing QC protocols between radiation therapy departments at University hospitals Rijeka and Osijek and developed the new ones. The protocols made according to international guidelines are publicly available at websites of the State Office for Radiological and Nuclear Safety and Croatian medical physics society in order to help other radiotherapy departments in Croatia to develop their own ones. Next step was reviewing of QC practices in different centres and exchanging experiences. For that purpose we defined a set of tests, according to the existing QC protocols. Then, on-site measurements were done to check QC parameters of linear accelerators and simulators in six radiation therapy centres in Croatia. In this paper we present the tests preformed, devices and analysing tools used, along with the overall results. Tests were preformed in six radiotherapy centres in Croatia on nine linear

  7. A survey of infection control practices of consultant anaesthesiologists in teaching hospitals of pakistan

    International Nuclear Information System (INIS)

    Yaqub, K.M.; Tariq, M.; Janjua, S.; Masroor, R.


    To determine the infection control practices of Anaesthesiologist in the teaching hospitals of Pakistan. Cross-sectional survey. The survey was closed after allowing 6 months for return of the replies. A questionnaire was distributed to 170 consultant anaesthesiologist randomly selected from all over Pakistan. Out of these, 90 (53%) were returned and analyzed. To reduce self-report bias, the forms were filled anonymously. Thirty four percent of the respondents always used masks, and only 9% used gloves in their every day practice. Only 18% of respondents stated that they always washed their hands after every patient contact and 54% reported that they always used aseptic technique for placing an indwelling cannula. Most respondents had a good knowledge of universal precautions for prevention of occupational transmission of infection. Five percent of the anaesthetists reported frequently or always reusing syringes for more than one patient. The practice of reusing syringes was significantly greater when the same consultants were anaesthetizing patients in private clinics rather than in their primary institutions (p 5, in 58% of cases. Whereas most responding anaesthesiologist exhibit appropriate infection control behaviour, there are several potentially hazardous practices that continue unabated. (author)

  8. Case-Logging Practices in Otolaryngology Residency Training: National Survey of Residents and Program Directors. (United States)

    Dermody, Sarah M; Gao, William; McGinn, Johnathan D; Malekzadeh, Sonya


    Objective (1) Evaluate the consistency and manner in which otolaryngology residents log surgical cases. (2) Assess the extent of instruction and guidance provided by program directors on case-logging practices. Study Design Cross-sectional national survey. Setting Accreditation Council for Graduate Medical Education otolaryngology residency programs in the United States. Subjects and Methods US otolaryngology residents, postgraduate year 2 through graduating chiefs as of July 2016, were recruited to respond to an anonymous questionnaire designed to characterize surgical case-logging practices. Program directors of US otolaryngology residency programs were recruited to respond to an anonymous questionnaire to elucidate how residents are instructed to log cases. Results A total of 272 residents and 53 program directors completed the survey, yielding response rates of 40.6% and 49.5%, respectively. Perceived accuracy of case logs is low among residents and program directors. Nearly 40% of residents purposely choose not to log certain cases, and 65.1% of residents underreport cases performed. More than 80% of program directors advise residents to log procedures performed outside the operating room, yet only 16% of residents consistently log such cases. Conclusion Variability in surgical case-logging behaviors and differences in provided instruction highlight the need for methods to improve consistency of logging practices. It is imperative to standardize practices across otolaryngology residency programs for case logs to serve as an accurate measure of surgical competency. This study provides a foundation for reform efforts within residency programs and for the Resident Case Log System.

  9. Breast Density Legislation in New England: A Survey Study of Practicing Radiologists. (United States)

    Lourenco, Ana P; DiFlorio-Alexander, Roberta M; Slanetz, Priscilla J


    This study aimed to assess radiologists' knowledge about breast density legislation as well as perceived practice changes resulting from the enactment of breast density legislation. This is an institutional review board-exempt anonymous email survey of 523 members of the New England Roentgen Ray Society. In addition to radiologist demographics, survey questions addressed radiologist knowledge of breast density legislation, knowledge of breast density as a risk factor for breast cancer, recommendations for supplemental screening, and perceived practice changes resulting from density notification legislation. Of the 523 members, 96 responded, yielding an 18% response rate. Seventy-three percent of respondents practiced in a state with breast density legislation. Sixty-nine percent felt that breast density notification increased patient anxiety about breast cancer, but also increased patient (74%) and provider (66%) understanding of the effect of breast density on mammographic sensitivity. Radiologist knowledge of the relative risk of breast cancer when comparing breasts of different density was variable. Considerable confusion and controversy regarding breast density persists, even among practicing radiologists. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  10. Songs composed for use in music therapy: a survey of original songwriting practices of music therapists. (United States)

    Jones, Jennifer D


    While researchers have documented the efficacy of clinical songwriting in music therapy, limited research has been conducted on songs composed by music therapists that address clinical goals. The purpose of this research was to examine the original songwriting practices of music therapists. Professional music therapists (N = 1,364) received a 14-question survey via email asking each to identify client populations and clinical goals addressed by original songs, their length of time in clinical practice, and specifics about their acquisition of songwriting skills. The data collected from 302 completed surveys revealed that respondents who used original songs were most likely to work with children and adolescents in schools or the developmental disability field and wrote songs in order to individualize treatment. Music therapists working with persons over 65 years of age in long term care or assisted living programs were the least likely to use original songs in clinical practice, opting for interventions utilizing the client's familiar music. Most music therapists found songwriting generally easy, but only 37% indicated that they acquired this skill during their undergraduate degree. Additional research on the clinical efficacy of original songs and therapist's compositional processes is needed to identify best practices models for strategic songwriting.

  11. Survey of Usual Practice: Dysphagia Therapy in Head & Neck Cancer Patients (United States)

    Krisciunas, Gintas P.; Sokoloff, William; Stepas, Katherine; Langmore, Susan E.


    There is no standardized dysphagia therapy for head and neck cancer patients and scant evidence to support any particular protocol, leaving institutions and individual speech language pathologists (SLPs) to determine their own protocols based on “typical” practices or anecdotal evidence. To gain an understanding of current usual practices, a national internet-based survey was developed and disseminated to SLPs who treat HNC patients. From a random sample of 4,000 ASHA SID 13 members, 1,931 fit the inclusion criteria, and 759 complete responses were recorded for a 39.3% response rate. Results were analyzed by institution type as well as by individual clinical experience. While some interesting trends emerged from the data, a lack of uniformity and consensus regarding best practices was apparent. This is undoubtedly due to a paucity of research adequately addressing the efficacy of any one therapy for dysphagia in the HNC population. PMID:22456699

  12. A survey of United States dental hygienists' knowledge, attitudes, and practices with infection control guidelines. (United States)

    Garland, Kandis V


    To assess knowledge, attitudes and practices of U.S. dental hygienists with infection control guidelines (ICG). Research has shown improved compliance with specific aspects of dental ICG is needed. This study supports the American Dental Hygienists' Association National Research Agenda's Occupational Health and Safety objective to investigate methods to decrease errors, risks and or hazards in health care. Data are needed to assess compliance, prevention and behavioral issues with current ICG practices. A proportional stratified random sample (n=2,500) was recruited for an online survey. Descriptive statistics summarized demographic characteristics and knowledge, attitudes and practices responses. Spearman's rho correlations determined relationships between knowledge, attitudes and practices responses (pexpectations for using ICG (rs=0.529) and no time to use (rs=-0.537). Themes from comments indicated time is a barrier, and respondents' perceived a need for involvement of all co-workers. Dental hygienists are adhering with most aspects of the ICG. High compliance with ICG among respondents in this study was associated with positive safety beliefs and practices, whereas lower compliance with ICG was associated with less positive safety beliefs and practices. A safety culture appears to be a factor in compliance with ICG.

  13. Professionals' Perspectives on Organizational Factors that Support or Hinder the Successful Implementation of Family-Centered Practice (United States)

    Wright, Alexandra; Hiebert-Murphy, Diane; Trute, Barry


    This article presents findings from an exploratory, qualitative study whose objective was to identify professionals' perceptions of organizational factors that support or hinder the implementation of family-centered practice (FCP). Two disability services organizations in Manitoba, Canada, were selected as the research sites. In 2002, all staff…

  14. Generalists to Specialists: Transformative Evidences and Impediments to Student-Centered Practices of Primary Music and Art Teachers in Singapore (United States)

    Costes-Onishi, Pamela; Caleon, Imelda


    This article fills in the knowledge gap in the student-centered practices of generalist music and art teachers to prepare 21st century learners. The study shows that generalists, after completing a specialist professional development program, struggle the most in connecting subject matter knowledge to pedagogical knowledge, specifically…

  15. A preliminary survey of the practice patterns of United States Guild Certified Feldenkrais PractitionersCM

    Directory of Open Access Journals (Sweden)

    Buchanan Patricia A


    Full Text Available Abstract Background The Feldenkrais Method® of somatic education purports to guide people of varying ages and abilities to improve function. Many people choose this method to aid with recovery from injury, manage chronic conditions, or enhance performance even though limited research supporting its safety and effectiveness exists to guide decisions about use and referral. Very little information about practitioner characteristics and practice patterns is publicly available to assist researchers in the design of appropriate safety and effectiveness studies. The purpose of this study was to obtain an initial overview of the characteristics of United States Guild Certified Feldenkrais PractitionersCM. Methods Of 1300 certified Feldenkrais® practitioners at the time of the study, there were 1193 practitioners with email accounts who were sent invitations to complete a web-based survey. The survey inquired about practice locations, additional credentials, service patterns and workloads during the previous 3 months. Response rate and descriptive statistics were calculated. Results The survey had a 32.3% (385/1193 response rate. The top states in which responders practiced were California (n = 92 and New York (n = 44. Most responders did not hold other credentials as traditional health care providers or as complementary and alternative medicine providers. Among those who did, the most common credentials were physical therapist (n = 83 and massage therapist (n = 38. Just over a third of traditional health care providers only provided Feldenkrais lessons, compared to 59.3% of complementary and alternative providers. On average, responders saw 7.6 ± 8.1 (median = 5 clients per week for individual lessons, 8.4 ± 11.5 (median = 5 clients per week for group lessons, and 2.9 ± 3.9 (median = 2 new clients per month for individual lessons. Conclusions This preliminary survey of United States Guild Certified Feldenkrais Practitioners indicated that most

  16. Attitudes of non-practicing chiropractors: a pilot survey concerning factors related to attrition

    Directory of Open Access Journals (Sweden)

    Wyatt Lawrence H


    Full Text Available Abstract Background Research into attitudes about chiropractors who are no longer engaged in active clinical practice is non-existent. Yet non-practicing chiropractors (NPCs represent a valid sub-group worthy of study. Aim The purpose of this research was to assess attrition attitudes of NPCs about the chiropractic profession and develop a scale to assess such attitudes. Methods A 48 item survey was developed using the PsychData software. This survey included 35 Likert-style items assessing various aspects of the profession namely financial, educational, psychosocial and political. An internet discussion site where NPCs may be members was accessed for recruitment purposes. Results A total of 70 valid responses were received for analysis. A majority of respondents were male with 66% being in non-practice status for 3 to 5 years and less with 43% indicating that they had graduated since the year 2000. Most respondents were employed either in other healthcare professions and non-chiropractic education. A majority of NPCs believed that business ethics in chiropractic were questionable and that overhead expense and student loans were factors in practice success. A majority of NPCs were in associate practice at one time with many believing that associates were encouraged to prolong the care of patients and that associate salaries were not fair. Most NPCs surveyed believed that chiropractic was not a good career choice and would not recommend someone to become a chiropractor. From this survey, a 12 item scale was developed called the "chiropractor attrition attitude scale" for future research. Reliability analysis of this novel scale demonstrated a coefficient alpha of 0.90. Conclusion The low response rate indicates that findings cannot be generalized to the NPC population. This study nonetheless demonstrates that NPCs attrition attitudes can be assessed. The lack of a central database of NPCs is a challenge to future research. Appropriate

  17. Nuclear Energy Center Site Survey, 1975. Part IV. Practical issues of implementation

    International Nuclear Information System (INIS)


    The objective of Part IV is to assemble, organize, and present facts, analyses, and responsible viewpoints with respect to issues going beyond technical and technical-economic tradeoff considerations that bear on NECs; to identify options; and to analyze and comment on merits of alternative options. Five broad groups of issues addressed include jurisdictional and institutional; economic; social and political; accident risk; national security; and nuclear material safeguards

  18. Adolescent testicular microlithiasis: A case-based, multinational survey of clinical management practices. (United States)

    Brodie, Katie E; Saltzman, Amanda F; Cost, Nicholas G


    Testicular microlithiasis (TM) is a condition characterized by calcium deposits within the testis, usually detected incidentally during ultrasonography of the scrotum. TM has been associated with the presence of, and possibly the development of, testicular malignancy. Our aim was to document international clinical management practices for TM and to analyze what factors and perception of risk influence conservative versus active management and follow-up. European Society for Paediatric Urology (ESPU) and Society for Pediatric Urology (SPU) members were invited to complete an online case-based survey of clinical management practices of TM. Eight cases had a single variable changed each time (classic versus limited TM, unilateral versus bilateral, prior cryptorchidism versus no cryptorchidism) to ascertain the provider's perception of risk. The respondents completed multiple choice questions on initial management, follow-up plan, length and interval of follow-up. Multivariate logistic regression was performed to determine factors associated with decisions on management and follow-up. There were 265 respondents to the survey from 35 countries (Table). Median time in practice was 13 years. Factors that were significantly associated with more aggressive initial management (more than counseling on self-examination) included: not yet in independent practice, low volume TM cases per year, those practicing pediatric and adult urology, classic appearance of TM and cryptorchidism. Factors that were significantly associated with urologist follow-up and active investigation included: European practitioners, low TM case volume per year, those practicing both pediatric urology and pediatric surgery, classic TM appearance and a case history of cryptorchidism. Interval and length of follow-up was wide-ranging, with most respondents favoring annual follow-up. Management of TM varies and a mix of surgeon and case factors significantly influences management strategies. This baseline

  19. How Educators Conceptualize and Teach Reflective Practice: A Survey of North American Pediatric Medical Educators. (United States)

    Butani, Lavjay; Bannister, Susan L; Rubin, Allison; Forbes, Karen L


    The objectives of this study were to explore pediatric undergraduate medical educators' understanding of reflective practice, the barriers they face in teaching this, the curricular activities they use, and the value they assign to reflective practice. Nine survey questions were sent to members of the Council on Medical Student Education in Pediatrics, an international pediatric undergraduate medical educator group. Quantitative data were analyzed using descriptive statistics. Open-ended responses were analyzed qualitatively through an iterative process to establish themes representing understanding of reflective practice and barriers in teaching this. Respondents representing 56% of all North American schools answered at least 1 survey question. Qualitative analysis of understanding of reflection revealed 11 themes spanning all components of reflective practice, albeit with a narrow view on triggers for reflection and a lower emphasis on understanding the why of things and on perspective-taking. The most frequent barriers in teaching this were the lack of skilled educators and limited time. Most respondents valued reflective skills but few reported confidence in their ability to teach reflection. Several curricular activities were used to teach reflection, the most common being narrative writing. Pediatric undergraduate medical educators value reflection and endorse its teaching. However, many do not have a complete understanding of the construct and few report confidence in teaching this. Implementing longitudinal curricula in reflective practice may require a culture change; opportunities exist for faculty development about the meaning and value of reflective practice and how best to teach this. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  20. Supporting near-peer teaching in general practice: a national survey. (United States)

    van de Mortel, Thea F; Silberberg, Peter L; Ahern, Christine M; Pit, Sabrina W


    Training bodies see teaching by junior doctors and vocational trainees in general practice (family medicine) as integral to a doctor's role. While there is a body of literature on teacher training programs, and on peer and near-peer teaching in hospitals and universities, there has been little examination of near-peer teaching in general practice. Near-peer teaching is teaching to those close to oneself but not at the same level in the training continuum. This study investigated the perceptions of key stakeholders on near-peer teaching in general practice, their current near-peer teaching activities, and methods of recruitment and support. A national anonymous online survey was used to obtain data on Australian stakeholders' perceptions of, and processes related to, near-peer teaching in general practice. Recruitment occurred via electronic invitations sent by training providers and stakeholder associations. Separate questionnaires, which were validated via several cycles of review and piloting, were developed for supervisors and learners. The survey included both fixed response and open response questions. Responses (n = 1,122) were obtained from 269 general practitioner supervisors, 221 general practice registrars, 319 prevocational trainees, and 313 medical students. All stakeholder groups agreed that registrars should teach learners in general practice, and 72% of registrars, 68% of prevocational trainees, and 33% of medical students reported having done some teaching in this setting. Three-quarters of supervisors allowed learners to teach. Having another learner observe their consultations was the most common form of teaching for registrars and prevocational trainees. Eight percent of registrars received some remuneration for teaching. The approach used to determine teaching readiness and quality varied greatly between supervisors. Near-peer teaching was supported by the majority of stakeholders, but is underutilised and has poor structural support

  1. Oblique Chest Views as a Routine Part of Skeletal Surveys Performed for Possible Physical Abuse--Is This Practice Worthwhile? (United States)

    Hansen, Karen Kirhofer; Prince, Jeffrey S.; Nixon, G. William


    Objective: To evaluate the utility of oblique chest views in the diagnosis of rib fractures when used as a routine part of the skeletal survey performed for possible physical abuse. Methods: Oblique chest views have been part of the routine skeletal survey protocol at Primary Children's Medical Center since October 2002. Dictated radiology reports…

  2. Factors associated with family-centered involvement in family practice--a cross-sectional multivariate analysis. (United States)

    Deutsch, Tobias; Frese, Thomas; Sandholzer, Hagen


    The importance of a family-centered approach in family practice has been emphasized. Knowledge about factors associated with higher family-centered involvement seems beneficial to stimulate its realization. German office-based family physicians completed a questionnaire addressing several aspects of family-centered care. Logistic regression was used to identify associations with the involvement overall and in different domains: routine inquiry and documentation of family-related information, family orientation regarding diagnosis and treatment, family-oriented dialogues, family conferences, and case-related collaboration with marriage and family therapists. We found significant associations between physicians' family-centered involvement and expected patient receptiveness, perceived impact of the family's influence on health, self-perceived psychosocial family-care competences (overall and concerning concepts for family orientation, psychosocial intervention in family conferences, and the communication of the idea of family counseling), advanced training in psychosocial primary care (PPC), personal acquaintance with family therapists (regarding case-related collaboration), and rural office environment. Increased emphasis on the family's influence on health in medical education and training, the provision of concepts for a family-centered perspective, and versatile skills for psychosocial intervention and inquiry of patient preferences, as well as the strengthening of networking between family physicians and family therapists, might promote the family-centered approach in family practice.

  3. [Treatment practice in patients with isolated blunt splenic injuries. A survey of Swiss traumatologists]. (United States)

    Schnüriger, B; Martens, F; Eberle, B M; Renzulli, P; Seiler, C A; Candinas, D


    The non-operative management (NOM) of blunt splenic injuries has gained widespread acceptance. However, there are still many controversies regarding follow-up of these patients. The purpose of this study was to survey active members of the Swiss Society of General and Trauma Surgery (SGAUC) to determine their practices regarding the NOM of isolated splenic injuries. A survey of active SGAUC members with a written questionnaire was carried out. The questionnaire was designed to elicit information about personal and facility demographics, diagnostic practices, in-hospital management, preferred follow-up imaging and return to activity. Out of 165 SGAUC members 52 (31.5%) completed the survey and 62.8% of all main trauma facilities in Switzerland were covered by the sample. Of the respondents 14 (26.9%) have a protocol in place for treating patients with splenic injuries. For initial imaging in hemodynamically stable patients 82.7% of respondents preferred ultrasonography (US). In cases of suspected splenic injury 19.2% of respondents would abstain from further imaging. In cases of contrast extravasation from the spleen half of the respondents would take no specific action. For low-grade injuries 86.5% chose to admit patients for an average of 1.6 days (range 0-4 days) with a continuously monitored bed. No differences in post-discharge activity restrictions between moderate and high-grade splenic injuries were found. The present survey showed considerable practice variation in several important aspects of the NOM of splenic injuries. Not performing further CT scans in patients with suspected splenic injuries and not intervening in cases of a contrast extravasation were the most important discrepancies to the current literature. Standardization of the NOM of splenic injuries may be of great benefit for both surgeons and patients.

  4. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland.

    LENUS (Irish Health Repository)

    Fanning, Rebecca A


    BACKGROUND AND OBJECTIVE: The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. METHODS: A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. RESULTS: Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. CONCLUSION: It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  5. Epidural analgesia practices for labour: results of a 2005 national survey in Ireland. (United States)

    Fanning, Rebecca A; Briggs, Liam P; Carey, Michael F


    The last 25 years have seen changes in the management of epidural analgesia for labour, including the advent of low-dose epidural analgesia, the development of new local anaesthetic agents, various regimes for maintaining epidural analgesia and the practice of combined spinal-epidural analgesia. We conducted a survey of Irish obstetric anaesthetists to obtain information regarding the conduct and management of obstetric epidural analgesia in Ireland in 2005. The specific objective of this survey was to discover whether new developments in obstetric anaesthesia have been incorporated into clinical practice. A postal survey was sent to all anaesthetists with a clinical commitment for obstetric anaesthesia in the sites approved for training by the College of Anaesthetists, Ireland. Fifty-three per cent of anaesthetists surveyed responded. The majority of anaesthetists (98%) use low-dose epidural analgesia for the maintenance of analgesia. Only 11% use it for test-dosing and 32% for the induction of analgesia. The combined spinal-epidural analgesia method is used by 49%, but two-thirds of those who use it perform fewer than five per month. Patient-controlled epidural analgesia was in use at only one site. It appears that Irish obstetric anaesthetists have adopted the low-dose epidural analgesia trend for the maintenance of labour analgesia. This practice is not as widespread, however, for test dosing, the induction of analgesia dose or in the administration of intermittent epidural boluses to maintain analgesia when higher concentrations are used. Since its introduction in 2000, levobupivacaine has become the most popular local anaesthetic agent.

  6. Self-reported recognition of undiagnosed life threatening conditions in chiropractic practice: a random survey

    Directory of Open Access Journals (Sweden)

    Daniel Dwain M


    Full Text Available Abstract Background The purpose of this study was to identify the type and frequency of previously undiagnosed life threatening conditions (LTC, based on self-reports of chiropractic physicians, which were first recognized by the chiropractic physician. Additionally this information may have a preliminary role in determining whether chiropractic education provides the knowledge necessary to recognize these events. Methods The study design was a postal, cross-sectional, epidemiological self-administered survey. Two thousand Doctors of Chiropractic in the US were randomly selected from a list of 57878. The survey asked respondents to state the number of cases from the list where they were the first physician to recognize the condition over the course of their practice careers. Space was provided for unlisted conditions. Results The response rate was 29.9%. Respondents represented 11442 years in practice and included 3861 patients with a reported undiagnosed LTC. The most commonly presenting conditions were in rank order: carcinoma, abdominal aneurysm, deep vein thrombosis, stroke, myocardial infarction, subdural hematoma and a large group of other diagnoses. The occurrence of a previously undiagnosed LTC can be expected to present to the chiropractic physician every 2.5 years based on the responding doctors reports. Conclusion Based on this survey chiropractic physicians report encountering undiagnosed LTC’s in the normal course of practice. The findings of this study are of importance to the chiropractic profession and chiropractic education. Increased awareness and emphasis on recognition of LTC is a critical part of the education process and practice life.

  7. A forecast of ophthalmology practice trends in saudi arabia: a survey of junior residents. (United States)

    Alwadani, Fahad; Alrushood, Aziz; Altokhy, Hisham; Alasbali, Tariq


    The aim of this study is to identify the trends in practice pattern among current ophthalmology residents in Saudi Arabia. Ophthalmology residents in Saudi Arabia responded anonymously to a written survey between November 2007 and February 2008. The survey contained questions on demographic information, medical education, residency training, career goals and factors influencing their career choice. The data were categorized by gender. The influence of gender on outcome was assessed in a univariate fashion using the Chi-square or Fisher exact test when appropriate. A P-value of 0.05 or less was considered statistically significant for all analyses. A total of 68 out of 85 residents (80%) responded to the survey. Over one-half of the residents preferred to pursue a fellowship within Saudi Arabia (53%), while others (25%) planned to train in North America. The majority of respondents wished to practice in an urban setting (63%). Anterior segment was the most desired subspecialty, while general ophthalmology and glaucoma were not a popular choice. Most residents were interested in refractive surgery (77%) and research (75%). The main factor influencing the decision to pursue ophthalmology was the ability to combine medicine and surgery (97%), while a positive elective experience was also an important factor, particularly for female respondents (91% vs. 57%; P < 0.001). Concerted efforts are required to encourage adoption to ophthalmic practice in public institutions rather than in private practice. In addition training in underrepresented subspecilaties should be encouraged to ensure adequate ophthalmic care for all citizens of Saudi Arabia.

  8. A Health Assessment Survey of Veteran Students: Utilizing a Community College-Veterans Affairs Medical Center Partnership. (United States)

    Misra-Hebert, Anita D; Santurri, Laura; DeChant, Richard; Watts, Brook; Sehgal, Ashwini R; Aron, David C


    To assess health status among student veterans at a community college utilizing a partnership between a Veterans Affairs Medical Center and a community college. Student veterans at Cuyahoga Community College in Cleveland, Ohio, in January to April 2013. A health assessment survey was sent to 978 veteran students. Descriptive analyses to assess prevalence of clinical diagnoses and health behaviors were performed. Logistic regression analyses were performed to assess for independent predictors of functional limitations. 204 students participated in the survey (21% response rate). Self-reported depression and unhealthy behaviors were high. Physical and emotional limitations (45% and 35%, respectively), and pain interfering with work (42%) were reported. Logistic regression analyses confirmed the independent association of self-reported depression with functional limitation (odds ratio [OR] = 3.3, 95% confidence interval [CI] 1.4-7.8, p statistic 0.72) and of post-traumatic stress disorder with pain interfering with work (OR 3.9, CI 1.1-13.6, p statistic 0.75). A health assessment survey identified priority areas to inform targeted health promotion for student veterans at a community college. A partnership between a Veterans Affairs Medical Center and a community college can be utilized to help understand the health needs of veteran students. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  9. Mental health professionals' family-focused practice with families with dependent children: a survey study. (United States)

    Tungpunkom, Patraporn; Maybery, Darryl; Reupert, Andrea; Kowalenko, Nick; Foster, Kim


    Many people with a mental illness are parents caring for dependent children. These children are at greater risk of developing their own mental health concerns compared to other children. Mental health services are opportune places for healthcare professionals to identify clients' parenting status and address the needs of their children. There is a knowledge gap regarding Thai mental health professionals' family-focused knowledge and practices when working with parents with mental illness and their children and families. This cross -sectional survey study examined the attitudes, knowledge and practices of a sample (n = 349) of the Thai mental health professional workforce (nurses, social workers, psychologists, psychiatrists) using a translated version of the Family-Focused Mental Health Practice Questionnaire (FFMHPQ). The majority of clinicians reported no training in family (76.8%) or child-focused practice (79.7%). Compared to other professional groups, psychiatric nurses reported lower scores on almost all aspects of family-focused practice except supporting clients in their parenting role within the context of their mental illness. Social workers scored highest overall including having more workplace support for family-focused practice as well as a higher awareness of family-focused policy and procedures than psychiatrists; social workers also scored higher than psychologists on providing support to families and parents. All mental health care professional groups reported a need for training and inter-professional practice when working with families. The findings indicate an important opportunity for the prevention of intergenerational mental illness in whose parents have mental illness by strengthening the professional development of nurses and other health professionals in child and family-focused knowledge and practice.

  10. Factors affecting dengue prevention practices: nationwide survey of the Malaysian public.

    Directory of Open Access Journals (Sweden)

    Li Ping Wong

    Full Text Available Efforts to stamp dengue in many dengue endemic countries has met little success. There is a need to re-examine and understand how the public at large view the dengue prevention efforts. This study aimed to examine the demographic factors, theoretical constructs of the Health Belief Model and knowledge about dengue and how these influence the practice of dengue prevention.A national telephone survey was carried out with 2,512 individuals of the Malaysian public aged 18-60 years.The majority (73% of the Malaysian public had a total dengue prevention score of 51-100 (of a possible score of 1-100. Multivariate analysis suggests significant correlates of higher dengue prevention practices with demographic background, perception of susceptibility to dengue, perceived density of mosquitoes in the neighbourhood and knowledge about dengue. Households of lower income of which the majority (40.7% were from the rural areas, were associated with the highest odds [OR = 1.33; 95%CI = 1.09-1.67; p = 0.004] of dengue prevention. Dengue prevention practices were also less likely to be undertaken in neighbourhoods where the responders perceived there is no and/or low density of mosquitoes. Dengue prevention practices are also less likely to be practiced by skilled workers [OR = 0.78; 95%CI = 0.63-0.95; p = 0.029] compared to those unemployed. Higher perceived susceptibility to dengue was associated with higher dengue prevention practices and participants with higher dengue knowledge were found to have a higher level of involvement in dengue prevention practices.Results from the study suggest that in formulating approaches to contain dengue, strategies should be developed to cultivate dengue prevention practices among urban population and target areas with low density of mosquitoes where public perceived a less likely chance of getting dengue. Dengue prevention campaigns should focus on messages highlighting the risk of contracting dengue and education to increase

  11. Evaluating Surgical Residents' Patient-Centered Communication Skills: Practical Alternatives to the "Apprenticeship Model". (United States)

    Newcomb, Anna; Trickey, Amber W; Lita, Elena; Dort, Jonathan


    The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to assess communication skills and provide feedback to residents. We aimed to develop a feasible data collection process that generates objective clinical performance information to guide training activities, inform ACGME milestone evaluations, and validate assessment instruments. Residents care for patients in the surgical clinic and in the hospital, and participate in a communication curriculum providing practice with standardized patients (SPs). We measured perception of resident communication using the 14-item Communication Assessment Tool (CAT), collecting data from patients at the surgery clinic and surgical wards in the hospital, and from SP encounters during simulated training scenarios. We developed a handout of CAT example behaviors to guide patients completing the communication assessment. Independent academic medical center. General surgery residents. The primary outcome is the percentage of total items patients rated "excellent;" we collected data on 24 of 25 residents. Outpatient evaluations resulted in significantly higher scores (mean 84.5% vs. 68.6%, p communication assessments in their concurrent patient population (p = 0.017), and (2) receiving CAT example instructions was associated with a lower percentage of excellent ratings by 9.3% (p = 0.047). Our data collection process provides a model for obtaining meaningful information about resident communication proficiency. CAT evaluations of surgical residents by the inpatient population had not previously been described in the literature; our results provide important insight into relationships between the evaluations provided by inpatients, clinic patients, and SPs in simulation. Our example behaviors guide shows promise for addressing a common concern, minimizing ceiling effects when measuring physician-patient communication. Copyright © 2017 Association of Program Directors in Surgery. Published by

  12. Applications of collaborative helping maps: supporting professional development, supervision and work teams in family-centered practice. (United States)

    Madsen, William C


    Collaborative, family-centered practice has become an influential approach in helping efforts across a broad spectrum of human services. This article draws from previous work that presented a principle-based, practice framework of Collaborative Helping and highlighted the use of Collaborative Helping maps as a tool both to help workers think their way through complex situations and to provide a guideline for constructive conversations between families and helpers about challenging issues. It builds on that work to examine ways to utilize Collaborative Helping maps at worker, supervisory, and organizational levels to enhance and sustain collaborative, family-centered practice and weave its core values and principles into the everyday fabric of organizational cultures in human service agencies and government agencies that serve poor and marginalized families and communities. © 2013 FPI, Inc.

  13. Prevention and diagnosis of ventilator-associated pneumonia: a survey on current practices in Southern Spanish ICUs. (United States)

    Sierra, Rafael; Benítez, Encarnación; León, Cristóbal; Rello, Jordi


    To assess the implementation of selected ventilator-associated pneumonia (VAP) prevention strategies, and to learn how VAP is diagnosed in the ICUs of Southern Spain. Multicentric survey. The ICUs of 32 hospitals of the public health-care system of Southern Spain. Directors of ICUs. None. Twenty-eight ICUs (87.5%) returned completed questionnaires. Ventilator circuits were changed every 72 h or longer in 75% of ICUs. Use of heat and moisture exchangers and open endotracheal suction systems were reported in 96% of ICUs. Subglottic secretion drainage was never used, and 57% of ICUs checked endotracheal tube cuff pressure at least daily. Semi-recumbent position was common (93%), and 67.5% of ICUs used frequently noninvasive ventilation. Continuous enteral feeding was reported in all ICUs. Sedative infusions were usually interrupted every day in 11% of ICUs. Seventy-five percent of ICUs had specific guidelines for antibiotic therapy of VAP, but rotation of antibiotics was uncommon (11%). Twenty-nine percent of ICUs diagnosed VAP without microbiological confirmation. The most used technique for microbiologic diagnosis was qualitative culture of endotracheal aspirates (42.8%). The centers with a larger structural complexity reported using VAP therapy guidelines more frequently than the smaller centers, but they did not utilized bronchoscopic techniques for diagnosing VAP. Common prevention and diagnostic procedures in clinical practice, including large teaching institutions, significantly differed from evidence-based recommendations and reports by research groups of excellence. In addition, our study suggests that clinical practice for preventing and diagnosing VAP is variable and many opportunities exist to improve the care of patients receiving mechanical ventilation.

  14. International survey for good practices in forecasting uncertainty assessment and communication (United States)

    Berthet, Lionel; Piotte, Olivier


    Achieving technically sound flood forecasts is a crucial objective for forecasters but remains of poor use if the users do not understand properly their significance and do not use it properly in decision making. One usual way to precise the forecasts limitations is to communicate some information about their uncertainty. Uncertainty assessment and communication to stakeholders are thus important issues for operational flood forecasting services (FFS) but remain open fields for research. French FFS wants to publish graphical streamflow and level forecasts along with uncertainty assessment in near future on its website (available to the greater public). In order to choose the technical options best adapted to its operational context, it carried out a survey among more than 15 fellow institutions. Most of these are providing forecasts and warnings to civil protection officers while some were mostly working for hydroelectricity suppliers. A questionnaire has been prepared in order to standardize the analysis of the practices of the surveyed institutions. The survey was conducted by gathering information from technical reports or from the scientific literature, as well as 'interviews' driven by phone, email discussions or meetings. The questionnaire helped in the exploration of practices in uncertainty assessment, evaluation and communication. Attention was paid to the particular context within which every insitution works, in the analysis drawn from raw results. Results show that most services interviewed assess their forecasts uncertainty. However, practices can differ significantly from a country to another. Popular techniques are ensemble approaches. They allow to take into account several uncertainty sources. Statistical past forecasts analysis (such as the quantile regressions) are also commonly used. Contrary to what was expected, only few services emphasize the role of the forecaster (subjective assessment). Similar contrasts can be observed in uncertainty

  15. Nuclear medicine practice in Japan. A report of the sixth nationwide survey in 2007

    International Nuclear Information System (INIS)

    Kuwabara, Yasuo; Koizumi, Kiyoshi; Ushijima, Yo


    The Subcommittee on the Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every 5 years since 1982 to provide detailed information on its present status. Questionnaires were sent to all institutions known to the Japan Radioisotope Association to conduct nuclear medicine examinations. The questionnaires addressed the number and kind of nuclear medicine examinations performed as well as the kind and dose of the radiopharmaceuticals used during the month of June 2007. The annual number of total or specific examinations was then estimated. Of the institutions sent questionnaires, 1219 were for in vivo study, 49 for in vitro study, and 212 for positron emission tomography (PET) study. Of these, 92.2% provided answers. A total of 1569 gamma cameras were installed in 1119 institutions, of which 70% were dual-head cameras. The estimated total annual number of in vivo examinations expressed by the number of administered radiopharmaceuticals was 1.41 million, representing a decrease of 11.5% when compared with that of the previous survey (2002). The frequency of study with respect to single-photon emission computed tomography (SPECT) slightly increased to 42.3% from 39.9% in the previous survey. The most frequently performed scintigraphy was bone (38.3%), followed by myocardium (26.2%) and brain perfusion (14.1%). Brain perfusion scintigraphy slightly increased, whereas tumor scintigraphy decreased by one-half when compared with the previous survey. The most commonly used radiopharmaceutical for each scintigraphy was 99m Tc-hydroxymethylene diphosphonate (HMDP) for bone, thallium-201 ( 201 Tl)-chloride for myocardium, gallium-67 ( 67 Ga)-citrate for tumor, and technetium-99m-ethylcysteinate dimmer ( 99m Tc-ECD) for brain. The number of PET institutes increased from 36 to 212. 18 F-fluorodeoxyglucose ( 18 F-FDG)-PET dramatically increased 14.8-fold during the past 5 years. Radionuclide therapy also increased. 131 I

  16. Evidence-based speech-language pathology practices in schools: findings from a national survey. (United States)

    Hoffman, Lavae M; Ireland, Marie; Hall-Mills, Shannon; Flynn, Perry


    This study documented evidence-based practice (EBP) patterns as reported by speech-language pathologists (SLPs) employed in public schools during 2010-2011. Using an online survey, practioners reported their EBP training experiences, resources available in their workplaces, and the frequency with which they engage in specific EBP activities, as well as their resource needs and future training format preferences. A total of 2,762 SLPs in 28 states participated in the online survey, 85% of whom reported holding the Certificate of Clinical Competence in Speech-Language Pathology credential. Results revealed that one quarter of survey respondents had no formal training in EBP, 11% of SLPs worked in school districts with official EBP procedural guidelines, and 91% had no scheduled time to support EBP activities. The majority of SLPs posed and researched 0 to 2 EBP questions per year and read 0 to 4 American Speech-Language-Hearing Association (ASHA) journal articles per year on either assessment or intervention topics. Use of ASHA online resources and engagement in EBP activities were documented to be low. However, results also revealed that school-based SLPs have high interest in additional training and resources to support scientifically based practices. Suggestions for enhancing EBP support in public schools and augmenting knowledge transfer are provided.

  17. Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification. (United States)

    Moreau, William J; Nabhan, Dustin C; Walden, Taylor


    The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool-3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool-3 as a sideline assessment tool.

  18. Survey of Knowledge, Attittudes and Practices about Antibiotic Use in Colombian Physicians

    Directory of Open Access Journals (Sweden)

    Jorge Cortes


    Full Text Available We applied a voluntary survey about knowledge, attittudes and practices about antibiotic prescription at three scientific meetings of the Asociacion Colombiana de Infectología, on February 2008. The survey was anonimous and individual. The results were analyzed using Excel 2007 and STATA 2000. We analyzed 96 surveys, 29 from general practitioners and 67 medical specialists. Physicians had wrong knowledge about antibiotic use between 29,2% and 67,42%. Most physicians (97.4% considered the antibiotics have to be sold only under medical prescription. Many physicians recognized having limited knowledge about antibiotic dosing interval and security. 60% physicians disagreed with the application of guidelines from other countries in our enviroment and 76% physician consider the infectious disease experts contribute to clinical management of patients. Physicians reported having support from an infectious disease expert on 72%, and had strategies to restrict the use of some antibiotics, likecontact isolation when multi-resistant organisms had been suspected. There were not differences between answers according to years of experience. Several physcians reported conservative practices and rational antibiotic use with limited knowledge about antibiotic pharmacokinetics and pharmacodynamics.

  19. Automation and Its Funding in the Library Media Centers in Secondary Schools in Georgia: A Survey. (United States)

    Baggett, Ann Utsey

    This report presents the results of a study whose purpose was to determine what automation is present in the library media centers in Georgia secondary schools and how it has been funded. A three-part questionnaire was sent to the media specialists in 50% of the secondary schools in Georgia, which were randomly selected. The analysis of the…

  20. A survey of Vaccine Utilization in a Private Medical Center in Lagos ...

    African Journals Online (AJOL)

    Safe and effective vaccines have been successful in reducing childhood morbidity and mortality. A study of routine immunization in a private clinic was undertaken to evaluate vaccine utilization. A retrospective evaluation of attendance at a private clinic routine immunization center was done. Quantity of vaccines received ...


    Approximately 13 million children are placed in non-parental child care during the work day; however, children's exposures to chemicals in child care centers have not been characterized. To address this data gap, three federal agencies teamed to characterize contaminants in child...

  2. The actual role of general practice in the Dutch health-care system: results of the Second Dutch National Survey of General Practice.

    NARCIS (Netherlands)

    Schellevis, F.G.; Westert, G.P.; Bakker, D.H. de


    A second Dutch National Survey of General Practice was carried out in 2001 with the aim of providing actual information about the role of general practice in the Dutch health-care system for researchers and policy makers. Data were collected on different levels (patients, general practitioners,

  3. A national survey to define a new core curriculum to prepare physicians for managed care practice. (United States)

    Meyer, G S; Potter, A; Gary, N


    All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.S. medical school curriculum deans (or equivalent school representatives); four focus groups of managed care practitioners, administrators, educators, and residents; and a survey of a national sample of physicians and medical directors. Findings indicate that almost all the 91 responding school representatives recognized the importance of revising their curricula to meet the managed care challenge and that the majority either had or were developing programs to train students for practice in managed care environments. The focus groups identified a core set of competencies for managed care practice, although numbers differed on whether the classroom or a managed care setting was the best place to teach the components of a new curriculum. Although medical directors and staff physicians differed with respect to the relative levels of importance of these competencies, the findings suggest that before medical school, training should focus on communication and interpersonal skills, information systems, and customer relations; during medical school, on clinical epidemiology, quality assurance, risk management, and decision analysis; during residency, on utilization management, managed care essentials, and multidisciplinary team building; and after residency, on a review of customer relations, communication skills, and utilization management. The authors conclude that a core curriculum and its sequencing can be identified, that the majority of

  4. Blood transfusion practice in the UK and Ireland: a survey of palliative care physicians. (United States)

    Neoh, Karen; Stanworth, Simon; Bennett, Michael I


    Red cell (blood) transfusions are used in palliative care to manage patients with symptomatic anaemia or when patients have lost blood. We aimed to understand current blood transfusion practice among palliative medicine doctors and compare this with National Institute for Health and Care Excellence (NICE) guidance. NICE guidance advocates more restrictive transfusion practice but is based on clinical trials in non-palliative care contexts; the extent to which these findings should be applied to palliative care remains unclear. Four clinical vignettes of common clinical palliative care scenarios were developed. Members of the Association for Palliative Medicine were invited to complete the survey. Results were compared with acceptable responses based on current NICE recommendations and analysed to determine the influence of respondents' gender, experience or work setting. 27% of 1070 members responded. Overall, ideal or acceptable responses were selected by less than half of doctors to all four vignettes. Doctors were more liberal in prescribing blood transfusions than NICE guidance would advocate. Senior doctors were less likely to choose an acceptable response than junior colleagues. Palliative care practice is varied and not consistent with a restrictive blood transfusion policy. More recently trained doctors follow less liberal practices than senior colleagues. More direct evidence of benefits and harms of blood transfusion is needed in palliative care to inform practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Teaching interpersonal skills in family practice: results of a national survey. (United States)

    Kahn, G; Cohen, B; Jason, H


    The increasing recognition of the importance of a well-developed set of interpersonal skills to the competent family physician has resulted in a rapid growth in the formal teaching of interpersonal skills within family practice residencies. Of the 168 programs responding to a national survey of family practice residencies, 88 percent indicated that they have formal programs in interpersonal skills. It is estimated that there are well over 500 family practice faculty members who have special responsibilities in teaching interpersonal skills. While most programs address the component skills of the interpersonal process (eg, demonstrating empathy, information gathering, information giving, and psychological intervention), it is of concern that only about half offer explicit training in patient education (53 percent), specific types of counseling (eg, family counseling, 55 percent), or some of the specific interpersonal skills important in team practice and practice management (eg, supervisory skills). One of the most striking findings was that 88 percent of the reporting programs use videotechnology, with 77 percent of these planning to increase their use. Although most programs evaluate their interpersonal skills training using both indirect and direct assessment methods, only 25 percent attempt to use patient outcome as a measure of teaching effectiveness.

  6. Promoting CPAP adherence in clinical practice: A survey of Swedish and Norwegian CPAP practitioners' beliefs and practices. (United States)

    Broström, Anders; Pakpour, Amir H; Nilsen, Per; Gardner, Benjamin; Ulander, Martin


    The benefits of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea are well established, but adherence tends to be low. Research exploring CPAP practitioners' beliefs around determinants of CPAP adherence, and the actions they use in clinical practice to promote CPAP adherence is lacking. This study aimed to: (i) develop and validate a questionnaire to assess beliefs and current practices among CPAP practitioners; (ii) explore practitioners' beliefs regarding the main determinants of patient adherence, and the actions practitioners most commonly use to promote CPAP adherence; and (iii) explore the associations between perceived determinants and adherence-promotion actions. One-hundred and forty-two CPAP practitioners in Sweden and Norway, representing 93% of all Swedish and 62% of all Norwegian CPAP centres, were surveyed via a questionnaire exploring potential determinants (18 items) and adherence-promotion actions (20 items). Confirmatory factor analysis and second-order structural equational modelling were used to identify patterns of beliefs, and potential associations with adherence-promotion actions. Patients' knowledge, motivation and attitudes were perceived by practitioners to be the main determinants of CPAP adherence, and educating patients about effects, management and treatment adjustments were the most common practices. Knowledge was shown to predict educational and informational actions (e.g. education about obstructive sleep apnea and CPAP). Educational and informational actions were associated with medical actions (e.g. treatment adjustment), but knowledge, attitude and support had no association with medical actions. These findings indicate that a wide variety of determinants and actions are considered important, though the only relationship observed between beliefs and actions was found for knowledge and educational and informational actions. © 2018 European Sleep Research Society.

  7. Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model. (United States)

    Basu, Sanjay; Phillips, Russell S; Song, Zirui; Landon, Bruce E; Bitton, Asaf


    We assess the financial implications for primary care practices of participating in patient-centered medical home (PCMH) funding initiatives. We estimated practices' changes in net revenue under 3 PCMH funding initiatives: increased fee-for-service (FFS) payments, traditional FFS with additional per-member-per-month (PMPM) payments, or traditional FFS with PMPM and pay-for-performance (P4P) payments. Net revenue estimates were based on a validated microsimulation model utilizing national practice surveys. Simulated practices reflecting the national range of practice size, location, and patient population were examined under several potential changes in clinical services: investments in patient tracking, communications, and quality improvement; increased support staff; altered visit templates to accommodate longer visits, telephone visits or electronic visits; and extended service delivery hours. Under the status quo of traditional FFS payments, clinics operate near their maximum estimated possible net revenue levels, suggesting they respond strongly to existing financial incentives. Practices gained substantial additional net annual revenue per full-time physician under PMPM or PMPM plus P4P payments ($113,300 per year, 95% CI, $28,500 to $198,200) but not under increased FFS payments (-$53,500, 95% CI, -$69,700 to -$37,200), after accounting for costs of meeting PCMH funding requirements. Expanding services beyond minimum required levels decreased net revenue, because traditional FFS revenues decreased. PCMH funding through PMPM payments could substantially improve practice finances but will not offer sufficient financial incentives to expand services beyond minimum requirements for PCMH funding. © 2016 Annals of Family Medicine, Inc.

  8. Assessment of surgical competence in North American graduate periodontics programs: a survey of current practices. (United States)

    Ghiabi, Edmond; Taylor, K Lynn


    This cross-sectional study was designed to document the methods utilized by North American graduate periodontics programs in assessing their residents' surgical skills. A survey of clinical skills assessment was mailed to directors of all fifty-eight graduate periodontics programs in Canada and the United States. Thirty-four programs (59 percent) responded. The data collected were analyzed using SPSS version 15.0. The results demonstrate that the most common practice for providing feedback and documenting residents' surgical skills in the programs surveyed was daily one-on-one verbal feedback given by an instructor. The next two most commonly reported methods were a standard checklist developed at program level and a combination of a checklist and verbal comments. The majority of the programs reported that the instructors met collectively once per term to evaluate the residents' progress. The results suggest that graduate periodontics programs provide their residents frequent opportunities for daily practice with verbal feedback from instructors. However, assessment strategies identified in other health professions as beneficial in fostering the integration of clinical skills practices are not employed.

  9. [Vocational training in general practice in Germany: a nation-wide survey among trainees]. (United States)

    Roos, Marco; Blauth, Eckart; Steinhäuser, Jost; Ledig, Thomas; Joos, Stefanie; Peters-Klimm, Frank


    The increasing shortage of (primary care) physicians in Germany is currently being discussed within and outside the profession. A national survey among general practice trainees aimed to explore their perspectives of vocational training (VT). After translation, cultural adaptation and web implementation of the questionnaire of the "Vasco da Gama Movement," the survey was conducted during 2009. Descriptive analyses were performed. Among 436 participants (mean age 36 years, 64% female, 49 months of VT) discipline-specific ("medically diverse discipline", "one-to-one care", and "holistic approach"), but also gender-related (females: "compatibility with family life", males: "autonomy and independence", and "opportunities to start their own practice") aspects were important to their choice of career. Despite the heavy workload job satisfaction, but not salary satisfaction, was generally high. Participants rated the following general conditions and content of VT as important: "structured rotations", "rotations in hospitals", "management skills", "working in a local care setting and in a multidisciplinary team" (all>88%). These results provide clues to improving VT in General Practice with respect to organisation and content including the consideration of gender-related living conditions. Furthermore, improvement and further development of VT programmes should ideally be part of an area-wide, interdisciplinary and intersectoral approach. Copyright © 2010. Published by Elsevier GmbH.

  10. Arranging the Pieces: A Survey of Library Practices Related to a Tabletop Game Collection

    Directory of Open Access Journals (Sweden)

    Teresa Slobuski


    Full Text Available Objective – The purpose of this study is to explore collection development, cataloguing, processing, and circulation practices for tabletop game collections in libraries. This study used the term “tabletop games” to refer to the array of game styles that are played in real-world, social settings, such as board games, dice and card games, collectible card games, and role-playing games. Methods – An online survey regarding tabletop games in libraries was developed with input from academic, public, and school librarians. Participants were recruited utilizing a snowball sampling technique involving electronic outlets and discussion lists used by librarians in school, public, and academic libraries. Results – One hundred nineteen libraries answered the survey. The results show that tabletop games have a presence in libraries, but practices vary in regard to collection development, cataloguing, processing, and circulation. Conclusion – Results indicate that libraries are somewhat fragmented in their procedures for tabletop collections. Libraries can benefit from better understanding how others acquire, process, and use these collections. Although they are different to other library collections, tabletop games do not suffer from extensive loss and bibliographic records are becoming more available. Best practices and guidance are still needed to fully integrate games into libraries and to help librarians feel comfortable piloting their own tabletop collections.

  11. Sedation practice in Nordic and non-Nordic ICUs: a European survey. (United States)

    Egerod, Ingrid; Albarran, John W; Ring, Mette; Blackwood, Bronagh


    A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries. A cross-sectional survey of ICU nurses attending the fourth European federation of Critical Care Nursing associations (EfCCNa) in Denmark, 2011. Data included use of protocols; sedation, pain and delirium assessment tools; collaborative decision-making; sedation and analgesic medications; and educational preparation related to sedation. Response rate was 42% (n = 291) from 22 countries where 53% (n = 148) used sedation protocols. Nordic nurses reported greater use of sedation (91% versus 67%, p Nordic nurses. Decision-making on sedation was more inter-professionally collaborative in Nordic ICUs (83% versus 61%, p Nordic nurses reported greater consistency in maintaining circadian rhythm (66% versus 49%, p Nordic context might be more germane to the goal of lighter sedation and better pain management. Our study raises awareness of current sedation practice, paving the way towards optimized ICU sedation management. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.

  12. The practice of bullying among Brazilian schoolchildren and associated factors, National School Health Survey 2015. (United States)

    Mello, Flávia Carvalho Malta; Silva, Jorge Luiz da; Oliveira, Wanderlei Abadio de; Prado, Rogério Ruscitto do; Malta, Deborah Carvalho; Silva, Marta Angélica Iossi


    This study explored associations between bullying and sociodemographic, mental health and risk behavior variables in school age children. This cross-sectional survey analyzed data from the National School Health Survey (PeNSE 2015). A multiple logistic regression analysis checked for factors associated with bullying. Nineteen point eight percent (95%CI 10.5 - 20.0) of the students claimed they practiced bullying. The practice of bullying was more common among students enrolled in private schools, those living with their parents, and those whose mothers have more years of schooling and are gainfully employed (28.1% CI 27.3-28.8). In terms of mental health characteristics, bullying was more common among those feeling alone, suffering from insomnia and with no friends. Looking at family characteristics, those reporting they are physically punished by family members (33.09% CI 33.1-34.6) and miss school without telling their family (28.4% 95% CI 27.9-29.0) are more likely to practice bullying. Bullying was more frequent among those reporting tobacco, alcohol and drug use, and among students claiming to have had sexual relations. The data shows that bullying is significant and interferes in school children's health and the teaching-learning process. This must be addressed looking at youth as protagonists and in an inter-sectoral context.

  13. Seroprevalence and "Knowledge, Attitudes and Practices" (KAPs) survey of endemic ovine brucellosis in Egypt. (United States)

    Hegazy, Yamen; Elmonir, Walid; Abdel-Hamid, Nour Hosny; Elbauomy, Essam Mohamed


    Between February and July 2014, a cross-sectional study to estimate the seroprevalence of brucellosis in sheep in the Kafrelsheikh district of Egypt was carried out, together with a survey of knowledge, attitudes and practices (KAPs) among local shepherds. A total of 273 serum samples were collected from 28 sheep flocks in 10 villages within the study area. These samples were analysed by the Rose Bengal Plate test (RBPT) test, with all positive samples being confirmed by complement fixation test (CFT). True seroprevalence was 20 % (95 % CI 15.3-24.7 %) with the prevalence of villages with at least one seropositive sheep estimated at 95.5 % (95 % CI 92.2-100 %); village flock seroprevalence ranged from 0 to 46.8 %. Results of the KAPs survey demonstrated that despite good knowledge regarding brucellosis being potentially present within their flocks, shepherds lacked knowledge regarding routes of livestock to humans disease transmission and the symptoms of brucellosis in humans. This lack of knowledge regarding disease transmission resulted in high-risk practices being widespread-practices such as assisting parturition without protective measures, throwing aborted material into water canals and a reluctance to remove animals that had aborted from the flock. This study proposes potential measures to reduce seroprevalence of brucellosis in sheep and reduce public health risks from brucellosis such as culling aborted livestock and educational campaigns among shepherds regarding disease risks and modes of transmission.

  14. Tobacco Cessation Intervention for People with Disabilities: Survey of Center for Independent Living Directors (United States)

    Moorhouse, Michael D.; Pomeranz, Jamie L.; Barnett, Tracey E.; Yu, Nami S.; Curbow, Barbara A.


    People with disabilities (PWD) are 50% more likely to smoke compared with the general population, yet interventions tailored to the needs of PWD remain limited. The authors surveyed directors from a leading disability service organization to assess their delivery of tobacco cessation interventions. Although tobacco cessation was identified as a…

  15. Perceptions and practices regarding women's vaginal health following radiation therapy: A survey of radiation oncologists practicing in the United States. (United States)

    Kachnic, Lisa A; Bruner, Deborah W; Qureshi, Muhammad M; Russo, Gregory A

    Vaginal stenosis (VS) is a recognized complication of pelvic and vaginal radiation therapy (RT). A 26-item survey assessing the signs/symptoms, risk factors, diagnosis, prevention, treatment, and impact of VS on women's sexual health was distributed to radiation oncologists. Descriptive statistics were calculated. Chi-square tests examined differences in categorical responses. A total of 233 (10.5%) participants completed the entire survey. Twelve percent, 21%, and 68% report treating gynecologic (GYN) tumors only, non-GYN pelvic tumors only, or both, respectively. Regarding risk factors, 78% believed that VS can be caused by pelvic RT alone, 91% by vaginal brachytherapy alone, and 98% by combined pelvic RT and vaginal brachytherapy. Approximately one-half of respondents felt that being postmenopausal and having a hysterectomy before radiation therapy were risk factors for VS, whereas the other half felt that these were not risk factors. All respondents agreed that VS is a clinical diagnosis. Respondents indicated that VS symptoms include dyspareunia, vaginal pain, dryness, and/or bleeding (100%, 90%, 85%, and 72%, respectively); 65% indicated all 4. The most commonly recommended treatment for VS is vaginal dilator use. Radiation oncologists who treat GYN-only versus non-GYN cancers were more likely to perform a vaginal examination, to distribute written instructions regarding vaginal dilator use (P = .002), to have vaginal bleeding reported after RT (P = .001), and to refer patients to a sexual counselor (P = .007). Most providers (73%) expressed willingness to participate in prospective research on the diagnosis and treatment of VS. This is the first large-scale survey of radiation oncologists' perceptions and practices regarding VS. There is agreement among providers regarding the signs/symptoms of VS and strategies for its prevention/treatment using vaginal dilators. Further prospective and observational research is needed. This survey shows a willingness on

  16. Evidence-Based Practice Standard Care for Acute Pain Management in Adults With Sickle Cell Disease in an Urgent Care Center. (United States)

    Kim, Sunghee; Brathwaite, Ron; Kim, Ook

    Vaso-occlusive episodes (VOEs) with sickle cell disease (SCD) require opioid treatment. Despite evidence to support rapid pain management within 30 minutes, care for these patients does not consistently meet this benchmark. This quality improvement study sought to decrease the first analgesic administration time, increase patient satisfaction, and expedite patient flow. A prospective pre-/postevaluation design was used to evaluate outcomes with patients 18 years or older with VOEs in an urgent care (UC) center after implementation of evidence-based practice standard care (EBPSC). A pre- and postevaluation survey of SCD patients' satisfaction with care and analogous surveys of the UC team to assess awareness of EBPSC were used. A retrospective review of the electronic medical records of patients with VOEs compared mean waiting time from triage to the first analgesic administration and the mean length of stay (LOS) over 6 months. Implementing EBPSC decreased the mean time of the first analgesic administration (P = .001), significantly increased patient satisfaction (P = .002), and decreased the mean LOS (P = .010). Implementing EBPSC is a crucial step for improving the management of VOEs and creating a positive patient experience. The intervention enhances the quality of care for the SCD population in a UC center.

  17. Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2009 Patient Survey (United States)

    Lebrun-Harris, Lydie A; Baggett, Travis P; Jenkins, Darlene M; Sripipatana, Alek; Sharma, Ravi; Hayashi, A Seiji; Daly, Charles A; Ngo-Metzger, Quyen


    Objective To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts. Data Sources/Study Setting Nationally representative data from the 2009 Health Center Patient Survey. Study Design Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients' health care experiences. Data Collection Computer-assisted personal interviews were conducted with health center patients. Principal Findings Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92). Conclusions There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use. PMID:23134588

  18. Daylighting practices of the architectural industry (baseline results of a national survey)

    Energy Technology Data Exchange (ETDEWEB)

    Hattrup, M.P.


    A national survey of over 300 commercial design architects was conducted to develop baseline information on their knowledge, perceptions, and use of daylighting in commercial building designs. Pacific Northwest Laboratory conducted the survey for the US Department of Energy's (DOE) Office of Building and Community Systems (BCS). In the survey daylighting was defined as the intentional use of natural light as a partial substitute for artificially generated light. The results suggested that architects need to be educated about the true benefits of daylighting and the impacts it can have on a building's energy performance. Educational programs that will increase the architects' understanding and awareness of modern daylighting technologies and practices should be developed by utilities, stage agencies, and the federal government. If more architects can be made aware of the true effectiveness and positive attributes of daylighting systems and technologies, daylighting may be used in more commercial buildings. The results of the survey show that the more familiar architects feel they are with daylighting, the more they use daylighting. 3 refs., 19 tabs.

  19. Usage of structured reporting in radiological practice: results from an Italian online survey

    Energy Technology Data Exchange (ETDEWEB)

    Faggioni, Lorenzo [University of Pisa, UO Radiodiagnostica 1, Department of Diagnostic and Interventional Radiology, Pisa (Italy); Coppola, Francesca [Sant' Orsola-Malpighi University Hospital, Malpighi Radiology Unit, Department of Diagnostic and Preventive Medicine, Bologna (Italy); Ferrari, Riccardo [Urgenza Emergenza, UOC Diagnostica per Immagini 1, Rome (Italy); Neri, Emanuele [Dipartimento di Ricerca Traslazionale, Universita di Pisa, Sezione Dipartimentale Radiodiagnostica 3, Azienda Ospedaliera Universitaria Pisana, Pisa (Italy); Regge, Daniele [Universita di Torino, Dipartimento di Scienze Chirurgiche, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (Italy)


    To assess the opinion on structured reporting (SR) and its usage by radiologist members of the Italian Society of Medical Radiology (SIRM) via an online survey. All members received an email invitation to join the survey as an initiative by the SIRM Imaging Informatics Chapter. The survey included 10 questions about demographic information, definition of radiological SR, its usage in everyday practice, perceived advantages and disadvantages over conventional reporting and overall opinion about SR. 1159 SIRM members participated in the survey. 40.3 % of respondents gave a correct definition of radiological SR, but as many as 56 % of them never used it at work. Compared with conventional reporting, the most appreciated advantages of SR were higher reproducibility (70.5 %), better interaction with referring clinicians (58.3 %) and the option to link metadata (36.7 %). Risk of excessive simplification (59.8 %), template rigidity (56.1 %) and poor user compliance (42.1 %) were the most significant disadvantages. Overall, most respondents (87.0 %) were in favour of the adoption of radiological SR. Most radiologists were interested in radiological SR and in favour of its adoption. However, concerns about semantic, technical and professional issues limited its diffusion in real working life, encouraging efforts towards improved SR standardisation and engineering. (orig.)

  20. Work health and safety in cotton ginning industry: a survey of practices in australia

    International Nuclear Information System (INIS)

    Soomro, N.


    This survey focuses on the WH and S (Work Health and Safety) practices in Australia and relates them with those in Pakistan. It also highlights the planned areas of work required on WH and S in cotton ginning industry of Pakistan. This article is one a series of research studies that will inform a broader approach development. The aim of the survey was to design a standardized health and safety Act for cotton ginning industry of Pakistan and to help ginners meet their due industry obligations under the model WH and S Act. The first component of the research study survey was to review the relevant Australian work and safety model as this provides a framework to protect the health, safety and welfare of all employees at work and of other people who might be affected by the job. The second aspect of the research study survey concerned site visits to cotton gins with the support of Australian Centre for Agricultural Health and Safety, Moree, NSW. During these visits the existing ginning process in terms of WH and S were reviewed. Informal interviews were also conducted with Gin Managers and Ginning Experts regarding WH and S in the Australian cotton ginning industry. (author)

  1. Social marketing strategies for reaching older people with disabilities: findings from a survey of centers for independent living participants. (United States)

    Moone, Rajean Paul; Lightfoot, Elizabeth


    Centers for independent living (CILs) provide critical supports, services, and advocacy for assisting people with disabilities in living independently. As there is a rapidly increasing population of older people with disabilities, many CILs are now considering how to actively engage older adults in their organizations. This study utilized a survey of older people with disabilities to help identify social marketing techniques that community organizations like CILs can use to effectively reach older people with disabilities. Utilizing the components of the social marketing mix in designing outreach efforts, including a critical examination of product, place, price, participants, and partnering, CILs and other community agencies can better reach older adults with disabilities.

  2. Quality-assurance plan for water-quality activities in the U.S. Geological Survey Washington Water Science Center (United States)

    Conn, Kathleen E.; Huffman, Raegan L.; Barton, Cynthia


    In accordance with guidelines set forth by the Office of Water Quality in the Water Mission Area of the U.S. Geological Survey, a quality-assurance plan has been created for use by the Washington Water Science Center (WAWSC) in conducting water-quality activities. This qualityassurance plan documents the standards, policies, and procedures used by the WAWSC for activities related to the collection, processing, storage, analysis, and publication of water-quality data. The policies and procedures documented in this quality-assurance plan for water-quality activities complement the quality-assurance plans for surface-water and groundwater activities at the WAWSC.

  3. Response Burden in Official Business Surveys: Measurement and Reduction Practices of National Statistical Institutes

    Directory of Open Access Journals (Sweden)

    Bavdaž Mojca


    Full Text Available Response burden in business surveys has long been a concern for National Statistical Institutes (NSIs for three types of reasons: political reasons, because response burden is part of the total administrative burden governments impose on businesses; methodological reasons, because an excessive response burden may reduce data quality and increase data-collection costs; and strategic reasons, because it affects relations between the NSIs and the business community. This article investigates NSI practices concerning business response burden measurement and reduction actions based on a survey of 41 NSIs from 39 countries. Most NSIs monitor at least some burden aspects and have implemented some actions to reduce burden, but large differences exist between NSIs’ methodologies for burden measurement and actions taken to reduce burden. Future research should find ways to deal with methodological differences in burden conceptualization, operationalization, and measurement, and provide insights into the effectiveness and efficiency of burden-reduction actions.

  4. Survey of diagnostic and treatment practices for multiple sclerosis in Europe

    DEFF Research Database (Denmark)

    Fernández, O; Delvecchio, M; Edan, G


    BACKGROUND AND PURPOSE: Up-to-date information is needed on the extent to which neurologists treating multiple sclerosis (MS) in Europe are integrating rapidly evolving diagnostic criteria, disease-modifying therapies and recommendations for monitoring disease activity into their clinical practice...... syndrome (CIS), relapsing-remitting MS (RRMS) and RRMS with breakthrough disease. RESULTS: Multiple sclerosis neurologists from 11 European countries responded to survey 1 (n = 233) and survey 2 (n = 171). Respondents agreed that they would not treat the patients in the RIS or CIS cases but would treat...... a patient with a relatively mild form of RRMS. Choice of treatment was evenly distributed among first-line injectables and oral treatments for mild RRMS, and moved to second-line treatment as the RRMS case increased in severity. Additional results on RRMS with breakthrough disease are presented. CONCLUSIONS...

  5. Complementary and Alternative Medicine Use Among Allergy Practices: Results of a Nationwide Survey of Allergists. (United States)

    Land, Michael H; Wang, Julie

    The use of complementary and alternative practices in the field of Allergy/Immunology is growing. A recent survey of American Academy of Allergy, Asthma, and Immunology members examining patterns of complementary and alternative medicine (CAM) use and adverse effects from CAM revealed that a majority of practitioners (81% of respondents) had patients who are using CAM therapies over conventional treatments and many practitioners (60% of survey respondents) have encountered patients experiencing adverse reactions. During routine office visits, a majority of practitioners do not ask patients about CAM use, and when they do, most do not have a standard intake form to take a CAM history. There is a strong need to increase knowledge and improve measures to prevent adverse reactions to CAMs. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  6. The actual role of general practice in the Dutch health-care system: results of the Second Dutch National Survey of General Practice.


    Schellevis, F.G.; Westert, G.P.; Bakker, D.H. de


    A second Dutch National Survey of General Practice was carried out in 2001 with the aim of providing actual information about the role of general practice in the Dutch health-care system for researchers and policy makers. Data were collected on different levels (patients, general practitioners, practices) and included morbidity (self-report and presented to general practitioners), diagnostic and therapeutic interventions, doctor-patient communication, and background characteristics. Compared ...

  7. A survey of percutaneous chest drainage practice in French university surgical ICU's. (United States)

    Remérand, F; Bazin, Y; Gage, J; Laffon, M; Fusciardi, J


    Percutaneous chest drainage guidelines were published in 2010 by the British Thoracic Society. On several points (insertion technique, drain size), they seem to differ from French practices. Our objectives were to evaluate practice of pleural drainage in French University surgical intensive care units (ICU's), and to compare it with the British guidelines. National phone survey. Physicians working in 58 ICU's were surveyed first in 2007, and subsequently in 2012. They were read a questionnaire to evaluate the demographic characteristics of their units, their indication for pleural drainage, how they quantified pleural effusion, and their technique for drain insertion. Data from the two surveys were compared to detect an evolution in practice following the publication of the British guidelines. Results are expressed as the mean response. In 2007, pleural drainage indications relied on various respiratory criteria in 91% of cases (versus 95% in 2012) and/or on pleural effusion volume in 71% of cases (versus 59% in 2012). Trocars (Monod or Joly) were used in 68% of the procedures in 2007. In the rest, either blunt dissection, a Pleurocath® or the Seldinger technique was utilized. From 2007 to 2012, the Seldinger technique increased in frequency (10% versus 22%, P=0.005) while Monod trocar usage decreased (41% vs 29%, P=0.012). Ultrasound before pleural effusion drainage became nearly systematic in 2012 (60% vs 86%, Pdrains) for pleural drainage in French ICU's differs significantly from the British guidelines. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  8. Survey of French spine surgeons reveals significant variability in spine trauma practices in 2013. (United States)

    Lonjon, G; Grelat, M; Dhenin, A; Dauzac, C; Lonjon, N; Kepler, C K; Vaccaro, A R


    In France, attempts to define common ground during spine surgery meetings have revealed significant variability in clinical practices across different schools of surgery and the two specialities involved in spine surgery, namely, neurosurgery and orthopaedic surgery. To objectively characterise this variability by performing a survey based on a fictitious spine trauma case. Our working hypothesis was that significant variability existed in trauma practices and that this variability was related to a lack of strong scientific evidence in spine trauma care. We performed a cross-sectional survey based on a clinical vignette describing a 31-year-old male with an L1 burst fracture and neurologic symptoms (numbness). Surgeons received the vignette and a 14-item questionnaire on the management of this patient. For each question, surgeons had to choose among five possible answers. Differences in answers across surgeons were assessed using the Index of Qualitative Variability (IQV), in which 0 indicates no variability and 1 maximal variability. Surgeons also received a questionnaire about their demographics and surgical experience. Of 405 invited spine surgeons, 200 responded to the survey. Five questions had an IQV greater than 0.9, seven an IQV between 0.5 and 0.9, and two an IQV lower than 0.5. Variability was greatest about the need for MRI (IQV=0.93), degree of urgency (IQV=0.93), need for fusion (IQV=0.92), need for post-operative bracing (IQV=0.91), and routine removal of instrumentation (IQV=0.94). Variability was lowest for questions about the need for surgery (IQV=0.42) and use of the posterior approach (IQV=0.36). Answers were influenced by surgeon specialty, age, experience level, and type of centre. Clinical practice regarding spine trauma varies widely in France. Little published evidence is available on which to base recommendations that would diminish this variability. Copyright © 2015. Published by Elsevier Masson SAS.

  9. Anaesthetic and ICU management of aneurysmal subarachnoid haemorrhage: a survey of European practice. (United States)

    Velly, Lionel J; Bilotta, Federico; Fàbregas, Neus; Soehle, Martin; Bruder, Nicolas J; Nathanson, Michael H


    Many aspects of the perioperative management of aneurysmal subarachnoid haemorrhage (SAH) remain controversial. It would be useful to assess differences in the treatment of SAH in Europe to identify areas for improvement. To determine the clinical practice of physicians treating SAH and to evaluate any discrepancy between practice and published evidence. An electronic survey. Physicians identified through each national society of neuroanaesthesiology and neurocritical care. A 31-item online questionnaire was distributed by the ENIG group. Questions were designed to investigate anaesthetic management of SAH and diagnostic and treatment approaches to cerebral vasospasm. The survey was available from early October to the end of November 2012. Completed surveys were received from 268 respondents, of whom 81% replied that aneurysm treatment was conducted early (within 24 h). Sixty-five percent of centres treated more than 60% of SAH by coiling, 19% had high-volume clipping (>60% of aneurysms clipped) and 16% used both methods equally. No clear threshold for arterial blood pressure target was identified during coiling, temporary clipping or in patients without vasospasm after the aneurysm had been secured. Almost all respondents used nimodipine (97%); 21% also used statins and 20% used magnesium for prevention of vasospasm. A quarter of respondents used intra-arterial vasodilators alone, 5% used cerebral angioplasty alone and 48% used both endovascular methods to treat symptomatic vasospasm. In high-volume clipping treatment centres, 58% of respondents used endovascular methods to manage vasospasm compared with 86% at high-volume coiling treatment centres (P practice patterns of European physicians involved in early treatment of SAH. Significant differences were noted among countries and between high and low-volume coiling centres.

  10. A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars

    Directory of Open Access Journals (Sweden)

    Cooke Georga PE


    Full Text Available Abstract Background Burnout and intolerance of uncertainty have been linked to low job satisfaction and lower quality patient care. While resilience is related to these concepts, no study has examined these three concepts in a cohort of doctors. The objective of this study was to measure resilience, burnout, compassion satisfaction, personal meaning in patient care and intolerance of uncertainty in Australian general practice (GP registrars. Methods We conducted a paper-based cross-sectional survey of GP registrars in Australia from June to July 2010, recruited from a newsletter item or registrar education events. Survey measures included the Resilience Scale-14, a single-item scale for burnout, Professional Quality of Life (ProQOL scale, Personal Meaning in Patient Care scale, Intolerance of Uncertainty-12 scale, and Physician Response to Uncertainty scale. Results 128 GP registrars responded (response rate 90%. Fourteen percent of registrars were found to be at risk of burnout using the single-item scale for burnout, but none met the criteria for burnout using the ProQOL scale. Secondary traumatic stress, general intolerance of uncertainty, anxiety due to clinical uncertainty and reluctance to disclose uncertainty to patients were associated with being at higher risk of burnout, but sex, age, practice location, training duration, years since graduation, and reluctance to disclose uncertainty to physicians were not. Only ten percent of registrars had high resilience scores. Resilience was positively associated with compassion satisfaction and personal meaning in patient care. Resilience was negatively associated with burnout, secondary traumatic stress, inhibitory anxiety, general intolerance to uncertainty, concern about bad outcomes and reluctance to disclose uncertainty to patients. Conclusions GP registrars in this survey showed a lower level of burnout than in other recent surveys of the broader junior doctor population in both Australia

  11. Safety practices, perceptions, and behaviors in radiation oncology: A national survey of radiation therapists. (United States)

    Woodhouse, Kristina Demas; Hashemi, David; Betcher, Kathryn; Doucette, Abigail; Weaver, Allison; Monzon, Brian; Rosenthal, Seth A; Vapiwala, Neha

    Radiation therapy is complex and demands high vigilance and precise coordination. Radiation therapists (RTTs) directly deliver radiation and are often the first to discover an error. Yet, few studies have examined the practices of RTTs regarding patient safety. We conducted a national survey to explore the perspectives of RTTs related to quality and safety. In 2016, an electronic survey was sent to a random sample of 1500 RTTs in the United States. The survey assessed department safety, error reporting, safety knowledge, and culture. Questions were multiple choice or recorded on a Likert scale. Results were summarized using descriptive statistics and analyzed using multivariate logistic regression. A total of 702 RTTs from 49 states (47% response rate) completed the survey. Respondents represented a broad distribution across practice settings. Most RTTs rated department patient safety as excellent (61%) or very good (32%), especially if they had an incident learning system (ILS) (odds ratio, 2.0). Only 21% reported using an ILS despite 58% reporting an accessible ILS in their department. RTTs felt errors were most likely to occur with longer shifts and poor multidisciplinary communication; 40% reported that burnout and anxiety negatively affected their ability to deliver care. Workplace bullying was also reported among 17%. Overall, there was interest (62%) in improving knowledge in patient safety. Although most RTTs reported excellent safety cultures within their facilities, overall, there was limited access to and utilization of ILSs by RTTs. Workplace issues identified may also represent barriers to delivering quality care. RTTs were also interested in additional resources regarding quality and safety. These results will further enhance safety initiatives and inform future innovative educational efforts in radiation oncology. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  12. Usage of structured reporting in radiological practice: results from an Italian online survey. (United States)

    Faggioni, Lorenzo; Coppola, Francesca; Ferrari, Riccardo; Neri, Emanuele; Regge, Daniele


    To assess the opinion on structured reporting (SR) and its usage by radiologist members of the Italian Society of Medical Radiology (SIRM) via an online survey. All members received an email invitation to join the survey as an initiative by the SIRM Imaging Informatics Chapter. The survey included 10 questions about demographic information, definition of radiological SR, its usage in everyday practice, perceived advantages and disadvantages over conventional reporting and overall opinion about SR. 1159 SIRM members participated in the survey. 40.3 % of respondents gave a correct definition of radiological SR, but as many as 56 % of them never used it at work. Compared with conventional reporting, the most appreciated advantages of SR were higher reproducibility (70.5 %), better interaction with referring clinicians (58.3 %) and the option to link metadata (36.7 %). Risk of excessive simplification (59.8 %), template rigidity (56.1 %) and poor user compliance (42.1 %) were the most significant disadvantages. Overall, most respondents (87.0 %) were in favour of the adoption of radiological SR. Most radiologists were interested in radiological SR and in favour of its adoption. However, concerns about semantic, technical and professional issues limited its diffusion in real working life, encouraging efforts towards improved SR standardisation and engineering. • Despite radiologists' awareness, radiological SR is little used in working practice. • Perceived SR advantages are reproducibility, better clinico-radiological interaction and link to metadata. • Perceived SR disadvantages are excessive simplification, template rigidity and poor user compliance. • Improved standardisation and engineering may be helpful to boost SR diffusion.

  13. Demographic survey centered around the Nevada Test Site, Nye County, Nevada

    International Nuclear Information System (INIS)

    Richard-Haggard, K.


    Demographic data were gathered for several small population centers on and around the Nevada Test Site (NTS). Population projections were made for the three townships that include most of the major population centers in the study area, based on the share approach. These townships were Alamo Township (Lincoln County), Beatty and Pahrump townships (Nye County). It was estimated that the total population of these three townships, plus Clark County, would reach a maximum of 934,000 people by the year 2000. It was assumed that the on-site population of the NTS would continue to be a function of activity at the site, and that this would, if anything, aid in the attainment of site objectives

  14. A Survey of a Remote Diagnosis Center for Nuclear Power Plants

    International Nuclear Information System (INIS)

    Choi, Yoo Rark; Lee, Jae Cheol; Kim, Jae Hee


    Methodologies for remote diagnosis have been developed and applied to medical care and lots of industrial fields. Modern science technolog