WorldWideScience

Sample records for clinical care sort

  1. Sorted.

    Science.gov (United States)

    Towers, S

    1997-04-01

    Each year in Accident and Emergency an increasing number of young people present with acute problems related to social drugs. These problems range from mild symptoms to life-threatening conditions, many of which can be extremely difficult and time consuming for staff to manage. It has become apparent that as with sex the experimental age for taking drugs is getting younger as youths are now far more 'streetwise' than their predecessors. This is one of the main reasons for this paper being written; it is imperative that staff are equipped with the appropriate knowledge to deal with the challenge and are educated about the problems associated with current drug trends. This potentially improves the quality of care and, in turn, good communication improves relationships. Ecstasy is once again becoming increasingly popular within mainstream clubs, as recently highlighted in the media, and with it reappear its problems. This article discusses the historical aspects of Ecstasy and aims to educate staff about its use and effects and provides health promotion advice for those who are involved in the care of people who take Ecstasy. PMID:9171546

  2. SORT:Ed - An Interactive Educational Game for HealthCare Students

    OpenAIRE

    Currell, Karen

    2011-01-01

    This short paper outlines an academic’s entrepreneurial journey from idea conception to the market place. Sort Ed is an interactive board game designed for paediatric student nurses and it set in a child’s ward. There is a huge market demand for this type of educational games in the UK especially by institutions that run healthcare management courses. This learning tool is a major contribution to the limited number of interactive educational games currently available to healthcare tutors and ...

  3. Novel Serial Positive Enrichment Technology Enables Clinical Multiparameter Cell Sorting

    Science.gov (United States)

    Tschulik, Claudia; Piossek, Christine; Bet, Jeannette; Yamamoto, Tori N.; Schiemann, Matthias; Neuenhahn, Michael; Martin, Klaus; Schlapschy, Martin; Skerra, Arne; Schmidt, Thomas; Edinger, Matthias; Riddell, Stanley R.; Germeroth, Lothar; Busch, Dirk H.

    2012-01-01

    A general obstacle for clinical cell preparations is limited purity, which causes variability in the quality and potency of cell products and might be responsible for negative side effects due to unwanted contaminants. Highly pure populations can be obtained best using positive selection techniques. However, in many cases target cell populations need to be segregated from other cells by combinations of multiple markers, which is still difficult to achieve – especially for clinical cell products. Therefore, we have generated low-affinity antibody-derived Fab-fragments, which stain like parental antibodies when multimerized via Strep-tag and Strep-Tactin, but can subsequently be removed entirely from the target cell population. Such reagents can be generated for virtually any antigen and can be used for sequential positive enrichment steps via paramagnetic beads. First protocols for multiparameter enrichment of two clinically relevant cell populations, CD4high/CD25high/CD45RAhigh ‘regulatory T cells’ and CD8high/CD62Lhigh/CD45RAneg ‘central memory T cells’, have been established to determine quality and efficacy parameters of this novel technology, which should have broad applicability for clinical cell sorting as well as basic research. PMID:22545138

  4. Novel serial positive enrichment technology enables clinical multiparameter cell sorting.

    Directory of Open Access Journals (Sweden)

    Christian Stemberger

    Full Text Available A general obstacle for clinical cell preparations is limited purity, which causes variability in the quality and potency of cell products and might be responsible for negative side effects due to unwanted contaminants. Highly pure populations can be obtained best using positive selection techniques. However, in many cases target cell populations need to be segregated from other cells by combinations of multiple markers, which is still difficult to achieve--especially for clinical cell products. Therefore, we have generated low-affinity antibody-derived Fab-fragments, which stain like parental antibodies when multimerized via Strep-tag and Strep-Tactin, but can subsequently be removed entirely from the target cell population. Such reagents can be generated for virtually any antigen and can be used for sequential positive enrichment steps via paramagnetic beads. First protocols for multiparameter enrichment of two clinically relevant cell populations, CD4(high/CD25(high/CD45RA(high 'regulatory T cells' and CD8(high/CD62L(high/CD45RA(neg 'central memory T cells', have been established to determine quality and efficacy parameters of this novel technology, which should have broad applicability for clinical cell sorting as well as basic research.

  5. Novel Serial Positive Enrichment Technology Enables Clinical Multiparameter Cell Sorting

    OpenAIRE

    Christian Stemberger; Stefan Dreher; Claudia Tschulik; Christine Piossek; Jeannette Bet; Yamamoto, Tori N.; Matthias Schiemann; Michael Neuenhahn; Klaus Martin; Martin Schlapschy; Arne Skerra; Thomas Schmidt; Matthias Edinger; Riddell, Stanley R.; Lothar Germeroth

    2012-01-01

    A general obstacle for clinical cell preparations is limited purity, which causes variability in the quality and potency of cell products and might be responsible for negative side effects due to unwanted contaminants. Highly pure populations can be obtained best using positive selection techniques. However, in many cases target cell populations need to be segregated from other cells by combinations of multiple markers, which is still difficult to achieve--especially for clinical cell product...

  6. Health care clinics in Cambodia.

    Science.gov (United States)

    Wollschlaeger, K

    1995-04-01

    Under the Pol Pot Khmer Rouge regime, most physicians with clinical experience were either killed or fled the country. The few practitioners who managed to survive were forced to hide their knowledge; much of that knowledge and experience is now lost. As part of a general process of national rehabilitation, Cambodia has trained since the 1980s hundreds of physicians and physician assistants. There were 700 physicians, 1300 physician assistants, and 4000 nurses in the country by 1992. Problems do, however, remain with medical education in Cambodia. In particular, the medical texts and lectures are in French, a language which very few of the younger generation speak; instructional texts are designed to meet the needs of developing nations, not a rehabilitating one like Cambodia; emphasis is upon curative health care, hospitals, and vertical programs instead of primary and preventive health care; Cambodian physicians are used to a system based upon the division of patients by ability to pay instead of by age, disease, or need; corruption has grown as the cost of living has outstripped the level of official salaries; and there is neither professional contact, feedback, nor program evaluation within health care programs. The authors is a resident in obstetrics and gynecology at the University of Chicago who worked at two clinics during a stay in Phnom Penh. She recommends that instead of simply training more doctors, these training-related problems should be addressed, including a revision of the curriculum to include both primary health care medicine and psychiatry. Moreover, people in Cambodia need to be taught the importance of preventive health care, which should then reduce the number of visits to physicians. This process will be accomplished more effectively with the cooperation of physicians, the government, nongovernmental organizations, and international organizations associated with health care. PMID:7787486

  7. Sorting Out Sorts

    OpenAIRE

    Jonathan B. Berk

    1998-01-01

    In this paper we analyze the theoretical implications of sorting data into groups and then running asset pricing tests within each group. We show that the way this procedure is implemented introduces a severe bias in favor of rejecting the model under consideration. By simply picking enough groups to sort into even the true asset pricing model can be shown to have no explanatory power within each group.

  8. Health care retail clinics: current perspectives

    OpenAIRE

    Kaissi, Amer

    2016-01-01

    Amer Kaissi Department of Health Care Administration, Trinity University, San Antonio, TX, USA Abstract: Retail clinics represent a major innovation with a radical value proposition in American health care: convenient locations and hours, walk-in care, short waiting times, and transparent pricing. Many organizations, groups, associations, and individual providers affect and are affected by retail clinics. The main winners from the retail clinic trend are insurance companies and third-party p...

  9. Access and care issues in urban urgent care clinic patients

    Directory of Open Access Journals (Sweden)

    Adams Jill C

    2009-12-01

    Full Text Available Abstract Background Although primary care should be the cornerstone of medical practice, inappropriate use of urgent care for non-urgent patients is a growing problem that has significant economic and healthcare consequences. The characteristics of patients who choose the urgent care setting, as well as the reasoning behind their decisions, is not well established. The purpose of this study was to determine the motivation behind, and characteristics of, adult patients who choose to access health care in our urgent care clinic. The relevance of understanding the motivation driving this patient population is especially pertinent given recent trends towards universal healthcare and the unclear impact it may have on the demands of urgent care. Methods We conducted a cross-sectional survey of patients seeking care at an urgent care clinic (UCC within a large acute care safety-net urban hospital over a six-week period. Survey data included demographics, social and economic information, reasons that patients chose a UCC, previous primary care exposure, reasons for delaying care, and preventive care needs. Results A total of 1, 006 patients were randomly surveyed. Twenty-five percent of patients identified Spanish as their preferred language. Fifty-four percent of patients reported choosing the UCC due to not having to make an appointment, 51.2% because it was convenient, 43.9% because of same day test results, 42.7% because of ability to get same-day medications and 15.1% because co-payment was not mandatory. Lack of a regular physician was reported by 67.9% of patients and 57.2% lacked a regular source of care. Patients reported delaying access to care for a variety of reasons. Conclusion Despite a common belief that patients seek care in the urgent care setting primarily for economic reasons, this study suggests that patients choose the urgent care setting based largely on convenience and more timely care. This information is especially applicable to

  10. Caring during clinical practice: Midwives’ perspective

    Directory of Open Access Journals (Sweden)

    Mmajapi E. Chokwe

    2013-09-01

    Full Text Available Background: Caring forms the core of nursing and midwifery. Despite caring being an important emotional aspect of midwifery and nursing, there are general public complaints about uncaring behaviour in midwifery. Therefore, there is a need to explore caring from midwives’ point of view with the hope of identifying solutions and recommendations for midwifery practice. Furthermore, the study aimed to stimulate debate and discussion about the caring behaviour of midwives.Objective: To explore caring during clinical practice as perceived and experienced by midwives.Method: The study was contextual, exploratory and qualitative. The participants were midwives working in state and private hospitals in Tshwane,South Africa where BTech II and III midwifery learners were allocated for work integrated learning (WIL. Data collection was carried out through self-report using a questionnaire and focus group. Questionnaires were distributed to 40 midwives at private and state hospitals in Tshwane. This was followed by two focus group sessions to ensure that data is enriched. The hermeneutic interpretive approach was used to analyse data, and analysis continued until saturation.Results: Themes of caring and uncaring related to patient care and midwives emerged. Thefindings illustrated that the midwives had excellent theoretical knowledge of caring, but someof them did not display caring behaviour during clinical practice.Conclusion: Some of the midwives did not display caring behaviour. Implication for practicewas provided based on the research findings. Recommendations included measures of improving caring behaviours during midwifery practice.

  11. [Home hospice care at a clinic].

    Science.gov (United States)

    Arai, F; Osako, M; Shimoaraiso, Y; Sakamoto, T; Miyashita, T; Yamanouchi, H; Kadokura, K; Yoshida, K; Dozono, F; Mamitsuka, K; Dozono, H

    1999-12-01

    For the people who want to stay at home until their last day, the primary doctor and clinic where they were diagnosed will be the most reliable supports. We have been operating a 19 bed clinic since 1996. In these three years, we have established what we call a "combination palliative care system." A team composed of two doctors, 13 nurses, 3 care aids, a social worker, and a counselor provides home care services as well as outpatient and inpatient care. From April, 1998 to March, 1999, 59 patients died of cancer. Among them, 25 patients died at home. Their primary cancers were lung (7), colon (3), pancreatic (2), breast (2), ovarian (2), brain (1), stomach (1), hepatoma (1), neck (1) and others. First of all, sufficient consultation with patients and family makes this care successful. Through this, the patient can choose his style of care. The whole staff is involved in this care in turn, so that all of us become acquainted with each patient. Home care includes: 1) medical and nursing service available 24 hours a day, 2) activation of social resources for the support of the patient user, 3) constructive cooperation with relevant institutions, 4) relieving the patient's physical and mental suffering, 5) aroma therapy, oil massage, hair cuts and music therapy, and 6) support by volunteers. In this way, as a neighborhood clinic, the combination palliative care system is valuable. PMID:10630230

  12. Providing semantic interoperability between clinical care and clinical research domains.

    Science.gov (United States)

    Laleci, Gokce Banu; Yuksel, Mustafa; Dogac, Asuman

    2013-03-01

    Improving the efficiency with which clinical research studies are conducted can lead to faster medication innovation and decreased time to market for new drugs. To increase this efficiency, the parties involved in a regulated clinical research study, namely, the sponsor, the clinical investigator and the regulatory body, each with their own software applications, need to exchange data seamlessly. However, currently, the clinical research and the clinical care domains are quite disconnected because each use different standards and terminology systems. In this article, we describe an initial implementation of the Semantic Framework developed within the scope of SALUS project to achieve interoperability between the clinical research and the clinical care domains. In our Semantic Framework, the core ontology developed for semantic mediation is based on the shared conceptual model of both of these domains provided by the BRIDG initiative. The core ontology is then aligned with the extracted semantic models of the existing clinical care and research standards as well as with the ontological representations of the terminology systems to create a model of meaning for enabling semantic mediation. Although SALUS is a research and development effort rather than a product, the current SALUS knowledge base contains around 4.7 million triples representing BRIDG DAM, HL7 CDA model, CDISC standards and several terminology ontologies. In order to keep the reasoning process within acceptable limits without sacrificing the quality of mediation, we took an engineering approach by developing a number of heuristic mechanisms. The results indicate that it is possible to build a robust and scalable semantic framework with a solid theoretical foundation for achieving interoperability between the clinical research and clinical care domains. PMID:23008263

  13. Integrating wound care research into clinical practice.

    Science.gov (United States)

    Ho, Chester H; Bogie, Kath M

    2007-10-01

    The process of integrating wound care research into clinical practice incorporates research methodology--i.e., the standardized practices, procedures, and rules by which research is performed--and an evidence-based approach. Using examples from the literature and clinician experience treating pressure ulcers in a 32-bed regional spinal cord injury unit in a tertiary referral center in Cleveland, Ohio, the authors describe this process and review the challenges faced by an interdisciplinary skin care team tasked with implementing evidence-based care. Additional considerations include determining the amount of current wound care that is evidence-based and whether wound prevention and care outcomes are improved through the use of evidence-based medicine. Five years after establishing the skin care team and implementing evidence-based care, improvements in care processes and short-term outcomes--specifically, pressure ulcer prevention and treatment protocols including documentation--have been realized. Studies to ascertain the effects of these changes on long-term outcomes are planned. PMID:17978411

  14. A nonparametric Bayesian alternative to spike sorting

    Science.gov (United States)

    Wood, Frank; Black, Michael J.

    2013-01-01

    The analysis of extra-cellular neural recordings typically begins with careful spike sorting and all analysis of the data then rests on the correctness of the resulting spike trains. In many situations this is unproblematic as experimental and spike sorting procedures often focus on well isolated units. There is evidence in the literature, however, that errors in spike sorting can occur even with carefully collected and selected data. Additionally, chronically implanted electrodes and arrays with fixed electrodes cannot be easily adjusted to provide well isolated units. In these situations, multiple units may be recorded and the assignment of waveforms to units may be ambiguous. At the same time, analysis of such data may be both scientifically important and clinically relevant. In this paper we address this issue using a novel probabilistic model that accounts for several important sources of uncertainty and error in spike sorting. In lieu of sorting neural data to produce a single best spike train, we estimate a probabilistic model of spike trains given the observed data. We show how such a distribution over spike sortings can support standard neuroscientific questions while providing a representation of uncertainty in the analysis. As a representative illustration of the approach, we analyzed primary motor cortical tuning with respect to hand movement in data recorded with a chronic multi-electrode array in non-human primates. We found that the probabilistic analysis generally agrees with human sorters but suggests the presence of tuned units not detected by humans. PMID:18602697

  15. Introducing Optometry Students to Clinical Patient Care.

    Science.gov (United States)

    Gable, Eileen M.

    2001-01-01

    Describes the innovative content and structure of an introductory course on clinical patient care at the Illinois College of Optometry. Critiques its success based on student grades and feedback, concluding that it was successful in imparting skills of data analysis but had minimal impact on students' ability to empathize with patients. (EV)

  16. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  17. Dementia Care: Confronting Myths in Clinical Management.

    Science.gov (United States)

    Neitch, Shirley M; Meadows, Charles; Patton-Tackett, Eva; Yingling, Kevin W

    2016-01-01

    Every day, patients with dementia, their families, and their physicians face the enormous challenges of this pervasive life-changing condition. Seeking help, often grasping at straws, victims, and their care providers are confronted with misinformation and myths when they search the internet or other sources. When Persons with Dementia (PWD) and their caregivers believe and/or act on false information, proper treatment may be delayed, and ultimately damage can be done. In this paper, we review commonly misunderstood issues encountered in caring for PWD. Our goal is to equip Primary Care Practitioners (PCPs) with accurate information to share with patients and families, to improve the outcomes of PWD to the greatest extent possible. While there are innumerable myths about dementia and its causes and treatments, we are going to focus on the most common false claims or misunderstandings which we hear in our Internal Medicine practice at Marshall Health. We offer suggestions for busy practitioners approaching some of the more common issues with patients and families in a clinic setting. PMID:27025116

  18. Integrated care for diabetes: clinical, psychosocial, and economic evaluation. Diabetes Integrated Care Evaluation Team.

    OpenAIRE

    1994-01-01

    OBJECTIVES--To evaluate integrated care for diabetes in clinical, psychosocial, and economic terms. DESIGN--Pragmatic randomised trial. SETTING--Hospital diabetic clinic and three general practice groups in Grampian. PATIENTS--274 adult diabetic patients attending a hospital clinic and registered with one of three general practices. INTERVENTION--Random allocation to conventional hospital clinic care or integrated care. Integrated care patients seen in general practice every three or four mon...

  19. Two-year Results From a Randomized Comparison of Everolimus-eluting and Sirolimus-eluting Stents in Patients Treated with Percutaneous Coronary Intervention (SORT OUT IV Trial). Featured clinical study

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Hansen, Henrik Steen; Christiansen, E H; Maeng, M; Hansen, Hans-Henrik Tilsted; Junker, Anders; Ravkilde, Jan; Kaltoft, A; Madsen, M; Sørensen, H T; Thuesen, L; Lassen, J F

    Two-year Results From a Randomized Comparison of Everolimus-eluting and Sirolimus-eluting Stents in Patients Treated with Percutaneous Coronary Intervention (SORT OUT IV Trial). Featured clinical study.......Two-year Results From a Randomized Comparison of Everolimus-eluting and Sirolimus-eluting Stents in Patients Treated with Percutaneous Coronary Intervention (SORT OUT IV Trial). Featured clinical study....

  20. Overcoming Recruitment Challenges in Palliative Care Clinical Trials

    OpenAIRE

    LeBlanc, Thomas W.; Lodato, Jordan E.; Currow, David C; Abernethy, Amy P.

    2013-01-01

    Challenges to clinical trial recruitment in palliative care are significant but not insurmountable. Through their experience with designing and deploying a social-marketing based protocol, the authors show that a carefully crafted recruitment and retention protocol can be effective.

  1. The Road to Excellence for Primary Care Resident Teaching Clinics.

    Science.gov (United States)

    Gupta, Reena; Dubé, Kate; Bodenheimer, Thomas

    2016-04-01

    Primary care residency programs and their associated primary care clinics face challenges in their goal to simultaneously provide a good education for tomorrow's doctors and excellent care for today's patients. A team from the Center for Excellence in Primary Care at the University of California, San Francisco, conducted site visits to 23 family medicine, internal medicine, and pediatric residency teaching clinics. The authors found that a number of programs have transformed themselves with respect to engaged leadership, resident scheduling, continuity of care for patients and residents, team-based care, and resident engagement in practice improvement. In this Commentary, the authors highlight the features of transforming programs that are melding inspiring resident education with excellent patient care. The authors propose a model, the 10 + 3 Building Blocks of Primary Care Teaching Clinics, to illustrate the themes that characterize transforming primary care residency programs. PMID:26826073

  2. Leaders, leadership and future primary care clinical research

    OpenAIRE

    Qureshi Nadeem; Mitchell Caroline; Magin Parker; McCowan Colin; Lasserson Daniel; Kadam Umesh; Hanratty Barbara; Del Mar Chris; Cleland Jennifer; Furler John; Rait Greta; Steel Nick; van Driel Mieke; Ward Alison

    2008-01-01

    Abstract Background A strong and self confident primary care workforce can deliver the highest quality care and outcomes equitably and cost effectively. To meet the increasing demands being made of it, primary care needs its own thriving research culture and knowledge base. Methods Review of recent developments supporting primary care clinical research. Results Primary care research has benefited from a small group of passionate leaders and significant investment in recent decades in some cou...

  3. Clinical outcomes after treatment of multiple lesions with zotarolimus-eluting versus sirolimus-eluting coronary stents (a SORT OUT III substudy

    Directory of Open Access Journals (Sweden)

    Thim Troels

    2012-03-01

    Full Text Available Abstract Background Data on clinical outcomes among patients treated with the zotarolimus-eluting Endeavor™ stent versus the sirolimus-eluting Cypher™ stent favor the sirolimus-eluting stent. However, a separate comparison of clinical outcome among patients treated for multiple lesions with these stents is lacking. We performed this comparison within the SORT OUT III trial data set. Methods Among 2332 patients randomized in SORT OUT III, 695 were treated for multiple lesions with zotarolimus-eluting (n = 350 or sirolimus-eluting (n = 345 stents and followed for 18 months. Major adverse cardiac events (MACE; composite of cardiac death, myocardial infarction, or target vessel revascularization (TVR; was the primary endpoint. Results Zotarolimus-eluting compared to sirolimus-eluting stent treatment was associated with increased MACE rate (13.2% vs. 2.6%; hazard ratio 5.29 with 95% confidence interval: 2.59-10.8. All secondary endpoints; all cause death, cardiac death, myocardial infarction, TVR, target lesion revascularization, in-stent restenosis, and definite stent thrombosis; were observed more frequently among zotarolimus-eluting stent treated patients. For all endpoints, hazard ratios were 1.6 to 4.6 times higher than in the overall results of the SORT OUT III trial. Conclusions We observed better clinical outcomes among patients treated for multiple lesions with the sirolimus-eluting stent compared to those treated with the zotarolimus-eluting stent.

  4. Quality of care of nurse-led and allied health personnel-led primary care clinics

    OpenAIRE

    Chin, WY; Lam, CLK; Lo, SV

    2011-01-01

    Objectives To review the literature regarding quality of care of nurse-led and allied health personnel-led primary care clinics with specific attention to the quality indicators for fall prevention, continence care, pulmonary rehabilitation, mental health, pharmaceutical care, and wound care services. Data sources Literature search from 1990 to 2010 including Ovid Medline, Cochrane Database, RAND (Research and Development) Corporation Health Database, the ACOVE (Assessing the Care of Vulnerab...

  5. The Certified Clinical Nurse Leader in Critical Care.

    Science.gov (United States)

    L'Ecuyer, Kristine M; Shatto, Bobbi J; Hoffmann, Rosemary L; Crecelius, Matthew L

    2016-01-01

    Challenges of the current health system in the United States call for collaboration of health care professionals, careful utilization of resources, and greater efficiency of system processes. Innovations to the delivery of care include the introduction of the clinical nurse leader role to provide leadership at the point of care, where it is needed most. Clinical nurse leaders have demonstrated their ability to address needed changes and implement improvements in processes that impact the efficiency and quality of patient care across the continuum and in a variety of settings, including critical care. This article describes the role of the certified clinical nurse leader, their education and skill set, and outlines outcomes that have been realized by their efforts. Specific examples of how clinical nurse leaders impact critical care nursing are discussed. PMID:27487750

  6. Access and care issues in urban urgent care clinic patients

    OpenAIRE

    Adams Jill C; Majeres Sharon; Batal Holly A; Scott David R; Dale Rita; Mehler Philip S

    2009-01-01

    Abstract Background Although primary care should be the cornerstone of medical practice, inappropriate use of urgent care for non-urgent patients is a growing problem that has significant economic and healthcare consequences. The characteristics of patients who choose the urgent care setting, as well as the reasoning behind their decisions, is not well established. The purpose of this study was to determine the motivation behind, and characteristics of, adult patients who choose to access hea...

  7. The DIAMOND initiative: implementing collaborative care for depression in 75 primary care clinics

    OpenAIRE

    Solberg, Leif I.; Crain, A. Lauren; Jaeckels, Nancy; Ohnsorg, Kris A.; Margolis, Karen L; Beck, Arne; Whitebird, Robin R.; Rossom, Rebecca C.; Crabtree, Benjamin F.; Andrew H. Van de Ven

    2013-01-01

    Background The many randomized trials of the collaborative care model for improving depression in primary care have not described the implementation and maintenance of this model. This paper reports how and the degree to which collaborative care process changes were implemented and maintained for the 75 primary care clinics participating in the DIAMOND Initiative (Depression Improvement Across Minnesota–Offering a New Direction). Methods Each clinic was trained to implement seven components o...

  8. Job Analysis Techniques for Restructuring Health Manpower Education and Training in the Navy Medical Department. Attachment 4. Clinic QPCB Task Sort for Clinical Physician Assistants--Dermatology, ENT, Opththalmology, Orthopedics, and Urology.

    Science.gov (United States)

    Technomics, Inc., McLean, VA.

    This publication is Attachment 4 of a set of 16 computer listed QPCB task sorts, by career level, for the entire Hospital Corps and Dental Technician fields. Statistical data are presented in tabular form for a detailed listing of job duties for clinical physician assistants. (BT)

  9. Clinical research and medical care: towards effective and complete integration

    OpenAIRE

    Sacristán, José A.

    2015-01-01

    Background Despite their close relationship, clinical research and medical care have become separated by clear boundaries. The purpose of clinical research is to generate generalizable knowledge useful for future patients, whereas medical care aims to promote the well-being of individual patients. The evolution towards patient-centered medicine and patient-oriented research, and the gradual standardization of medicine are contributing to closer ties between clinical research and medical pract...

  10. Careful science? Bodywork and care practices in randomised clinical trials

    DEFF Research Database (Denmark)

    Jespersen, Astrid Pernille; Bønnelycke, Julie; Eriksen, Hanne Hellerup

    2013-01-01

    the focus to reflect everyday practices would foster better targeted public health campaigns. This article is based on our participation in FINE, a multidisciplinary Danish research project. The core methodology of FINE was a randomised controlled trial in which 61 moderately overweight men were put...... into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday...... lives. Care practices are an inherent part of producing scientific facts but they are removed from the recognised results of scientific practice and thus from common public health recommendations. However, knowledge about the strategic use of care practices in lifestyle interventions is important for...

  11. A nonparametric Bayesian alternative to spike sorting

    OpenAIRE

    Wood, Frank; Black, Michael J.

    2008-01-01

    The analysis of extra-cellular neural recordings typically begins with careful spike sorting and all analysis of the data then rests on the correctness of the resulting spike trains. In many situations this is unproblematic as experimental and spike sorting procedures often focus on well isolated units. There is evidence in the literature, however, that errors in spike sorting can occur even with carefully collected and selected data. Additionally, chronically implanted electrodes and arrays ...

  12. Critical care clinical trials: getting off the roller coaster.

    Science.gov (United States)

    Goodwin, Andrew J

    2012-09-01

    Optimizing care in the ICU is an important goal. The heightened severity of illness in patients who are critically ill combined with the tremendous costs of critical care make the ICU an ideal target for improvement in outcomes and efficiency. Incorporation of evidence-based medicine into everyday practice is one method to optimize care; however, intensivists have struggled to define optimal practices because clinical trials in the ICU have yielded conflicting results. This article reviews examples where such conflicts have occurred and explores possible causes of these discrepant data as well as strategies to better use critical care clinical trials in the future. PMID:22948575

  13. What is Clinical Safety in Electronic Health Care Record Systems?

    Science.gov (United States)

    Davies, George

    There is mounting public awareness of an increasing number of adverse clinical incidents within the National Health Service (NHS), but at the same time, large health care projects like the National Programme for IT (NPFIT) are claiming that safer care is one of the benefits of the project and that health software systems in particular have the potential to reduce the likelihood of accidental or unintentional harm to patients. This paper outlines the approach to clinical safety management taken by CSC, a major supplier to NPFIT; discusses acceptable levels of risk and clinical safety as an end-to-end concept; and touches on the future for clinical safety in health systems software.

  14. Derivation of sorting programs

    Science.gov (United States)

    Varghese, Joseph; Loganantharaj, Rasiah

    1990-01-01

    Program synthesis for critical applications has become a viable alternative to program verification. Nested resolution and its extension are used to synthesize a set of sorting programs from their first order logic specifications. A set of sorting programs, such as, naive sort, merge sort, and insertion sort, were successfully synthesized starting from the same set of specifications.

  15. Diabetes quality management in care groups and outpatient clinics

    OpenAIRE

    Campmans-Kuijpers, M.J.E.

    2015-01-01

    This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with better outcomes in diabetes care. Quality management was measured with newly developed questionnaires about organisation of care, multidisciplinary teamwork, patient centeredness, performance results, q...

  16. Health profiles of foreigners attending primary care clinics in Malaysia

    OpenAIRE

    Ab Rahman, Norazida; Sivasampu, Sheamini; Mohamad Noh, Kamaliah; Khoo, Ee Ming

    2016-01-01

    Background The world population has become more globalised with increasing number of people residing in another country for work or other reasons. Little is known about the health profiles of foreign population in Malaysia. The aim of this study was to provide a detailed description of the health problems presented by foreigners attending primary care clinics in Malaysia. Methods Data were derived from the 2012 National Medical Care Survey (NMCS), a cross sectional survey of primary care enco...

  17. ClinicalKey: a point-of-care search engine.

    Science.gov (United States)

    Vardell, Emily

    2013-01-01

    ClinicalKey is a new point-of-care resource for health care professionals. Through controlled vocabulary, ClinicalKey offers a cross section of resources on diseases and procedures, from journals to e-books and practice guidelines to patient education. A sample search was conducted to demonstrate the features of the database, and a comparison with similar tools is presented. PMID:23394422

  18. Fundamentals of randomized clinical trials in wound care

    DEFF Research Database (Denmark)

    Brölmann, Fleur E; Eskes, Anne M; Sumpio, Bauer E;

    2013-01-01

    . Randomized clinical trials (RCTs) are universally acknowledged as the study design of choice for comparing treatment effects. To give high-level evidence the appreciation it deserves in wound care, we propose a step-by-step reporting standard for comprehensive and transparent reporting of RCTs in wound care...

  19. 20. Integrating Cannabis Into Clinical Care

    OpenAIRE

    Abrams, Donald

    2013-01-01

    Focus Areas: Integrative Approaches to Care, Mental Health, Alleviating Pain Cannabis is now available to patients as a medicine in 18 states and the District of Columbia. Unfortunately, due to the long-standing prohibition, most providers have little information regarding the medicinal use of this versatile botanical. The history of cannabis as medicine will be reviewed. This presentation will summarize the main components of the plant and their pharmacologic effects, highlighting the entour...

  20. Clinical research in primary dental care.

    Science.gov (United States)

    Heasman, P A; Macpherson, L E; Haining, S A; Breckons, M

    2015-08-28

    Many commissioning bodies for research expect that researchers will actively involve the public and patients in their projects. The National Institute for Health Research (NIHR), for example, involves members of the public in reviewing funding applications and making recommendations about research funding. The NIHR's portfolio is currently operating in 97% of NHS Trusts and this now includes research sited in primary dental care. This paper presents some case studies of these and other projects which are designed specifically for patient benefit in dental services in the community. This means there is no necessity to translate the outcomes of such research from a university or hospital base to the general population as the projects are undertaken in dental practices that provide primary dental care to (predominantly) NHS patients. The relevance of the outcomes to dental care is, therefore, likely to be of direct interest and importance to commissioners of healthcare funding in the UK who have a duty to use evidence bases for commissioning decisions. PMID:26315174

  1. Memory Complaints Associated with Seeking Clinical Care

    Directory of Open Access Journals (Sweden)

    Carolina Pires

    2012-01-01

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

  2. Memory complaints associated with seeking clinical care

    NARCIS (Netherlands)

    C. Pires; D. Silva; J. Maroco; S. Ginó; T. Mendes; B.A. Schmand; M. Guerreiro; A. de Mendonça

    2012-01-01

    Diagnosis of mild cognitive impairment relies on the presence of memory complaints. However, memory complaints are very frequent in healthy people. The objective of this study was to determine the severity and type of memory difficulties presented by elderly patients who seek for clinical help, as c

  3. Memory Complaints Associated with Seeking Clinical Care

    OpenAIRE

    Dina Silva; João Maroco; Sandra Ginó; Tiago Mendes; Schmand, Ben A; Manuela Guerreiro; Alexandre Mendonça; Carolina Pires

    2012-01-01

    Diagnosis of mild cognitive impairment relies on the presence of memory complaints. However, memory complaints are very frequent in healthy people. The objective of this study was to determine the severity and type of memory difficulties presented by elderly patients who seek for clinical help, as compared to the memory difficulties reported by subjects in the community. Assessment of subjective memory complaints was done with the subjective memory complaints scale (SMC). The mini-mental stat...

  4. Integrated and Gender-Affirming Transgender Clinical Care and Research.

    Science.gov (United States)

    Reisner, Sari L; Radix, Asa; Deutsch, Madeline B

    2016-08-15

    Transgender (trans) communities worldwide, particularly those on the trans feminine spectrum, are disproportionately burdened by HIV infection and at risk for HIV acquisition/transmission. Trans individuals represent an underserved, highly stigmatized, and under-resourced population not only in HIV prevention efforts but also in delivery of general primary medical and clinical care that is gender affirming. We offer a model of gender-affirmative integrated clinical care and community research to address and intervene on disparities in HIV infection for transgender people. We define trans terminology, briefly review the social epidemiology of HIV infection among trans individuals, highlight gender affirmation as a key social determinant of health, describe exemplar models of gender-affirmative clinical care in Boston MA, New York, NY, and San Francisco, CA, and offer suggested "best practices" for how to integrate clinical care and research for the field of HIV prevention. Holistic and culturally responsive HIV prevention interventions must be grounded in the lived realities the trans community faces to reduce disparities in HIV infection. HIV prevention interventions will be most effective if they use a structural approach and integrate primary concerns of transgender people (eg, gender-affirmative care and management of gender transition) alongside delivery of HIV-related services (eg, biobehavioral prevention, HIV testing, linkage to care, and treatment). PMID:27429189

  5. Rural nurse specialists: clinical practice and the politics of care.

    Science.gov (United States)

    Fitzgerald, Ruth P

    2008-01-01

    Doctor flight from rural areas is an international phenomenon that places great pressure on primary health care delivery. In New Zealand, the response to these empty doctors' surgeries has been the introduction of nurse-led rural health clinics that have attracted controversy both in the media and from urban-based doctors over whether such nurse-led care is a direct substitution of medical care. This article analyzes the reflections of nurses working in some of these clinics who suggest that their situation is more complex than a direct substitution of labor. Although the nurses indicate some significant pressures moving them closer to the work of doctoring, they actively police this cross-boundary work and labor simultaneously to shore up their nursing identities. My own conclusions support their assertions. I argue that it is the maintenance of a holistic professional habitus that best secures their professional identity as nurses while they undertake the cross-boundary tasks of primary rural health care. There are clear professional benefits and disadvantages for the nurses in these situations, which make the positions highly politicized. These recurring divisions of labor within medical care giving and the elaboration of new types of care worker form an appropriate although neglected topic of study for anthropologists. The study of the social organization of clinical medicine is much enriched by paying closer attention to its interaction with allied health professions and their associated understandings of "good" care. PMID:18663640

  6. Fundamentals of randomized clinical trials in wound care

    DEFF Research Database (Denmark)

    Eskes, Anne M; Brölmann, Fleur E; Sumpio, Bauer E;

    2012-01-01

    The care for chronic and acute wounds is a substantial problem around the world. This has led to a plethora of products to accelerate healing. Unfortunately, the quality of studies evaluating the efficacy of such wound care products is frequently low. Randomized clinical trials are universally...... acknowledged as the study design of choice for comparing treatment effects, as they eliminate several sources of bias. We propose a framework for the design and conduct of future randomized clinical trials that will offer strong scientific evidence for the effectiveness of wound care interventions. While...... randomization is a necessary feature of a robust comparative study, it is not sufficient to ensure a study at low risk of bias. Randomized clinical trials should also ensure adequate allocation concealment and blinding of outcome assessors, apply intention-to-treat analysis, and use patient-oriented outcomes...

  7. Clinical knowledge management at the point of care

    Directory of Open Access Journals (Sweden)

    Cheong-Lieng Teng

    2012-07-01

    Full Text Available In the developing world, clinical knowledgemanagement in primary care has a long way to go.Clinical decision support systems, despite its promise torevolutionise healthcare, is slow in its implementationdue to the lack of financial investment in informationtechnology. Point-of-care resources, such ascomprehensive electronic textbooks delivered via theweb or mobile devices, have yet to be fully utilised bythe healthcare organisation or individual clinicians.Increasing amount of applicable knowledge of goodquality (e.g. clinical practice guidelines and otherpre-appraised resources are now available via theinternet. The policy makers and clinicians need tobe more informed about the potential benefits andlimitations of these new tools and resources and makethe necessary budgetary provision and learn how best toharness them for patient care.

  8. k -Bitonic sort

    Institute of Scientific and Technical Information of China (English)

    高庆狮; 胡玥; 刘志勇

    1999-01-01

    A k-bitonic sort which generalizes the bitonic sort is proposed. The theorem of the bitonic sort, which merges two monotonic sequences into one order sequence, is extended into the theorem of k-bitonic sort. The k-bitonic sort merges K (=2k or 2k-1) monotonic sequences into one order sequence in steps, where k=[K/2] is an integer and k≥1. The k-bitonic sort is the Batcher’s bitonic sort when k=1.

  9. Integrating cannabis into clinical cancer care.

    Science.gov (United States)

    Abrams, D I

    2016-03-01

    Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use. For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia. Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects. PMID:27022315

  10. Integrating cannabis into clinical cancer care

    Science.gov (United States)

    Abrams, D.I.

    2016-01-01

    Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use. For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia. Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects. PMID:27022315

  11. Leaders, leadership and future primary care clinical research

    Directory of Open Access Journals (Sweden)

    Qureshi Nadeem

    2008-09-01

    Full Text Available Abstract Background A strong and self confident primary care workforce can deliver the highest quality care and outcomes equitably and cost effectively. To meet the increasing demands being made of it, primary care needs its own thriving research culture and knowledge base. Methods Review of recent developments supporting primary care clinical research. Results Primary care research has benefited from a small group of passionate leaders and significant investment in recent decades in some countries. Emerging from this has been innovation in research design and focus, although less is known of the effect on research output. Conclusion Primary care research is now well placed to lead a broad re-vitalisation of academic medicine, answering questions of relevance to practitioners, patients, communities and Government. Key areas for future primary care research leaders to focus on include exposing undergraduates early to primary care research, integrating this early exposure with doctoral and postdoctoral research career support, further expanding cross disciplinary approaches, and developing useful measures of output for future primary care research investment.

  12. Avi Sorting Network

    OpenAIRE

    Avinash Bansal; Kamal Gupta

    2012-01-01

    Sorting network is an abstract mathematical modelwhich can be used as a multiple-input, multiple-output switchingnetwork to sort the data in ascending or descending order [1].Sorting has been one of the most critical applications on parallelcomputing machines. Many classic textbooks on algorithms likeThomas H. Cormen, therefore consider this problem in greatdetail and list many sorting network for this purpose [2]. Thereare many sorting algorithms as the Bubble / Insertion sorter,Odd-Even sor...

  13. The enhancement of clinical competence through caring science.

    Science.gov (United States)

    Levy-Malmberg, Rika; Hilli, Yvonne

    2014-12-01

    This theoretical research attempts to create a new basis for dialogue between two independent research fields that are connected by an inseparable link. The first, nursing science, is a body of professional knowledge, while the second, caring as an independent body of pure knowledge, conducts basic research with an aspiration towards applicability. This theoretical research uses the guidelines of the Buberian dialogue, which provides new meaning to the concept of clinical competence. The results emphasise the need to adopt abstract knowledge into the nursing field in order to improve the graduate's clinical capabilities. The combination of assessing clinical capability in a judgmental manner together with the dialogical humanistic approach of caring science may create a genuine platform and meeting event as a maturing process, which is intended to promote educational goals, which subsequently receive new meaning, that is, a different type of assessment. However, this assessment cannot be measured since a wide range of ethical moral aspects regarding both the student and the patient will have to be included. Nevertheless, this dialogue between nursing science and caring science can implement evidence on the basis of trust and can be used as a dialogical tool for evaluating clinical skills with the goal of empowering the educational field in nursing. Consequently, this clinical competence is called 'caring maturing means', and the goal is to convert the learning process into a meaningful event with the aim of improvement. PMID:24308907

  14. Provider and Clinic Cultural Competence in a Primary Care Setting

    OpenAIRE

    Paez, Kathryn A; Allen, Jerilyn K.; Carson, Kathryn A.; Cooper, Lisa A.

    2007-01-01

    A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA. completed an on-line survey which includ...

  15. [Individualised care plan during extracorporeal membrane oxygenation. A clinical case].

    Science.gov (United States)

    Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C

    2016-01-01

    An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy. PMID:27137415

  16. Avi Sorting Network

    Directory of Open Access Journals (Sweden)

    Avinash Bansal

    2012-09-01

    Full Text Available Sorting network is an abstract mathematical modelwhich can be used as a multiple-input, multiple-output switchingnetwork to sort the data in ascending or descending order [1].Sorting has been one of the most critical applications on parallelcomputing machines. Many classic textbooks on algorithms likeThomas H. Cormen, therefore consider this problem in greatdetail and list many sorting network for this purpose [2]. Thereare many sorting algorithms as the Bubble / Insertion sorter,Odd-Even sorter, Sort the data in O(log2 n2 time complexity andsome other sorter have O(n2 as time complexity, where n is thenumber of elements. In this paper we propose a sorting networkcalled “Avi S orter” having time complexity O(n log2 n which isbased on just similar to bubble sort algorithm. This sortingnetwork provides the easy way to understand and manipulate theconcept of sorting network.

  17. Guest Editorial: Card sort methodology: An objective measure in rehabilitation research

    Directory of Open Access Journals (Sweden)

    Haitham Jahrami, PhD

    2012-04-01

    Full Text Available Card sort clinical tests such as the Wisconsin Card Sort Test and Activity Card Sort are well known in several clinical practices, including psychiatry, neurology, neuropsychology, and learning disabilities. However, card sort methodology is less famous as a research methodology. This editorial attempts to shed light on the novelty of the card sort methodology and its relevance to rehabilitation research.

  18. Guest Editorial: Card sort methodology: An objective measure in rehabilitation research

    OpenAIRE

    Haitham Jahrami, PhD

    2012-01-01

    Card sort clinical tests such as the Wisconsin Card Sort Test and Activity Card Sort are well known in several clinical practices, including psychiatry, neurology, neuropsychology, and learning disabilities. However, card sort methodology is less famous as a research methodology. This editorial attempts to shed light on the novelty of the card sort methodology and its relevance to rehabilitation research.

  19. Selective sorting of waste

    CERN Multimedia

    2007-01-01

    Not much effort needed, just willpower In order to keep the cost of disposing of waste materials as low as possible, CERN provides two types of recipient at the entrance to each building: a green plastic one for paper/cardboard and a metal one for general refuse. For some time now we have noticed, to our great regret, a growing negligence as far as selective sorting is concerned, with, for example, the green recipients being filled with a mixture of cardboard boxes full of polystyrene or protective wrappers, plastic bottles, empty yogurts pots, etc. …We have been able to ascertain, after careful checking, that this haphazard mixing of waste cannot be attributed to the cleaning staff but rather to members of the personnel who unscrupulously throw away their rubbish in a completely random manner. Non-sorted waste entails heavy costs for CERN. For information, once a non-compliant item is found in a green recipient, the entire contents are sent off for incineration rather than recycling… We are all concerned...

  20. [Clinical practice guidelines and primary care. SESPAS report 2012].

    Science.gov (United States)

    Atienza, Gerardo; Bañeres, Joaquim; Gracia, Francisco Javier

    2012-03-01

    Clinical practice guidelines are intended to serve as a bridge between the decision levels and the sources of knowledge, giving decision makers the best synthesis of scientific evidence and an analysis of context, to provide elements of judgement and to transfer scientific knowledge into clinical practice. However, the actual impact on health care is variable and effectiveness in changing medical practice, moderate. Qualitative and quantitative studies show that most primary care physicians consider that the guides are a valuable source of advice and training and a kind of improving the quality of healthcare. However, they underline its rigidity, the difficulty to apply to individual patients and that their main goal is to reduce healthcare costs. In Spain, there are several experiences as GuíaSalud in developing clinical practice guidelines aimed specifically at primary care. However, the proper implementation of a clinical practice guideline includes not only the quality and thoroughness of the evidence, but the credibility of professionals and organizations and other contextual factors such as characteristics of patients, providers and organizations or systems. An important step in future research is to develop a better theoretical understanding of organizational change that is required for management and professionals to give appropriate guidance to the implementation of the clinical practice guidelines. PMID:21993072

  1. Clinical features and multidisciplinary approaches to dementia care

    Directory of Open Access Journals (Sweden)

    Gr

    2011-05-01

    Full Text Available Jacob HG Grand¹, Sienna Caspar², Stuart WS MacDonald11Department of Psychology, University of Victoria, Victoria, BC, Canada; 2Interdisciplinary Graduate Studies, University of British Columbia, Vancouver, BC, CanadaAbstract: Dementia is a clinical syndrome of widespread progressive deterioration of cognitive abilities and normal daily functioning. These cognitive and behavioral impairments pose considerable challenges to individuals with dementia, along with their family members and caregivers. Four primary dementia classifications have been defined according to clinical and research criteria: 1 Alzheimer’s disease; 2 vascular dementias; 3 frontotemporal dementias; and 4 dementia with Lewy bodies/Parkinson’s disease dementia. The cumulative efforts of multidisciplinary healthcare teams have advanced our understanding of dementia beyond basic descriptions, towards a more complete elucidation of risk factors, clinical symptoms, and neuropathological correlates. The characterization of disease subtypes has facilitated targeted management strategies, advanced treatments, and symptomatic care for individuals affected by dementia. This review briefly summarizes the current state of knowledge and directions of dementia research and clinical practice. We provide a description of the risk factors, clinical presentation, and differential diagnosis of dementia. A summary of multidisciplinary team approaches to dementia care is outlined, including management strategies for the treatment of cognitive impairments, functional deficits, and behavioral and psychological symptoms of dementia. The needs of individuals with dementia are extensive, often requiring care beyond traditional bounds of medical practice, including pharmacologic and non-pharmacologic management interventions. Finally, advanced research on the early prodromal phase of dementia is reviewed, with a focus on change-point models, trajectories of cognitive change, and threshold models of

  2. What is a Sorting Function?

    DEFF Research Database (Denmark)

    Henglein, Fritz

    2009-01-01

    What is a sorting function—not a sorting function for a given ordering relation, but a sorting function with nothing given? Formulating four basic properties of sorting algorithms as defining requirements, we arrive at intrinsic notions of sorting and stable sorting: A function is a sorting funct...

  3. Roterende sorte huller

    DEFF Research Database (Denmark)

    Jerslev, Kristian

    Sorte huller har normalt været anset som statiske, mens alle andre legemer i Universet roterer. Dette stemmer imidlertid ikke overens med den nylige opdagelse af et roterende sort hul i midten af galaksen NGC 1365. Hvilken effekt har rotationen af et sort hul på legemer i dets nærhed, og hvordan...... kan astronomer i det hele taget måle, at sorte huller roterer?...

  4. Secondary uses of clinical data in primary care.

    Science.gov (United States)

    Teasdale, Sheila; Bates, David; Kmetik, Karen; Suzewits, Jeff; Bainbridge, Mike

    2007-01-01

    This paper, presented as a panel at the American Medical Informatics Association (AMIA) Fall Symposium 2006, explores a number of secondary uses of primary care clinical data derived from point-of-care systems, and the issues arising from those uses. The authors (from the USA and the UK) describe, compare and contrast some secondary uses: pay-for-performance, public disclosure, clinical audit, health resource planning, and clinical system usage; in various environments: national health system, network of small family practice offices, and university teaching centres. In the UK, such data are now being used in pay-for-performance for GPs, and approximately 35% of their salary has been put at risk, which has resulted in close scrutiny. In the USA, pay-for-performance is at an earlier stage but is increasingly prevalent and continues to be hotly debated. Some of the issues that arise from these uses of clinical data - data quality including accuracy, comparability, perverse incentives, effect of secondary uses on care provision, and security and confidentiality among others - were discussed. Finally, options and opportunities for improving secondary uses of data in the light of the issues covered earlier were considered. PMID:18005563

  5. Secondary uses of clinical data in primary care

    Directory of Open Access Journals (Sweden)

    Sheila Teasdale

    2007-09-01

    Full Text Available This paper, presented as a panel at the American Medical Informatics Association (AMIA Fall Symposium 2006, explores a number of secondary uses of primary care clinical data derived from point-of care systems, and the issues arising from those uses. The authors (from the USA and the UK describe, compare and contrast some secondary uses: pay-for-performance, public disclosure, clinical audit, health resource planning, and clinical system usage; in various environments: national health system, network of small family practice offices, and university teaching centres. In the UK, such data are now being used in pay-for-performance for GPs, and approximately 35% of their salary has been put at risk, which has resulted in close scrutiny. In the USA, pay-for-performance is at an earlier stage but is increasingly prevalent and continues to be hotly debated. Some of the issues that arise from these uses of clinical data _data quality including accuracy, comparability, perverse incentives, effect of secondary uses on care provision, and security and confidentiality among others _were discussed. Finally, options and opportunities for improving secondary uses of data in the light of the issues covered earlier were considered.

  6. Sorting Algorithms with Restrictions

    CERN Document Server

    Aslanyan, Hakob

    2011-01-01

    Sorting is one of the most used and well investigated algorithmic problem [1]. Traditional postulation supposes the sorting data archived, and the elementary operation as comparisons of two numbers. In a view of appearance of new processors and applied problems with data streams, sorting changed its face. This changes and generalizations are the subject of investigation in the research below.

  7. Event detection using population-based health care databases in randomized clinical trials

    DEFF Research Database (Denmark)

    Thuesen, Leif; Jensen, Lisette Okkels; Tilsted, Hans Henrik; Mæng, Michael; Terkelsen, Christian; Thayssen, Per; Ravkilde, Jan; Christiansen, Evald Høj; Bøtker, Hans Erik; Madsen, Morten; Lassen, Jens F

    2013-01-01

    To describe a new research tool, designed to reflect routine clinical practice and relying on population-based health care databases to detect clinical events in randomized clinical trials.......To describe a new research tool, designed to reflect routine clinical practice and relying on population-based health care databases to detect clinical events in randomized clinical trials....

  8. Designing healthcare information technology to catalyse change in clinical care.

    Science.gov (United States)

    Lester, William T; Zai, Adrian H; Grant, Richard W; Chueh, Henry C

    2008-01-01

    The gap between best practice and actual patient care continues to be a pervasive problem in our healthcare system. Efforts to improve on this knowledge-performance gap have included computerised disease management programs designed to improve guideline adherence. However, current computerised reminder and decision support interventions directed at changing physician behaviour have had only a limited and variable effect on clinical outcomes. Further, immediate pay-for-performance financial pressures on institutions have created an environment where disease management systems are often created under duress, appended to existing clinical systems and poorly integrated into the existing workflow, potentially limiting their real-world effectiveness. The authors present a review of disease management as well as a conceptual framework to guide the development of more effective health information technology (HIT) tools for translating clinical information into clinical action. PMID:18534073

  9. Designing healthcare information technology to catalyse change in clinical care

    Directory of Open Access Journals (Sweden)

    William Lester

    2008-05-01

    Full Text Available The gap between best practice and actual patient care continues to be a pervasive problem in our healthcare system. Efforts to improve on this knowledge_performance gap have included computerised disease management programs designed to improve guideline adherence. However, current computerised reminder and decision support interventions directed at changing physician behaviour have had only a limited and variable effect on clinical outcomes. Further, immediate pay-for-performance financial pressures on institutions have created an environmentwhere disease management systems are often created under duress, appended to existing clinical systems and poorly integrated into the existing workflow, potentially limiting their realworld effectiveness. The authors present a review of disease management as well as a conceptual framework to guide the development of more effective health information technology (HIT tools for translating clinical information into clinical action.

  10. Risk perception and clinical decision making in primary care

    DEFF Research Database (Denmark)

    Barfoed, Benedicte Marie Lind

    2015-01-01

    Objectives We aim to present new knowledge about different perspectives of health care professionals’ risk perceptions and clinical decision making. Furthermore, we intend to discuss differences between professional and personal risk perceptions and the impact on decisions in terms of both short...... considerations and the specific context. Most research has been focused on understanding of the concepts of risk. However healthcare professionals’ risk perception and personal attitudes also affect their clinical decision-making and risk communication. The differences between health care professionals’ personal...... and professional risk perception and attitudes and the subsequent impact on patients’ decision making have not previously been discussed. Content 1. Peder Halvorsen, MD, Professor, General Practice, Department of Community Medicine, The Arctic University of Norway: Making good decisions: Intuition or...

  11. Cost differentials of dental outpatient care across clinical dentistry branches

    OpenAIRE

    Jovana Rančić; Nemanja Rančić; Nemanja Majstorović; Vladimir Biočanin; Marko Milosavljević; Mihajlo Jakovljević

    2015-01-01

    Background: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens.Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services.Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was...

  12. Clinical review: Airway hygiene in the intensive care unit

    OpenAIRE

    Jelic, Sanja; Cunningham, Jennifer A; Factor, Phillip

    2008-01-01

    Maintenance of airway secretion clearance, or airway hygiene, is important for the preservation of airway patency and the prevention of respiratory tract infection. Impaired airway clearance often prompts admission to the intensive care unit (ICU) and can be a cause and/or contributor to acute respiratory failure. Physical methods to augment airway clearance are often used in the ICU but few are substantiated by clinical data. This review focuses on the impact of oral hygiene, tracheal suctio...

  13. Chronic patient care at North West Province clinics

    Directory of Open Access Journals (Sweden)

    Claire van Deventer

    2009-04-01

    Full Text Available Background: Chronic illnesses are a significant burden to the health services in South Africa. There is a specific national health plan whereby chronically ill patients who are acceptably controlled should be managed at clinic level. The perception has emerged that the management of primary care has not been optimal in the Southern District of the North West Province. This provided the motivation to initiate this research, namely consideration of chronic patient care at clinics in the North West Province of South Africa.Method: A cross-sectional descriptive study was carried out at four randomly selected clinics covering four sub-districts in the Southern District (North West Province. This was done using charts and registers at the clinics. Inclusion criteria were patients older than 18, and presenting with the following chronic illnesses: asthma/chronic obstructive airways disease (COAD, hypertension, diabetes and epilepsy. The major focus areas were the regular assessment of the patients, the level of control of the illness and the use of the Essential Drugs List and Standard Treatment Guidelines (EDL/STG.Results: In the cases of all the chronic illnesses it was found that regular assessments were poorly done, with asthma (peak flow measurements being the most poorly done. Control was generally less than 50% for all the illnesses, although the EDL was followed fairly well by the personnel at the clinics.Conclusion: In the light of the burden of chronic illness the results give cause for great concern about the quality of care for chronically ill patients, and reasons were sought for some of the poor results. A subsequent decision was taken to carry out comprehensive quality improvement projects on each of the illnesses over the following five years.

  14. Kangaroo mother care for infantile colic: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Reza Saeidi

    2010-03-01

    Full Text Available "n Normal 0 false false false EN-US 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: Infantile colic has been defined as episodes of excessive and persistent crying without known medical cause. Kangaroo mother care is a new method for baby care with several advantages. A universally available and biologically sound method of care for all newborns, with three components: skin-to-skin contact, exclusive breastfeeding, support to the mother-infant dyad. This study designed for evaluating Kangaroo mother care on infantile colic.  "n"nMethods: This study was a randomized controlled trial. From 1th may 2008 to 1 may 2009 a total of 70 children, aged 3-12 weeks with persistent colic symptoms were studied. The children were referred to Sheikh clinic, Mashhad, Iran, because of excessive crying. Normal mother-infant pairs were recruited at 3 to 12 weeks of age after obtaining baseline for two days. Subjects divided randomly to kangaroo care or conventional care group and mothers in both groups filled diary for seven days. "n"nResults: In the beginning of the study, the infants in kangaroo care group had 3.5 hr/d crying and after the intervention, it decreased to 1.7 hr/d, the difference were significant (p<0.05. But there were no difference in feeding duration between

  15. Clinical Predictors of Intensive Care Unit Admission for Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Mohammad Hasan Kargar Maher

    2015-07-01

    Full Text Available IntroductionChildren with severe asthma attack are a challenging group of patients who could be difficult to treat and leading to significant morbidity and mortality. Asthma attack severity is qualitatively estimated as mild, moderate and severe attacks and respiratory failure based on conditions such as respiration status, feeling of dyspnea, and the degree of unconsciousness. part of which are subjective rather than objective. We investigated clinical findings as predictors of severe attack and probable requirement for Pediatric Intensive Care Unit (PICU admission.Materials and MethodsIn a cross sectional and analytical study 120 patients with asthma attack were enrolled from April 2010 to April 2014 (80 admitted in the ward and 40 in pediatric intensive care unit. Predictors of PICU admission were investigated regarding to initial heart rate(HR, respiratory rate (RR, Arterial Oxygen Saturation(SaO2 and PaCo2 and clinically evident cyanosis.ResultsInitial heart rate(p-value=0.02, respiratory rate (p-value=0.03, Arterial Oxygen Saturation(p-value=0.02 and PaCo2(p-value=0.03 and clinically evident cyanosis were significantly different in two groups(Ward admitted and PICU admittedConclusion There was a significant correlation between initial vital sign and blood gas analysis suggesting usefulness of these factors as predictors of severe asthma attack and subsequent clinical course.

  16. Shared care and implementation of a pediatric clinical pathway

    DEFF Research Database (Denmark)

    Langfrits, Mette Sørensen; Thomsen, RW; Rubak, Jens Mørck; Høst, Arne; Rubak, Sune Leisgaard Mørck

    and children with uncontrolled asthma should be followed at the pediatrics department. Study 2) An increased overall proportion of children with well-controlled asthma. Study 3) Favorable changes in the use of asthma medication. Study 4) Self-reported higher quality of life among children with asthma...... either at a hospital specialist out-patient clinic at the pediatrics department at Viborg hospital or at one of 100 GPs in the Viborg area. At baseline the involved health care professionals participated in an introduction to the clinical pathway and treatment guide. Furthermore the clinical pathway and...... supported by Folkesundhed i Midten. We sincerely thank Lars G. Hansen (Head of Department of Pediatrics, Viborg Hospital) for his help and participation....

  17. Provider and clinic cultural competence in a primary care setting.

    Science.gov (United States)

    Paez, Kathryn A; Allen, Jerilyn K; Carson, Kathryn A; Cooper, Lisa A

    2008-03-01

    A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities. PMID:18164114

  18. Improving COPD Care in a Medically Underserved Primary Care Clinic: A Qualitative Study of Patient Perspectives.

    Science.gov (United States)

    Glasser, Irene; Wang, Fei; Reardon, Jane; Vergara, Cunegundo D; Salvietti, Ralph; Acevedo, Myrtha; Santana, Blanca; Fortunato, Gil

    2016-10-01

    We conducted a focus group study in an urban hospital-based primary care teaching clinic serving an indigent and Hispanic (predominantly Puerto Rican) population in New England in order to learn how patients with Chronic Obstructive Lung Disease (COPD) perceive their disease, how they experience their medical care, and the barriers they face managing their disease and following medical recommendations. The research team included medical doctors, nurses, a medical anthropologist, a clinical pharmacist, a hospital interpreter, and a systems analyst. Four focus groups were conducted in Spanish and English in April and May 2014. The demographic characteristics of the 25 focus group participants closely reflected the demographics of the total COPD clinic patients. The participants were predominantly female (72%) and Hispanic (72%) and had a median age of 63. The major themes expressed in the focus groups included: problems living with COPD; coping with complexities of comorbid illnesses; challenges of quitting smoking and maintaining cessation; dealing with second-hand smoke; beliefs and myths about quitting smoking; difficulty paying for and obtaining medications; positive experiences obtaining and managing medications; difficulties in using sleep machines at home; expressions of disappointment with the departure of their doctors; and overall satisfaction with the clinic health care providers. The study led to the creation of an action plan that addresses the concerns expressed by the focus study participants. The action plan is spearheaded by a designated bilingual and bicultural nurse and is now in operation. PMID:26807853

  19. Clinical Features Of Acute Febrile Thrombocytopaenia Among Patients Attending Primary Care Clinics

    OpenAIRE

    Fah, Tong Seng; MMed, Noorazah Abdul Aziz; Liew, Chin Gek; Omar, Khairani

    2006-01-01

    Introduction: Identifying clinical features that differentiate acute febrile thrombocytopaenia from acute febrile illness without thrombocytopaenia can help primary care physician to decide whether to order a full blood count (FBC). This is important because thrombocytopaenia in viral fever may signify more serious underlying aetiology like dengue infection.

  20. Impact of clinical pharmacist in an Indian Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mohamed Hisham

    2016-01-01

    Full Text Available Background and Objectives: A critically ill patient is treated and reviewed by physicians from different specialties; hence, polypharmacy is a very common. This study was conducted to assess the impact and effectiveness of having a clinical pharmacist in an Indian Intensive Care Unit (ICU. It also evaluates the clinical pharmacist interventions with a focus on optimizing the quality of pharmacotherapy and patient safety. Materials and Methods: The prospective, observational study was carried out in medical and surgical/trauma ICU over a period of 1 year. All detected drug-related problems and interventions were categorized based on the Pharmaceutical Care Network Europe system. Results: During the study period, average monthly census of 1032 patients got treated in the ICUs. A total of 986 pharmaceutical interventions due to drug-related problems were documented, whereof medication errors accounted for 42.6% (n = 420, drug of choice problem 15.4% (n = 152, drug-drug interactions were 15.1% (n = 149, Y-site drug incompatibility was 13.7% (n = 135, drug dosing problems were 4.8% (n = 47, drug duplications reported were 4.6% (n = 45, and adverse drug reactions documented were 3.8% (n = 38. Drug dosing adjustment done by the clinical pharmacist included 140 (11.9% renal dose, 62 (5.2% hepatic dose, 17 (1.4% pediatric dose, and 104 (8.8% insulin dosing modifications. A total of 577 drug and poison information queries were answered by the clinical pharmacist. Conclusion: Clinical pharmacist as a part of multidisciplinary team in our study was associated with a substantially lower rate of adverse drug event caused by medication errors, drug interactions, and drug incompatibilities.

  1. Sorting a distribution theory

    CERN Document Server

    Mahmoud, Hosam M

    2011-01-01

    A cutting-edge look at the emerging distributional theory of sorting Research on distributions associated with sorting algorithms has grown dramatically over the last few decades, spawning many exact and limiting distributions of complexity measures for many sorting algorithms. Yet much of this information has been scattered in disparate and highly specialized sources throughout the literature. In Sorting: A Distribution Theory, leading authority Hosam Mahmoud compiles, consolidates, and clarifies the large volume of available research, providing a much-needed, comprehensive treatment of the

  2. Exploring the leadership role of the clinical nurse specialist on an inpatient palliative care consulting team.

    Science.gov (United States)

    Stilos, Kalli; Daines, Pat

    2013-03-01

    Demand for palliative care services in Canada will increase owing to an aging population and the evolving role of palliative care in non-malignant illness. Increasing healthcare demands continue to shape the clinical nurse specialist (CNS) role, especially in the area of palliative care. Clinical nurse specialists bring specialized knowledge, skills and leadership to the clinical setting to enhance patient and family care. This paper highlights the clinical leadership role of the CNS as triage leader for a hospital-based palliative care consulting team. Changes to the team's referral and triage processes are emphasized as key improvements to team efficiency and timely access to care for patients and families. PMID:24863582

  3. Missing Clinical Information in NHS hospital outpatient clinics: prevalence, causes and effects on patient care

    Directory of Open Access Journals (Sweden)

    Moorthy Krishna

    2011-05-01

    Full Text Available Abstract Background In Britain over 39,000 reports were received by the National Patient Safety Agency relating to failures in documentation in 2007 and the UK Health Services Journal estimated in 2008 that over a million hospital outpatient visits each year might take place without the full record available. Despite these high numbers, the impact of missing clinical information has not been investigated for hospital outpatients in the UK. Studies in primary care in the USA have found 13.6% of patient consultations have missing clinical information, with this adversely affecting care in about half of cases, and in Australia 1.8% of medical errors were found to be due to the unavailability of clinical information. Our objectives were to assess the frequency, nature and potential impact on patient care of missing clinical information in NHS hospital outpatients and to assess the principal causes. This is the first study to present such figures for the UK and the first to look at how clinicians respond, including the associated impact on patient care. Methods Prospective descriptive study of missing information reported by surgeons, supplemented by interviews on the causes. Data were collected by surgeons in general, gastrointestinal, colorectal and vascular surgical clinics in three teaching hospitals across the UK for over a thousand outpatient appointments. Fifteen interviews were conducted with those involved in collating clinical information for these clinics. The study had ethics approval (Hammersmith and Queen Charlotte's & Chelsea Research Ethics Committee, reference number (09/H0707/27. Participants involved in the interviews signed a consent form and were offered the opportunity to review and agree the transcript of their interview before analysis. No patients were involved in this research. Results In 15% of outpatient consultations key items of clinical information were missing. Of these patients, 32% experienced a delay or disruption

  4. Fuel sorting evaluation

    International Nuclear Information System (INIS)

    An evaluation of functions and requirements associated with sorting fuel from the Hanford K Basins is presented to support design issue resolution decisions for achieving interim fuel storage. Potential requirements are recommended for implementation in design activities. The recommendations are provided as input to a management decision process where decisions are finalized and the sorting issue is closed

  5. Three Sorts of Naturalism

    DEFF Research Database (Denmark)

    Fink, Hans

    2006-01-01

    In "Two sorts of Naturalism" John McDowell is sketching his own sort of naturalism in ethics as an alternative to "bald naturalism". In this paper I distinguish materialist, idealist and absolute conceptions of nature and of naturalism in order to provide a framework for a clearer understanding o...

  6. Sorting to Extremes

    Science.gov (United States)

    Baum, Sandy; McPherson, Michael S.

    2011-01-01

    The world of higher education is a world of sorting, selecting, and ranking--on both sides of the market. Colleges select students to recruit and then to admit; students choose where to apply and which offer to accept. The sorting process that gets the most attention is in the higher reaches of the market, where it is not too much to say that…

  7. Layers in sorting practices: Sorting out patients with potential cancer

    DEFF Research Database (Denmark)

    Møller, Naja Holten; Bjørn, Pernille

    2011-01-01

    sorting mechanism, but is handled by informal sorting mechanisms. We identify two informal sorting mechanisms with large impact on the sorting practices, namely subtle categorizing and collective remembering. These informal sorting mechanisms have implications for the design of electronic booking systems...

  8. Quality-of-care standards for early arthritis clinics.

    Science.gov (United States)

    Ivorra, José Andrés Román; Martínez, Juan Antonio; Lázaro, Pablo; Navarro, Federico; Fernandez-Nebro, Antonio; de Miguel, Eugenio; Loza, Estibaliz; Carmona, Loreto

    2013-10-01

    The diagnosis and treatment of early arthritis is associated with improved patient outcomes. One way to achieve this is by organising early arthritis clinics (EACs). The objective of this project was to develop standards of quality for EACs. The standards were developed using the two-round Delphi method. The questionnaire, developed using the best-available scientific evidence, includes potentially relevant items describing the dimensions of quality of care in the EAC. The questionnaire was completed by 26 experts (physicians responsible for the EACs in Spain and chiefs of the rheumatology service in Spanish hospitals). Two hundred and forty-four items (standards) describing the quality of the EAC were developed, grouped by the following dimensions: (1) patient referral to the EAC; (2) standards of structure for an EAC; (3) standards of process; (4) relation between primary care physicians and the EAC; (5) diagnosis and assessment of early arthritis; (6) patient treatment and follow-up in the EAC; (7) research and training in an EAC; and (8) quality of care perceived by the patient. An operational definition of early arthritis was also developed based on eight criteria. The standards developed can be used to measure/establish the requirements, resources, and processes that EACs have or should have to carry out their treatment, research, and educational activities. These standards may be useful to health professionals, patient associations, and health authorities. PMID:23568381

  9. [Ethics in clinical practice and in health care].

    Science.gov (United States)

    Pintor, S; Mennuni, G; Fontana, M; Nocchi, S; Giarrusso, P; Serio, A; Fraioli, A

    2015-01-01

    The clinical ethics is the identification, analysis and solution of moral problems that can arise during the care of a patient. Given that when dealing with ethical issues in health care some risks will be encountered (talking about ethics in general, or as a problem overlapped with others in this area, or by delegation to legislative determinations) in the text certain important aspects of the topic are examined. First of all ethics as human quality of the relationship between people for the common good, especially in health services where there are serious problems like the life and the health. It is also necessary a "humanizing relationship" between those who work in these services in order to achieve quality and efficiency in this business. It is important a proper training of health professionals, especially doctors, so that they can identify the real needs and means of intervention. It is also important that scientific research must respect fundamental ethical assumptions. In conclusion, ethics in health care is not a simple matter of "cookbook" rules, but involves the responsibility and consciousness of individual operators. PMID:26378763

  10. Considerations for Implementation of Cancer Molecular Diagnostics Into Clinical Care.

    Science.gov (United States)

    Hayes, Daniel F

    2016-01-01

    Physicians have provided personalized care with as much precision as possible for several centuries. However, increasingly sophisticated understanding of the human genome and of cancer biology has permitted identification of genetic and phenotypic distinctions that might permit development of new tumor biomarker tests for risk categorization, screening, differential diagnosis, prognosis, prediction, and monitoring. Both commercial and academic laboratories are offering tests for single analytes, panels of tests of single analytes, multiparameter assays coalesced into a signature, and total genomic, transcriptomic, or proteomic analyses. However, the absence of a consistent regulatory environment has led to marketing of assays without proven analytic validity or clinical utility. U.S. Food and Drug Administration (FDA) approval or clearance does not necessarily imply that use of the test will improve patient outcomes, and FDA discretion to permit laboratory-developed tests results in unknown benefit, or harm, of others. In this regard, a "bad tumor marker is as bad as a bad drug." Caveat emptor is not a satisfactory approach to delivering high-quality care. Rather, adoption of tumor biomarker tests should be based on high levels of evidence generated in scientifically rigorous studies that demonstrate both analytical validity and clinical utility. Doing so will ensure that clinicians and patients are confident that a tumor biomarker test is likely to improve their outcomes. PMID:27249708

  11. Primary care satellite clinics and improved access to general and mental health services.

    OpenAIRE

    Rosenheck, R

    2000-01-01

    OBJECTIVES: To evaluate the relationship between the implementation of community-based primary care clinics and improved access to general health care and/or mental health care, in both the general population and among people with disabling mental illness. STUDY SETTING: The 69 new community-based primary care clinics in underserved areas, established by the Department of Veterans Affairs (VA) between the last quarter of FY 1995 and the second quarter of FY 1998, including the 21 new clinics ...

  12. Seniors’ perspectives on care: a case study of the Alex Seniors health clinic, Calgary

    OpenAIRE

    Shaw, Marta; Rypien, Candace; Drummond, Neil; Harasym, Patricia; Nixon, Lara

    2015-01-01

    Background Primary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to th...

  13. Comparison of 5 health care professionals’ratings of the clinical significance of drug related problems

    DEFF Research Database (Denmark)

    Villesen, Christine; Hojsted, Jette; Kjeldsen, Lene Juel;

    2014-01-01

    Background Patients have medicines reviews conducted by different health care professionals in different settings. Introducing a clinical panel to drug related problems (DRPs) to evaluate their clinical significance is common practice. The clinical panel discuss the potential consequences and com...

  14. Patient engagement: an investigation at a primary care clinic

    Directory of Open Access Journals (Sweden)

    Gill PS

    2013-03-01

    Full Text Available Preetinder Singh Gill College of Technology, Eastern Michigan University, Ypsilanti, MI, USA Background: Engaged employees are an asset to any organization. They are instrumental in ensuring good commercial outcomes through continuous innovation and incremental improvement. A health care facility is similar to a regular work setting in many ways. A health care provider and a patient have roles akin to a team leader and a team member/stakeholder, respectively. Hence it can be argued that the concept of employee engagement can be applied to patients in health care settings in order to improve health outcomes. Methods: Patient engagement data were collected using a survey instrument from a primary care clinic in the northern Indian state of Punjab. Canonical correlation equations were formulated to identify combinations which were strongly related to each other. In addition, the cause-effect relationship between patient engagement and patient-perceived health outcomes was described using structural equation modeling. Results: Canonical correlation analysis showed that the first set of canonical variables had a fairly strong relationship, ie, a magnitude > 0.80 at the 95% confidence interval, for five dimensions of patient engagement. Structural equation modeling analysis yielded a β ≥ 0.10 and a Student's t statistic ≥ 2.96 for these five dimensions. The threshold Student's t statistic was 1.99. Hence it was found the β values were significant at the 95% confidence interval for all census regions. Conclusion: A scaled reliable survey instrument was developed to measured patient engagement. Better patient engagement is associated with better patient-perceived health outcomes. This study provides preliminary evidence that patient engagement has a causal relationship with patient-perceived health outcomes. Keywords: patient engagement, health outcomes, communication, provider effectiveness, patient incentive

  15. Impact of an oncology palliative care clinic on access to home care services.

    Science.gov (United States)

    Jang, Raymond W; Burman, Debika; Swami, Nadia; Kotler, Jennifer; Banerjee, Subrata; Ridley, Julia; Mak, Ernie; Bryson, John; Rodin, Gary; Le, Lisa W; Zimmermann, Camilla

    2013-08-01

    Home care (HC) is important for patients with cancer as performance status declines. Our study of 1224 patients at a Canadian cancer center examined the impact of an oncology palliative care clinic (OPCC) on HC referral. The HC referral frequency was calculated before and after the first OPCC consultation, in total and according to performance status (Palliative Performance Scale, PPS). Characteristics associated with HC referral were investigated. After the first OPCC consultation, there was an increase in HC referral from 39% (477 of 1224; 49% of those with PPS ≤60) to 69% (841 of 1224; 88% of those with PPS ≤60). Factors independently associated with HC referral were poor PPS (P < .001) and older age (P = .003). Thus OPCC involvement resulted in markedly increased HC referrals, particularly for older patients with poor performance status. PMID:22777408

  16. Following AACP Guidelines for Transitions in Care: The Transitional Care Clinic.

    Science.gov (United States)

    Velligan, Dawn I; Roberts, David; Martinez, Melissa; Fredrick, Megan; Hillner, Kiley; Luber, Philip

    2016-03-01

    The period of transition from hospital to community services is critical for individuals with serious mental illness. The American Association of Community Psychiatry developed guidelines for transitional services in behavioral health care. This column describes ways in which the Transitional Care Clinic (TCC) at the University of Texas Health Science Center at San Antonio has implemented these guidelines. The TCC includes active outreach to hospitals and a Web-based referral system that allows hospital staff to make TCC appointments for patients for as soon as the day after discharge. The program includes a unique group intake process that allows rapid development of individualized plans while maximizing access to services and use of provider time. PMID:26567939

  17. Cost differentials of dental outpatient care across clinical dentistry branches

    Directory of Open Access Journals (Sweden)

    Jovana Rančić

    2015-03-01

    Full Text Available Background: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens.Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services.Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was adopted. Sample size was 752 complete episodes of treatment in 250 patients, selected in 2012/2013 throughout several specialist state- and private-owned dental clinics in Serbia. All direct costs of dental care were taken into account and expressed in Euros (€.Results: Mean total costs of dental care were € 46 ± 156 per single dentist visit while total costs incurred by this population sample were € 34,424. Highest unit utilization of services belongs to conservative dentistry (31.9%, oral surgery (19.5% and radiology (17.4%, while the resource with the highest monetary value belongs to implantology € 828 ± 392, orthodontics € 706 ± 667 and prosthetics € 555 ± 244. The most frequently treated diagnosis was tooth decay (33.8% unit services provided, pulpitis (11.2% and impacted teeth (8.5%, while most expensive to treat were anomalies of tooth position (€ 648 ± 667, abnormalities of size and form of teeth (€ 508 ± 705 and loss of teeth due to accident, extraction or local periodontal disease (€ 336 ± 339.Conclusion: Although the range of dental costs currently falls behind EU average, Serbia’s emerging economy is likely to expand in the long run while market demand for dental services will grow. Due to threatened financial sustainability of current health insurance patterns in Western Balkans, getting acquainted with true size and structure of dental care costs could essentially support informed decision making in future

  18. [HOLDING OBJECTIVE STRUCTURED CLINICAL EXAMINATIONS FOR ANESTHESIOLOGY AND INTENSIVE CARE CLINICAL RESIDENCY IN STATE GRADUATES CERTIFICATION].

    Science.gov (United States)

    Schegolev, A V; Andreenko, A A; Ershov, E N; Lahin, R E; Makarenko, E P

    2016-01-01

    The modern system of medical education requires objective methods to assess clinical competence of medical specialists. Application of objective structured clinical examination (OSCE) during the final certification of graduates of clinical residency allows to evaluate the theoretical knowledge, manual skills. Enabling simulation scenarios in the program makes it possible to objectively evaluate the important non-technical skills of anesthesiologists, identify gaps in the system of training and modify it. The experience of the objective structured clinical examination as part of the state certification of graduates of clinical residency of the Department ofAnesthesiology and Intensive Care, Military MedicalAcademy after C M Kirov allows us to consider this technique in an objective way a comprehensive assessment of the competence of health professionals. Students confirmed its highly realistic, they have revealed the presence of emotional stress during the simulation sessions, the majority agreed that the simulation session increased the level of their readiness to address these situations in clinical practice. Staff of the department is planning to testing and introduction rating scales into a system of assessment, to improved exam program, increasing the number of clinical scenarios for simulation sessions. PMID:27192861

  19. Wage Sorting Trends

    DEFF Research Database (Denmark)

    Bagger, Jesper; Vejlin, Rune Majlund; Sørensen, Kenneth Lykke

    Using a population-wide Danish Matched Employer-Employee panel from 1980-2006, we document a strong trend towards more positive assortative wage sorting. The correlation between worker and firm fixed effects estimated from a log wage regression increases from -0.07 in 1981 to .14 in 2001. The...... nonstationary wage sorting pattern is not due to compositional changes in the labor market, primarily occurs among high wage workers, and comprises 41 percent of the increase in the standard deviation of log real wages between 1980 and 2006. We show that the wage sorting trend is associated with worker...

  20. Wearable technology as a booster of clinical care

    Science.gov (United States)

    Jonas, Stephan; Hannig, Andreas; Spreckelsen, Cord; Deserno, Thomas M.

    2014-03-01

    Wearable technology defines a new class of smart devices that are accessories or clothing equipped with computational power and sensors, like Google Glass. In this work, we propose a novel concept for supporting everyday clinical pathways with wearable technology. In contrast to most prior work, we are not focusing on the omnipresent screen to display patient information or images, but are trying to maintain existing workflows. To achieve this, our system supports clinical staff as a documenting observer, only intervening adequately if problems are detected. Using the example of medication preparation and administration, a task known to be prone to errors, we demonstrate the full potential of the new devices. Patient and medication identifier are captured with the built-in camera, and the information is send to a transaction server. The server communicates with the hospital information system to obtain patient records and medication information. The system then analyses the new medication for possible side-effects and interactions with already administered drugs. The result is sent to the device while encapsulating all sensitive information respecting data security and privacy. The user only sees a traffic light style encoded feedback to avoid distraction. The server can reduce documentation efforts and reports in real-time on possible problems during medication preparation or administration. In conclusion, we designed a secure system around three basic principles with many applications in everyday clinical work: (i) interaction and distraction is kept as low as possible; (ii) no patient data is displayed; and (iii) device is pure observer, not part of the workflow. By reducing errors and documentation burden, our approach has the capability to boost clinical care.

  1. Monitored anesthesia care (MAC sedation: clinical utility of fospropofol

    Directory of Open Access Journals (Sweden)

    Eric A Harris

    2009-12-01

    Full Text Available Eric A Harris, David A Lubarsky, Keith A CandiottiDepartment of Anesthesiology, Perioperative Management, and Pain Medicine, University of Miami/Miller School of MedicineAbstract: Fospropofol, a phosphorylated prodrug version of the popular induction agent propofol, is hydrolyzed in vivo to release active propofol, formaldehyde, and phosphate. Pharmacodynamic studies show fospropofol provides clinically useful sedation and EEG/bispectral index suppression while causing significantly less respiratory depression than propofol. Pain at the injection site, a common complaint with propofol, was not reported with fospropofol; the major patient complaint was transitory perianal itching during the drug’s administration. Although many clinicians believe fospropofol can safely be given by a registered nurse, the FDA mandated that fospropofol, like propofol, must be used only in the presence of a trained anesthesia provider.Keywords: fospropofol, propofol, monitored anesthesia care

  2. Clinical review: Airway hygiene in the intensive care unit

    Science.gov (United States)

    Jelic, Sanja; Cunningham, Jennifer A; Factor, Phillip

    2008-01-01

    Maintenance of airway secretion clearance, or airway hygiene, is important for the preservation of airway patency and the prevention of respiratory tract infection. Impaired airway clearance often prompts admission to the intensive care unit (ICU) and can be a cause and/or contributor to acute respiratory failure. Physical methods to augment airway clearance are often used in the ICU but few are substantiated by clinical data. This review focuses on the impact of oral hygiene, tracheal suctioning, bronchoscopy, mucus-controlling agents, and kinetic therapy on the incidence of hospital-acquired respiratory infections, length of stay in the hospital and the ICU, and mortality in critically ill patients. Available data are distilled into recommendations for the maintenance of airway hygiene in ICU patients. PMID:18423061

  3. The Point-of-Care Laboratory in Clinical Microbiology.

    Science.gov (United States)

    Drancourt, Michel; Michel-Lepage, Audrey; Boyer, Sylvie; Raoult, Didier

    2016-07-01

    Point-of-care (POC) laboratories that deliver rapid diagnoses of infectious diseases were invented to balance the centralization of core laboratories. POC laboratories operate 24 h a day and 7 days a week to provide diagnoses within 2 h, largely based on immunochromatography and real-time PCR tests. In our experience, these tests are conveniently combined into syndrome-based kits that facilitate sampling, including self-sampling and test operations, as POC laboratories can be operated by trained operators who are not necessarily biologists. POC laboratories are a way of easily providing clinical microbiology testing for populations distant from laboratories in developing and developed countries and on ships. Modern Internet connections enable support from core laboratories. The cost-effectiveness of POC laboratories has been established for the rapid diagnosis of tuberculosis and sexually transmitted infections in both developed and developing countries. PMID:27029593

  4. Optimal use of MRI in clinical trials, clinical care and clinical registries of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Møller-Bisgaard, Signe

    2014-01-01

    Magnetic resonance imaging (MRI) clearly is more sensitive than clinical examination and conventional radiography (x-ray) for detection of inflammation (synovitis, bone marrow oedema (osteitis) and tenosynovitis) and damage (bone erosion and cartilage loss/joint space narrowing) in patients with...... validated method which in less time and with fewer patients than x-ray can discriminate between different therapies regarding structural damage progression, and which on top of this offers detailed assessment of upstream inflammatory drivers of damage. In routine clinical care, MRI can contribute to an...... benefits of including MRI in treat-to-target strategies. The benefits of incorporating MRI into clinical registries are not yet known, but may include improved knowledge about the real-life advantages of MRI, as well as opportunities to develop better clinical and laboratory composite measures to monitor...

  5. Sorting Out Seasonal Allergies

    Science.gov (United States)

    ... Close ‹ Back to Health Library Sorting Out Seasonal Allergies Sneezing, runny nose, nasal congestion. Symptoms of the ... How do I know if I have seasonal allergies? According to Dr. Georgeson, the best way to ...

  6. Taking care: practice and philosophy of communication in a critical care follow-up clinic.

    Science.gov (United States)

    Hazzard, Anthony; Harris, Wendy; Howell, David

    2013-06-01

    Human consciousness is inextricable from communication. The conditions of communication in the clinical context are defined by the caring intention and the unequal relationship, which imply special responsibilities on the part of the clinician. The conventional hermeneutic model of communication proposes a close examination of the context of the other, and an objective effort to get close to their consciousness by interpretation of their expressions. The clinician is supposed to lay aside subjective factors but make use of her/his clinical knowledge and skills. At University College Hospital Critical Care follow-up clinic, the communicative task involves history taking; partly by questionnaire and partly by attention to the patient's agenda - assessing needs, providing information and facilitating access to further help. In recent years the provision of Critical Care has become ever more complex, both in terms of the sophisticated medical and nursing techniques it can offer to patients and in the range of conditions it can undertake to treat. This range and complexity is reflected in the variety of problems and consequences that may be encountered at follow-up. Communicative techniques should take account of the emotional vulnerability of patients emerging from severe illness. Attentive listening should identify special anxieties, and care with phraseology aims to avoid further distress. Issues of memory, depression and trauma may be expected, and the interview technique must be flexible enough to offer emotional containment if need be. The consultation should be therapeutic in its conduct but should not embark upon actual psychotherapy or seek to dismantle the patient's defences. Contemporary hermeneutic perspectives emphasise the contextual situatedness of the clinician's consciousness, and propose a model of communication as 'blending of horizons' rather than as objective interpretation. Systems theory contributes to an understanding of the influence on

  7. Integrating substance abuse care with community diabetes care: implications for research and clinical practice

    Directory of Open Access Journals (Sweden)

    Ghitza UE

    2013-01-01

    Full Text Available Udi E Ghitza,1 Li-Tzy Wu,2 Betty Tai11Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, 2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USAAbstract: Cigarette smoking and alcohol use are prevalent among individuals with diabetes in the US, but little is known about screening and treatment for substance use disorders in the diabetic population. This commentary discusses the scope and clinical implications of the public health problem of coexisting substance use and diabetes, including suggestions for future research. Diabetes is the seventh leading cause of death in the US, and is associated with many severe health complications like cardiovascular disease, stroke, kidney damage, and limb amputations. There are an estimated 24 million adults in the US with type 2 diabetes. Approximately 20% of adults aged 18 years or older with diabetes report current cigarette smoking. The prevalence of current alcohol use in the diabetic population is estimated to be around 50%–60% in epidemiological surveys and treatment-seeking populations. Cigarette smoking is associated with an increased risk of type 2 diabetes in a dose-dependent manner and is an independent modifiable risk factor for development of type 2 diabetes. Diabetic patients with an alcohol or other drug use disorder show a higher rate of adverse health outcomes. For example, these patients experience more frequent and severe health complications as well as an increased risk of hospitalization, and require longer hospital stays. They are also less likely to seek routine care for diabetes or adhere to diabetes treatment than those without an alcohol or other drug use disorder. The Affordable Care Act of 2010 and the Mental Health Parity Act and Addiction Equity Act of 2008 provide opportunities for facilitating integration of

  8. Challenges in Translating GWAS Results to Clinical Care.

    Science.gov (United States)

    Scheinfeldt, Laura B; Schmidlen, Tara J; Gerry, Norman P; Christman, Michael F

    2016-01-01

    Clinical genetic testing for Mendelian disorders is standard of care in many cases; however, it is less clear to what extent and in which situations clinical genetic testing may improve preventive efforts, diagnosis and/or prognosis of complex disease. One challenge is that much of the reported research relies on tag single nucleotide polymorphisms (SNPs) to act as proxies for assumed underlying functional variants that are not yet known. Here we use coronary artery disease and melanoma as case studies to evaluate how well reported genetic risk variants tag surrounding variants across population samples in the 1000 Genomes Project Phase 3 data. We performed a simulation study where we randomly assigned a "functional" variant and evaluated how often this simulated functional variant was correctly tagged in diverse population samples. Our results indicate a relatively large error rate when generalizing increased genetic risk of complex disease across diverse population samples, even when generalizing within geographic regions. Our results further highlight the importance of including diverse populations in genome-wide association studies. Future work focused on identifying functional variants will eliminate the need for tag SNPs; however, until functional variants are known, caution should be used in the interpretation of genetic risk for complex disease using tag SNPs. PMID:27527156

  9. Clinical characteristics and preventable acute care spending among a high cost inpatient population

    OpenAIRE

    Ronksley, Paul E.; Kobewka, Daniel M.; McKay, Jennifer A.; Rothwell, Deanna M.; Mulpuru, Sunita; Forster, Alan J

    2016-01-01

    Background A small proportion of patients account for the majority of health care spending. The objectives of this study were to explore the clinical characteristics, patterns of health care use, and the proportion of acute care spending deemed potentially preventable among high cost inpatients within a Canadian acute-care hospital. Methods We identified all individuals within the Ottawa Hospital with one or more inpatient hospitalization between April 1, 2010 and March 31, 2011. Clinical cha...

  10. “Youth friendly” clinics: Considerations for linking and engaging HIV-infected adolescents into care

    OpenAIRE

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

    2013-01-01

    Linkage and engagement in care are critical corollaries to the health of HIV-infected adolescents. The adolescent HIV epidemic and adolescents’ unique barriers to care necessitates innovation in the provision of care, including the consideration of the clinical experience. Little research has addressed how “youth friendly” clinics may influence care retention for HIV-infected youth. We conducted 124 interviews with providers, outreach workers, and case managers, at 15 Adolescent Medicine Tria...

  11. An Unsupervised Online Spike-Sorting Framework.

    Science.gov (United States)

    Knieling, Simeon; Sridharan, Kousik S; Belardinelli, Paolo; Naros, Georgios; Weiss, Daniel; Mormann, Florian; Gharabaghi, Alireza

    2016-08-01

    Extracellular neuronal microelectrode recordings can include action potentials from multiple neurons. To separate spikes from different neurons, they can be sorted according to their shape, a procedure referred to as spike-sorting. Several algorithms have been reported to solve this task. However, when clustering outcomes are unsatisfactory, most of them are difficult to adjust to achieve the desired results. We present an online spike-sorting framework that uses feature normalization and weighting to maximize the distinctiveness between different spike shapes. Furthermore, multiple criteria are applied to either facilitate or prevent cluster fusion, thereby enabling experimenters to fine-tune the sorting process. We compare our method to established unsupervised offline (Wave_Clus (WC)) and online (OSort (OS)) algorithms by examining their performance in sorting various test datasets using two different scoring systems (AMI and the Adamos metric). Furthermore, we evaluate sorting capabilities on intra-operative recordings using established quality metrics. Compared to WC and OS, our algorithm achieved comparable or higher scores on average and produced more convincing sorting results for intra-operative datasets. Thus, the presented framework is suitable for both online and offline analysis and could substantially improve the quality of microelectrode-based data evaluation for research and clinical application. PMID:26711713

  12. Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

    Directory of Open Access Journals (Sweden)

    Kessy Flora

    2011-05-01

    Full Text Available Abstract Background The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. Methods Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. Results The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". Conclusions Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker

  13. Twenty years of human immunodeficiency virus care at the Mayo Clinic: Past, present and future

    OpenAIRE

    Cummins, Nathan W.; Badley, Andrew D.; Kasten, Mary J.; Sampath, Rahul; Temesgen, Zelalem; Whitaker, Jennifer A; Wilson, John W.; Yao, Joseph D; Zeuli, John; Stacey A Rizza

    2016-01-01

    The Mayo human immunodeficiency virus (HIV) Clinic has been providing patient centered care for persons living with HIV in Minnesota and beyond for the past 20 years. Through multidisciplinary engagement, vital clinical outcomes such as retention in care, initiation of antiretroviral therapy and virologic suppression are maximized. In this commentary, we describe the history of the Mayo HIV Clinic and its best practices, providing a “Mayo Model” of HIV care that exceeds national outcomes and ...

  14. Clinical nursing care for transgender patients with cancer.

    Science.gov (United States)

    Levitt, Nathan

    2015-06-01

    Transgender people often face barriers in their pursuit of receiving sensitive and informed health care, and many avoid preventive care and care for life threatening conditions because of those obstacles. This article focuses on cancer care of the transgender patient, as well as ways that nurses and other providers can help to create a transgender-sensitive healthcare environment. PMID:26000586

  15. VCT clinic HIV burden and its link with HIV care clinic at the University of Gondar hospital

    Directory of Open Access Journals (Sweden)

    Alemie Getahun

    2012-11-01

    Full Text Available Abstract Background Voluntary Counselling and Testing (VCT is an important component of any HIV/AIDS control and prevention activities. VCT makes people aware of their HIV serostatus and enables early identification of those who need care. It is an important link to HIV care and support. The main aim of this study is to describe the HIV burden at VCT and define the relationship between the VCT Center and the HIV Chronic Care Clinic of the University of Gondar (UoG Hospital. Methods It is a record based descriptive study undertaken by using data collected by health professionals at the VCT center and the HIV chronic care clinic of the UoG Hospital. Patient data collected from 2005/06 to 2008/09 was investigated. Analysis was carried out using the SPSS version 16.0. Results A total of 19,168 people were tested for HIV and a prevalence of 25.4% was obtained. 4298 HIV positive people were referred to the HIV chronic care clinic but only 27% actually registered at the clinic. Chi-square analyses showed residence, age and time of VCT visit showed significant relations with hospital care attendance. Conclusion The overall HIV prevalence is high. The data obtained at the HIV care clinic regarding patients’ clinical conditions at acceptance were incomplete. Improvements are required on the link between VCT and HIV care and documentation of data.

  16. Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care

    Science.gov (United States)

    Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care, a 2010 workshop sponsored by the Epidemiology and Genomics Research Program.

  17. A Pharmacist-Led Point-of-Care INR Clinic: Optimizing Care in a Family Health Team Setting

    OpenAIRE

    Jennifer Rossiter; Gursharan Soor; Deanna Telner; Babak Aliarzadeh; Jennifer Lake

    2013-01-01

    Purpose. Monitoring patients' international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodt...

  18. Assessment of a pharmacist-driven point-of-care spirometry clinic within a primary care physicians office

    OpenAIRE

    Cawley MJ; Pacitti R; Warning W

    2011-01-01

    Objective: To assess value-added service of a pharmacist-driven point-of-care spirometry clinic to quantify respiratory disease abnormalities within a primary care physicians officeMethods: This retrospective, cohort study was an analysis of physician referred patients who attended our spirometry clinic during 2008-2010 due to pulmonary symptoms or disease. After spirometry testing, data was collected retrospectively to include patient demographics, spirometry results, and pulmonary pharmaceu...

  19. Ready, steady, SORT!

    CERN Multimedia

    Laëtitia Pedroso

    2010-01-01

    The selective or ecological sorting of waste is already second nature to many of us and concerns us all. As the GS Department's new awareness-raising campaign reminds us, everything we do to sort waste contributes to preserving the environment.    Placemats printed on recycled paper using vegetable-based ink will soon be distributed in Restaurant No.1.   Environmental protection is never far from the headlines, and CERN has a responsibility to ensure that the 3000 tonnes and more of waste it produces every year are correctly and selectively sorted. Materials can be given a second life through recycling and re-use, thereby avoiding pollution from landfill sites and incineration plants and saving on processing costs. The GS Department is launching a new poster campaign designed to raise awareness of the importance of waste sorting and recycling. "After conducting a survey to find out whether members of the personnel were prepared to make an effort to sort a...

  20. Microfluidic sorting of microtissues.

    Science.gov (United States)

    Buschke, D G; Resto, P; Schumacher, N; Cox, B; Tallavajhula, A; Vivekanandan, A; Eliceiri, K W; Williams, J C; Ogle, B M

    2012-03-01

    Increasingly, invitro culture of adherent cell types utilizes three-dimensional (3D) scaffolds or aggregate culture strategies to mimic tissue-like, microenvironmental conditions. In parallel, new flow cytometry-based technologies are emerging to accurately analyze the composition and function of these microtissues (i.e., large particles) in a non-invasive and high-throughput way. Lacking, however, is an accessible platform that can be used to effectively sort or purify large particles based on analysis parameters. Here we describe a microfluidic-based, electromechanical approach to sort large particles. Specifically, sheath-less asymmetric curving channels were employed to separate and hydrodynamically focus particles to be analyzed and subsequently sorted. This design was developed and characterized based on wall shear stress, tortuosity of the flow path, vorticity of the fluid in the channel, sorting efficiency and enrichment ratio. The large particle sorting device was capable of purifying fluorescently labelled embryoid bodies (EBs) from unlabelled EBs with an efficiency of 87.3% ± 13.5%, and enrichment ratio of 12.2 ± 8.4 (n = 8), while preserving cell viability, differentiation potential, and long-term function. PMID:22505992

  1. Sorting Plastic Waste in Hydrocyclone

    Directory of Open Access Journals (Sweden)

    Ernestas Šutinys

    2011-02-01

    Full Text Available The article presents material about sorting plastic waste in hydrocyclone. The tests on sorting plastic waste were carried out. Also, the findings received from the performed experiment on the technology of sorting plastic waste are interpreted applying an experimental model of the equipment used for sorting plastics of different density.Article in Lithuanian

  2. The palliative care clinical nurse consultant: an essential link.

    Science.gov (United States)

    O'Connor, Margaret; Chapman, Ysanne

    2008-01-01

    This study describes the role of acute hospital palliative care nurse consultants and makes recommendations about future directions for the role development of this role. While the palliative care nurse consultant role is accepted in the acute setting there is little evidence or literature about what contributes to the success of this role. A three-phase study was undertaken to describe the role of palliative care nurse consultants in acute hospitals in Melbourne, Australia. The first phase of the three-phase study, involving in-depth qualitative interviews with the palliative care nurse consultants, is reported in this article. Using open-ended semi-structured questions, 10 palliative care nurse consultants were interviewed using open-ended questions about aspects of their role and the interviews were thematically analysed. Four main themes were identified that clarified the role; being the internal link; being the lynch pin; being responsive and being challenged. The palliative care nurse consultants were the first point of introduction to palliative care and thus they saw a significant role in introducing the concept of palliative care to those requiring palliative care, their families and others. They are an important link between the settings of care required by people accessing palliative care-acute, in-patient palliative care and community care. The palliative care nurse consultants saw themselves in leadership positions that in some ways defy boundaries, because of the inherent complexity and diversity of the role. The palliative care nurse consultants' role appears to be pivotal in providing expert advice to staff and people requiring palliative care, and connecting palliative care services both within the hospital and to external services. PMID:19112925

  3. Usual Care as the Control Group in Clinical Trials of Nonpharmacologic Interventions

    OpenAIRE

    Thompson, B Taylor; Schoenfeld, David

    2007-01-01

    We discuss the pros and cons of including usual care as a control arm in clinical trials of nonpharmacologic interventions. Usual care is a term used to describe the full spectrum of patient care practices in which clinicians have the opportunity (which is not necessarily seized) to individualize care. The decision to use usual care as the control arm should be based on the nature of the research question and the uniformity of usual-care practices. The use of a usual-care arm in a two-arm tri...

  4. The Inverse Care Law: Clinical Primary Care Encounters in Deprived and Affluent Areas of Scotland

    OpenAIRE

    Mercer, Stewart W.; Watt, Graham C M

    2007-01-01

    PURPOSE The inverse care law states that the availability of good medical care tends to vary inversely with the need for it in the population served, but there is little research on how the inverse care law actually operates.

  5. Adolescents with Special Needs: Clinical Challenges in Reproductive Health Care.

    Science.gov (United States)

    Quint, Elisabeth H

    2016-02-01

    Adolescents with special needs have unique reproductive health care needs related to their physical and cognitive issues. This review discusses some of the most common concerns that are encountered in clinical practice, as the clinician will partner with the adolescent and her family to guide her through the pubertal transition and to help navigate the risks and rights of reproduction. Families often seek anticipatory guidance before menarche on menstrual hygiene, abuse risk and sexuality and can be reassured that most teens with special needs do very well with menstruation. The clinician needs to evaluate the teenager's reproductive knowledge as well her risk for abuse and coercion and her ability to consent to sexual activity, if she requests contraception. Menstrual management is mostly based on the impact of the menstrual cycles on the teenager's life and activities. The adolescents may have a decreased ability to tolerate menses or pain, or experience changes in seizure pattern or altered mood. Hormonal treatment is often used to assist with menstrual hygiene, cyclical mood changes or dysmenorrhea. The goal of treatment can be complete amenorrhea, alleviate pain or regulate and decrease menstrual flow. The unique risks and benefits of hormonal treatment for this special population are highlighted. PMID:26542013

  6. Pharmacy intervention at an intensive care rehabilitation clinic

    OpenAIRE

    MacTavish, P.; McPeake, J.; Devine, H.; Kinsella, J; Daniel, M; Fenlon, C.; Quasim, T.

    2016-01-01

    Introduction: During an intensive care stay, patients often have their chronic medications withheld for a variety of reasons and new drugs commenced [1]. As patients are often under the care of a number of different medical teams during their admission there is potential for these changes to be inadvertently continued [2]. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE) is a five week rehabilitation programme for patients and their care...

  7. Fulfilling an Unmet Need: Roles for Clinical Pharmacists in Preconception Care.

    Science.gov (United States)

    DiPietro Mager, Natalie A

    2016-02-01

    Preconception care refers to a set of interventions that identify and address biomedical, behavioral, and social risks to a woman's health that may negatively impact a future pregnancy. A great need for preconception care currently exists in the United States, and women's attitudes about discussions with health care providers about healthy and safe pregnancies are positive. Clinical pharmacists are well positioned to work with other health care and public health professionals to ensure that all women of childbearing potential have access to preconception care. As part of the collaborative health care team, clinical pharmacists can directly provide services or support and referrals to other members of the health care team or to community resources through clinical-community linkages. Specifically, clinical pharmacists can provide education, counseling, and/or services to women to address family planning, medication and disease state management, immunizations, screenings, health promotion, and substance use. Clinical pharmacists can also impact preconception care through drug information services, advocacy, and research. Preconception care services can be incorporated into daily pharmacy practice, and there are potential means for reimbursement. Multiple roles exist for clinical pharmacists to fulfill unmet needs in preconception care. PMID:26846305

  8. Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review

    OpenAIRE

    Delaney, Lori J; van Haren, Frank; Lopez, Violeta

    2015-01-01

    Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequent...

  9. The need for hospital care of patients with clinically localized prostate cancer managed by noncurative intent

    DEFF Research Database (Denmark)

    Brasso, K; Friis, S; Juel, K;

    2000-01-01

    We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy.......We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy....

  10. 77 FR 50548 - Agency Information Collection: (PACT Clinical Innovation Study: Engaging Caregivers in the Care...

    Science.gov (United States)

    2012-08-21

    ... AFFAIRS Agency Information Collection: (PACT Clinical Innovation Study: Engaging Caregivers in the Care of... No. 2900--New (VA Form 10-0537). SUPPLEMENTARY INFORMATION: Title: PACT Clinical Innovation Study... social services. The information will help VA develop and test a care management intervention that...

  11. PO02 - Clinical profile of children admitted to a paediatric intensive care unit due to acute clinical deterioration

    DEFF Research Database (Denmark)

    Jensen, Claus Sixtus; Aagaard, Hanne; Olesen, Hanne Vebert;

    2016-01-01

    Theme: Intensive care Background: There has been an increased number of critically ill patients admitted to paediatric departments. Only a few studies have described the various causes of unplanned admission to paediatric intensive care units (PICU) due to clinical deterioration. However, an...... critical ill children in paediatric wards....

  12. Emergency Training, Education And Perceived Clinical Skills For Tsunami Care Among Nurses In Banda Aceh, Indonesia

    OpenAIRE

    Cut Husna; Urai Hatthakit; Aranya Chaowalit

    2011-01-01

    Background: Nurses are a part of health care provider who has responsibility to respond to disaster. The nurses ought to have sufficient knowledge and skills in caring for patients in disasters such as in a tsunami. Clinical skills of nurses effectively help the nurses in handling the tsunami emergency response.Objectives: To describe the levels of perceived clinical skills for tsunami care in acute response phase (6 months) after tsunami struck, and to examine the relationship between emerge...

  13. Sorting and sustaining cooperation

    DEFF Research Database (Denmark)

    Vikander, Nick

    2013-01-01

    This paper looks at cooperation in teams where some people are selfish and others are conditional cooperators, and where lay-offs will occur at a fixed future date. I show that the best way to sustain cooperation prior to the lay-offs is often in a sorting equilibrium, where conditional cooperators...

  14. What are the effective ways to translate clinical leadership into health care quality improvement?

    OpenAIRE

    McSherry, Robert

    2016-01-01

    Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translat...

  15. Clinical and regulatory protocols for the management of impaired vision in the public health care network

    Directory of Open Access Journals (Sweden)

    Jayter Silva Paula

    2011-06-01

    Full Text Available PURPOSE: To describe the procedures used in developing Clinical and Regulatory Protocols for primary care teams to use in the management of the most common scenarios of impaired vision in Southern Brazil. METHODS: A retrospective review of 1.333 referral forms from all primary care practitioners was performed in Ribeirão Preto city, during a 30-day period. The major ophthalmic diagnostic categories were evaluated from those referrals forms. The Clinical and Regulatory Protocols development process was held afterwards and involved scientific cooperation between a university and the health care system, in the form of workshops attended by primary care practitioners and regulatory system team members composed of health care administrators, ophthalmologists, and professors of ophthalmology and social medicine. RESULTS: The management of impaired vision was chosen as the theme, since it accounted for 43.6% of the ophthalmology-related referrals from primary care providers of Ribeirão Preto. The Clinical and Regulatory Protocols developed involve distinctive diagnostic and therapeutic interventions that can be performed at the primary care level and in different health care settings. The most relevant clinical and regulatory interventions were expressed as algorithms in order to facilitate the use of the Clinical and Regulatory Protocols by health care practitioners. CONCLUSIONS: These Clinical and Regulatory Protocols could represent a useful tool for health systems with universal access, as well as for health care networks based on primary care and for regulatory system teams. Implementation of these Clinical and Regulatory Protocols can minimize the disparity between the needs of patients with impaired vision and the treatment modalities offered, resulting in a more cooperative health care network.

  16. Clinical microbiology in the intensive care unit: Strategic and operational characteristics

    OpenAIRE

    Bhattacharya S; Mondal A.

    2010-01-01

    Infection is a major cause of morbidity and mortality among patients admitted in intensive care units (ICUs). The application of the principles and the practice of Clinical Microbiology for ICU patients can significantly improve clinical outcome. The present article is aimed at summarising the strategic and operational characteristics of this unique field where medical microbiology attempts to venture into the domain of direct clinical care of critically ill patients. The close and strategic ...

  17. Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial

    OpenAIRE

    2012-01-01

    Objective To examine the effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared with general practitioners. Design Multicentre randomised controlled trial. Setting Nine memory clinics and 159 general practitioners in the Netherlands. Participants 175 patients with a new diagnosis of mild to moderate dementia living in the community and their informal caregivers. Interventions Usual care provided by memory clinic or general practitioner. Main out...

  18. Clinical data integration model : core interoperability ontology for research using primary care data

    OpenAIRE

    Ethier, J.-F.; Curcin, V; Barton, A.; Bastiaens, H.; et al

    2015-01-01

    Abstract: Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on "Managing Interoperability and Complexity in Health Systems". Background: Primary care data is the single richest source of routine health care data. However its use, both in research and clinical work, often requires data from multiple clinical sites, clinical trials databases and registries. Data integration and interoperability are therefore of utmost importance. Objectives: TRANSFoRm's...

  19. Foot care and footwear practices among patients attending a specialist diabetes clinic in Jamaica

    OpenAIRE

    Gayle, Krystal A.T.; Tulloch-Reid, Marshall K.; Younger, Novie O; Francis, Damian K.; Shelly R. McFarlane; Wright-Pascoe, Rosemarie A.; Boyne, Michael S.; Wilks, Rainford J; Ferguson, Trevor S

    2012-01-01

    This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI) Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care practices and types of footwear worn. Participants were a subset of a sex-stratified random sample of clinic attendees and were interviewed in 2010. Data analysis included frequency estimates ...

  20. What are the effective ways to translate clinical leadership into health care quality improvement?

    Directory of Open Access Journals (Sweden)

    McSherry R

    2016-02-01

    Full Text Available Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks. Keywords: governance

  1. CLINICAL PSYCHOLOGICAL ASSESSMENT IN LITHUANIAN HEALTH CARE INSTITUTIONS: OPINION ANALYSIS OF PROFESSIONALS

    OpenAIRE

    Augustinas Rotomskis

    2015-01-01

    Purpose – to investigate the state of clinical psychological assessment in the Lithuanian health care system: 1) what kind of tests are used in clinical practice and what are clinicians opinions about them; 2) what kind of psychological functions are assessed in clinical practice and what is the opinion of clinicians about the assessment of these psychological functions; 3) what kind of issues are the most pressing in clinical assessment. Design/methodology/approach – 101 clinical psychol...

  2. Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics

    OpenAIRE

    Fermo JD; Whitley HP; Thompson AM; Ragucci KR

    2009-01-01

    Until recently, Prothrombin Time/International Normalized Ratio (PT/INR) measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT) device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory. Objective: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed an...

  3. Sorting quantum systems efficiently

    Science.gov (United States)

    Ionicioiu, Radu

    2016-01-01

    Measuring the state of a quantum system is a fundamental process in quantum mechanics and plays an essential role in quantum information and quantum technologies. One method to measure a quantum observable is to sort the system in different spatial modes according to the measured value, followed by single-particle detectors on each mode. Examples of quantum sorters are polarizing beam-splitters (PBS) – which direct photons according to their polarization – and Stern-Gerlach devices. Here we propose a general scheme to sort a quantum system according to the value of any d-dimensional degree of freedom, such as spin, orbital angular momentum (OAM), wavelength etc. Our scheme is universal, works at the single-particle level and has a theoretical efficiency of 100%. As an application we design an efficient OAM sorter consisting of a single multi-path interferometer which is suitable for a photonic chip implementation. PMID:27142705

  4. Gold ore sorting

    International Nuclear Information System (INIS)

    Apparatus for sorting lumps of gold-bearing ore according to their gold content is described. It includes means for irradiating the lumps of ore with neutrons, e.g. a neutron tube adapted to produce at least 1010 neutrons per second with an energy of less than 4.5 MeV. The resulting intensity of 297 keV gamma rays arising from the nuclear reaction 197Au(n,n'#betta#) 197Au is measured. The measured gamma ray intensity from a given lump of ore is used to sort that lump of ore from other lumps. The apparatus includes various cylinders and a vibrator for presenting the lumps of ore to the neutrons in a geometrical configuration such as to enable the lumps to be irradiated uniformly. (author)

  5. Lipoprotein sorting in bacteria.

    Science.gov (United States)

    Okuda, Suguru; Tokuda, Hajime

    2011-01-01

    Bacterial lipoproteins are synthesized as precursors in the cytoplasm and processed into mature forms on the cytoplasmic membrane. A lipid moiety attached to the N terminus anchors these proteins to the membrane surface. Many bacteria are predicted to express more than 100 lipoproteins, which play diverse functions on the cell surface. The Lol system, composed of five proteins, catalyzes the localization of Escherichia coli lipoproteins to the outer membrane. Some lipoproteins play vital roles in the sorting of other lipoproteins, lipopolysaccharides, and β-barrel proteins to the outer membrane. On the basis of results from biochemical, genetic, and structural studies, we discuss the biogenesis of lipoproteins in bacteria, their importance in cellular functions, and the molecular mechanisms underlying efficient sorting of hydrophobic lipoproteins to the outer membrane through the hydrophilic periplasm. PMID:21663440

  6. Sorting quantum systems efficiently.

    Science.gov (United States)

    Ionicioiu, Radu

    2016-01-01

    Measuring the state of a quantum system is a fundamental process in quantum mechanics and plays an essential role in quantum information and quantum technologies. One method to measure a quantum observable is to sort the system in different spatial modes according to the measured value, followed by single-particle detectors on each mode. Examples of quantum sorters are polarizing beam-splitters (PBS) - which direct photons according to their polarization - and Stern-Gerlach devices. Here we propose a general scheme to sort a quantum system according to the value of any d-dimensional degree of freedom, such as spin, orbital angular momentum (OAM), wavelength etc. Our scheme is universal, works at the single-particle level and has a theoretical efficiency of 100%. As an application we design an efficient OAM sorter consisting of a single multi-path interferometer which is suitable for a photonic chip implementation. PMID:27142705

  7. Heideggers sorte arv

    DEFF Research Database (Denmark)

    Olesen, Søren Gosvig

    2015-01-01

    Martin Heidegger var antisemit, men er hans tænkning og intellektuelle arv det også? Søren Gosvig Olesen opsøger den store tyske tænkers arvinger og bindene fra 1938-48 i Heideggers efterladte ’Sorte hæfter’, hvor den lille mands meninger blander sig med en stor tænkers tanker......Martin Heidegger var antisemit, men er hans tænkning og intellektuelle arv det også? Søren Gosvig Olesen opsøger den store tyske tænkers arvinger og bindene fra 1938-48 i Heideggers efterladte ’Sorte hæfter’, hvor den lille mands meninger blander sig med en stor tænkers tanker...

  8. Event shape sorting

    Science.gov (United States)

    Kopečná, Renata; Tomášik, Boris

    2016-04-01

    We propose a novel method for sorting events of multiparticle production according to the azimuthal anisotropy of their momentum distribution. Although the method is quite general, we advocate its use in analysis of ultra-relativistic heavy-ion collisions where a large number of hadrons is produced. The advantage of our method is that it can automatically sort out samples of events with histograms that indicate similar distributions of hadrons. It takes into account the whole measured histograms with all orders of anisotropy instead of a specific observable ( e.g., v_2 , v_3 , q_2 . It can be used for more exclusive experimental studies of flow anisotropies which are then more easily compared to theoretical calculations. It may also be useful in the construction of mixed-events background for correlation studies as it allows to select events with similar momentum distribution.

  9. Chip-based droplet sorting

    Energy Technology Data Exchange (ETDEWEB)

    Beer, Neil Reginald; Lee, Abraham; Hatch, Andrew

    2014-07-01

    A non-contact system for sorting monodisperse water-in-oil emulsion droplets in a microfluidic device based on the droplet's contents and their interaction with an applied electromagnetic field or by identification and sorting.

  10. Chip-based droplet sorting

    Science.gov (United States)

    Beer, Neil Reginald; Lee, Abraham; Hatch, Andrew

    2014-07-01

    A non-contact system for sorting monodisperse water-in-oil emulsion droplets in a microfluidic device based on the droplet's contents and their interaction with an applied electromagnetic field or by identification and sorting.

  11. Teaching Sorting in ICT

    OpenAIRE

    Szlávi, Péter; Törley, Gábor

    2009-01-01

    This article is aimed at considering how an algorithmic problem - more precisely a sorting problem - can be used in an informatics class in primary and secondary education to make students mobilize the largest possible amount of their intellectual skills in the problem solving process. We will be outlining a method which essentially forces students to utilize their mathematical knowledge besides algorithmization in order to provide an efficient solution. What is more, they are expected to ...

  12. Twenty years of human immunodeficiency virus care at the Mayo Clinic: Past, present and future

    Science.gov (United States)

    Cummins, Nathan W; Badley, Andrew D; Kasten, Mary J; Sampath, Rahul; Temesgen, Zelalem; Whitaker, Jennifer A; Wilson, John W; Yao, Joseph D; Zeuli, John; Rizza, Stacey A

    2016-01-01

    The Mayo human immunodeficiency virus (HIV) Clinic has been providing patient centered care for persons living with HIV in Minnesota and beyond for the past 20 years. Through multidisciplinary engagement, vital clinical outcomes such as retention in care, initiation of antiretroviral therapy and virologic suppression are maximized. In this commentary, we describe the history of the Mayo HIV Clinic and its best practices, providing a “Mayo Model” of HIV care that exceeds national outcomes and may be applicable in other settings. PMID:27175350

  13. Sorting out Ideas about Function

    Science.gov (United States)

    Hillen, Amy F.; Malik, LuAnn

    2013-01-01

    Card sorting has the potential to provide opportunities for exploration of a variety of topics and levels. In a card-sorting task, each participant is presented with a set of cards--each of which depicts a relationship--and is asked to sort the cards into categories that make sense to him or her. The concept of function is critical to…

  14. Pair Wise Sorting: A New Way of Sorting

    Directory of Open Access Journals (Sweden)

    Md. Jahangir Alam

    2010-12-01

    Full Text Available This paper presents a technique for sorting numerical data in an efficient way. The numbers of comparisons i.e. the running time of this technique is dependent on distribution or diversity of the value of data items as like as other efficient algorithms. When the total number of data is even, this method groups that data into a collection of pairs and therefore establishes the sorting constraints on each of the pairs. The control is traversed through the list of elements by changing the position of each pair which is the major principle of this technique. On the other hand, when the total number of elements is odd, this method sorts all elements except the last one in the same was as mentioned earlier and the last element is sorted using the general Insertion Sort. This algorithm is therefore a hybrid sorting method that sorts elementary numeric data in a faster and efficient manner.

  15. Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical Setting

    Science.gov (United States)

    Ogrinc, Greg; Hoffman, Kimberly G.; Stevenson, Katherine M.; Shalaby, Marc; Beard, Albertine S.; Thörne, Karin E.; Coleman, Mary T.; Baum, Karyn D.

    2016-01-01

    Problem Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. Approach From 2008–2012, an iterative, interactive process was used to develop the ECLS model and its core elements—patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012–2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site’s ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Outcomes Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. Next Steps The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. PMID:26760058

  16. Systematic review of studies of quality of clinical care in general practice in the UK, Australia and New Zealand

    OpenAIRE

    Seddon, M; Marshall, M.; Campbell, S; Roland, M.

    2001-01-01

    Objectives—Little is known about the quality of clinical care provided outside the hospital sector, despite the increasingly important role of clinical generalists working in primary care. In this study we aimed to summarise published evaluations of the quality of clinical care provided in general practice in the UK, Australia, and New Zealand.

  17. Clinical outcomes after treatment of multiple lesions with zotarolimus-eluting versus sirolimus-eluting coronary stents (a SORT OUT III substudy)

    DEFF Research Database (Denmark)

    Thim, Troels; Maeng, Michael; Lassen, Jens Flensted; Kaltoft, Anne; Jensen, Lisette Okkels; Ravkilde, Jan; Thayssen, Per; Christiansen, Evald Høj; Engstrøm, Thomas; Madsen, Morten; Thuesen, Leif; Tilsted, Hans-Henrik

    2012-01-01

    Data on clinical outcomes among patients treated with the zotarolimus-eluting Endeavor™ stent versus the sirolimus-eluting Cypher™ stent favor the sirolimus-eluting stent. However, a separate comparison of clinical outcome among patients treated for multiple lesions with these stents is lacking. ...

  18. The utility of a health risk assessment in providing care for a rural free clinic population

    OpenAIRE

    Scariati, Paula D; Williams, Cyndy

    2007-01-01

    Abstract Background Free clinics are an important part of our country's health safety net, serving a working poor uninsured population. With limited resources and heavily dependent upon volunteer health care providers, these clinics have historically focused on stopgap, band-aid solutions to the population's health problems. Embracing a new paradigm, free clinics are now prioritizing resources for disease prevention and health promotion. Methods We initiated a Healthy Friday Clinic project in...

  19. Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology

    OpenAIRE

    Esposito, Pasquale; Dal Canton, Antonio

    2014-01-01

    Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and financing. Different tools have been developed, including incident analysis, health technology assessment and clinical audit. The clinical audit consist of measuring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine in order to identify the changes needed to improve t...

  20. [Critical issues in clinical practice guidelines for geriatric care].

    Science.gov (United States)

    Zanetti, Ermellina

    2014-01-01

    Behavioral and psychological symptoms of dementia(BPSD) are one of the most disturbing issues in the management of patients, both for caregivers and health care personnel. Aim of this paper is to critically appraise the available guidelines on the non pharmacological management of BPSD. Some effective interventions such as person centred care, communication skills e dementia care mapping are not mentioned while interventions of dubious efficacy (aromatherapy, per therapy, light therapy or music therapy) are proposed. The variability in the expression of behavioral disorders and the different causes suggest an accurate tailoring of the interventions, based on the assessment of the patient, the organization and the environment. Further studies are necessary to improve the implementation of the non drug strategies for the management of BPSDs. PMID:25532924

  1. Criteria for clinical audit of women friendly care and providers' perception in Malawi

    Directory of Open Access Journals (Sweden)

    van den Broek Nynke

    2008-07-01

    Full Text Available Abstract Background There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. Objective We sought to (a establish standards for women friendly care and (b explore attitudinal barriers which could impede the proper implementation of clinical audit. Methods We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. Results The standards addressed different aspects of care given to women in maternity units, namely (i reception, (ii attitudes towards women, (iii respect for culture, (iv respect for women, (v waiting time, (vi enabling environment, (vii provision of information, (viii individualised care, (ix provision of skilled attendance at birth and emergency obstetric care, (x confidentiality, and (xi proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54 agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%, and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%. Conclusion Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers.

  2. Introduction to integrative primary care: the health-oriented clinic.

    Science.gov (United States)

    Fortney, Luke; Rakel, Dave; Rindfleisch, J Adam; Mallory, Jill

    2010-03-01

    Integrative medicine is healing-oriented medicine that accounts for the whole person (body, mind, and spirit), including all aspects of lifestyle. Integrative medicine emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative. This article describes ways to bring the integrative perspective into primary care practice. Several approaches are described, including some that are routinely used in the authors' practice. Changes in practice philosophy that can (1) help inform primary care redesign, (2) facilitate the creation of patient-centered medical homes, (3) strengthen provider-patient relationships, and (4) enhance patient satisfaction are also provided. PMID:20188994

  3. Self-reported health care seeking behavior in rural Ethiopia: Evidence from clinical vignettes

    OpenAIRE

    2013-01-01

    Between 2000 and 2011, Ethiopia rapidly expanded its health-care infrastructure recording an 18-fold increase in the number of health posts and a 7-fold increase in the number of health centers. However, annual per capita outpatient utilization has increased only marginally. The extent to which individuals forego necessary health care, especially why and who foregoes care are issues that have received little attention in the context of low-income countries. This paper uses five clinical vigne...

  4. Clinical profile of hospital acquired pneumonia in a tertiary care hospital, South India

    OpenAIRE

    Vasuki V.

    2016-01-01

    Background: Hospital acquired infections continue to be an important cause of morbidity and mortality among hospitalized patients. Hospital acquired pneumonia (HAP) results in a significant increase in the cost of care of hospitalized patients. Its development prolongs a patient's stay in the Intensive Care Unit (ICU). Accurate information concerning the clinical profile of HAP is lacking in South India. This study was conducted prospectively to evaluate the clinical profile of HAP in ICU pat...

  5. Clinical Practice Guidelines as Instruments for Sound Health Care Priority Setting.

    Science.gov (United States)

    Lawler, Patrick R; Norheim, Ole F

    2015-11-01

    This editorial discusses the potential role that physician-authored clinical practice guidelines could play in health care priority setting decisions in the United States. We briefly review the challenges associated with increasingly obligate health care priority setting in the United States and discuss accountability for these decisions. We then propose a potential role for clinical practice guidelines in addressing these challenges, while considering the ethical foundations of such a proposal. PMID:26342516

  6. CLINICAL PSYCHOLOGICAL ASSESSMENT IN LITHUANIAN HEALTH CARE INSTITUTIONS: OPINION ANALYSIS OF PROFESSIONALS

    Directory of Open Access Journals (Sweden)

    Augustinas Rotomskis

    2015-07-01

    Full Text Available Purpose – to investigate the state of clinical psychological assessment in the Lithuanian health care system: 1 what kind of tests are used in clinical practice and what are clinicians opinions about them; 2 what kind of psychological functions are assessed in clinical practice and what is the opinion of clinicians about the assessment of these psychological functions; 3 what kind of issues are the most pressing in clinical assessment. Design/methodology/approach – 101 clinical psychologists, who work in Lithuanian health care institutions, completed a questionnaire about their opinion on clinical psychological assessment. Findings – Attention, memory, executive functions, intelligence and emotions are the most important and frequently assessed psychological functions in clinical practice. Neuropsychogical assessment of attention, memory, executive functions, are viewed as the most problematic fields of assessment. The adaptation, standartization and revision of the various neuropsychological tests is suggested. The most pressing issues in clinical practice are: 1 the assessment of specific psychological functions (neuropsychological and psychosocial functioning; 2 the assessment of specific disorders (schizophrenia spectrum disorders and autism spectrum disorders; 3 the asessment of specific stages of development (children and teenagers. Research limitations/implications – 32 percent of health care institutions (30 out of 95 identified institutions, which provide mental health care, did not participate in the study. The majority of these institutions are from the provinces. Practical implications – psychological assessment plays a key role in the practice of a clinical psychologist. This study investigated and pinpointed the most pressing issues and needs of psychologists in clinical practice. According to the study results, recommendations ascertaining to the adaptation and revision of tests and preparation of clinical psychologists

  7. Fluorescence activated cell sorting.

    Science.gov (United States)

    Bonner, W. A.; Hulett, H. R.; Sweet, R. G.; Herzenberg, L. A.

    1972-01-01

    An instrument has been developed for sorting biological cells. The cells are rendered differentially fluorescent and incorporated into a small liquid stream illuminated by a laser beam. The cells pass sequentially through the beam, and fluorescent light from the cells gives rise to electrical signals. The stream is broken into a series of uniform size drops downstream of the laser. The cell signals are used to give appropriate electrostatic charges to drops containing the cells. The drops then pass between two charged plates and are deflected to appropriate containers. The system has proved capable of providing fractions containing large numbers of viable cells highly enriched in a particular functional type.

  8. Opening the Black Box of Clinical Collaboration in Integrated Care Models for Frail, Elderly Patients

    Science.gov (United States)

    de Stampa, Matthieu; Vedel, Isabelle; Bergman, Howard; Novella, Jean-Luc; Lechowski, Laurent; Ankri, Joel; Lapointe, Liette

    2013-01-01

    Purpose: The purpose of the study was to understand better the clinical collaboration process among primary care physicians (PCPs), case managers (CMs), and geriatricians in integrated models of care. Methods: We conducted a qualitative study with semistructured interviews. A purposive sample of 35 PCPs, 7 CMs, and 4 geriatricians was selected in…

  9. Preliminary Validation of a Screening Tool for Adolescent Panic Disorder in Pediatric Primary Care Clinics

    Science.gov (United States)

    Queen, Alexander H.; Ehrenreich-May, Jill; Hershorin, Eugene R.

    2012-01-01

    This study examines the validity of a brief screening tool for adolescent panic disorder (PD) in a primary care setting. A total of 165 participants (ages 12-17 years) seen in two pediatric primary care clinics completed the Autonomic Nervous System Questionnaire (ANS; Stein et al. in Psychosomatic Med 61:359-364, 40). A subset of those screening…

  10. The new production theory for health care through clinical reengineering: a study of clinical guidelines--Part II.

    Science.gov (United States)

    Sharp, J R

    1995-01-01

    In Part I of this two-part article, in the December 1994 issue of the journal, the author discussed the manufacturing theories of Peter Drucker in terms of their applicability for the health care field. He concluded that Drucker's four principles and practices of manufacturing--statistical quality control, manufacturing accounting, modular organization, and systems approach--do have application to the health care system. Clinical guidelines, a variation on the Drucker theory, are a specific example of the manufacturing process in health. The performance to date of some guidelines and their implications for the health care reform debate are discussed in Part II of the article. PMID:10139603

  11. Health-care technology assessment: a clinical perspective.

    Science.gov (United States)

    Chantler, Cyril

    2004-01-01

    Health technology assessment needs to relate to contemporary questions which concern public health-care systems: how to keep people healthy, how to focus on the needs of those with chronic disabilities and integrate care between the hospital and the community, how to encourage and audit effective teamwork, and how to establish a consensus about what is effective and affordable. Clinicians have an ethical responsibility to practice efficiently and economically, for profligacy in the care of one patient may mean that another is treated inadequately. For similar reasons, clinicians need to play a full role in the management of services. Advice from health technology assessment is vital and needs to be accurate, relevant, timely, clear, and accessible. As well as being concerned about what works, we need also to eliminate from practice what does not. Regular audit and appraisal of practice against the evidence base should be useful in this respect. Alternative approaches to management, such as the provision of care as opposed to aggressive treatments, need to be evaluated, and health technology assessment needs to consider how services are delivered, not just specific treatments. PMID:15176183

  12. Improving the quality of nurse clinical documentation for chronic patients at primary care clinics: A multifaceted intervention

    Directory of Open Access Journals (Sweden)

    Ozayr H. Mahomed

    2015-02-01

    Full Text Available Background: Deficiencies in record keeping practices have been reported at primary care level in the public health sector in South Africa. These deficiencies have the potential to negatively impact patient health outcomes as the break in information may hinder continuity of care. This disruption in information management has particular relevance for patients with chronic diseases.Objectives: The aim of this study was to establish if the implementation of a structured clinical record (SCR as an adjunct tool to the algorithmic guidelines for chronic disease management improved the quality of clinical records at primary care level.Method: A quasi-experimental study (before and after study with a comparison group was conducted across 30 primary health care clinics (PHCs located in three districts in South Africa. Twenty PHCs that received the intervention were selected as intervention clinics and 10 facilities were selected as comparison facilities. The lot quality assurance sampling (LQAS method was used to determine the number of records required to be reviewed per diagnostic condition per facility.Results: There was a a statistically significant increase in the percentage of clinical records achieving compliance to the minimum criteria from the baseline to six months post-intervention for both HIV patients on antiretroviral treatment and patients with non-communicable diseases (hypertension and diabetes.Conclusions: A multifaceted intervention using a SCR to supplement the educational outreach component (PC 101 training has demonstrated the potential for improving the quality of clinical records for patients with chronic diseases at primary care clinics in South Africa.

  13. Evaluation of patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics

    Directory of Open Access Journals (Sweden)

    Fermo JD

    2009-12-01

    Full Text Available Until recently, Prothrombin Time/International Normalized Ratio (PT/INR measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory. Objective: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT device versus venipuncture within ambulatory care clinics at our institution. Methods: All patients currently treated with warfarin therapy who were managed by clinical pharmacists for anticoagulation monitoring at the Medical University of South Carolina (MUSC Family Medicine Center and University Diagnostic Center, were enrolled. Patients were asked to complete a satisfaction survey regarding their anticoagulation monitoring. In addition, data related to emergency department (ED visits, hospitalizations and percent of time in the INR therapeutic range for 6 months pre- and post-implementation of POCT device was collected. This information was obtained through an electronic patient information database, Oacis. Results: A total of 145 patients were included in the data collection from the two clinics. The majority (41% of these patients were taking warfarin for atrial fibrillation. Satisfaction surveys were completed by 86 (59 % of patients. The surveys revealed that POCT device was preferred over venipuncture in 95% of patients. Reasons for the preference included more face-to-face interaction, less wait time, less pain, less blood needed, and quicker results. Of the 145 patients who were included in the objective data analysis, no significant differences were found in the number of hospitalizations, ED visits, or percent of time in the INR therapeutic range pre- and post- implementation of POCT device

  14. Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda

    OpenAIRE

    Babigumira, Joseph B; Sethi, Ajay K.; Smyth, Kathleen A.; Singer, Mendel E.

    2009-01-01

    Background: Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. Objective: To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Methods: Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical ...

  15. Chromosome analysis and sorting

    Czech Academy of Sciences Publication Activity Database

    Doležel, Jaroslav; Kubaláková, Marie; Suchánková, Pavla; Kovářová, Pavlína; Bartoš, Jan; Šimková, Hana

    Weinheim : Wiley-VCH, 2007 - (Doležel, J.; Greilhuber, J.; Suda, J.), s. 373-403 ISBN 978-3-527-31487-4 R&D Projects: GA ČR GA521/04/0607; GA ČR GP521/05/P257; GA ČR GD521/05/H013; GA MŠk(CZ) LC06004 Grant ostatní: Mendelova zemědělská a lesnická univerzita v Brně / Agronomická fakulta(CZ) ME 844 Institutional research plan: CEZ:AV0Z5038910 Source of funding: V - iné verejné zdroje ; V - iné verejné zdroje ; V - iné verejné zdroje ; V - iné verejné zdroje ; V - iné verejné zdroje Keywords : Plant flow cytometry * chromosome sorting * flow cytogenetics Subject RIV: EB - Genetics ; Molecular Biology http://books. google .com/books?id=3cwakORieqUC&pg=PA373&lpg=PA373&dq=Chromosome+analysis+and+sorting&source=web&ots=8IyvJlBQyq&sig=_NlXyQQgBCwpj1pTC9YITvvVZqU

  16. Good clinical practice guidelines for care home residents with diabetes: an executive summary.

    Science.gov (United States)

    Sinclair, A J

    2011-07-01

    A Task and Finish Group of Diabetes UK was convened over 14 months to undertake a systematic review of the original 1999 British Diabetic Association guidance on care home diabetes, incorporate new research findings and produce a set of recommendations that are evidenced-based, practical and implementable within UK care home settings. The anticipation of Diabetes UK is that these guidelines will represent a national policy of good clinical practice for diabetes care within care homes. This executive summary demonstrates how the full guidelines should provide a framework of assessment of the quality of diabetes care within care homes, for use by regulatory bodies who have responsibility for this provision of diabetes care. This document is primarily based on recommendations for adults living within British care home environments and its focus, by virtue of the nature and characteristics of residents, is on older adults. Improvements in diabetes care within residential and nursing homes are likely to follow a sustained commitment by health and social care professionals to ensure that the well-being of residents with diabetes is paramount, that high-quality policies of diabetes care are implemented and monitored and effective diabetes education is a mandatory and integral part of care home staff training. PMID:21672001

  17. Care delivery value chains for ophthalmic clinics in Switzerland

    OpenAIRE

    Bühlmann Samuel

    2009-01-01

    Perceived patient value is often not aligned with the emerging expenses for health care services. In other words, the costs are often supposed as rising faster than the actual value for the patients. This fact is causing major concerns to governments, health plans, and individuals. Attempts to solve the problem have habitually been on the operational effectiveness side: increasing patient volume, minimizing costs, rationing, or closing hospitals, usually resulting in a zero-sum game. Only few...

  18. Cultural Competence in Elderly Care within the Clinical Practice Setting

    OpenAIRE

    Dhadda, Sukdeep

    2014-01-01

    i Abstract  Aims: This study sought to assess the knowledge, skills, attitudes and practice of nurses towards the issue of culture, in order to assess their level of cultural competence (CC) and its impact upon healthcare provision within the speciality of elderly care.  Background: The UK continues to be an increasingly diverse and ageing population; hence, it is important that healthcare professionals become aware of the needs of older ethnic minority patients. CC is one approach...

  19. Outcome research in palliative care: could it represent a new dimension of clinical research or clinical practice?

    Science.gov (United States)

    Tassinari, Davide; Maltoni, Marco; Sartori, Sergio; Fantini, Manuela; Poggi, Barbara; Ravaioli, Alberto

    2005-03-01

    Outcome research is a new dimension of clinical research, and all fields of clinical medicine are involved in this kind of analysis. Overall survival and quality of life are the main outcomes identified in clinical oncology. The former must be the main outcome whenever possible; the latter has to be the main outcome when an improvement of overall survival cannot be expected. It follows that quality of life is the main outcome of palliative care, in which the patient instead of the disease represents the target of the clinical approach. In our critical paper, we review the meaning of clinical outcomes in palliative care, classifying the outcomes as main and surrogate outcomes, and the results of the trials as indexes of activity and efficacy of a treatment. We also review the main randomized clinical trials on the treatment of cancer cachexia, trying to define the role of the treatments in cachexia-related symptom control and quality of life improvement. Strictly related to outcome analysis is the dimension of pharmacoeconomic evaluation. The models of the different designs of pharmacoeconomic analysis are revisited in an attempt to conjugate the pharmacoeconomic evaluation with the particular dimension of palliative care. PMID:15580363

  20. Serving transgender people: clinical care considerations and service delivery models in transgender health.

    Science.gov (United States)

    Wylie, Kevan; Knudson, Gail; Khan, Sharful Islam; Bonierbale, Mireille; Watanyusakul, Suporn; Baral, Stefan

    2016-07-23

    The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in transgender health, although the best evidence supports introducing modules on transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in transgender health-care decisions, effective models of health service provision, and available surgical interventions for transgender people. PMID:27323926

  1. American Society of Clinical Oncology policy statement: opportunities in the patient protection and affordable care act to reduce cancer care disparities.

    Science.gov (United States)

    Moy, Beverly; Polite, Blase N; Halpern, Michael T; Stranne, Steven K; Winer, Eric P; Wollins, Dana S; Newman, Lisa A

    2011-10-01

    Patients in specific vulnerable population groups suffer disproportionately from cancer. The elimination of cancer disparities is critically important for lessening the burden of cancer. The Patient Protection and Affordable Care Act provides both opportunities and challenges for addressing cancer care disparities and access to care. The American Society of Clinical Oncology (ASCO) advocates for policies that ensure access to cancer care for the underserved. Such policies include insurance reform and the reduction of economic barriers to quality health care. Building on ASCO's prior statement on disparities in cancer care (2009), this article summarizes elements of the health care law that are relevant to cancer disparities and provides recommendations for addressing major provisions in the law. It outlines specific strategies to address insurance reform, access to care, quality of care, prevention and wellness, research on health care disparities, and diversity in the health care workforce. ASCO is committed to leading efforts toward the improvement of cancer care among the most vulnerable patients. PMID:21810680

  2. A cross-national comparison of the quality of clinical care using vignettes.

    Science.gov (United States)

    Peabody, John W; Liu, Anli

    2007-09-01

    In studies comparing clinical practice to evidence-based standards, researchers have found that quality of care is inconsistently provided to different segments of the population in both developing and developed countries. To test the hypothesis that quality of care varies widely within different countries, we conducted a prospectively designed evaluation of quality for three common clinical conditions: diarrhoea, tuberculosis and prenatal care. Five countries participated in the study: China, the Philippines, Mexico, El Salvador and India. Within each country, physicians were randomly selected from tertiary care hospitals, district level hospitals, and public and private outpatient clinics. A total of 488 previously validated case vignettes were administered to 300 participating physicians. Vignettes were scored according to evidence and expert based quality criteria. We used a random effects model to estimate the associations between quality scores by case, physician characteristics, study site, and country. We found that average quality of care was low (61.0%), but there exists a wide variation in overall quality (30-93%). While there was little difference in average quality scores between countries (60.2 to 62.6%), variation within countries was broad. The wide variation was consistent across facility type, medical condition and domain of care. We also found that younger, female, tertiary care and specialist physicians performed better than their counterparts. We conclude that some physicians provide exceptional care even in the setting of limited resources. Furthermore, poor quality can be addressed by health policy planners by directing remediation toward the lowest performers. PMID:17660225

  3. Role Model Ambulatory Care Clinical Training Site in a Community-Based Pharmacy.

    Science.gov (United States)

    Magarian, Edward O.; And Others

    1993-01-01

    An interdisciplinary project provided ambulatory care clinical training for pharmacy and nursing students in community-based pharmacies, promoting early detection and medical follow-up of common health problems within the community. Students learned new clinical skills in patient health assessment, new diagnostic technologies, patient education…

  4. Integrated Clinical Geriatric Pharmacy Clerkship in Long Term, Acute and Ambulatory Care.

    Science.gov (United States)

    Polo, Isabel; And Others

    1994-01-01

    A clinical geriatric pharmacy clerkship containing three separate practice areas (long-term, acute, and ambulatory care) is described. The program follows the medical education clerkship protocol, with a clinical pharmacy specialist, pharmacy practice resident, and student. Participation in medical rounds, interdisciplinary conferences, and…

  5. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    Science.gov (United States)

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  6. Clinical intuition in mental health care: A discussion and focus groups

    NARCIS (Netherlands)

    Witteman, C.L.M.; Spaanjaars, N.L.; Aarts, A.A.

    2012-01-01

    Clinical intuition in mental health care has been written off as a mysterious kind of ability to ‘see through’ clients, something that clinicians who favour evidence-based practice should have nothing to do with. We propose another understanding of clinical intuition. Similar to other types of profe

  7. Clinical Curriculum Reform and Advanced Care Training at the New England College of Optometry.

    Science.gov (United States)

    Wilson, Roger

    1998-01-01

    Discusses how the New England College of Optometry has expanded clinical education so graduates are equipped to handle new and advanced clinical and patient-care responsibilities and meet the changing standards of professional entry-level competency. The reform process, third- and fourth-year curriculum components, rotations, and plans for…

  8. Balancing Patient Care and Student Education: Learning to Deliver Bad News in an Optometry Teaching Clinic

    Science.gov (United States)

    Spafford, Marlee M.; Schryer, Catherine F.; Creutz, Stefan

    2009-01-01

    Learning to counsel patients in a teaching clinic or hospital occurs in the presence of the competing agendas of patient care and student education. We wondered about the challenges that these tensions create for clinical novices learning to deliver bad news to patients. In this preliminary study, we audio-taped and transcribed the interviews of…

  9. Adherence to Measuring What Matters Measures Using Point-of-Care Data Collection Across Diverse Clinical Settings

    OpenAIRE

    Kamal, AH; Bull, J; Ritchie, CS; Kutner, JS; Hanson, LC; Friedman, F; Jr, TDH; Grp, AAHPMRCW

    2016-01-01

    Measuring What Matters (MWM) for palliative care has prioritized data collection efforts for evaluating quality in clinical practice. How these measures can be implemented across diverse clinical settings using point-of-care data collection on quality is unknown.To evaluate the implementation of MWM measures by exploring documentation of quality measure adherence across six diverse clinical settings inherent to palliative care practice.We deployed a point-of-care quality data collection syste...

  10. A Pharmacist-Led Point-of-Care INR Clinic: Optimizing Care in a Family Health Team Setting.

    Science.gov (United States)

    Rossiter, Jennifer; Soor, Gursharan; Telner, Deanna; Aliarzadeh, Babak; Lake, Jennifer

    2013-01-01

    Purpose. Monitoring patients' international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodtesting at lab and pharmacist follow up of INR by phone) from February 2008 to April 2008 were compared with charts of patients attending a weekly POC INR clinic from February 2010 to April 2010. Time in therapeutic range (TTR) was measured for both groups. Results. 119 patient charts were reviewed and 114 had TTR calculated. After excluding patients with planned inconsistent Coumadin use (20), such as initiating Coumadin treatment or stopping for a surgical procedure, the mean TTR increased from 64.41% to 77.09% with the implementation of the POC clinic. This was a statistically significant difference of 12.68% (CI: 1.18, 24.18; P = 0.03). Conclusion. A pharmacist-led POC-INR clinic improves control of anticoagulation therapy in patients receiving warfarin and should be considered for implementation in other family medicine settings. PMID:24455250

  11. Implementation of a drug therapy monitoring clinic in a primary-care setting.

    Science.gov (United States)

    Yanchick, J K

    2000-12-15

    The development and implementation of a drug therapy monitoring clinic in the primary-care clinics of a military hospital are described. To improve patient care and decrease costs associated with treating chronic diseases, in August 1995 the pharmacy department established a drug therapy monitoring clinic. The clinic was responsible for initiating and monitoring treatment plans for patients with chronic diseases, implementing clinical guidelines, providing educational programs, collecting and analyzing outcome data, and handling requests for medication extensions. Treatment followed existing national standards and Department of Defense guidelines modified for the institution. The clinic began with one clinical pharmacy specialist, and within a year it added another clinical pharmacist and a technician. The clinic first obtained patients via consultations from providers in primary care; this was soon extended to all departments. In addition, the pharmacist was available to see walk-in patients needing medication extensions. Later, referrals came for inpatients and patients seen in the emergency room for asthma or diabetes mellitus, as well as for inpatients receiving oral anticoagulation therapy. For fiscal year 1999, the clinic saw 104 (+/- 44.3) patients per month seeking medication extensions. It also handled 24,873 clinical interventions that year, resulting in projected annual savings of $1,085,560. Chart review indicated that compliance with national standards improved dramatically for patients with diabetes mellitus or asthma followed by pharmacists compared with physician monitoring during the same period and before the clinic began. The wait time for reviewing laboratory results and for patients receiving anticoagulation therapy was eliminated, and doses were changed immediately, if needed. A comprehensive pharmacist-managed drug therapy monitoring clinic for outpatients with chronic diseases can result in positive patient outcomes and more cost

  12. [Clinical consensus statement on the care of the child with a tracheostomy].

    Science.gov (United States)

    Urrestarazu, Paula; Varón, Juan; Rodríguez, Aldana; Ton, Valeria; Vila, Fernando; Cipriani, Silvina; Moncada, Karina; Antonioli, Cintia P; Timoni, María A; Altina, Martha E; Nociti, Yamila B; Silva, Mariana L; Del Valle Rodríguez, Liliana; Rivas, Esteban; Boailchuk, Ivanna; Nieto, Mary E; Botto, Hugo A

    2016-02-01

    The care of the child with a tracheostomy deserves special attention because of the potential devastating airway compromise and because of the need of competent care by caregivers and professionals. The recommendations on tracheostomy care published are few and approaches are inconsistent among different institutions. This clinical consensus statement aims to improve care for children with tracheostomies. A literature search was conducted, reviewed and revised by this group of experts, who concurred with these statements, based on the best evidence available and taking into account the local context. PMID:26914079

  13. Self-care practices developed by pregnant women in a prenatal outpatient clinic

    Directory of Open Access Journals (Sweden)

    Sueli Riul da Silva

    2014-12-01

    Full Text Available The objective of this descriptive, cross-sectional, quantitative study was to examine self-care practices developed by pregnant women in a prenatal outpatient clinic. Ninety-nine pregnant women participated. The survey was conducted in a public outpatient clinic in Minas Gerais. A questionnaire was administered. The responses were analyzed using descriptive statistics. The results indicated greater self-care in relation to consumption of toxic substances (alcohol and drugs, hygiene, rest and nutrition. Others, such as physical exercise, wearing sunscreen and breast care were not deemed as priorities by the participants. Most reported receiving self-care guidance from health professionals, especially physicians and nurses. Defining the nature of the theme could contribute to the reorganization of health services, in order to provide better strategies for delivering quality care to pregnant women, especially the development of educational practices. doi: 10.5216/ree.v16i4.21779.

  14. Volunteering for Clinical Trials Can Help Improve Health Care for Everyone | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Clinical Trials Volunteering for Clinical Trials Can Help Improve Health Care for Everyone Past ... healthy people to help," says Melanie Modlin about clinical trials. "We have a role to play in helping ...

  15. Multi-professional audit supports clinical governance in projecting and implementing a new stroke care area

    Directory of Open Access Journals (Sweden)

    Marco Masina

    2013-03-01

    Full Text Available Patients with acute stroke have better outcomes in terms of survival or regaining independence if they receive organized inpatient care in a specific setting (Stroke Unit, SU where a coordinated multidisciplinary team can ensure the best level of care. The clinical governance of an SU requires a systematic monitoring of diagnostic, clinical and therapeutic processes through a structured audit. The entire project and set up of a new SU in Bentivoglio, Italy, were based on a model that focused on multidisciplinary teamwork and clinical governance. An audit based on the Benjamin audit cycle followed every step of the set up of the new SU. Markers from national and international guidelines and from the Italian Regional Audit, together with a specific database were used. The audit showed a high level of care and a significant improvement in the majority of clinical, diagnostic and therapeutic parameters. Only a few markers (i.e. waiting times for ultrasound tomography and prescription of oral anticoagulation therapy required specific projects in order to improve the results. Our experience confirmed that a structured audit can support clinical governance of an SU by monitoring clinical processes and quality of care. Such an audit involves the whole professional team and shows the effects of any single actions. It also helps integration and co-operation among staff. Furthermore, a structured audit is a useful instrument for professional accountability for both qualitative and quantitative aspects of care.

  16. PROPOSAL OF A CLINICAL CARE PATHWAY FOR THE MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING

    Directory of Open Access Journals (Sweden)

    Matheus Cavalcante FRANCO

    2015-12-01

    Full Text Available Background - Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. Objective - The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. Methods - It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. Results - The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. Conclusion - The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

  17. Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care

    Directory of Open Access Journals (Sweden)

    Thomas Y. Avery

    2014-01-01

    Full Text Available For the diagnosis of systemic autoimmune rheumatic diseases (SARD, patients are screened for anti-nuclear antibodies (ANA. ANA, as assessed by indirect immunofluorescence (IIF, have a poor specificity. This hampers interpretation of positive results in clinical settings with low pretest probability of SARD. We hypothesized that the utility of positive ANA IIF results increases from primary to tertiary care. We retrospectively determined ANA, anti-ENA, and anti-dsDNA antibody prevalence in patient cohorts from primary (n=1453, secondary (n=1621, and tertiary (n=1168 care settings. Results reveal that from primary care to tertiary care, ANA prevalence increases (6.2, 10.8, and 16.0%, resp.. Moreover, in primary care low titres (70% versus 51% and 52% in secondary and tertiary care, resp. are more frequent and anti-ENA/dsDNA reactivities are less prevalent (21% versus 39% in secondary care. Typically, in tertiary care the prevalence of anti-ENA/dsDNA reactivities (21% is lower than expected. From this descriptive study we conclude that positive ANA IIF results are more prone to false interpretation in clinical settings with low pretest probabilities for SARD, as in primary care. Whether alternative approaches, that is, immunoadsorption of anti-DFS70 antibodies or implementation of anti-ENA screen assays, perform better, needs to be determined.

  18. Screening for Harsh Punishment in a Pediatric Primary Care Clinic

    Science.gov (United States)

    Feigelman, Susan; Dubowitz, Howard; Lane, Wendy; Prescott, Leslie; Meyer, Walter; Tracy, J. Kathleen; Kim, Jeongeun

    2009-01-01

    Objectives: To determine: (1) the prevalence of harsh punishment among parents in a pediatric clinic, and (2) the sensitivity, specificity, predictive values, and stability of a brief screening measure. Methods: A subset of families involved in a study of child maltreatment prevention were recruited for this study. Two items in a parent screening…

  19. Gender Differences in Sorting

    DEFF Research Database (Denmark)

    Merlino, Luca Paolo; Parrotta, Pierpaolo; Pozzoli, Dario

    and causing the most productive female workers to seek better jobs in more female-friendly firms in which they can pursue small career advancements. Nonetheless, gender differences in promotion persist and are found to be similar in all firms when we focus on large career advancements. These results......In this paper, we investigate the sorting of workers in firms to understand gender gaps in labor market outcomes. Using Danish employer-employee matched data, we fiend strong evidence of glass ceilings in certain firms, especially after motherhood, preventing women from climbing the career ladder...... provide evidence of the sticky floor hypothesis, which, together with the costs associated with changing employer, generates persistent gender gaps....

  20. Teleoperated robotic sorting system

    Science.gov (United States)

    Roos, Charles E.; Sommer, Edward J.; Parrish, Robert H.; Russell, James R.

    2000-01-01

    A method and apparatus are disclosed for classifying materials utilizing a computerized touch sensitive screen or other computerized pointing device for operator identification and electronic marking of spatial coordinates of materials to be extracted. An operator positioned at a computerized touch sensitive screen views electronic images of the mixture of materials to be sorted as they are conveyed past a sensor array which transmits sequences of images of the mixture either directly or through a computer to the touch sensitive display screen. The operator manually "touches" objects displayed on the screen to be extracted from the mixture thereby registering the spatial coordinates of the objects within the computer. The computer then tracks the registered objects as they are conveyed and directs automated devices including mechanical means such as air jets, robotic arms, or other mechanical diverters to extract the registered objects.

  1. Clinical care of adult Turner syndrome--new aspects

    DEFF Research Database (Denmark)

    Trolle, Christian; Mortensen, Kristian Havmand; Hjerrild, Britta E;

    2012-01-01

    TS female enters adulthood it is less clear who should be the primary care giver. Morbidity and mortality is increased, especially due to the risk of dissection of the aorta and other cardiovascular diseases, as well as the risk of type 2 diabetes, hypertension, osteoporosis, thyroid disease and...... treatment for increasing height, are becoming well founded. Osteoporosis, diabetes, both type 1 and 2, hypothyroidism, obesity and a host of other endocrine diseases and conditions are seen more frequently in TS. Prevention, intervention and proper treatment is only just being recognized. Hypertension is...

  2. Experience of clinical pharmaceutical care carried out in pediatric respiratory department

    Institute of Scientific and Technical Information of China (English)

    DU Xiao-ming; JIAN Ling-yan; ZHAO Li-mei

    2008-01-01

    Objective To discuss the role of clinical pharmacists in providing pharmaceutical care in pediatric respiratory department. Methods Supply pharmaceutical information, participate in clinical rounds, provide the rationalization proposal, help doctors to formulate correctly dose regimen, enhance medication efficiency; establish medicine record for the patient, record the drugs which were used, provide pharmaceutical care for the patient such as disease propaganda, medicine-use education, medicine consultation and so on. Results Promote rational administration, enhance the security of medical practice, the clinical pharmacists' work obtains the doctors' approval; improve the medication compliance, reduce patients' economy and spiritual burden, and obtain the patients' trust. Conclusions The pharmaeeutical care carried out in pediatric respiratory department can help reduce the incidence of medication errors, cut down the medication cost, shorten the time of patients to be hospitalized, raise the medication efficieney, and promote the doctor-patient relationship harmoniously. In a word the clinical pharmacists are indispensable.

  3. Implementing and sustaining transformational change in health care: lessons learnt about clinical process redesign.

    Science.gov (United States)

    McGrath, Katherine M; Bennett, Denise M; Ben-Tovim, David I; Boyages, Steven C; Lyons, Nigel J; O'Connell, Tony J

    2008-03-17

    *Clinical process redesign has enabled significant improvements in the delivery of health care services in emergency departments and elective surgery programs in New South Wales and at Flinders Medical Centre in South Australia, with tangible benefits for patients and staff. *The principles used in clinical process redesign are not new; they have been applied in other industries with significant gains for many years, but have only recently been introduced into health care systems. *Through experience with clinical process redesign, we have learnt much about the factors critical to the success of implementing and sustaining this process in the health care setting. *The key elements for success are leadership by senior executives, clinical leadership, team-based problem solving, a focus on the patient journey, access to data, ambitious targets, strong performance management, and a process for maintaining improvement. PMID:18341474

  4. Integrating HIV care and treatment into primary healthcare: Are clinics equipped?

    Directory of Open Access Journals (Sweden)

    Talitha Crowley

    2014-01-01

    Full Text Available Background: The demand for HIV care and treatment services is increasing rapidly and strategies to sustain long-term care should be employed. The decentralisation and integration of HIV care and treatment services into primary healthcare (PHC is vitally important in order to ensure optimal access to life-saving antiretroviral therapy and ongoing chronic care. Conversely, the PHC system is fraught with the current burden of disease. Setting: The study was conducted in PHC clinics in the uMgungundlovu district, Kwa-Zulu Natal.Aim: The objectives of the study were to assess whether PHC clinics were equipped to deliver integrated HIV services and to evaluate the availability of resources as well as support systems for HIV care and treatment in PHC clinics.Methods: A quantitative, cross-sectional descriptive study was undertaken in 20 randomly-selected, eligible clinics in the uMgungundlovu district, KwaZulu-Natal, South Africa. An evaluation instrument was completed through observations and review of the clinic data records. Criteria were based on the World Health Organization’s guide to indicators for antiretroviral programmes as well as South African HIV standards for PHC facilities.Results: None of the clinics were equipped adequately. Clinics with a higher patient load had poorer scores, whilst clinics providing antiretroviral therapy were better equipped in terms of human resources and infrastructure.Conclusion: HIV services are an essential part of primary healthcare and clinics need to be equipped adequately in order to render this service. It is unlikely that the over-burdened health system would be able to cope with an increased number of patients on antiretroviral therapy in the long term, whilst maintaining quality of services, without support being given to PHC clinics.

  5. Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

    Directory of Open Access Journals (Sweden)

    Kocarnik Beverly Mielke

    2012-11-01

    Full Text Available Abstract Background Although oral hypoglycemic agents (OHAs are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence. Methods This retrospective cohort study analyzed 280,603 diabetes patients in 196 primary care clinics within the Veterans Affairs healthcare system. Pharmacists presence, number of pharmacist full-time equivalents (FTEs, and the degree to which pharmacy services are perceived as a bottleneck in each clinic were obtained from the 2007 VA Clinical Practice Organizational Survey—Primary Care Director Module. Patient-level adherence to OHAs using medication possession ratios (MPRs were constructed using refill data from administrative pharmacy databases after adjusting for patient characteristics. Clinic-level OHA adherence was measured as the proportion of patients with MPR >= 80%. We analyzed associations between pharmacy measures and clinic-level adherence using linear regression. Results We found no significant association between pharmacist presence and clinic-level OHA adherence. However, adherence was lower in clinics where pharmacy services were perceived as a bottleneck. Conclusions Pharmacist presence, regardless of the amount of FTE, was not associated with OHA medication adherence in primary care clinics. The exact role of pharmacists in clinics needs closer examination in order to determine how to most effectively use these resources to improve patient-centered outcomes including medication adherence.

  6. Clinical accompaniment: the critical care nursing students’ experiences in a private hospital

    OpenAIRE

    N. Tsele; Marie Muller

    2000-01-01

    The quality of clinical accompaniment of the student enrolled for the post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General) is an important dimension of the educational/learning programme. The clinical accompanist/mentor is responsible for ensuring the student’s compliance with the clinical outcomes of the programme in accordance with the requirements laid down by the Nursing Education Institution and the South African Nursing Council. The purpose of this...

  7. Traditional Chinese Medicine in Cancer Care: A Review of Controlled Clinical Studies Published in Chinese

    OpenAIRE

    Li, Xun; Yang, Guoyan; Li, Xinxue; Zhang, Yan; Yang, Jingli; Chang, Jiu; Sun, Xiaoxuan; Zhou, Xiaoyun; Guo, Yu; Xu, Yue; Liu, Jianping; Bensoussan, Alan

    2013-01-01

    Background Traditional Chinese medicine (TCM) has been widely applied for cancer care in China. There have been a large number of controlled clinical studies published in Chinese literature, yet no systematic searching and analysis has been done. This study summarizes the current evidence of controlled clinical studies of TCM for cancer. Methods We searched all the controlled clinical studies of TCM therapies for all kinds of cancers published in Chinese in four main Chinese electronic databa...

  8. PSYCHIATRIC CLINICAL PLACEMENT UPON NURSING STUDENTS PERCEIVED KNOWLEDGE IN CARING FOR MENTALLY ILL

    OpenAIRE

    Herry Prasetyo

    2012-01-01

    Background: The implementation of a psychiatric clinical placement has been an integral component in Indonesia Nursing Academies. Purpose: The research was to investigate how nursing students’ perceived knowledge in caring for mentally ill patients as a result of their psychiatric clinical placement. Method: A descriptive survey design commonly called non-experimental design was used in this research. Students, who had completed two weeks in a psychiatric clinical placement as a component of ...

  9. An approach to measure compliance to clinical guidelines in psychiatric care

    OpenAIRE

    Brommels Mats; Wistedt Anna; Forsner Tord; Forsell Yvonne

    2008-01-01

    Abstract Background The aim of this study was to measure six months compliance to Swedish clinical guidelines in psychiatric care after an active supported implementation process, using structured measures derived from the guidelines. Methods In this observational study four psychiatric clinics each participated in active implementation of the clinical guidelines for the assessment and treatment of depression and guidelines for assessment and treatment of patients with suicidal behaviours dev...

  10. Dying in two acute hospitals: would usual care meet Australian national clinical standards?

    Science.gov (United States)

    Clark, Katherine; Byfieldt, Naomi; Green, Malcolm; Saul, Peter; Lack, Jill; Philips, Jane L

    2014-05-01

    The Australian Commission for Quality and Safety in Health Care (ACQSHC) has articulated 10 clinical standards with the aim of improving the consistency of quality healthcare delivery. Currently, the majority of Australians die in acute hospitals. But despite this, no agreed standard of care exists to define the minimum standard of care that people should accept in the final hours to days of life. As a result, there is limited capacity to conduct audits that focus on the gap between current care and recommended care. There is, however, accumulating evidence in the end of life literature to define which aspects of care are likely to be considered most important to those people facing imminent death. These themes offer standards against which to conduct audits. This is very apt given the national recommendation that healthcare should be delivered in the context of considering people's wishes while always treating people with dignity and respect. PMID:24589365

  11. The effect of nursing management development program on clinical competency in coronary care unit

    Directory of Open Access Journals (Sweden)

    Ali Akbar Vaezi

    2011-03-01

    Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.

  12. A CLINICAL STUDY OF VAULT PROLAPSE IN TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Chandrashekar

    2016-01-01

    Full Text Available Objective of the study was to assess clinical parameters of patients with vault prolapse and its results of surgery. A prospective study of 11 patients with vault prolapse seen from October 2009 to July 2011 with 2 years of follow-up. Clinical parameter like age, parity, symptoms, POP-Q staging, type of previous hysterectomy and interval of onset of symptoms for prolapsed. All are presented with complaints of mass per vagina, next with difficulty in voiding urine. Majority of them are followed by vaginal hysterectomy then abdominal hysterectomy. 9 out of 11 were undergone sacrospinous ligament fixation and 2 are abdominal sacrocolpopexy done. The post-operative complications were fever in one patient and urinary tract infection in other patient. No recurrence of prolapsed noted up to 2 years of follow-up. Sacrospinous colpopexy is simple and efficacious procedure, which is indicated in vault prolapsed

  13. Assessing methods for measurement of clinical outcomes and quality of care in primary care practices

    Directory of Open Access Journals (Sweden)

    Green Michael E

    2012-07-01

    Full Text Available Abstract Purpose To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC practices. Methods This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30 were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Results Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Conclusions Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were

  14. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain

    Directory of Open Access Journals (Sweden)

    Keenum Michael

    2006-08-01

    Full Text Available Abstract Background Previous clinical trials have assessed the percentage of participants who utilized further health care after a period of conservative care for low back pain, however no chiropractic clinical trial has determined the total amount of care during this time and any differences based on assigned treatment group. The objective of this clinical trial follow-up was to assess if there was a difference in the total number of office visits for low back pain over one year after a four week clinical trial of either a form of physical therapy (Exercise Program or a form of chiropractic care (Flexion Distraction for chronic low back pain. Methods In this randomized clinical trial follow up study, 195 participants were followed for one year after a four-week period of either a form of chiropractic care (FD or a form of physical therapy (EP. Weekly structured telephone interview questions regarded visitation of various health care practitioners and the practice of self-care for low back pain. Results Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p Conclusion During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care.

  15. The ADHD Clinic: a collaborative model of care.

    Science.gov (United States)

    Campbell, Lisa; Allan, Carla

    2014-01-01

    Hyperactivity Disorder (ADHD) is a common chronic and often life-persistent neurobehavioral disorder. At Children's Mercy Hospital, collaboration between a developmental-behavioral pediatrician and a behavioral psychologist, both of whom specialize in ADHD, allows the use of both medication and behavior modification which are recommended by the American Academy of Pediatrics and which are equally effective as stand-alone therapies. Children who receive both of these treatment modalities also fare better than those who receive only medication in a number of areas. This article will describe our collaborative clinic model and will address considerations of parent preference about these therapeutic approaches. PMID:25011340

  16. Improving documentation of clinical care within a clinical information network – an essential initial step in efforts to understand and improve care in kenyan hospitals

    OpenAIRE

    English, MC; Tuti, T; Paton, C.; Malla, L; Clinical Information Network

    2016-01-01

    In many low income countries health information systems are poorly equipped to provide detailed information on hospital care and outcomes. Information is thus rarely used to support practice improvement. We describe efforts to tackle this challenge and to foster learning concerning collection and use of information. This could improve hospital services in Kenya. We are developing a Clinical Information Network, a collaboration spanning 14 hospitals, policy makers and researchers with the g...

  17. Leveraging HIV platforms to work toward comprehensive primary care in rural Malawi: the Integrated Chronic Care Clinic.

    Science.gov (United States)

    Wroe, Emily B; Kalanga, Noel; Mailosi, Bright; Mwalwanda, Stanley; Kachimanga, Chiyembekezo; Nyangulu, Kondwani; Dunbar, Elizabeth; Kerr, Lila; Nazimera, Lawrence; Dullie, Luckson

    2015-12-01

    This case study describes an integrated chronic care clinic that utilizes a robust HIV program as a platform for NCD screening and treatment. A unique model, the integrated chronic care clinic provides longitudinal care for patients with an array of chronic diseases including HIV and common NCDs, allowing for a single visit for all of a patient's conditions. Set in Malawi's remote Neno District, this clinic structure aims to (1) increase access to care for NCD patients, (2) maximize efficiency given the severe human resource shortages, and (3) replicate strong HIV outcomes for patients with other chronic conditions. The goal is to increase the number of health facilities in Neno capable of fully delivering Malawi's Essential Health Package, the set of cost-effective interventions endorsed by Malawi MOH to reduce burden of disease and leading causes of death. While implementation is ongoing and processes are evolving, this model of healthcare delivery has already improved the accessibility of NCD care by allowing patients to have all of their chronic conditions treated on the same day at their nearest health facility, notably without additional investment of human and financial resources. Currently, 6781 patients on antiretroviral therapy and 721 patients with NCDs are benefitting, including 379 with hypertension, 187 with asthma, 144 with epilepsy, and 76 with diabetes. Among the NCD patient population, 15.1% are HIV-positive. Success hinged largely on several factors, including clear leadership and staff ownership of their specific duties, and a well-defined and uniform patient flow process. Furthermore, deliberate and regular conversations about challenges allowed for constant iteration and improvement of processes. Moving forward, several tasks remain. We are refining the data management process to further consolidate medical records, along with integrating our tracking processes for clients who miss appointments. Additionally, we are exploring opportunities for

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

    Science.gov (United States)

    Lordly, Daphne; Taper, Janette

    2008-01-01

    Traditionally, an emphasis has been placed on dietetic interns' attainment of entry-level clinical competence in acute care facilities. The perceived risks and benefits of acquiring entry-level clinical competence within long-term and acute care clinical environments were examined. The study included a purposive sample of recent graduates and dietitians (n=14) involved in an integrated internship program. Study subjects participated in in-depth individual interviews. Data were thematically analyzed with the support of data management software QSR N6. Perceived risks and benefits were associated with receiving clinical training exclusively in either environment; risks in one area surfaced as benefits in the other. Themes that emerged included philosophy of care, approach to practice, working environment, depth and breadth of experience, relationships (both client and professional), practice outcomes, employment opportunities, and attitude. Entry-level clinical competence is achievable in both acute and long-term care environments; however, attention must be paid to identified risks. Interns who consider gaining clinical competence exclusively in one area can reduce risks and better position themselves for employment in either practice area by incorporating an affiliation in the other area into their internship program. PMID:18334052

  19. Clinical events classification for using the EHR to provide better patient care.

    Science.gov (United States)

    Lugovkina, Tatyana; Richards, Bernard

    2010-01-01

    The Healthcare Record has been used in a "Before and After" situation to improve patient care. The main paradigm of the modern Health Care is changing towards pervasive person-centric care including prevention and home care. Medical compunetics is a very important applicative field for improving the interoperability and the quality of the healthcare information system, especially in the current climate with the empowerment patients. The success depends on the choice of the Clinical Events Classification for structuring the span of clinical information. For the purposes of universalizing medical electronic data-bases, it is very important to organize the data regarding Clinical Events in such manner that it would be possible to use this information-structure in different fields of Clinical Practice: e.g., for the creation of the diagnostic and drug-assistance protocols, for the evaluation of the quality of drug prescribing, and for communication with patients as well. For this purpose all Clinical Events were divided to 5 classes. This Paper will describe a "Before and After" situation consequent upon the introduction of the Clinical Events Classification and the introduction of Protocols for drug-prescribing. Use of the Protocol brought about a 50% reduction in mortality. PMID:20543351

  20. Information and research needs of acute-care clinical nurses.

    Science.gov (United States)

    Spath, M; Buttlar, L

    1996-01-01

    The majority of nurses surveyed used the library on a regular but limited basis to obtain information needed in caring for or making decisions about their patients. A minority indicated that the libraries in their own institutions totally met their information needs. In fact, only 4% depended on the library to stay abreast of new information and developments in the field. Many of the nurses had their own journal subscriptions, which could account in part for the limited use of libraries and the popularity of the professional journal as the key information source. This finding correlates with the research of Binger and Huntsman, who found that 95% of staff development educators relied on professional journal literature to keep up with current information in the field, and only 45% regularly monitored indexing-and-abstracting services. The present study also revealed that nurses seek information from colleagues more than from any other source, supporting the findings of Corcoran-Perry and Graves. Further research is necessary to clarify why nurses use libraries on a limited basis. It appears, as Bunyan and Lutz contend, that a more aggressive approach to marketing the library to nurses is needed. Further research should include an assessment of how the library can meet the information needs of nurses for both research and patient care. Options to be considered include offering library orientation sessions for new staff nurses, providing current-awareness services by circulating photocopied table-of-contents pages, sending out reviews of new monographs, inviting nurses to submit search requests on a topic, scheduling seminars and workshops that teach CD-ROM and online search strategies, and providing information about electronic databases covering topics related to nursing. Information on databases may be particularly important in light of the present study's finding that databases available in CD-ROM format are consulted very little. Nursing education programs should

  1. Resolving sorting mechanisms into exosomes

    NARCIS (Netherlands)

    Stoorvogel, Willem

    2015-01-01

    The complexity of mechanisms driving protein sorting into exosomes is only beginning to emerge. In a paper recently published in Cell Research, Roucourt et al. report that trimming of heparan sulfate side chains of syndecans by endosomal heparanase facilitates sorting into exosomes by the formation

  2. Evaluating a Clinical Decision Support Interface for End-of-Life Nurse Care

    Science.gov (United States)

    Febretti, Alessandro; Stifter, Janet; Keenan, Gail M; Lopez, Karen D; Johnson, Andrew; Wilkie, Diana J

    2016-01-01

    Clinical Decision Support Systems (CDSS) are tools that assist healthcare personnel in the decision-making process for patient care. Although CDSSs have been successfully deployed in the clinical setting to assist physicians, few CDSS have been targeted at professional nurses, the largest group of health providers. We present our experience in designing and testing a CDSS interface embedded within a nurse care planning and documentation tool. We developed four prototypes based on different CDSS feature designs, and tested them in simulated end-of-life patient handoff sessions with a group of 40 nurse clinicians. We show how our prototypes directed nurses towards an optimal care decision that was rarely performed in unassisted practice. We also discuss the effect of CDSS layout and interface navigation in a nurse’s acceptance of suggested actions. These findings provide insights into effective nursing CDSS design that are generalizable to care scenarios different than end-of-life.

  3. Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review.

    Science.gov (United States)

    Delaney, Lori J; Van Haren, Frank; Lopez, Violeta

    2015-01-01

    Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequently cited in both subjective and objective studies. As a result, interventions are targeted towards modifiable factors to ameliorate their impact. This paper reviews normal sleep physiology and the impact that sleep disturbance has on patient psychophysiological recovery, and the contribution that the clinical environment has on intensive care patients' sleep. PMID:25852963

  4. CLINICAL PROFILE OF CHILDHOOD POISONING IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Poornima

    2016-03-01

    Full Text Available BACKGROUND Accidents including poisoning are one of the leading causes of morbidity and mortality among children in the west. Poisoning, while never accounting for a large number of accidental deaths, have acquired prominence now because they have not decreased at the same rate as the infectious diseases. METHODS An observational study was done in Department of Paediatrics KIMS Bangalore to know the incidence and pattern of childhood poisoning, to know the morbidity and mortality resulting from childhood poisoning. 86 children aged between 0-18 years were admitted to the paediatric intensive care unit with history of poisoning during the 2-year period of the study (Nov 13-Nov 15 were included. Diagnosis of poisoning was made on the basis of history and examination findings, Relevant investigations were done and Profile of patients with poisoning, their symptoms, type of poisoning and outcome were analysed. RESULTS The average duration of stay in the hospital was 2.7 days. Poisoning was accidental in 80 (93% patients whereas suicidal intent was present in only 6 (7% patients. Total 5 (5.8% patients died of which 4 were due to insecticide and pesticide poisoning and one was due to kerosene poisoning. CONCLUSION In the present study the probable reason for higher incidence of poisoning by insecticides & pesticides could be the involvement of higher age group and more involvement of adolescent children.

  5. Governing the research-care divide in clinical biobanking: Dutch perspectives.

    Science.gov (United States)

    Boeckhout, Martin; Douglas, Conor M W

    2015-01-01

    Biobanking, the large-scale, systematic collection of data and tissue for open-ended research purposes, is on the rise, particularly in clinical research. The infrastructures for the systematic procurement, management and eventual use of human tissue and data are positioned between healthcare and research. However, the positioning of biobanking infrastructures and transfer of tissue and data between research and care is not an innocuous go-between. Instead, it involves changes in both domains and raises issues about how distinctions between research and care are drawn and policed. Based on an analysis of the emergence and development of clinical biobanking in the Netherlands, this article explores how processes of bio-objectification associated with biobanking arise, redefining the ways in which distinctions between research and clinical care are governed. PMID:26246123

  6. Developing a sustainable foot care clinic in a homeless shelter within an academic-community partnership.

    Science.gov (United States)

    Schoon, Patricia M; Champlin, Barbara E; Hunt, Roberta J

    2012-12-01

    Nursing faculty are confronted with the need to design community learning activities with vulnerable populations to prepare students for nursing practice. The creation of sustainable academic-community partnerships with agencies providing care to underserved populations meets this challenge. This article describes the development and implementation of a foot care clinic in a homeless shelter, created through a model of curricular integration, faculty engagement, and a long-term academic-community partnership. A transformative pedagogical approach based on service-learning was used to facilitate student understanding of social justice through activities that promote citizenship, develop advocacy skills, and increase knowledge and skills related to the role of the public health nurse in the community. The process of designing and developing a community clinical learning activity and the essential components for sustainability are discussed. Student outcomes are addressed. Recommendations for implementing a foot care clinic within an academic–community partnership are outlined. PMID:23362514

  7. Urgency in Pediatric Dentistry: Care Profile of the Integrated Pediatric Clinic of FOUFAL

    OpenAIRE

    Noelle Albuquerque AMORIM; Taciane Roberta Cardoso da SILVA; SANTOS Lucineide de Melo; Maria Dânia Holanda TENÓRIO; José Ivo Limeira dos REIS

    2007-01-01

    Objective: To analyze the profile of the urgency care provided atthe Integrated Pediatric Clinic of the School of Dentistry of theFederal University of Alagoas (FOUFAL).Method: 221 patient files were analyzed between April toNovember 2006 and the following data were analyzed by descriptivestatistics: patient identification, type of urgency, involved tooth(teeth), diagnosis and proposed treatment. Only complete files wereincluded.Results: Urgency care was most frequently sought by femalechildr...

  8. Natriuretic peptide vs. clinical information for diagnosis of left ventricular systolic dysfunction in primary care

    OpenAIRE

    Wachter Rolf; Pouwels Claudia; Kleta Sibylle; Wetzel Dirk; Kochen Michael M; Lüers Claus; Scherer Martin; Koschack Janka; Herrmann-Lingen Christoph; Pieske Burkert; Binder Lutz

    2008-01-01

    Abstract Background Screening of primary care patients at risk for left ventricular systolic dysfunction by a simple blood-test might reduce referral rates for echocardiography. Whether or not natriuretic peptide testing is a useful and cost-effective diagnostic instrument in primary care settings, however, is still a matter of debate. Methods N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, clinical information, and echocardiographic data of left ventricular systolic function wer...

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

    Directory of Open Access Journals (Sweden)

    L. V. Laktionova

    2014-07-01

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

  10. Development of a Clinical Protocol for Home Hospice Care for Koreans

    OpenAIRE

    Lee, Won-Hee; Lee, Chang-Geol

    2005-01-01

    As the Korean government's recognition of the importance of hospice service grows, the government has initiated a variety of hospice services in Korea. Each hospice organization has shown a significant difference in its health care delivery methods, constitution and care content. Developing a clinical protocol is essential for establishing standardized hospice services. A preliminary protocol was drawn up by examining the records of terminal patients (n=541) in a home hospice organization whi...

  11. Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

    OpenAIRE

    Kocarnik Beverly Mielke; Liu Chuan-Fen; Wong Edwin S; Perkins Mark; Maciejewski Matthew L; Yano Elizabeth M; Au David H; Piette John D; Bryson Chris L

    2012-01-01

    Abstract Background Although oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence. Methods This retrospective cohort s...

  12. Clinical Audit of Diabetes Care in the Bahrain Defence Forces Hospital

    OpenAIRE

    Al-Baharna, Marwa M.; Whitford, David L

    2013-01-01

    Objectives: Primary care audits in Bahrain have consistently revealed a failure to meet recognised standards of delivery of process and outcome measures to patients with diabetes. This study aimed to establish for the first time the quality of diabetes care in a Bahraini hospital setting. Methods: A retrospective clinical audit was conducted of a random sample of patients attending the Diabetes and Endocrine Center at the Bahrain Defence Forces Hospital over a 15-month period which ended in J...

  13. Interprofessional clinical training improves self-efficacy of health care students

    DEFF Research Database (Denmark)

    Nørgaard, Birgitte; Draborg, Eva; Vestergaard, Erik;

    2013-01-01

    ) and a comparison group (405 students). The intervention was provided by an interprofessional clinical study unit (ICS) and included students from nursing, medicine, physiotherapy, occupational therapy, laboratory technology and radiography. Self-efficacy data were collected through web-based questionnaires......Background: Interprofessional collaboration potentially enhances patient safety and satisfaction, and reduces tensions and conflicts among health care professionals. Such collaboration is challenging, however, because health care professionals lack sufficient knowledge of other professional roles...

  14. Identifying the barriers to conducting outcomes research in integrative health care clinic settings - a qualitative study

    OpenAIRE

    Findlay-Reece Barbara; Kania Ania; Mulkins Andrea; Verhoef Marja J; Mior Silvano

    2010-01-01

    Abstract Background Integrative health care (IHC) is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM) with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a...

  15. Care of burns in Scotland: 3-year data from the managed clinical network national registry

    OpenAIRE

    Gilhooly, Charlotte; Kinsella, John

    2014-01-01

    Introduction The Managed Clinical Network for Care of Burns in Scotland (COBIS) was launched in April 2007. Primary aims included establishing and maintaining a registry of complex burn injury in Scotland and setting mechanisms to regularly audit outcome of burn treatment against nationally agreed standards of care. On behalf of COBIS, we present 3-year incidence and mortality data of Scottish patients admitted with a complex burn injury in this abstract. Methods From January 2010 o...

  16. Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic

    OpenAIRE

    Dillon Carla; Twells Laurie; Bishop Lisa; Young Stephanie; Hawboldt John; O'Shea Patrick

    2011-01-01

    Abstract Background The beneficial outcomes of oral anticoagulation therapy are dependent upon achieving and maintaining an optimal INR therapeutic range. There is growing evidence that better outcomes are achieved when anticoagulation is managed by a pharmacist with expertise in anticoagulation management rather than usual care by family physicians. This study compared a pharmacist managed anticoagulation program (PC) to usual physician care (UC) in a family medicine clinic. Methods A retros...

  17. Use of dependency and prioritization tools by clinical nurse specialists in palliative care: an exploratory study.

    LENUS (Irish Health Repository)

    Bracken, Mairéad

    2011-12-01

    The principal aim was to assess the utility of three needs assessment\\/dependency tools for use in community-based palliative care services. Specific objectives were to assess a sample of patients receiving specialist palliative care community nursing using these tools, to assess the predictive ability of each tool, and to explore the utility of prioritizing and measuring patient dependency from a clinical nurse specialist (CNS) perspective.

  18. Knowledge of sexually transmitted infections among women attending primary health care clinics in Moshi, Tanzania.

    OpenAIRE

    2011-01-01

    Introduction Untreated STIs may have serious complications. Knowledge of STIs is important in order to prevent this, and to promote care seeking and treatment. Previous studies have found knowledge to be associated with sexual behavior and socioeconomical factors. The aim of our study was to describe the knowledge of STIs among women attending primary health care clinics in Moshi, Tanzania, to identify their sources of knowledge and evaluate if the level of knowledge is associated with soc...

  19. Breast cancer and depression: issues in clinical care

    Directory of Open Access Journals (Sweden)

    Thingbaijam B. Singh

    2012-11-01

    Full Text Available Many of breast-cancer patients experience distress and most of them experience depression which may lead to amplification of physical symptoms, increased functional impairment, and poor treatment adherence. We did a review on available literature from PubMed about prevalence, distress magnitudes, coping styles, and treatment methods of major depression in women with breast cancer from 1978 to 2010. Diagnosis and treatment of depressive episodes in women with breast cancer is challenging because of overlapping symptoms and co-morbid conditions. Major depression is often under-recognized and undertreated among breast cancer patients. This review highlighted the issues on identifying and managing depression in breast cancer patients in clinical settings. (Med J Indones. 2012;21:240-6Keywords: Breast cancer, coping, depression, distress

  20. Multidisciplinary Aortopathy Clinics Should Now Be the Standard of Care in Canada.

    Science.gov (United States)

    Bradley, Timothy J; Bowdin, Sarah C

    2016-01-01

    Thoracic aortic aneurysm is often undiagnosed and has a very poor prognosis when presented with acute aortic dissection. Early diagnosis, expert medical management, and elective aortic surgery are the cornerstones of improvement of long-term survival in thoracic aortic disease (TAD). International guidelines now recommend the acute and long-term management of patients with TAD to occur within multidisciplinary aortopathy clinics under the care of professionals with specific training and experience. Multidisciplinary "heart teams" are recognized to be more focused on patient-centric care, to facilitate faster clinical decision times with increased adherence to guideline-directed therapy, and to improve knowledge translation and physician and patient satisfaction. The range of differential diagnoses for TAD has expanded rapidly over the past decade. Diagnosis of an index case with a syndromic or nonsyndromic familial TAD allows for preventative care. Effective family screening can save lives by allowing for elective management of thoracic aortic aneurysm rather than emergent care of acute aortic complications. Expert cardiac imaging with access to the full range of required imaging modalities is central to all clinical management decisions. Medical and surgical management of TAD is now provided as personalized care according to patient- and disease-specific factors. Special considerations apply to pregnancy management for women with TAD. Multidisciplinary aortopathy clinics should now be the standard of care for the management of TAD in Canada and we should implement best practice guidelines. With the already established and emerging clinics, the stage is now set to build a Canadian Aortopathy Clinics Trials network. PMID:26621141

  1. Critical action research applied in clinical placement development in aged care facilities.

    Science.gov (United States)

    Xiao, Lily D; Kelton, Moira; Paterson, Jan

    2012-12-01

    The aim of this study was to develop quality clinical placements in residential aged care facilities for undergraduate nursing students undertaking their nursing practicum topics. The proportion of people aged over 65 years is expected to increase steadily from 13% in 2006 to 26% of the total population in Australia in 2051. However, when demand is increasing for a nursing workforce competent in the care of older people, studies have shown that nursing students generally lack interest in working with older people. The lack of exposure of nursing students to quality clinical placements is one of the key factors contributing to this situation. Critical action research built on a partnership between an Australian university and five aged care organisations was utilised. A theoretical framework informed by Habermas' communicative action theory was utilised to guide the action research. Multiple research activities were used to support collaborative critical reflection and inform actions throughout the action research. Clinical placements in eight residential aged care facilities were developed to support 179 nursing students across three year-levels to complete their practicum topics. Findings were presented in three categories described as structures developed to govern clinical placement, learning and teaching in residential aged care facilities. PMID:23134277

  2. A case study: the clinical application of quadrangular dialogue--a caring in nursing teaching model.

    Science.gov (United States)

    Sumner, Jane F

    2004-01-01

    Teaching caring in nursing is expected of nursing faculty, but the practical application is rarely explained. It has been regarded as the moral responsibility of faculty to teach in a caring way. This case study relates how one faculty applied the concepts to quadrangular dialogue a caring model of nursing education to the experience of baccalaureate student nurses in their first clinical rotation. The components of quadrangular dialogue will be described, and applied to a specific patient who was cared for by students in one semester. This model is developed from Habermas' (1995) Theory of Communicative Action and Moral Consciousness, Bishop and Scudder's (1990) Triadic Dialogue and a caring in nursing paradigm developed by this author. It explains how the patient, nursing student and nursing faculty are all first person in the interaction, while the illness is object. By acknowledging the humanness of participants, validation and fulfillment for each follow. PMID:16646898

  3. Establishing a community-based lung cancer multidisciplinary clinic as part of a large integrated health care system: aurora health care.

    Science.gov (United States)

    Bjegovich-Weidman, Marija; Haid, Max; Kumar, Santhosh; Huibregtse, Carol; McDonald, Jean; Krishnan, Santosh

    2010-11-01

    A community cancer clinic, through cooperation with its parent health care system, developed a lung cancer multidisciplinary clinic (MDC) to enhance patient care and prevent out-migration to competing health care systems. The local medical and radiation oncologists collaborated with a thoracic surgeon from the tertiary care hospital in establishing the lung MDC. All the participating physicians are employed by the health care system. A cancer care coordinator assured that all necessary tests were obtained and available to the physicians at least 1 day before the clinic. The multidisciplinary team also included a pulmonologist and met every third week. Other sub-specialists were involved as necessary. Final treatment recommendations using National Comprehensive Cancer Network guidelines were made for each patient at the MDC visit. This clinic, once established, resulted in significant improvements in the quality of care, patient satisfaction and retention of patients. Time from diagnosis to initiation of treatment was reduced to a mean of 18 days from a mean of 24 days. The community cancer clinic had an increase in lung cancer patient care by 28% and a 9.1% increase in gross revenue. The tertiary care hospital benefited by providing all patients with definitive surgery, including minimally invasive surgery. The tertiary hospital thoracic surgeon had a 75% increase in referrals from the lung MDC geographic area over the previous year. This collaboration in the development of MDCs demonstrates how patients, caregivers, and the health care system benefit from MDCs. PMID:21358947

  4. Patient Satisfaction with Health Care Services Provided at HIV Clinics at Amana and Muhimbili Hospitals in Dar es Salaam.

    OpenAIRE

    Kagashe, G A B; Rwebangila, F

    2011-01-01

    Since the establishment of free HIV/AIDS care and treatment services in Tanzania a lot of research has been done to assess how health care providers discharge their duties in these clinics. Little research however has been done regarding satisfaction of HIV patients with free health care services provided. To determine satisfaction of HIV patients with health care services provided at the HIV clinics and specifically, to determine patients' satisfaction with the general physical environment o...

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

    Science.gov (United States)

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

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective. PMID:26683238

  6. The human microbiome: opportunities and challenges for clinical care.

    Science.gov (United States)

    Rogers, G B

    2015-09-01

    There is a growing appreciation of the importance of the human microbiome to our normal physiology. This complex microbial ecosystem plays a range of roles, including influencing the development and function of our immune systems, providing essential nutrients, regulating metabolism and protecting us from opportunistic infections. Our increasing understanding of these processes is due, to a large extent, to the development of high-throughput sequencing technologies, providing for the first time a means by which complex microbial dynamics can be detailed. There is also a growing recognition that disruption of commensal microbiota, a phenomenon known as dysbiosis, is associated with several common disorders, including inflammatory bowel disease, type 2 diabetes and oncogenesis. Further, where innate immunity fails to protect us, the microbial communities that colonise the external surfaces of our bodies represent a ready source of infection. This review discusses the mechanisms that govern our interaction with our resident microbiota, both in health and disease, the technological advances that allow us to gain insight into these relationships, and the way in which our growing understanding can inform clinical practice. PMID:25443179

  7. What is next after transfer of care from hospital to home for stroke patients? Evaluation of a community stroke care service based in a primary care clinic

    Directory of Open Access Journals (Sweden)

    Aznida Firzah Abdul Aziz

    2013-01-01

    Full Text Available Context: Poststroke care in developing countries is inundated with poor concordance and scarce specialist stroke care providers. A primary care-driven health service is an option to ensure optimal care to poststroke patients residing at home in the community. Aims: We assessed outcomes of a pilot long-term stroke care clinic which combined secondary prevention and rehabilitation at community level. Settings and Design: A prospective observational study of stroke patients treated between 2008 and 2010 at a primary care teaching facility. Subjects and Methods: Analysis of patients was done at initial contact and at 1-year post treatment. Clinical outcomes included stroke risk factor(s control, depression according to Patient Health Questionnaire (PHQ9, and level of independence using Barthel Index (BI. Statistical Analysis Used: Differences in means between baseline and post treatment were compared using paired t-tests or Wilcoxon-signed rank test. Significance level was set at 0.05. Results: Ninety-one patients were analyzed. Their mean age was 62.9 [standard deviation (SD 10.9] years, mean stroke episodes were 1.30 (SD 0.5. The median interval between acute stroke and first contact with the clinic 4.0 (interquartile range 9.0 months. Mean systolic blood pressure decreased by 9.7 mmHg (t = 2.79, P = 0.007, while mean diastolic blood pressure remained unchanged at 80mmHg (z = 1.87, P = 0.06. Neurorehabilitation treatment was given to 84.6% of the patients. Median BI increased from 81 (range: 2−100 to 90.5 (range: 27−100 (Z = 2.34, P = 0.01. Median PHQ9 scores decreased from 4.0 (range: 0−22 to 3.0 (range: 0−19 though the change was not significant (Z= −0.744, P = 0.457. Conclusions: Primary care-driven long-term stroke care services yield favorable outcomes for blood pressure control and functional level.

  8. Public health clinic-based hepatitis C testing and linkage to care in Baltimore.

    Science.gov (United States)

    Falade-Nwulia, O; Mehta, S H; Lasola, J; Latkin, C; Niculescu, A; O'Connor, C; Chaulk, P; Ghanem, K; Page, K R; Sulkowski, M S; Thomas, D L

    2016-05-01

    Testing and linkage to care are important determinants of hepatitis C virus (HCV) treatment effectiveness. Public health clinics serve populations at high risk of HCV. We investigated their potential to serve as sites for HCV testing, initiation of and linkage to HCV care. Cross-sectional study of patients accessing sexually transmitted infection (STI) care at the Baltimore City Health Department (BCHD) STI clinics, from June 2013 through April 2014 was conducted. Logistic regression was used to assess factors associated with HCV infection and specialist linkage to care. Between 24 June 2013 and 15 April 2014, 2681 patients were screened for HCV infection. Overall, 189 (7%) were anti-HCV positive, of whom 185 (98%) received follow-up HCV RNA testing, with 155 (84%) testing RNA positive. Of 155 RNA-positive individuals, 138 (89%) returned to the STI clinic for HCV RNA results and initial HCV care including counselling regarding transmission and harm reduction in alcohol, and 132 (85%) were referred to a specialist for HCV care. With provision of patient navigation services, 81 (52%) attended an offsite HCV specialist appointment. Alcohol use and lack of insurance coverage were associated with lower rates of specialist linkage (OR 0.4 [95% CI 0.1-0.9] and OR 0.4 [95% CI 0.1-0.9], respectively). We identified a high prevalence of HCV infection in BCHD STI clinics. With availability of patient navigation services, a large proportion of HCV-infected patients linked to off-site specialist care. PMID:26840570

  9. Effective Strategies for Global Health Research, Training and Clinical Care: A Narrative Review

    OpenAIRE

    2014-01-01

    The purpose of this narrative review was to synthesize the evidence on effective strategies for global health research, training and clinical care in order to identify common structures that have been used to guide program development. A Medline search from 2001 to 2011 produced 951 articles, which were reviewed and categorized. Thirty articles met criteria to be included in this review. Eleven articles discussed recommendations for research, 8 discussed training and 11 discussed clinical car...

  10. Improving detection of familial hypercholesterolaemia in primary care using electronic audit and nurse-led clinics

    OpenAIRE

    Green, P.; Neely, D; Humphries, S.E.; Medway FH Audit Steering Committee; Saunders, T; Gray, V; Gordon, L; Payne, J.; Carter, S.; Neuwirth, C; Rees, A; Gallagher, H.

    2016-01-01

    Abstract Rationale, aims and objectives In the UK fewer than 15% of familial hypercholesterolemia (FH) cases are diagnosed, representing a major gap in coronary heart disease prevention. We wished to support primary care doctors within the Medway Clinical Commissioning Group (CCG) to implement NICE guidance (CG71) and consider the possibility of FH in adults who have raised total cholesterol concentrations, thereby improving the detection of people with FH. Methods Utilizing clinical decision...

  11. Identifying low-value clinical practices in critical care medicine: protocol for a scoping review

    OpenAIRE

    Niven, Daniel J; McCormick, T Jared; Straus, Sharon E; Hemmelgarn, Brenda R.; Jeffs, Lianne P.; Stelfox, Henry T

    2015-01-01

    Introduction Reducing unnecessary, low-value clinical practice (ie, de-adoption) is key to improving value for money in healthcare, especially among patients admitted to intensive care units (ICUs) where resource consumption exceeds other medical and surgical populations. Research suggests that low-value clinical practices are common in medicine, however systematically and objectively identifying them is a widely cited barrier to de-adoption. We will conduct a scoping review to identify low-v...

  12. Clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital

    OpenAIRE

    Qureshi, Fawad; Shafi, Azhar; Ali, Sheeraz; Siddiqui, Neelam

    2016-01-01

    Objective: To determine the clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital. Methods: This was a cross-sectional study conducted on 200 patients undergoing first line chemotherapy with minimum of two cycles at inpatient department and chemotherapy bay of Shaukat Khanum Memorial Cancer Hospital and Research Centre Pakistan. Anticipatory nausea and vomiting develops before administration of chemotherapy. Clinical signs and symp...

  13. Analysis of X-Ray Film Quality in Primary Health Care Clinics in Riyadh

    OpenAIRE

    Mohammad Omar Alsubael

    2009-01-01

    The relationship between image quality and processing conditions was assessed in a survey of 26 primary health care clinics in Riyadh City. Each clinic is equipped with a basic X-ray room and a darkroom that has a small table-top automatic processor. Rooms were evaluated for the quality of safe light, light leakage, storage of films and chemicals and processor temperature setting. A relationship was obtained between the quality of these parameters and the analysis of characteristic curves (H ...

  14. Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses

    OpenAIRE

    Cho, Ok Min; Kim, Hwasoon; Lee, Young Whee; Cho, Insook

    2016-01-01

    Objectives The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. Methods Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. On...

  15. The Technical Quality of Delivered Care for People with Inflammatory Bowel Disease in Tabriz Gastroenterology Clinics

    OpenAIRE

    Jafar Sadegh Tabrizi; Mohammad Hossein Somi; Sima Asghari; Mohammad Asghari Jafarabadi; Farid Gharibi; Saeideh Alidoost

    2015-01-01

    Background: The Inflammatory Bowel Disease (IBD) is considered as one of the chronic diseasesrequiring complicated treatment. This study aimed to assess technical quality of providing care for patients with IBD. Methods: This cross-sectional study was conducted on 94 people with IBD using interviews and simple random sampling methods in Gastroenterology, Endoscopy and clinic of Imam Reza Hospital and Golgasht Clinic in Tabriz in 2012. The data collection tool was a researcher-desi...

  16. Dependence and caring in clinical communication: The relevance of attachment and other theories

    OpenAIRE

    Salmon, Peter; Young, Bridget

    2009-01-01

    Objective Clinical relationships are usually asymmetric, being defined by patients’ dependence and practitioners’ care. Our aims are to: (i) identify literature that can contribute to theory for researching and teaching clinical communication from this perspective; (ii) highlight where theoretical development is needed; and (iii) test the utility of the emerging theory by identifying whether it leads to implications for educational practice. Methods Selective and critical review of research c...

  17. Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Jade Bilardi

    Full Text Available Few data are available on how women manage recurring bacterial vaginosis (BV and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV.A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews.The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching.In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.

  18. A clinical approach to the nutritional care process in protein-energy wasting hemodialysis patients

    OpenAIRE

    Mar Ruperto; Sánchez-Muniz, Francisco J; Guillermina Barril

    2014-01-01

    Introduction: Malnutrition/wasting/cachexia are complex-disease conditions that frequently remain undiagnosed and/or untreated in up to 75% of prevalent hemodialysis (HD) patients. The nutrition care process (NCP) based on assessment, diagnosis, intervention and monitoring of nutritional status is a systematic method that nutrition professionals use to make decisions in clinical practice. Objective: This review examines from a clinical-nutritional practice point of view: a) nutritional status...

  19. Enhancement of clinical teaching for undergraduate students in primary health care facilities / Reginah Masakona

    OpenAIRE

    Masakona, Reginah

    2014-01-01

    The study comprises an investigation of the quality of the clinical teaching environment of undergraduate students in the accredited Primary health care ( PHC) facilities used by a provincial nursing college in Limpopo. The researcher, who is employed full time in one of the accredited PHC facilities to which undergraduate students are admitted for clinical practice, became aware of the tension between the undergraduate students and professional nurses working in the PHC facility during th...

  20. Hemophilia and von Willebrand's disease: 1. Diagnosis, comprehensive care and assessment. Association of Hemophilia Clinic Directors of Canada.

    OpenAIRE

    1995-01-01

    OBJECTIVE: To present current strategies for the assessment and comprehensive care of patients with hemophilia and von Willebrand's disease. OPTIONS: Hospital care, home care, single-provider care and multidisciplinary care. OUTCOMES: Morbidity and quality of life associated with bleeding and treatment. EVIDENCE: Relevant clinical studies and reports published from 1974 to 1994 were examined. A search was conducted of own reprint files, MEDLINE, citations in the articles reviewed and referenc...

  1. Integrating substance abuse care with community diabetes care: implications for research and clinical practice

    OpenAIRE

    Ghitza UE; Wu LT; Tai B

    2013-01-01

    Udi E Ghitza,1 Li-Tzy Wu,2 Betty Tai11Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, 2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USAAbstract: Cigarette smoking and alcohol use are prevalent among individuals with diabetes in the US, but little is known about screening and treatment for substance use disorders in the d...

  2. Surgical Precision in Clinical Documentation Connects Patient Safety, Quality of Care, and Reimbursement.

    Science.gov (United States)

    Kittinger, Benjamin J; Matejicka, Anthony; Mahabir, Raman C

    2016-01-01

    Emphasis on quality of care has become a major focus for healthcare providers and institutions. The Centers for Medicare and Medicaid Services has multiple quality-of-care performance programs and initiatives aimed at providing transparency to the public, which provide the ability to directly compare services provided by hospitals and individual physicians. These quality-of-care programs highlight the transition to pay for performance, rewarding physicians and hospitals for high quality of care. To improve the use of pay for performance and analyze quality-of-care outcome measures, the Division of Plastic Surgery at Scott & White Memorial Hospital participated in an inpatient clinical documentation accuracy project (CDAP). Performance and improvement on metrics such as case mix index, severity of illness, risk of mortality, and geometric mean length of stay were assessed after implementation. After implementation of the CDAP, the division of plastic surgery showed increases in case mix index, calculated severity of illness, and calculated risk of mortality and a decrease in length of stay. For academic plastic surgeons, quality of care demands precise documentation of each patient. The CDAP provides one avenue to hone clinical documentation and performance on quality measures. PMID:26903784

  3. Impact of Pharmaceutical Home Care on Compliances and Clinical Outcomes of Hypertensive Patients

    Directory of Open Access Journals (Sweden)

    Luh P. F Larasanty

    2015-09-01

    Full Text Available In the Indonesian health universal coverage system the hypertensive patients that grouped into the refer back patient treatment category, is one target of pharmaceutical home care. The aim of this study was to carried out the impact of pharmaceutical home care on patient compliances and clinical outcomes of hypertension without compeling indication out-patient on Wangaya General Hospital in the municipality of Denpasar Bali. Design research is an experimental study with one group pre-post test design. The thirteen patients who met the inclusion criteria will be given pharmaceutical home care services for 16 visits over three months period. The complianced levels were scored and statistical analyzed using linear regression and wilcoxon test. The pharmaceutical home care visit could increase the patients adherence to antihypertensive drug administration, increasing diet compliance, and adherence of physical exercise from good adherence to excellent adherence (p value=0,001, Pharmaceutical home care visit could increase patient compliance to restrictions of smoking and alcohol consumption from good adherence to very good adherence. The decreasing of the patient’s systolic blood pressure correlated to the pharmacist home visit (p value=0,000. The pharmaceutical home care has influenced on health behavior of hypertensive patients and the patients concordance to take their medication and introduced better clinical outcome.

  4. Conducting radiogenomic research – Do not forget careful consideration of the clinical data

    International Nuclear Information System (INIS)

    The field of radiogenomics has evolved substantially over the last few years. Cooperative research groups have been established and high throughput genotyping has become increasingly feasible and affordable. Nevertheless, a number of clinical and dosimetric issues need to be carefully considered in order to fully exploit these new possibilities.

  5. First-Year Residents' Caring, Medical Knowledge, and Clinical Judgment in Relation to Laboratory Utilization.

    Science.gov (United States)

    Yarnold, Paul R.; And Others

    1994-01-01

    A study of 36 first-year Northwestern University (Illinois) medical residents found that students' medical knowledge was a predictor of increased laboratory test use, that clinical judgment was a predictor of decreased laboratory use, and that level of caring was statistically unrelated to amount of laboratory use. (Author/MSE)

  6. Rehabilitation Therapists’ Clinical Questions in the Context of Evidence-based Patient Care : An Exploratory Study

    OpenAIRE

    Lorie A. Kloda; Bartlett, Joan C.

    2009-01-01

    In this qualitative study, rehabilitation therapists (occupational therapists, physiotherapists, and speech-language pathologists) working in stroke care will be asked about their clinical questions. The goals of the study are: to identify common characteristics of questions, to develop a typology of questions, and to uncover reasons why certain questions are pursued.

  7. Clinic, hospital try to fulfill vision of coordinated care with joint venture company.

    Science.gov (United States)

    2000-09-01

    Coordinated Care Services Inc., a joint venture of Carle Foundation and Carle Clinic Association in Urbana, IL, shares its initial successes and ongoing challenges after one year of operation. The biggest barrier to further improvements remains insufficient information management capability. PMID:11186347

  8. Factors Predicting Oncology Care Providers' Behavioral Intention to Adopt Clinical Decision Support Systems

    Science.gov (United States)

    Wolfenden, Andrew

    2012-01-01

    The purpose of this quantitative correlation study was to examine the predictors of user behavioral intention on the decision of oncology care providers to adopt or reject the clinical decision support system. The Unified Theory of Acceptance and Use of Technology (UTAUT) formed the foundation of the research model and survey instrument. The…

  9. Patient safety and quality of care: How may clinical simulation contribute?

    Directory of Open Access Journals (Sweden)

    Sanne Jensen

    2015-09-01

    Full Text Available The usability of health information technology (IT is increasingly recognized as critically important to the development of systems that ensure patient safety and quality of care. The substantial complexity of organizations, work practice and physical environments within the healthcare sector influences the development and application of health IT. When health IT is introduced in local clinical work practices, potential patient safety hazards and insufficient support of work practices need to be examined. Qualitative methods, such as clinical simulation, may be used to evaluate new technology in correlation with the clinical context and to study the interaction between users, technology and work practice. Compared with the “classic” methods, such as heuristic inspection and usability testing, clinical simulation takes the clinical context into account. Clinical simulation can be useful in many processes in the human-centred design cycle. In the requirement specification, clinical simulation can be useful to analyze user requirements and work practice as well to evaluate requirements. In the design of health IT, clinical simulation can be used to evaluate clinical information systems and serve as common ground to help to achieve a shared understanding between various communities of practice. In a public procurement process, a clinical simulation-based assessment can help give insight into different solutions and how they support work practice. Before organizational implementation, clinical simulation is a very suitable means, by which to assess an application in connection with work practice.

  10. Transformation of VHA health data into clinically useful information to provide quality veteran care

    Directory of Open Access Journals (Sweden)

    Seth Eisen, MD, MSc

    2010-10-01

    Full Text Available The Veterans Health Administration (VHA is the largest integrated healthcare system in the United States, caring for nearly 6 million of the nation's 23 million veterans annually. VHA provides a full range of primary care, mental health, medical specialty, surgical, and rehabilitative services to enrolled veterans. It employs over 240,000 staff (including 65,000 health professionals and manages over 1,400 sites of care (medical centers, outpatient clinics, nursing homes, and counseling centers. The critical need for a comprehensive electronic medical record system is demonstrated by the observation that approximately 130 million outpatient encounters, 600,000 hospitalizations, over 400 million laboratory tests and radiological procedures, and 170 million prescription fills are provided annually. In addition, nearly 1 billion clinically related free-text notes are recorded annually, representing a small fraction of the total electronic data collected over the past two decades.

  11. On Approximability of Block Sorting

    CERN Document Server

    Narayanaswamy, N S

    2011-01-01

    Block Sorting is a well studied problem, motivated by its applications in Optical Character Recognition (OCR), and Computational Biology. Block Sorting has been shown to be NP-Hard, and two separate polynomial time 2-approximation algorithms have been designed for the problem. But questions like whether a better approximation algorithm can be designed, and whether the problem is APX-Hard have been open for quite a while now. In this work we answer the latter question by proving Block Sorting to be Max-SNP-Hard (APX-Hard). The APX-Hardness result is based on a linear reduction of Max-3SAT to Block Sorting. We also provide a new lower bound for the problem via a new parametrized problem k-Block Merging.

  12. Medical errors in primary care clinics – a cross sectional study

    Directory of Open Access Journals (Sweden)

    Khoo Ee Ming

    2012-12-01

    Full Text Available Abstract Background Patient safety is vital in patient care. There is a lack of studies on medical errors in primary care settings. The aim of the study is to determine the extent of diagnostic inaccuracies and management errors in public funded primary care clinics. Methods This was a cross-sectional study conducted in twelve public funded primary care clinics in Malaysia. A total of 1753 medical records were randomly selected in 12 primary care clinics in 2007 and were reviewed by trained family physicians for diagnostic, management and documentation errors, potential errors causing serious harm and likelihood of preventability of such errors. Results The majority of patient encounters (81% were with medical assistants. Diagnostic errors were present in 3.6% (95% CI: 2.2, 5.0 of medical records and management errors in 53.2% (95% CI: 46.3, 60.2. For management errors, medication errors were present in 41.1% (95% CI: 35.8, 46.4 of records, investigation errors in 21.7% (95% CI: 16.5, 26.8 and decision making errors in 14.5% (95% CI: 10.8, 18.2. A total of 39.9% (95% CI: 33.1, 46.7 of these errors had the potential to cause serious harm. Problems of documentation including illegible handwriting were found in 98.0% (95% CI: 97.0, 99.1 of records. Nearly all errors (93.5% detected were considered preventable. Conclusions The occurrence of medical errors was high in primary care clinics particularly with documentation and medication errors. Nearly all were preventable. Remedial intervention addressing completeness of documentation and prescriptions are likely to yield reduction of errors.

  13. Respiratory Virus Detection and Clinical Diagnosis in Children Attending Day Care

    Science.gov (United States)

    Moe, Nina; Pedersen, Bård; Nordbø, Svein Arne; Skanke, Lars Høsøien; Krokstad, Sidsel; Smyrnaios, Anastasios; Døllner, Henrik

    2016-01-01

    Background Respiratory viruses often have been studied in children with respiratory tract infection (RTI), but less knowledge exists about viruses in asymptomatic children. We have studied the occurrence of a broad panel of respiratory viruses in apparently healthy children attending day care, taking into account the influence of possible confounding factors, such as age, clinical signs of respiratory tract infection (RTI), location (day-care section) and season. Methods We have studied 161 children in two day-care centers, each with separate sections for younger and older children, during four autumn and winter visits over a two-year period. A total of 355 clinical examinations were performed, and 343 nasopharyngeal samples (NPS) were analyzed by semi-quantitative, real-time, polymerase chain reaction (PCR) tests for 19 respiratory pathogens. Result Forty-three percent of all NPS were PCR-positive for ≥ 1 of 13 virus species, with high species variation during visits. Rhinovirus 26% (88/343 NPS), enterovirus 12% (40/343) and parechovirus 9% (30/343) were detected in every visit, and the rates varied in relation to age, day-care section and season. Ten other viruses were detected in ≤ 3% of the NPS. Generally, viruses occurred together in the NPS. In 24% (79/331) of the clinical examinations with available NPS, the children had clear signs of RTI, while in 41% (135/331) they had mild signs, and in 35% (117/331) the children had no signs of RTI. Moreover, viruses were found in 70% (55/79) of children with clear signs of RTI, in 41% (55/135) with mild signs and in 30% (35/117) without any signs of RTI (p < 0.001). Conclusions Positive PCR tests for respiratory viruses, particularly picornaviruses, were frequently detected in apparently healthy children attending day care. Virus detection rates were related to age, presence of clinical signs of RTI, location in day care and season. PMID:27433803

  14. The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

    OpenAIRE

    Ann M. Fugit, Pharm.D., BCPS; Sallie D. Mayer, Pharm.D., MBA, BCPS, CDE; Radha S. Vanmali, Pharm.D., BCACP

    2013-01-01

    Objective: Describe the role and integration of ambulatory care pharmacists in a Human Immunodeficiency Virus (HIV) clinic within a free and bilingual clinic with regards to types of interventions made during the patient-pharmacist visit. Design: Retrospective, single-centered, chart review. Setting: Free, bilingual clinic in Richmond, VA. Participants: Thirty-two adult patients with diagnosed HIV receiving care in the clinic between June 30, 2010 and January 26, 2011. Main Outcome Measure: T...

  15. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care.

    Science.gov (United States)

    Lyon, Jennifer A; Kuntz, Gretchen M; Edwards, Mary E; Butson, Linda C; Auten, Beth

    2015-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n = 21), interviews (n = 2), and an online survey (n = 167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly affective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians' perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics. PMID:26211792

  16. The Lived Experience and Training Needs of Librarians Serving at the Clinical Point-of-Care

    Science.gov (United States)

    Kuntz, Gretchen M.; Edwards, Mary E.; Butson, Linda C.; Auten, Beth

    2016-01-01

    This study examines the emotional experiences and perceptions of librarians embedded into clinical care teams and how those perceptions affect their training and preparation needs. Qualitative research methodologies were applied to textual data drawn from focus groups (n=21), interviews (n=2), and an online survey (n=167), supplemented by quantitative survey data. Phenomenological results show librarians experience strongly effective responses to clinical rounding. Important factors include personal confidence; relationships with team members, patients, and families; and the stressful environment. Analysis of librarians’ perceived educational needs indicates that training must address specialized subjects including medical knowledge, clinical culture, and institutional politics. PMID:26211792

  17. Clinical Care Pathways for Patients With Hepatitis C: Reducing Critical Barriers to Effective Treatment.

    Science.gov (United States)

    Howes, Nik; Lattimore, Sam; Irving, William Lucien; Thomson, Brian James

    2016-01-01

    Background.  Engagement of individuals infected with hepatitis C virus (HCV) with care pathways remains a major barrier to realizing the benefits of new and more effective antiviral therapies. After an exploratory study, we have undertaken an evidence-based redesign of care pathways for HCV, including the following: (1) reflex testing of anti-HCV-positive samples for HCV RNA; (2) annotation of laboratory results to recommend referral of actively infected patients to specialist clinics; (3) educational programs for primary care physicians and nurses; and (4) the establishment of needs-driven community clinics in substance misuse services. Methods.  In this study, we conducted a retrospective cohort study of progression through care pathways of individuals with a new diagnosis of HCV infection made between January 2010 and January 2012. We also analyzed patient flow through new care pathways and compared this with our baseline study of identical design. Results.  A total of 28 980 samples were tested for anti-HCV antibody during the study period and yielded 273 unique patients with a new diagnosis of HCV infection. Of these, 38% were tested in general practice, 21% were tested in substance misuse services, 23% were tested in secondary care, and 18% were tested in local prisons. Overall, 80% of patients were referred to specialist clinics, 70% attended for assessment, and 38% commenced treatment, in comparison to 49%, 27%, and 10%, respectively, in the baseline study. Referral rates from all testing sources improved. Conclusions.  This study provides timely evidence that progression through care pathways can be enhanced, and it demonstrates reduction of key barriers to eradication of HCV. PMID:26900576

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

    Directory of Open Access Journals (Sweden)

    Henrard Jean-Claude

    2009-04-01

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

  19. Quality of COPD care in hospital outpatient clinics in Denmark: The KOLIBRI study

    DEFF Research Database (Denmark)

    Lange, P.; Andersen, Klaus Kaae; Munch, E.;

    2009-01-01

    Background: We studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines. Methods: We performed two audits of the...... hospital records one year apart before and after the educational programme for the participating doctors and nurses. A total of 941 patient records were included in the first audit and 927 in the second. The indicators of quality of care comprised amongst others referral to pulmonary rehabilitation......, smoking cessation advice, nutritional advice, instruction in inhalation technique and assessment of BMI, smoking status, pack years, lung function parameters, dyspnoea oxygen saturation and comorbidities. Results. In general, the quality of care for COPD patients in Denmark was suboptimal and not in...

  20. Clinical Chemistry Laboratory Automation in the 21st Century - Amat Victoria curam (Victory loves careful preparation).

    Science.gov (United States)

    Armbruster, David A; Overcash, David R; Reyes, Jaime

    2014-08-01

    The era of automation arrived with the introduction of the AutoAnalyzer using continuous flow analysis and the Robot Chemist that automated the traditional manual analytical steps. Successive generations of stand-alone analysers increased analytical speed, offered the ability to test high volumes of patient specimens, and provided large assay menus. A dichotomy developed, with a group of analysers devoted to performing routine clinical chemistry tests and another group dedicated to performing immunoassays using a variety of methodologies. Development of integrated systems greatly improved the analytical phase of clinical laboratory testing and further automation was developed for pre-analytical procedures, such as sample identification, sorting, and centrifugation, and post-analytical procedures, such as specimen storage and archiving. All phases of testing were ultimately combined in total laboratory automation (TLA) through which all modules involved are physically linked by some kind of track system, moving samples through the process from beginning-to-end. A newer and very powerful, analytical methodology is liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS). LC-MS/MS has been automated but a future automation challenge will be to incorporate LC-MS/MS into TLA configurations. Another important facet of automation is informatics, including middleware, which interfaces the analyser software to a laboratory information systems (LIS) and/or hospital information systems (HIS). This software includes control of the overall operation of a TLA configuration and combines analytical results with patient demographic information to provide additional clinically useful information. This review describes automation relevant to clinical chemistry, but it must be recognised that automation applies to other specialties in the laboratory, e.g. haematology, urinalysis, microbiology. It is a given that automation will continue to evolve in the clinical laboratory

  1. Clinical accompaniment: the critical care nursing students’ experiences in a private hospital

    Directory of Open Access Journals (Sweden)

    N. Tsele

    2000-09-01

    Full Text Available The quality of clinical accompaniment of the student enrolled for the post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General is an important dimension of the educational/learning programme. The clinical accompanist/mentor is responsible for ensuring the student’s compliance with the clinical outcomes of the programme in accordance with the requirements laid down by the Nursing Education Institution and the South African Nursing Council. The purpose of this study was to explore and describe the experiences of the students enrolled for a post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General, in relation to the clinical accompaniment in a private hospital in Gauteng. An exploratory, descriptive and phenomenological research design was utilised and individual interviews were conducted with the ten students in the research hospital. A content analysis was conducted and the results revealed both positive and negative experiences by the students in the internal and external worlds. The recommendations include the formulation of standards for clinical accompaniment of students. the evaluation of the quality of clinical accompaniment of students and empowerment of the organisation, clinical accompanists/mentors and clinicians.

  2. Risk management and clinical governance for complex home-based health care.

    Science.gov (United States)

    Lewis, Mary; Noyes, Jane

    2007-07-01

    Healthcare professionals have an obligation to enable children with complex needs to lead 'ordinary lives' at home but the views of professionals and family members often diverge in relation to the management of risks. Nurses are increasingly taking on the clinical responsibility for children with complex needs within a multidisciplinary, multi-agency team, yet have little training or experience in adapting risk management and clinical governance frameworks to home-based settings. Risk management frameworks for home-based care for children with complex health and social care needs are introduced in this article. Best practice guidance and resources for adapting risk management frameworks are presented to meet this identified gap in knowledge and experience. Children, young people and their parents have increasing expectations relating to the type and quality of home-based support they receive. Developing and applying clinical governance and risk management frameworks are part of improving outcomes for children with complex needs and their families. PMID:17694890

  3. Implementation and evaluation of a clinical data management programme in a primary care centre.

    LENUS (Irish Health Repository)

    Sweeney, J

    2014-11-01

    Electronic health records (EHR) support clinical management, administration, quality assurance, research, and service planning. The aim of this study was to evaluate a clinical data management programme to improve consistency, completeness and accuracy of EHR information in a large primary care centre with 10 General Practitioners (GPs). A Clinical Data Manager was appointed to implement a Data Management Strategy which involved coding consultations using ICPC-2 coding, tailored support and ongoing individualised feedback to clinicians. Over an eighteen month period there were improvements in engagement with and level of coding. Prior to implementation (August 2011) 4 of the 10 GPs engaged in regular coding and 69% of their consultation notes were coded. After 12 months, all 10 GPs and 6 nurses were ICPC-2 coding their consultations and monthly coding levels had increased to 98%. This structured Data Management Strategy provides a feasible sustainable way to improve information management in primary care.

  4. Admission to intensive care can be reliably predicted using only clinical judgment

    DEFF Research Database (Denmark)

    Brabrand, M.

    2015-01-01

    Introduction Not all patients in need of critical care arrive in clinical distress and some deteriorate after arrival. Identifying these patients early in their clinical course could potentially improve outcome. The present study was performed with the aim of assessing whether nursing and physician...... staffwere able to identify patients in need of critical care using only clinical judgment and to compare this with the National Early Warning Score (NEWS). Methods This was a prospective cohort study of all adult patients with a first-time admission to a medical admission unit at a 450-bed regional teaching...... hospital over a 3-month period in 2010. All subspecialties of internal medicine are present as well as a level 2 ICU. Upon first contact with the patient after arrival, nursing staffand physicians were asked to report their estimation of the probability of ICU admission (0 to 100%). Survival status was...

  5. ESBLs producing Enterobacteriaceae in critical care areas – a clinical and cost analysis from a tertiary health care centre

    Directory of Open Access Journals (Sweden)

    Hena Rani

    2012-04-01

    Full Text Available Objective: ESBLs pose a major threat in clinical therapeutics. In the present study we have tried to do clinical analysis of one hundred ESBLs producing Enterobacteriaceae isolates from various clinical specimens from patients admitted in critical care areas. Methods: ESBLs detection was done by CLSI, DDS and Vitek methods. Clinical analysis of each patient was done by regularly visiting in CCA and reviewing patient’s status and medical records. Results: All of the 13 patients on foley’s catheter grew ESBLs positive isolates and amongst 10 non catheterized patients, 9 grew ESBLs negative isolates. Thirteen out of 14 patients on CVP/arterial line grew ESBLs positive isolates. Out of 24 patients who underwent surgery, 22 grew ESBLs positive isolate. Forty seven out of 68 patients who were on 3rd or 4th generation cephalosporins within last 1 month of giving the sample grew ESBLs positive isolates. Conclusion: We have found a statistically significant (p<0.0.05 relationship in between foley’s catheterization and production of ESBLs from urinary isolates. There was no statistically significant association in between CVP/arterial line and blood culture isolates. We did not find difference in mortality rates in between patients infected with ESBLs positive or negative isolates. The mortality in patients was associated with their primary illness or associated co-morbid conditions. We found that the detection of ESBLs is important for the de-escalation of therapy thereby saving net cost of treatment.

  6. Factors impacting on nurses' transference of theoretical knowledge of holistic care into clinical practice.

    Science.gov (United States)

    Henderson, Saras

    2002-12-01

    Since nurse education moved to universities, a reoccurring concern of health consumers, health administrators, and some practising nurses is that nurses are not able to transfer the theoretical knowledge of holistic care into practice. Much has been written about this concern usually under the heading of the theory-practice gap. A common reason that has been highlighted as the cause of this gap is that the theoretical knowledge that nurses learn in academia is predicated on concepts such as humanism and holistic caring. In contrast, the bureaucratic organisation where nurses provide care tends to be based on management concepts where cost containment and outcome measures are more acceptable. Hence nurses' learned values of holistic caring are pitted against the reality of the practice setting. So what is this practice reality? This paper attempts to provide an insider view of why the theoretical knowledge of holistic care may be difficult to enact in the clinical setting. In-depth taped interviews with nurses and participant observation were conducted in acute care hospitals in Western Australia. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings indicated that utilitarian nursing and role models had impacted on the transference of theoretical knowledge of holistic care into practice. The paper outlines some measures that nurses themselves can undertake to ensure the narrowing of the theory-practice gap in this area. PMID:19036306

  7. An approach to measure compliance to clinical guidelines in psychiatric care

    Directory of Open Access Journals (Sweden)

    Brommels Mats

    2008-07-01

    Full Text Available Abstract Background The aim of this study was to measure six months compliance to Swedish clinical guidelines in psychiatric care after an active supported implementation process, using structured measures derived from the guidelines. Methods In this observational study four psychiatric clinics each participated in active implementation of the clinical guidelines for the assessment and treatment of depression and guidelines for assessment and treatment of patients with suicidal behaviours developed by The Stockholm Medical Advisory Board for Psychiatry. The implementation programme included seminars, local implementation teams, regular feedback and academic visits. Additionally two clinics only received the guidelines and served as controls. Compliance to guidelines was measured using indicators, which operationalised requirements of preferred clinical practice. 725 patient records were included, 365 before the implementation and 360 six months after. Results Analyses of indicators registered showed that the actively implementing clinics significantly improved their compliance to the guidelines. The total score differed significantly between implementation clinics and control clinics for management of depression (mean scores 9.5 (1.3 versus 5.0 (1.5, p Conclusion Compliance to clinical guidelines measured by process indicators of required clinical practice was enhanced by an active implementation.

  8. The Emerging Microbe Project: Developing Clinical Care Plans Based on Pathogen Identification and Clinical Case Studies

    Directory of Open Access Journals (Sweden)

    Lauren A. O'Donnell

    2015-08-01

    Full Text Available For many students in the health sciences, including doctor of pharmacy (PharmD students, basic and clinical sciences often appear detached from each other. In the infectious disease field, PharmD students additionally struggle with mastering the diversity of microorganisms and the corresponding therapies. The objective of this study was to design an interdisciplinary project that integrates fundamental microbiology with clinical research and decision-making skills. The Emerging Microbe Project guided students through the identification of a microorganism via genetic sequence analysis. The unknown microbe provided the basis for a patient case that asked the student to design a therapeutic treatment strategy for an infected patient. Outside of lecture, students had two weeks to identify the pathogen using nucleotide sequences, compose a microbiology report on the pathogen, and recommend an appropriate therapeutic treatment plan for the corresponding clinical case. We hypothesized that the students would develop a better understanding of the interplay between basic microbiology and infectious disease clinical practice, and that they would gain confidence and skill in independently selecting appropriate antimicrobial therapies for a new disease state. The exercise was conducted with PharmD students in their second professional year of pharmacy school in a required infectious disease course. Here, we demonstrate that the Emerging Microbe Project significantly improved student learning through two assessment strategies (assignment grades and exam questions, and increased student confidence in clinical infectious disease practice. This exercise could be modified for other health sciences students or undergraduates depending upon the level of clinical focus required of the course.

  9. The Emerging Microbe Project: Developing Clinical Care Plans Based on Pathogen Identification and Clinical Case Studies.

    Science.gov (United States)

    O'Donnell, Lauren A; Perry, Michael W; Doup, Dane't R

    2015-12-01

    For many students in the health sciences, including doctor of pharmacy (PharmD) students, basic and clinical sciences often appear detached from each other. In the infectious disease field, PharmD students additionally struggle with mastering the diversity of microorganisms and the corresponding therapies. The objective of this study was to design an interdisciplinary project that integrates fundamental microbiology with clinical research and decision-making skills. The Emerging Microbe Project guided students through the identification of a microorganism via genetic sequence analysis. The unknown microbe provided the basis for a patient case that asked the student to design a therapeutic treatment strategy for an infected patient. Outside of lecture, students had two weeks to identify the pathogen using nucleotide sequences, compose a microbiology report on the pathogen, and recommend an appropriate therapeutic treatment plan for the corresponding clinical case. We hypothesized that the students would develop a better understanding of the interplay between basic microbiology and infectious disease clinical practice, and that they would gain confidence and skill in independently selecting appropriate antimicrobial therapies for a new disease state. The exercise was conducted with PharmD students in their second professional year of pharmacy school in a required infectious disease course. Here, we demonstrate that the Emerging Microbe Project significantly improved student learning through two assessment strategies (assignment grades and exam questions), and increased student confidence in clinical infectious disease practice. This exercise could be modified for other health sciences students or undergraduates depending upon the level of clinical focus required of the course. PMID:26753029

  10. Clinical status and philosophy of clinical care of radionuclide-treated beagles

    International Nuclear Information System (INIS)

    A manual for therapy of beagles is reviewed. The following protocol is outlined and described: antibiotic therapy, chemotherapy for neoplasms, hormone therapy, nutritional therapy, radiation therapy, steroid therapy, and miscellaneous treatments. The manual also includes sections on diagnosis and discussions of individual cases. Tables summarizing clinical cases seen during 1974 are presented

  11. The Role of Rural Health Clinics in Hospitalization Due to Ambulatory Care Sensitive Conditions: A Study in Nebraska

    Science.gov (United States)

    Zhang, Wanqing; Mueller, Keith J.; Chen, Li-Wu; Conway, Kevin

    2006-01-01

    Context: Hospitalization due to ambulatory care sensitive conditions (ACSCs) is often used as an indicator for measuring access to primary care. Rural health clinics (RHCs) provide basic primary care services for rural residents in health professional shortage areas (HPSAs). The relationship between RHCs and ACSCs is unclear. Purpose: The purpose…

  12. The Vermont Model for Rural HIV Care Delivery: Eleven Years of Outcome Data Comparing Urban and Rural Clinics

    Science.gov (United States)

    Grace, Christopher; Kutzko, Deborah; Alston, W. Kemper; Ramundo, Mary; Polish, Louis; Osler, Turner

    2010-01-01

    Context: Provision of human immunodeficiency virus (HIV) care in rural areas has encountered unique barriers. Purpose: To compare medical outcomes of care provided at 3 HIV specialty clinics in rural Vermont with that provided at an urban HIV specialty clinic. Methods: This was a retrospective cohort study. Findings: Over an 11-year period 363 new…

  13. Comprehensive clinical care for men who have sex with men: an integrated approach.

    Science.gov (United States)

    Mayer, Kenneth H; Bekker, Linda-Gail; Stall, Ron; Grulich, Andrew E; Colfax, Grant; Lama, Javier R

    2012-07-28

    Men who have sex with men (MSM) have unique health-care needs, not only because of biological factors such as an increased susceptibility to infection with HIV and sexually transmitted infections associated with their sexual behaviour, but also because of internalisation of societal stigma related to homosexuality and gender non-conformity, resulting in depression, anxiety, substance use, and other adverse outcomes. Successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive clinical care programmes for MSM that address these health disparities and root causes of maladaptive behaviour (eg, societal homophobia). Health-care providers need to become familiar with local outreach agencies, hotlines, and media that can connect MSM with positive role models and social opportunities. Research is needed to understand how many MSM lead resilient and productive lives in the face of discrimination to develop assets-based interventions that build on community support. Optimum clinical care for sexual and gender minorities is a fundamental human right. MSM deserve to be treated with respect, and health-care providers need to interact with them in ways that promote disclosure of actionable health information. PMID:22819653

  14. Initiation of antiretroviral therapy at rural primary health care clinics in KwaZulu Natal

    Directory of Open Access Journals (Sweden)

    Hilda Ganesen-Moothusamy

    2013-05-01

    Full Text Available South Africa bears the greatest burden of HIV infection globally with the most infected people living in KwaZulu-Natal (KZN. Decentralised medical care for HIV positive patients and antiretroviral therapy (ART delivery to primary health care facilities were proposed nationally to achieve adequate ART coverage for patients in need of treatment. This study described the HIV positive patients who accessed medical care and were initiated on ART at two existing government Primary Health Care (PHC clinics with no added donor support, in Ilembe, KZN. This was an observational descriptive study of ART initiation from 01 April 2008 to 30 April 2009. Data were collected from clinical records kept on site. HIV Testing and the pre-ART programmes which consisted of medical care prior to ART initiation are briefly described. Socio-economic, demographic and clinical characteristics of patients who were initiated on ART were sampled and described. A minority (2.95% of the study population tested for HIV of which 36.0%tested positive. Majority (60.0% of patients who joined the pre-ART programme care did not return. The ART sample consisted of 375 patients of whom 65.0%were women, 85.9%were unmarried, 61.6%were unemployed and 50.4%had a secondary level of education. Tuberculosis (TB prevalence and incidence at ART initiation were 22.1%and 14.7%respectively. The prevalence of Syphilis and Hepatitis B co-infections were 13.1%and 8.6 %respectively. Two thirds of female patients (66.4% received a Pap smear result of which the majority (62.3% were abnormal. Uptake for HIV testing followed by relevant CD4 testing was poor. High TB, Hepatitis B and Syphilis co-infection was noted amongst patients initiated on ART. Cervical cancer screening must be intensified. Although ART initiation with no added external resources was successful, record keeping was suboptimal.

  15. Clinical major option: a model for implementing critical care nursing into baccalaureate preparation.

    Science.gov (United States)

    Robertson, K A

    2000-01-01

    What was initiated as a directive from a provincial government in an attempt to increase the number of critical care nurses has evolved into an exciting educational opportunity for many nurses and student nurses in the year 2000. Between 1993 and 1997 there has been significant downsizing of acute care beds across Canada (Code Blue: Critical Care Nursing in Nova Scotia, 1998). At the same time patient acuity has increased, due to shorter hospital stays, and the number of nurses working full-time has decreased with the increased use of casual nurses. Several studies at both the provincial and national levels report current and future shortages of specialized nurses (emergency, critical care and perioperative). It is expected that this shortage will continue into the future, a shortage that is driven by technological advances, as well as an aging general and nursing population. Continued shortages of these acute care nurses will result in fierce competition for skilled nurses as well as aggressive recruitment and retention strategies (Code Blue: Critical Care Nursing in Nova Scotia, 1998). It is generally agreed within the nursing community that specialty nurses in critical care require a unique body of knowledge that is not acquired in a basic undergraduate nursing program (Fitzsimmons, Hadley, & Shively, 1999). This specialized knowledge can be gained informally through experience; however, it is largely developed in additional formal education programs. The purpose of this article is to outline a strategy for the delivery of specialty education at three educational levels in acute care nursing with three streams: emergency, critical care and perioperative nursing. This clinical major option is to be delivered in partnership among the Queen Elizabeth Hospital II, the Health Science Centre and Dalhousie University School of Nursing, Halifax, Nova Scotia, Canada. This model of offering specialty education in university preparation could be a template for preparing

  16. Foot care and footwear practices among patients attending a specialist diabetes clinic in Jamaica.

    Science.gov (United States)

    Gayle, Krystal A T; Tulloch Reid, Marshall K; Younger, Novie O; Francis, Damian K; McFarlane, Shelly R; Wright-Pascoe, Rosemarie A; Boyne, Michael S; Wilks, Rainford J; Ferguson, Trevor S

    2012-10-12

    This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI) Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care practices and types of footwear worn. Participants were a subset of a sex-stratified random sample of clinic attendees and were interviewed in 2010. Data analysis included frequency estimates of the various foot care practices and types of footwear worn. Participants had a mean age of 57.0±14.3 years and mean duration of diabetes of 17.0±10.3 years. Fifty-three percent of participants reported being taught how to care for their feet, while daily foot inspection was performed by approximately 60% of participants. Most participants (90%) reported daily use of moisturizing lotion on the feet but almost 50% used lotion between the toes. Approximately 85% of participants reported wearing shoes or slippers both indoors and outdoors but over 40% reported walking barefoot at some time. Thirteen percent wore special shoes for diabetes while over 80% wore shoes without socks at some time. Although much larger proportions reported wearing broad round toe shoes (82%) or leather shoes (64%), fairly high proportions reported wearing pointed toe shoes (39%), and 43% of women wore high heel shoes. In conclusion, approximately 60% of patients at the UHWI diabetic clinic engage in daily foot inspection and other recommended practices, but fairly high proportions reported foot care or footwear choices that should be avoided. PMID:24765484

  17. Foot care and footwear practices among patients attending a specialist diabetes clinic in Jamaica

    Directory of Open Access Journals (Sweden)

    Krystal A.T. Gayle

    2012-10-01

    Full Text Available This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care practices and types of footwear worn. Participants were a subset of a sex-stratified random sample of clinic attendees and were interviewed in 2010. Data analysis included frequency estimates of the various foot care practices and types of footwear worn. Participants had a mean age of 57.0±14.3 years and mean duration of diabetes of 17.0±10.3 years. Fifty-three percent of participants reported being taught how to care for their feet, while daily foot inspection was performed by approximately 60% of participants. Most participants (90% reported daily use of moisturizing lotion on the feet but almost 50% used lotion between the toes. In conclusion, approximately 85% of participants reported wearing shoes or slippers both indoors and outdoors but over 40% reported walking barefoot at some time. Thirteen percent wore special shoes for diabetes while over 80% wore shoes without socks at some time. Although much larger proportions reported wearing broad round toe shoes (82% or leather shoes (64%, fairly high proportions reported wearing pointed toe shoes (39%, and 43% of women wore high heel shoes. Approximately 60% of patients at the UHWI diabetic clinic engage in daily foot inspection and other recommended practices, but fairly high proportions reported foot care or footwear choices that should be avoided.

  18. Justification for conducting neurological clinical trials as part of patient care within private practice.

    Science.gov (United States)

    Beran, R G; Stepanova, D; Beran, M E

    2016-05-01

    The aim of this review was to assess the benefits and drawbacks of conducting neurological clinical trials and research in private practice for the patients, clinician, Practice Manager, sponsors/Clinical Research Organisations (CROs) and Clinical Trial Coordinator (CTC) to determine if this is justified for all involved. A combination of literature reviews, original research articles and books were selected from 2005 to 2015. Provided that the practice has sufficient number of active trials to prevent financial loss, support staff, adequate facilities and equipment and time, the benefits outweigh the drawbacks. Clinical trials provide patients with more thorough monitoring, re-imbursement of trial-related expenses and the opportunity to try an innovative treatment at no charge when other options have failed. For the clinician, clinical trials provide more information to ensure better care for their patients and improved treatment methods, technical experience and global recognition. Trials collect detailed and up-to-date information on the benefits and risks of drugs, improving society's confidence in clinical research and pharmaceuticals, allow trial sponsors to explore new scientific questions and accelerate innovation. For the CTC, industry-sponsored clinical trials allow potential entry for a career in clinical research giving CTCs the opportunity to become Clinical Research Associates (CRAs), Study Start-Up Managers or Drug Safety Associates. PMID:27040457

  19. Customer satisfaction survey with clinical laboratory and phlebotomy services at a tertiary care unit level.

    Science.gov (United States)

    Koh, Young Rae; Kim, Shine Young; Kim, In Suk; Chang, Chulhun L; Lee, Eun Yup; Son, Han Chul; Kim, Hyung Hoi

    2014-09-01

    We performed customer satisfaction surveys for physicians and nurses regarding clinical laboratory services, and for outpatients who used phlebotomy services at a tertiary care unit level to evaluate our clinical laboratory and phlebotomy services. Thus, we wish to share our experiences with the customer satisfaction survey for clinical laboratory and phlebotomy services. Board members of our laboratory designed a study procedure and study population, and developed two types of questionnaire. A satisfaction survey for clinical laboratory services was conducted with 370 physicians and 125 nurses by using an online or paper questionnaire. The satisfaction survey for phlebotomy services was performed with 347 outpatients who received phlebotomy services by using computer-aided interviews. Mean satisfaction scores of physicians and nurses was 58.1, while outpatients' satisfaction score was 70.5. We identified several dissatisfactions with our clinical laboratory and phlebotomy services. First, physicians and nurses were most dissatisfied with the specimen collection and delivery process. Second, physicians and nurses were dissatisfied with phlebotomy services. Third, molecular genetic and cytogenetic tests were found more expensive than other tests. This study is significant in that it describes the first reference survey that offers a survey procedure and questionnaire to assess customer satisfaction with clinical laboratory and phlebotomy services at a tertiary care unit level. PMID:25187892

  20. ALGORITHM FOR SORTING GROUPED DATA

    Science.gov (United States)

    Evans, J. D.

    1994-01-01

    It is often desirable to sort data sets in ascending or descending order. This becomes more difficult for grouped data, i.e., multiple sets of data, where each set of data involves several measurements or related elements. The sort becomes increasingly cumbersome when more than a few elements exist for each data set. In order to achieve an efficient sorting process, an algorithm has been devised in which the maximum most significant element is found, and then compared to each element in succession. The program was written to handle the daily temperature readings of the Voyager spacecraft, particularly those related to the special tracking requirements of Voyager 2. By reducing each data set to a single representative number, the sorting process becomes very easy. The first step in the process is to reduce the data set of width 'n' to a data set of width '1'. This is done by representing each data set by a polynomial of length 'n' based on the differences of the maximum and minimum elements. These single numbers are then sorted and converted back to obtain the original data sets. Required input data are the name of the data file to read and sort, and the starting and ending record numbers. The package includes a sample data file, containing 500 sets of data with 5 elements in each set. This program will perform a sort of the 500 data sets in 3 - 5 seconds on an IBM PC-AT with a hard disk; on a similarly equipped IBM PC-XT the time is under 10 seconds. This program is written in BASIC (specifically the Microsoft QuickBasic compiler) for interactive execution and has been implemented on the IBM PC computer series operating under PC-DOS with a central memory requirement of approximately 40K of 8 bit bytes. A hard disk is desirable for speed considerations, but is not required. This program was developed in 1986.

  1. Effective Clinical Practices in Managed Care Findings From Ten Case Studies

    OpenAIRE

    Suzanne Felt-Lisk; Kleinman, Lawrence C.

    2000-01-01

    Presents findings from a study designed to look at how some of the nation's high-performing HMOs have achieved their success. Notes that delivering high-quality care is a driving force for nearly all of the plans studied, as is a culture of respect for clinicians. For printed copies call The Commonwealth Fund at (888) 777-2744, ask for publication number 427. The plan-specific summary reports are also available in a volume titled "Effective Clinical Practices in Managed Care: Ten Case Studies...

  2. Clinical care of two patients with Ebola virus disease in the United States.

    Science.gov (United States)

    Lyon, G Marshall; Mehta, Aneesh K; Varkey, Jay B; Brantly, Kent; Plyler, Lance; McElroy, Anita K; Kraft, Colleen S; Towner, Jonathan S; Spiropoulou, Christina; Ströher, Ute; Uyeki, Timothy M; Ribner, Bruce S

    2014-12-18

    West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history. Two patients with EVD were transferred from Liberia to our hospital in the United States for ongoing care. Malaria had also been diagnosed in one patient, who was treated for it early in the course of EVD. The two patients had substantial intravascular volume depletion and marked electrolyte abnormalities. We undertook aggressive supportive measures of hydration (typically, 3 to 5 liters of intravenous fluids per day early in the course of care) and electrolyte correction. As the patients' condition improved clinically, there was a concomitant decline in the amount of virus detected in plasma. PMID:25390460

  3. Encouraging primary care research: evaluation of a one-year, doctoral clinical epidemiology research course

    Science.gov (United States)

    Liira, Helena; Koskela, Tuomas; Thulesius, Hans; Pitkälä, Kaisu

    2016-01-01

    Objective Research and PhDs are relatively rare in family medicine and primary care. To promote research, regular one-year research courses for primary care professionals with a focus on clinical epidemiology were started. This study explores the academic outcomes of the first four cohorts of research courses and surveys the participants’ perspectives on the research course. Design An electronic survey was sent to the research course participants. All peer-reviewed scientific papers published by these students were retrieved by literature searches in PubMed. Setting Primary care in Finland. Subjects A total of 46 research course participants who had finished the research courses between 2007 and 2012. Results Of the 46 participants 29 were physicians, eight nurses, three dentists, four physiotherapists, and two nutritionists. By the end of 2014, 28 of the 46 participants (61%) had published 79 papers indexed in PubMed and seven students (15%) had completed a PhD. The participants stated that the course taught them critical thinking, and provided basic research knowledge, inspiration, and fruitful networks for research. Conclusion A one-year, multi-professional, clinical epidemiology based research course appeared to be successful in encouraging primary care research as measured by research publications and networking. Activating teaching methods, encouraging focus on own research planning, and support from peers and tutors helped the participants to embark on research projects that resulted in PhDs for 15% of the participants. Key PointsClinical research and PhDs are rare in primary care in Finland, which has consequences for the development of the discipline and for the availability of clinical lecturers at the universities.A clinical epidemiology oriented, one-year research course increased the activity in primary care research. Focus on own research planning and learning the challenges of research with peers appeared to enhance the success of a doctoral

  4. Relationship of Clinical Nursing Competence to Nursing Occupational Experience in Hospice/Palliative Care Nurses in Japan

    OpenAIRE

    Kaori Tsutsumi; Keiko Sekido

    2015-01-01

    Aim: The purpose of this research is to examine the relationship between the clinical nursing competence and nursing occupational experience in hospice/palliative care nurses (HPN) in Japan. Methods: A mail survey using an anonymous self-administered questionnaire was conducted on clinical nursing competence regarding communication, care and prediction of worsening of symptoms with the authors’ previous research as a framework. The subjects were nurses working in hospice/palliative care units...

  5. The prevalence of body dysmorphic disorder and its clinical correlates in a VA primary care behavioral health clinic.

    Science.gov (United States)

    Kelly, Megan M; Zhang, Jinxin; Phillips, Katharine A

    2015-07-30

    We examined the prevalence of body dysmorphic disorder (BDD) in a Veterans Affairs (VA) primary care behavioral health clinic. Of 100 Veterans, 11% (95% CI = 6.3-18.6%) had current BDD and 12% (95% CI = 7.0-19.8%) had lifetime BDD. However, only 8.3% of these Veterans had been diagnosed with BDD. BDD was significantly associated with a substantially elevated rate of suicide attempts, major depression, and obsessive-compulsive disorder. This severe disorder appears to be underdiagnosed in VA settings. PMID:25935375

  6. Transitional care in clinical networks for young people with juvenile idiopathic arthritis: current situation and challenges.

    Science.gov (United States)

    Cruikshank, Mary; Foster, Helen E; Stewart, Jane; Davidson, Joyce E; Rapley, Tim

    2016-04-01

    Clinical networks for paediatric and adolescent rheumatology are evolving, and their effect and role in the transition process between paediatric and adult services are unknown. We therefore explored the experiences of those involved to try and understand this further. Health professionals, young people with juvenile idiopathic arthritis and their families were recruited via five national health service paediatric and adolescent rheumatology specialist centres and networks across the UK. Seventy participants took part in focus groups and one-to-one interviews. Data was analysed using coding, memoing and mapping techniques to identify features of transitional services across the sector. Variation and inequities in transitional care exist. Although transition services in networks are evolving, development has lagged behind other areas with network establishment focusing more on access to paediatric rheumatology multidisciplinary teams. Challenges include workforce shortfalls, differences in service priorities, standards and healthcare infrastructures, and managing the legacy of historic encounters. Providing equitable high-quality clinically effective services for transition across the UK has a long way to go. There is a call from within the sector for more protected time, staff and resources to develop transition roles and services, as well as streamlining of local referral pathways between paediatric and adult healthcare services. In addition, there is a need to support professionals in developing their understanding of transitional care in clinical networks, particularly around service design, organisational change and the interpersonal skills required for collaborative working. Key messages • Transitional care in clinical networks requires collaborative working and an effective interface with paediatric and adult rheumatology.• Professional centrism and historic encounters may affect collaborative relationships within clinical networks.• Education

  7. Medical Service Provision and Costs: Do Walk-In Clinics Differ from Other Primary Care Delivery Settings?

    OpenAIRE

    Darrel J. Weinkauf; Boris Kralj

    1998-01-01

    Reductions in health care funding by both the federal and provincial governments in recent years have focused attention on the cost-effectiveness of health care delivery, particularly on the delivery of primary care services. We use data extracted from the Ontario Health Insurance Plan (OHIP) claims database to assess differences between walk-in clinics and other primary care delivery settings in initial visit costs, follow-up visit costs, service duplication, and diagnoses treated. Our analy...

  8. Qualitative inquiry: a method for validating patient perceptions of palliative care while enrolled on a cancer clinical trial

    OpenAIRE

    Slota, Christina; Ulrich, Connie M.; Miller-Davis, Claiborne; Baker, Karen; Wallen, Gwenyth R.

    2014-01-01

    Background Palliative care is a vital component of patient-centered care. It has increasingly become central to the management and care of seriously ill patients by integrating physical, psychosocial, and spiritual supportive services. Through qualitative inquiry, this paper examines cancer patients’ perceptions of the process and outcomes of the pain and palliative care consultative services they received while enrolled in a clinical trial. Methods A qualitative analysis of open-ended questi...

  9. 'Healthy gums do matter': A case study of clinical leadership within primary dental care.

    Science.gov (United States)

    Moore, D; Saleem, S; Hawthorn, E; Pealing, R; Ashley, M; Bridgman, C

    2015-09-25

    The Health and Social Care Act 2012 heralded wide reaching reforms intended to place clinicians at the heart of the health service. For NHS general dental practice, the conduits for this clinical leadership are the NHS England local professional networks. In Greater Manchester, the local professional network has developed and piloted a clinician led quality improvement project: 'Healthy Gums DO Matter, a Practitioner's Toolkit'. Used as a case study, the project highlighted the following facilitators to clinical leadership in dentistry: supportive environment; mentoring and transformational leadership; alignment of project goals with national policy; funding allowance; cross-boundary collaboration; determination; altruism; and support from wider academic and specialist colleagues. Barriers to clinical leadership identified were: the hierarchical nature of healthcare, territorialism and competing clinical commitments. PMID:26404983

  10. Usual Care and Informed Consent in Clinical Trials of Oxygen Management in Extremely Premature Infants.

    Directory of Open Access Journals (Sweden)

    Irene Cortés-Puch

    Full Text Available The adequacy of informed consent in the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial (SUPPORT has been questioned. SUPPORT investigators and publishing editors, heads of government study funding agencies, and many ethicists have argued that informed consent was adequate because the two oxygen saturation target ranges studied fell within a range commonly recommended in guidelines. We sought to determine whether each oxygen target as studied in SUPPORT and four similar randomized controlled trials (RCTs was consistent with usual care.PubMed, EMBASE, Web of Science, and Scopus were searched for English articles back to 1990 providing information on usual care oxygen management in extremely premature infants. Data were extracted on intended and achieved oxygen saturation levels as determined by pulse oximetry. Twenty-two SUPPORT consent forms were examined for statements about oxygen interventions.While the high oxygen saturation target range (91 to 95% was consistent with usual care, the low range (85 to 89% was not used outside of the SUPPORT trial according to surveys and clinical studies of usual care. During usual care, similar lower limits (< 88% were universally paired with higher upper limits (≥ 92% and providers skewed achieved oxygen saturations toward the upper-end of these intended ranges. Blinded targeting of a low narrow range resulted in significantly lower achieved oxygen saturations and a doubling of time spent below the lower limit of the intended range compared to usual care practices. The SUPPORT consent forms suggested that the low oxygen saturation arm was a widely practiced subset of usual care.SUPPORT does not exemplify comparative effectiveness research studying practices or therapies in common use. Descriptions of major differences between the interventions studied and commonly practiced usual care, as well as potential risks associated with these differences, are essential elements of adequate

  11. Characteristics of ambulatory care clinics and pharmacists in Veterans Affairs medical centers. IMPROVE investigators. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers.

    Science.gov (United States)

    Alsuwaidan, S; Malone, D C; Billups, S J; Carter, B L

    1998-01-01

    The type and extent of ambulatory care clinical pharmaceutical services in selected Veterans Affairs medical centers (VAMCs) were studied as part of a larger project. Questionnaires were sent to the 174 VAMCs to determine the extent of clinical pharmacy activity in ambulatory care clinics, characteristics of outpatient pharmacies and clinics, and characteristics of ambulatory care pharmacists in VAMCs and to identify sites for the IMPROVE (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers) project. Fifty VAMCs responded to the survey. There were 512 ambulatory care clinics within these VAMCs. There was some pharmacist coverage in 75% of the clinics. The highest pharmacist coverage was in walk-in refill, therapeutic drug monitoring, and anticoagulation clinics. Clinical pharmacists at 68% of the VAMCs had prescribing privileges in ambulatory care clinics. Clinical pharmacists managed 29.9% of the clinics. The types of clinics most commonly managed by pharmacists were therapeutic drug monitoring, anticoagulation, walk-in refill, and lipid clinics. Nurse practitioners or physician assistants also were providing primary care in 41% of the clinics. There were 242 ambulatory care clinical pharmacy specialists practicing in the 50 VAMCs. Of these, 41.3% had three years or less of ambulatory care experience. Most pharmacists were in the clinic five days per week. A Pharm.D. degree was the highest degree obtained for 76.9%. Ambulatory care pharmaceutical services are common in VAMCs and are being provided by numerous clinical pharmacists. PMID:9437478

  12. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

    Science.gov (United States)

    Runowicz, Carolyn D; Leach, Corinne R; Henry, N Lynn; Henry, Karen S; Mackey, Heather T; Cowens-Alvarado, Rebecca L; Cannady, Rachel S; Pratt-Chapman, Mandi L; Edge, Stephen B; Jacobs, Linda A; Hurria, Arti; Marks, Lawrence B; LaMonte, Samuel J; Warner, Ellen; Lyman, Gary H; Ganz, Patricia A

    2016-02-20

    The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for

  13. Queues and care: how medical residents organize their work in a busy clinic.

    Science.gov (United States)

    Finlay, W; Mutran, E J; Zeitler, R R; Randall, C S

    1990-09-01

    How do medical residents organize their work in settings where queue demands are heavy and resources are limited? Under such conditions, a queue theory would predict the delivery of care that is indifferent to clients' needs or that gets rid of clients as quickly as possible. In an exploratory case study of medical residents in a Veterans Administration outpatient clinic, we found instead that the medical residents' work was characterized by a high level of professional commitment: they provided thorough medical examinations and attempted to expedite patient care in other ways. We attribute the residents' professional ethos to opportunities provided in the VA hospital to learn the craft of routine medicine and to be directly responsible for patient care; such opportunities were not available in other settings. PMID:2133482

  14. Preparing culturally and linguistically diverse nursing students for clinical practice in the health care setting.

    Science.gov (United States)

    Harvey, Theresa; Robinson, Carolyn; Frohman, Rena

    2013-07-01

    The number of culturally and linguistically diverse (CALD) students seeking enrollment in higher education courses in Western countries where English is the predominant language has grown considerably in the past decade, especially in undergraduate health care courses. When enrolled in nursing courses, students are required to complete clinical placements. Such experiences can create significant challenges for CALD students where language, cultural differences, and interpretation of cultural norms complicate the learning process. To assist CALD nursing students to transition successfully, an extracurricular integrated curriculum program was developed and implemented at a university in Queensland, Australia. The program is a series of interactive workshops based on the principles of caring pedagogy and student-centered learning. The program applies strategies that combine small-group discussions with peers, role-plays, and interactions with final-year nursing student volunteers. Evaluation of the program suggests it has assisted most of the students surveyed to be successful in their clinical studies. PMID:23721071

  15. Sorting and selection in posets

    DEFF Research Database (Denmark)

    Daskalakis, Constantinos; Karp, Richard M.; Mossel, Elchanan;

    2011-01-01

    Classical problems of sorting and searching assume an underlying linear ordering of the objects being compared. In this paper, we study these problems in the context of partially ordered sets, in which some pairs of objects are incomparable. This generalization is interesting from a combinatorial...... from two decades ago by Faigle and Turán. In particular, we present the first algorithm that sorts a width-$w$ poset of size $n$ with query complexity $O(n(w+\\log n))$ and prove that this query complexity is asymptotically optimal. We also describe a variant of Mergesort with query complexity $O......(wn\\log\\frac{n}{w})$ and total complexity $O(w^{2}n\\log\\frac{n}{w})$; an algorithm with the same query complexity was given by Faigle and Turán, but no efficient implementation of that algorithm is known. Both our sorting algorithms can be applied with negligible overhead to the more general problem of reconstructing...

  16. Implementation of integrated stepped care for unhealthy alcohol use in HIV clinics

    OpenAIRE

    Edelman, E. Jennifer; Hansen, Nathan B.; Cutter, Christopher J.; Danton, Cheryl; Fiellin, Lynn E.; O’Connor, Patrick G.; Williams, Emily C.; Maisto, Stephen A.; Bryant, Kendall J.; FIELLIN, David A.

    2016-01-01

    Background Effective counseling and pharmacotherapy for unhealthy alcohol use are rarely provided in HIV treatment settings to patients. Our goal was to describe factors influencing implementation of a stepped care model to address unhealthy alcohol use in HIV clinics from the perspectives of social workers, psychologists and addiction psychiatrists. Methods We conducted two focus groups with Social Workers (n = 4), Psychologists (n = 2), and Addiction Psychiatrists (n = 4) involved in an ong...

  17. A qualitative study of the cultural changes in primary care organisations needed to implement clinical governance.

    OpenAIRE

    Marshall, Martin; Sheaff, Rod; Rogers, Anne; Campbell, Stephen; Halliwell, Shirley; Pickard, Susan; Sibbald, Bonnie; Roland, Martin

    2002-01-01

    BACKGROUND: It is commony claimed that changing the culture of health organisations is a fundamental prerequisite for improving the National Health Service (NHS). Little is currently known about the nature or importance of culture and cultural change in primary care groups and trusts (PCG/Ts) or their constituent general practices. AIMS: To investigate the importance of culture and cultural change for the implementation of clinical governance in general practice by PCG/Ts, to identify perceiv...

  18. Primary care clinic location decision-making and spatial accessibility for the region of Thessaly

    OpenAIRE

    Yorgos N. Photis; Manetos, Panos

    2008-01-01

    The prospect for establishing a General Clinic at the Thessaly Region was examined. The new facility aimes to provide full medical care by qualified scientists (permanent personnel, shareholders or associates), by experienced, trained and skilled nursing personnel, fully organised with sophisticated technological equipment, in a hospitable and pleasant environment, with easy and fast access. The main aim of this study is the determination of the optimum location for the construction of...

  19. Multimedia abstract generation of intensive care data: the automation of clinical processes through AI methodologies.

    Science.gov (United States)

    Jordan, Desmond; Rose, Sydney E

    2010-04-01

    Medical errors from communication failures are enormous during the perioperative period of cardiac surgical patients. As caregivers change shifts or surgical patients change location within the hospital, key information is lost or misconstrued. After a baseline cognitive study of information need and caregiver workflow, we implemented an advanced clinical decision support tool of intelligent agents, medical logic modules, and text generators called the "Inference Engine" to summarize individual patient's raw medical data elements into procedural milestones, illness severity, and care therapies. The system generates two displays: 1) the continuum of care, multimedia abstract generation of intensive care data (MAGIC)-an expert system that would automatically generate a physician briefing of a cardiac patient's operative course in a multimodal format; and 2) the isolated point in time, "Inference Engine"-a system that provides a real-time, high-level, summarized depiction of a patient's clinical status. In our studies, system accuracy and efficacy was judged against clinician performance in the workplace. To test the automated physician briefing, "MAGIC," the patient's intraoperative course, was reviewed in the intensive care unit before patient arrival. It was then judged against the actual physician briefing and that given in a cohort of patients where the system was not used. To test the real-time representation of the patient's clinical status, system inferences were judged against clinician decisions. Changes in workflow and situational awareness were assessed by questionnaires and process evaluation. MAGIC provides 200% more information, twice the accuracy, and enhances situational awareness. This study demonstrates that the automation of clinical processes through AI methodologies yields positive results. PMID:20012610

  20. CLINICAL DECISION MAKING IN NURSING CARE: EVIDENCE BASED PRACTICE AND SENIORITY

    OpenAIRE

    Sivasangari Subramaniam; Sotheenathan Krishinan; Revathy U. Thandapani; Hans Van Rostenberghe; Azriani Berahim

    2015-01-01

    In the nursing profession, EBP makes a positive contribution to healthcare outcomes, care delivery, clinical teaching and research. The research objective was to determine the nurses' knowledge, attitude, practice towards EBP and barriers to use EBP in four (4) Government Hospitals in Malaysia, Hospital Universiti Sains Malaysia (HUSM), Hospital Pulau Pinang (HPP), Hospital Sultan Abdul Halim (HSAH) and Hospital Seberang Jaya (HSJ). A cross-sectional study was conducted from January until Dec...

  1. German ambulatory care physicians' perspectives on clinical guidelines – a national survey

    OpenAIRE

    Böcken Jan; Dieterle Wilfried E; Schnee Melanie; Kempkens Daniela; Butzlaff Martin; Rieger Monika A

    2006-01-01

    Abstract Background There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM) The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. Methods Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Lik...

  2. The Epidemiology of Upper Respiratory Infections at a Tertiary Care Center: Prevalence, Seasonality, and Clinical Symptoms

    OpenAIRE

    2014-01-01

    Improved multiplex PCR detection methods are facilitating the correlation of the etiology of respiratory tract infections with specific symptoms or clinical manifestations. We conducted a retrospective analysis of the incidence of respiratory pathogens and initial symptoms in 1,286 patients at a tertiary care center tested by multiplex respiratory pathogen PCR from July 1, 2012, to June 30, 2013. Rhinovirus/enterovirus (Rhino/Entero) infections were the most prevalent (25.4%) followed by resp...

  3. Maternal near miss in the intensive care unit: clinical and epidemiological aspects

    OpenAIRE

    Oliveira, Leonam Costa; da Costa, Aurélio Antônio Ribeiro

    2015-01-01

    Objective To analyze the epidemiological clinical profile of women with maternal near miss according to the new World Health Organization criteria. Methods A descriptive crosssectional study was conducted, in which the records of patients admitted to the obstetric intensive care unit of a tertiary hospital in Recife (Brazil) over a period of four years were analyzed. Women who presented at least one near miss criterion were included. The variables studied were age, race/color, civil status, e...

  4. Evaluation of a pharmacist-managed anticoagulation clinic: Improving patient care

    OpenAIRE

    Bungard, Tammy J; Gardner, Leslie; Archer, Stephen L.; Hamilton, Peter; Ritchie, Bruce; Tymchak, Wayne; Tsuyuki, Ross T.

    2009-01-01

    Background Anticoagulation management services (AMSs) are widely used for anticoagulation management in many countries. Our AMS is a pharmacist-run ambulatory clinic with a physician advisory committee that manages patients referred with complicated anticoagulation histories. This paper assesses the adequacy of anticoagulation, rates of anticoagulant-related events and associated health care resource utilization for patients before and after referral to our AMS. Methods Consecutive patients r...

  5. Non-attendance at psychiatric outpatient clinics: communication and implications for primary care.

    OpenAIRE

    Killaspy, H; Banerjee, S.; King, M.; LLOYD, M

    1999-01-01

    BACKGROUND: What should happen when an outpatient fails to attend a psychiatric clinic? Guidelines from the General Medical Services Committee suggest that general practitioners (GPs) have no further responsibility of care for a patient once a referral to a psychiatrist has been made. This raises questions about the formulation of effective management plans for those patients with whom psychiatric services find it difficult to engage due to non-compliance with assessment and follow-up. AIMS: ...

  6. Clinical risk factors and bronchoscopic features of invasive aspergillosis in Intensive Care Unit patients

    OpenAIRE

    ALIYALI, M.; HEDAYATI, M.T.; HABIBI, M.R.; KHODAVAISY, S.

    2013-01-01

    Summary Introduction. Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunocompromised patients. During recent years, a rising incidence of IA in Intensive Care Unit (ICU) patients has been reported. The patterns of IA related infection may differ according to the type of underlying disease. Unfortunately little is known about the characteristics of IA in ICU patients. In the present study we assessed IA related clinical and bronchoscopy findings in ICU patien...

  7. Optimizing Drug Prescribing in Managed Care Populations: Improving Clinical and Economic Outcomes

    OpenAIRE

    Rachel Czubak; Jasmine Tucker; Zarowitz, Barbara J.

    2004-01-01

    Managed care presents interesting opportunities to optimize clinical and economic outcomes related to drug prescribing. There are very few randomized controlled trials that have evaluated methods to educate or incentivize physicians, implement formulary management or guideline tools, profile physicians, and implement pharmacist interventions to ensure optimal drug prescribing. Single methods of optimizing medication outcomes have not been shown to be as effective as multifaceted approaches. S...

  8. [Improving the Care Accuracy of Percutaneously Inserted Central Catheters Using Objective Structured Clinical Examination].

    Science.gov (United States)

    Yang, Pei-Hsin; Hsu, Hsin-Chieh; Chiang, Chia-Chin; Tseng, Yun-Shan

    2016-06-01

    Approximately 9,800 adverse events related to medical tubing are reported in Taiwan every year. Most neonates in critical condition and premature infants acquire fluid, nutrition, and infusion solution using percutaneously inserted central catheters (PICCs). Objective structured clinical examination (OSCE) is an objective evaluative tool that may be used to measure the clinical competence of healthcare professionals. Very little is known about the effects of OSCE in Taiwan in terms of improving the accuracy of use of PICCs in nursing care and of reducing unexpected medical tubing removals. The present project aimed to explore the effects of an OSCE course on these two issues in the realms of standard operating procedures, care protocols, and training equipment at a neonatal intermediate unit in Taiwan. The duration of the present study ran from 2/20/2013 to 10/30/2013. The results showed that nurses' knowledge of PICCs improved from 87% to 91.5%; nurses' skill-care accuracy related to PICCs improved from 59.1% to 97.3%; and incidents of unexpected tube removals declined from 63.6% to 16.7%. This project demonstrated that OSCE courses improve the quality of PICC nursing care. Additionally, the instant feedback mechanism within the OSCE course benefited both teachers and students. PMID:27250965

  9. A Laboratory Test Expert System for Clinical Diagnosis Support in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Rodrigo Fernandez-Millan

    2015-08-01

    Full Text Available Clinical Decision Support Systems have the potential to reduce lack of communication and errors in diagnostic steps in primary health care. Literature reports have showed great advances in clinical decision support systems in the recent years, which have proven its usefulness in improving the quality of care. However, most of these systems are focused on specific areas of diseases. In this way, we propose a rule-based expert system, which supports clinicians in primary health care, providing a list of possible diseases regarding patient’s laboratory tests results in order to assist previous diagnosis. Our system also allows storing and retrieving patient’s data and the history of patient’s analyses, establishing a basis for coordination between the various health care levels. A validation step and speed performance tests were made to check the quality of the system. We conclude that our system could improve clinician accuracy and speed, resulting in more efficiency and better quality of service. Finally, we propose some recommendations for further research.

  10. Hybrid optical and acoustic force based sorting

    Science.gov (United States)

    O'Mahoney, Paul; Brodie, Graham W.; Wang, Han; Demore, Christine E. M.; Cochran, Sandy; Spalding, Gabriel C.; MacDonald, Michael P.

    2014-09-01

    We report the combined use of optical sorting and acoustic levitation to give particle sorting. Differing sizes of microparticles are sorted optically both with and without the aid of acoustic levitation, and the results compared to show that the use of acoustic trapping can increase sorting efficiency. The use of a transparent ultrasonic transducer is also shown to streamline the integration of optics and acoustics. We also demonstrate the balance of optical radiation pressure and acoustic levitation to achieve vertical sorting.

  11. [Affection, proximity, frequency and hesitant clinical practice: basis of the "bond" between Down syndrome patients and primary health care?].

    Science.gov (United States)

    Fontanella, Bruno José Barcellos; Setoue, Cesar Seiji; Melo, Débora Gusmão

    2013-07-01

    The national policy of comprehensive care in clinical genetics propounds that families and individuals with genetic disorders should receive ongoing assistance at primary health care (PHC) level. In this study, the social representation of professionals working in family health care units (FHCU) is investigated based on their "bond" with Down syndrome patients, bearing in mind that this expression currently contains relevant meanings in the clinical practice and service management routine. Sixteen practitioners were interviewed, and the sample was defined by theoretical saturation. The statements given by the participants expressed knowledge based mainly on affective skills, physical proximity and patients' frequency of attendance at the family health care unit (FHCU). Clinical skills of other kinds, especially cognitive skills, do not appear to justify the notion of "bond." The results indicate the need of continuous professional education and definition of guidelines and approaches in care to the most common syndromes in the context of primary health care (PHC). PMID:23827892

  12. The prevalence of medical/clinical technology over psychosocial care actions in outpatient mental health services

    Directory of Open Access Journals (Sweden)

    Regina Celia Fiorati

    2013-10-01

    Full Text Available The scope of this study was to evaluate how aspects of mental health policy in Brazil have been conceived and implemented in outpatient services, such as the Regional Outpatient Mental Health Clinic and the Psychosocial Care Center II, both in Ribeirão Preto, São Paulo. Semi-direct interviews and focus groups were conducted with 22 health professionals. The theoretical method and data analysis were supported by the dialectical hermeneutic framework of Jürgen Habermas. The following aspects were detected: considerable technological advancement in health actions and centrality of clinical-medical technology in relation to other nonmedical therapeutic actions; the prioritization of treatment options emphasizing pathology and drug therapy, and a process of mounting precariousness in labor relations. With respect to psychosocial rehabilitation, analysis revealed that instrumental and technically-oriented treatment is imposed upon the practical and dialogical rationale proposed by Brazilian Psychiatric Reform. As an alternative, participatory evaluative research is required in order to unify clinical and psychosocial rehabilitation actions in therapeutic projects, while establishing mechanisms to promote the improvement of care based on the psychosocial care model.

  13. The prevalence of medical/clinical technology over psychosocial care actions in outpatient mental health services.

    Science.gov (United States)

    Fiorati, Regina Celia; Saeki, Toyoko

    2013-10-01

    The scope of this study was to evaluate how aspects of mental health policy in Brazil have been conceived and implemented in outpatient services, such as the Regional Outpatient Mental Health Clinic and the Psychosocial Care Center II, both in Ribeirão Preto, São Paulo. Semi-direct interviews and focus groups were conducted with 22 health professionals. The theoretical method and data analysis were supported by the dialectical hermeneutic framework of Jürgen Habermas. The following aspects were detected: considerable technological advancement in health actions and centrality of clinical-medical technology in relation to other nonmedical therapeutic actions; the prioritization of treatment options emphasizing pathology and drug therapy, and a process of mounting precariousness in labor relations. With respect to psychosocial rehabilitation, analysis revealed that instrumental and technically-oriented treatment is imposed upon the practical and dialogical rationale proposed by Brazilian Psychiatric Reform. As an alternative, participatory evaluative research is required in order to unify clinical and psychosocial rehabilitation actions in therapeutic projects, while establishing mechanisms to promote the improvement of care based on the psychosocial care model. PMID:24061022

  14. A Heapify Based Parallel Sorting Algorithm

    Directory of Open Access Journals (Sweden)

    M. A.A.A. Hija

    2008-01-01

    Full Text Available Quick sort is a sorting algorithm whose worst case running time is θ(n2 on an input array of n numbers. It is the best practical for sorting because it has the advantage of sorting in place. Problem statement: Behavior of quick sort is complex, we proposed in-place 2m threads parallel heap sort algorithm which had advantage in sorting in place and had better performance than classical sequential quick sort in running time. Approach: The algorithm consisted of several stages, in first stage; it splits input data into two partitions, next stages it did the same partitioning for prior stage which had been spitted until 2 m partitions was reached equal to the number of available processors, finally it used heap sort to sort respectively ordered of non internally sorted partitions in parallel. Results: Results showed the speed of algorithm about double speed of classical Quick sort for a large input size. The number of comparisons needed was reduced significantly. Conclusion: In this study we had been proposed a sorting algorithm that uses less number of comparisons with respect to original quick sort that in turn requires less running time to sort the same input data.

  15. The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

    Directory of Open Access Journals (Sweden)

    Kunimitsu Ayano

    2009-04-01

    Full Text Available Abstract Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics, which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96. Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07, illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15, the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22, and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06. Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and

  16. The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

    Science.gov (United States)

    Kunimitsu, Ayano

    2009-01-01

    Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics), which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96). Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07), illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15), the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22), and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06). Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and government statistics in

  17. What would it take? Stakeholders' views and preferences for implementing a health care manager program in community mental health clinics under health care reform.

    Science.gov (United States)

    Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto

    2015-02-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. PMID:25542194

  18. A mixed methods evaluation of a patient care clinic located within a pharmacy school.

    Science.gov (United States)

    Jorgenson, Derek J; Landry, Eric J L; Lysak, Katherine J

    2016-08-01

    Background The Medication Assessment Center is a faculty and student run patient care clinic located within the pharmacy school at the University of Saskatchewan (Canada). It was created as a novel experiential education site for pharmacy students and to provide clinical pharmacist services for complex patients who have trouble accessing services elsewhere. Objective To determine if the clinical services provided by faculty and students at the Medication Assessment Center are valuable to patients who are referred to the program. Setting The Medication Assessment Center, which is faculty and student run patient care clinic. Method Convergent mixed methods design comprised of a retrospective patient chart audit and a paper based patient experience survey. All patients who attended at least one appointment at the Medication Assessment Center between March 1, 2014 and July 31, 2015 were included in the chart audit. All new patients who were referred between April 1, 2015 and October 26, 2015 were included in the survey. Main outcome measures Recommendations made by the pharmacist and patient experience survey indicators. Results 173 patients were included in the chart audit, which found that patients were elderly (64.8 years), highly medically complex (13.8 medications and 6.5 diagnoses each), and had a large number of recommendations made by the pharmacist to adjust drug therapy (6.2 per patient). 121 questionnaires were mailed to patients with a response rate of 66.9 % (n = 81). The survey found high levels of support and satisfaction for the program, including more than half of patients (59.2 %) who reported that their health had improved as a result of the Medication Assessment Center. Conclusion The patient care and experiential education program offered by the Medication Assessment Center provides a valuable service to patients who are referred to the clinic. PMID:27166829

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

    Directory of Open Access Journals (Sweden)

    Kotecha A

    2015-10-01

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

  20. Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic

    Directory of Open Access Journals (Sweden)

    Dillon Carla

    2011-08-01

    Full Text Available Abstract Background The beneficial outcomes of oral anticoagulation therapy are dependent upon achieving and maintaining an optimal INR therapeutic range. There is growing evidence that better outcomes are achieved when anticoagulation is managed by a pharmacist with expertise in anticoagulation management rather than usual care by family physicians. This study compared a pharmacist managed anticoagulation program (PC to usual physician care (UC in a family medicine clinic. Methods A retrospective cohort study was carried out in a family medicine clinic which included a clinical pharmacist. In 2006, the pharmacist assumed anticoagulation management. For a 17-month period, the PC group (n = 112 of patients on warfarin were compared to the UC patients (n = 81 for a similar period prior to 2006. The primary outcome was the percentage of time patients' INR was in the therapeutic range (TTR. Secondary outcomes were the percentage of time in therapeutic range within ± 0.3 units of the recommended range (expanded TTR and percentage of time the INR was >5.0 or Results The baseline characteristics were similar between the groups. Fifty-five percent of the PC group was male with a mean age of 67 years; 51% of the UC group was male with a mean age of 71 years. The most common indications for warfarin in both groups were atrial fibrillation, mechanical heart valves and deep vein thrombosis. The TTR was 73% for PC and 65% for UC (p 5 were 0.3% for PC patients and 0.1% for UC (p Conclusion The pharmacist-managed anticoagulation program within a family practice clinic compared to usual care by the physicians achieved significantly better INR control as measured by the percentage of time patients' INR values were kept in both the therapeutic and expanded range. Based on the results of this study, a collaborative family practice clinic using pharmacists and physicians may be an effective model for anticoagulation management with these results verified in future

  1. Mechanism-based classification of pain for physical therapy management in palliative care: A clinical commentary

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available Pain relief is a major goal for palliative care in India so much that most palliative care interventions necessarily begin first with pain relief. Physical therapists play an important role in palliative care and they are regarded as highly proficient members of a multidisciplinary healthcare team towards management of chronic pain. Pain necessarily involves three different levels of classification-based upon pain symptoms, pain mechanisms and pain syndromes. Mechanism-based treatments are most likely to succeed compared to symptomatic treatments or diagnosis-based treatments. The objective of this clinical commentary is to update the physical therapists working in palliative care, on the mechanism-based classification of pain and its interpretation, with available therapeutic evidence for providing optimal patient care using physical therapy. The paper describes the evolution of mechanism-based classification of pain, the five mechanisms (central sensitization, peripheral neuropathic, nociceptive, sympathetically maintained pain and cognitive-affective are explained with recent evidence for physical therapy treatments for each of the mechanisms.

  2. Measuring quality in maternal-newborn care: developing a clinical dashboard.

    Science.gov (United States)

    Sprague, Ann E; Dunn, Sandra I; Fell, Deshayne B; Harrold, Joann; Walker, Mark C; Kelly, Sherrie; Smith, Graeme N

    2013-01-01

    Pregnancy, birth, and the early newborn period are times of high use of health care services. As well as opportunities for providing quality care, there are potential missed opportunities for health promotion, safety issues, and increased costs for the individual and the system when quality is not well defined or measured. There has been a need to identify key performance indicators (KPIs) to measure quality care within the provincial maternal-newborn system. We also wanted to provide automated audit and feedback about these KPIs to support quality improvement initiatives in a large Canadian province with approximately 140 000 births per year. We therefore worked to develop a maternal-newborn dashboard to increase awareness about selected KPIs and to inform and support hospitals and care providers about areas for quality improvement. We mapped maternal-newborn data elements to a quality domain framework, sought feedback via survey for the relevance and feasibility of change, and examined current data and the literature to assist in setting provincial benchmarks. Six clinical performance indicators of maternal-newborn quality care were identified and evidence-informed benchmarks were set. A maternal-newborn dashboard with "drill down" capacity for detailed analysis to enhance audit and feedback is now available for implementation. While audit and feedback does not guarantee individuals or institutions will make practice changes and move towards quality improvement, it is an important first step. Practice change and quality improvement will not occur without an awareness of the issues. PMID:23343794

  3. Adjunctive naturopathic care for type 2 diabetes: patient-reported and clinical outcomes after one year

    Directory of Open Access Journals (Sweden)

    Bradley Ryan

    2012-04-01

    Full Text Available Abstract Background Several small, uncontrolled studies have found improvements in self-care behaviors and reductions in clinical risk in persons with type 2 diabetes who received care from licensed naturopathic physicians. To extend these findings and determine the feasibility and promise of a randomized clinical trial, we conducted a prospective study to measure the effects of adjunctive naturopathic care (ANC in primary care patients with inadequately controlled type 2 diabetes. Methods Forty patients with type 2 diabetes were invited from a large integrated health care system to receive up to eight ANC visits for up to one year. Participants were required to have hemoglobin A1c (HbA1c values between 7.5-9.5 % and at least one additional cardiovascular risk factor (i.e., hypertension, hyperlipidemia or overweight. Standardized instruments were administered by telephone to collect outcome data on self-care, self-efficacy, diabetes problem areas, perceived stress, motivation, and mood. Changes from baseline scores were calculated at 6- and 12-months after entry into the study. Six and 12-month changes in clinical risk factors (i.e., HbA1c, lipid and blood pressure were calculated for the ANC cohort, and compared to changes in a cohort of 329 eligible, non-participating patients constructed using electronic medical records data. Between-cohort comparisons were adjusted for age, gender, baseline HbA1c, and diabetes medications. Six months was pre-specified as the primary endpoint for outcome assessment. Results Participants made 3.9 ANC visits on average during the year, 78 % of which occurred within six months of entry into the study. At 6-months, significant improvements were found in most patient-reported measures, including glucose testing (P = 0.001, diet (P = 0.001, physical activity (P = 0.02, mood (P = 0.001, self-efficacy (P = 0.0001 and motivation to change lifestyle (P = 0.003. Improvements in glucose testing, mood, self-efficacy and

  4. [Care for the elderly with frequent falls: the fall clinic in Zeeuws-Vlaanderen, the Netherlands].

    Science.gov (United States)

    Faber, M; Vet-Heijne, F

    2005-09-01

    A fall-clinic forms part of the fall-prevention program in Zeeuws-Vlaanderen. In this paper it is explained how elderly who are prone to falling are examined in the fall-clinic to find the underlying cause of their fall problem. The complete examination is termed the fall-risk analysis (FRA). In a six year period 121 elderly visited the fall-clinic. On average they were 78 +/- 8 years of age (mean +/- standarddeviation) and 76% was female. An insufficient muscle force of the hip flexors was the most prominent limitation that could be related to the increased fall risk. Based on the FRA on average 4.3 +/- 1.7 actions were proposed, where a referral to a specialist or physical therapist was most frequently proposed. The fall-clinic is integrated into existing structures of the Dutch health care services. Additional attention is given to case finding by means of district-nurses and family physicians. In this way a highly qualitative health care chain is being created for the falling elderly. PMID:16194064

  5. Self-care and adherence to medication: a survey in the hypertension outpatient clinic

    Directory of Open Access Journals (Sweden)

    Lip Gregory YH

    2008-02-01

    Full Text Available Abstract Background Self-care practices for patients with hypertension include adherence to medication, use of blood pressure self-monitoring and use of complementary and alternative therapies (CAM The prevalence of CAM use and blood pressure self-monitoring have not been described in a UK secondary care population of patients with hypertension and their impact on adherence to medication has not been described. Adherence to medication is important for blood pressure control, but poor adherence is common. The study aimed to determine the prevalence of self-care behaviours in patients attending a secondary care hypertension clinic. Methods Cross-sectional questionnaire survey. 196 patients attending a secondary care hypertension clinic in a teaching hospital serving a multiethnic population, Birmingham, UK. Main outcome measures: Prevalence of use of CAM, home monitors, adherence to anti-hypertensive medication. Results CAM use in previous 12 months was reported by 66 (43.1% respondents. CAM users did not differ statistically from non-CAM users by age, gender, marital status or education. Vitamins, prayer a dietary supplements were the most commonly used CAM. Nine (12.7% women reported using herbal CAM compared to one man (1.2%, (p = 0.006. Ten (6.7% respondents reported ever being asked by a doctor about CAM use. Perfect adherence to anti-hypertensive medication was reported by 26 (44.8% CAM-users and 46 (60.5% non-CAM users (p = 0.07. Being female and a CAM user was significantly associated with imperfect adherence to anti-hypertensive medication. Older and white British respondents were significantly more likely to report perfect adherence. Blood pressure monitors were used by 67 (43.8% respondents, which was not associated with gender, CAM use or adherence to medication. Conclusion Hypertensive patients use a variety of self-care methods, including CAM, home blood pressure monitors, and adherence to prescribed medication. This study found the

  6. Deformability-based capsule sorting

    Science.gov (United States)

    Le Goff, Anne; Munier, Nadege; Maire, Pauline; Edwards-Levy, Florence; Salsac, Anne-Virginie

    2015-11-01

    Many microfluidic devices have been developed for cancer diagnosis applications, most of which relying on costly antibodies. Since some cancer cells display abnormal mechanical properties, new sorting tools based on mechanical sensing are of particular interest. We present a simple, passive pinched flow microfluidic system for capsule sorting. The device consists of a straight microchannel containing a cylindrical obstacle. Thanks to a flow-focusing module placed at the channel entrance, capsules arrive well-centered in the vicinity of the obstacle. Pure size-sorting can be achieved at low shear rate. When increasing the shear rate, capsules are deformed in the narrow space between the pillar and the wall. The softer the capsule, the more tightly it wraps around the obstacle. After the obstacle, streamlines diverge, allowing for the separation between soft capsules, that follow central streamlines, and stiff capsules, that drift away from the obstacle with a wider angle. This proves that we have developed a flexible multipurpose sorting microsystem based on a simple design.

  7. Identification of the critical success factors involved in the implementation of clinical governance arrangements within primary care

    Directory of Open Access Journals (Sweden)

    Beverley Ellis

    2002-03-01

    Full Text Available The study explores the theoretical grounding for clinical governance development as a quality improvement activity and an understanding and awareness of interactions between culture, power and leadership within primary care. The deepest and most difficult elements of culture to change are basic assumptions - 'the way we do things round here'. The study also explores the government commendation to adopt the EFQM Excellence Model as a framework for clinical governance. This research is based on a longitudinal study across two primary care groups, exploring the nature and origin of people's viewpoints, the reasons for them and subsequent consequences in respect to implementing clinical governance arrangements within primary care.

  8. Translation of clinical prediction rules for febrile children to primary care practice: an observational cohort study

    Science.gov (United States)

    van Ierland, Yvette; Elshout, Gijs; Berger, Marjolein Y; Vergouwe, Yvonne; de Wilde, Marcel; van der Lei, Johan; Mol, Henriëtte A; Oostenbrink, Rianne

    2015-01-01

    Background Clinical prediction rules (CPRs) to identify children with serious infections lack validation in low-prevalence populations, which hampers their implementation in primary care practice. Aim To evaluate the diagnostic value of published CPRs for febrile children in primary care. Design and setting Observational cohort study among febrile children (<16 years) who consulted five GP cooperatives (GPCs) in the Netherlands. Method Alarm signs of serious infection and clinical management were extracted from routine clinical practice data and manually recoded with a structured electronic data-entry program. Eight CPRs were selected from literature. CPR-variables were matched with alarm signs and CPRs were applied to the GPC-population. ‘Referral to emergency department (ED)’ was used as a proxy outcome measure for ‘serious infection’. CPR performance was assessed by calibration analyses, sensitivity, specificity, and area under the ROC-curve (ROC-area). Results A total of 9794 GPC-contacts were eligible, 54% male, median age 2.3 years (interquartile range 1.0–4.6 years) and 8.1% referred to ED. Frequencies of CPR-variables varied from 0.5% (cyanosis, drowsy) to 25% (temperature ≥40°C). Alarm signs frequently included in CPRs were ‘ill appearance’, ‘inconsolable’, and ‘abnormal circulatory or respiratory signs’. The height of the CPR’s predicted risks generally corresponded with being (or not being) referred to the ED in practice. However, calibration-slopes indicated that three CPRs underestimated the risk of serious infection in the GPC-population. Sensitivities ranged from 42% to 54%, specificities from 68% to 89%. ROC-areas ranged from 0.52 to 0.81, with best performance of CPRs for children aged <3 months. Conclusion Published CPRs performed moderately well in the primary out-of-hours care population. Advice is given on how to improve translation of CPRs to primary care practice. PMID:25824182

  9. Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain

    DEFF Research Database (Denmark)

    Slade, Susan C; Kent, Peter; Bucknall, Tracey;

    2015-01-01

    INTRODUCTION: Low back pain is the highest ranked condition contributing to years lived with disability, and is a significant economic and societal burden. Evidence-based clinical practice guidelines are designed to improve quality of care and reduce practice variation by providing graded...... recommendations based on the best available evidence. Studies of low back pain guideline implementation have shown no or modest effects at changing clinical practice. OBJECTIVES: To identify enablers and barriers to adherence to clinical practice guidelines for the management of low back pain. METHODS AND...... ANALYSIS: A systematic review and meta-synthesis of qualitative studies that will be conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Eight databases will be searched using a priori inclusion/exclusion criteria. Two...

  10. Bioinformatics Workflow for Clinical Whole Genome Sequencing at Partners HealthCare Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Ellen A. Tsai

    2016-02-01

    Full Text Available Effective implementation of precision medicine will be enhanced by a thorough understanding of each patient’s genetic composition to better treat his or her presenting symptoms or mitigate the onset of disease. This ideally includes the sequence information of a complete genome for each individual. At Partners HealthCare Personalized Medicine, we have developed a clinical process for whole genome sequencing (WGS with application in both healthy individuals and those with disease. In this manuscript, we will describe our bioinformatics strategy to efficiently process and deliver genomic data to geneticists for clinical interpretation. We describe the handling of data from FASTQ to the final variant list for clinical review for the final report. We will also discuss our methodology for validating this workflow and the cost implications of running WGS.

  11. Incorporating Experiential Learning Techniques to Improve Self-Efficacy in Clinical Special Care Dentistry Education.

    Science.gov (United States)

    Watters, Amber L; Stabulas-Savage, Jeanine; Toppin, James D; Janal, Malvin N; Robbins, Miriam R

    2015-09-01

    The New York University College of Dentistry has introduced a clinical rotation for fourth-year dental students that focuses on treating people with special health care needs (PSN). The aim of this study was to investigate the hypothesis that clinical experience in treating patients with special health care needs during predoctoral education is associated with increased self-assessed student ability and comfort and therefore self-efficacy. The study also investigated whether other characteristics, such as prior personal or volunteer experience with this population, service-mindedness, and/or the inclination to treat underserved populations, were associated with comfort in treating PSN. A survey was used to assess changes in students' perceived knowledge, beliefs, and attitudes regarding treating PSN before and after the clinical experience for July 2012-June 2013. The survey included questions about students' service-mindedness, comfort, perceptions of abilities of PSN and educational importance of learning to treat PSN, desire for clinical experience, and future intent or interest in treating PSN. Out of 364 students invited to participate, 127 surveys were returned, for a response rate of 34.9%. The results showed statistically significant increases on six items following training: impressions about the importance of oral health among PSN, comfort in treating people with cognitive disabilities and with medical complexities, intent to treat PSN in future practice, interest in including PSN in postgraduate training, and belief that PSN could be treated in the private practice setting. These students reported preferring to learn in the clinical setting over didactic instruction. This clinical experience was associated with improved self-efficacy in treating PSN and increased intentions to treat this population in future practice. Improvements were particularly evident among those with the least prior experience with PSN and were independent of other aspects of the

  12. [Exactly what is ethical nursing care? the perspective of the clinical humanities].

    Science.gov (United States)

    Yu, An-Bang

    2014-10-01

    As Taiwan enters the post-modern era of professional medical care, a host of issues relating to nursing care are becoming increasingly pressing. On the one hand, the wide range of ailments of body and mind requiring treatment is placing a major financial burden on the national health care system. On the other hand, few hospitals are able to provide "comprehensive care of body and mind." In addition to primary prevention, the most effective way to reduce the overall cost of medical care is to effectively bring volunteer caregivers (those who have an "ethical connection" with the patient, i.e., family, friends, neighbors, volunteers, etc.) into all levels of the caregiving process. Moreover, as medical ethics becomes increasingly focused on the well-being of the patient, more attention is being given to the healing relationship itself. Due to its ability to swiftly relieve a wide variety of ailments, the Western medical model has become widely accepted in Asia. Yet, a patient may feel a greater sense of healing when treatment is based on the principles of ethical caregiving. For example, in the way it quickly relieves the prevailing symptoms, psychiatric medication is like a freeway. By contrast, volunteer caregiving is more like a local road, which may be slower, but eventually takes one all the way home. Thus, making nursing care more person-centered and indigenized gives the patient a sense of not only being cured, but also being "cared for." However, for a long time the theory and practice of nursing education in Taiwan has been based on the Western model of nursing. In this model nursing is treated as a branch of the biological sciences, an overall approach quite different from the traditional view of caregiving in Asian societies. Nonetheless, recent research and clinical practice indicates that an indigenized form of nursing care may be a more suitable approach to comprehensive care, and that such an approach has much potential for widespread application in

  13. Implementation of cancer clinical care pathways: a successful model of collaboration between payers and providers.

    Science.gov (United States)

    Feinberg, Bruce A; Lang, James; Grzegorczyk, James; Stark, Donna; Rybarczyk, Thomas; Leyden, Thomas; Cooper, Joseph; Ruane, Thomas; Milligan, Scott; Stella, Philip; Scott, Jeffrey A

    2012-05-01

    Despite rising medical costs within the US health care system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of health care in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the health care cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology health care consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program. PMID:22942833

  14. Clinical decision making on the use of physical restraint in intensive care units

    Directory of Open Access Journals (Sweden)

    Xinqian Li

    2014-12-01

    Full Text Available Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients' safety and to prevent unexpected accidents. However, existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales, the negative physical and emotional effects on patients, but the lack of perceived alternatives. This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses. By reviewing the literature, intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases. However, it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint. Besides that, such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated. Therefore, despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint, it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

  15. Family Composition and Expressions of Family-Focused Care Needs at an Academic Memory Disorders Clinic

    Directory of Open Access Journals (Sweden)

    Brandalyn C. Riedel

    2013-01-01

    Full Text Available Objective. To understand who dementia patients identify as their family and how dementia affects family life. Background. Dementia care is often delivered in family settings, so understanding the constituency and needs of the family unit involved in care is important for determining contributors to family quality of life. Design/Methods. Seventy-seven families receiving care at an academic dementia clinic completed questionnaires regarding the affected person and the family. Responses were categorized as focused on an individual’s needs or the family’s needs. Results. Respondents identified a mean of 3.77 family members involved in care. Spouse (80.5%, daughter (58.4%, son (46.8%, and stepchild or child-in-law (37.7% were the most frequently listed family members. Questions regarding the effect of dementia-related changes in cognition and mood were most likely to elicit a family-focused response. Questionnaire items that inquired about specific medical questions and strategies to improve family function were least likely to elicit a family-focused response. Conclusions. Both caregivers and persons with dementia frequently provided family-focused responses, supporting the construct of dementia as an illness that affects life in the family unit. This finding reinforces the potential utility of family-centered quality of life measures in assessing treatment success for people with dementia.

  16. Epidemiology, clinical characteristics and resource implications of pandemic (H1N1) 2009 in intensive care units in Ireland.

    LENUS (Irish Health Repository)

    Nicolay, Nathalie

    2010-12-01

    To describe the incidence, clinical characteristics and outcomes of critically ill patients in Ireland with pandemic (H1N1) 2009 infection, and to provide a dynamic assessment of the burden of such cases on Irish intensive care units.

  17. Genomic analysis in the clinic: benefits and challenges for health care professionals and patients in Brazil.

    Science.gov (United States)

    Ashton-Prolla, Patrícia; Goldim, José Roberto; Vairo, Filippo Pinto E; da Silveira Matte, Ursula; Sequeiros, Jorge

    2015-07-01

    Despite significant advances in the diagnosis and treatment of genetic diseases in the last two decades, there is still a significant proportion where a causative mutation cannot be identified and a definitive genetic diagnosis remains elusive. New genome-wide or high-throughput multiple gene tests have brought new hope to the field, since they can offer fast, cost-effective and comprehensive analysis of genetic variation. This is particularly interesting in disorders with high genetic heterogeneity. There are, however, limitations and concerns regarding the implementation of genomic analysis in everyday clinical practice, including some particular to emerging and developing economies, as Brazil. They include the limited number of actionable genetic variants known to date, difficulties in determining the clinical validity and utility of novel variants, growth of direct-to-consumer genetic testing using a genomic approach and lack of proper training of health care professionals to adequately request, interpret and use genetic information. Despite all these concerns and limitations, the availability of genomic tests has grown at an extremely rapid pace and commercially available services include initiatives in almost all areas of clinical genetics, including newborn and carrier screening. We discuss the benefits and limitations of genomic testing, as well as the ethical implications and the challenges for genetic education and enough available and qualified health care professionals, to ensure the adequate process of informed consent, meaningful interpretation and use of genomic data and definition of a clear regulatory framework in the particular context of Brazil. PMID:26040235

  18. Clinical care and technical recommendations for 90yttrium microsphere treatment of liver cancer

    International Nuclear Information System (INIS)

    Selective internal radiation therapy (SIRT) with 90yttrium microspheres is a relatively new clinical modality for treating non-resectable malignant liver tumours. This interventional radiology technique employs percutaneous microcatheterisation of the hepatic arterial vasculature to selectively deliver radioembolic microspheres into neoplastic tissue. SIRT results in measurable tumour responses or delayed disease progression in the majority of eligible patients with hepatocellular carcinoma or hepatic metastases arising from colorectal cancer. It has also been successfully used as palliative therapy for non-colorectal malignancies metastatic to the liver. Although most adverse events are mild and transient, SIRT also carries some risks for serious and – rarely – fatal outcomes. In particular, entry of microspheres into non-target vessels may result in radiation-induced tissue damage, such as severe gastric ulceration or radiation cholecystitis. Radiation-induced liver disease poses another significant risk. By careful case selection, considered dose calculation and meticulous angiographic technique, it is possible to minimise the incidence of such complications to less than 10% of all treatments. As the number of physicians employing SIRT expands, there is an increasing need to consolidate clinical experience and expertise to optimise patient outcomes. Authored by a panel of clinicians experienced in treating liver tumours via SIRT, this paper collates experience in vessel mapping, embolisation, dosimetry, microsphere delivery and minimisation of non-target delivery. In addition to these clinical recommendations, the authors propose institutional criteria for introducing SIRT at new centres and for incorporating the technique into multidisciplinary care plans for patients with hepatic neoplasms.

  19. Who Enrolls Onto Clinical Oncology Trials? A Radiation Patterns of Care Study Analysis

    International Nuclear Information System (INIS)

    Purpose: To identify factors significantly influencing accrual to clinical protocols by analyzing radiation Patterns of Care Study (PCS) surveys of 3,047 randomly selected radiotherapy (RT) patients. Methods and Materials: Patterns of Care Study surveys from disease sites studied for the periods 1992-1994 and 1996-1999 (breast cancer, n = 1,080; prostate cancer, n = 1,149; esophageal cancer, n = 818) were analyzed. The PCS is a National Cancer Institute-funded national survey of randomly selected RT institutions in the United States. Patients with nonmetastatic disease who received RT as definitive or adjuvant therapy were randomly selected from eligible patients at each institution. To determine national estimates, individual patient records were weighted by the relative contribution of each institution and patients within each institution. Data regarding participation in clinical trials were recorded. The factors age, gender, race, type of insurance, and practice type of treating institution (academic or not) were studied by univariate and multivariate analyses. Results: Overall, only 2.7% of all patients were accrued to clinical protocols. Of these, 57% were enrolled on institutional review board-approved institutional trials, and 43% on National Cancer Institute collaborative group studies. On multivariate analysis, patients treated at academic facilities (p = 0.0001) and white patients (vs. African Americans, p = 0.0002) were significantly more likely to participate in clinical oncology trials. Age, gender, type of cancer, and type of insurance were not predictive. Conclusions: Practice type and race significantly influence enrollment onto clinical oncology trials. This suggests that increased communication and education regarding protocols, particularly focusing on physicians in nonacademic settings and minority patients, will be essential to enhance accrual

  20. Herpes Zoster Vaccine in the Long-Term Care Setting: A Clinical and Logistical Conundrum.

    Science.gov (United States)

    Schafer, Katherine Montag; Reidt, Shannon

    2016-01-01

    Advancing age is associated with an increased risk of herpes zoster (shingles) infection and latent effects such as postherpetic neuralgia. The herpes zoster vaccine is recommended in those 60 years of age and older and has been shown to prevent both the primary disease and associated complications. While this recommendation applies to those living in long-term care facilities, there is little clinical evidence to support use in this population. Additionally, there are logistical barriers that may complicate the use of the vaccine. The article examines the evidence for vaccinating residents in long-term care facilities and discusses logistical barriers to vaccination. Pharmacists and providers may consider life expectancy and other factors when evaluating which patients should receive the vaccination. PMID:26803085

  1. [Climacteric women: a proposal for nursing clinical care based on Freirean ideas].

    Science.gov (United States)

    Vidal, Cláudia Rejane Pinheiro Maciel; Miranda, Karla Corrêa Lima; Pinheiro, Patrícia Neyva da Costa; Rodrigues, Dafne Paiva

    2012-01-01

    The study aims to discuss the concepts of caring and education and propose a strategy for health education as a possibility for clinical nursing care for women in menopause based on the educational principles of Paulo Freire. Over the years, different paradigms of Health Education are conditioned by different strategies, many of them reductionists, which require questioning and implementation of more integral and participatory actions. From this thought, we seek an opportunity for education that includes the "Other" in their complexity, enabling the women in their climacteric phase can also be assisted in full. In this scenario, we visualize the principles of Paulo Freire as a framework to guide this development; it shows a dialectic education, solidarity, without arrogance, articulating the scientific knowledge and popular knowledge, translating his method in a collective work. PMID:23258690

  2. European AIDS Clinical Society Standard of Care meeting on HIV and related coinfections

    DEFF Research Database (Denmark)

    Mussini, C; Antinori, A; Bhagani, S;

    2016-01-01

    OBJECTIVES: The objective of the 1st European AIDS Clinical Society meeting on Standard of Care in Europe was to raise awareness of the European scenario and come to an agreement on actions that could be taken in the future. METHODS: Data-driven presentations were given on specific topics followed...... by interactive panel discussions. RESULTS: In Eastern European countries, the epidemic is largely driven by injecting drug use, in contrast with Western Europe where the infection mainly occurs through heterosexual contact. A high proportion of people living with HIV remain unaware of their infection...... diagnosed multi-drug-resistant cases. Hepatitis C is widespread in selected geographical areas and risk groups. CONCLUSIONS: The key conclusion from the meeting was that a high-priority group of actions could be identified, including: increasing HIV awareness and testing, improving training for health care...

  3. Clinical priorities, barriers and solutions in end-of-life cancer care research across Europe. Report from a workshop

    DEFF Research Database (Denmark)

    Sigurdardottir, Katrin Ruth; Haugen, Dagny Faksvåg; van der Rijt, Carin C D;

    2010-01-01

    The PRISMA project is aiming to co-ordinate research priorities, measurement and practice in end-of-life (EOL) care in Europe. As part of PRISMA we undertook a questionnaire survey and a subsequent workshop to (1) identify clinical priorities for EOL care research in Europe and propose a future...... research agenda and (2) identify barriers to EOL care research, and possibilities and solutions to improve the research....

  4. Mental health service provision for adults with intellectual disability: sources of referrals, clinical characteristics and pathways to care

    OpenAIRE

    Tsakanikos, Elias

    2006-01-01

    There is a certain amount of ambiguity and confusion over the provision of mental health services for people with intellectual disabilities (ID) referred by both primary care services (Primary Care (PC) / Social Services (SS)) and secondary care services (Generic Mental Health Services (GMHS)). Psychosocial and clinical characteristics of new referrals (N = 791) were compared with regard to their source of referral. GMHS referrals were more likely to have schizophrenia spectrum disorder, pers...

  5. Identifying cases of undiagnosed, clinically significant COPD in primary care: qualitative insight from patients in the target population

    OpenAIRE

    Leidy, Nancy K.; Kim, Katherine; Bacci, Elizabeth D.; Yawn, Barbara P.; Mannino, David M.; Thomashow, Byron M; Barr, R Graham; Rennard, Stephen I; Houfek, Julia F; Han, Meilan K.; Meldrum, Catherine A.; Make, Barry J.; Bowler, Russ P; Steenrod, Anna W.; Murray, Lindsey T

    2015-01-01

    Background: Many cases of chronic obstructive pulmonary disease (COPD) are diagnosed only after significant loss of lung function or during exacerbations. Aims: This study is part of a multi-method approach to develop a new screening instrument for identifying undiagnosed, clinically significant COPD in primary care. Methods: Subjects with varied histories of COPD diagnosis, risk factors and history of exacerbations were recruited through five US clinics (four pulmonary, one primary care). Ph...

  6. Telephone care coordination for smokers in VA mental health clinics: protocol for a hybrid type-2 effectiveness-implementation trial

    OpenAIRE

    Rogers, Erin; Fernandez, Senaida; Gillespie, Colleen; Smelson, David; Hagedorn, Hildi J; Elbel, Brian; Kalman, David; Axtmayer, Alfredo; Kurowski, Karishma; Sherman, Scott E

    2013-01-01

    Background This paper describes an innovative protocol for a type-II hybrid effectiveness-implementation trial that is evaluating a smoking cessation telephone care coordination program for Veterans Health Administration (VA) mental-health clinic patients. As a hybrid trial, the protocol combines implementation science and clinical trial methods and outcomes that can inform future cessation studies and the implementation of tobacco cessation programs into routine care. The primary objectives ...

  7. Utilization and cost of a new model of care for managing acute knee injuries: the Calgary acute knee injury clinic

    OpenAIRE

    Lau Breda HF; Lafave Mark R; Mohtadi Nicholas G; Butterwick Dale J

    2012-01-01

    Abstract Background Musculoskeletal disorders (MSDs) affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC). The g...

  8. Assessing the HIV Care Continuum in Latin America: progress in clinical retention, cART use and viral suppression

    OpenAIRE

    Rebeiro, Peter F.; Carina Cesar; Shepherd, Bryan E.; Raquel B De Boni; Cortés, Claudia P.; Fernanda Rodriguez; Pablo Belaunzarán-Zamudio; Pape, Jean W; Denis Padgett; Daniel Hoces; McGowan, Catherine C; Pedro Cahn

    2016-01-01

    Introduction: We assessed trends in HIV Care Continuum outcomes associated with delayed disease progression and reduced transmission within a large Latin American cohort over a decade: clinical retention, combination antiretroviral therapy (cART) use and viral suppression (VS). Methods: Adults from Caribbean, Central and South America network for HIV epidemiology clinical cohorts in seven countries contributed data between 2003 and 2012. Retention was defined as two or more HIV care visits an...

  9. An HMO-Sponsored Primary Care-Based Disease Management and Case Management Initiative: Economic and Selected Clinical Outcomes

    OpenAIRE

    Jaan Sidorov; Franz Joseph Fisher; Sabrina Girolami; Otto Wolke

    2002-01-01

    Objective: To describe the cost savings achieved in a health maintenance organization (HMO)-sponsored primary care-based case management and disease management programs. Methods: The HMO-sponsored programs recruited patients in the primary care setting and relied on clinical guidelines and HMO-employed patient education nurses and case management nurses. Total per member per month (PMPM) charges for medical services and changes in selected clinical outcomes before and after entry into HMO-spo...

  10. Internal Medicine Residents’ Perceptions of Team-Based Care and its Educational Value in the Continuity Clinic: A Qualitative Study

    OpenAIRE

    Soones, TN; O Brien, BC; Julian, KA

    2015-01-01

    © 2015, Society of General Internal Medicine. BACKGROUND : In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents’ education in the ambulatory setting. OBJECTIVE: To identify factors affecting residents’ experience of team-based care within continuity clinics and the impact of these teams ...

  11. High Uptake of Systematic HIV Counseling and Testing and TB Symptom Screening at a Primary Care Clinic in South Africa

    OpenAIRE

    Annelies Van Rie; Kate Clouse; Colleen Hanrahan; Katerina Selibas; Ian Sanne; Sharon Williams; Peter Kim; Jean Bassett

    2014-01-01

    BACKGROUND: Timely diagnosis and treatment of tuberculosis (TB) and HIV is important to reduce morbidity and mortality, and break the cycle of ongoing transmission. METHODS: We performed an implementation research study to develop a model for systematic TB symptom screening and HIV counseling and testing (HCT) for all adult clients at a primary care clinic and prospectively evaluate the 6-month coverage and yield, and 18-month sustainability at a primary care clinic in Johannesburg, South Afr...

  12. Evaluation of a task-shifting strategy involving peer educators in HIV care and treatment clinics in Lusaka, Zambia

    OpenAIRE

    Lonny J. Born; Chibesa Wamulume; Kim A. Neroda; Nicole Quiterio; Giganti, Mark J.; Mary Morris; Carolyn Bolton-Moore; Shelagh Baird; Maggie Sinkamba; Topp, Stephanie M; Stewart E. Reid

    2012-01-01

    Rapid expansion of antiretroviral therapy (ART) and a shortage of health care workers (HCWs) required the implementation of a peer educator (PE) model as part of a task-shifting strategy in Lusaka District clinics. The purpose of this study was to evaluate patient and staff perceptions regarding whether the PE program: a) relieved the workload on professional HCWs; and b) delivered services of acceptable quality. Qualitative and quantitative data were gathered from five primary care clinics d...

  13. Regular clinic attendance in two large San Francisco HIV primary care settings.

    Science.gov (United States)

    Cohen, Jenny K; Santos, Glenn-Milo; Moss, Nicholas J; Coffin, Phillip O; Block, Nikolas; Klausner, Jeffrey D

    2016-05-01

    Although poor clinic attendance is associated with increased morbidity and mortality among HIV-infected individuals, less is known about predictors of retention and the acceptability of targeted interventions to increase regular clinic attendance. To better understand which patients are at risk for irregular clinic attendance and to explore interventions to aid in retention to care, we surveyed patients attending two outpatient HIV clinics affiliated with the University of California, San Francisco. A total of 606 participants were surveyed, and the analysis was restricted to the 523 male respondents. Of this group, 45% (N = 299) reported missing at least one visit a year. Missing a clinic visit was associated with being African American (aOR = 1.99; 95%CI 1.12-3.52), being a man who has sex with both men and women (aOR=2.72; 95%CI 1.16-6.37), and reporting at least weekly methamphetamine use (aOR=5.79; 95%CI 2.47-13.57). Participants who reported a monthly income greater than $2000 were less likely to miss an appointment (aOR = 0.56; 95%CI 0.34-0.93). Regarding possible retention interventions, most patients preferred phone calls over other forms of support. These findings support the need for ongoing engagement support with particular attention to at-risk sub-groups. PMID:26654093

  14. DARE-AKI: Does enhanced Detection, clinical Analytics, Referral and Early therapy improve AKI outcomes in secondary care?

    Directory of Open Access Journals (Sweden)

    Alistair Connell

    2015-10-01

    The ability to provide rich, patient-specific information to clinicians is one of the primary incentives to developing expensive clinical information systems. To date, efforts to use automated alerting for AKI have largely failed. We have developed a software platform and allied care bundle that directly addresses existing deficiencies in care and the difficulties encountered in previous trials. Specif

  15. What Would It Take? Stakeholders’ Views and Preferences for Implementing a Health Care Manager Program in Community Mental Health Clinics Under Health Care Reform

    OpenAIRE

    Cabassa, Leopoldo J.; Gomes, Arminda P.; Lewis-Fernández, Roberto

    2014-01-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders’ recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from ...

  16. Identifying the barriers to conducting outcomes research in integrative health care clinic settings - a qualitative study

    Directory of Open Access Journals (Sweden)

    Findlay-Reece Barbara

    2010-01-01

    Full Text Available Abstract Background Integrative health care (IHC is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a further study in 2008, to explore the reasons why IHC clinics are not conducting outcomes research and to identify strategies for conducting successful in-house outcomes research programs. The results of the latter study are reported here. Methods A total of 25 qualitative interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews. Results Barriers identified by participants fell into four categories: organizational culture, organizational resources, organizational environment and logistical challenges. Cultural challenges relate to the philosophy of IHC, organizational leadership and practitioner attitudes and beliefs. Participants also identified significant issues relating to their organization's lack of resources such as funding, compensation, infrastructure and partnerships/linkages. Environmental challenges such as the nature of a clinic's patient population and logistical issues such as the actual implementation of a research program and the applicability of research data also posed challenges to the conduct of research. Embedded research leadership, integration of personal and professional values about research, alignment of research activities and clinical workflow processes are some of the factors identified by participants that support IHC clinics' ability to conduct outcomes research. Conclusions Assessing and enhancing the broader

  17. Swarm-Based Spatial Sorting

    CERN Document Server

    Amos, Martyn

    2008-01-01

    Purpose: To present an algorithm for spatially sorting objects into an annular structure. Design/Methodology/Approach: A swarm-based model that requires only stochastic agent behaviour coupled with a pheromone-inspired "attraction-repulsion" mechanism. Findings: The algorithm consistently generates high-quality annular structures, and is particularly powerful in situations where the initial configuration of objects is similar to those observed in nature. Research limitations/implications: Experimental evidence supports previous theoretical arguments about the nature and mechanism of spatial sorting by insects. Practical implications: The algorithm may find applications in distributed robotics. Originality/value: The model offers a powerful minimal algorithmic framework, and also sheds further light on the nature of attraction-repulsion algorithms and underlying natural processes.

  18. Lipid sorting revealed by SANS

    International Nuclear Information System (INIS)

    We have investigated the lipid sorting in a binary small unilamellar vesicle (SUV) composed of cone-shaped (1,2-dihexanoyl-sn-glycero-3-phosphocholine: DHPC) and cylinder-shaped (1,2-dipalmitoyl-sn-glycero-3-phosphocholine: DPPC) lipids. In order to reveal the lipid sorting we adopted a contrast matching technique of small angle neutron scattering (SANS), which extracts the distribution of deuterated lipids in the bilayer quantitatively. The SANS profile of deuterated SUVs at the contrast matching condition showed a characteristic scattering profile, indicating an asymmetric distribution of cone-shaped lipids in the bilayer. The fitting of the observed SANS profile revealed that most DHPC molecules are localized in the outer leaflet, which supports that the shape of the lipid is strongly coupled with the membrane curvature. We compared the obtained asymmetric distribution of the cone-shaped lipids in the bilayer with the theoretical prediction based on the curvature energy model. (author)

  19. THE ORGANIZATION WORKS TO IMPROVE THE CLINICAL AND ECONOMIC OUTCOMES OF CARE FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    O. I. Apolikhin

    2015-01-01

    Full Text Available Objective. Improving health outcomes in prostate cancer by developing optimal approaches to early detection, staging and treatment of disease. Materials and methods. Urologic care for patients with prostate cancer in the Voronezh region is divided according to the conception of the Program "Urology" into 4 of standardized, integrated stages. The first stage are primary care physicians. The purpose of this stage is a screening questionnaire for men of Voronezh region between the ages of 45 to 74 years using a modified international questionnaire lower urinary tract symptoms (IPSS and nomograms individual risk of prostate cancer (SWOP №1.            In case of identification of risk groups for prostate cancer, patients were sent to the urologist at the place of residence, which is conducting special examinations (FRA, ultrasound of the kidneys, bladder, TRUS, UFW, forming a risk group for verification of diagnosis. Then the patient is directed to the second stage of inter-regional urology center (ITC, whose task in the diagnostic phase is to verify the diagnosis.    In case of confirmation of the diagnosis by an urologist of ITC there was created the interactive consultation on the basis of remote Advisory portal Nethealth.ru together with leading research Institute of urology and regional urology center they identified the clinical significance of the disease and subsequent treatment strategy. In case of the detection of clinically significant prostate cancer patient is sent to the third stage - Regional or an optional fourth stage (center providing PMF - the Federal urology center, where he is treated with highly specialized medical care and conducted quality control.   In case of detection of clinically insignificant PC assistance was provided at the level of ITC (active surveillance, watchful waiting, hormone therapy on the recommendations of the oncourologist of regional urology center.Results. During the realisation of the

  20. Concept design of a clinic ship for the health care system in the Peruvian Amazon basin

    OpenAIRE

    Mendoza Vassallo, Pedro Nicolás; Biot, Marco; Bresciani, Ferruccio

    2013-01-01

    In the Peruvian Amazon basin rivers are the only link among the small communities, scattered on a wide territory. With that in mind and according to the needs of local communities, a health care network system based on mobile clinic units onboard small crafts has been conceived, within a cooperation programme between the Universidad Católica Santo Toribio de Mogrovejo (Perú) and the University of Trieste (Italy). This way, patients along the inland waterways can be reached. Ships to be operat...

  1. The prevalence of medical/clinical technology over psychosocial care actions in outpatient mental health services

    OpenAIRE

    Regina Celia Fiorati; Toyoko Saeki

    2013-01-01

    The scope of this study was to evaluate how aspects of mental health policy in Brazil have been conceived and implemented in outpatient services, such as the Regional Outpatient Mental Health Clinic and the Psychosocial Care Center II, both in Ribeirão Preto, São Paulo. Semi-direct interviews and focus groups were conducted with 22 health professionals. The theoretical method and data analysis were supported by the dialectical hermeneutic framework of Jürgen Habermas. The following aspects we...

  2. The Kaiser Permanente Colorado Clinical Pharmacy Anticoagulation Service as a model of modern anticoagulant care.

    Science.gov (United States)

    Witt, Daniel M

    2008-01-01

    The Clinical Pharmacy Anticoagulation Service (CPAS) at Kaiser Permanente Colorado grew from a single pharmacist assisting a single physician to a comprehensive service staffed by over 20 employees. CPAS provides care for over 7200 patients with each CPAS pharmacist managing all aspects of anticoagulation therapy for 150 to 500 patients. Unique aspects of CPAS include its centralized organization structure, the use of telepharmacy, collaboration drug therapy management agreement with referring physicians and a robust research agenda. Results of various CPAS research projects have been published in the peer-reviewed medical literature. PMID:18804262

  3. Screening and diagnosing depression in women visiting GPs' drop in clinic in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Johansson Sven-Erik

    2008-06-01

    Full Text Available Abstract Background Only half of all depressions are diagnosed in Primary Health Care (PHC. Depression can remain undetected for a long time and entail high costs for care and low quality of life for the individuals. Drop in clinic is a common form of organizing health care; however the visits are short and focus on solving the most urgent problems. The aim of this study was to investigate the prevalence and severity of depression among women visiting the GPs' drop in clinic and to identify possible clues for depression among women. Methods The two-stage screening method with "high risk feedback" was used. Beck's Depression Inventory (BDI was used to screen 155 women visiting two GPs' drop in clinic. Women who screened positive (BDI score ≥10 were invited by the GP to a repeat visit. Major depression (MDD was diagnosed according to DSM-IV criteria and the severity was assessed with Montgomery-Asberg Depression Rating Scale (MADRS. Women with BDI score Results The two-stage method worked well with a low rate of withdrawals in the second step, when the GP invited the women to a repeat visit. The prevalence of depression was 22.4% (95% CI 15.6–29.2. The severity was mild in 43%, moderate in 53% and severe in 3%. The depressed women mentioned mental symptoms significantly more often (69% than the controls (15% and were to a higher extent sick-listed for a longer period than 14 days. Nearly one third of the depressed women did not mention mental symptoms. The majority of the women who screened as false positive for depression had crisis reactions and needed further care from health professionals in PHC. Referrals to a psychiatrist were few and revealed often psychiatric co-morbidity. Conclusion The prevalence of previously undiagnosed depression among women visiting GPs' drop in clinic was high. Clues for depression were identified in the depressed women's symptom presentation; they often mention mental symptoms when they visit the GP for somatic

  4. Single beam atom sorting machine

    International Nuclear Information System (INIS)

    We create two overlapping one-dimensional optical lattices using a single laser beam, a spatial light modulator and a high numerical aperture lens. These lattices have the potential to trap single atoms, and using the dynamic capabilities of the spatial light modulator may shift and sort atoms to a minimum atom-atom separation of 1.52 μm. We show how a simple feedback circuit can compensate for the spatial light modulator's intensity modulation

  5. Swarm-Based Spatial Sorting

    OpenAIRE

    Amos, Martyn; Don, Oliver

    2008-01-01

    Purpose: To present an algorithm for spatially sorting objects into an annular structure. Design/Methodology/Approach: A swarm-based model that requires only stochastic agent behaviour coupled with a pheromone-inspired "attraction-repulsion" mechanism. Findings: The algorithm consistently generates high-quality annular structures, and is particularly powerful in situations where the initial configuration of objects is similar to those observed in nature. Research limitations/implications: Exp...

  6. Patients' attitudes to medical and psychosocial aspects of care in fertility clinics

    DEFF Research Database (Denmark)

    Schmidt, L; Holstein, B E; Boivin, J;

    2003-01-01

    among infertile people. METHODS: We conducted an epidemiological study based on questionnaires among all new couples attending five fertility clinics with a response rate of 80.0% and a total of 2250 patients. RESULTS: The vast majority of both men and women considered a high level of medical...... services for both men and women was high infertility-related stress in the marital, personal and social domain. CONCLUSIONS: A supportive attitude from medical staff and the provision of both medical and psychosocial information and support should be integral aspects of medical care in fertility clinics....... Although only a minority of the participants perceived professional psychosocial services as important, they should be available for patients whose infertility causes them much strain, especially for patients whose marital relationship suffered much because of infertility....

  7. Dientes! Community dental clinic: dental care for low-income residents of Santa Cruz County.

    Science.gov (United States)

    Balzer, J; Webb, C

    1998-05-01

    Dientes! is a private nonprofit community dental clinic that was established in 1994 to provide dental care for low-income residents of Santa Cruz County. Its founders were successful in securing support from a diverse group of community agencies, including city and county governments, philanthropic foundations, the dental community, and corporate and individual donors. Dientes! provides approximately 250 visits per month in a three-chair clinic in Santa Cruz; a school-based program in Watsonville began March 1998. The major challenge facing Dientes! is to establish a reliable financial base that will allow the program to better meet the needs of low-income county residents over the long term. PMID:10528572

  8. Mining electronic health records: towards better research applications and clinical care

    DEFF Research Database (Denmark)

    Jensen, Peter B; Jensen, Lars Juhl; Brunak, Søren

    2012-01-01

    revealing unknown disease correlations. Integrating EHR data with genetic data will also give a finer understanding of genotype-phenotype relationships. However, a broad range of ethical, legal and technical reasons currently hinder the systematic deposition of these data in EHRs and their mining. Here, we......Clinical data describing the phenotypes and treatment of patients represents an underused data source that has much greater research potential than is currently realized. Mining of electronic health records (EHRs) has the potential for establishing new patient-stratification principles and for...... consider the potential for furthering medical research and clinical care using EHR data and the challenges that must be overcome before this is a reality....

  9. Computerized clinical decision support systems for acute care management: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

    Directory of Open Access Journals (Sweden)

    Sahota Navdeep

    2011-08-01

    Full Text Available Abstract Background Acute medical care often demands timely, accurate decisions in complex situations. Computerized clinical decision support systems (CCDSSs have many features that could help. However, as for any medical intervention, claims that CCDSSs improve care processes and patient outcomes need to be rigorously assessed. The objective of this review was to systematically review the effects of CCDSSs on process of care and patient outcomes for acute medical care. Methods We conducted a decision-maker-researcher partnership systematic review. MEDLINE, EMBASE, Evidence-Based Medicine Reviews databases (Cochrane Database of Systematic Reviews, DARE, ACP Journal Club, and others, and the Inspec bibliographic database were searched to January 2010, in all languages, for randomized controlled trials (RCTs of CCDSSs in all clinical areas. We included RCTs that evaluated the effect on process of care or patient outcomes of a CCDSS used for acute medical care compared with care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results Thirty-six studies met our inclusion criteria for acute medical care. The CCDSS improved process of care in 63% (22/35 of studies, including 64% (9/14 of medication dosing assistants, 82% (9/11 of management assistants using alerts/reminders, 38% (3/8 of management assistants using guidelines/algorithms, and 67% (2/3 of diagnostic assistants. Twenty studies evaluated patient outcomes, of which three (15% reported improvements, all of which were medication dosing assistants. Conclusion The majority of CCDSSs demonstrated improvements in process of care, but patient outcomes were less likely to be evaluated and far less likely to show positive results.

  10. Word Sorts for General Music Classes

    Science.gov (United States)

    Cardany, Audrey Berger

    2015-01-01

    Word sorts are standard practice for aiding children in acquiring skills in English language arts. When included in the general music classroom, word sorts may aid students in acquiring a working knowledge of music vocabulary. The author shares a word sort activity drawn from vocabulary in John Lithgow's children's book "Never Play…

  11. Sorting device suitable for nuclear plants

    International Nuclear Information System (INIS)

    A device is described for handling and sorting various items and especially linen from laundry bags of a nuclear plant for separation of contaminated and non contaminated objects before washing. It includes reception means, a glove box type enclosure for sorting and exit means of sorted items. Preferentially a ventilation maintains a depression inside

  12. On the Construction of Sorted Reactive Systems

    DEFF Research Database (Denmark)

    Birkedal, Lars; Debois, Søren; Hildebrandt, Thomas

    2008-01-01

    We develop a theory of sorted bigraphical reactive systems. Every application of bigraphs in the literature has required an extension, a sorting, of pure bigraphs. In turn, every such application has required a redevelopment of the theory of pure bigraphical reactive systems for the sorting at hand...

  13. Natriuretic peptide vs. clinical information for diagnosis of left ventricular systolic dysfunction in primary care

    Directory of Open Access Journals (Sweden)

    Wachter Rolf

    2008-02-01

    Full Text Available Abstract Background Screening of primary care patients at risk for left ventricular systolic dysfunction by a simple blood-test might reduce referral rates for echocardiography. Whether or not natriuretic peptide testing is a useful and cost-effective diagnostic instrument in primary care settings, however, is still a matter of debate. Methods N-terminal pro-brain natriuretic peptide (NT-proBNP levels, clinical information, and echocardiographic data of left ventricular systolic function were collected in 542 family practice patients with at least one cardiovascular risk factor. We determined the diagnostic power of the NT-proBNP assessment in ruling out left ventricular systolic dysfunction and compared it to a risk score derived from a logistic regression model of easily acquired clinical information. Results 23 of 542 patients showed left ventricular systolic dysfunction. Both NT-proBNP and the clinical risk score consisting of dyspnea at exertion and ankle swelling, coronary artery disease and diuretic treatment showed excellent diagnostic power for ruling out left ventricular systolic dysfunction. AUC of NT-proBNP was 0.83 (95% CI, 0.75 to 0.92 with a sensitivity of 0.91 (95% CI, 0.71 to 0.98 and a specificity of 0.46 (95% CI, 0.41 to 0.50. AUC of the clinical risk score was 0.85 (95% CI, 0.79 to 0.91 with a sensitivity of 0.91 (95% CI, 0.71 to 0.98 and a specificity of 0.64 (95% CI, 0.59 to 0.67. 148 misclassifications using NT-proBNP and 55 using the clinical risk score revealed a significant difference (McNemar test; p Conclusion The evaluation of clinical information is at least as effective as NT-proBNP testing in ruling out left ventricular systolic dysfunction in family practice patients at risk. If these results are confirmed in larger cohorts and in different samples, family physicians should be encouraged to rely on the diagnostic power of the clinical information from their patients.

  14. Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity

    Directory of Open Access Journals (Sweden)

    Birtwhistle Richard

    2003-12-01

    Full Text Available Abstract Background Controlled clinical trials of health care interventions are either explanatory or pragmatic. Explanatory trials test whether an intervention is efficacious; that is, whether it can have a beneficial effect in an ideal situation. Pragmatic trials measure effectiveness; they measure the degree of beneficial effect in real clinical practice. In pragmatic trials, a balance between external validity (generalizability of the results and internal validity (reliability or accuracy of the results needs to be achieved. The explanatory trial seeks to maximize the internal validity by assuring rigorous control of all variables other than the intervention. The pragmatic trial seeks to maximize external validity to ensure that the results can be generalized. However the danger of pragmatic trials is that internal validity may be overly compromised in the effort to ensure generalizability. We are conducting two pragmatic randomized controlled trials on interventions in the management of hypertension in primary care. We describe the design of the trials and the steps taken to deal with the competing demands of external and internal validity. Discussion External validity is maximized by having few exclusion criteria and by allowing flexibility in the interpretation of the intervention and in management decisions. Internal validity is maximized by decreasing contamination bias through cluster randomization, and decreasing observer and assessment bias, in these non-blinded trials, through baseline data collection prior to randomization, automating the outcomes assessment with 24 hour ambulatory blood pressure monitors, and blinding the data analysis. Summary Clinical trials conducted in community practices present investigators with difficult methodological choices related to maintaining a balance between internal validity (reliability of the results and external validity (generalizability. The attempt to achieve methodological purity can

  15. Design of Garbage Sorting Machine

    Directory of Open Access Journals (Sweden)

    Stephen K. Adzimah

    2009-01-01

    Full Text Available Problem statement: Domestic waste collection, sorting and disposal are major problems in many developing countries such as Ghana. It is an undeniable fact that the environment has been engulfed in filth. This filth comprises of the garbage and waste generated in homes, workplace and industrial setups. Most of this waste has found its way into the streets, gutters, in and around the homes, dung hills and worst of all, water bodies, many of which are sources of the drinking water treated at high costs or not treated at all. Approach: Garbage needs to be sorted into various components and each of such components like textile materials, polythene, foodstuffs, metals and glassware would then have to be handled separately at the disposal or recycling site. Such a process required a certain degree of literacy, discipline and certain basic equipment, for example separate collector bins or sorting bags. In the developed world this is not much a problem because every home has different polythene bags into which the various constituents of domestic waste are put right at the generation point. Separate collection bins were also provided at vantage points for the various types of domestic garbage collection. In the developing countries these arrangements have not been feasible because of the level of literacy, lack of appreciation of the problem, non-availability of the different types of polythene bags and poverty. Currently, most garbage collection in the developing countries is done by depositing every thing into a single container from where they are hauled to be dumped in landfills or burned in incinerators. Refuse disposal by land filling requires a sizeable land for the sole purpose of refuse disposal. This may lead to (1: Encumbering large tracks of prime land, which could not be put to other uses (2: Pollution of ground water by the leachate from the landfills (3: Breeding of leaches, rodents, mosquitoes and (4: Generation of strong stench coming

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

    Directory of Open Access Journals (Sweden)

    Mansfield Richard J

    2005-02-01

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

  17. STUDY OF SEVERITY OF HYPONATRAEMIA AND ITS CLINICAL OUTCOME IN PATIENTS ADMITTED TO TERTIARY CARE ICU

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    Hareesh

    2016-06-01

    Full Text Available BACKGROUND OF THE STUDY Hyponatraemia is a commonly encountered plasma electrolyte abnormality noticed in the patients admitted to ICU, which has a diverse variety of manifestations. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life-threatening and is associated with increased mortality and morbidity. OBJECTIVES To study the clinical profile at different levels of hyponatraemia in ICU patients and its clinical outcome at different levels. METHODOLOGY A retrospective descriptional study was done at Intensive Care Unit of Dr. B.R. Ambedkar Medical College and Hospital during the period from April 2015 to March 2016 among the patients having serum sodium levels less than 135 mEq/L. RESULTS Commonly involved age group is between 50 to 70 years. Severe form of Hyponatraemia is seen in elderly males. The most common underlying predisposing factor for hyponatraemia in our case series was sepsis (26% followed by gastrointestinal fluid loss (15.5%, diabetic ketoacidosis (10% and cirrhosis of liver (10%. Mortality was highest with severe hyponatraemia (10.5% who had pulmonary sepsis, metabolic encephalopathy, diabetic ketoacidosis and cirrhosis of liver. CONCLUSIONS Hyponatraemia is one of the good predictor of ICU mortality in association with wide variety of systemic diseases and wide spectrum of clinical profile.

  18. Radiographer's impact on improving clinical decision-making, patient care and patient diagnosis: a pilot study

    International Nuclear Information System (INIS)

    This pilot study attempts to quantify the benefits of a documented radiographic clinical history through the use of the clinical history template form designed by Egan and Baird. Six radiographers completed the clinical history template for 40 patients and four radiologists included the recorded information as part of their reporting process. A focus discussion group was held between the radiographers to ascertain the level of satisfaction and benefits encountered with the use of the template form. A questionnaire was designed for the radiologists to complete regarding the usefulness of the template form with respect to the radiological reporting process. Results/Discussion: 15 cases for which the form was used demonstrated a direct benefit in respect to improved radiographic clinical decision-making. Radiographers agreed the template form aided the establishment of a stronger radiographer-patient relationship during the radiographic examination. Two radiologists agreed the form aided in establishing a radiological diagnosis and suggested the form be implemented as part of the standard departmental protocol. Despite the small sample size, there is evidence the form aided radiographic decision-making and assisted in the establishment of an accurate radiological diagnosis. The overall consensus amongst radiographers was that it enhanced radiographer-patient communication and improved the level of patient care. Copyright (2004) Australian Institute of Radiography

  19. An evaluation of clinical pharmacist service on a neurology care unit.

    Science.gov (United States)

    Yi, Zhan-Miao; Sun, Shu-Sen; Li, Xiao-Xiao; Lu, Ming; Zhai, Suo-Di

    2016-02-01

    Background Medications used to treat neurological diseases may result in adverse effects. Research is needed to demonstrate pharmacist value and their roles in patient care. Objective To categorize the types and severities of the prescribing errors intercepted and to describe clinical activities conducted by neurology ward pharmacists. Method Pharmacists prospectively reviewed medication orders over an 18-month period with inventions documented and categorized. Results A total of 341 prescribing errors in 1183 patients were intercepted. The most common error types were dosing frequency (35.8 %) and medication selection (21.5 %). The top five most detected error medications were those indicated for hyperhomocysteinemia (22.0 %), stress ulcer prophylaxis (12.3 %), poor circulation (10.9 %), hyperglycemia (6.5 %), and infections (5.9 %). Although 67.5 % of the detected errors having the potential causing no harm, 26.4 % of the errors may require intervention, and 6.2 % may increase the length of stay. The number of errors decreased from 19 to 10 per month during the study period. Clinical pharmacists also actively engaged in medication use evaluation, clinical decision support system optimization, and education to patients and providers. Conclusion Presence of clinical pharmacists at the neurology unit may help in early detection of prescribing errors with increased patient safety. PMID:26659084

  20. How to protect incompetent clinical research subjects involved in critical care or emergency settings.

    Science.gov (United States)

    Zamperetti, Nereo; Piccinni, Mariassunta; Bellomo, Rinaldo; Citerio, Giuseppe; Mistraletti, Giovanni; Gristina, Giuseppe; Giannini, Alberto

    2016-04-01

    Clinical research is an essential component of medical activity, and this is also true in intensive care. Adequate information and consent are universally considered necessary for the protection of research subjects. However, in emergency situations, the majority of critical patients are unable to consent and a valid legal representative is often unavailable. The situation is even more complex in Italy, where the relevant legislation fails to specify how investigators should manage research in emergency or critical care setting when it involves incompetent patients who do not have an appointed legal representative. While special measures for the protection of incompetent subjects during emergency research are necessary, not allowing such research at all dooms critically ill patients to receive non-evidence-based treatments without the prospect of improvement. The recently-issued EU Regulation n. 536/2014 will probably help shed light on this situation. Indeed, it specifically addresses the issue of "research in emergency situations" and introduces detailed rules aimed at protecting patients while allowing research. In this article, we argue that obtaining informed consent during emergency research on incompetent subjects in unrealistic, and that in most cases substituted judgment on the part of a proxy carries major flaws. Strict criteria in evaluating the risk-benefit ratio of proposed intervention and a careful evaluation of the trial by a local or national Research Ethics Committee are perhaps the most practicable solution. PMID:26154445

  1. Chronic obstructive pulmonary disease and heart failure: research and clinical practice in primary care

    Directory of Open Access Journals (Sweden)

    Francesco Chiumeo

    2015-12-01

    Full Text Available The treatment of chronic obstructive pulmonary disease (COPD and comorbidities, increasing with age, is the challenge that nowadays health care systems are facing to better care treat these patients. For this reason a clinical trial was conducted in the province of Trento by a group of 30 volunteer general practitioners members of SNAMID (Scientific Society for Continuing Medical Education of General Practitioners. The objectives were to identify: i prevalence of COPD in patients (65-98 years in the province of Trento; ii presence and incidence of heart failure (HF in COPD patients; iii early detection of other chronic diseases; and iv improving electronic medical records (EMR as an innovation way of professional care management. From May 2011 to October 2013, 17 doctors completed the two-year work using the EMR. The studied patients were men and women (65-98 years, suffering from COPD; the considered data included: anthropometric information, smoking status, International Classification of Diseases (ICD-9 diagnosis of COPD, HF and chronic diseases, specific blood and instrumental tests. The extracted results were then linked with data of sentinel therapies, collected by the EMR. The database obtained identified patients with COPD or HF not previously recognized with ICD-9 diagnosis. The study identified the sentinel drugs chosen for COPD and HF, excluding other drugs not selective for the study or confusing for a proper statistical evaluation.

  2. Teaching Emotional Intelligence to Intensive Care Unit Nurses and their General Health: A Randomized Clinical Trial

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    S Ghadakpoor

    2013-07-01

    Full Text Available Background: Emotion and how people manage it is an important part of personality that would immensely affect their health. Investigations showed that emotional intelligence is significantly related to and can predict psychological health.Objective: To determine the effect of teaching emotional intelligence to intensive care unit nurses on their general health.Methods: This randomized clinical trial (registered as IRCT201208022812N9 was conducted on 52 of 200 in intensive care unit nurses affiliated to Shiraz University of Medical Sciences. They were recruited through purposeful convenience sampling and then randomly categorized into two groups. The intervention group members were trained in emotional intelligence. Bar-on emotional intelligence and Goldberg's general health questionnaires were administered to each participant before, immediately after, and one month after the intervention.Results: While the mean score of general health for the intervention group decreased from 25.4 before the intervention, to 18.1 immediately after the intervention and to 14.6 one month later, for the control group, it increased from 22.0, to 24.2 and to 26.5, respectively (pConclusion: Teaching emotional intelligence improved the general health of intensive care unit nurses.

  3. Urgency in Pediatric Dentistry: Care Profile of the Integrated Pediatric Clinic of FOUFAL

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    Noelle Albuquerque AMORIM

    2007-09-01

    Full Text Available Objective: To analyze the profile of the urgency care provided atthe Integrated Pediatric Clinic of the School of Dentistry of theFederal University of Alagoas (FOUFAL.Method: 221 patient files were analyzed between April toNovember 2006 and the following data were analyzed by descriptivestatistics: patient identification, type of urgency, involved tooth(teeth, diagnosis and proposed treatment. Only complete files wereincluded.Results: Urgency care was most frequently sought by femalechildren (55.7%; the age ranged between 2 and 14 years (meanage =7.6 years; toothache was the most common cause of urgencycare (53.84%; most cases of dental urgencies involved primarymandibular second molars (34.7%; the maxillary central incisorswere the most affected by traumatic injuries in both the primary(78.5% and permanent (76.2% dentitions; extraction (44% wasthe most common dental procedure followed by root canal therapy(34.5% and restorative treatment (24.5%; dental caries (48.3%was the diagnosis most frequently associated with toothachefollowed by irreversible pulpitis (22.8% and reversible pulpitis(16.1%.Conclusions: Most patients that sought treatment at the UrgencyService of the Pediatric Dentistry Clinic at FOUFAL were femalechildren with a low socioeconomic level. Toothache was the mostfrequent reason for the urgency appointments, extraction was themost common procedure, affecting mainly the primary dentition andthe mandibular second molars.

  4. Clinical demand in an emergency care unit according to the Manchester triage system

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    Aline Santos Diniz

    2014-06-01

    Full Text Available The general objective of the present study is to identify the clinical demand of patients cared for by nursing professionals according to the risk classification of an Emergency Care Unit, following the Manchester triage system. It is a quantitative descriptive study whose sample was composed of 364 patient records. The data was analyzed via the Statistical Package for the Social Sciences, using descriptive, bivariate statistics and Spearman’s correlation. The patient’s main complaints were: “Adult indisposition,” “Problems with the limbs,” “Abdominal pain,” and “Headaches.” There was inverse correlation between age and risk classification (rs = -0.14 p=0,005, and time of admittance and risk classification (rs = -1.02, p=0.046. We conclude that the patients classified according to risk presented urgent and non-urgent complaints. The higher the patient’s age and the later in the day they were admitted, the more severe their clinical condition.   doi: 10.5216/ree.v16i2.21700.

  5. The clinical value of routine whole-body magnetic resonance imaging (MRI) in palliative care

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    Geitung, Jonn Terje (Department of Radiology, Haraldspass Deaconess (University) Hospital (Norway); Department of Surgical Sciences, University of Bergen (Norway)), Email: jtgeit@online.no; Eikeland, Joakim (Department of Public Health and Primary Health Care, University of Bergen (Norway)); Rosland, Jan Henrik (Department of Public Health and Primary Health Care, University of Bergen (Norway); Sunniva Clinic for Palliative Care, Haraldsplass Deaconess (University) Hospital (Norway))

    2012-03-15

    Background. Whole-body MRI (WBMRI) has become an accessible method for detecting different types of pathologies both in the skeleton and the viscera, which may explain painful conditions, for example tumors and inflammation. Purpose. To assess a possible value of using WBMRI in order to improve palliative care. Material and Methods. Twenty patients (all eligible patients) admitted to the Department for Palliative Care were consecutively included in this study. They underwent a modified WBMRI, with fewer and shorter pulse sequences than in a standard WBMRI, to reduce patient stress. However, the patients' physicians were to exclude patients where little might be obtained and discomfort, distress, and pain could be induced. The treating physicians registered clinical utility directly after receiving the MRI report in a questionnaire. The registration was repeated after ended treatment. Results. Eighty percent had new findings detected, and 40% of the patients had a change in treatment due to the MRI result, mainly changes in analgesics and/or radiation therapy. Conclusion. The WBMRI helped the clinicians to improve treatment and a majority of the patients benefited from this. In eight patients the treatment was changed due to the results. The clinical value (utility) was indicated to be high

  6. Comparison of Two Clinical Teaching Models for Veterinary Emergency and Critical Care Instruction.

    Science.gov (United States)

    Conner, Bobbi J; Behar-Horenstein, Linda S; Su, Yu

    2016-01-01

    Standards to oversee the implementation and assessment of clinical teaching of emergency and critical care for veterinary students do not exist. The purpose of this study was to assess differences in the learning environment between two veterinary emergency and critical care clinical rotations (one required, one elective) with respect to caseload, technical/procedural opportunities, direct faculty contact time, client communication opportunities, and students' perception of practice readiness. The authors designed a 22-item survey to assess differences in the learning environment between the two rotations. It was sent electronically to 35 third- and fourth-year veterinary medicine students. Bivariate analysis, including the Wilcoxon signed-rank test and the t-test, were used to compare differences between pre-test and post-test scores among students. Twenty-six students' responses were included from the required rotation and nine from the elective rotation. Findings showed that students preferred the elective community emergency department setting to the required academic setting and that there were statistically significantly more positive experiences related to the variables of interest. Students saw significantly more cases at the community emergency department setting. Findings from this study offer guidance to assess students' emergency department rotations, suggest how teaching interactions can be modified for optimal learning experiences, and ensure that students receive maximal opportunities to treat patients that are representative of what they would encounter in practice. PMID:26751912

  7. The clinical value of routine whole-body magnetic resonance imaging (MRI) in palliative care

    International Nuclear Information System (INIS)

    Background. Whole-body MRI (WBMRI) has become an accessible method for detecting different types of pathologies both in the skeleton and the viscera, which may explain painful conditions, for example tumors and inflammation. Purpose. To assess a possible value of using WBMRI in order to improve palliative care. Material and Methods. Twenty patients (all eligible patients) admitted to the Department for Palliative Care were consecutively included in this study. They underwent a modified WBMRI, with fewer and shorter pulse sequences than in a standard WBMRI, to reduce patient stress. However, the patients' physicians were to exclude patients where little might be obtained and discomfort, distress, and pain could be induced. The treating physicians registered clinical utility directly after receiving the MRI report in a questionnaire. The registration was repeated after ended treatment. Results. Eighty percent had new findings detected, and 40% of the patients had a change in treatment due to the MRI result, mainly changes in analgesics and/or radiation therapy. Conclusion. The WBMRI helped the clinicians to improve treatment and a majority of the patients benefited from this. In eight patients the treatment was changed due to the results. The clinical value (utility) was indicated to be high

  8. I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

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    Denilson Campos de Albuquerque

    2015-06-01

    Full Text Available Background: Heart failure (HF is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%, dyslipidemia (36.7% and diabetes (34%. Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.

  9. How does the Shift-insertion sort behave when the sorting elements follow a Normal distribution?

    CERN Document Server

    Pal, Mita; Mahanti, N C

    2012-01-01

    The present paper examines the behavior of Shift-insertion sort (insertion sort with shifting) for normal distribution inputs and is in continuation of our earlier work on this new algorithm for discrete distribution inputs, namely, negative binomial. Shift insertion sort is found more sensitive for main effects but not for all interaction effects compared to conventional insertion sort.

  10. Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome.

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    Lucy C S Lum

    2015-06-01

    Full Text Available The increasing incidence of dengue among adults in Malaysia and other countries has important implications for health services. Before 2004, in order to cope with the surge in adult dengue admissions, each of the six medical wards in a university hospital took turns daily to admit and manage patients with dengue. Despite regular in-house training, the implementation of the WHO 1997 dengue case management guidelines by the multiple medical teams was piecemeal and resulted in high variability of care. A restructuring of adult dengue inpatient service in 2004 resulted in all patients being admitted to one ward under the care of the infectious disease unit. Hospital and Intensive Care Unit admission criteria, discharge criteria and clinical laboratory testing were maintained unchanged throughout the study period.To evaluate the impact of cohorting adult dengue patients on the quality of care and the clinical outcome in a university hospital in Malaysia.A pre (2003 and post-intervention (2005-6 retrospective study was undertaken.Cohorting all dengue patients under the care of the Infectious Disease team in a designated ward in 2004.The number of patients enrolled was 352 in 2003, 785 in 2005 and 1158 in 2006. The evaluation and detection of haemorrhage remained high (>90% and unchanged throughout the study period. The evaluation of plasma leakage increased from 35.4% pre-intervention to 78.8% post-intervention (p = <0.001 while its detection increased from 11.4% to 41.6% (p = <0.001. Examination for peripheral perfusion was undertaken in only 13.1% of patients pre-intervention, with a significant increase post-intervention, 18.6% and 34.2% respectively, p = <0.001. Pre-intervention, more patients had hypotension (21.5% than detected peripheral hypoperfusion (11.4%, indicating that clinicians recognised shock only when patients developed hypotension. In contrast, post-intervention, clinicians recognised peripheral hypoperfusion as an early sign of

  11. Glycaemic Control among Patients with Diabetes in Primary Care Clinics in Jamaica, 1995 and 2012

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    MA Harris

    2014-11-01

    Full Text Available Objective: To compare the quality of care received by patients with diabetes in public primary care clinics in 2012 with that reported in 1995. Methods: Patient records were audited at six randomly selected Type III health centres in the South East Health Region of Jamaica. The 2012 audit data were compared with published data from a similar audit conducted in 1995. Quality of care measures included timely screening tests and counselling of the patients. Fasting and postprandial glucose tests were used to assess glycaemic control. Results: Two hundred and forty-two patient records were analysed in 2012, and 185 in 1995. In 2012, 88% of patients were weighed within the last year compared with 43% in 1995. Advice on physical activity increased from 1% to 60% and on dietary practices from 6% to 79%. No patient had done the HBA1C in 1995 compared to 38% in 2012. In 1995, 66% had blood glucose measured at a laboratory during the last year while in 2012, 60% had a laboratory test and 90% were tested at the clinic by glucometer. Blood pressure control increased from 19% in 1995 to 41% in 2012 (p < 0.001. Poor glucose control was recorded among 61% of patients in 1995 compared with 68% in 2012. Conclusions: There was no improvement in glycaemic control. Health providers and patients must work together to improve patient outcomes. This will involve closer patient monitoring, treatment intensification where indicated, and the adoption of lifestyle practices that can lead to better control.

  12. Use of Complementary Therapies Among Primary Care Clinic Patients With Arthritis

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    Carla J. Herman

    2004-10-01

    Full Text Available Introduction Use of complementary and alternative medicine (CAM for chronic conditions has increased in recent years. There is little information, however, on CAM use among adults with clinic-confirmed diagnoses, including arthritis, who are treated by primary care physicians. Methods To assess the frequency and types of CAM therapy used by Hispanic and non-Hispanic white women and men with osteoarthritis, rheumatoid arthritis, or fibromyalgia, we used stratified random selection to identify 612 participants aged 18–84 years and seen in university-based primary care clinics. Respondents completed an interviewer-administered survey in English or Spanish. Results Nearly half (44.6% of the study population was of Hispanic ethnicity, 71.4% were women, and 65.0% had annual incomes of less than $25,000. Most (90.2% had ever used CAM for arthritis, and 69.2% were using CAM at the time of the interview. Current use was highest for oral supplements (mainly glucosamine and chondroitin (34.1%, mind-body therapies (29.0%, and herbal topical ointments (25.1%. Fewer participants made current use of vitamins and minerals (16.6%, herbs taken orally (13.6%, a CAM therapist (12.7%, CAM movement therapies (10.6%, special diets (10.1%, or copper jewelry or magnets (9.2%. Those with fibromyalgia currently used an average of 3.9 CAM therapies versus 2.4 for those with rheumatoid arthritis and 2.1 for those with osteoarthritis. Current CAM use was significantly associated with being female, being under 55 years of age, and having some college education. Conclusion Hispanic and non-Hispanic white arthritis patients used CAM to supplement conventional treatments. Health care providers should be aware of the high use of CAM and incorporate questions about its use into routine assessments and treatment planning.

  13. Latent Class Analysis of Substance Use among Adolescents Presenting to Urban Primary Care Clinics

    Science.gov (United States)

    Bohnert, Kipling M.; Walton, Maureen A.; Resko, Stella; Barry, Kristen T.; Chermack, Stephen T.; Zucker, Robert A.; Zimmerman, Marc A.; Booth, Brenda M.; Blow, Frederic C.

    2015-01-01

    Background Polysubstance use during adolescence is a significant public health concern; however, few studies have investigated patterns of use during this developmental window within the primary care setting. Objectives This study uses an empirical method to classify adolescents into polysubstance use groups, and examines correlates of the empirically-defined groups. Methods Data come from patients, ages 12-18 years, presenting to urban, primary care community health clinics (Federally Qualified Health Centers) in two cities in the Midwestern United States (n=1664). Latent class analysis (LCA) was used to identify classes of substance users. Multinomial logistic regression was used to examine variables associated with class membership. Results LCA identified three classes: Class 1 (64.5%) exhibited low probabilities of all types of substance use; Class 2 (24.6%) was characterized by high probabilities of cannabis use and consequences; Class 3 (10.9%) had the highest probabilities of polysubstance use, including heavy episodic drinking and misuse of prescription drugs. Those in Class 2 and Class 3 were more likely to be older, and have poorer grades, poorer health, higher levels of psychological distress, and more sexual partners than those in Class 1. Individuals in Class 3 were also less likely to be African-American than those in Class 1. Conclusion Findings provide novel insight into the patterns of polysubstance use among adolescents presenting to low-income urban primary care clinics. Future research should examine the efficacy of interventions that address the complex patterns of substance use and concomitant health concerns among adolescents. PMID:24219231

  14. Polarized sorting and trafficking in epithelial cells

    Institute of Scientific and Technical Information of China (English)

    Xinwang Cao; Michal A Surma; Kai Simons

    2012-01-01

    The polarized distribution of proteins and lipids at the surface membrane of epithelial cells results in the formation of an apical and a basolateral domain,which are separated by tight junctions.The generation and maintenance of epithelial polarity require elaborate mechanisms that guarantee correct sorting and vectorial delivery of cargo molecules.This dynamic process involves the interaction of sorting signals with sorting machineries and the formation of transport carriers.Here we review the recent advances in the field of polarized sorting in epithelial cells.We especially highlight the role of lipid rafts in apical sorting.

  15. Improving year-end transfers of care in academic ambulatory clinics: a survey of pediatric resident physician perceptions

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    Carlos F. Lerner

    2012-05-01

    Full Text Available Background: In resident primary care continuity clinics, at the end of each academic year, continuity of care is disrupted when patients cared for by the graduating class are redistributed to other residents. Yet, despite the recent focus on the transfers of care between resident physicians in inpatient settings, there has been minimal attention given to patient care transfers in academic ambulatory clinics. We sought to elicit the views of pediatric residents regarding year-end patient handoffs in a pediatric resident continuity clinic.Methods: Residents assigned to a continuity clinic of a large pediatric residency program completed a questionnaire regarding year-end transfers of care.Results: Thirty-one questionnaires were completed out of a total 45 eligible residents (69% response. Eighty seven percent of residents strongly or somewhat agreed that it would be useful to receive a written sign-out for patients with complex medical or social issues, but only 35% felt it would be useful for patients with no significant issues. Residents more frequently reported having access to adequate information regarding their new patients’ medical summary (53% and care plan (47% than patients’ functional abilities (30%, social history (17%, or use of community resources (17%. When rating the importance of receiving adequate sign-out in each those domains, residents gave most importance to the medical summary (87% of residents indicating very or somewhat important and plan of care (84%. Residents gave less importance to receiving sign-out regarding their patients’ functional abilities (71% social history (58%, and community resources (58%. Residents indicated that lack of access to adequate patient information resulted in additional work (80%, delays or omissions in needed care (56%, and disruptions in continuity of care (58%.Conclusions: In a single-site study, residents perceive that they lack adequate information during year-end patient transfers

  16. Clinical guidelines on central venous catheterisation. Swedish Society of Anaesthesiology and Intensive Care Medicine.

    Science.gov (United States)

    Frykholm, P; Pikwer, A; Hammarskjöld, F; Larsson, A T; Lindgren, S; Lindwall, R; Taxbro, K; Oberg, F; Acosta, S; Akeson, J

    2014-05-01

    Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should

  17. Machine-vision based optofluidic cell sorting

    DEFF Research Database (Denmark)

    Glückstad, Jesper; Bañas, Andrew

    available light and creating 2D or 3D beam distributions aimed at the positions of the detected cells. Furthermore, the beam shaping freedom provided by GPC can allow optimizations in the beam’s propagation and its interaction with the laser catapulted and sorted cells....... machine vision1. This approach is gentler, less invasive and more economical compared to conventional FACS-systems. As cells are less responsive to plastic or glass objects commonly used in the optical manipulation literature2, and since laser safety would be an issue in clinical use, we develop efficient...... approaches in utilizing lasers and light modulation devices. The Generalized Phase Contrast (GPC) method3-9 that can be used for efficiently illuminating spatial light modulators10 or creating well-defined contiguous optical traps11 is supplemented by diffractive techniques capable of integrating the...

  18. Ultrasound in sports medicine: relevance of emerging techniques to clinical care of athletes.

    Science.gov (United States)

    Yim, Eugene Sun; Corrado, Gianmichael

    2012-08-01

    The applications of ultrasound in managing the clinical care of athletes have been expanding over the past decade. This review provides an analysis of the research that has been published regarding the use of ultrasound in athletes and focuses on how these emerging techniques can impact the clinical management of athletes by sports medicine physicians. Electronic database literature searches were performed using the subject terms 'ultrasound' and 'athletes' from the years 2003 to 2012. The following databases were searched: PubMed, Web of Science, Cochrane Library, CINAHL, and SPORTDiscus™. The search produced 617 articles in total, with a predominance of articles focused on cardiac and musculoskeletal ultrasound. 266 of the studies involved application of ultrasound in evaluating the cardiovascular properties of athletes, and 151 studies involved musculoskeletal ultrasound. Other applications of ultrasound included abdominal, vascular, bone density and volume status. New techniques in echocardiography have made significant contributions to the understanding of the physiological changes that occur in the athlete's heart in response to the haemodynamic stress associated with different types of activity. The likely application of these techniques will be in managing athletes with hypertrophic cardiomyopathy, and the techniques are near ready for application into clinical practice. These techniques are highly specialized, however, and will require referral to dedicated laboratories to influence the clinical management of athletes. Investigation of aortic root pathology and pulmonary vascular haemodynamics are also emerging, but will require additional studies with larger numbers and outcomes analysis to validate their clinical utility. Some of these techniques are relatively simple, and thus hold the potential to enter clinical management in a point-of-care fashion. Musculoskeletal ultrasound has demonstrated a number of diagnostic and therapeutic techniques

  19. General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease: implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

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    Fay Crawford

    2010-12-01

    Conclusions Adoption of the SCI-DC foot assessment tool in primary care is not perceived as clinically necessary. Although information recorded by specialist services on SCI-DC is helpful, important structural barriers to its implementation mean the potential benefits associated with its use are unlikely to be realised; greater engagement with primary care priorities for diabetes management is needed to assist its successful implementation and adoption.

  20. Family physician and endocrinologist coordination as the basis for diabetes care in clinical practice

    Directory of Open Access Journals (Sweden)

    Calle Jose R

    2008-07-01

    care may be important to enhance diabetes management in primary care settings. Trial registration Clinical Trial number ISRCTN75037597

  1. Cultivation and Implementation of Community-Engaged Pharmacy Services in a Free Clinic to Enhance Care for the Medically Underserved

    OpenAIRE

    Emmeline Tran, Pharm.D. Candidate; Brandon T. Jennings, Pharm.D.

    2013-01-01

    Partnerships between community free clinics and academic medical centers improve patient outcomes and enhance learning opportunities for students. A community-academic partnership between the Maliheh Free Clinic and the University of Utah College of Pharmacy was formed to fulfill a community need for pharmacy services, to promote interdisciplinary patient care, and to provide an experiential opportunity for students. The Maliheh Free Clinic based in Salt Lake City, Utah provides free primary ...

  2. Tooth agenesis in patients referred to an Irish tertiary care clinic for the developmental dental disorders.

    LENUS (Irish Health Repository)

    Hashem, Atef A

    2010-01-01

    PURPOSE: This study was carried out to determine the prevalence, severity and pattern of hypodontia in Irish patients referred to a tertiary care clinic for developmental dental disorders. MATERIALS AND METHODS: Details of 168 patients with hypodontia referred during the period 2002-2006 were entered in a database designed as a national record. Tooth charting was completed using clinical and radiographic examinations. The age of patients ranged from 7-50 years, with a median age of 20 years (Mean: 21.79; SD: 8.005). RESULTS: Hypodontia referrals constituted 65.5% of the total referrals. Females were more commonly affected than males with a ratio of 1.3:1. The number of referrals reflected the population density in this area; the majority were referrals from the public dental service. Mandibular second premolars were the most commonly missing teeth, followed by maxillary second premolars and maxillary lateral incisors; maxillary central incisors were the least affected. Symmetry of tooth agenesis between the right and left sides was an evident feature. Slightly more teeth were missing on the left side (n = 725) than on the right side (n = 706) and in the maxillary arch (n = 768) as compared to the mandibular arch (n = 663). Some 54% of patients had severe hypodontia with more than six teeth missing; 32% had moderate hypodontia, with four to six teeth missing. The most common pattern of tooth agenesis was four missing teeth. CONCLUSION: Hypodontia was a common presentation in a population referred to this tertiary care clinic. The pattern and distribution of tooth agenesis in Irish patients appears to follow the patterns reported in the literature.

  3. Information, Motivation, and Behavioral Skills for Early Pre-ART Engagement in HIV Care among Patients Entering Clinical Care in KwaZulu-Natal, South Africa

    Science.gov (United States)

    SMITH, Laramie R.; AMICO, K. Rivet; SHUPER, Paul A.; CHRISTIE, Sarah; FISHER, William A.; CORNMAN, Deborah H.; DOSHI, Monika; MacDONALD, Susan; PILLAY, Sandy; FISHER, Jeffrey D.

    2013-01-01

    Little is known regarding factors implicated in early engagement and retention in HIV-care among individuals not yet eligible for antiretroviral therapy (pre-ART) in sub-Saharan Africa. Identifying such factors is critical for supporting retention in pre-ART clinical care to ensure timely ART initiation and optimize long-term health outcomes. We assessed patients’ pre-ART HIV-care related information, motivation, and behavioral skills among newly diagnosed ART-ineligible patients initiating care in KwaZulu-Natal, South Africa. The survey was interviewer-administered to eligible patients who were 18 years of age or older, newly entering care (diagnosed within the last 6-months), and ineligible for ART (CD4 count >200 cells/mm3) in one of four primary care clinical sites. Self-reported information, motivation and behavioral skills specific to retention in pre-ART HIV-care were characterized by categorizing responses into those reflecting potential strengths and those reflective of potential deficits. Information, motivation, and behavioral skills deficits sufficiently prevalent in the overall sample (i.e., ≥30% prevalent) were identified as areas in need of specific attention through intervention efforts adapted to the clinic level. Gender-based differences were also evaluated. A total of 288 patients (75% female) completed structured interviews. Across the sample, 8 information, 8 motivation, and 8 behavioral skills deficit areas were identified as sufficiently prevalent to warrant specific targeted attention. Gender differences did not emerge. The deficits in pre-ART HIV-care related information, motivation and behavioral skills that were identified suggest that efforts to improve accurate information on immune function and HIV disease are needed, as is accurate information regarding HIV treatment and transmission risk prior to ART initiation. Additional efforts to facilitate the development of social support, including positive interactions with clinic staff

  4. Creating an optical spectroscopy system for use in a primary care clinical setting (Conference Presentation)

    Science.gov (United States)

    Eshein, Adam; Nguyen, The-Quyen; Radosevich, Andrew J.; Gould, Bradley; Wu, Wenli; Konda, Vani; Yang, Leslie W.; Koons, Ann; Feder, Seth; Valuckaite, Vesta; Roy, Hemant K.; Backman, Vadim

    2016-03-01

    While there are a plethora of in-vivo spectroscopic techniques that have demonstrated the ability to detect a number of diseases in research trials, very few techniques have successfully become a fully realized clinical technology. This is primarily due to the stringent demands on a clinical device for widespread implementation. Some of these demands include: simple operation requiring minimal or no training, safe for in-vivo patient use, no disruption to normal clinic workflow, tracking of system performance, warning for measurement abnormality, and meeting all FDA guidelines for medical use. Previously, our group developed a fiber optic probe-based optical sensing technique known as low-coherence enhanced backscattering spectroscopy (LEBS) to quantify tissue ultrastructure in-vivo. Now we have developed this technique for the application of prescreening patients for colonoscopy in a primary care (PC) clinical setting. To meet the stringent requirements for a viable medical device used in a PC clinical setting, we developed several novel components including an automated calibration tool, optical contact sensor for signal acquisition, and a contamination sensor to identify measurements which have been affected by debris. The end result is a state-of-the-art medical device that can be realistically used by a PC physician to assess a person's risk for harboring colorectal precancerous lesions. The pilot study of this system shows great promise with excellent stability and accuracy in identifying high-risk patients. While this system has been designed and optimized for our specific application, the system and design concepts are universal to most in-vivo fiber optic based spectroscopic techniques.

  5. A clinical approach to the nutritional care process in protein-energy wasting hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Mar Ruperto

    2014-04-01

    Full Text Available Introduction: Malnutrition/wasting/cachexia are complex-disease conditions that frequently remain undiagnosed and/or untreated in up to 75% of prevalent hemodialysis (HD patients. The nutrition care process (NCP based on assessment, diagnosis, intervention and monitoring of nutritional status is a systematic method that nutrition professionals use to make decisions in clinical practice. Objective: This review examines from a clinical-nutritional practice point of view: a nutritional status as a mortality causative factor; b phenotypic characteristics of malnutri-tion/wasting/cachexia, and c current trends of NCP with special emphasis on nutritional support and novel nutrient and pharmacologic adjunctive therapies in HD patients. Method: A literature review was conducted using the Pubmed, Science Direct, Scielo, Scopus, and Medline electronic scientific basis. Studies which assessing nutritional status and nutritional support published from 1990 to 2013 in HD patients were included and discussed. Results: From all the epidemiological data analyzed, NCP was the suggested method for identifying malnut rition/ wasting or cachexia in clinical practice. Nutrition support as an unimodal therapy was not completely able to reverse wasting in HD patients. Novel experimental therapeutic strategies including the use of appetite stimulants, ghrelin agonist, MC4-R antagonists, anabolic steroids, anti-inflammatory drugs, cholecalciferol, and other components are still under clinical evaluation. Conclusion: Nutritional status is a strong predictor of morbidity and mortality in HD patients. The terms called malnutrition, wasting and cachexia have different nutritional therapeutics implications. The NCP is a necessary tool for assessing and monitoring nutritional status in the current clinical practice. Novel pharmacological therapies or specific nutrient supplementation interventions studies are required.

  6. Marital Sorting and Parental Wealth

    OpenAIRE

    Kerwin Kofi Charles; Erik Hurst; Alexandra Killewald

    2011-01-01

    Using data from the Panel Study of Income Dynamics (PSID), this paper studies the degree to which spouses sort in the marriage market on the basis of parental wealth. We estimate a variety of models, including transition matrices, OLS and TSLS models to deal with measurement error in wealth reports. Our various results show that men and women in the U.S. marry spouses whose parents have wealth similar to that of their own parents; and are very unlikely to marry persons from very different par...

  7. Microfluidic systems for optical sorting

    Czech Academy of Sciences Publication Activity Database

    Ježek, Jan; Pilát, Zdeněk; Šerý, Mojmír; Kaňka, Jan; Samek, Ota; Bernatová, Silvie; Zemánek, Pavel

    Bellingham : SPIE, 2012, 86970W: 1-9. ISBN 978-0-8194-9481-8. [CPS 2012. Czech-Polish-Slovak Optical Conference on Wave and Quantum Aspects of Contemporary Optics /18./. Ostravice (CZ), 03.09.2012-07.09.2012] R&D Projects: GA MPO FR-TI1/433; GA MŠk ED0017/01/01; GA ČR GAP205/11/1687 Institutional support: RVO:68081731 Keywords : microfluidic * cell sorting * optical tweezers * Raman spectroscopy Subject RIV: BH - Optics, Masers, Lasers

  8. Clinical treatment adherence of health care workers and students exposed to potentially infectious biological material

    Directory of Open Access Journals (Sweden)

    Maria Cristina Mendes de Almeida

    2015-04-01

    Full Text Available OBJECTIVE To assess adherence to clinical appointments by health care workers (HCW and students who suffered accidents with potentially infectious biological material. METHOD A retrospective cross-sectional study that assessed clinical records of accidents involving biological material between 2005 and 2010 in a specialized unit. RESULTS A total of 461 individuals exposed to biological material were treated, of which 389 (84.4% were HCWs and 72 (15.6% students. Of the 461 exposed individuals, 307 (66.6% attended a follow-up appointment. Individuals who had suffered an accident with a known source patient were 29 times more likely to show up to their scheduled follow-up appointments (OR: 29.98; CI95%: 16.09-55.83. CONCLUSION The predictor in both univariate and multivariate analyses for adherence to clinical follow-up appointment was having a known source patient with nonreactive serology for the human immunodeficiency virus and/or hepatitis B and C.

  9. An Integrated Model for Patient Care and Clinical Trials (IMPACT) to support clinical research visit scheduling workflow for future learning health systems.

    Science.gov (United States)

    Weng, Chunhua; Li, Yu; Berhe, Solomon; Boland, Mary Regina; Gao, Junfeng; Hruby, Gregory W; Steinman, Richard C; Lopez-Jimenez, Carlos; Busacca, Linda; Hripcsak, George; Bakken, Suzanne; Bigger, J Thomas

    2013-08-01

    We describe a clinical research visit scheduling system that can potentially coordinate clinical research visits with patient care visits and increase efficiency at clinical sites where clinical and research activities occur simultaneously. Participatory Design methods were applied to support requirements engineering and to create this software called Integrated Model for Patient Care and Clinical Trials (IMPACT). Using a multi-user constraint satisfaction and resource optimization algorithm, IMPACT automatically synthesizes temporal availability of various research resources and recommends the optimal dates and times for pending research visits. We conducted scenario-based evaluations with 10 clinical research coordinators (CRCs) from diverse clinical research settings to assess the usefulness, feasibility, and user acceptance of IMPACT. We obtained qualitative feedback using semi-structured interviews with the CRCs. Most CRCs acknowledged the usefulness of IMPACT features. Support for collaboration within research teams and interoperability with electronic health records and clinical trial management systems were highly requested features. Overall, IMPACT received satisfactory user acceptance and proves to be potentially useful for a variety of clinical research settings. Our future work includes comparing the effectiveness of IMPACT with that of existing scheduling solutions on the market and conducting field tests to formally assess user adoption. PMID:23684593

  10. Sorting and Selection in Posets

    CERN Document Server

    Daskalakis, Constantinos; Mossel, Elchanan; Riesenfeld, Samantha; Verbin, Elad

    2007-01-01

    Classical problems of sorting and searching assume an underlying linear ordering of the objects being compared. In this paper, we study a more general setting, in which some pairs of objects are incomparable. This generalization is relevant in applications related to rankings in sports, college admissions, or conference submissions. It also has potential applications in biology, such as comparing the evolutionary fitness of different strains of bacteria, or understanding input-output relations among a set of metabolic reactions or the causal influences among a set of interacting genes or proteins. Our results improve and extend results from two decades ago of Faigle and Tur\\'{a}n. A measure of complexity of a partially ordered set (poset) is its width. Our algorithms obtain information about a poset by queries that compare two elements. We present an algorithm that sorts, i.e. completely identifies, a width w poset of size n and has query complexity O(wn + nlog(n)), which is within a constant factor of the in...

  11. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement

    OpenAIRE

    Chen, RC; Rumble, RB; Loblaw, DA; Finelli, A.; Ehdaie, B; Cooperberg, MR; Morgan, SC; Tyldesley, S; Haluschak, JJ; Tan, W.; Justman, S; Jain, S

    2016-01-01

    To endorse Cancer Care Ontario's guideline on Active Surveillance for the Management of Localized Prostate Cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines developed by other professional organizations.The Active Surveillance for the Management of Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. The ASCO Endorsement Panel then reviewed the content and the recommenda...

  12. Fast Parallel Sorting Algorithms on GPUs

    Directory of Open Access Journals (Sweden)

    Bilal Jan

    2012-12-01

    Full Text Available This paper presents a comparative analysis of the three widely used parallel sorting algorithms: Odd-Even sort, Rank sort and Bitonic sort in terms of sorting rate, sorting time and speed-up on CPU anddifferent GPU architectures. Alongside we have implemented novel parallel algorithm: min-max butterflynetwork, for finding minimum and maximum in large data sets. All algorithms have been implementedexploiting data parallelism model, for achieving high performance, as available on multi-core GPUsusing the OpenCL specification. Our results depicts minimum speed-up19x of bitonic sort against oddevensorting technique for small queue sizes on CPU and maximum of 2300x speed-up for very largequeue sizes on Nvidia Quadro 6000 GPU architecture. Our implementation of full-butterfly networksorting results in relatively better performance than all of the three sorting techniques: bitonic, odd-evenand rank sort. For min-max butterfly network, our findings report high speed-up of Nvidia quadro 6000GPU for high data set size reaching 224 with much lower sorting time.

  13. Recyclable Waste Paper Sorting Using Template Matching

    Science.gov (United States)

    Osiur Rahman, Mohammad; Hussain, Aini; Scavino, Edgar; Hannan, M. A.; Basri, Hassan

    This paper explores the application of image processing techniques in recyclable waste paper sorting. In recycling, waste papers are segregated into various grades as they are subjected to different recycling processes. Highly sorted paper streams will facilitate high quality end products, and save processing chemicals and energy. Since 1932 to 2009, different mechanical and optical paper sorting methods have been developed to fill the demand of paper sorting. Still, in many countries including Malaysia, waste papers are sorted into different grades using manual sorting system. Due to inadequate throughput and some major drawbacks of mechanical paper sorting systems, the popularity of optical paper sorting systems is increased. Automated paper sorting systems offer significant advantages over human inspection in terms of fatigue, throughput, speed, and accuracy. This research attempts to develop a smart vision sensing system that able to separate the different grades of paper using Template Matching. For constructing template database, the RGB components of the pixel values are used to construct RGBString for template images. Finally, paper object grade is identified based on the maximum occurrence of a specific template image in the search image. The outcomes from the experiment in classification for White Paper, Old Newsprint Paper and Old Corrugated Cardboard are 96%, 92% and 96%, respectively. The remarkable achievement obtained with the method is the accurate identification and dynamic sorting of all grades of papers using simple image processing techniques.

  14. Energy efficient data sorting using standard sorting algorithms

    KAUST Repository

    Bunse, Christian

    2011-01-01

    Protecting the environment by saving energy and thus reducing carbon dioxide emissions is one of todays hottest and most challenging topics. Although the perspective for reducing energy consumption, from ecological and business perspectives is clear, from a technological point of view, the realization especially for mobile systems still falls behind expectations. Novel strategies that allow (software) systems to dynamically adapt themselves at runtime can be effectively used to reduce energy consumption. This paper presents a case study that examines the impact of using an energy management component that dynamically selects and applies the "optimal" sorting algorithm, from an energy perspective, during multi-party mobile communication. Interestingly, the results indicate that algorithmic performance is not key and that dynamically switching algorithms at runtime does have a significant impact on energy consumption. © Springer-Verlag Berlin Heidelberg 2011.

  15. Open Knee: Open Source Modeling & Simulation to Enable Scientific Discovery and Clinical Care in Knee Biomechanics

    Science.gov (United States)

    Erdemir, Ahmet

    2016-01-01

    Virtual representations of the knee joint can provide clinicians, scientists, and engineers the tools to explore mechanical function of the knee and its tissue structures in health and disease. Modeling and simulation approaches such as finite element analysis also provide the possibility to understand the influence of surgical procedures and implants on joint stresses and tissue deformations. A large number of knee joint models are described in the biomechanics literature. However, freely accessible, customizable, and easy-to-use models are scarce. Availability of such models can accelerate clinical translation of simulations, where labor intensive reproduction of model development steps can be avoided. The interested parties can immediately utilize readily available models for scientific discovery and for clinical care. Motivated by this gap, this study aims to describe an open source and freely available finite element representation of the tibiofemoral joint, namely Open Knee, which includes detailed anatomical representation of the joint's major tissue structures, their nonlinear mechanical properties and interactions. Three use cases illustrate customization potential of the model, its predictive capacity, and its scientific and clinical utility: prediction of joint movements during passive flexion, examining the role of meniscectomy on contact mechanics and joint movements, and understanding anterior cruciate ligament mechanics. A summary of scientific and clinically directed studies conducted by other investigators are also provided. The utilization of this open source model by groups other than its developers emphasizes the premise of model sharing as an accelerator of simulation-based medicine. Finally, the imminent need to develop next generation knee models are noted. These are anticipated to incorporate individualized anatomy and tissue properties supported by specimen-specific joint mechanics data for evaluation, all acquired in vitro from varying age

  16. The Value of Admission Clinical Data for Diagnosing Heart Failure in Long-term Care

    Science.gov (United States)

    Heckman, George A.; Foebel, Andrea D.; Dubin, Joel A.; Ng, Jennifer; Turpie, Irene D.; Hussack, Patricia; McKelvie, Robert S.

    2013-01-01

    Background Heart failure (HF) is common in long-term care (LTC). Diagnostic uncertainty is important barrier to optimal HF management, stemming from inadequate health information transfer upon LTC admission. We determine the utility of admission clinical information to confirm a HF diagnosis in new LTC residents. Methods This was a prospective cohort study. From February 2004 to November 2006, information about new residents from 41 LTC homes in Ontario, Canada, was collected from residents and caregivers, and all available health records. A prior HF diagnosis was confirmed by consensus review of available data by two independent experts. Multivariate modelling was utilized to determine the utility of the admission clinical assessment in confirming a prior HF diagnosis. Results A total of 449 residents were included for analysis, aged 84.3±6.5 years, and 21.6% had a prior HF diagnosis. The most useful clinical item for diagnosing HF was a “history of HF”. The final model included “history of HF’ (OR [odds ratio] 13.66, 95% CI 6.61–28.24), “fluid on the lungs” (OR 2.01, 95% CI 1.04–3.89), “orthopnea” (OR 1.76, 95% CI 0.93–3.33), “taking β-blocker” (OR 2.09, 95% CI 1.10–3.94), “taking loop diuretics” (OR 2.11, 95% CI 1.12–3.98), and “history of coronary artery disease” (OR 2.83, 95% CI 1.42–5.64). Conclusion Elements of the clinical assessment for new LTC residents can help confirm a prior HF diagnosis. An admission history of HF is highly predictive. PMID:24278092

  17. Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

    Directory of Open Access Journals (Sweden)

    Marta Di Pasquale

    2016-02-01

    Full Text Available Hospital-acquired pneumonia (HAP is a frequent cause of nosocomial infections, responsible for great morbidity and mortality worldwide. The majority of studies on HAP have been conducted in patients hospitalized in the intensive care unit (ICU, as mechanical ventilation represents a major risk factor for nosocomial pneumonia and specifically for ventilator-associated pneumonia. However, epidemiological data seem to be different between patients acquiring HAP in the ICU vs. general wards, suggesting the importance of identifying non ICU-acquired pneumonia (NIAP as a clinical distinct entity in terms of both etiology and management. Early detection of NIAP, along with an individualized management, is needed to reduce antibiotic use and side effects, bacterial resistance and mortality. The present article reviews the pathophysiology, diagnosis, treatment and prevention of NIAP.

  18. The role of ethnicity in clinical psychopathology and care pathways of adults with intellectual disabilities.

    LENUS (Irish Health Repository)

    Tsakanikos, Elias

    2011-04-27

    The objective of this study was to explore whether people with intellectual disability from ethnic minority groups have higher rates of mental health problems and access different care pathways than their White counterparts. Clinical and socio-demographic data were collected for 806 consecutive new referrals to a specialist mental health service for people with intellectual disabilities in South London. Referrals were grouped according to their ethnic origin. The analyses showed that there was an over-representation of referrals from ethnic minority groups with diagnoses of schizophrenia spectrum disorder. In addition, Black participants were more likely to have an autistic spectrum disorder. Referrals of ethnic minority groups were considerably younger than White referrals, and less likely to be in supported residences. The results are discussed in the context of cultural and familial factors in particular ethnic groups that may play an important role in accessing and using mental health services.

  19. Non-Intensive Care Unit Acquired Pneumonia: A New Clinical Entity?

    Science.gov (United States)

    Di Pasquale, Marta; Aliberti, Stefano; Mantero, Marco; Bianchini, Sonia; Blasi, Francesco

    2016-01-01

    Hospital-acquired pneumonia (HAP) is a frequent cause of nosocomial infections, responsible for great morbidity and mortality worldwide. The majority of studies on HAP have been conducted in patients hospitalized in the intensive care unit (ICU), as mechanical ventilation represents a major risk factor for nosocomial pneumonia and specifically for ventilator-associated pneumonia. However, epidemiological data seem to be different between patients acquiring HAP in the ICU vs. general wards, suggesting the importance of identifying non ICU-acquired pneumonia (NIAP) as a clinical distinct entity in terms of both etiology and management. Early detection of NIAP, along with an individualized management, is needed to reduce antibiotic use and side effects, bacterial resistance and mortality. The present article reviews the pathophysiology, diagnosis, treatment and prevention of NIAP. PMID:26927074

  20. Clinical Innovation in pre-hospital care: An introduction to Critical Care Paramedics in the United Kingdom

    OpenAIRE

    Jashapara, Ashok

    2011-01-01

    The aim of the project was to evaluate the development of ‘Critical Care Paramedics’ (CCPs) at South East Coast Ambulance NHS Trust (SECAmb) in the UK. SECAmb has developed a new CCP role in response to numerous national reports critical of sub-standard pre-hospital care for seriously ill and injured patients, and the need to save more lives. There is an ongoing debate on the use of doctors and paramedics in pre-hospital care and the evidence is mixed whether one is more effective...

  1. Fixing the Sorting Algorithm for Android, Java and Python

    NARCIS (Netherlands)

    Gouw, C.P.T. de; Boer, F.S. de

    2015-01-01

    Tim Peters developed the Timsort hybrid sorting algorithm in 2002. TimSort was first developed for Python, a popular programming language, but later ported to Java (where it appears as java.util.Collections.sort and java.util.Arrays.sort). TimSort is today used as the default sorting algorithm in Ja

  2. German ambulatory care physicians' perspectives on clinical guidelines – a national survey

    Directory of Open Access Journals (Sweden)

    Böcken Jan

    2006-07-01

    Full Text Available Abstract Background There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a clinical practice guidelines (CPG and b evidence based medicine (EBM The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. Methods Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale. 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables. Results Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP as well as general practitioners (GP agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP or specialists (S (Student's t-test mean GP 2.57, S 2.84, p Conclusion Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs.

  3. Isolated inhalational injury: Clinical course and outcomes in a multidisciplinary intensive care unit

    Directory of Open Access Journals (Sweden)

    Jose Chacko

    2012-01-01

    Full Text Available Background and Aims: Although smoke inhalation is well known to cause acute lung injury, there are few reports in literature that study the evolution, clinical course and outcomes of isolated inhalational lung injury in a modern intensive care setting. A major fire disaster provided us the opportunity to study victims of isolated inhalational injury admitted to our Multidisciplinary Intensive Care Unit (MICU. Materials and Methods: We studied the clinical course, ICU and hospital outcomes of 13 victims of a fire disaster who required mechanical ventilation for isolated inhalational lung injury. All patients were followed up at regular intervals, and their functional status was assessed at 8 months after hospital discharge. Results: The Lung Injury Scores (LIS worsened to reach a nadir on Day 3 of injury. There was a significant correlation between the LIS on Day 3 and duration of mechanical ventilation (r = 0.8; P = 0.003, ICU (r = 0.8; P = 0.002 and hospital (r = 0.6; P = 0.02 days. Late-onset airway complications were encountered in four patients. Three of them required long-term artificial airways - two with a tracheostomy while the third patient required surgical insertion of a "T" tube. Persistent problems with phonation occurred in two patients. At 8 months postdischarge, all patients were independent with activities of daily living; all were back to work, except for two who continued to need artificial airways. Conclusions: Inhalational lung injury progresses over the first few days and is worst after 72 h. Late-onset airway complications may manifest after several weeks and require repeated intervention.

  4. Accountable Care Organizations and Clinical Commissioning Groups face an uncertain challenge for improving public health

    Directory of Open Access Journals (Sweden)

    Douglas J. Noble

    2012-04-01

    Full Text Available Accountable Care Organizations (ACO in the United States of America (USA and Clinical Commissioning Groups (CCG in the United Kingdom (UK are new proposed organizations in health services both tasked with a role which includes improving public health.  Although there are very significant differences between the UK and USA health systems there appears to be a similar confusion as to how ACO and CCG will regard and address public or population health.  The role of ACO in improving population health and evaluating the health needs of their registered and insured patients remains ill-defined and poorly explored.  Likewise, in the current UK National Health Service (NHS reorganisation, control and commissioning of appropriate local health services are passing from Primary Care Trusts (PCT to new cross-organizational structures (CCG.  CCG groups aim to be, like ACO, physician led.  They will also assume a role for public or population health, but this role, like that of the newly-forming ACO, is currently unclear.  Lessons learned from the USA and UK experience of new organizations tasked with a role in improving public health may inform mechanisms for physician led organizations in the UK and the USA to assess health needs, monitor population health information and improve population health outcomes.

  5. Implementation of cancer clinical care pathways: s successful model of collaboration between payers and providers.

    Science.gov (United States)

    Feinberg, Bruce A; Lang, James; Grzegorczyk, James; Stark, Donna; Rybarczyk, Thomas; Leyden, Thomas; Cooper, Joseph; Ruane, Thomas; Milligan, Scott; Stella, Phillip; Scott, Jeffrey A

    2012-05-01

    Despite rising medical costs within the US healthcare system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of healthcare in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the healthcare cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology healthcare consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program. PMID:22694114

  6. Characteristics of Patients Who Report Confusion After Reading Their Primary Care Clinic Notes Online.

    Science.gov (United States)

    Root, Joseph; Oster, Natalia V; Jackson, Sara L; Mejilla, Roanne; Walker, Jan; Elmore, Joann G

    2016-01-01

    Patient access to online electronic medical records (EMRs) is increasing and may offer benefits to patients. However, the inherent complexity of medicine may cause confusion. We elucidate characteristics and health behaviors of patients who report confusion after reading their doctors' notes online. We analyzed data from 4,528 patients in Boston, MA, central Pennsylvania, and Seattle, WA, who were granted online access to their primary care doctors' clinic notes and who viewed at least one note during the 1-year intervention. Three percent of patients reported confusion after reading their visit notes. These patients were more likely to be at least 70 years of age (p reading visit notes (relative risk [RR] 4.83; confidence interval [CI] 3.17, 7.36) compared to patients who were not confused. In adjusted analyses, they were less likely to report feeling more in control of their health (RR 0.42; CI 0.25, 0.71), remembering their care plan (RR 0.26; CI 0.17, 0.42), and understanding their medical conditions (RR 0.32; CI 0.19, 0.54) as a result of reading their doctors' notes compared to patients who were not confused. Patients who were confused by reading their doctors' notes were less likely to report benefits in health behaviors. Understanding this small subset of patients is a critical step in reducing gaps in provider-patient communication and in efforts to tailor educational approaches for patients. PMID:26529325

  7. Prevalence and factors affecting home blood pressure documentation in routine clinical care: a retrospective study

    Directory of Open Access Journals (Sweden)

    Babcock Kelly

    2010-05-01

    Full Text Available Abstract Background Home blood pressure (BP is closely linked to patient outcomes. However, the prevalence of its documentation has not been examined. The objective of this study was to analyze the prevalence and factors affecting documentation of home BP in routine clinical care. Methods A retrospective study of 142,973 encounters of 9,840 hypertensive patients with diabetes from 2000 to 2005 was performed. The prevalence of recorded home BP and the factors associated with its documentation were analyzed. We assessed validity of home BP information by comparing the difference between home and office BP to previously published prospective studies. Results Home BP was documented in narrative notes for 2.08% of encounters where any blood pressure was recorded and negligibly in structured data (EMR flowsheets. Systolic and diastolic home BP in narrative notes were lower than office BP readings by 9.6 and 2.5 mm Hg, respectively (p Conclusions Home BP readings provide a valid representation of the patient's condition, yet are seldom documented despite their potential utility in both patient care and research. Strong association between higher patient income and home BP documentation suggests that the cost of the monitors may be a limiting factor; reimbursement of home BP monitoring expenses should be pursued.

  8. The “CROMa” Project: A Care Pathway for Clinical Management of Patients with Bisphosphonate Exposure

    Directory of Open Access Journals (Sweden)

    Mauro Capocci

    2014-01-01

    Full Text Available Aim. To describe 7 years of activity of “CROMa” (Coordination of Research on Osteonecrosis of the Jaws project of “Sapienza” University of Rome. Materials and Methods. A preventive and therapeutic care pathway was created for patients with bisphosphonates (BPs exposure. Demographic, social, behavioural, pharmacological, and clinical variables were registered in a dedicated database. Results. In the project, 502 patients, 403 females and 99 males, were observed. Bone pathologies were 79% osteometabolic diseases (OMD and 21% metastatic cancer (CA. Females were 90% in OMD group and 41% in CA. BP administration was 54% oral, 31% IV, and 11% IM; 89% of BPs were amino-BP and 11% non-amino-BP. Consistently with bone pathology (OMD/CA, alendronate appears to be prevalent for OMD (40% relative, while zoledronate was indicated in 92% of CA patients. Out of 502 cases collected, 28 BRONJ were detected: 17 of them were related to IV BP treatment. Preventive oral assessment was required for 50% of CA patients and by 4% of OMD patients. Conclusions. The proposed care pathway protocols for BP exposed patients appeared to be useful to meet treatment and preventive needs, in both oncological and osteometabolic diseases patients. Patients’ and physicians’ prevention awareness can be the starting point of a multilevel prevention system.

  9. Clinical and economic efficacy of medical equipment at municipal health care institutions in megapolis

    Directory of Open Access Journals (Sweden)

    Gataullin M.R.

    2011-12-01

    Full Text Available Introduction of health insurance system provided modernization of medical facilities and equipment. High costs on medical equipment especially imported require economic analysis of its use. The aim of the study was to conduct clinical and economic analysis of efficacy of medical equipment use by municipal health care agencies in megapolis. Materials and methods: Annual reports on medical devices and anonymous questionnaires were included into the research. The study revealed the following results: more than 48,65% of medical equipment owned by hospitals exploited during 6-10 years and was retired. Due to insufficient funding only 49,13% of all medical equipment undergoes technical maintenance. Lack of equipment reduces the amount of free medical service. Conclusion: Health care institutions are provided with medical equipment in 30-40%. It results in quality of medical equipment in polyclinics and hospitals where up to 80% of technology is obsolete. Rational use of medical equipment makes possible to provide diagnostic assistance to population in megapolis

  10. Recent Clinical Characteristics of Labors Using Three Japanese Systems of Midwife-Led Primary Delivery Care

    Science.gov (United States)

    Suzuki, Shunji

    2016-01-01

    Objective. The objective of this study was to describe the recent clinical characteristics of labor using 3 systems of Japanese midwife-led primary delivery care, as follows: (1) those intending to give birth at home managed by midwives who do not belong to our hospital, (2) those planning to give birth in our hospital managed by the same midwives, and (3) those planning to give birth managed by midwives who belong to our hospital. Methods. A retrospective cohort study was performed. Results. There were no significant differences in the obstetric or neonatal outcomes among the 3 groups. The rate of transfers during labor with the system involving midwives belonging to our hospital was higher than those with the other 2 systems. In addition, the timing of transfers in the system with the midwives belonging to our hospital was earlier than with the other 2 systems. Among the 3 groups, there were no significant differences in the rate of the main 2 indications for transfers: fetal heart rate abnormality and failure to progress. Conclusion. There were no significant differences in perinatal outcomes among the 3 systems; however, there were some differences in the status of transfers to obstetric shared care. PMID:27034827

  11. Conflict of interest in online point-of-care clinical support websites.

    Science.gov (United States)

    Amber, Kyle T; Dhiman, Gaurav; Goodman, Kenneth W

    2014-08-01

    Point-of-care evidence-based medicine websites allow physicians to answer clinical queries using recent evidence at the bedside. Despite significant research into the function, usability and effectiveness of these programmes, little attention has been paid to their ethical issues. As many of these sites summarise the literature and provide recommendations, we sought to assess the role of conflicts of interest in two widely used websites: UpToDate and Dynamed. We recorded all conflicts of interest for six articles detailing treatment for the following conditions: erectile dysfunction, fibromyalgia, hypogonadism, psoriasis, rheumatoid arthritis and Crohn's disease. These diseases were chosen as their medical management is either controversial, or they are treated using biological drugs which are mostly available by brand name only. Thus, we hypothesised that the role of conflict of interest would be more significant in these conditions than in an illness treated with generic medications or by strict guidelines. All articles from the UpToDate articles demonstrated a conflict of interest. At times, the editor and author would have a financial relationship with a company whose drug was mentioned within the article. This is in contrast with articles on the Dynamed website, in which no author or editor had a documented conflict. We offer recommendations regarding the role of conflict of interest disclosure in these point-of-care evidence-based medicine websites. PMID:24493079

  12. Growth monitoring in the evolution of clinic based health care through a community based action program.

    Science.gov (United States)

    Chaudhuri, S N

    1988-01-01

    In Calcutta, India a voluntary organization was established in 1975 called the Child in Need Institute (CINI) in order to nutritionally rehabilitate the poor. CINI detected malnutrition by utilizing "weight for age" charts and treated malnutrition with food supplements. Women must purchase a growth card to enter the program. Patients are registered, weighed and plotted, given on ort demonstration, educated in health and nutrition, shown supplementary feeding techniques, given a health check up and immunizations, and are given antenatal care. The growth card is referred to at all stages of the care, which causes mothers to realize that it is very important to their health. CINI eventually established mobile clinics run by women's groups. 50% of all children under 3 participate monthly and 30% more participate at 2-3 month intervals. Mothers are more willing to correct the nutrition of their children when they understand the growth charts. The India Institute of Medical Sciences in 1986 assessed the KAP (knowledge, awareness, performance) of 132 village mothers. They found significant appreciation for growth monitoring. Mothers have also become more aware of the importance of sanitation, frequent feeding, and clean water. The growth chart is a tool, but is also viewed as a symbol of the activities of CINI. PMID:3391668

  13. Health care consumers’ perspectives on pharmacist integration into private general practitioner clinics in Malaysia: a qualitative study

    Directory of Open Access Journals (Sweden)

    Saw PS

    2015-03-01

    Full Text Available Pui San Saw,1 Lisa M Nissen,2,3 Christopher Freeman,2,4 Pei Se Wong,3 Vivienne Mak5 1School of Postgraduate Studies and Research, International Medical University, Kuala Lumpur, Malaysia; 2School of Clinical Sciences, Queensland University Technology, Brisbane, QLD, Australia; 3School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia; 4School of Pharmacy, University of Queensland, St Lucia, QLD, Australia; 5School of Pharmacy, Monash University Malaysia, Selangor, Malaysia Background: Pharmacists are considered medication experts but are underutilized and exist mainly at the periphery of the Malaysian primary health care team. Private general practitioners (GPs in Malaysia are granted rights under the Poison Act 1952 to prescribe and dispense medications at their primary care clinics. As most consumers obtain their medications from their GPs, community pharmacists’ involvement in ensuring safe use of medicines is limited. The integration of a pharmacist into private GP clinics has the potential to contribute to quality use of medicines. This study aims to explore health care consumers’ views on the integration of pharmacists within private GP clinics in Malaysia.Methods: A purposive sample of health care consumers in Selangor and Kuala Lumpur, Malaysia, were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analyzed using NVivo 10. Results: A total of 24 health care consumers participated in two focus groups and six semi-structured interviews. Four major themes were identified: 1 pharmacists’ role viewed mainly as supplying medications, 2 readiness to accept pharmacists in private GP clinics, 3 willingness to pay for pharmacy services, and 4 concerns about GPs’ resistance to pharmacist integration. Consumers felt that a pharmacist integrated into a private GP clinic could offer potential benefits such as to provide trustworthy

  14. Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative.

    Science.gov (United States)

    Frayne, Daniel J; Verbiest, Sarah; Chelmow, David; Clarke, Heather; Dunlop, Anne; Hosmer, Jennifer; Menard, M Kathryn; Moos, Merry-K; Ramos, Diana; Stuebe, Alison; Zephyrin, Laurie

    2016-05-01

    Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care system. The Clinical Workgroup of the National Preconception Health and Health Care Initiative proposes nine core measures that can be assessed at initiation of prenatal care to index a woman's preconception wellness. A two-stage web-based modified Delphi survey and a face-to-face meeting of key opinion leaders in women's reproductive health resulted in identifying seven criteria used to determine the core measures. The Workgroup reached unanimous agreement on an aggregate of nine preconception wellness measures to serve as a surrogate but feasible assessment of quality preconception care within the larger health community. These include indicators for: 1) pregnancy intention, 2) access to care, 3) preconception multivitamin with folic acid use, 4) tobacco avoidance, 5) absence of uncontrolled depression, 6) healthy weight, 7) absence of sexually transmitted infections, 8) optimal glycemic control in women with pregestational diabetes, and 9) teratogenic medication avoidance. The focus of the proposed measures is to quantify the effect of health care systems on advancing preconception wellness. The Workgroup recommends that health care systems adopt these nine preconception wellness measures as a metric to monitor performance of preconception care practice. Over time, monitoring these baseline measures will establish benchmarks and allow for comparison within and among regions, health care systems, and communities to drive improvements. PMID:27054935

  15. The one-stop clinic as the standard of out-patient care in a hospital urology department

    OpenAIRE

    Alvaro Páez; Enrique Redondo; Javier Sáenz; Mercedes Marín; Nuria Juárez; Manuel Durán

    2011-01-01

    PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians invol...

  16. Assessment of oral self-care in patients with periodontitis: a pilot study in a dental school clinic in Japan

    OpenAIRE

    Masuda Hitomi; Hayakawa Hiroki; Matsumoto Shinya; Ueshima Fumie; Kikuchi Momomi; Saito Atsushi; Makiishi Takemi

    2009-01-01

    Abstract Background Oral hygiene education is central to every stage of periodontal treatment. Successful management of periodontal disease depends on the patient's capacity for oral self-care. In the present study, the oral self-care and perceptions of patients attending a dental school clinic in Japan were assessed using a short questionnaire referring to existing oral health models. Methods A cross-sectional study design was used. The study population consisted of sixty-five patients (age ...

  17. Patient safety culture in Norwegian primary care: a study in out-of-hours casualty clinics and GP practices

    OpenAIRE

    2014-01-01

    Objective. This study aimed to investigate patient safety attitudes amongst health care providers in Norwegian primary care by using the Safety Attitudes Questionnaire, in both out-of-hours (OOH) casualty clinics and GP practices. The questionnaire identifies five major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions. Design. Cross-sectional study. Statistical analysis included multiple linear regression and indepen...

  18. Patient safety culture in Norwegian primary care: a study in out-of-hours casualty clinics and GP practices

    OpenAIRE

    Bondevik, Gunnar Tschudi; Hofoss, Dag; Hansen, Elisabeth Holm; Deilkås, Ellen Catharina Tveter

    2014-01-01

    Abstract Objective. This study aimed to investigate patient safety attitudes amongst health care providers in Norwegian primary care by using the Safety Attitudes Questionnaire, in both out-of-hours (OOH) casualty clinics and GP practices. The questionnaire identifies five major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions. Design. Cross-sectional study. Statistical analysis included multiple linear regression an...

  19. Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: a randomized controlled trial

    OpenAIRE

    Junod Perron, Noëlle Astrid; Dominice Dao, Mélissa; Righini, Nadia Camparini; Humair, Jean-Paul Luc André; Broers Kayser, Barbara; Narring, Françoise; Haller-Hester, Dagmar; Gaspoz, Jean-Michel

    2013-01-01

    Background Telephone or text-message reminders have been shown to significantly reduce the rate of missed appointments in different medical settings. Since text-messaging is less resource-demanding, we tested the hypothesis that text-message reminders would be as effective as telephone reminders in an academic primary care clinic. Methods A randomized controlled non-inferiority trial was conducted in the academic primary care division of the Geneva University Hospitals between November 2010 a...

  20. Highlights From the Third Annual Mayo Clinic Conference on Systems Engineering and Operations Research in Health Care

    OpenAIRE

    Kamath, Janine R. A.; Osborn, John B; Roger, Véronique L; Rohleder, Thomas R.

    2011-01-01

    In August 2010, the Third Annual Mayo Clinic Conference on Systems Engineering and Operations Research in Health Care was held. The continuing mission of the conference is to gather a multidisciplinary group of systems engineers, clinicians, administrators, and academic professors to discuss the translation of systems engineering methods to more effective health care delivery. Education, research, and practice were enhanced via a mix of formal presentations, tutorials, and informal gatherings...

  1. Acceptability and feasibility of integration of HIV care services into antenatal clinics in rural Kenya: A qualitative provider interview study

    OpenAIRE

    Winestone, Lena E.; Bukusi, Elizabeth A.; Cohen, Craig R.; Kwaro, Daniel; Kley, Nicole; Turan, Janet M.

    2011-01-01

    The aim of this study was to explore the perspectives of healthcare providers on the advantages and disadvantages of integrating HIV care services, including highly active antiretroviral therapy (HAART), into antenatal care (ANC) clinics in rural Kenya. We conducted a qualitative study using in-depth interviews and thematic analysis; 36 healthcare providers from 6 health centres in Nyanza Province, Kenya participated. Effects on service providers included increased workload due to the incorpo...

  2. Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa

    OpenAIRE

    Maphuthego D. Mathibe; Stephen J.H. Hendricks; Anne-Marie Bergh

    2015-01-01

    Background: Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration.Objective: This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics.Meth...

  3. Patient safety culture in Norwegian primary care: A study in out-of-hours casualty clinics and GP practices

    OpenAIRE

    2014-01-01

    Abstract Objective. This study aimed to investigate patient safety attitudes amongst health care providers in Norwegian primary care by using the Safety Attitudes Questionnaire, in both out-of-hours (OOH) casualty clinics and GP practices. The questionnaire identifies five major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions. Design. Cross-sectional study. Statistical analysis included multiple linear regression an...

  4. Prevention of ventilator-associated pneumonia in the intensive care unit: A review of the clinically relevant recent advancements

    OpenAIRE

    Holly Keyt; Paola Faverio; Restrepo, Marcos I.

    2014-01-01

    Ventilator-associated pneumonia (VAP) is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged. In this article we will review recent literature pertaining to evidence-based VAP-prevention strategies that have resulted in clinical...

  5. Considerations in Applying the Results of Randomized Controlled Clinical Trials to the Care of Older Adults With Kidney Disease in the Clinical Setting: The SHARP Trial.

    Science.gov (United States)

    Butler, Catherine R; O'Hare, Ann M

    2016-01-01

    The Study of Heart and Renal Protection (SHARP) found that treatment with ezetemibe and low-dose simvastatin reduced the incidence of major atherosclerotic events in patients with kidney disease. Due to the paucity of evidence-based interventions that lower cardiovascular morbidity in this high-risk population, the SHARP trial will likely have a large impact on clinical practice. However, applying the results of clinical trials conducted in select populations to the care of individual patients in real-world settings can be fraught with difficulty. This is especially true when caring for older adults with complex comorbidity and limited life expectancy. These patients are often excluded from clinical trials, frequently have competing health priorities, and may be less likely to benefit and more likely to be harmed by medications. We discuss key considerations in applying the results of the SHARP trial to the care of older adults with CKD in real-world clinical settings using guiding principles set forth by the American Geriatrics Society's Expert Panel on the Care of Older Adults with Multimorbidity. Using this schema, we emphasize the importance of evaluating trial results in the unique context of each patient's goals, values, priorities, and circumstances. PMID:26709060

  6. Patterns of retention in clinical care among HIV-positive men in the UK CHIC Study

    Directory of Open Access Journals (Sweden)

    G Sethi

    2012-11-01

    Full Text Available We examined disparities in engagement and retention-in-care among men in the UK Collaborative HIV Cohort (CHIC Study according to ethnic group and mode of HIV infection. All male subjects in UK CHIC from 1996–2011 were included. We considered factors associated with both initial engagement (follow-up>1 day and consistent retention in care (no interval between consecutive CD4/viral load (VL measures>6 months. Logistic regression was used to identify associations with ethnic group and mode of HIV infection after adjusting for covariates at study entry (age, year, use of antiretrovirals (ART, AIDS. Analyses of retention also adjusted for VL/CD4 at entry and clinic. The 33210 men had a median (interquartile range age of 36 (30,42 years at study entry, ethnic group was white (21851, 65.8%, black African (4374, 13.2%, black other (1539, 4.6%, Asian (967, 2.9%, other (2337, 7.0% and unknown (2142, 6.5%. Mode of infection was sex between men (MSM (22260, 67.0%, heterosexual sex (HET (6286, 18.9%, other (1556, 4.7% and unknown (3108, 9.4%. 32045 (96.5% men were initially engaged in care, with no major differences by ethnic group after adjustment. Compared to MSM, initial engagement was less likely in those with heterosexual (adjusted odds ratio 0.77 [95% confidence interval 0.63–0.95] or other (0.43 [0.33–0.56] modes of infection. Other factors associated with initial engagement were older age, receipt of ART and having AIDS at entry; those entering UK CHIC in 2008–2011 were less likely to engage due to the shorter follow-up time. Of the men initially engaged in care, 12644 (44.0% were consistently retained with no interval between consecutive CD4/VL>6 months. Consistent retention was more likely in MSM than in those with other modes of infection (HET: 0.76 [0.68–0.84]; other 0.54 [0.46–0.62]. Ethnic group again did not impact greatly on subsequent retention. Other independent predictors of retention were older age, receipt of ART and AIDS at

  7. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Directory of Open Access Journals (Sweden)

    Joke Bilcke

    Full Text Available This is one of the first studies to (1 describe the out-of-hospital burden of influenza-like-illness (ILI and clinically diagnosed flu, also for patients not seeking professional medical care, (2 assess influential background characteristics, and (3 formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever, a longer duration of illness, more use of medication (especially antibiotics and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries.

  8. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries. PMID:25032688

  9. Influenza-Like-Illness and Clinically Diagnosed Flu: Disease Burden, Costs and Quality of Life for Patients Seeking Ambulatory Care or No Professional Care at All

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011–2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5–6 symptoms over a 6-day period; required 1.6 physician visits and 86–91% took medication. An average episode amounted to €51–€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries. PMID:25032688

  10. Successful Integration of Hepatitis C Virus Point-of-Care Tests into the Denver Metro Health Clinic.

    Science.gov (United States)

    Jewett, A; Al-Tayyib, A A; Ginnett, L; Smith, B D

    2013-01-01

    Background. The Centers for Disease Control and Prevention (CDC) recommends testing and linkage to care for persons most likely infected with hepatitis C virus (HCV), including persons with human immunodeficiency virus. We explored facilitators and barriers to integrating HCV point-of-care (POC) testing into standard operations at an urban STD clinic. Methods. The OraQuick HCV rapid antibody test was integrated at the Denver Metro Health Clinic (DMHC). All clients with at least one risk factor were offered the POC test. Research staff conducted interviews with clients (three HCV positive and nine HCV negative). Focus groups were conducted with triage staff, providers, and linkage-to-care counselors. Results. Clients were pleased with the ease of use and rapid return of results from the HCV POC test. Integrating the test into this setting required more time but was not overly burdensome. While counseling messages were clear to staff, clients retained little knowledge of hepatitis C infection or factors related to risk. Barriers to integrating the HCV POC test into clinic operations were loss to follow-up and access to care. Conclusion. DMHC successfully integrated HCV POC testing and piloted a HCV linkage-to-care program. Providing testing opportunities at STD clinics could increase identification of persons with HCV infection. PMID:24455220

  11. Successful Integration of Hepatitis C Virus Point-of-Care Tests into the Denver Metro Health Clinic

    Directory of Open Access Journals (Sweden)

    A. Jewett

    2013-01-01

    Full Text Available Background. The Centers for Disease Control and Prevention (CDC recommends testing and linkage to care for persons most likely infected with hepatitis C virus (HCV, including persons with human immunodeficiency virus. We explored facilitators and barriers to integrating HCV point-of-care (POC testing into standard operations at an urban STD clinic. Methods. The OraQuick HCV rapid antibody test was integrated at the Denver Metro Health Clinic (DMHC. All clients with at least one risk factor were offered the POC test. Research staff conducted interviews with clients (three HCV positive and nine HCV negative. Focus groups were conducted with triage staff, providers, and linkage-to-care counselors. Results. Clients were pleased with the ease of use and rapid return of results from the HCV POC test. Integrating the test into this setting required more time but was not overly burdensome. While counseling messages were clear to staff, clients retained little knowledge of hepatitis C infection or factors related to risk. Barriers to integrating the HCV POC test into clinic operations were loss to follow-up and access to care. Conclusion. DMHC successfully integrated HCV POC testing and piloted a HCV linkage-to-care program. Providing testing opportunities at STD clinics could increase identification of persons with HCV infection.

  12. Building relationships with physicians. Internal marketing efforts help strengthen organizational bonds at a rural health care clinic.

    Science.gov (United States)

    Peltier, J W; Boyt, T; Westfall, J E

    1997-01-01

    Physician turnover is costly for health care organizations, especially for rural organizations. One approach management can take to reduce turnover is to promote physician loyalty by treating them as an important customer segment. The authors develop an information--oriented framework for generating physician loyalty and illustrate how this framework has helped to eliminate physician turnover at a rural health care clinic. Rural health care organizations must develop a more internal marketing orientation in their approach to establishing strong relationship bonds with physicians. PMID:10173904

  13. Retention in Early Care at an HIV Outpatient Clinic in Rio de Janeiro, Brazil, 2000–2013

    OpenAIRE

    Silva, DS; de Boni, RB; Lake, JE; Cardoso, SW; S. Ribeiro; Moreira, RI; Clark, JL; Veloso, VG; B Grinsztejn; Luz, PM

    2016-01-01

    © 2015 Springer Science+Business Media New York Retention in early HIV care has been associated with virologic suppression and improved survival, but remains understudied in Brazil. We estimated retention in early HIV care for the period 2000–2013, and identified socio-demographic and clinical factors associated with good retention in an urban cohort from Rio de Janeiro, Brazil. Antiretroviral therapy-naïve, HIV-infected persons ≥18 years old linked to care between 2000 and 2011 were included...

  14. Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care

    Directory of Open Access Journals (Sweden)

    Sissel Steihaug

    2016-07-01

    Full Text Available Introduction: This article summarizes and synthesizes the findings of four separate but inter-linked empirical projects which explored challenges of collaboration in the Norwegian health system from the perspectives of providers and patients. The results of the four projects are summarised in eight articles. Methods: The eight articles constituted our empirical material. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work. Results: Providers’ collaboration across all contexts was hampered by organizational and individual factors, including, differences in professional power, knowledge bases, and professional culture. The lack of appropriate collaboration between providers impeded clinical work. Mental health service users experienced fragmented services leading to insecurity and frustration. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients. Conclusion: Focusing on the different perspectives and the inequality in power between patients and healthcare providers and between different providers might contribute to a better environment for achieving appropriate collaboration. Organizational systems need to be redesigned to better nurture collaborative relationships and information sharing and support integrated working between providers, health care professionals and patients.

  15. Colorectal adenomatous polyposis syndromes: Genetic determinism, clinical presentation and recommendations for care.

    Science.gov (United States)

    Buecher, Bruno

    2016-02-01

    Colorectal adenomatous polyposis constitutes a diverse group of disorders with different modes of inheritance. Molecular diagnosis of this condition has become more complex. In fact, somatic mosaicism for APC mutations now appears to be more frequent than previously thought and rare germline alterations of this gene may be implicated in patients tested negative for "classical" APC mutations (point mutations and large genomic rearrangements). Moreover, the knowledge concerning several aspects of the MUTYH-associated polyposis has improved since its first description in 2002 and germline mutations in new genes have recently been implicated in some cases of unexplained adenomatous polyposis. Genetic testing in probands and their relatives should be conducted in the context of pre- and post-test genetic counseling. The recent advent of New Generation Sequencing (NGS) techniques affords the opportunity to rapidly screen patients for a comprehensive panel of colorectal cancer susceptibility genes in a cost-effective fashion. This type of approach will probably replace the classical sequential approach based on clinical presumptive diagnoses in the near future. The risk of colorectal cancer is very high in affected patients in the absence of appropriate care. Clinical management is complex and should be provided in centers with special expertise in these diseases. This review focuses on the various colorectal adenomatous polyposis syndromes with special attention to more innovative and important aspects. PMID:26805944

  16. Prevalence of Aspergillus species in clinical samples isolated in an Indian tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Xess Immaculata

    2004-12-01

    Full Text Available CONTEXT (BACKGROUND: In recent times, it has become important to determine the prevalence of different Aspergillus species in clinical samples in view of difference in antifungal susceptibility noted in some species. AIMS: To determine the species prevalence of Aspergillus isolates in various clinical samples received in the Mycology Laboratory at our institute. METHOD: Over a period of 4-years, a total of 18,731 samples were processed, and species identification carried out by standard microbiological methods. RESULTS: Four hundred and fifty six samples (2.43% were culture positive for Aspergillus species. A.flavus (46.93% was the most common isolate, followed by A.fumigatus (37.72% and A.niger (15.35%. It was observed that A.fumigatus was the predominant species isolated from blood and respiratory specimens, A.flavus was predominantly isolated from nasal polyps whereas A.niger predominated in nail specimens. Culture positivity was highest in the age group 12-65 years and in males. Sixty-nine patients (15.13% were admitted to the intensive care unit. CONCLUSIONS: The study highlights the diverse manifestations caused by Aspergillus species in human beings and also throws light on the different species prevalent locally. The knowledge would prove useful in selecting empirical antifungal therapy and formulating prophylactic and pre-emptive strategies.

  17. Extending Our Understanding of Burnout and Its Associated Factors: Providers and Staff in Primary Care Clinics.

    Science.gov (United States)

    Spinelli, William M; Fernstrom, Karl M; Galos, Dylan L; Britt, Heather R

    2016-09-01

    Burnout has been identified as an occupational hazard in the helping professions for many years and is often overlooked, as health-care systems strive to improve cost and quality. The Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS) are tools for assessing burnout prevalence and its associated factors. We describe how we used them in outpatient clinics to assess burnout for multiple job types. Traditional statistical techniques and seemingly unrelated regression were used to describe the sample and evaluate the association between work life domains and burnout. Of 838 eligible participants, 467 (55.7%) were included for analysis. Burnout prevalence varied across three job categories: providers (37.5%), clinical assistants (24.6%), and other staff (28.0%). It was not related to age, gender, or years of tenure but was lower in part-time workers (24.6%) than in full-time workers (33.9%). Analysis of the AWS subscales identified organizational correlates of burnout. Accurately identifying and defining the operative system factors associated with burnout will make it possible to create successful interventions. Using the MBI and the AWS together can highlight the relationship between system work experiences and burnout. PMID:27000131

  18. CLINICAL OUTCOME WITH ADD ON RACECADOTRIL VERSUS STANDARD CARE IN PAEDIATRIC GASTROENTERITIS – OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Vijayalakshmi

    2016-02-01

    Full Text Available BACKGROUND Acute gastroenteritis (AGE is a diarrheal disease of rapid onset, with an increase in the water content, volume, or frequency of stools and often self-limiting. The WHO recommends ORS as the treatment of choice for children with mild to moderate gastroenteritis in both developed and developing countries. Racecadotril, an intestinal enkephalinase inhibitor, has been used as treatment because it would decrease the duration of acute diarrhea and fluid loss. Racecadotril has sufficient proven efficacy in the treatment of acute diarrhea in children. We evaluated the clinical outcome with add on Racecadotril versus standard care in paediatric gastroenteritis. METHODS This open-label randomized study was undertaken at department of Pediatrics, Medical College, for a period of two years. A total 42 children, age group between 3- 10 years of age having watery non-bloody diarrhea with mild to moderate dehydration were enrolled in the study. Patients with severe dehydration, bloody diarrhea or hypersensitivity to Racecadotril were excluded from the study. The patients were randomly assigned to receive intravenous rehydration therapy + Racecadotril (1.5mg/Kg three times a day or intravenous rehydration therapy alone. The bedside nurse or care giver was instructed to administer the medication. All patients received standardized follow - up care for 7 days. The primary outcomes recorded were percentage of patients having diarrhea, median Stool frequency and percentage of patients switched to complete oral re-rehydration on day 3 and day-7. RESULTS Out of 42 children in each group whose data were analyzed, 27 patients received intravenous rehydration therapy + Racecadotril (1.5mg/Kg three times a day and remaining 15 received intravenous rehydration therapy alone. All patients were age and gender matched, however percentage of patients who were moderately dehydrated were marginally higher in Racecadotril add on group. More than 50% reduction in

  19. The clinical safety of disabled patients: Proposal for a methodology for analysis of health care risks and specific measures for improvement

    OpenAIRE

    Perea Pérez, Bernardo; Labajo González, María Elena; Bratos Murillo, Manuel; Santiago Sáez, Andrés; Albarrán Juan, María Elena; Villa Vigil, Manuel Alfonso

    2013-01-01

    The clinical risks associated with health care have been a known factor since ancient times, and their prevention has constituted one of the foundations of health care. However, concern for the risks involved in health care treatments has risen very significantly in recent years, becoming a modern current of concern for clinical health care risks which is referred to by the name of “patient safety” in the scientific literature. Unfortunately, there are no studies on patient safety in dental p...

  20. Fast algorithms for sorting and searching strings

    Energy Technology Data Exchange (ETDEWEB)

    Bentley, J.L. [Bell Labs., Murray Hill, NJ (United States); Sedgewick, R. [Princeton Univ., NJ (United States)

    1997-06-01

    We present theoretical algorithms for sorting and searching multikey data, and derive from them practical C implementations for applications in which keys are character strings. The sorting algorithm blends Quicksort and radix sort; it is competitive with the best known C sort codes. The searching algorithm blends tries and binary search trees; it is faster than hashing and other commonly used search methods. The basic ideas behind the algorithms date back at least to the 1960s, but their practical utility has been overlooked. We also present extensions to more complex string problems, such as partial-match searching.

  1. Unrecognized Norovirus Infections in Health Care Institutions and Their Clinical Impact

    Science.gov (United States)

    Sukhrie, Faizel H. A.; Bogerman, Jolanda; Verhoef, Linda; Mde Melo, Mariana; Vonk, Alieke G.; Koopmans, Marion

    2012-01-01

    Noroviruses (NoVs) have emerged as the leading cause of acute viral gastroenteritis (GE) in humans. Although diagnostic facilities have greatly improved, significant underdiagnosis of NoV in hospitals may still occur, thereby increasing clinical burden and nosocomial spread. We evaluated the underdiagnosis of sporadic NoV infections in a tertiary care hospital and estimated its clinical impact. From December 2008 until July 2009, fecal samples specifically referred for bacterial but not viral examination were retrospectively tested for NoV by real-time PCR. The clinical and virological data from patients with undiagnosed NoV infection (missed patients) were evaluated and compared with those from patients with recognized NoV. During the study period, 45 patients with undiagnosed NoV were detected, whereas 50 patients were regularly diagnosed. The missed NoV cases were more frequently adults than children (80% versus 46%; P < 0.001). The viral load levels did not differ between the diagnosed and missed patients, but missed patients more frequently presented without diarrhea (20% versus 4%; P < 0.07). The newly admitted missed NoV cases with GE underwent more diagnostic imaging (24% versus 4%; P < 0.01) and tended to be hospitalized longer. When missed-NoV patients were included, the number of nosocomial clusters doubled and missed patients were index cases in 5 of the 6 clusters. These data indicate that NoV infections are frequently missed despite routine laboratory testing and demonstrate that underdiagnosis of NoV patients is associated with costly abdominal imaging and nosocomial clustering. Awareness of NoV infection in adult patients and education about the importance of viral GE should be increased. PMID:22785184

  2. Nutritional Care of Gastric Cancer Patients with Clinical Outcomes and Complications: A Review.

    Science.gov (United States)

    Choi, Wook Jin; Kim, Jeongseon

    2016-04-01

    The incidence and mortality of gastric cancer have been steadily decreased over the past few decades. However, gastric cancer is still one of the leading causes of cancer deaths across many regions of the world, particularly in Asian countries. In previous studies, nutrition has been considered one of significant risk factors in gastric cancer patients. Especially, malnourished patients are at greater risk of adverse clinical outcomes (e.g., longer hospital stay) and higher incidence of complications (e.g., wound/infectious complications) compared to well-nourished patients. Malnutrition is commonly found in advanced gastric cancer patients due to poor absorption of essential nutrients after surgery. Therefore, nutritional support protocols, such as early oral and enternal feeding, have been proposed in many studies, to improve unfavorable clinical outcomes and to reduce complications due to delayed application of oral nutritional support or parental feeding. Also, the supplied with enternal immune-enriched diet had more benefits in improving clinical outcomes and fewer complications compared to a group supplied with control formula. Using nutritional screening tools, such as nutritional risk index (NRI) and nutritional risk screening (NRS 2002), malnourished patients showed higher incidence of complications and lower survival rates than non-malnourished patients. However, a long-term nutritional intervention, such as nutritional counseling, was not effective in the patients. Therefore, early assessment of nutritional status in patients using a proper nutritional screening tool is suggested to prevent malnutrition and adverse health outcomes. Further studies with numerous ethnic groups may provide stronger scientific evidences in association between nutritional care and recovery from surgery in patients with gastric cancer. PMID:27152296

  3. Nutritional Care of Gastric Cancer Patients with Clinical Outcomes and Complications: A Review

    Science.gov (United States)

    Choi, Wook Jin

    2016-01-01

    The incidence and mortality of gastric cancer have been steadily decreased over the past few decades. However, gastric cancer is still one of the leading causes of cancer deaths across many regions of the world, particularly in Asian countries. In previous studies, nutrition has been considered one of significant risk factors in gastric cancer patients. Especially, malnourished patients are at greater risk of adverse clinical outcomes (e.g., longer hospital stay) and higher incidence of complications (e.g., wound/infectious complications) compared to well-nourished patients. Malnutrition is commonly found in advanced gastric cancer patients due to poor absorption of essential nutrients after surgery. Therefore, nutritional support protocols, such as early oral and enternal feeding, have been proposed in many studies, to improve unfavorable clinical outcomes and to reduce complications due to delayed application of oral nutritional support or parental feeding. Also, the supplied with enternal immune-enriched diet had more benefits in improving clinical outcomes and fewer complications compared to a group supplied with control formula. Using nutritional screening tools, such as nutritional risk index (NRI) and nutritional risk screening (NRS 2002), malnourished patients showed higher incidence of complications and lower survival rates than non-malnourished patients. However, a long-term nutritional intervention, such as nutritional counseling, was not effective in the patients. Therefore, early assessment of nutritional status in patients using a proper nutritional screening tool is suggested to prevent malnutrition and adverse health outcomes. Further studies with numerous ethnic groups may provide stronger scientific evidences in association between nutritional care and recovery from surgery in patients with gastric cancer. PMID:27152296

  4. Factors that influence the clinical decision-making of rehabilitation professionals in long-term care settings.

    Science.gov (United States)

    Wainwright, Susan Flannery; McGinnis, Patricia Quinn

    2009-01-01

    The purpose of this qualitative research was to evaluate the reasoning of clinicians practicing in long-term care facilities and to explore factors influencing their professional development. Eighteen participants were recruited from eight clinical sites and included seven occupational therapists, eight physical therapists, and three speech therapists distributed across three groups relative to experience. Nonparticipant observation and videotape of therapist-patient interactions were used in semi-structured interviews with each participant. Qualitative data analysis software was used during a process of open and axial coding, followed by thematic analysis. The facilitory and inhibitory factors that affect clinical reasoning and professional development were identified. Rehabilitation professionals in long-term care demonstrated clinical reasoning within the context of patient-centered goals. Well-developed and explicit programs for mentorship, professional development, and continuing education fostered their clinical reasoning abilities. Participants perceived that these factors were vital to achieving optimal patient outcomes. PMID:19753425

  5. Utility of routine data sources for feedback on the quality of cancer care: an assessment based on clinical practice guidelines

    Directory of Open Access Journals (Sweden)

    Baade Peter

    2009-05-01

    Full Text Available Abstract Background Not all cancer patients receive state-of-the-art care and providing regular feedback to clinicians might reduce this problem. The purpose of this study was to assess the utility of various data sources in providing feedback on the quality of cancer care. Methods Published clinical practice guidelines were used to obtain a list of processes-of-care of interest to clinicians. These were assigned to one of four data categories according to their availability and the marginal cost of using them for feedback. Results Only 8 (3% of 243 processes-of-care could be measured using population-based registry or administrative inpatient data (lowest cost. A further 119 (49% could be measured using a core clinical registry, which contains information on important prognostic factors (e.g., clinical stage, physiological reserve, hormone-receptor status. Another 88 (36% required an expanded clinical registry or medical record review; mainly because they concerned long-term management of disease progression (recurrences and metastases and 28 (11.5% required patient interview or audio-taping of consultations because they involved information sharing between clinician and patient. Conclusion The advantages of population-based cancer registries and administrative inpatient data are wide coverage and low cost. The disadvantage is that they currently contain information on only a few processes-of-care. In most jurisdictions, clinical cancer registries, which can be used to report on many more processes-of-care, do not cover smaller hospitals. If we are to provide feedback about all patients, not just those in larger academic hospitals with the most developed data systems, then we need to develop sustainable population-based data systems that capture information on prognostic factors at the time of initial diagnosis and information on management of disease progression.

  6. Predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care.

    OpenAIRE

    Huntington, S. E.; Thorne, C.; Bansi, L. K.; Anderson, J.; Newell, M. L.; Taylor, G P; Pillay, D.; Hill, T; Tookey, P A; Sabin, C.A.; UK Collaborative HIV Cohort Study and the National Stu

    2013-01-01

    OBJECTIVES: To describe predictors of pregnancy and changes in pregnancy incidence among HIV-positive women accessing HIV clinical care. METHODS: Data were obtained through the linkage of two separate studies: the UK Collaborative HIV Cohort study (UK CHIC), a cohort of adults attending 13 large HIV clinics; and the National Study of HIV in Pregnancy and Childhood (NSHPC), a national surveillance study of HIV-positive pregnant women. Pregnancy incidence was measured using the proportion of wo...

  7. Patient involvement in decision-making: a cross-sectional study in a Malaysian primary care clinic

    OpenAIRE

    Ambigapathy, Ranjini; Chia, Yook Chin; Ng, Chirk Jenn

    2016-01-01

    Objective Shared decision-making has been advocated as a useful model for patient management. In developing Asian countries such as Malaysia, there is a common belief that patients prefer a passive role in clinical consultation. As such, the objective of this study was to determine Malaysian patients’ role preference in decision-making and the associated factors. Design A cross-sectional study. Setting Study was conducted at an urban primary care clinic in Malaysia in 2012. Participants Patie...

  8. Male, Mobile, and Moneyed: Loss to Follow-Up vs. Transfer of Care in an Urban African Antiretroviral Treatment Clinic

    OpenAIRE

    Marson, Kara G.; Tapia, Kenneth; Kohler, Pamela; McGrath, Christine J.; John-Stewart, Grace C.; Richardson, Barbra A.; Njoroge, Julia W.; Kiarie, James N.; Sakr, Samah R.; Michael H Chung

    2013-01-01

    Objectives The purpose of this study was to analyze characteristics, reasons for transferring, and reasons for discontinuing care among patients defined as lost to follow-up (LTFU) from an antiretroviral therapy (ART) clinic in Nairobi, Kenya. Design The study used a prospective cohort of patients who participated in a randomized, controlled ART adherence trial between 2006 and 2008. Methods Participants were followed from pre-ART clinic enrollment to 18 months after ART initiation, and were ...

  9. NATURE OF PRECEPTORSHIP AND ITS IMPACT ON CLINICAL NURSING CARE FROM THE PERSPECTIVES OF RELEVANT NURSING STAFF

    OpenAIRE

    Bukhari, Elham

    2012-01-01

    THE UNIVERSITY OF MANCHESTERABSTRACT OF THESIS submitted by Elham Ali Bukhari for the degree of Doctor of Philosophy and entitled Nature of preceptorship and its impact on clinical nursing care from the perspectives of relevant nursing staff. December 2011____________________________________________________________________Background: previous studies have revealed that newly hired nurses experience stress and anxiety when entering a new clinical setting. Failure to support and prepare these n...

  10. Design and realization of sort manipulator of crystal-angle sort machine

    Science.gov (United States)

    Wang, Ming-shun; Chen, Shu-ping; Guan, Shou-ping; Zhang, Yao-wei

    2005-12-01

    It is a current tendency of development in automation technology to replace manpower with manipulators in working places where dangerous, harmful, heavy or repetitive work is involved. The sort manipulator is installed in a crystal-angle sort machine to take the place of manpower, and engaged in unloading and sorting work. It is the outcome of combing together mechanism, electric transmission, and pneumatic element and micro-controller control. The step motor makes the sort manipulator operate precisely. The pneumatic elements make the sort manipulator be cleverer. Micro-controller's software bestows some simple artificial intelligence on the sort manipulator, so that it can precisely repeat its unloading and sorting work. The combination of manipulator's zero position and step motor counting control puts an end to accumulating error in long time operation. A sort manipulator's design in the practice engineering has been proved to be correct and reliable.

  11. “Somebody to Say ‘Come On We Can Sort This’”: A Qualitative Study of Primary Care Consultation Among Older Adults With Symptomatic Foot Osteoarthritis

    Science.gov (United States)

    Thomas, Martin J; Moore, Andrew; Roddy, Edward; Peat, George

    2013-01-01

    Objective To examine the experiences of primary care consultation among older adults with symptomatic foot osteoarthritis (OA). Methods Eleven participants (6 women and 5 men) ages 56–80 years who had radiographically confirmed symptomatic foot OA and consulted a general practitioner in the last 12 months for foot pain were purposively sampled. Semistructured interviews explored the nature of the foot problem, help-seeking behaviors, and consultation experiences. Verbatim transcripts were analyzed using interpretative phenomenological analysis. Results The decision to consult a physician was often the outcome of a complex process influenced by quantitative and qualitative changes in symptoms, difficulty maintaining day-to-day roles and responsibilities and the effect this had on family and work colleagues, and a reluctance to present a fragile or aging self to the outside world. Self-management was commonly negotiated alongside multimorbidities. Upon seeking help, participants often believed they received limited information, they were given a brief or even cursory assessment, and that treatment was focused on the prescription of analgesic drugs. Conclusion This is the first qualitative study of primary care experiences among patients with symptomatic foot OA. The experience of primary care seldom appeared to move beyond a label of arthritis and an unwelcome emphasis on pharmacologic treatment. PMID:23861315

  12. Computerized clinical decision support systems for primary preventive care: A decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes

    Directory of Open Access Journals (Sweden)

    Wilczynski Nancy L

    2011-08-01

    Full Text Available Abstract Background Computerized clinical decision support systems (CCDSSs are claimed to improve processes and outcomes of primary preventive care (PPC, but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement if at least 50% of the relevant study outcomes were statistically significantly positive. Results We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63% RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34% trials assessed patient outcomes, and four (29% reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15% and two (5% trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Conclusions

  13. Knowledge of and attitude to foot care amongst Type 2 diabetes patients attending a university-based primary care clinic in Nigeria

    Directory of Open Access Journals (Sweden)

    Rabi I. Ekore

    2010-03-01

    Full Text Available Background: Individuals living with diabetes mellitus are at an increased risk of developing foot ulcers and cardiovascular complications or a neuropathy that may result in amputations. These complications have been shown to be already present in about 10% of diabetic patients at the time of diagnosis.Objectives: This study was carried out to determine the level of awareness and attitude to foot care among adult diabetic patients attending a university health centre (i.e. a primary care centre and to emphasise the ever-present need for health education and promotion and early complication detection (especially of foot problems among diabetic patients.Method: A descriptive cross-sectional, clinic-based study was carried out at the University of Ibadan Health Centre (Jaja Clinic. The study population consisted of consenting adult diabetic patients. Data were collected by the self-administration of structured questionnaires to eligible subjects and were analysed using the SPSS v.15software. Appropriate statistics were employed to analyse the collected data.Results: A total of 137 patients participated in the study and ranged in age from 37 to 75 years, with the mean ± SD age being 58.2 ± 9.2 years. Of the participants, 98 (71.5% were men and 39 (28.5%were women; all of the participants were married. The duration of illness ranged from 1 year to 20 years, with the median duration of illness being 3 ± 1.7 years. One hundred and twenty-six (92%patients had never received any education on foot care from their healthcare providers, while 11(8% had received some form of foot care education. Among those who had never received any foot care education, 92 (73% had been diabetic for 1–5 years, while the remaining 34 (27% had been diabetic for 6 – 20 years. Of the foot care measures that were known, 35 (25.5% patients knew to wash their feet daily and dry in between the toes thoroughly, 31 (22.6% knew not to go outdoors barefooted, 27 (19.7% checked

  14. Clinical and epidemiological characteristics of patients with uveitis in an emergency eye care center in Brazil

    Directory of Open Access Journals (Sweden)

    Eduardo Nery Rossi Camilo

    2014-01-01

    Full Text Available Purpose: To analyze the clinical and epidemiological characteristics of patients with uveitis in an emergency eye care center. Methods: We conducted a prospective, observational study of patients with active uveitis admitted between May 2012 and July 2012 to an emergency eye care center. Results: The majority of patients were male (63.2%, with a mean age of 43.2 years; 66.2% patients were of mixed ethnicity, 22.5% were Caucasian, and 11.3% were black. Anterior uveitis was observed in 70.1% patients, posterior uveitis in 26.5%, and panuveitis in 3.4%; no patient was diagnosed with intermediate uveitis. All patients had a sudden and acute presentation. The most frequent symptoms were ocular pain (76.9%, redness (59.8%, and visual blurring (46.2%. The majority of patients had unilateral disease (94.9% with a mean symptom duration of 6.2 days. Diffuse and anterior uveitis were associated with ocular pain (p<0.001. Scotomata and floaters were more frequent in patients with posterior uveitis (p=0.003 and p=0.016, respectively. Patients with anterior uveitis presented with better visual acuity (p=0.025. Granulomatous keratotic precipitates were more frequent in patients with posterior uveitis (p=0.038. An etiological diagnosis based on the evaluation at the emergency center was made in 45 patients (38.5%. Conclusions: Acute anterior uveitis was the most frequent form of uveitis. Initial patient evaluation provided sufficient information for deciding primary therapy and aided in arriving at an etiological diagnosis in a considerable number of patients.

  15. Differences in clinical and epidemiological features between tuberculosis cases notified in primary and tertiary health care

    Directory of Open Access Journals (Sweden)

    Pâmela Curbani

    2014-04-01

    Full Text Available Objective: To compare, on the basis of clinical, radiological and epidemiological aspects, all cases of tuberculosis (TB diagnosed in the tertiary healthcare services to those diagnosed at the primary healthcare providers in the municipality of Vitória-ES. Methods: Cross- sectional, retrospective study, with analysis of the SINAN’s database, to identify all cases among residents of the municipality of Vitória-ES and diagnosed with TB in 2006 and 2007. Patients were divided into two groups: cases diagnosed in Primary Health Care (PHC and those diagnosed in Tertiary Health Care (THC. For statistical analysis, it was used the software STATA CORP 9.0. Results: 338 patients were identified; 207 (61.24% of these were diagnosed in PHC and 131 (38.76% in THC. The pulmonary form was predominant in both groups. However, the extrapulmonary form presented higher frequency in the THC group. When analyzing the results of sputum smear, the positivity was found in 114 (55.07% patients of the PHC and in 57 (43.51% of THC. Regarding the positive cultures, 119 (57.48% patients diagnosed in PHC and only 38 (29% in THC tested positive. Conclusion: There is evidence of high proportion of patients with TB communicated as “new cases” in THC in the city and it was observed a predominance of the pulmonary form in both groups - PHC and THC, although the extrapulmonary form was more frequent in the latter. doi:10.5020/18061230.2013.p251

  16. 75 FR 21301 - Office of Clinical and Preventive Services; Elder Care Initiative Long-Term Care Grant Program

    Science.gov (United States)

    2010-04-23

    ...-term care services for American Indians and Alaska Native (AI/AN) elders. This program is authorized...). Background The AI/AN elder population is growing rapidly and the AI/AN population as a whole is aging. The... dignity. While families continue to be the backbone of LTC for AI/AN elders, there is well documented...

  17. Clinical value of CARE dose 4D technique in decreasing CT scanning dose of adult chest

    International Nuclear Information System (INIS)

    Objective: To investigate the value of CARE Dose 4D technique in decreasing radiation dose and improving image quality of multi-slice spiral CT in adult chest scanning. Methods: 100 patients of chest CT scanning were equally divided into study group and control group randomly. CARE Dose 4D Technique was used in study group. Effective mAs value, volume CT dose index (CTDIvol) and dose length product (DLP) were displayed automatically in machine while chest scanning; those values and actual mAs value of every image were recorded respectively. The image quality at apex of lung, lower edge of aorta arch, middle area of left atrium and base of lung on every image of 400 images was judged and classified as three level (excellent, good, poor) by two deputy chief physicians with double blind method, the image noise at corresponding parts was measured. Results: While setting 80 mAs for quality reference mAs, the effective mAs value in study group most decreased 44 mAs than control group with an average decrease of 9.60 (12.0%), CTDIvol with 4.75 mGy with an average decrease of 0.95 mCy (11.0%), DLP 99.50% in study group, with 98.0% in control group. But it was higher at apex of lung and base of lung, lower at middle area of left atrium, and similar at lower edge of aorta arch in study group than contrast group. The image noise were lower at apex of lung and base of lung in study group than control group (t =6.299 and 2.332, all P<0.05), higher at middle area of left atrium in study group than control group (t=3.078, P<0.05) and similar at lower edge of aorta arch in study group than control group (t=1.191, P>0.05). Conclusions: CARE Dose 4D technique provides a function regulated mAs real-time on line, it not only raises utilization rate of radiation and decreases radiation dose, but also promises and increases image quality in chest CT scanning, and has some clinical significance. (authors)

  18. Nosocomial infections: knowledge and source of information among clinical health care students in Ghana

    Directory of Open Access Journals (Sweden)

    Bello AI

    2011-08-01

    Full Text Available Ajediran I Bello1, Eunice N Asiedu1, Babatunde OA Adegoke2, Jonathan NA Quartey1, Kwadwo O Appiah-Kubi1, Bertha Owusu-Ansah11Department of Physiotherapy, School of Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana; 2Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, NigeriaBackground: This study determined and compared the knowledge of nosocomial infections among clinical health care students at the College of Health Sciences, University of Ghana.Methods: Two hundred undergraduate health care students from four academic programs participated in the study. The study sample was drawn from each academic program by a simple random sampling technique using the class directory from each course. The Infection Control Standardized Questionnaire (ICSQ was used to assess the knowledge of students about three main domains, ie, hand hygiene, nosocomial infections, and standard precautions. A maximum score of 50 was obtainable, and respondents with scores ≥70% were classified as having a satisfactory knowledge. The response on each item was coded numerically to generate data for statistical analysis. Comparison of knowledge on the domains among categories of students was assessed using the Kruskal–Wallis test, while associations between courses of study and knowledge about nosocomial infections were determined using the Chi-square test. All statistical tests had a significant level of 5% (P < 0.05Results: Overall mean percentage score of the participants on ICSQ was 65.4 ± 2.58, with medical, physiotherapy, radiography, and nursing students recording mean percentage scores of 70.58 ± 0.62, 65.02 ± 2.00, 64.74 ± 1.19, and 61.31 ± 2.35, respectively. The main source of information about the prevention of nosocomial infections as cited by participants was their routine formal training in class. There was no significant association (P > 0.05 between course of study and knowledge of

  19. Analyzing the "CareGap": assessing gaps in adherence to clinical guidelines in adult soft tissue sarcoma.

    Science.gov (United States)

    Waks, Zeev; Goldbraich, Esther; Farkash, Ariel; Torresani, Michele; Bertulli, Rossella; Restifo, Nicola; Locatelli, Paolo; Casali, Paolo; Carmeli, Boaz

    2013-01-01

    Clinical decision support systems (CDSSs) are gaining popularity as tools that assist physicians in optimizing medical care. These systems typically comply with evidence-based medicine and are designed with input from domain experts. Nonetheless, deviations from CDSS recommendations are abundant across a broad spectrum of disorders, raising the question as to why this phenomenon exists. Here, we analyze this gap in adherence to a clinical guidelines-based CDSS by examining the physician treatment decisions for 1329 adult soft tissue sarcoma patients in northern Italy using patient-specific parameters. Dubbing this analysis "CareGap", we find that deviations correlate strongly with certain disease features such as local versus metastatic clinical presentation. We also notice that deviations from the guideline-based CDSS suggestions occur more frequently for patients with shorter survival time. Such observations can direct physicians' attention to distinct patient cohorts that are prone to higher deviation levels from clinical practice guidelines. This illustrates the value of CareGap analysis in assessing quality of care for subsets of patients within a larger pathology. PMID:23542965

  20. Engineering a Cache-Oblivious Sorting Algorithm

    DEFF Research Database (Denmark)

    Brodal, Gerth Stølting; Fagerberg, Rolf; Vinther, Kristoffer

    2007-01-01

    This paper is an algorithmic engineering study of cache-oblivious sorting. We investigate by empirical methods a number of implementation issues and parameter choices for the cache-oblivious sorting algorithm Lazy Funnelsort, and compare the final algorithm with Quicksort, the established standard...