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Sample records for compliance medication understanding

  1. The impact of an automated dose-dispensing scheme on user compliance, medication understanding, and medication stockpiles

    DEFF Research Database (Denmark)

    Larsen, Anna Bira; Haugbølle, Lotte Stig

    2007-01-01

    the assumed user benefits. Neither Danish nor international studies dealt with users' perspective on ADD in general or with respect to the pinpointed benefits, and thus exploration was needed. OBJECTIVES: The objective of this article is to respond to the following research question: How does ADD affect users......' handling and consumption of medication in terms of compliance behavior, and how does the assumption of user benefits made by health professionals and legislators measure up to users' experiences with ADD? METHODS: The results built on a secondary analysis of 9 qualitative interviews with a varied selection...... understanding, nor does it automatically eliminate stockpiles of old medication in users' homes. The gap between the perspectives of users and health professionals makes a compelling case for considering users' voices in the development and implementation of future health technologies....

  2. [Insufficient medication compliance in Parkinson's disease].

    Science.gov (United States)

    Aerts, Marjolein B; van der Eijk, Martijn; Kramers, Kees; Bloem, Bastiaan R

    2011-01-01

    Medication compliance is generally suboptimal, particularly in patients with complex polypharmacy. This generic treatment problem is described here for Parkinson's disease (PD). We would expect patients with PD to have good medication compliance, since missed doses immediately result in worsening of symptoms. However, recent research has revealed that PD patients demonstrate poor medication compliance. Poor medication compliance is particularly undesirable for patients with PD because regular intake of medication is required for optimal treatment effect. Possible ways of improving medication compliance are pharmacotherapeutic measures and behavioural interventions. Modern methods of communication (text message reminders) and 'smart' pill dispensers may be beneficial, but the advantages of such interventions have not yet been scientifically studied.

  3. [Insufficient medication compliance in Parkinson's disease

    NARCIS (Netherlands)

    Aerts, M.B.; Eijk, M. van der; Kramers, C.; Bloem, B.R.

    2011-01-01

    Medication compliance is generally suboptimal, particularly in patients with complex polypharmacy. This generic treatment problem is described here for Parkinson's disease (PD). We would expect patients with PD to have good medication compliance, since missed doses immediately result in worsening of

  4. Understand Your Medication

    Science.gov (United States)

    ... Disease Lookup > Asthma > Living with Asthma > Managing Asthma Understand Your Asthma Medication There are a variety of ... healthcare team. They can help make sure you understand the correct way to take the medicines, or ...

  5. Understanding Medical Words

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Understanding Medical Words Past Issues / Summer 2009 Table of Contents For ... Medicine that teaches you about many of the words related to your health care Do you have ...

  6. Understanding and managing compliance in the nature conservation context.

    Science.gov (United States)

    Arias, Adrian

    2015-04-15

    Nature conservation relies largely on peoples' rule adherence. However, noncompliance in the conservation context is common: it is one of the largest illegal activities in the world, degrading societies, economies and the environment. Understanding and managing compliance is key for ensuring effective conservation, nevertheless crucial concepts and tools are scattered in a wide array of literature. Here I review and integrate these concepts and tools in an effort to guide compliance management in the conservation context. First, I address the understanding of compliance by breaking it down into five key questions: who?, what?, when?, where? and why?. A special focus is given to 'why?' because the answer to this question explains the reasons for compliance and noncompliance, providing critical information for management interventions. Second, I review compliance management strategies, from voluntary compliance to coerced compliance. Finally, I suggest a system, initially proposed for tax compliance, to balance these multiple compliance management strategies. This paper differs from others by providing a broad yet practical scope on theory and tools for understanding and managing compliance in the nature conservation context. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Understanding Medical Research

    Science.gov (United States)

    ... you hear about the results of a new medical research study. Sometimes the results of one study ... when reading or listening to reports of new medical findings. Some questions that can help you evaluate ...

  8. Understanding how to maintain compliance in the current regulatory climate

    International Nuclear Information System (INIS)

    Bignell, D.T.; Burns, R.

    1995-01-01

    High level radioactive waste facilities must maintain compliance with all regulatory requirements, even those requirements that have been promulgated after the facility was placed into operation. Facilities must aggressively pursue compliance because environmental laws often impose strict liability for violations; therefore, an honest mistake is no defense. Radioactive waste management is constantly under the public microscope, particularly those facilities that handle high-level radioactive waste. The Savannah River Site has effectively met the challenges of regulatory compliance in its HLRW facilities and plans are being formulated to meet future regulatory requirements as well. Understanding, aggressively achieving, and clearly demonstrating compliance is essential for the continued operations of radioactive waste management facilities. This paper examines how HLRW facilities are impacted by regulatory requirements and how compliance in this difficult area is achieved and maintained

  9. Compliance to medication among hypertensive patients in Murtala ...

    African Journals Online (AJOL)

    Compliance to medication among hypertensive patients in Murtala Mohammed Specialist Hospital, Kano, Nigeria. M Kabir, Z Iliyasu, LS Abubakar, M Jibril. Abstract. Background: Non-compliance to blood pressure-lowering medication is a major reason for poor control of hypertension worldwide. We assessed the level of ...

  10. Medication compliance behavior in psychiatric out‑patients with ...

    African Journals Online (AJOL)

    2014-10-24

    Oct 24, 2014 ... No statistically significant relationship was found between substance use ... Access this article online ... Medication compliance in psychiatric patients in Nigeria. 372 ... had seen their physician until the sample size of 208 was.

  11. Compliance to medication among hypertensive patients in Murtala ...

    African Journals Online (AJOL)

    %). Patients ... A major factor accounting for inadequate ... counting the remaining pills or pill counting systems). ... Information obtained included socio- .... medication compliance on the control of hypertension. ... Archives of Internal Medicine.

  12. PCI compliance understand and implement effective PCI data security standard compliance

    CERN Document Server

    Williams, Branden R

    2012-01-01

    The credit card industry established the PCI Data Security Standards to provide a minimum standard for how vendors should protect data to ensure it is not stolen by fraudsters. PCI Compliance, 3e, provides the information readers need to understand the current PCI Data Security standards, which have recently been updated to version 2.0, and how to effectively implement security within your company to be compliant with the credit card industry guidelines and protect sensitive and personally identifiable information. Security breaches continue to occur on a regular basis, affecting millions of

  13. PCI Compliance Understand and Implement Effective PCI Data Security Standard Compliance

    CERN Document Server

    Chuvakin, Anton

    2010-01-01

    Identity theft and other confidential information theft have now topped the charts as the #1 cybercrime. In particular, credit card data is preferred by cybercriminals. Is your payment processing secure and compliant?. Now in its second edition, PCI Compliance has been revised to follow the new PCI DSS standard 1.2.1. Also new to this edition: Each chapter has how-to guidance to walk you through implementing concepts, and real-world scenarios to help you relate to the information and better grasp how it impacts your data. This book provides the information that you need to understand the curre

  14. Role of illness perceptions and medication beliefs on medication compliance of elderly hypertensive cohorts.

    Science.gov (United States)

    Rajpura, Jigar R; Nayak, Rajesh

    2014-02-01

    Poor compliance with antihypertensive medications is one possible reason why its success in clinical trials has not been translated into everyday practice. In addition, medication noncompliance in elderly leads to increased hospitalizations, physician visits, and higher health care costs. The study assessed influence of illness perceptions and medications beliefs on medication compliance of elderly hypertensive cohorts. A cross-sectional survey research design, utilizing self-administered health surveys, was adapted to address key study objectives. Conceptualized associations among the study variables were explored to assess their individual as well as their collective impact on the medication compliance. A total of 78 (66%) study samples were found to be noncompliant with their medications. Analysis revealed that perceptions about illness and beliefs about medication jointly played a significant role in the prediction of medication compliance (F = 5.966, P compliance building in elderly populations having hypertension by incorporating the value and importance of patient perceptions of illness and medications in order to achieve desired patient outcomes.

  15. Compliance with hygiene procedures among medical faculty students

    Directory of Open Access Journals (Sweden)

    Anna Kawalec

    2014-10-01

    Full Text Available Background: Many of the healthcare-associated infections (HCAIs are transmitted by healthcare workers’ hands, which actively contributes to transferring pathogens from patient to patient and within the healthcare environment. Hand hygiene is the easiest and cheapest method for preventing HCAIs. The article presents the compliance with hygiene procedures in a group of medical students of the Wroclaw Medical University. Material and Methods: The anonymous survey was conducted among 112 students. The survey included questions about the frequency of disinfection of hands and stethoscopes, changing clothes into clean ones, compliance with recommendations for healthcare workers, as well as subjective assessment of the availability of disinfectants in the hospital. Results: The results of the survey revealed that 35.7% of students did not disinfect their hands before each patient’s examination, 90% of them indicated limited access to disinfectants as the most important reason. The majority (93.8% of respondents were trained in hand hygiene. In 34.82% the availability of disinfectants in hospitals was assesed as good, 62.5% of respondents drew attention to the fact that the dispensers were often empty. Compliance with recommendations for healthcare workers: 66.9% posessed white coat with short sleeves, 52.68% wore wristwatch or jewelery on their hands, 50% of students laundered white coat less frequently than once a week, 9.82% did not disinfect their stethoscope at all, 15.18% did that before each patient’s examination. Conclusions: Students compliance with hand hygiene now and in their future work as doctors is the easiest method for preventing HCAIs. Providing easy access to disinfectants in the hospital environment and shaping hygiene habits during clinical activities play an essential role. Med Pr 2014;65(5:593–599

  16. Compliance pluralisme and processes : Understanding compliance behavior in restaurants in China

    NARCIS (Netherlands)

    Wu, Y.

    2017-01-01

    This research aimed to offer a case study of dynamic compliance processes in selected Chinese restaurants with the main methods of participant observation and in-depth interviews. It applied an integrated and dynamic research approach, called descriptive analysis of compliance behavior, which

  17. Improving admission medication reconciliation compliance using the electronic tool in admitted medical patients

    Science.gov (United States)

    Taha, Haytham; abdulhay, dana; Luqman, Neama; Ellahham, Samer

    2016-01-01

    Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity that is fully occupied most of the time. SKMC senior management has made a commitment to make quality and patient safety a top priority. Our governing body Abu Dhabi Health Services Company has identified medication reconciliation as a critical patient safety measure and key performance indicator (KPI). The medication reconciliation electronic form a computerized decision support tool was introduced to improve medication reconciliation compliance on transition of care at admission, transfer and discharge of patients both in the inpatient and outpatient settings. In order to improve medication reconciliation compliance a multidisciplinary task force team was formed and led this quality improvement project. The purpose of this publication is to indicate the quality improvement interventions implemented to enhance compliance with admission medication reconciliation and the outcomes of those interventions. We chose to conduct the pilot study in general medicine as it is the busiest department in the hospital, with an average of 390 patients admitted per month during the study period. The study period was from April 2014 till October 2015 and a total of 8576 patients were evaluated. The lessons learned were disseminated throughout the hospital. Our aim was to improve admission medication reconciliation compliance using the electronic form in order to ensure patient safety and reduce preventable harm in terms of medication errors. Admission medication reconciliation compliance improved in general medicine from 40% to above 85%, and this improvement was sustained for the last four months of the study period. PMID:27822371

  18. Compliance and Cognitive Function: A Methodological Approach to Measuring Unintentional Errors in Medication Compliance in the Elderly.

    Science.gov (United States)

    Isaac, Lisa M.; And Others

    1993-01-01

    Assessed multiple aspects of cognitive performance, medication planning ability, and medication compliance in 20 elderly outpatients. Findings suggest that aspects of attention/concentration, visual and verbal memory, and motor function which are untapped by simple mental status assessment are related to medication access, planning, and compliance…

  19. Identification of factors involved in medication compliance: incorrect inhaler technique of asthma treatment leads to poor compliance

    Directory of Open Access Journals (Sweden)

    Darbà J

    2016-02-01

    Full Text Available Josep Darbà,1 Gabriela Ramírez,2 Antoni Sicras,3 Laura García-Bujalance,4 Saku Torvinen,5 Rainel Sánchez-de la Rosa6 1Department of Economics, Universitat de Barcelona, 2BCN Health Economics & Outcomes Research S.L., 3Department of Planning, Badalona Serveis Assistencials S.A., Barcelona, 4Market Access Department, Teva Pharmaceutical, Madrid, Spain; 5Market Access Department, Teva Pharmaceuticals Europe BV, Amsterdam, the Netherlands; 6Medical Department, Teva Pharmaceutical, Madrid, Spain Objective: To identify the impact of delivery device of inhaled corticosteroids and long-acting β2-agonist (ICS/LABA on asthma medication compliance, and investigate other factors associated with compliance. Materials and methods: We conducted a retrospective and multicenter study based on a review of medical registries of asthmatic patients treated with ICS/LABA combinations (n=2,213 whose medical devices were either dry powder inhalers (DPIs, such as Accuhaler®, Turbuhaler®, and NEXThaler® or pressurized metered-dose inhalers (pMDI. Medication compliance included persistence outcomes through 18 months and medication possession ratios. Data on potential confounders of treatment compliance such as asthma exacerbations, comorbidities, demographic characteristics, and health care resource utilization were also explored. Results: The probability of asthma medication compliance in case of DPIs was lower compared to pMDIs, which suggests that inhaler devices influence inhalation therapies. There were additional confounding factors that were considered as explanatory variables of compliance. A worse measure of airflow obstruction (forced expiration volume in 1 second, comorbidities and general practitioner (GP consultations more than once per month decreased the probability of compliance. Within comorbidities, alcoholism was positively associated with compliance. Patients of 29–39, 40–50, and 51–61 age groups or suffering from more than two

  20. Public understanding for medical radiation

    International Nuclear Information System (INIS)

    Yoo, Seongyeol

    1994-01-01

    Main sources of radiation exposure are radiography for the diagnosis of disease and radiation therapy to kill cancer cells, which are using X-ray generators or radioisotopes. The radiation of medical purpose irradiates intentionally to the patients. Another example of intentional exposure is occupational workers who are handling radiological equipment. The patients receive radiation more than the dose exposed to the occupational workers, but there is no doubt for the secondary radiation hazard. Although the epidemiologic studies represents that even low dose irradiation can cause epidemiologic studies represents that even low dose irradiation can cause cancer or congenital anomaly in human as a late effect, the risk is negligible, particularly when it is compared with the incidence of same disease in general population

  1. Factors Impacting On Patient Compliance with Medical Advice: Empirical Study

    Directory of Open Access Journals (Sweden)

    Krot Katarzyna

    2017-06-01

    Full Text Available The purpose of this paper to identify factors which have a bearing on compliance with medical advice in various age groups. The survey was conducted, using the CAWI method, on a representative sample of 1000 respondents who declared having used healthcare services in the previous six months. Control of competences is one of the strongest factors which is common for the oldest and youngest groups. Interestingly, trust in the integrity and honesty of doctors is significant for the youngest patients, i.e., the higher is the level of trust, the lower is the tendency to non-comply. Another type of trust is related to the benevolence of doctors and is significant to patients of the middle age group. Satisfaction is a significant predictor in the two oldest groups of patients. High levels of satisfaction seem to deter people from non-adherence to recommended treatment regimens. The results of the present study provide knowledge about the nature and diversity of factors behind patient compliance in various age groups.

  2. Transcript for Understanding Medical Words: A Tutorial

    Science.gov (United States)

    ... medlineplus.gov/medicalwordstranscript.html Transcript for Understanding Medical Words: A Tutorial To use the sharing features on ... get to what those mean in a minute. Word Roots Word Roots. Let's begin with body parts. ...

  3. Direct medical costs and medication compliance among fibromyalgia patients: duloxetine initiators vs. pregabalin initiators.

    Science.gov (United States)

    Sun, Peter; Peng, Xiaomei; Sun, Steve; Novick, Diego; Faries, Douglas E; Andrews, Jeffrey S; Wohlreich, Madelaine M; Wu, Andrew

    2014-01-01

    To assess and compare direct medical costs and medication compliance between patients with fibromyalgia who initiated duloxetine and patients with fibromyalgia who initiated pregabalin in 2008. A retrospective cohort study design was used based on a large US national commercial claims database (2006 to 2009). Patients with fibromyalgia aged 18 to 64 who initiated duloxetine or pregabalin in 2008 and who had continuous health insurance 1 year preceding and 1 year following the initiation were selected into duloxetine cohort or pregabalin cohort based on their initiated agent. Medication compliance was measured by total supply days, medication possession ratio (MPR), and proportion of patients with MPR ≥ 0.8. Direct medical costs were measured by annual costs per patient and compared between the cohorts in the year following the initiation. Propensity score stratification and bootstrapping methods were used to adjust for distribution bias, as well as cross-cohort differences in demographic, clinical and economic characteristics, and medication history prior to the initiation. Both the duloxetine (n = 3,033) and pregabalin (n = 4,838) cohorts had a mean initiation age around 49 years, 89% were women. During the postindex year, compared to the pregabalin cohort, the duloxetine cohort had higher totally annual supply days (273.5 vs. 176.6, P costs ($2,994.9 vs. $4,949.6, P costs ($8,259.6 vs. $10,312.2, P costs ($5,214.6 vs. $5,290.8, P > 0.05), and lower total medical costs ($16,469.1 vs. $20,552.6, P compliance and consumed less inpatient, outpatient, and total medical costs than those who initiated pregabalin. © 2013 The Authors Pain Practice © 2013 World Institute of Pain.

  4. Understanding Patients? Process to Use Medical Marijuana

    OpenAIRE

    Crowell, Tara L

    2016-01-01

    Given the necessity to better understand the process patients need to go through in order to seek treatment via medical marijuana, this study investigates this process to better understand this phenomenon. Specifically, Compassion Care Foundation (CCF) and Stockton University worked together to identify a solution to this problem. Specifically, 240 new patients at CCF were asked to complete a 1-page survey regarding various aspects associated with their experience prior to their use of medici...

  5. Understanding Recreational Fishers' Compliance with No-take Zones in the Great Barrier Reef Marine Park

    Directory of Open Access Journals (Sweden)

    Adrian Arias

    2013-12-01

    Full Text Available Understanding fishers' compliance is essential for the successful management of marine protected areas. We used the random response technique (RRT to assess recreational fishers' compliance with no-take zones in the Great Barrier Reef Marine Park (GBRMP. The RRT allowed the asking of a sensitive question, i.e., "Did you, knowingly, fish within in a Green Zone during the last 12 months?" while protecting respondents' confidentiality. Application of the RRT through a survey of recreational fishers indicated that the majority of recreational fishers, 90%, comply with no-take zones. Likewise, most fishers, 92%, reported not personally knowing anyone who had intentionally fished in a no-take zone, indicating that fishers' perceive high levels of compliance among their peers. Fishers were motivated to comply with no-take zones primarily by their beliefs about penalties for noncompliance, followed by beliefs about the fishery benefits of no-take zones. Results suggest that compliance-related communication efforts by the managing authority have partially succeeded in maintaining appropriate compliance levels and that future efforts should accentuate normative compliance drivers that will encourage voluntary compliance. We conclude that compliance monitoring should be integrated into the adaptive management of the GBRMP and other protected areas; in this case social surveys using the RRT are effective tools.

  6. A Study to Determine the Correlation between Continuity of Care and Patient Medication Compliance

    Science.gov (United States)

    1984-08-01

    U (III FILE ’Y TO DETERMINE THE CORRELATION BETWEEN CONTINUITY OF CARE AND PATIENT MEDICATION COMPLIANCE IA Graduate Research Project Submitted to...43 APPENDIX A. PATIENT MEDICATION COMPLIANCE QUESTIONNAIRE . . . . . 45 B. COMPUTER CODED INPUT FORMAT . . . . . . . ...... 48 C. RESEARCH DATA...and that adhered to by the patient . This failure to comply with medical recommendations results in a waste of health resources, frustration to the

  7. What role does measuring medication compliance play in evaluating the efficacy of naltrexone?

    Science.gov (United States)

    Baros, Alicia M; Latham, Patricia K; Moak, Darlene H; Voronin, Konstantin; Anton, Raymond F

    2007-04-01

    Compliance with medication in pharmacotherapy trials of alcoholism has been shown to be equal to, or more, important than in other areas of medicine. Research has suggested that naltrexone's effectiveness can be greatly influenced by the compliance of participants in clinical trials. Presently, we compare 2 compliance measurement methods [urine riboflavin and medication event monitoring system (MEMS)] used simultaneously to evaluate naltrexone's efficacy and the impact of compliance on the size of observable treatment effects. One hundred and thirty-seven of 160 randomized alcoholic patients completed 12-weeks (84 days) of naltrexone or placebo and cognitive behavioral therapy (CBT) or motivational enhancement therapy (MET). Urine riboflavin was determined during study weeks 2, 6, and 12. The MEMS provided a detailed computerized record of when a participant opened their medication bottle throughout the trial. Baseline predictors of MEMS (80% openings) and urine riboflavin (>or=1,500 ng/mL by fluorimetry) compliance were examined. The effects of the treatments in the compliant participants defined by one, the other, or both methods were compared and contrasted with a previously reported intent-to-treat analysis where compliance was not taken into account. Age was predictive of compliance. 105 participants were deemed compliant via urine riboflavin criteria, 87 via MEMS, and 77 when both criteria were met, with no significant differences between treatment groups. The most compliant participants showed a significant medication by therapy interaction. Those treated with naltrexone/CBT showed more abstinence days (pcompliance measurement methods. Compliance measurement does appear to influence the evaluation of the efficacy of naltrexone within the context of CBT. Treatment effect sizes approximately doubled in the most compliant individuals. Measuring compliance by either of 2 distinct methods provides approximately similar results. As compliance with naltrexone

  8. Understanding Patients’ Process to Use Medical Marijuana

    Directory of Open Access Journals (Sweden)

    Tara L Crowell

    2016-09-01

    Full Text Available Given the necessity to better understand the process patients need to go through in order to seek treatment via medical marijuana, this study investigates this process to better understand this phenomenon. Specifically, Compassion Care Foundation (CCF and Stockton University worked together to identify a solution to this problem. Specifically, 240 new patients at CCF were asked to complete a 1-page survey regarding various aspects associated with their experience prior to their use of medicinal marijuana—diagnosis, what prompted them to seek treatment, level of satisfaction with specific stages in the process, total length of time the process took, and patient’s level of pain. Results reveal numerous patient diagnoses for which medical marijuana is being prescribed; the top 4 most common are intractable skeletal spasticity, chronic and severe pain, multiple sclerosis, and inflammatory bowel disease. Next, results indicate a little over half of the patients were first prompted to seek alternative treatment from their physicians, while the remaining patients indicated that other sources such as written information along with friends, relatives, media, and the Internet persuaded them to seek treatment. These data indicate that a variety of sources play a role in prompting patients to seek alternative treatment and is a critical first step in this process. Additional results posit that once patients began the process of qualifying to receive medical marijuana as treatment, the process seemed more positive even though it takes patients on average almost 6 months to obtain their first treatment after they started the process. Finally, results indicate that patients are reporting a moderately high level of pain prior to treatment. Implication of these results highlights several important elements in the patients’ initial steps toward seeking medical marijuana, along with the quality and quantity of the process patients must engage in prior to

  9. Burnout syndrome: understanding of medical teaching professionals

    OpenAIRE

    Jaqueline Brito Vidal Batista; Thaíza Ferreira Costa; Jocerlânia Maria Dias de Morais; Eveline de Oliveira Barros; Patrícia Serpa de Souza Batista; Márcia Adriana Dias Meirelles Moreira; Jessyka Cibelly Minervina da Costa Silva; Débora Rodrigues Alves de Lima; Ana Hévila Marinho Bezerra; Irany Carvalho da Silva

    2017-01-01

    This study aimed to investigate the understanding of medical teaching professionals about Burnout Syndrome. This is a qualitative, exploratory study, consisting of ten teaching physicians, who work at the hospital of a higher education institution. The data were collected from May to June 2013, through a form with questions pertinent to the proposed research objective, after approval by the Research Ethics Committee (Protocol No. 84022), and analyzed qualitatively, through the content analysi...

  10. Compliance to topical anti-glaucoma medications among patients at a tertiary hospital in North India

    Directory of Open Access Journals (Sweden)

    Ketaki Rajurkar

    2018-06-01

    Full Text Available Purpose: The present study aims to estimate the prevalence of non-compliance and improper drop administration technique among glaucoma patients and describe common obstacles to medication compliance. Methods: A hospital-based cross-sectional study, using standardized questionnaire and direct observation by study personnel was conducted among glaucoma patients aged 18 years and above at a tertiary care charitable eye hospital in North India. 151 consecutive glaucoma patients on medical therapy following up at the glaucoma clinics for at least 6 months were recruited. Non-compliance was defined as missing at-least one drop of medication per week and (or the inability to accurately describe the medication regimen. Study personnel also assessed drop administration technique during application of eye drops by patients treating ophthalmologist-provided information, including measures of disease stability. Factors such as socioeconomic status, presence of caregiver, and number of medications with their effect on compliance were studied using chi-square statistics. Results: Among 151 patients interviewed, around 49% of patients reported problems in using glaucoma medications, with 16% of them reporting total non-compliance. 35% of patients demonstrated improper drop administration technique. Forgetfulness was cited as the main reason for being non-compliant and had a significant association with non-compliance (P = 0.00. Paying patients were more compliant as compared to subsidized patients (P = 0.05. Disease was more stable in compliant patients compared to non-compliant patients (P = 0.05. No other factor had significant association with compliance (P > 0.05. Conclusions: Over 50% of the patients surveyed were non-compliant, and 35% demonstrated improper administration technique. Glaucoma patients should be educated on the importance of compliance and aids that minimize forgetfulness, and delivery systems facilitating the delivery of

  11. Establishing Compliance with Liquid Medication Administration in a Child with Autism

    Science.gov (United States)

    Schiff, Averil; Tarbox, Jonathan; Lanagan, Taira; Farag, Peter

    2011-01-01

    Children with autism often display difficulty with swallowing pills and liquid medications. In the current study, stimulus fading and positive reinforcement established compliance with liquid medication administration in a young boy with autism. The boy's mother eventually administered liquid medication on her own. (Contains 1 figure.)

  12. Limited Awareness of the Essences of Certification or Compliance Markings on Medical Devices.

    Science.gov (United States)

    Foo, Jong Yong Abdiel; Tan, Xin Ji Alan

    2017-06-01

    Medical devices have been long used for odiagnostic, therapeutic or rehabilitation purposes. Currently, they can range from a low-cost portable device that is often used for personal health monitoring to high-end sophisticated equipment that can only be operated by trained professionals. Depending on the functional purposes, there are different certification or compliance markings on the device when it is sold. One common certification marking is the Conformité Européenne affixation but this has a range of certification mark numbering for a variety of functional purposes. While the regulators and medical device manufacturers understand the associated significance and clinical implications, these may not be apparent to the professionals (using or maintaining the device) and the general public. With portable healthcare devices and mobile applications gaining popularity, better awareness of certification marking will be needed. Particularly, there are differences in the allowed functional purposes and the associated cost derivations of devices with a seemingly similar nature. A preferred approach such as an easy-to-understand notation next to any certification marking on a device can aid in differentiation without the need to digest mountainous regulatory details.

  13. Medication apprehension and compliance among dialysis patients--a comprehensive guidance attitude.

    Science.gov (United States)

    Katzir, Ze'ev; Boaz, Mona; Backshi, Irena; Cernes, Relu; Barnea, Zvi; Biro, Alexander

    2010-01-01

    Compliance with treatment regimens is a continuing challenge for chronic dialysis patients and their medical caregivers. Poor patient adherence to prescribed medications can adversely affect treatment outcome. In this pre- versus post-intervention study, 89 chronic dialysis patients [75 hemodialysis (HD), 14 continuous ambulatory peritoneal dialysis (CAPD); mean age 62.7 +/- 12.39 years, 34 females] responded to a written questionnaire designed to assess knowledge about and compliance with 5 groups of prescribed medications: metabolic drugs, antihypertensives, cardiac-supporting agents, peptic disease therapy and hematological replacement therapy. Mode of intake, storage, means of supply and source of information for each class of drug were also assessed. Patients then received both oral and written instructions regarding their prescribed medications (intervention). This information was repeated 3 months later. Six months after the intervention, patients were re-administered the questionnaires. Response to the questionnaires and laboratory data were compared prior to and following the intervention. Overall, compliance with prescribed medications significantly improved following the intervention, from 89 to 95.7%, p = 0.0007. This relative improvement was greater in HD than CAPD patients (27 vs. 2%, p dialysis vintage. Compared to baseline values, post-intervention blood hemoglobin, hematocrit, mean corpuscular volume, ferritin and Ca levels were significantly improved. Dialysis patients appear to benefit from receiving comprehensive guidance about medications, in terms of compliance with medications and blood chemistry and hematology measures. (c) 2009 S. Karger AG, Basel.

  14. Burnout syndrome: understanding of medical teaching professionals

    Directory of Open Access Journals (Sweden)

    Jaqueline Brito Vidal Batista

    2017-04-01

    Full Text Available This study aimed to investigate the understanding of medical teaching professionals about Burnout Syndrome. This is a qualitative, exploratory study, consisting of ten teaching physicians, who work at the hospital of a higher education institution. The data were collected from May to June 2013, through a form with questions pertinent to the proposed research objective, after approval by the Research Ethics Committee (Protocol No. 84022, and analyzed qualitatively, through the content analysis technique (Bardin. Among the 10 participants in the study, eight had adequate knowledge about Burnout Syndrome, while others showed insufficient knowledge. From the empirical material analysis, five thematic categories emerged: Syndrome characterized by physical and psychological exhaustion due to work stress; Physical and psychological signs and symptoms of Burnout Syndrome; Burnout syndrome and its implications for the worker’s health; The most vulnerable workers who develop Burnout Syndrome and Relation of Burnout Syndrome to the work of the teaching physician. The study showed that most participants in the research adequately understand Burnout Syndrome, but the subject is still little explored in academia. Therefore, intervention measures are necessary with the professionals of the risk group and new studies that contribute to expand the knowledge about that syndrome, aiming to improve the quality of life of the workers. Keywords: Worker’s Health; Professional Exhaustion; Doctors; Professors; Work Conditions.   DOI: http://dx.doi.org/10.3823/2397

  15. Emergency Telemedicine: Achieving and Maintaining Compliance with the Emergency Medical Treatment and Labor Act.

    Science.gov (United States)

    Rockwell, Kimberly Lovett; Gilroy, Alexis

    2018-03-12

    Telemedicine is a growing and important platform for medical delivery in the emergency department. Emergency telemedicine outlays often confront and conflict with important federal healthcare regulations. Because of this, academic medical centers, critical access hospitals, and other providers interested in implementing emergency telemedicine have often delayed or forgone such services due to reasonable fears of falling out of compliance with regulatory restrictions imposed by the Emergency Medical Treatment and Labor Act ("EMTALA"). This article offers insights into methods for implementing emergency telemedicine services while maintaining EMTALA compliance. Critical analysis of EMTALA and its attendant regulations. The primary means of ensuring EMTALA compliance while implementing emergency telemedicine programs include incorporating critical clinical details into the services contracts and implementing robust written policies that anticipate division of labor issues, the need for backup coverage, triaging, patient transfer protocols, and credentialing issues. With adequate up-front due diligence and meaningful contracting, hospitals and telemedicine providers can avoid common EMTALA liability pitfalls.

  16. Improved Hand Hygiene Compliance is Associated with the Change of Perception toward Hand Hygiene among Medical Personnel

    OpenAIRE

    Lee, Seung Soon; Park, Se Jeong; Chung, Moon Joo; Lee, Ju Hee; Kang, Hyun Joo; Lee, Jeong-a; Kim, Yong Kyun

    2014-01-01

    Background Hand hygiene compliance has improved significantly through hand hygiene promotion programs that have included poster campaign, monitoring and performance feedback, and education with special attentions to perceived subjective norms. We investigated factors associated with improved hand hygiene compliance, focusing on whether the improvement of hand hygiene compliance is associated with changed perception toward hand hygiene among medical personnel. Materials and Methods Hand hygien...

  17. Medication compliance behavior in psychiatric out‑patients with ...

    African Journals Online (AJOL)

    Background: Psychotropic medication adherence is a major challenge in psychiatric patients with comorbidity. Objective: The objective was to determine medication adherence behavior among psychiatric out‑patients with psychoactive substance use comorbidity in a Nigerian Tertiary Hospital. Settings and Design: A ...

  18. Non-compliance to anti-hypertensive medication and its associated factors among hypertensives

    International Nuclear Information System (INIS)

    Bilal, A.; Riaz, M.; Shafiq, N.U.; Ahmed, M.; Sheikh, S.; Rasheed, S.

    2015-01-01

    Non-compliance to anti-hypertensive drugs can have negative impact on cardiovascular outcome. Various studies have been conducted on the issue but the factors are not yet explored properly, particularly in Pakistan. This study was conducted to determine the frequency and factors associated with non-compliance to anti-hypertensive medications in Karachi. Methods: This descriptive cross sectional study was conducted on 113 indoor hypertensive patients included by purposive sampling, aged 30 years and above diagnosed at least 6 months back in public sector tertiary care institutes of Karachi from March to October 2011. Data was collected through a questionnaire in Urdu. Demographic data, hypertension diagnosis, medical co-morbidity, current number of anti-hypertensive medicines, frequency of missing prescribed antihypertensive therapy and other factors affecting compliance pertaining to medicines, patient, physician and health care centre were included in the questionnaire. Results: This study revealed that 68.14% patients were non-compliant. Non-compliance was found to be associated with gender and socioeconomic status. Duration of hypertension, duration between follow up visits to physician, number of drugs, careless attitude, role of physician and limiting access to health care center are found to be important factors in non-compliance. Conclusions: Multiple factors including patients, medicine and health care system related, which can be prevented with simple measures, were found responsible for higher prevalence of non-compliance against anti-hypertensive medicines. (author)

  19. Developing medical device software in compliance with regulations.

    Science.gov (United States)

    Zema, M; Rosati, S; Gioia, V; Knaflitz, M; Balestra, G

    2015-08-01

    In the last decade, the use of information technology (IT) in healthcare has taken a growing role. In fact, the adoption of an increasing number of computer tools has led to several benefits related to the process of patient care and allowed easier access to social and health care resources. At the same time this trend gave rise to new challenges related to the implementation of these new technologies. Software used in healthcare can be classified as medical devices depending on the way they are used and on their functional characteristics. If they are classified as medical devices they must satisfy specific regulations. The aim of this work is to present a software development framework that can allow the production of safe and high quality medical device software and to highlight the correspondence between each software development phase and the appropriate standard and/or regulation.

  20. I. INTRODUCTION: UNDERSTANDING MEDICINES AND MEDICAL INTERVENTIONS.

    Science.gov (United States)

    Lockhart, Kristi L; Keil, Frank C

    2018-06-01

    We live in an increasingly pharmacological and medical world, where children and adults frequently encounter alleged treatments for an enormous range of illnesses. How do we come to understand what heals and why? Here, 15 studies explore how 1,414 children (ages 5-11) and 882 adults construe the efficacies of different kinds of cures. Developmental patterns in folk physics, psychology, and biology lead to predictions about which expectations about cures will remain relatively constant across development and which will change. With respect to stability, we find that even young school children (ages 5-7) distinguish between physical and psychological disorders and the treatments most effective for each. In contrast, young children reason differently about temporal properties associated with cures. They often judge that dramatic departures from prescribed schedules will continue to be effective. Young children are also less likely than older ages to differentiate between the treatment needs of acute versus chronic disorders. Young children see medicines as agent-like entities that migrate only to afflicted regions while having "cure-all" properties, views that help explain their difficulties grasping side effects. They also differ from older children and adults by judging pain and effort as reducing, instead of enhancing, a treatment's power. Finally, across all studies, optimism about treatment efficacy declines with age. Taken together, these studies show major developmental changes in how children envision the ways medicines work in the body. Moreover, these findings link to broader patterns in cognitive development and have implications for how medicines should be explained to children. © 2018 The Society for Research in Child Development, Inc.

  1. Personal and social factors regarding medical non-compliance in cardiac failure patients

    International Nuclear Information System (INIS)

    Mujtaba, S.F.; Masood, T.; Khalid, D.

    2011-01-01

    Objective: To determine the frequency and association of various personal and social factors with medical non-compliance in cardiac failure patients. Study Design: Cross-sectional, observational study. Place and Duration of Study: National Institute of Cardiovascular Diseases (NICVD), Karachi from January to August 2010. Methodology: Patients admitted in the medical wards of NICVD, who were being treated for cardiac failure, were included. Information regarding basic demographics, education level, self engagement in therapy and status of compliance was obtained by questionnaire. Statistical analysis was carried out by using Fisher's exact test and chi-square. Level of significance was < 0.05. Data was analyzed using SPSS V-15. Out of 267 patients, 73 (27.3%) were compliant while 194 (72.7%) were non-compliant. Educated, self caring patient, and those who knew names of their medications were more compliant than the rest. Conclusion: Medical non-compliance is very common in heart failure patients. Illiteracy and no self engagement in therapy are associated with non-compliance. (author)

  2. understanding medical ethics in a contemporary society

    African Journals Online (AJOL)

    drclement

    these basic principles will go a long way in reducing the ... medical practitioner must therefore be prepared at all ... physician accepts to see a patient, he must define in his ... tells the nurse who is doing daily ..... International Journal of Medical ...

  3. Optimizing urine drug testing for monitoring medication compliance in pain management.

    Science.gov (United States)

    Melanson, Stacy E F; Ptolemy, Adam S; Wasan, Ajay D

    2013-12-01

    It can be challenging to successfully monitor medication compliance in pain management. Clinicians and laboratorians need to collaborate to optimize patient care and maximize operational efficiency. The test menu, assay cutoffs, and testing algorithms utilized in the urine drug testing panels should be periodically reviewed and tailored to the patient population to effectively assess compliance and avoid unnecessary testing and cost to the patient. Pain management and pathology collaborated on an important quality improvement initiative to optimize urine drug testing for monitoring medication compliance in pain management. We retrospectively reviewed 18 months of data from our pain management center. We gathered data on test volumes, positivity rates, and the frequency of false positive results. We also reviewed the clinical utility of our testing algorithms, assay cutoffs, and adulterant panel. In addition, the cost of each component was calculated. The positivity rate for ethanol and 3,4-methylenedioxymethamphetamine were us to optimize our testing panel for monitoring medication compliance in pain management and reduce cost. Wiley Periodicals, Inc.

  4. Understanding Medications and What They Do

    Science.gov (United States)

    ... only in hospitals. What Are Medicines? Medicines are chemicals or compounds used to cure, halt, or prevent disease; ease symptoms; or help in the diagnosis of illnesses. Advances in medications have enabled doctors to cure many ...

  5. Understanding IBD Medications and Side Effects

    Science.gov (United States)

    ... important not to suddenly stop taking this medication. Immunomodulators: These include azathioprine, 6-mercaptopurine (6-MP), methotrexate, ... ongoing inflammation. Usually given orally (methotrexate is injectable), immunomodulators are typically used in people for whom aminosalicylates ...

  6. Relationship of Personal- Social and Therapeutic Factors with Medication Compliance in TB Patients in Ahwaz

    Directory of Open Access Journals (Sweden)

    S Jahani

    2012-01-01

    Full Text Available Introduction: Despite the implementation of DOTS strategy, TB remains one of the ten leading causes of death in developing countries. Compliance with treatment is affected by social, cultural, and economic factors, and patients’ knowledge and attitude as well. The aim of this study was to determine the relationship between compliance with treatment and personal, social and therapeutic factors in TB patients in Ahwaz. Methods: This cross-sectional descriptive study was conducted on 167 TB patients. Subjects were selected based on target. The data were collected using a questionnaire, and by observation, sputum analysis, and Kvzart Ponce urine test. The validity of the questionnaire was tested by the method of content validity, and its internal consistency and reliability was tested by Cronbach's alpha coefficient. Data analyzed by SpSS. Results: Among all subjects, 52.7% of patients showed complete compliance and 35.2% and 12% of them showed partial and poor compliance, respectively. There was a significant relationship between treatment compliance and gender(p=0.009, quality of monthly income(p=0.007, and addiction(p=0.001. The quality of treatment compliance was not significantly related to age, marital status, educational level, ethnicity, and medical complications. Conclusion: The findings showed that Incomplete treatment of TB is much worse than not treating it, because the lack of precision in the administration and consumption of anti-tuberculosis drugs, leads to the emergence of resistant TB. Paying attention to the factors decreasing treatment compliance and trying to eliminate them may lead to better treatment and lower incidence and prevalence of tuberculosis in the community.

  7. A comparison of medication administration errors from original medication packaging and multi-compartment compliance aids in care homes: A prospective observational study.

    Science.gov (United States)

    Gilmartin-Thomas, Julia Fiona-Maree; Smith, Felicity; Wolfe, Rory; Jani, Yogini

    2017-07-01

    No published study has been specifically designed to compare medication administration errors between original medication packaging and multi-compartment compliance aids in care homes, using direct observation. Compare the effect of original medication packaging and multi-compartment compliance aids on medication administration accuracy. Prospective observational. Ten Greater London care homes. Nurses and carers administering medications. Between October 2014 and June 2015, a pharmacist researcher directly observed solid, orally administered medications in tablet or capsule form at ten purposively sampled care homes (five only used original medication packaging and five used both multi-compartment compliance aids and original medication packaging). The medication administration error rate was calculated as the number of observed doses administered (or omitted) in error according to medication administration records, compared to the opportunities for error (total number of observed doses plus omitted doses). Over 108.4h, 41 different staff (35 nurses, 6 carers) were observed to administer medications to 823 residents during 90 medication administration rounds. A total of 2452 medication doses were observed (1385 from original medication packaging, 1067 from multi-compartment compliance aids). One hundred and seventy eight medication administration errors were identified from 2493 opportunities for error (7.1% overall medication administration error rate). A greater medication administration error rate was seen for original medication packaging than multi-compartment compliance aids (9.3% and 3.1% respectively, risk ratio (RR)=3.9, 95% confidence interval (CI) 2.4 to 6.1, ppackaging (from original medication packaging-only care homes) and multi-compartment compliance aids (RR=2.3, 95%CI 1.1 to 4.9, p=0.03), and between original medication packaging and multi-compartment compliance aids within care homes that used a combination of both medication administration

  8. Perceived treatment effectiveness, medication compliance, and complementary and alternative medicine use among veterans with bipolar disorder.

    Science.gov (United States)

    Jarman, Christopher N; Perron, Brian E; Kilbourne, Amy M; Teh, Carrie Farmer

    2010-03-01

    Recent research shows a high rate of complementary and alternative medicine (CAM) use among persons with mental disorders, although correlates and patterns of CAM use are relatively unknown. This study tested whether CAM use is associated with perceived effectiveness of conventional treatment (i.e., psychotropic medication and psychotherapy) and medication compliance among persons with bipolar disorder. Patients with bipolar disorder (n = 435) were included as part of a naturalistic cohort study. Measures of CAM utilization, medication compliance, and perceptions of the effectiveness of psychotropic medications and psychotherapy were based on previously established questionnaires. Associations were tested using bivariate and multivariate analyses. Bivariate analyses showed that patients who did not perceive psychotherapy as effective at improving social, family, or job functioning reported greater CAM use. However, medication compliance was not significantly associated with use of CAM. Patients who used oral (e.g., herbal therapies) or cognitive (e.g., meditation) CAM were more likely to report that their medications were not effective at relieving manic or depressive symptoms. Users of cognitive CAM were more likely to report that their medications did not help with social, job, or family functioning, and that they did not prevent recurrences of manic or depressive episodes. None of the bivariate associations remained significant in multivariate analyses. Prior research has suggested that persons who are dissatisfied with treatment for medical conditions are more likely to use CAM therapies. However, the results of this study do not show CAM therapies to be associated with perceived effectiveness of treatments for mental health problems among this sample of persons with serious mental illnesses. This suggests that motivations for CAM use may vary by population and condition. Because few correlates of CAM use among persons with serious mental illnesses are known

  9. The introduction of compulsory compliance testing of medical diagnostic x-ray equipment in Western Australia

    International Nuclear Information System (INIS)

    Rafferty, M. W.; Jacob, C. S.

    1995-01-01

    Performance testing of medical diagnostic X-ray equipment can reveal equipment faults which, while not always clinically detectable, may contribute to reduced image quality and unnecessary radiation exposure of both patients and staff. Routine testing of such equipment is highly desirable to identify such faults and allows them to be rectified. The Radiological council of Western Australia is moving towards requiring compulsory compliance testing of all (new and existing) medical diagnostic X-ray equipment that all new mobile radiographic and new mammographic X-ray equipment be issued with a compliance test certificate as a prerequisite for registration. Workbooks which provide details of the tests required and recommended test methods have been prepared for medical radiographic (mobile and fixed), fluoroscopic and mammographic X-ray equipment. It is intended that future workbooks include details of the tests and methods for dental and computed tomography X-ray units. The workbooks are not limited to the compliance testing of items as specified in the Regulations, but include tests for other items such as film processing, darkrooms and image quality (for fluoroscopic equipment). Many of the workbook tests could be used within a regular quality assurance program for diagnostic X-ray equipment. Persons who conduct such compliance tests will need to be licensed and have all test certificates endorsed by a qualified expert. Suitable training and assessment of compliance testers will be required. Notification of such tests (including non-compliant items and corrective actions taken) will be required by the Radiological Council as a condition of equipment registration. 9 refs

  10. Learning from “Shadow Security”: Why understanding non-compliance provides the basis for effective security

    OpenAIRE

    Kirlappos, I.; Parkin, S.; Sasse, M. A.

    2014-01-01

    Over the past decade, security researchers and practitioners have tried to understand why employees do not comply with organizational security policies and mechanisms. Past re-search has treated compliance as a binary decision: people comply, or they do not. From our analysis of 118 in-depth interviews with individuals (employees in a large multinational organization) about security non-compliance, a 3rd response emerges: shadow security. This describes the instances where security-conscious ...

  11. FDA (Food and Drug Administration) Compliance Program Guidance Manual (FY 88). Section 4. Medical and radiological devices

    International Nuclear Information System (INIS)

    1988-01-01

    The FDA Compliance Program Guidance Manual provides a system for issuing and filing program plans and instructions directed to Food and Drug Administration Field operations for project implementation. Section IV provides those chapters of the Compliance Program Guidance Manual which pertain to the areas of medical and radiological devices. Some of the areas of coverage include laser and sunlamp standards inspections, compliance testing of various radiation-emitting products such as television receivers and microwave ovens, emergency response planning and policy, premarket approval and device manufacturers inspections, device problem reporting, sterilization of devices, and consumer education programs on medical and radiological devices

  12. Improved Hand Hygiene Compliance is Associated with the Change of Perception toward Hand Hygiene among Medical Personnel

    Science.gov (United States)

    Park, Se Jeong; Chung, Moon Joo; Lee, Ju Hee; Kang, Hyun Joo; Lee, Jeong-a; Kim, Yong Kyun

    2014-01-01

    Background Hand hygiene compliance has improved significantly through hand hygiene promotion programs that have included poster campaign, monitoring and performance feedback, and education with special attentions to perceived subjective norms. We investigated factors associated with improved hand hygiene compliance, focusing on whether the improvement of hand hygiene compliance is associated with changed perception toward hand hygiene among medical personnel. Materials and Methods Hand hygiene compliance and perceptions toward hand hygiene among medical personnel were compared between the second quarter of 2009 (before the start of a hand hygiene promotion program) and the second quarter of 2012. We assessed adherence to hand hygiene among medical personnel quarterly according to the WHO recommended method for direct observation. Also, we used a modified self-report questionnaire to collect perception data. Results Hand hygiene compliance among physicians and nurses improved significantly from 19.0% in 2009 to 74.5% in 2012 (P Hand hygiene compliance among the medical personnel continued to improve, with a slight decline in 2013. Perceptions toward hand hygiene improved significantly between 2009 and 2012. Specifically, improvements were evident in intention to adhere to hand hygiene, knowledge about hand hygiene methods, knowledge about hand hygiene indications including care of a dirty and a clean body site on the same patient, perceived behavioral and subjective norms, positive attitude toward hand hygiene promotion campaign, perception of difficulty in adhering to hand hygiene, and motivation to improve adherence to hand hygiene. Conclusions The examined hand hygiene promotion program resulted in improved hand hygiene compliance and perception toward hand hygiene among medical personnel. The improved perception increased hand hygiene compliance. Especially, the perception of being a role model for other colleagues is very important to improve hand hygiene

  13. Interventions for enhancing medication compliance/adherence with benefits in treatment outcomes

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2007-01-01

    Full Text Available Scientific background: Poor compliance or adherence in drug therapy can cause increased morbidity, mortality and enormous costs in the healthcare system (in Germany annually approximately 10 billion euros. Different methods are used for enhancing the compliance or adherence. Research questions: The evaluation addresses the questions about existence, efficacy, cost-benefit relation as well as ethical-social and juridical implications of strategies for enhancing compliance or adherence in drug therapy with concomitant improvements in treatment outcomes. Methods: A systematic literature search was conducted in the medical, also health economic relevant, literature databases in January 2007, beginning from 2002. Systematic reviews on the basis of (randomised controlled trials (RCT concerning interventions to enhance compliance or adherence with regard to treatment outcomes as well as systematic reviews of health economic analyses were included in the evaluation. Additionally, it was also searched for publications which primarily considered ethical-social and juridical aspects of these interventions for the German context. Results: One systematic review with data for 57 RCT was included in the medical evaluation and one systematic review with data for six studies into the health economic evaluation. No publication primary concerning ethical-social or juridical implications could be identified. A significant positive effect on the treatment outcome was reported for 22 evaluated interventions. For many interventions the results can be classified as reliable: counseling with providing an information leaflet and compliance diary chart followed by phone consultation for helicobacter pylori positive patients, repeated counseling for patients with acute asthma symptoms, telephone calls to establish the level of compliance and to make recommendations based on that for the therapy of cardiovascular diseases, calls of an automated telephone system with phone

  14. Compliance with referrals to medical specialist care: patient and general practice determinants: a cross-sectional study.

    Science.gov (United States)

    van Dijk, Christel E; de Jong, Judith D; Verheij, Robert A; Jansen, Tessa; Korevaar, Joke C; de Bakker, Dinny H

    2016-02-01

    In a gatekeeper system, primary care physicians and patients jointly decide whether or not medical specialist care is needed. However, it is the patient who decides to actually use the referral. Referral non-compliance could delay diagnosis and treatment. The objective of this study was to assess patient compliance with a referral to medical specialist care and identify patient and practice characteristics that are associated with it. Observational study using data on 48,784 referrals to medical specialist care derived from electronic medical records of 58 general practices for the period 2008-2010. Referral compliance was based on claims data of medical specialist care. Logistic multilevel regression analyses were conducted to determine associations between patient and general practice characteristics and referral compliance. In 86.6% of the referrals, patients complied. Patient and not practice characteristics were significantly associated with compliance. Patients from deprived urban areas and patients aged 18-44 years were less likely to comply, whereas patients aged 65 years and older were more likely to comply. About 1 in 8 patients do not use their referral. These patients may not receive adequate care. Demographic and socio-economic factors appear to affect compliance. The results of this study may be used to make general practitioners more aware that some patients are more likely to be noncompliant with referrals.

  15. Economic impact of compliance to treatment with antidiabetes medication in type 2 diabetes mellitus: a review paper.

    Science.gov (United States)

    Breitscheidel, L; Stamenitis, S; Dippel, F-W; Schöffski, O

    2010-03-01

    Suboptimal compliance and failure to persist with antidiabetes therapies are of potential economic significance. The present research aims to describe the impact of poor compliance and persistence with antidiabetes medications on the cost of healthcare or its components for patients with type 2 diabetes mellitus (T2DM). Literature search was conducted in PubMed for relevant articles published in the period between 1 January 2000 and 30 April 2009. Thus, it is possible that relevant articles not listed in PubMed, but available in other databases are not included in the current review. Studies describing economic consequence of compliance and/or persistence with pharmaceutical antidiabetes treatment were identified. The variability in the studies reviewed was high, making it extremely difficult to make a comparison between them. Of 449 articles corresponding to the primary search algorithm, 12 studies (all conducted in USA) fulfilled the inclusion criteria regarding the economic impact of compliance and/or persistence with treatment on the overall cost of T2DM care or its components. Compliance was assessed via medication possession ratio (MPR) in ten studies, where it ranged from 0.52 to 0.93 depending on regimen. Persistence was assessed in one study. Mean total annual costs per T2DM patient varied between the studies, ranging from $4570 to $17338. In seven studies, medication compliance was inversely associated with total healthcare costs, while in four other studies inverse associations between medication compliance and hospitalisation costs were reported. In one study increased adherence did not change overall healthcare costs. Improved compliance may lead to reductions of the total healthcare costs in T2DM, Further research is needed in countries other than the US to assess impact of compliance and persistence to pharmacotherapy on T2DM costs in country-specific settings.

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

    Science.gov (United States)

    Johnson, Bill

    2014-01-01

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

  17. The impact of cognitive insight, self-stigma, and medication compliance on the quality of life in patients with schizophrenia.

    Science.gov (United States)

    Lien, Yin-Ju; Chang, Hsin-An; Kao, Yu-Chen; Tzeng, Nian-Sheng; Lu, Chien-Wen; Loh, Ching-Hui

    2018-02-01

    Impaired quality of life (QoL) is a common and clinically relevant feature of schizophrenia. In the present study, we attempted to formulate a model of QoL in the chronic stage of schizophrenia by including key variables-namely cognitive insight, self-stigma, insight into treatment, and medication compliance-that were proposed as its significant predictors in previous studies. We employed structural equation modeling (SEM) to simultaneously test the associations between these variables. A total of 170 community-dwelling patients with schizophrenia participated in this study. Cognitive insight, self-stigma, insight into treatment, medication compliance, and QoL were assessed through self-reporting. Symptoms were rated by interviewers. The influences of cognitive insight, stigma, insight into treatment, and medication compliance on QoL were supported using SEM. Our findings indicated that cognitive insight had a significant, positive, and direct effect on both self-stigma and insight into treatment; in contrast, it had a negative and direct effect on medication compliance. Notably, no evidence indicated a direct effect of cognitive insight on QoL. Thus, individuals with high cognitive insight reported low QoL because of stigma, low medication compliance, and their increased insight into treatment. In contrast, cognitive insight might indirectly ameliorate QoL mediated by the effect of insight into treatment on medication compliance. The findings provide additional support of the links between cognitive and clinical insight, self-stigma, medication compliance, and QoL in those with schizophrenia and suggest the need for screening and intervention services appropriate for this high-risk population.

  18. Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures.

    Science.gov (United States)

    Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Greene, Laurence; Patel, Barry; Higgins, Peter D R

    2016-07-01

    Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.

  19. Symptom experience associated with immunosuppressive drugs after liver transplantation in adults : possible relationship with medication non-compliance?

    NARCIS (Netherlands)

    Drent, Gerda; Moons, P.; De Geest, S.; Kleibeuker, J. H.; Haagsma, E. B.

    2008-01-01

    Symptom experience (occurrence and perceived distress) associated with side effects of immunosuppressive medications in organ transplant patients may well be associated with poorer quality of life and medication non-compliance. The aims of this study were: first, to assess symptom experience in

  20. Irish medical students’ understanding of the intern year

    LENUS (Irish Health Repository)

    Gouda, P,

    2016-03-01

    Upon completion of medical school in Ireland, graduates must make the transition to becoming interns. The transition into the intern year may be described as challenging as graduates assume clinical responsibilities. Historically, a survey of interns in 1996 found that 91% felt unprepared for their role. However, recent surveys in 2012 have demonstrated that this is changing with preparedness rates reaching 52%. This can be partially explained by multiple initiatives at the local and national level. Our study aimed evaluate medical student understanding of the intern year and associated factors. An online, cross-sectional survey was sent out to all Irish medical students in 2013 and included questions regarding their understanding of the intern year. Two thousand, two hundred and forty-eight students responded, with 1224 (55.4%) of students agreeing or strongly agreeing that they had a good understanding of what the intern year entails. This rose to 485 (73.7%) among senior medical students. Of junior medical students, 260 (42.8%) indicated they understood what the intern year, compared to 479 (48.7%) of intermediate medical students. Initiatives to continue improving preparedness for the intern year are essential in ensuring a smooth and less stressful transition into the medical workforce

  1. Depot-medication compliance for patients with psychotic disorders: the importance of illness insight and treatment motivation.

    Science.gov (United States)

    Noordraven, Ernst L; Wierdsma, André I; Blanken, Peter; Bloemendaal, Anthony Ft; Mulder, Cornelis L

    2016-01-01

    Noncompliance is a major problem for patients with a psychotic disorder. Two important risk factors for noncompliance that have a severe negative impact on treatment outcomes are impaired illness insight and lack of motivation. Our cross-sectional study explored how they are related to each other and their compliance with depot medication. Interviews were conducted in 169 outpatients with a psychotic disorder taking depot medication. Four patient groups were defined based on low or high illness insight and on low or high motivation. The associations between depot-medication compliance, motivation, and insight were illustrated using generalized linear models. Generalized linear model showed a significant interaction effect between motivation and insight. Patients with poor insight and high motivation for treatment were more compliant (94%) (95% confidence interval [CI]: 1.821, 3.489) with their depot medication than patients with poor insight and low motivation (61%) (95% CI: 0.288, 0.615). Patients with both insight and high motivation for treatment were less compliant (73%) (95% CI: 0.719, 1.315) than those with poor insight and high motivation. Motivation for treatment was more strongly associated with depot-medication compliance than with illness insight. Being motivated to take medication, whether to get better or for other reasons, may be a more important factor than having illness insight in terms of improving depot-medication compliance. Possible implications for clinical practice are discussed.

  2. Social, Economic, and Medical Factors Associated With Solifenacin Therapy Compliance Among Workers Who Suffer From Lower Urinary Tract Symptoms.

    Science.gov (United States)

    Kosilov, Kirill Vladimirovich; Alexandrovich, Loparev Sergay; Gennadyevna, Kuzina Irina; Viktorovna, Shakirova Olga; Sergeevna, Zhuravskaya Natalia; Ivanovich, Ankudinov Ivan

    2016-09-01

    The prevalence of hyperactive-type lower urinary tract symptoms is 45.2%, with shares of overactive bladder (OAB) and urge incontinence (UI) symptoms of 10.7% and 8.2%, respectively. We investigated the possible impact of a wide range of social, economic, and medical factors on compliance with solifenacin treatment in the working population. Social, economic, and medical factors as well as the Overactive Bladder questionnaire - the OAB-q Short Form (OAB-q SF), bladder diaries, and uroflowmetry of 1,038 people who were administered solifenacin for a year were gathered from employer documentation. Among the subjects, 32% maintained their compliance with solifenacin treatment throughout the year. Only 65% of the patients had compliance exceeding 80%, and 17% of patients had compliance of ≥50%, yet less than 80% were still taking solifenacin 12 months after the beginning of this experiment. Working people whose compliance level was, at least, 80% had reliably higher (P≤0.01) average age, annual salary, and treatment efficacy, and a greater treatment satisfaction level, as well as a lack of satisfaction with other antimuscarinic treatments and higher rate of urge UI diagnosis. The same cohort also featured a lower level (P≤0.01) of caffeine abuse and lower share of salary spent purchasing solifenacin. This study has shown that compliance with solifenacin treatment is associated with a number of significant medical, social, and economic factors. The medical factors included the type of urination disorder, severity of incontinence symptoms, presence of side effects, treatment efficacy and patients' satisfaction with it, and experience using other antimuscarinic treatments. Among the social and economic factors, those with the strongest correlation to compliance were patient age, employment in medicine and education, annual income level, percentage of solifenacin purchase expenditures, and caffeine abuse. Factors with a weaker, but still significant, association were

  3. Social, Economic, and Medical Factors Associated With Solifenacin Therapy Compliance Among Workers Who Suffer From Lower Urinary Tract Symptoms

    Directory of Open Access Journals (Sweden)

    Kirill Vladimirovich Kosilov

    2016-09-01

    Full Text Available Purpose The prevalence of hyperactive-type lower urinary tract symptoms is 45.2%, with shares of overactive bladder (OAB and urge incontinence (UI symptoms of 10.7% and 8.2%, respectively. We investigated the possible impact of a wide range of social, economic, and medical factors on compliance with solifenacin treatment in the working population. Methods Social, economic, and medical factors as well as the Overactive Bladder questionnaire – the OAB-q Short Form (OAB-q SF, bladder diaries, and uroflowmetry of 1,038 people who were administered solifenacin for a year were gathered from employer documentation. Results Among the subjects, 32% maintained their compliance with solifenacin treatment throughout the year. Only 65% of the patients had compliance exceeding 80%, and 17% of patients had compliance of ≥50%, yet less than 80% were still taking solifenacin 12 months after the beginning of this experiment. Working people whose compliance level was, at least, 80% had reliably higher (P≤0.01 average age, annual salary, and treatment efficacy, and a greater treatment satisfaction level, as well as a lack of satisfaction with other antimuscarinic treatments and higher rate of urge UI diagnosis. The same cohort also featured a lower level (P≤0.01 of caffeine abuse and lower share of salary spent purchasing solifenacin. Conclusions This study has shown that compliance with solifenacin treatment is associated with a number of significant medical, social, and economic factors. The medical factors included the type of urination disorder, severity of incontinence symptoms, presence of side effects, treatment efficacy and patients’ satisfaction with it, and experience using other antimuscarinic treatments. Among the social and economic factors, those with the strongest correlation to compliance were patient age, employment in medicine and education, annual income level, percentage of solifenacin purchase expenditures, and caffeine abuse. Factors

  4. Do medical students really understand plagiarism? - Case study.

    Science.gov (United States)

    Badea, Oana

    2017-01-01

    In the last decade, more and more medicine students are involved in research, either in the form of a research project within specialized courses or as a scientific article to be presented at student international conferences or published in prestigious medical journals. The present study included 250 2nd year medical students, currently studying within the University of Medicine and Pharmacy of Craiova, Romania. There were collected 239 responses, with a response rate of 95.6%. In our study, the results showed that foreign students within the University of Medicine and Pharmacy of Craiova did have some issues understanding plagiarism with fewer foreign students (34%) than Romanian students (66%) recognizing that simply changing words does not avoid plagiarism. In our opinion, there should be put more emphasis upon plagiarism implications and its aspects, as well, with a permanent order to try to prevent future attempts of plagiarizing among medical students as future researchers within the medical science field.

  5. Regulatory Compliance to Assure the Safety of the Operation of a Medical Cyclotron

    International Nuclear Information System (INIS)

    Dela Cruz, Joselito

    2015-01-01

    Khealth Corporation, in Partnership with the National Kidney and Transplant Institute, has established a medical cyclotron facility to accommodate the up-and-coming needs of tracers for PET/CT in different centers and hospitals all over the country. This facility houses a 16.5 MeV GE PET trace 880 particle accelerator that can produce 14 Ci (518 GBq) of Fluorine-18. Its structure has adopted global standard designs in meeting the safety during its use, radiopharmaceutical production and distribution. Compliances were remarkably fulfilled from the building construction, machine acquisition, commissioning, operations up to the quality control and assurance. Furthermore, various regulatory challenges during the current standardization of radiopharmaceutical utilization were encountered however time dedication and efforts were wielded until all have been successfully justified and acquired. (author)

  6. Why do farmers behave as they do? Understanding compliance with rural, agricultural, and food attribute standards

    NARCIS (Netherlands)

    Herzfeld, T.; Jongeneel, R.A.

    2012-01-01

    Agricultural production experiences a shift in underlying institutions during the last years., Importance of private stakeholders like retailers, processors, consumers as well as tax payers is, emerging. Eligibility for single farm payments and marketing of products is linked to compliance with,

  7. Medical Students' Understanding of Directed Questioning by Their Clinical Preceptors.

    Science.gov (United States)

    Lo, Lawrence; Regehr, Glenn

    2017-01-01

    Phenomenon: Throughout clerkship, preceptors ask medical students questions for both assessment and teaching purposes. However, the cognitive and strategic aspects of students' approaches to managing this situation have not been explored. Without an understanding of how students approach the question and answer activity, medical educators are unable to appreciate how effectively this activity fulfills their purposes of assessment or determine the activity's associated educational effects. A convenience sample of nine 4th-year medical students participated in semistructured one-on-one interviews exploring their approaches to managing situations in which they have been challenged with questions from preceptors to which they do not know the answer. Through an iterative and recursive analytic reading of the interview transcripts, data were coded and organized to identify themes relevant to the students' considerations in answering such questions. Students articulated deliberate strategies for managing the directed questioning activity, which at times focused on the optimization of their learning but always included considerations of image management. Managing image involved projecting not only being knowledgeable but also being teachable. The students indicated that their considerations in selecting an appropriate strategy in a given situation involved their perceptions of their preceptors' intentions and preferences as well as several contextual factors. Insights: The medical students we interviewed were quite sophisticated in their understanding of the social nuances of the directed questioning process and described a variety of contextually invoked strategies to manage the situation and maintain a positive image.

  8. Using the Theory of Normative Social Behavior to Understand Compliance with a Smoke-Free Law in a Middle-Income Country

    Science.gov (United States)

    Byron, M. J.; Cohen, J. E.; Frattaroli, S.; Gittelsohn, J.; Jernigan, D. H.

    2016-01-01

    Smoke-free laws, which ban smoking in public venues, can be effective in protecting public health, but it has been difficult to achieve compliance with these laws in low- and middle-income countries. This study was conducted to understand the social norms around public smoking and learn how to improve compliance in Bogor, the first Indonesian city…

  9. Assessment of parental understanding of paediatric medical prescriptions

    Directory of Open Access Journals (Sweden)

    Sadiqua Anjum, Nasir Mohiuddin M, Narayan Reddy U, Narsing Rao J, Sana Afreen, Mir S Adil, Javeedullah M

    2014-07-01

    Full Text Available Introduction: Medical prescriptions are bound to be misinterpreted by patients and pharmacists if not properly conveyed. Pediatric prescriptions differ from adult prescriptions having wide variation in doses and formulations. There is a need to evaluate the lacunae in the parental understanding of pediatric prescriptions. Aims and objective: To evaluate the parental understanding of pediatric prescription and to evaluate the adequacy of communication with the physician and pharmacist regarding the same. Material and methods: 550 parents were enrolled and their literacy level was noted. They were subjected to modify MUSE questionnaire. Physician’s prescription was analyzed in terms of ease of understanding by parents. These parents were followed up till the pharmacies and the pharmacist understanding of prescription was analyzed and their communication with parents regarding drug usage was noted. Finally, ease of usage of drugs by parents was noted. Results: MUSE scale was modified to suit pediatric prescription understanding by parents and also additional questions were asked to include complete parental understanding of doctor’s prescription. Majority of parents failed to completely understand the written prescription. Though around 80% of pharmacist could understand the prescription, their communication with parents was poor resulting in difficulty for parents to even enquire about medicines from them. Parental overall understanding of prescription increased with their literacy levels. Conclusion: Not all prescriptions are completely understood by parents as well as a pharmacist. This can lead to misuse of drugs. Efforts to explain the drug usage are not adequate enough from the doctor or the pharmacist. While communicating literacy levels of parents is not being considered which may further worsen the understanding ability

  10. Compliance testing of medical diagnostic x-ray equipment: three years experience of a public hospital in western Australia

    International Nuclear Information System (INIS)

    Tuchyna, T.; Jacob, C.S.

    2000-01-01

    Full text: A formal compliance testing program which began on 1 January 1997 called for all medical and diagnostic x-ray equipment to be tested according to protocols established by the Western Australian Radiological Council. This work describes the impact of the legislation three years post implementation on a major teaching Hospital with 45 x-ray tubes located throughout 37 rooms. Testing is performed prior to scheduled service by licensed compliance testers according to test methods specified in the Western Australian Compliance Testing Workbook, 1997. A dedicated non-invasive x-ray beam analyser is instrumental in accurately determining radiation output parameters of the generator and x-ray tube. Assessment of compliance is determined by a Qualified Expert. Repair and re-testing of non-compliant items is coordinated with service personnel. Notices of non-compliance were received for approximately 60% of the equipment in the Hospital following the equipment' first annual test. Reasons and seriousness of failure varied according to equipment category, test category, equipment use and age. The majority of non-compliance issues were resolved within 90 days. At the end of the third year of testing, approximately 75% of the x-ray units tested met the compliance criteria. The main reasons for non-compliance were found to be design limitations associated with old technology and the current radiation legislation that makes it difficult for older equipment to meet the stringent criteria. The number and categories of failure did not significantly decrease in the second or third years of testing. Exemptions from compliance criteria have been sought for two units on the basis of age and design. Units unable to meet the criteria following several repair attempts or where the cost of repair was deemed not justified, were decommissioned. Formal testing of medical x-ray equipment has demonstrated various non-compliance issues that did not significantly improve during the

  11. Analysis of Factors Affecting Patients’ Compliance to Topical Antiglaucoma Medications in Egypt as a Developing Country Model

    Directory of Open Access Journals (Sweden)

    Nahla B. Abu Hussein

    2015-01-01

    Full Text Available Purpose. To study factors affecting patients’ compliance to antiglaucoma medications in Egypt where there are unique factors as a developing country. Patients and Methods. A cross-sectional descriptive study on 440 Egyptian patients with open angle glaucoma (OAG recruited for over two years. The patients were thoroughly interviewed about their age, education level, duration of glaucoma, difficulty in instilling the drops, medication regimens, a family history of glaucoma, knowledge of the disease, and the presence of medical insurance. Results. 236 (53.6% were noncompliant compared to 204 (46.4% who were compliant. Females had a tendency for higher compliance (p=0.061. Patient age above 50 years and low level of education and negative family history of glaucoma were factors significantly associated with poor compliance (p<0.0001. Polytherapy and lack of medical insurance could be contributing factors. Conclusion. Egyptian patients have a high rate of noncompliance compared to the average in literature. Great effort is needed in educating patients about the importance of medications and the risk and the prognosis of this disease. Economic factors must also be taken into consideration in developing countries with large number of poor patients. We recommend simplifying drug regimens, incorporating electronic dose monitors, and creating reminders for follow-up visits of glaucoma patients.

  12. Influence of social competence of physicians on patient compliance with osteoporosis medications--a study on Polish postmenopausal women.

    Science.gov (United States)

    Bryl, Nadia; Horst-Sikorska, Wanda; Ignaszak-Szczepaniak, Magdalena; Marcinkowska, Michalina; Michalak, Michał; Sewerynek, Ewa

    2012-07-01

    The aim of the study was to examine the impact of social competence of physicians on the effectiveness of patient compliance and persistence with therapy. The study included physicians and their patients, previously diagnosed with osteoporosis, and eligible to receive pharmacological treatment. The physicians were evaluated with the social competence questionnaire involving three dimensions: social exposure, intimacy and assertiveness, as well as in the combined scale. All patients in the study group were prescribed the same medication: alendronate once a week. Compliance and persistence of the patients were juxtaposed with social interaction skills of physicians during 7 scheduled appointments at 2-month intervals. Doctor's effectiveness in situations demanding close interpersonal contact was higher in the group with good compliance--group A (p fear and

  13. A model-driven privacy compliance decision support for medical data sharing in Europe.

    Science.gov (United States)

    Boussi Rahmouni, H; Solomonides, T; Casassa Mont, M; Shiu, S; Rahmouni, M

    2011-01-01

    Clinical practitioners and medical researchers often have to share health data with other colleagues across Europe. Privacy compliance in this context is very important but challenging. Automated privacy guidelines are a practical way of increasing users' awareness of privacy obligations and help eliminating unintentional breaches of privacy. In this paper we present an ontology-plus-rules based approach to privacy decision support for the sharing of patient data across European platforms. We use ontologies to model the required domain and context information about data sharing and privacy requirements. In addition, we use a set of Semantic Web Rule Language rules to reason about legal privacy requirements that are applicable to a specific context of data disclosure. We make the complete set invocable through the use of a semantic web application acting as an interactive privacy guideline system can then invoke the full model in order to provide decision support. When asked, the system will generate privacy reports applicable to a specific case of data disclosure described by the user. Also reports showing guidelines per Member State may be obtained. The advantage of this approach lies in the expressiveness and extensibility of the modelling and inference languages adopted and the ability they confer to reason with complex requirements interpreted from high level regulations. However, the system cannot at this stage fully simulate the role of an ethics committee or review board.

  14. Context and clinical reasoning : Understanding the medical student perspective.

    Science.gov (United States)

    McBee, Elexis; Ratcliffe, Temple; Schuwirth, Lambert; O'Neill, Daniel; Meyer, Holly; Madden, Shelby J; Durning, Steven J

    2018-04-27

    Studies have shown that a physician's clinical reasoning performance can be influenced by contextual factors. We explored how the clinical reasoning performance of medical students was impacted by contextual factors in order to expand upon previous findings in resident and board certified physicians. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of medical students in order to describe what impact the presence of contextual factors has on their reasoning performance. Seventeen medical student participants viewed three video recordings of clinical encounters portraying straightforward diagnostic cases in internal medicine with explicit contextual factors inserted. Participants completed a computerized post-encounter form as well as a think-aloud protocol. Three authors analyzed verbatim transcripts from the think-aloud protocols using a constant comparative approach. After iterative coding, utterances were analyzed and grouped into categories and themes. Six categories and ten associated themes emerged, which demonstrated overlap with findings from previous studies in resident and attending physicians. Four overlapping categories included emotional disturbances, behavioural inferences about the patient, doctor-patient relationship, and difficulty with closure. Two new categories emerged to include anchoring and misinterpretation of data. The presence of contextual factors appeared to impact clinical reasoning performance in medical students. The data suggest that a contextual factor can be innate to the clinical scenario, consistent with situated cognition theory. These findings build upon our understanding of clinical reasoning performance from both a theoretical and practical perspective.

  15. Understanding the debate on medical education research: a sociological perspective.

    Science.gov (United States)

    Albert, Mathieu

    2004-10-01

    Since the mid-1990s, a debate has taken place among medical education scholars regarding the forms that research should take and the roles it should play. Editors of major journals in medical education and prominent researchers in the domain have repeatedly addressed the issue and have attempted to define what medical education research should be. The goal of this article is to look at the debate from a sociological perspective and to outline the social factors shaping it. An analysis of the texts published since 1990 addressing the issue shows that the debates can be deconstructed in four topics: epistemology, methodology, the primary purpose of medical education research, and the "quality" of the projects carried out in the domain. However, the debates can also be amalgamated and synthesized using the concept of "field" as developed by sociologist Pierre Bourdieu. A "field" refers to the configuration of power relations among individuals, social groups, or institutions within a domain of activities. Scientific fields are typically structured around a "bipolar" opposition pattern. At one pole stand those individuals who promote greater collaboration with nonscientists as well as research aimed at responding to practical needs. At the opposite pole stand those individuals who aspire to achieve independence of the field from such external constraints. The use of the concept of "field" allows us to understand the debate from a larger perspective and to establish parallels with similar debates in other scientific fields. In doing so, we will have the opportunity to learn from the experience of these other fields and be more reflective about the debate in which we engage.

  16. Understanding non-compliance with WHO-multidrug therapy among leprosy patients in Assam, India

    Directory of Open Access Journals (Sweden)

    Sumit Kar

    2010-01-01

    Full Text Available Objectives: The study was undertaken to assess the adherence to World Health Organization (WHO-multidrug therapy (MDT and its successful completion by the leprosy patients and the extent of such defaulting, its correlates and reasons. Design: Retrograde cohort analysis was conducted during the first quarter of 2007 from the cases registered for WHO-MDT treatment during 2002 to 2005 in Kamrup district of Assam, India. Results: A total of 254 leprosy cases reflected the treatment seeking behavior of registered cases during the study period. Majority of the cases were from urban areas and defaulter rate higher in urban areas. The study group consisted of 60.63% males and 39.37% females.. Both the compliance and default was higher in the age group of 16 to 30 years. Majority of defaulters (32.28% had passed the high school leaving certificate examination had per capita monthly income between Rs 500 - 749 (30.71% and belonged to social class IV (33.86% and V (30.71%. Significant statistical association was found between gender, literacy status, per capita income per month and socioeconomic status with treatment outcome. On analysis for the reasons of defaulting treatment; majority (33.07% defaulted treatment due to loss of occupational hours when they come for receiving drugs at health center, 25.98% defaulted due to adverse reactions of drugs and 18.11% feared social stigma among major causes. Conclusions: The causes of defaulting treatment were related to gender, educational status, income as well as social class, or some combination of these. Recommendations, on strategic interventions to obviate the cause for noncompliance, were presented.

  17. Preclinical medical students’ understandings of academic and medical professionalism: visual analysis of mind maps

    Science.gov (United States)

    Rees, Charlotte E

    2017-01-01

    Introduction Several studies have begun to explore medical students’ understandings of professionalism generally and medical professionalism specifically. Despite espoused relationships between academic (AP) and medical professionalism (MP), previous research has not yet investigated students’ conceptualisations of AP and MP and the relationships between the two. Objectives The current study, based on innovative visual analysis of mind maps, therefore aims to contribute to the developing literature on how professionalism is understood. Methods We performed a multilayered analysis of 98 mind maps from 262 first-year medical students, including analysing textual and graphical elements of AP, MP and the relationships between AP and MP. Results The most common textual attributes of AP were learning, lifestyle and personality, while attributes of MP were knowledge, ethics and patient-doctor relations. Images of books, academic caps and teachers were used most often to represent AP, while images of the stethoscope, doctor and red cross were used to symbolise MP. While AP-MP relations were sometimes indicated through co-occurring text, visual connections and higher-order visual metaphors, many students struggled to articulate the relationships between AP and MP. Conclusions While the mind maps’ textual attributes shared similarities with those found in previous research, suggesting the universality of some professionalism attributes, our study provides new insights into students’ conceptualisations of AP, MP and AP-MP relationships. We encourage medical educators to help students develop their understandings of AP, MP and AP-MP relationships, plus consider the feasibility and value of mind maps as a source of visual data for medical education research. PMID:28821520

  18. FDA (Food and Drug Administration) compliance program guidance manual and updates (FY 86). Section 4. Medical and radiological devices. Irregular report

    International Nuclear Information System (INIS)

    1986-01-01

    The FDA Compliance Program Guidance Manual provides a system for issuing and filing program plans and instructions directed to Food and Drug Administration Field operations for project implementation. Section IV provides those chapters of the Compliance Program Guidance Manual which pertain to the areas of medical and radiological devices. Some of the areas of coverage include laser and sunlamp standards inspections, compliance testing of various radiation-emitting products such as television receivers and microwave ovens, emergency response planning and policy, premarket approval and device manufacturers inspections, device problem reporting, sterilization of devices, and consumer education programs on medical and radiological devices

  19. Sin and suffering in a Catholic understanding of medical ethics.

    Science.gov (United States)

    Garcia, J L A

    2006-08-01

    Drawing chiefly on recent sources, in Part One I sketch an untraditional way of articulating what I claim to be central elements of traditional Catholic morality, treating it as based in virtues, focused on the recipients ("patients") of our attention and concern, and centered in certain person-to-person role-relationships. I show the limited and derivative places of "natural law," and therefore of sin, within that framework. I also sketch out some possible implications for medical ethics of this approach to moral theory, and briefly contrast these with the influential alternative offered by the "principlism" of Beauchamp and Childress. In Part Two, I turn to a Catholic understanding of the nature and meaning of human suffering, drawing especially on writings and addresses of the late Pope John Paul II. He reminds us that physical and mental suffering can provide an opportunity to share in Christ's salvific sacrifice, better to see the nature of our earthly vocation, and to reflect on the dependence that inheres in human existence. At various places, and especially in my conclusion, I suggest a few ways in which this can inform bioethical reflection on morally appropriate responses to those afflicted by physical or mental pain, disability, mental impairment, disease, illness, and poor health prospects. My general point is that mercy must be informed by appreciation of the person's dignity and status. Throughout, my approach is philosophical rather than theological.

  20. Compliance Framing - Framing Compliance

    OpenAIRE

    Lutz-Ulrich Haack; Martin C. Reimann

    2012-01-01

    Corporations have to install various organizational measures to comply with legal as well as internal guidelines systematically. Compliance management systems have the challenging task to make use of an internal compliance-marketing approach in order to ensure not only an adequate but also effective compliance-culture. Compliance-literature and findings of persuasive goal-framing-theory give opposite implications for establishing a rather values- versus rule-based compliance-culture respectiv...

  1. Globalization and healthcare: understanding health and medical tourism.

    Science.gov (United States)

    Carrera, Percivil M; Bridges, John Fp

    2006-08-01

    Faced with long waiting lists, the high cost of elective treatment and fewer barriers to travel, the idea of availing healthcare in another country is gaining greater appeal to many. The objective of this review is to perform a literature review of health and medical tourism, to define health and medical tourism based on the medical literature and to estimate the size of trade in healthcare. The Medline database was used for our literature review. In our initial search for 'health tourism' and 'medical tourism' we found a paucity of formal literature as well as conceptual ambiguity in the literature. Subsequently, we reviewed the literature on 'tourism' in general and in the context of healthcare. On the basis of 149 papers, we then sought to conceptualize health tourism and medical tourism. Based on our definitions, we likewise sought to estimate market capacity internationally. We defined health tourism as "the organized travel outside one's local environment for the maintenance, enhancement or restoration of an individual's wellbeing in mind and body". A subset of this is medical tourism, which is "the organized travel outside one's natural healthcare jurisdiction for the enhancement or restoration of the individual's health through medical intervention". At the international level, health tourism is an industry sustained by 617 million individuals with an annual growth of 3.9% annually and worth US$513 billion. In conclusion, this paper underscored the issue of a severely limited formal literature that is compounded by conceptual ambiguity facing health and medical tourism scholarship. In clarifying the concepts and standardizing definitions, and providing evidence with regard to the scale of trade in healthcare, we hope to assist in furthering fundamental research tasks, including the further development of reliable and comparable data, the push and pull factors for engaging in health and medical tourism, and the impact of health tourism but, more so, medical

  2. Exploring the usage of a mobile phone application in transplanted patients to encourage medication compliance and education.

    Science.gov (United States)

    Zanetti-Yabur, Alana; Rizzo, Amanda; Hayde, Nicole; Watkins, Anthony C; Rocca, Juan P; Graham, Jay A

    2017-10-01

    Medication non-adherence in transplant patients is a grave problem that results in increased rejection episodes, graft loss and significant morbidity. The efficacy of users and non-users of a mobile phone application (mobile app) in promoting medication adherence was investigated. The Beliefs about Medicine Questionnaire (BMQ) and Morisky Medication Adherence Scale (MMAS-8) were used in these cohorts to assess the predilection for poor adherence. Serum tacrolimus, creatinine levels, and rejection episodes were also recorded. Lastly, the patients were tested on their recall of their immunosuppression. Overall, patients had extremely negative beliefs about medication reflected in their tendency toward higher predicted rates of non-adherence. Interestingly, though not significant, app users had higher rates of medication recollection. The high-risk nature of this population demands efforts to abrogate non-adherence. Caregivers are charged with the responsibility to offer patients a feasible option to safeguard treatment compliance. Mobile apps are a potentially powerful tool, which can be used to decrease non-adherence. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Understanding Medical Words: A Tutorial from the National Library of Medicine

    Science.gov (United States)

    ... page: https://medlineplus.gov/medicalwords.html Understanding Medical Words: A Tutorial from the National Library of Medicine ... enable JavaScript. This tutorial teaches you about medical words. You'll learn about how to put together ...

  4. Lay understanding of common medical terminology in oncology

    NARCIS (Netherlands)

    Pieterse, Arwen H.; Jager, Nienke A.; Smets, Ellen M. A.; Henselmans, Inge

    2013-01-01

    The purpose of this study was to replicate and extend an earlier study carried out in the UK of lay understanding of cancer-related terms in a Dutch sample, by (i) examining understanding of common terms relating to diagnosis, prognosis, and treatment and (ii) experimentally exploring the effect of

  5. "Understanding" medical school curriculum content using KnowledgeMap.

    Science.gov (United States)

    Denny, Joshua C; Smithers, Jeffrey D; Miller, Randolph A; Spickard, Anderson

    2003-01-01

    To describe the development and evaluation of computational tools to identify concepts within medical curricular documents, using information derived from the National Library of Medicine's Unified Medical Language System (UMLS). The long-term goal of the KnowledgeMap (KM) project is to provide faculty and students with an improved ability to develop, review, and integrate components of the medical school curriculum. The KM concept identifier uses lexical resources partially derived from the UMLS (SPECIALIST lexicon and Metathesaurus), heuristic language processing techniques, and an empirical scoring algorithm. KM differentiates among potentially matching Metathesaurus concepts within a source document. The authors manually identified important "gold standard" biomedical concepts within selected medical school full-content lecture documents and used these documents to compare KM concept recognition with that of a known state-of-the-art "standard"-the National Library of Medicine's MetaMap program. The number of "gold standard" concepts in each lecture document identified by either KM or MetaMap, and the cause of each failure or relative success in a random subset of documents. For 4,281 "gold standard" concepts, MetaMap matched 78% and KM 82%. Precision for "gold standard" concepts was 85% for MetaMap and 89% for KM. The heuristics of KM accurately matched acronyms, concepts underspecified in the document, and ambiguous matches. The most frequent cause of matching failures was absence of target concepts from the UMLS Metathesaurus. The prototypic KM system provided an encouraging rate of concept extraction for representative medical curricular texts. Future versions of KM should be evaluated for their ability to allow administrators, lecturers, and students to navigate through the medical curriculum to locate redundancies, find interrelated information, and identify omissions. In addition, the ability of KM to meet specific, personal information needs should be

  6. Additional mailing phase for FIT after a medical offer phase: The best way to improve compliance with colorectal cancer screening in France.

    Science.gov (United States)

    Piette, Christine; Durand, Gérard; Bretagne, Jean-François; Faivre, Jean

    2017-03-01

    Compliance with colorectal cancer screening is critical to its effectiveness. The organisation of the mass screening programme in France has recently been modified with no evaluation of the consequences. To evaluate the impact of the way the screening test is delivered on compliance. During the first six months of the screening campaign (Ille-Vilaine, Brittany), general practitioners were asked to propose a faecal immunochemical test (FIT), OC-Sensor, to individuals at average risk for colorectal cancer (n=152,097). A subset of non-participants in the medical phase (n=13,071) was randomly chosen to receive a reminder that included the screening test or a simple postal reminder without the screening test. Compliance was 31% if the screening test was proposed during a medical consultation. In non-participants during the medical phase, it was 45% in those receiving both a reminder and the screening test and 28% amongst those receiving a simple reminder. An estimated overall participation rate of 54% can be expected if non-participants in the medical phase are sent a reminder together with the screening test. In France, a compliance rate above the minimum uptake rate of 45% recommended by European Union experts can be achieved if the FIT is mailed to non-participants after the medical free-offer phase. Copyright © 2016. Published by Elsevier Ltd.

  7. 15 CFR Notes Applicable to State... - Notes applicable to State of Understanding related to Medical Equipment:

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Notes applicable to State of Understanding related to Medical Equipment: applicable Notes applicable to State of Understanding related to Medical Equipment: Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY,...

  8. Understanding Preclerkship Medical Students' Poor Performance in Prescription Writing.

    Science.gov (United States)

    James, Henry; Al Khaja, Khalid A J; Tayem, Yasin I; Veeramuthu, Sindhan; Sequeira, Reginald P

    2016-05-01

    This study aimed to explore reasons for poor performance in prescription writing stations of the objective structured practical examination (OSPE) and absenteeism in prescription writing sessions among preclerkship medical students at the Arabian Gulf University (AGU) in Manama, Bahrain. This descriptive study was carried out between September 2014 and June 2015 among 157 preclerkship medical students at AGU. Data were collected using focus group discussions and a questionnaire with closed- and open-ended items. All 157 students participated in the study (response rate: 100.0%). The most frequently cited reasons for poor performance in OSPE stations were an inability to select the correct drugs (79.6%), treatment duration (69.4%), drug quantity (69.4%) and drug formulation (68.2%). Additionally, students reported inadequate time for completing the stations (68.8%). During focus group discussions, students reported other reasons for poor performance, including examination stress and the difficulty of the stations. Absenteeism was attributed to the length of each session (55.4%), lack of interest (50.3%), reliance on peers for information (48.4%) and optional attendance policies (47.1%). Repetitive material, large group sessions, unmet student expectations and the proximity of the sessions to summative examinations were also indicated to contribute to absenteeism according to open-ended responses or focus group discussions. This study suggests that AGU medical students perform poorly in prescription writing OSPE stations because of inadequate clinical pharmacology knowledge. Participation in prescription writing sessions needs to be enhanced by addressing the concerns identified in this study. Strategies to improve attendance and performance should take into account the learner-teacher relationship.

  9. Understanding Preclerkship Medical Students’ Poor Performance in Prescription Writing

    Directory of Open Access Journals (Sweden)

    Henry James

    2016-05-01

    Full Text Available Objectives: This study aimed to explore reasons for poor performance in prescription writing stations of the objective structured practical examination (OSPE and absenteeism in prescription writing sessions among preclerkship medical students at the Arabian Gulf University (AGU in Manama, Bahrain. Methods: This descriptive study was carried out between September 2014 and June 2015 among 157 preclerkship medical students at AGU. Data were collected using focus group discussions and a questionnaire with closed- and open-ended items. Results: All 157 students participated in the study (response rate: 100.0%. The most frequently cited reasons for poor performance in OSPE stations were an inability to select the correct drugs (79.6%, treatment duration (69.4%, drug quantity (69.4% and drug formulation (68.2%. Additionally, students reported inadequate time for completing the stations (68.8%. During focus group discussions, students reported other reasons for poor performance, including examination stress and the difficulty of the stations. Absenteeism was attributed to the length of each session (55.4%, lack of interest (50.3%, reliance on peers for information (48.4% and optional attendance policies (47.1%. Repetitive material, large group sessions, unmet student expectations and the proximity of the sessions to summative examinations were also indicated to contribute to absenteeism according to open-ended responses or focus group discussions. Conclusion: This study suggests that AGU medical students perform poorly in prescription writing OSPE stations because of inadequate clinical pharmacology knowledge. Participation in prescription writing sessions needs to be enhanced by addressing the concerns identified in this study. Strategies to improve attendance and performance should take into account the learner-teacher relationship.

  10. Using Social Cognitive Theory to Predict Medication Compliance Behavior in Patients with Depression in Southern United States in 2016 in a Cross-Sectional Study.

    Science.gov (United States)

    Bennett, Britney; Sharma, Manoj; Bennett, Russell; Mawson, Anthony R; Buxbaum, Sarah G; Sung, Jung Hye

    2018-03-01

    Introduction: Depression is a major public health issue. One of the concerns in depression research and practice pertains to non-compliance to prescribed medications. The purpose of the study was to predict compliance with medication use for patients with depression using social cognitive theory (SCT). Based on this study it was envisaged that recommendations for interventions to enhance compliance for medication use could be developed for patients with depression. Methods: The study was conducted using cross sectional design (n=148) in southern United States with a convenience sample of clinic-based depression patients with a 37-item valid and reliable questionnaire. Sample size was calculated to be 148 using G*Power (five predictors with a 0.80 power at the 0.05 alpha level and an estimated effect size of 0.10 with an inflation by 10% for missing data). Social cognitive theory constructs of expectations, self-efficacy and self-efficacy in overcoming barriers, self-control, and environment were reified. Data were analyzed using multiple linear regression and multiple logistic regression analyses. Results: Self-control for taking medication for depression (P=0.04), expectations for taking medication for depression (P=0.025), age (P<0.0001) and race (P=0.04) were significantly related to intent for taking medication for depression (Adjusted R 2 = 0.183). In race, Blacks had lower intent to take medication for depression. Conclusion: Social cognitive theory is weakly predictive with low explained variance for taking medication for depression. It needs to be bolstered by newer theories like integrative model or multi-theory model of health behavior change for designing educational interventions aimed at enhancing compliance to medication for depression.

  11. Using Social Cognitive Theory to Predict Medication Compliance Behavior in Patients with Depression in Southern United States in 2016 in a Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Britney Bennett

    2018-03-01

    Full Text Available Introduction: Depression is a major public health issue. One of the concerns in depression research and practice pertains to non-compliance to prescribed medications. The purpose of the study was to predict compliance with medication use for patients with depression using social cognitive theory (SCT. Based on this study it was envisaged that recommendations for interventions to enhance compliance for medication use could be developed for patients with depression. Methods: The study was conducted using cross sectional design (n=148 in southern United States with a convenience sample of clinic-based depression patients with a 37-item valid and reliable questionnaire. Sample size was calculated to be 148 using G*Power (five predictors with a 0.80 power at the 0.05 alpha level and an estimated effect size of 0.10 with an inflation by 10% for missing data. Social cognitive theory constructs of expectations, self-efficacy and self-efficacy in overcoming barriers, self-control, and environment were reified. Data were analyzed using multiple linear regression and multiple logistic regression analyses. Results: Self-control for taking medication for depression (P=0.04, expectations for taking medication for depression (P=0.025, age (P<0.0001 and race (P=0.04 were significantly related to intent for taking medication for depression (Adjusted R2 = 0.183. In race, Blacks had lower intent to take medication for depression. Conclusion: Social cognitive theory is weakly predictive with low explained variance for taking medication for depression. It needs to be bolstered by newer theories like integrative model or multi-theory model of health behavior change for designing educational interventions aimed at enhancing compliance to medication for depression.

  12. A preliminary study to understand tacit knowledge and visual routines of medical experts through gaze tracking.

    Science.gov (United States)

    Anderson, Blake; Shyu, Chi-Ren

    2010-11-13

    Many decisions made by medical experts are based on scans from advanced imaging technologies. Interpreting a medical image is a trained, systematic procedure and an excellent target for identifying potential visual routines through image informatics. These visual routines derived from experts contain many clues about visual knowledge and its representation. This study uses an inexpensive webcam-based gaze tracking method to collect data from multiple technologists' survey of medical and non-medical images. Through computational analysis of the results, we expect to provide insight into the behaviors and properties related to medical visual routines. Discovering the visual processes associated with medical images will help us recognize and understand the tacit knowledge gained from extensive experience with medical imagery. These expert routines could potentially be used to reduce medical error, train new experts, and provide an understanding of the human visual system in medicine.

  13. Understanding medical symptoms: a conceptual review and analysis.

    Science.gov (United States)

    Malterud, Kirsti; Guassora, Ann Dorrit; Graungaard, Anette Hauskov; Reventlow, Susanne

    2015-12-01

    The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor's office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew Leder's phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer's biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik's concept "situational disease" explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated.

  14. Using Ethnography to Understand Patients’ Perspectives on Medication Use

    DEFF Research Database (Denmark)

    Lau, Sofie Rosenlund

    2014-01-01

    an ethnographic approach to medicine use may help gaining new knowledge in the field of social pharmacy. Methods: The study is inspired by the methodology of Following the Technology as introduced in Science and Technology Studies (e.g. Mol 2000) – that is by observing the real-time activities related...... to the phenomenon of interest, in this case hypercholesterolemia and statins. The phenomenon is followed in various locations and practices to which it travels. Thus, by using an ethnographic approach I seek to reconstruct an understanding of related events and practices of the people involved. The fieldwork...

  15. Understanding Compliance in Patriarchal Religions: Mormon Women and the Latter Day Saints Church as a Case Study

    Directory of Open Access Journals (Sweden)

    Reid Leamaster

    2018-04-01

    Full Text Available Defining compliance as acquiescence in situations of inequality, this article explores patterns of compliance to gender traditionalism from the analysis of interviews with Mormon women. Analysis reveals that Mormon women face unique, context-specific mechanisms for stifling resistance to gender traditionalism. Additionally, many of the Mormon women interviewed who do not comply with traditional gender expectations regarding motherhood still accept and defend gender traditionalism. We explain this pattern with a concept that we call ideological compensation, which means that women in gender traditional religions defend gender traditionalism even if they do not live it as a way to compensate for their non-compliance. Finally, we find that some of the women frame their compliance to Mormon gender traditionalism as a statement of resistance against the broader society. We describe this phenomenon with a concept known as subcultural resistance. Overall, this study sheds light on how Mormon women interpret traditional gender expectations and the mechanisms that are put in place to stifle resistance.

  16. Can oral fluid cannabinoid testing monitor medication compliance and/or cannabis smoking during oral THC and oromucosal Sativex administration?

    Science.gov (United States)

    Lee, Dayong; Karschner, Erin L; Milman, Garry; Barnes, Allan J; Goodwin, Robert S; Huestis, Marilyn A

    2013-06-01

    We characterize cannabinoid disposition in oral fluid (OF) after dronabinol, synthetic oral Δ(9)-tetrahydrocannabinol (THC), and Sativex, a cannabis-extract oromucosal spray, and evaluate whether smoked cannabis relapse or Sativex compliance can be identified with OF cannabinoid monitoring. 5 and 15 mg synthetic oral THC, low (5.4 mg THC, 5.0 mg cannabidiol (CBD)) and high (16.2 mg THC, 15.0 mg CBD) dose Sativex, and placebo were administered in random order (n=14). Oral fluid specimens were collected for 10.5 h after dosing and analyzed for THC, CBD, cannabinol (CBN), and 11-nor-9-carboxy-THC (THCCOOH). After oral THC, OF THC concentrations decreased over time from baseline, reflecting residual THC excretion from previously self-administered smoked cannabis. CBD and CBN also were rarely detected. After Sativex, THC, CBD and CBN increased greatly, peaking at 0.25-1 h. Median CBD/THC and CBN/THC ratios were 0.82-1.34 and 0.04-0.06, respectively, reflecting cannabinoids' composition in Sativex. THCCOOH/THC ratios within 4.5 h post Sativex were ≤ 1.6 pg/ng, always lower than after oral THC and placebo. THCCOOH/THC ratios increased throughout each dosing session. Lack of measurable THC, CBD and CBN in OF following oral THC, and high OF CBD/THC ratios after Sativex distinguish oral and sublingual drug delivery routes from cannabis smoking. Low THCCOOH/THC ratios suggest recent Sativex and smoked cannabis exposure. These data indicate that OF cannabinoid monitoring can document compliance with Sativex pharmacotherapy, and identify relapse to smoked cannabis during oral THC medication but not Sativex treatment, unless samples were collected shortly after smoking. Published by Elsevier Ireland Ltd.

  17. Prescription copay reduction program for diabetic employees: impact on medication compliance and healthcare costs and utilization.

    Science.gov (United States)

    Nair, Kavita V; Miller, Kerri; Saseen, Joseph; Wolfe, Pamela; Allen, Richard Read; Park, Jinhee

    2009-01-01

    To examine the impact of a value-based benefit design on utilization and expenditures. This benefit design involved all diabetes-related drugs and testing supplies placed on the lowest copay tier for 1 employer group. The sample of diabetic members were enrolled from a 9-month preperiod and for 2 years after the benefit design was implemented. Measured outcomes included prescription drug utilization for diabetes and medical utilization. Generalized measures were used to estimate differences between years 1 and 2 and the preperiod adjusting for age, gender, and comorbidity risk. Diabetes prescription drug use increased by 9.5% in year 1 and by 5.5% in year 2, and mean adherence increased by 7% to 8% in year 1 and fell slightly in year 2 compared with the preperiod. Pharmacy expenditures increased by 47% and 53% and expenditures for diabetes services increased by 16% and 32% in years 1 and 2, respectively. Increases in adherence and use of diabetes medications were observed. There were no compensatory cost-savings for the employer through lower utilization of medical expenditures in the first 2 years. Adherent patients had fewer emergency department visits than nonadherent patients after the implementation of this benefit design.

  18. History of Medical Understanding and Misunderstanding of Acid Base Balance

    Science.gov (United States)

    Aiken, Christopher Geoffrey Alexander

    2013-01-01

    To establish how controversies in understanding acid base balance arose, the literature on acid base balance was reviewed from 1909, when Henderson described how the neutral reaction of blood is determined by carbonic and organic acids being in equilibrium with an excess of mineral bases over mineral acids. From 1914 to 1930, Van Slyke and others established our acid base principles. They recognised that carbonic acid converts into bicarbonate all non-volatile mineral bases not bound by mineral acids and determined therefore that bicarbonate represents the alkaline reserve of the body and should be a physiological constant. They showed that standard bicarbonate is a good measure of acidosis caused by increased production or decreased elimination of organic acids. However, they recognised that bicarbonate improved low plasma bicarbonate but not high urine acid excretion in diabetic ketoacidosis, and that increasing pCO2 caused chloride to shift into cells raising plasma titratable alkali. Both indicate that minerals influence pH. In 1945 Darrow showed that hyperchloraemic metabolic acidosis in preterm infants fed milk with 5.7 mmol of chloride and 2.0 mmol of sodium per 100 kcal was caused by retention of chloride in excess of sodium. Similar findings were made but not recognised in later studies of metabolic acidosis in preterm infants. Shohl in 1921 and Kildeberg in 1978 presented the theory that carbonic and organic acids are neutralised by mineral base, where mineral base is the excess of mineral cations over anions and organic acid is the difference between mineral base, bicarbonate and protein anion. The degree of metabolic acidosis measured as base excess is determined by deviation in both mineral base and organic acid from normal. PMID:24179938

  19. A Deterrence Approach to Regulate Nurses' Compliance with Electronic Medical Records Privacy Policy.

    Science.gov (United States)

    Kuo, Kuang-Ming; Talley, Paul C; Hung, Ming-Chien; Chen, Yen-Liang

    2017-11-03

    Hospitals have become increasingly aware that electronic medical records (EMR) may bring about tangible/intangible benefits to managing institutions, including reduced medical errors, improved quality-of-care, curtailed costs, and allowed access to patient information by healthcare professionals regardless of limitations. However, increased dependence on EMR has led to a corresponding increase in the influence of EMR breaches. Such incursions, which have been significantly facilitated by the introduction of mobile devices for accessing EMR, may induce tangible/intangible damage to both hospitals and concerned individuals. The purpose of this study was to explore factors which may tend to inhibit nurses' intentions to violate privacy policy concerning EMR based upon the deterrence theory perspective. Utilizing survey methodology, 262 responses were analyzed via structural equation modeling. Results revealed that punishment certainty, detection certainty, and subjective norm would most certainly and significantly reduce nurses' intentions to violate established EMR privacy policy. With these findings, recommendations for health administrators in planning and designing effective strategies which may potentially inhibit nurses from violating EMR privacy policy are discussed.

  20. Systematic evaluation of "compliance" to prescribed treatment medications and "abstinence" from psychoactive drug abuse in chemical dependence programs: data from the comprehensive analysis of reported drugs.

    Science.gov (United States)

    Blum, Kenneth; Han, David; Femino, John; Smith, David E; Saunders, Scott; Simpatico, Thomas; Schoenthaler, Stephen J; Oscar-Berman, Marlene; Gold, Mark S

    2014-01-01

    This is the first quantitative analysis of data from urine drug tests for compliance to treatment medications and abstinence from drug abuse across "levels of care" in six eastern states of America. Comprehensive Analysis of Reported Drugs (CARD) data was used in this post-hoc retrospective observational study from 10,570 patients, filtered to include a total of 2,919 patients prescribed at least one treatment medication during 2010 and 2011. The first and last urine samples (5,838 specimens) were analyzed; compliance to treatment medications and abstinence from drugs of abuse supported treatment effectiveness for many. Compared to non-compliant patients, compliant patients were marginally less likely to abuse opioids, cannabinoids, and ethanol during treatment although more likely to abuse benzodiazepines. Almost 17% of the non-abstinent patients used benzodiazepines, 15% used opiates, and 10% used cocaine during treatment. Compliance was significantly higher in residential than in the non-residential treatment facilities. Independent of level of care, 67.2% of the patients (n = 1963; Pabuse detected in either the first or last urine samples (abstinence). Moreover, in 2010, 16.9% of the patients (n = 57) were abstinent at first but not at last urine (deteriorating abstinence), the percentage dropped to 13.3% (n = 174) in 2011; this improvement over years was statistically significant. A longitudinal analysis for abstinence and compliance was studied in a randomized subset from 2011, (n = 511) representing 17.5% of the total cohort. A statistically significant upward trend (p = 2.353×10-8) of abstinence rates as well as a similar but stronger trend for compliance ((p = 2.200×10-16) was found. Being cognizant of the trend toward drug urine testing being linked to medical necessity eliminating abusive screening, the interpretation of these valuable results require further intensive investigation.

  1. Patient empowerment by increasing the understanding of medical language for lay users.

    Science.gov (United States)

    Topac, V; Stoicu-Tivadar, V

    2013-01-01

    Patient empowerment is important in order to increase the quality of medical care and the life quality of the patients. An important obstacle for empowering patients is the language barrier the lay patient encounter when accessing medical information. To design and develop a service that will help increase the understanding of medical language for lay persons. The service identifies and explains medical terminology from a given text by annotating the terms in the original text with the definition. It is based on an original terminology interpretation engine that uses a fuzzy matching dictionary. The service was implemented in two projects: a) into the server of a tele-care system (TELEASIS) with the purpose of adapting medical text assigned by medical personnel for the assisted patients. b) Into a dedicated web site that can adapt the medical language from raw text or from existing web pages. The output of the service was evaluated by a group of persons, and the results indicate that such a system can increase the understanding of medical texts. Several design decisions were driven from the evaluation, and are being considered for future development. Other tests measuring accuracy and time performance for the fuzzy terminology recognition have been performed. Test results revealed good performance for accuracy and excellent results regarding time performance. The current version of the service increases the accessibility of medical language by explaining terminology with a good accuracy, while allowing the user to easily identify errors, in order to reduce the risk of incorrect terminology recognition.

  2. Understanding the types of fraud in claims to South African medical schemes.

    Science.gov (United States)

    Legotlo, T G; Mutezo, A

    2018-03-28

    Medical schemes play a significant role in funding private healthcare in South Africa (SA). However, the sector is negatively affected by the high rate of fraudulent claims. To identify the types of fraudulent activities committed in SA medical scheme claims. A cross-sectional qualitative study was conducted, adopting a case study strategy. A sample of 15 employees was purposively selected from a single medical scheme administration company in SA. Semi-structured interviews were conducted to collect data from study participants. A thematic analysis of the data was done using ATLAS.ti software (ATLAS.ti Scientific Software Development, Germany). The study population comprised the 17 companies that administer medical schemes in SA. Data were collected from 15 study participants, who were selected from the medical scheme administrator chosen as a case study. The study found that medical schemes were defrauded in numerous ways. The perpetrators of this type of fraud include healthcare service providers, medical scheme members, employees, brokers and syndicates. Medical schemes are mostly defrauded by the submission of false claims by service providers and syndicates. Fraud committed by medical scheme members encompasses the sharing of medical scheme benefits with non-members (card farming) and non-disclosure of pre-existing conditions at the application stage. The study concluded that perpetrators of fraud have found several ways of defrauding SA medical schemes regarding claims. Understanding and identifying the types of fraud events facing medical schemes is the initial step towards establishing methods to mitigate this risk. Future studies should examine strategies to manage fraudulent medical scheme claims.

  3. Serum potassium monitoring for users of ethinyl estradiol/drospirenone taking medications predisposing to hyperkalemia: physician compliance and survey of knowledge and attitudes.

    Science.gov (United States)

    Mona Eng, Patricia; Seeger, John D; Loughlin, Jeanne; Oh, Kelly; Walker, Alexander M

    2007-02-01

    Yasmin-28 [ethinyl estradiol 0.03 mg/drospirenone 3 mg (EE/DRSP)] contains drospirenone, a progestin component that possesses antimineralocorticoid activity with a potassium-sparing diuretic effect similar to that in spironolactone. Product labeling recommends potassium monitoring in the first month of use for women concurrently receiving medication that may increase serum potassium. We evaluated compliance with this recommendation by measuring monitoring around the date of oral contraceptive (OC) initiation in women who received EE/DRSP while being treated with medications predisposing to hyperkalemia and in similar women who received other OCs. Because preliminary analyses indicated incomplete compliance, we surveyed physicians who prescribed EE/DRSP to women receiving drugs predisposing to hyperkalemia on their knowledge and attitudes with regard to the recommendation. We conducted this study using data from the Ingenix Research Datamart, which includes insurance claims for reimbursement for medical services and prescription medications for approximately 8,000,000 members of a large nationally dispersed health plan. We used claims for pharmacy dispensings of prescription medications to identify all women aged 10-59 years old who initiated EE/DRSP or other OCs during the first 3 years of EE/DRSP availability (July 2001 to June 2004). The frequency of potassium monitoring was measured by identifying claims for serum potassium tests. We conducted a telephone survey of 58 physicians who had prescribed EE/DRSP up to June 2003 to women who received concomitant hyperkalemic drugs. Although potassium monitoring was generally more frequent among EE/DRSP initiators receiving concomitant hyperkalemic drugs than among other OC initiators receiving similar medications, only 40% of 466 EE/DRSP initiators with concurrent hyperkalemic treatment had potassium tests. More than 98% of surveyed physicians were aware of the potassium-sparing property of EE/DRSP. Compared with

  4. Understanding the Use of Educational Technology among Faculty, Staff, and Students at a Medical University

    Science.gov (United States)

    Kazley, Abby Swanson; Annan, Dustin L.; Carson, Nancy E.; Freeland, Melissa; Hodge, Ashley B.; Seif, Gretchen A.; Zoller, James S.

    2013-01-01

    A college of health professions at a medical university located in the southeastern United States is striving to increase the use of educational technology among faculty, staff, and students. A strategic planning group was formed and charged with enhancing the use of educational technology within the college. In order to understand the current…

  5. Understanding the drivers on medical workloads: an analysis of spectators at the Australian Football League.

    Science.gov (United States)

    Zeitz, Kathryn; Haghighi, Pari Delir; Burstein, Frada; Williams, Jeffrey

    2013-06-01

    The present study was designed to further understand the psychosocial drivers of crowds impacting on the demand for healthcare. This involved analysing different spectator crowds for medical usage at mass gatherings; more specifically, did different football team spectators (of the Australian Football League) generate different medical usage rates. In total, 317 games were analysed from 10 venues over 2 years. Data were analysed by the ANOVA and Pearson correlation tests. RESULTS; Spectators who supported different football teams generated statistically significant differences in patient presentation rates (PPR) (F15, 618=1.998, P=0.014). The present study confirmed previous findings that there is a positive correlation between the crowd size and PPR at mass gatherings but found a negative correlation between density and PPR (r = -0.206, n=317, Pemergency medical care. In measuring demand for emergency medical services there is a need to develop a more sophisticated understanding of a variety of drivers in addition to traditional metrics such as temperature, crowd size and other physical elements. In this study we saw that spectators who supported different football teams generated statistically significant differences in PPR. What is known about this topic? Understanding the drivers of emergency medical care is most important in the mass gathering setting. There has been minimal analysis of psychological 'crowd' variables. What does this paper add? This study explores the psychosocial impact of supporting a different team on the PPR of spectators at Australian Football League matches. The value of collecting and analysing these types of data sets is to support more balanced planning, better decision support and knowledge management, and more effective emergency medical demand management. What are the implications for practitioners? This information further expands the body of evidence being created to understand the drivers of emergency medical demand and usage

  6. Mapping Tax Compliance

    DEFF Research Database (Denmark)

    Boll, Karen

    2014-01-01

    Tax compliance denotes the act of reporting and paying taxes in accordance with the tax laws. Current social science scholarship on tax compliance can almost entirely be divided into behavioural psychology analyses and critical tax studies. This article, which presents two cases of how tax...... compliance is constructed, challenges the explanatory reaches of today's social science approaches, arguing that an alternative approach to understanding tax compliance is worthwhile exploring. This other choice of approach, inspired by actor–network theory (ANT), adopts a more practice-oriented focus...... that studies tax compliance where it takes place as well as what it is made of. Consequently, this article argues that tax compliance is a socio-material assemblage and that complying is a distributed action. The article concludes by highlighting how an ANT approach contributes to the further theoretical...

  7. New approach for cognitive analysis and understanding of medical patterns and visualizations

    Science.gov (United States)

    Ogiela, Marek R.; Tadeusiewicz, Ryszard

    2003-11-01

    This paper presents new opportunities for applying linguistic description of the picture merit content and AI methods to undertake tasks of the automatic understanding of images semantics in intelligent medical information systems. A successful obtaining of the crucial semantic content of the medical image may contribute considerably to the creation of new intelligent multimedia cognitive medical systems. Thanks to the new idea of cognitive resonance between stream of the data extracted from the image using linguistic methods and expectations taken from the representaion of the medical knowledge, it is possible to understand the merit content of the image even if teh form of the image is very different from any known pattern. This article proves that structural techniques of artificial intelligence may be applied in the case of tasks related to automatic classification and machine perception based on semantic pattern content in order to determine the semantic meaning of the patterns. In the paper are described some examples presenting ways of applying such techniques in the creation of cognitive vision systems for selected classes of medical images. On the base of scientific research described in the paper we try to build some new systems for collecting, storing, retrieving and intelligent interpreting selected medical images especially obtained in radiological and MRI examinations.

  8. Brand names of Portuguese medication: understanding the importance of their linguistic structure and regulatory issues.

    Science.gov (United States)

    Pires, Carla; Vigário, Marina; Cavaco, Afonso

    2015-08-01

    Among other regulatory requirements, medicine brands should be composed of single names without abbreviations to prevent errors in prescription of medication. The purposes of the study were to investigate the compliance of a sam ple of Portuguese medicine brand names with Portuguese pharmaceutical regulations. This includes identifying their basic linguistic characteristics and comparing these features and their frequency of occurrence with benchmark values of the colloquial or informal language. A sample of 474 brand names was selected. Names were analyzed using manual (visual analyses) and computer methods (FreP - Frequency Patterns of Phonological Objects in Portuguese and MS word). A significant number of names (61.3%) failed to comply with the Portuguese phonologic system (related to the sound of words) and/or the spelling system (related to the written form of words) contained more than one word, comprised a high proportion of infrequent syllable types or stress patterns and included abbreviations. The results suggest that some of the brand names of Portuguese medication should be reevaluated, and that regulation on this issue should be enforced and updated, taking into consideration specific linguistic and spelling codes.

  9. From spoken narratives to domain knowledge: mining linguistic data for medical image understanding.

    Science.gov (United States)

    Guo, Xuan; Yu, Qi; Alm, Cecilia Ovesdotter; Calvelli, Cara; Pelz, Jeff B; Shi, Pengcheng; Haake, Anne R

    2014-10-01

    Extracting useful visual clues from medical images allowing accurate diagnoses requires physicians' domain knowledge acquired through years of systematic study and clinical training. This is especially true in the dermatology domain, a medical specialty that requires physicians to have image inspection experience. Automating or at least aiding such efforts requires understanding physicians' reasoning processes and their use of domain knowledge. Mining physicians' references to medical concepts in narratives during image-based diagnosis of a disease is an interesting research topic that can help reveal experts' reasoning processes. It can also be a useful resource to assist with design of information technologies for image use and for image case-based medical education systems. We collected data for analyzing physicians' diagnostic reasoning processes by conducting an experiment that recorded their spoken descriptions during inspection of dermatology images. In this paper we focus on the benefit of physicians' spoken descriptions and provide a general workflow for mining medical domain knowledge based on linguistic data from these narratives. The challenge of a medical image case can influence the accuracy of the diagnosis as well as how physicians pursue the diagnostic process. Accordingly, we define two lexical metrics for physicians' narratives--lexical consensus score and top N relatedness score--and evaluate their usefulness by assessing the diagnostic challenge levels of corresponding medical images. We also report on clustering medical images based on anchor concepts obtained from physicians' medical term usage. These analyses are based on physicians' spoken narratives that have been preprocessed by incorporating the Unified Medical Language System for detecting medical concepts. The image rankings based on lexical consensus score and on top 1 relatedness score are well correlated with those based on challenge levels (Spearman correlation>0.5 and Kendall

  10. Compliance with RSV prophylaxis: Global physicians’ perspectives

    Directory of Open Access Journals (Sweden)

    Kari S Anderson

    2009-07-01

    Full Text Available Kari S Anderson, Victoria M Mullally, Linda M Fredrick, Andrew L CampbellAbbott Laboratories, Abbott Park, IL, USAAbstract: Respiratory syncytial virus (RSV is a significant cause of morbidity in high-risk infants. Palivizumab is proven to prevent serious RSV disease, but compliance with prophylaxis (monthly doses during the RSV season is essential to ensure protection. We invited 453 pediatricians to participate in a survey to identify their perspectives of barriers to compliance and interventions to improve compliance with palivizumab prophylaxis schedules. One hundred physicians from five continents completed the survey, identifying caregiver inconvenience, distance to clinic, cost of prophylaxis, and lack of understanding of the severity of RSV as the most common reasons for noncompliance. They recommended provision of educational materials about RSV, reminders from hospital or clinic, and administration of prophylaxis at home to increase compliance. Globally, physicians recognize several obstacles to prophylaxis compliance. This survey suggests that focused proactive interventions such as empowering caregivers with educational materials and reducing caregiver inconvenience may be instrumental to increase compliance.Keywords: medication adherence, respiratory syncytial virus infections, infant, premature, immunization, passive

  11. Understanding Patients' Process to Use Medical Marijuana: A Southern New Jersey Community Engagement Project.

    Science.gov (United States)

    Crowell, Tara L

    2016-09-01

    Given the necessity to better understand the process patients need to go through in order to seek treatment via medical marijuana, this study investigates this process to better understand this phenomenon. Specifically, Compassion Care Foundation (CCF) and Stockton University worked together to identify a solution to this problem. Specifically, 240 new patients at CCF were asked to complete a 1-page survey regarding various aspects associated with their experience prior to their use of medicinal marijuana-diagnosis, what prompted them to seek treatment, level of satisfaction with specific stages in the process, total length of time the process took, and patient's level of pain. Results reveal numerous patient diagnoses for which medical marijuana is being prescribed; the top 4 most common are intractable skeletal spasticity, chronic and severe pain, multiple sclerosis, and inflammatory bowel disease. Next, results indicate a little over half of the patients were first prompted to seek alternative treatment from their physicians, while the remaining patients indicated that other sources such as written information along with friends, relatives, media, and the Internet persuaded them to seek treatment. These data indicate that a variety of sources play a role in prompting patients to seek alternative treatment and is a critical first step in this process. Additional results posit that once patients began the process of qualifying to receive medical marijuana as treatment, the process seemed more positive even though it takes patients on average almost 6 months to obtain their first treatment after they started the process. Finally, results indicate that patients are reporting a moderately high level of pain prior to treatment. Implication of these results highlights several important elements in the patients' initial steps toward seeking medical marijuana, along with the quality and quantity of the process patients must engage in prior to obtaining treatment. In

  12. Can achievement emotions be used to better understand motivation, learning, and performance in medical education?

    Science.gov (United States)

    Artino, Anthony R; Holmboe, Eric S; Durning, Steven J

    2012-01-01

    In this article, we consider an emergent theory of human emotion. The overarching purpose of the article is to introduce medical education researchers to the notion of achievement emotions and provide a brief overview of how this work can inform the theory, research, and practice of medical education. First, we define achievement emotions and describe one of the leading contemporary theories of achievement emotions, control-value theory (Pekrun R. 2006. The control-value theory of achievement emotions: Assumptions, corollaries, and implications for educational research and practice. Educ Psychol Rev 18:315-341.). Next, we distinguish between different types of achievement emotions, their proximal causes, and their consequences for motivation, learning, and performance, and we discuss several implications for educational practice. Finally, we end with a call for more research on achievement emotions in medical education to facilitate our understanding of emotions and their impact on important educational outcomes.

  13. Criminal Compliance

    Directory of Open Access Journals (Sweden)

    Cristina Antonella Andretta

    2015-10-01

    The article discusses the concepts of both compliance and criminal compliance, its main components and structure as well as the main rules relating to its global application, and finally his emergence in the Ecuadorian legal system.

  14. Understanding Medical Students' Experience with Stress and Its Related Constructs: A Focus Group Study from Singapore.

    Science.gov (United States)

    Farquhar, Julia; Lie, Desiree; Chan, Angelique; Ow, Mandy; Vidyarthi, Arpana

    2018-02-01

    In order to protect medical students from burnout and its untoward psychiatric effects, it is imperative to understand their stress, burnout, coping, and resilience experiences. This study aimed to derive collective definitions from the medical student perspective, to identify common themes of students' experiences, and to distinguish pre-clinical and clinical year students' experiences relating to these four constructs. The authors conducted focus groups of medical students in Singapore across 4 years using a semi-structured question guide. Participants shared their understanding, experiences, and the relationships between stress, burnout, coping, and resilience. Coders independently evaluated construct definitions and derived common themes through an iterative process, and compared transcripts of pre-clinical and clinical year students to determine differences in experience over time. Nine focus groups (54 students, 28 females, mean age 24.3) were conducted. Students identified common definitions for each construct. Nine themes emerged within three domains: (1) relating constructs to personal experience, (2) interrelating stress, burnout, coping, and resilience, and (3) understanding the necessity of stress. Compared to clinical students, pre-clinical students reported theory-based rather than reality-based experiences and exam-induced stress, defined constructs using present rather than future situations, and described constructs as independent rather than interrelated. This sample of medical students in Singapore shares a common understanding of stress, burnout, coping, and resilience, but experiences these uniquely. They perceive a positive role for stress. These findings build upon prior literature, suggesting an interrelationship between stress and its related constructs and adding the novel perspective of students from an Asian country.

  15. Helping medical students to acquire a deeper understanding of truth-telling.

    Science.gov (United States)

    Hurst, Samia A; Baroffio, Anne; Ummel, Marinette; Burn, Carine Layat

    2015-01-01

    Truth-telling is an important component of respect for patients' self-determination, but in the context of breaking bad news, it is also a distressing and difficult task. We investigated the long-term influence of a simulated patient-based teaching intervention, integrating learning objectives in communication skills and ethics into students' attitudes and concerns regarding truth-telling. We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year). Open-ended responses were analysed to explore medical students' reported difficulties in breaking bad news. This intervention was implemented during the last preclinical year of a problem-based medical curriculum, in collaboration between the doctor-patient communication and ethics programs. Over time, concerns such as empathy and truthfulness shifted from a personal to a relational focus. Whereas 'truthfulness' was a concern for the content of the message, 'truth-telling' included concerns on how information was communicated and how realistically it was received. Truth-telling required empathy, adaptation to the patient, and appropriate management of emotions, both for the patient's welfare and for a realistic understanding of the situation. Our study confirms that an intervention confronting students with a realistic situation succeeds in making them more aware of the real issues of truth-telling. Medical students deepened their reflection over time, acquiring a deeper understanding of the relational dimension of values such as truth-telling, and honing their view of empathy.

  16. Understanding the psychosocial and physical work environment in a Singapore medical school.

    Science.gov (United States)

    Chan, G C T; Koh, D

    2007-02-01

    This study aims to understand the physical and psychosocial work environment, expectations and the perceived levels of stress encountered of medical students in Singapore. A cross-sectional study employing a self-administered work environment questionnaire was applied over a one-week period to the entire 2003/2004 medical school cohort (1,069 students, response rate 85 percent) from the first to fifth (final) years at the National University of Singapore. 3.3 percent had at least one needlestick injury within the academic year. The majority (especially the clinical students) also had musculoskeletal complaints (neck and back mainly) within the last three months. Using the General Health Questionnaire, it was found that 49.6 percent encountered significant stress and 64.6 percent reported that more than 60 percent of their total life stress was due to medical school. The most important psychosocial stressors were: too much work and difficulty in coping. The clinical students were particularly concerned about being good medical students and doctors. The reasons for choosing Medicine as a career and social health (health, study and sleep habits) were also studied. The health risks of a medical student are primarily psychosocial in nature. The biggest challenges are work demands, maintaining a work-life balance and managing the psychosocial work environment.

  17. Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients.

    Science.gov (United States)

    Patzer, Rachel E; Serper, Marina; Reese, Peter P; Przytula, Kamila; Koval, Rachel; Ladner, Daniela P; Levitsky, Josh M; Abecassis, Michael M; Wolf, Michael S

    2016-10-01

    We sought to evaluate the prevalence of medication understanding and non-adherence of entire drug regimens among kidney transplantation (KT) recipients and to examine associations of these exposures with clinical outcomes. Structured, in-person interviews were conducted with 99 adult KT recipients between 2011 and 2012 at two transplant centers in Chicago, IL; and Atlanta, GA. Nearly, one-quarter (24%) of participants had limited literacy as measured by the Rapid Estimate of Adult Literacy in Medicine test; patients took a mean of 10 (SD=4) medications and 32% had a medication change within the last month. On average, patients knew what 91% of their medications were for (self-report) and demonstrated proper dosing (via observed demonstration) for 83% of medications. Overall, 35% were non-adherent based on either self-report or tacrolimus level. In multivariable analyses, fewer months since transplant and limited literacy were associated with non-adherence (all Padherence, and hospitalization could help target appropriate self-care interventions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Paediatric nurses' understanding of the process and procedure of double-checking medications.

    Science.gov (United States)

    Dickinson, Annette; McCall, Elaine; Twomey, Bernadette; James, Natalie

    2010-03-01

    To understand paediatric nurses' understanding and practice regarding double-checking medication and identify facilitators and barriers to the process of independent double-checking (IDC). A system of double-checking medications has been proposed as a way of minimising medication error particularly in situations involving high-risk medications, complex processes such as calculating doses, or high-risk patient populations such as infants and children. While recommendations have been made in support of IDC in paediatric settings little is known about nursing practice and the facilitators and barriers to this process. A descriptive qualitative design was used. Data were collected via three focus group interviews. Six to seven paediatric nurses participated in homogenous groups based on level of practice. Data were analysed using thematic analysis. This study demonstrates that, while IDC is accepted and promoted as best practice in a paediatric setting, there is a lack of clarity as to what this means. This study supports other studies in relation to the influence of workload, distraction and environmental factors on the administration process but highlights the need for more research in relation to the impact of the power dynamic between junior and senior nurses. The issue of automaticity has been unexplored in relation to nursing practice but this study indicates that this may have an important influence on how care is delivered to patients. While the focus of this study was in the paediatric setting, the findings have relevance to other settings and population groups. The adoption of IDC in health care settings must have in place: policy and guidelines that clearly define the process of checking, educational support, an environment that supports peer critique and review, well-designed medication areas and accessible resources to support drug administration.

  19. Understanding the value of mixed methods research: the Children's Safety Initiative-Emergency Medical Services.

    Science.gov (United States)

    Hansen, Matthew; O'Brien, Kerth; Meckler, Garth; Chang, Anna Marie; Guise, Jeanne-Marie

    2016-07-01

    Mixed methods research has significant potential to broaden the scope of emergency care and specifically emergency medical services investigation. Mixed methods studies involve the coordinated use of qualitative and quantitative research approaches to gain a fuller understanding of practice. By combining what is learnt from multiple methods, these approaches can help to characterise complex healthcare systems, identify the mechanisms of complex problems such as medical errors and understand aspects of human interaction such as communication, behaviour and team performance. Mixed methods approaches may be particularly useful for out-of-hospital care researchers because care is provided in complex systems where equipment, interpersonal interactions, societal norms, environment and other factors influence patient outcomes. The overall objectives of this paper are to (1) introduce the fundamental concepts and approaches of mixed methods research and (2) describe the interrelation and complementary features of the quantitative and qualitative components of mixed methods studies using specific examples from the Children's Safety Initiative-Emergency Medical Services (CSI-EMS), a large National Institutes of Health-funded research project conducted in the USA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Increasing nursing students' understanding and accuracy with medical dose calculations: A collaborative approach.

    Science.gov (United States)

    Mackie, Jane E; Bruce, Catherine D

    2016-05-01

    Accurate calculation of medication dosages can be challenging for nursing students. Specific interventions related to types of errors made by nursing students may improve the learning of this important skill. The objective of this study was to determine areas of challenge for students in performing medication dosage calculations in order to design interventions to improve this skill. Strengths and weaknesses in the teaching and learning of medication dosage calculations were assessed. These data were used to create online interventions which were then measured for the impact on student ability to perform medication dosage calculations. The setting of the study is one university in Canada. The qualitative research participants were 8 nursing students from years 1-3 and 8 faculty members. Quantitative results are based on test data from the same second year clinical course during the academic years 2012 and 2013. Students and faculty participated in one-to-one interviews; responses were recorded and coded for themes. Tests were implemented and scored, then data were assessed to classify the types and number of errors. Students identified conceptual understanding deficits, anxiety, low self-efficacy, and numeracy skills as primary challenges in medication dosage calculations. Faculty identified long division as a particular content challenge, and a lack of online resources for students to practice calculations. Lessons and online resources designed as an intervention to target mathematical and concepts and skills led to improved results and increases in overall pass rates for second year students for medication dosage calculation tests. This study suggests that with concerted effort and a multi-modal approach to supporting nursing students, their abilities to calculate dosages can be improved. The positive results in this study also point to the promise of cross-discipline collaborations between nursing and education. Copyright © 2016 Elsevier Ltd. All rights

  1. Regulatory Enforcement and Compliance

    DEFF Research Database (Denmark)

    May, Peter J.; Winter, Søren

    1999-01-01

    This study of municipal enforcement of agro-environmental regulations in Denmark provides an empirical understanding of how enforcement affects compliance. A key contribution is sorting out the relative influence of inspectors' different styles of enforcement and choices made by enforcement...... agencies. The latter are shown to be more important in bringing about compliance than are inspectors' enforcement styles. Municipal agencies are shown to increase compliance through the use of third parties, more frequent inspection, and setting priorities for inspection of major items. The findings about...

  2. A new model to understand the career choice and practice location decisions of medical graduates.

    Science.gov (United States)

    Stagg, P; Greenhill, J; Worley, P S

    2009-01-01

    Australian medical education is increasingly influenced by rural workforce policy. Therefore, understanding the influences on medical graduates' practice location and specialty choice is crucial for medical educators and medical workforce planners. The South Australian Flinders University Parallel Rural Community Curriculum (PRCC) was funded by the Australian Government to help address the rural doctor workforce shortage. The PRCC was the first community based medical education program in Australia to teach a full academic year of medicine in South Australian rural general practices. The aim of this research was to identify what factors influence the career choices of PRCC graduates. A retrospective survey of all contactable graduates of the PRCC was undertaken. Quantitative data were analysed using SPSS 14.0 for Windows. Qualitative data were entered into NVIVO 7 software for coding, and analysed using content analysis. Usable data were collected from 46 of the 86 contactable graduates (53%). More than half of the respondents (54%) reported being on a rural career path. A significant relationship exists between being on a rural career pathway and making the decision prior to or during medical school (p = 0.027), and between graduates in vocational training who are on an urban career path and making a decision on career specialty after graduation from medical school (p = .004). Graduates in a general practice vocational training program are more likely to be on a rural career pathway than graduates in a specialty other than general practice (p = .003). A key influence on graduates' practice location is geographic location prior to entering medical school. Key influences on graduates choosing a rural career pathway are: having a spouse/partner with a rural background; clinical teachers and mentors; the extended rural based undergraduate learning experience; and a specialty preference for general practice. A lack of rural based internships and specialist training

  3. A Way to Understand Inpatients Based on the Electronic Medical Records in the Big Data Environment

    Directory of Open Access Journals (Sweden)

    Hongyi Mao

    2017-01-01

    Full Text Available In recent decades, information technology in healthcare, such as Electronic Medical Record (EMR system, is potential to improve service quality and cost efficiency of the hospital. The continuous use of EMR systems has generated a great amount of data. However, hospitals tend to use these data to report their operational efficiency rather than to understand their patients. Base on a dataset of inpatients’ medical records from a Chinese general public hospital, this study applies a configuration analysis from a managerial perspective and explains inpatients management in a different way. Four inpatient configurations (valued patients, managed patients, normal patients, and potential patients are identified by the measure of the length of stay and the total hospital cost. The implications of the finding are discussed.

  4. Insights and models from medical anthropology for understanding the healing activity of the Historical Jesus

    Directory of Open Access Journals (Sweden)

    John J. Pilch

    1995-12-01

    Full Text Available This essay sketches a basic introdution to medical anthropology as a key to understanding and interpreting  the healing activity of the historical Jesus described in the gospels. It presents select literature, leading experts, fundamental concepts, and insights and models of special value to biblical specialists. Only a cross-cultural discipline like medical anthropology allows the investigator to  interpret texts and events from other cultures with respect for their distinctive cultural contexts in order to draw more appropriate conclusions and applications in other cultures. Applications to biblical texts are not included in this essay but may be found in other articles published by the author and listed in the bibliography.

  5. Helping medical students to acquire a deeper understanding of truth-telling

    Directory of Open Access Journals (Sweden)

    Samia A. Hurst

    2015-11-01

    Full Text Available Problem: Truth-telling is an important component of respect for patients’ self-determination, but in the context of breaking bad news, it is also a distressing and difficult task. Intervention: We investigated the long-term influence of a simulated patient-based teaching intervention, integrating learning objectives in communication skills and ethics into students’ attitudes and concerns regarding truth-telling. We followed two cohorts of medical students from the preclinical third year to their clinical rotations (fifth year. Open-ended responses were analysed to explore medical students’ reported difficulties in breaking bad news. Context: This intervention was implemented during the last preclinical year of a problem-based medical curriculum, in collaboration between the doctor–patient communication and ethics programs. Outcome: Over time, concerns such as empathy and truthfulness shifted from a personal to a relational focus. Whereas ‘truthfulness’ was a concern for the content of the message, ‘truth-telling’ included concerns on how information was communicated and how realistically it was received. Truth-telling required empathy, adaptation to the patient, and appropriate management of emotions, both for the patient's welfare and for a realistic understanding of the situation. Lessons learned: Our study confirms that an intervention confronting students with a realistic situation succeeds in making them more aware of the real issues of truth-telling. Medical students deepened their reflection over time, acquiring a deeper understanding of the relational dimension of values such as truth-telling, and honing their view of empathy.

  6. Protocol compliance of administering parenteral medication in Dutch hospitals: an evaluation and cost-estimation of the implementation.

    NARCIS (Netherlands)

    Schilp, J.; Boot, S.; Blok, C. de; Spreeuwenberg, P.; Wagner, C.

    2014-01-01

    Objectives: Preventable adverse drug events (ADEs) are closely related to administration processes of parenteral medication. The Dutch Patient Safety Program provided a protocol for administering parenteral medication to reduce the amount of ADEs. The execution of the protocol was evaluated and a

  7. Understanding complexities of synaptic transmission in medically intractable seizures: A paradigm of epilepsy research

    Directory of Open Access Journals (Sweden)

    Jyotirmoy Banerjee

    2013-01-01

    Full Text Available Investigating the changes associated with the development of epileptic state in humans is complex and requires a multidisciplinary approach. Understanding the intricacies of medically intractable epilepsy still remains a challenge for neurosurgeons across the world. A significant number of patients who has undergone resective brain surgery for epilepsy still continue to have seizures. The reason behind this therapy resistance still eludes us. Thus to develop a cure for the difficult to treat epilepsy, we need to comprehensively study epileptogenesis. Although various animal models are developed but none of them replicate the pathological conditions in humans. So the ideal way to understand epileptogenecity is to examine the tissue resected for the treatment of intractable epilepsy. Advanced imaging and electrical localization procedures are utilized to establish the epileptogenic zone in epilepsy patients. Further molecular and cytological studies are required for the microscopic analysis of brain samples collected from the epileptogenic focus. As alterations in inhibitory as well as excitatory synaptic transmission are key features of epilepsy, understanding the regulation of neurotransmission in the resected surgery zone is of immense importance. Here we summarize various modalities of in vitro slice analysis from the resected brain specimen to understand the changes in GABAergic and glutamatergic synaptic transmission in epileptogenic zone. We also review evidence pertaining to the proposed role of nicotinic receptors in abnormal synaptic transmission which is one of the major causes of epileptiform activity. Elucidation of current concepts in regulation of synaptic transmission will help develop therapies for epilepsy cases that cannot me managed pharmacologically.

  8. A paradigm for understanding trust and mistrust in medical research: The Community VOICES study.

    Science.gov (United States)

    Smirnoff, M; Wilets, I; Ragin, D F; Adams, R; Holohan, J; Rhodes, R; Winkel, G; Ricci, E M; Clesca, C; Richardson, L D

    2018-01-01

    To promote justice in research practice and rectify health disparities, greater diversity in research participation is needed. Lack of trust in medical research is one of the most significant obstacles to research participation. Multiple variables have been identified as factors associated with research participant trust/mistrust. A conceptual model that provides meaningful insight into the interplay of factors impacting trust may promote more ethical research practice and provide an enhanced, actionable understanding of participant mistrust. A structured survey was developed to capture attitudes toward research conducted in emergency situations; this article focuses on items designed to assess respondents' level of trust or mistrust in medical research in general. Community-based interviews were conducted in English or Spanish with 355 New York City residents (white 42%, African American 29%, Latino 22%). Generally favorable attitudes toward research were expressed by a majority (85.3%), but many respondents expressed mistrust. Factor analysis yielded four specific domains of trust/mistrust, each of which was associated with different demographic variables: general trustworthiness (older age, not disabled); perceptions of discrimination (African American, Latino, Spanish language preference); perceptions of deception (prior research experience, African American); and perceptions of exploitation (less education). The four domains identified in the analysis provide a framework for understanding specific areas of research trust/mistrust among disparate study populations. This model offers a conceptual basis for the design of tailored interventions that target specific groups to promote trust of individual researchers and research institutions as well as to facilitate broader research participation.

  9. Medical abortion: understanding perspectives of rural and marginalized women from rural South India.

    Science.gov (United States)

    Sri, B Subha; Ravindran, T K Sundari

    2012-09-01

    To understand how rural and other groups of marginalized women define safe abortion; their perspectives and concerns regarding medical abortion (MA); and what factors affect their access to safe abortion. Focus group discussions were held with various groups of rural and marginalized women in Tamil Nadu to understand their perspectives and concerns on abortion, especially MA. Nearly a decade after mifepristone was approved for abortion in India, most study participants had never heard of MA. When they learned of the method, most preferred it over other methods of abortion. The women also had questions and concerns about the method and recommendations on how services should be provided. Their definition of a "safe abortion" included criteria beyond medical safety. They placed a high priority on "social safety," including confidentiality and privacy. In their view, factors affecting access to safe abortion and choice of provider included cost, assurance of secrecy, promptness of service provision, and absence of provider gatekeeping and provider-imposed conditions for receiving services. Women's preference for MA shows the potential of this technology to address the problem of unsafe abortion in India. Women need better access to information and services to realize this potential, however. Women's preferences regarding information dissemination and service provision need to be taken into account if policies and programs are to be truly responsive to the needs of marginalized women. Copyright © 2012. Published by Elsevier Ireland Ltd.

  10. Case based learning: a method for better understanding of biochemistry in medical students.

    Science.gov (United States)

    Nair, Sandhya Pillai; Shah, Trushna; Seth, Shruti; Pandit, Niraj; Shah, G V

    2013-08-01

    Health professionals need to develop analytic and diagnostic thinking skills and not just a mere accumulation of large amount of facts. Hence, Case Based Learning (CBL) has been used in the medical curriculum for this reason, so that the students are exposed to the real medical problems, which helps them in develop analysing abilities. This also helps them in interpreting and solving the problems and in the course of doing this, they develop interest. In addition to didactic lectures, CBL was used as a learning method. This study was conducted in the Department of Biochemistry, S.B.K.S.M.I and R.C, Sumandeep Vidyapeeth ,Piparia, Gujarat, India. A group of 100 students were selected and they were divided into two groups as the control group and the study group. A total of 50 students were introduced to case based learning, which formed the study group and 50 students who attended didactic lectures formed the control group. A very significant improvement (pmedical curriculum for a better understanding of Biochemistry among the medical students.

  11. CDL self-certification and medical examiner's certificate reporting : protect your CDL, compliance is easy, find out how.

    Science.gov (United States)

    2011-01-01

    Starting Jan. 30, 2012, the Iowa Department of Transportation (DOT) will implement new federal regulations that require all CDL holders and applicants to certify the type of driving they do, and require interstate CDL holders that carry a Medical Exa...

  12. Using snowball sampling method with nurses to understand medication administration errors.

    Science.gov (United States)

    Sheu, Shuh-Jen; Wei, Ien-Lan; Chen, Ching-Huey; Yu, Shu; Tang, Fu-In

    2009-02-01

    We aimed to encourage nurses to release information about drug administration errors to increase understanding of error-related circumstances and to identify high-alert situations. Drug administration errors represent the majority of medication errors, but errors are underreported. Effective ways are lacking to encourage nurses to actively report errors. Snowball sampling was conducted to recruit participants. A semi-structured questionnaire was used to record types of error, hospital and nurse backgrounds, patient consequences, error discovery mechanisms and reporting rates. Eighty-five nurses participated, reporting 328 administration errors (259 actual, 69 near misses). Most errors occurred in medical surgical wards of teaching hospitals, during day shifts, committed by nurses working fewer than two years. Leading errors were wrong drugs and doses, each accounting for about one-third of total errors. Among 259 actual errors, 83.8% resulted in no adverse effects; among remaining 16.2%, 6.6% had mild consequences and 9.6% had serious consequences (severe reaction, coma, death). Actual errors and near misses were discovered mainly through double-check procedures by colleagues and nurses responsible for errors; reporting rates were 62.5% (162/259) vs. 50.7% (35/69) and only 3.5% (9/259) vs. 0% (0/69) were disclosed to patients and families. High-alert situations included administration of 15% KCl, insulin and Pitocin; using intravenous pumps; and implementation of cardiopulmonary resuscitation (CPR). Snowball sampling proved to be an effective way to encourage nurses to release details concerning medication errors. Using empirical data, we identified high-alert situations. Strategies for reducing drug administration errors by nurses are suggested. Survey results suggest that nurses should double check medication administration in known high-alert situations. Nursing management can use snowball sampling to gather error details from nurses in a non

  13. Attitudes, understanding, and concerns regarding medical research amongst Egyptians: A qualitative pilot study

    Directory of Open Access Journals (Sweden)

    Raafat May

    2007-08-01

    Full Text Available Abstract Background Medical research must involve the participation of human subjects. Knowledge of patients' perspectives and concerns with their involvement in research would enhance recruitment efforts, improve the informed consent process, and enhance the overall trust between patients and investigators. Several studies have examined the views of patients from Western countries. There is limited empirical research involving the perspectives of individuals from developing countries. The purpose of this study is to examine the attitudes of Egyptian individuals toward medical research. Such information would help clarify the type and extent of concerns regarding research participation of individuals from cultural, economic, and political backgrounds that differ from those in developed countries. Methods We conducted semi-structured interviews with 15 Egyptian individuals recruited from the outpatient settings (public and private at Ain Shams University in Cairo, Egypt. Interviews were taped, transcribed, and translated. Thematic analysis followed. Results All individuals valued the importance of medical research; however most would not participate in research that involved more than minimal risk. Individuals were comfortable with studies involving surveys and blood sampling, but many viewed drug trials as being too risky. All participants valued the concept of informed consent, as they thought that their permission to be in a research study was paramount. Many participants had discomfort with or difficulty in the understanding several research concepts: randomization, double-blind, and clinical equipoise. Trust in the physicians performing research was important in deciding to participate in clinical research. The small sample size and the selection bias associated with obtaining information from only those who agreed to participate in a research study represent limitations in this study. Conclusion Overall, individuals in our sample recognize

  14. Compliance status

    International Nuclear Information System (INIS)

    Black, D.G.

    1995-01-01

    This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford's compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute

  15. Compliance status

    Energy Technology Data Exchange (ETDEWEB)

    Black, D.G.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford`s compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute.

  16. Performing compliance

    DEFF Research Database (Denmark)

    Wimmelmann, Camilla Lawaetz

    2017-01-01

    the local policy workers front-staged some practices in the implementation process and back-staged others. The local policy workers deliberately performed ‘guideline compliance’ by using information control and impression management techniques. The findings suggest that local guideline compliance should...... be regarded as a staged performance in which deliberate techniques are used to produce and manage certain impressions of compliance....

  17. DEVELOPMENT OF THE QUESTIONNAIRE ON COMPLIANCE TO MEDICAL NUTRITION THERAPY FOR TYPE 2 DIABETIC PATIENTS AND ASSESSMENT OF ITS POTENTIAL USE

    Directory of Open Access Journals (Sweden)

    E. G. Starostina

    2016-01-01

    Full Text Available Background: А  specific questionnaire is necessary to perform quantitative assessment of compliance to medical nutrition therapy in patients with type 2 diabetes mellitus (DM.Aim: Тo develop a questionnaire to assess how type 2 diabetic patients adhere with the principles of medical nutrition therapy and to identify factors associated with good dietary compliance.Materials and methods: We proposed a questionnaire "Dietary adherence test" (DAT and validated it in 300 inand out-patients with type 2 DM. DAT was validated against the diabetes-related behavior score, diabetes-related knowledge score, and HbA1c level; the internal consistency coefficient (Cronbach's alfa was also calculated.Results: Cronbach's alfa for primary raw and standardized data were 0.7444 and 0.7413, respectively, thus meeting the required range of 0.7–0.8. The score on DAT item 1 (the title item and total score (the sum of scores of item 2 to 10 correlated with the diabetes-related behavior score (r=0.21, р=0.0006 and r=0.34, р<0.0001, respectively. Patients with poor dietary compliance (average DAT score≤2 had a significantly lower score on the subscale "Nutrition" of the diabetes knowledge test, than those with good dietary compliance (average DAT score≥2 (44.9±15.6 vs 60.2±16.2, р<0.0001. Patients who perceived their diet as the most burdensome element of life with diabetes, had lower total DAT score (24.1±4.6 than those who did not see their diet as a problem (25.9±5.1, р=0.001. There was a  significant difference in average DAT score between patients on insulin therapy and patients on oral treatment (2.8±0.6 vs 2.9±0.6, respectively, р=0.019. Patients with poor and good dietary adherence, according to DAT, differed in their duration of diabetes, social status and diabetes-related behavior score. There was a  weak correlation between the DAT score and duration of diabetes (r=0.16, р=0.009, and weak inverse correlation between the DAT score and

  18. Year 2000 compliance issues.

    Science.gov (United States)

    1999-03-01

    This month, we continue our coverage of the year 2000 (Y2K) problem as it affects healthcare facilities and the professionals who work in them. We present the following articles: "Checking PCs for Y2K Compliance"--In this article, we describe the probable sources of Y2K-related errors in PCs and present simple procedures for testing the Y2K compliance of PCs and application software. "Y2K Assessment Equipment Expectations"--In this article, we review the Y2K compliance data from a small sampling of hospitals to help answer the question "What percentage of medical equipment will likely be susceptible to Y2K problems?" "Y2K Labeling of Medical Devices"--In this article, we discuss the pros and cons of instituting a program to label each medical device with its Y2K status. Also in this section, we present an updated list of organizations that support ECRI's Position Statement on the testing of medical devices for Y2K compliance, which we published in the December 1998 issue of Health Devices (27[12]). And we remind readers of the services ECRI can offer to help healthcare institutions cope with the Y2K problem.

  19. Understanding older adults' medication decision making and behavior: A study on over-the-counter (OTC) anticholinergic medications.

    Science.gov (United States)

    Holden, Richard J; Srinivas, Preethi; Campbell, Noll L; Clark, Daniel O; Bodke, Kunal S; Hong, Youngbok; Boustani, Malaz A; Ferguson, Denisha; Callahan, Christopher M

    2018-03-06

    Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects. To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications. The study had a cross-sectional design with multiple methods. A total of 84 adults participated in qualitative research interviews (n = 24), in-store shopper observations (n = 39), and laboratory-based simulated OTC shopping tasks (n = 21). Simulated shopping participants also rank-ordered eight factors on their importance for OTC decision making. Findings revealed that many participants had concerns about medication adverse effects, generally, but were not aware of age-related risk associated with the use of anticholinergic medications. Analyses produced a map of the workflow of OTC-related behavior and decision making as well as related barriers such as difficulty locating medications or comparing them to an alternative. Participants reported effectiveness, adverse effects or health risks, and price as most important to their OTC medication purchase and use decisions. A persona analysis identified two types of consumers: the habit follower, who frequently purchased OTC medications and considered them safe; and the deliberator, who was more likely to weigh their options and consider alternatives to OTC medications. A conceptual model of OTC medication purchase and use is presented. Drawing on study findings and behavioral theories, the model depicts dual processes for OTC medication decision making - habit-based and deliberation-based - as well as the antecedents and consequences of decision making. This model suggests

  20. Informed consent and stimulant medication: adolescents' and parents' ability to understand information about benefits and risks of stimulant medication for the treatment of attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Schachter, Debbie; Tharmalingam, Sukirtha; Kleinman, Irwin

    2011-04-01

    This study of informed consent examines understanding of information needed to consent to stimulant treatment for attention-deficit/hyperactivity disorder (ADHD). The understanding of adolescents with ADHD, their parents, control adolescents, and their parents is compared. Fifty-eight ADHD and 64 control adolescents between the ages of 12 and 16 and their parents were studied. Baseline understanding of information was determined. Subjects received information relevant to informed consent for stimulation medication and afterward were evaluated on their recall understanding and their final understanding. Knowledge was increased after the information session for all subjects. There was no significant difference between unadjusted baseline, recall, and final knowledge of control adolescents and parents. Although unadjusted baseline, recall, and final knowledge of ADHD adolescents is significantly less than that of parents, 78% of ADHD adolescents had final understanding scores within 2 standard deviations of parents' scores. After controlling for baseline understanding and cognitive variables, there was no significant difference between understanding of ADHD adolescents and ADHD parents, whereas control adolescents understanding scores were higher than that of their parents. Understanding was highly associated with mathematics achievement in all groups. The majority of adolescents with ADHD, both with and without a history of stimulant medication treatment, have understanding that is similar to their parents and their inclusion in the informed consent process should be encouraged. Extra care should be afforded to those adolescents with low numeracy or literacy to ensure their understanding.

  1. Modeling Patient Treatment With Medical Records: An Abstraction Hierarchy to Understand User Competencies and Needs.

    Science.gov (United States)

    St-Maurice, Justin D; Burns, Catherine M

    2017-07-28

    Health care is a complex sociotechnical system. Patient treatment is evolving and needs to incorporate the use of technology and new patient-centered treatment paradigms. Cognitive work analysis (CWA) is an effective framework for understanding complex systems, and work domain analysis (WDA) is useful for understanding complex ecologies. Although previous applications of CWA have described patient treatment, due to their scope of work patients were previously characterized as biomedical machines, rather than patient actors involved in their own care. An abstraction hierarchy that characterizes patients as beings with complex social values and priorities is needed. This can help better understand treatment in a modern approach to care. The purpose of this study was to perform a WDA to represent the treatment of patients with medical records. The methods to develop this model included the analysis of written texts and collaboration with subject matter experts. Our WDA represents the ecology through its functional purposes, abstract functions, generalized functions, physical functions, and physical forms. Compared with other work domain models, this model is able to articulate the nuanced balance between medical treatment, patient education, and limited health care resources. Concepts in the analysis were similar to the modeling choices of other WDAs but combined them in as a comprehensive, systematic, and contextual overview. The model is helpful to understand user competencies and needs. Future models could be developed to model the patient's domain and enable the exploration of the shared decision-making (SDM) paradigm. Our work domain model links treatment goals, decision-making constraints, and task workflows. This model can be used by system developers who would like to use ecological interface design (EID) to improve systems. Our hierarchy is the first in a future set that could explore new treatment paradigms. Future hierarchies could model the patient as a

  2. Is the metaphor of 'barriers to change' useful in understanding implementation? Evidence from general medical practice.

    Science.gov (United States)

    Checkland, Kath; Harrison, Stephen; Marshall, Martin

    2007-04-01

    To investigate how general medical practices in the UK react to bureaucratic initiatives, such as National Health Service (NHS) National Service Frameworks (NSFs), and to explore the value of the metaphor of 'barriers to change' for understanding this. Interviews, non-participant observation and documentary analysis within case studies of four practices in northern England. The practices had not actively implemented NSFs. At interview, various 'barriers' that had prevented implementation were listed, including the complexity of the documents and lack of time. Observation suggested that these barriers were constructions used by the participants to make sense of the situation in which they found themselves. The metaphor of 'removing barriers to change' was of limited use in a context where non-implementation of policy was an emergent property of underlying organizational realities, likely to be modifiable only if these realities were addressed.

  3. A framework for understanding international medical graduate challenges during transition into fellowship programs.

    Science.gov (United States)

    Sockalingam, Sanjeev; Khan, Attia; Tan, Adrienne; Hawa, Raed; Abbey, Susan; Jackson, Timothy; Zaretsky, Ari; Okrainec, Allan

    2014-01-01

    Previous studies have highlighted unique needs of international medical graduates (IMG) during their transition into medical training programs; however, limited data exist on IMG needs specific to fellowship training. We conducted the following mixed-method study to determine IMG fellow training needs during the transition into fellowship training programs in psychiatry and surgery. The authors conducted a mixed-methods study consisting of an online survey of IMG fellows and their supervisors in psychiatry or surgery fellowship training programs and individual interviews of IMG fellows. The survey assessed (a) fellows' and supervisors' perceptions on IMG challenges in clinical communication, health systems, and education domains and (b) past orientation initiatives. In the second phase of the study, IMG fellows were interviewed during the latter half of their fellowship training, and perceptions regarding orientation and adaptation to fellowship in Canada were assessed. Survey data were analyzed using descriptive and Mann-Whitney U statistics. Qualitative interviews were analyzed using grounded theory methodology. The survey response rate was 76% (35/46) and 69% (35/51) for IMG fellows and supervisors, respectively. Fellows reported the greatest difficulty with adapting to the hospital system, medical documentation, and balancing one's professional and personal life. Supervisors believed that fellows had the greatest difficulty with managing language and slang in Canada, the healthcare system, and an interprofessional team. In Phase 2, fellows generated themes of disorientation, disconnection, interprofessional team challenges, a need for IMG fellow resources, and a benefit from training in a multicultural setting. Our study results highlight the need for IMG specific orientation resources for fellows and supervisors. Maslow's Hierarchy of Needs may be a useful framework for understanding IMG training needs.

  4. On the validity of language: speaking, knowing and understanding in medical geography.

    Science.gov (United States)

    Scarpaci, J L

    1993-09-01

    This essay examines methodological problems concerning the conceptualization and operationalization of phenomena central to medical geography. Its main argument is that qualitative research can be strengthened if the differences between instrumental and apparent validity are better understood than the current research in medical geography suggests. Its premise is that our definitions of key terms and concepts must be reinforced throughout the design of research should our knowledge and understanding be enhanced. In doing so, the paper aims to move the methodological debate beyond the simple dichotomies of quantitative vs qualitative approaches and logical positivism vs phenomenology. Instead, the argument is couched in a postmodernist hermeneutic sense which questions the validity of one discourse of investigation over another. The paper begins by discussing methods used in conceptualizing and operationalizing variables in quantitative and qualitative research design. Examples derive from concepts central to a geography of health-care behavior and well-being. The latter half of the essay shows the uses and misuses of validity studies in selected health services research and the current debate on national health insurance.

  5. Comic strips help children understand medical research: targeting the informed consent procedure to children's needs.

    Science.gov (United States)

    Grootens-Wiegers, Petronella; de Vries, Martine C; van Beusekom, Mara M; van Dijck, Laura; van den Broek, Jos M

    2015-04-01

    Children involved in medical research often fail to comprehend essential research aspects. In order to improve information provision, a participatory approach was used to develop new information material explaining essential concepts of medical research. A draft of a comic strip was developed by a science communicator in collaboration with pediatricians. The draft was presented to children participating in a clinical trial and to two school classes. Children were consulted for further development in surveys and interviews. Subsequently, the material was revised and re-evaluated in four school classes with children of varying ages and educational levels. In the first evaluation, children provided feedback on the storyline, wording and layout. Children thought the comic strip was 'fun' and 'informative'. Understanding of 8 basic research aspects was on average 83% and all above 65%, illustrating that children understood and remembered key messages. A comic strip was developed to support the informed consent process. Children were consulted and provided feedback. The resulting material was well understood and accepted. Involving children in the development of information material can substantially contribute to the quality of the material. Children were excited to participate and to 'be a part of science'. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Virtualized healthcare delivery: understanding users and their usage patterns of online medical consultations.

    Science.gov (United States)

    Jung, Changmi; Padman, Rema

    2014-12-01

    Virtualization of healthcare delivery via patient portals has facilitated the increasing interest in online medical consultations due to its benefits such as improved convenience and flexibility, lower cost, and time savings. Despite this growing interest, adoption by both consumers and providers has been slow, and little is known about users and their usage and adoption patterns. To learn characteristics of online healthcare consumers and understand their patterns of adoption and usage of online clinical consultation services (or eVisits delivered via the portal) such as adoption time for portal users, whether adoption hazard changes over time, and what factors influence patients to become early/late adopters. Using online medical consultation records between April 1, 2009 and May 31, 2010 from four ambulatory practices affiliated with a major healthcare provider, we conduct simple descriptive analysis to understand the users of online clinical consults and their usage patterns. Multilevel Logit regression is employed to measure the effect of patient and primary care provider characteristics on the likelihood of eVisit adoption by the patient, and survival analysis and Ordered Logit regression are applied to study eVisit adoption patterns that delineate elements describing early or late adopters. On average, eVisit adopters are younger and predominantly female. Their primary care providers participate in the eVisit service, highlighting the importance of physician's role in encouraging patients to utilize the service. Patients who are familiar with the patient portal are more likely to use the service, as are patients with more complex health issues. Younger and female patients have higher adoption hazard, but gender does not affect the decision of adopting early vs. late. These adopters also access the patient portal more frequently before adoption, indicating that they are potentially more involved in managing their health. The majority of eVisits are submitted

  7. The Voluntariat: A Freirean framework to understand the nature of undergraduate international (medical experiences

    Directory of Open Access Journals (Sweden)

    Seemi Qaiser

    2016-12-01

    Full Text Available Despite literature documenting limited and asymmetrical benefits along with ethical issues, short-term international volunteering is increasingly popular among North American university students as a perceived advantage when applying to professional healthcare schools or the job market. Academic institutions are also encouraging students to pursue international experiences in order to cultivate values as global citizens. These experiences are most typically limited to economically privileged students. Furthermore, international activities in developing countries often lack a pedagogy of social justice and may confirm a simplistic understanding of development. Brazilian educator Paulo Freire’s “liberation pedagogy” provides a framework for understanding the limitations of international volunteering, whereby the presence of privileged volunteers implementing Western models of development may hinder aspects of local movements. Regardless, university students face intense competition in accessing opportunities, such as medical school, and pay large sums to participate in volunteering to strengthen their academic credentials. We propose that these students form “the voluntariat.” They simultaneously play two roles by, first, contributing to the conditions that oppress the very communities in which they volunteer and, second, by playing a role as objects of oppression by the liberal institutions of learning and employment to which they are attempting to gain access.

  8. The Voluntariat: A Frieirean framework to understand the nature of undergraduate international (medical) experiences.

    Science.gov (United States)

    Qaiser, Seemi; Dimaras, Helen; Hamel, Paul

    2016-12-01

    Despite literature documenting limited and asymmetrical benefits along with ethical issues, short-term international volunteering is increasingly popular among North American university students as a perceived advantage when applying to professional healthcare schools or the job market. Academic institutions are also encouraging students to pursue international experiences in order to cultivate values as global citizens. These experiences are most typically limited to economically privileged students. Furthermore, international activities in developing countries often lack a pedagogy of social justice and may confirm a simplistic understanding of development. Brazilian educator Paulo Freire's "liberation pedagogy" provides a framework for understanding the limitations of international volunteering, whereby the presence of privileged volunteers implementing Western models of development may hinder aspects of local movements. Regardless, university students face intense competition in accessing opportunities, such as medical school, and pay large sums to participate in volunteering to strengthen their academic credentials. We propose that these students form "the voluntariat." They simultaneously play two roles by, first, contributing to the conditions that oppress the very communities in which they volunteer and, second, by playing a role as objects of oppression by the liberal institutions of learning and employment to which they are attempting to gain access.

  9. ADHERENCE TO LONG-TERM TREATMENT OF CARDIOVASCULAR DISEASE AND NON-COMPLIANCE WITH MEDICAL RECOMMENDATIONS: THE OPINION OF PATIENTS AND PHYSICIANS BY THE RESULTS OF FOCUSED INTERVIEW

    Directory of Open Access Journals (Sweden)

    O. N. Semenova

    2015-09-01

    Full Text Available Aim. To study the subjective opinion of patients and doctors about their individual experiences with adherence to treatment for chronic cardiovascular diseases in the group focused interview of patients and their physicians.Material and methods. 3 groups of patients from clinical studies adhering to the doctor's recommendations (focus-group 1 and 3 groups of patients hospitalized for cardiovascular events, not adhering to recommendations after discharge (focus-group 2 and one focus-group of doctors were analyzed. Group discussion was performed by a moderator (experienced sociologist, with no medical training who was not familiar with the patients and physicians.Results. 47 patients (25 (53.2 % men and 22 (46.8% women and 6 doctors participated in the study. Paternalistic model of communication with doctors present in the minds of all patients. In patients of the first group this results in a full confidence in the doctor and compliance with all recommendations while in patients of the second group lack of care in the outpatient clinic makes them "offended" by the underestimation of their trust and causes non-compliance. Physicians intuitively divide patients into less and more "attractive" for themselves. This "division" on the one hand may have some predictive value in respect of patients’ adherence to a further treatment, and on the other hand, the "doctors’ prejudice" in relation to the patient may adversely effect the behavior of the patients and failure to follow the recommendations in the future.Conclusion. The significant paternalism on the part of the patient on the one hand increases the responsibility of the physician for his patient, and on the other hand – increases opportunities for his influence on the patients’ behavior.

  10. ADHERENCE TO LONG-TERM TREATMENT OF CARDIOVASCULAR DISEASE AND NON-COMPLIANCE WITH MEDICAL RECOMMENDATIONS: THE OPINION OF PATIENTS AND PHYSICIANS BY THE RESULTS OF FOCUSED INTERVIEW

    Directory of Open Access Journals (Sweden)

    O. N. Semenova

    2014-01-01

    Full Text Available Aim. To study the subjective opinion of patients and doctors about their individual experiences with adherence to treatment for chronic cardiovascular diseases in the group focused interview of patients and their physicians.Material and methods. 3 groups of patients from clinical studies adhering to the doctor's recommendations (focus-group 1 and 3 groups of patients hospitalized for cardiovascular events, not adhering to recommendations after discharge (focus-group 2 and one focus-group of doctors were analyzed. Group discussion was performed by a moderator (experienced sociologist, with no medical training who was not familiar with the patients and physicians.Results. 47 patients (25 (53.2 % men and 22 (46.8% women and 6 doctors participated in the study. Paternalistic model of communication with doctors present in the minds of all patients. In patients of the first group this results in a full confidence in the doctor and compliance with all recommendations while in patients of the second group lack of care in the outpatient clinic makes them "offended" by the underestimation of their trust and causes non-compliance. Physicians intuitively divide patients into less and more "attractive" for themselves. This "division" on the one hand may have some predictive value in respect of patients’ adherence to a further treatment, and on the other hand, the "doctors’ prejudice" in relation to the patient may adversely effect the behavior of the patients and failure to follow the recommendations in the future.Conclusion. The significant paternalism on the part of the patient on the one hand increases the responsibility of the physician for his patient, and on the other hand – increases opportunities for his influence on the patients’ behavior.

  11. Compliance Issues in Higher Education

    Science.gov (United States)

    Benedek, Petra

    2016-01-01

    Efficiency in the 1980's, quality in the 1990's, compliance in the 2010's - private sector management techniques and mechanisms find their way to public services. This paper facilitates the understanding of how compliance management controls can improve operations and prevent or detect failure or wrong doing. The last few years' empirical research…

  12. Understanding the adoption dynamics of medical innovations: affordances of the da Vinci robot in the Netherlands.

    Science.gov (United States)

    Abrishami, Payam; Boer, Albert; Horstman, Klasien

    2014-09-01

    This study explored the rather rapid adoption of a new surgical device - the da Vinci robot - in the Netherlands despite the high costs and its controversial clinical benefits. We used the concept 'affordances' as a conceptual-analytic tool to refer to the perceived promises, symbolic meanings, and utility values of an innovation constructed in the wider social context of use. This concept helps us empirically understand robot adoption. Data from 28 in-depth interviews with diverse purposively-sampled stakeholders, and from medical literature, policy documents, Health Technology Assessment reports, congress websites and patients' weblogs/forums between April 2009 and February 2014 were systematically analysed from the perspective of affordances. We distinguished five interrelated affordances of the robot that accounted for shaping and fulfilling its rapid adoption: 'characteristics-related' affordances such as smart nomenclature and novelty, symbolising high-tech clinical excellence; 'research-related' affordances offering medical-technical scientific excellence; 'entrepreneurship-related' affordances for performing better-than-the-competition; 'policy-related' affordances indicating the robot's liberalised provision and its reduced financial risks; and 'communication-related' affordances of the robot in shaping patients' choices and the public's expectations by resonating promising discourses while pushing uncertainties into the background. These affordances make the take-up and use of the da Vinci robot sound perfectly rational and inevitable. This Dutch case study demonstrates the fruitfulness of the affordances approach to empirically capturing the contextual dynamics of technology adoption in health care: exploring in-depth actors' interaction with the technology while considering the interpretative spaces created in situations of use. This approach can best elicit real-life value of innovations, values as defined through the eyes of (potential) users

  13. Achieving Accreditation Council for Graduate Medical Education duty hours compliance within advanced surgical training: a simulation-based feasibility assessment.

    Science.gov (United States)

    Obi, Andrea; Chung, Jennifer; Chen, Ryan; Lin, Wandi; Sun, Siyuan; Pozehl, William; Cohn, Amy M; Daskin, Mark S; Seagull, F Jacob; Reddy, Rishindra M

    2015-11-01

    Certain operative cases occur unpredictably and/or have long operative times, creating a conflict between Accreditation Council for Graduate Medical Education (ACGME) rules and adequate training experience. A ProModel-based simulation was developed based on historical data. Probabilistic distributions of operative time calculated and combined with an ACGME compliant call schedule. For the advanced surgical cases modeled (cardiothoracic transplants), 80-hour violations were 6.07% and the minimum number of days off was violated 22.50%. There was a 36% chance of failure to fulfill any (either heart or lung) minimum case requirement despite adequate volume. The variable nature of emergency cases inevitably leads to work hour violations under ACGME regulations. Unpredictable cases mandate higher operative volume to ensure achievement of adequate caseloads. Publically available simulation technology provides a valuable avenue to identify adequacy of case volumes for trainees in both the elective and emergency setting. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. What do medical students understand by research and research skills? Identifying research opportunities within undergraduate projects.

    Science.gov (United States)

    Murdoch-Eaton, Deborah; Drewery, Sarah; Elton, Sarah; Emmerson, Catherine; Marshall, Michelle; Smith, John A; Stark, Patsy; Whittle, Sue

    2010-01-01

    Undergraduate research exposure leads to increased recruitment into academic medicine, enhanced employability and improved postgraduate research productivity. Uptake of undergraduate research opportunities is reported to be disappointing, and little is known about how students perceive research. To investigate opportunities for undergraduate participation in research, recognition of such opportunities, and associated skills development. A mixed method approach, incorporating student focus and study groups, and documentary analysis at five UK medical schools. Undergraduates recognised the benefits of acquiring research skills, but identified practical difficulties and disadvantages of participating. Analysis of 905 projects in four main research skill areas - (1) research methods; (2) information gathering; (3) critical analysis and review; (4) data processing - indicated 52% of projects provided opportunities for students to develop one or more skills, only 13% offered development in all areas. In 17%, project descriptions provided insufficient information to determine opportunities. Supplied with information from a representative sample of projects (n = 80), there was little consensus in identifying skills among students or between students and researchers. Consensus improved dramatically following guidance on how to identify skills. Undergraduates recognise the benefits of research experience but need a realistic understanding of the research process. Opportunities for research skill development may not be obvious. Undergraduates require training to recognise the skills required for research and enhanced transparency in potential project outcomes.

  15. A cross-cultural comparison of British and Pakistani medical students' understanding of schizophrenia.

    Science.gov (United States)

    Furnham, Adrian; Raja, Nazia; Khan, Umar Ali

    2008-06-30

    This study aimed to compare British, British Pakistani and Native Pakistani (from Pakistan) medical students' beliefs about the manifestation, causes and cures of schizophrenia, prior to any psychiatric training. A total of 305 participants completed a questionnaire on general beliefs about people with schizophrenia, causal explanations concerning the aetiology of schizophrenia and the role of hospitals and society in treating people with schizophrenia. It was predicted that compared with the British and British Pakistanis, the Pakistanis would have more negative beliefs and attitudes, considering people with schizophrenia to be more dangerous and unpredictable; they were also expected to use more superstitious beliefs to explain the cause of schizophrenia and its symptoms; as well as believe more in seeking help from God and faith healers. There was strong evidence to suggest that Pakistanis possessed more negative beliefs and attitudes about people with schizophrenia, but there was no evidence to indicate that Pakistanis believed more in superstitious causal explanations. Pakistanis were more likely to consider seeking help from faith healers, but not God, compared with British Pakistanis and the British. Results confirm previous European-Asian difference in the understanding of the cause, manifestation and cure of schizophrenia. The impact of traditional and Western cultural influences on British Pakistanis is considered.

  16. J. Marion Sims and the Vesicovaginal Fistula: Historical Understanding, Medical Ethics, and Modern Political Sensibilities.

    Science.gov (United States)

    Wall, L Lewis

    To review the historical background surrounding the early work of Dr. J. Marion Sims, who developed the first consistently successful surgical technique for the repair of obstetric vesicovaginal fistulas by operating on a group of young, enslaved, African American women who had this condition between 1846 and 1849. Review of primary source documents on Sims and his operations, early 19th century clinical literature on the treatment of vesicovaginal fistula, the introduction of ether and chloroform anesthesia into surgical practice, and the literature on the early 19th century medical ethics pertaining to surgical innovation. The goals are to understand Sims's operations within the clinical context of the 1840s and to avoid the problems of "presentism," in which beliefs, attitudes, and practices of the 21st century are anachronistically projected backward into the early 19th century. The object is to judge Sims within the context of his time, not to hold him accountable to standards of practice which were not developed until a century after his death. A narrative of what Sims did is presented within the context of the therapeutic options available to those with fistula in the early 19th century. Review of the available material demonstrates that Sims' first fistula operations were legal, that they were carried out with express therapeutic intent for the purpose of repairing these women's injuries, that they conformed to the ethical requirements of his time, and that they were performed with the patients' knowledge, cooperation, assent, and assistance.

  17. Understanding the role of contextual cues in supporting the formation of medication-taking habits

    Directory of Open Access Journals (Sweden)

    Katarzyna Stawarz

    2015-10-01

    in the presence of stable cues, with time they start to guide the behaviour and provide triggers to action (Lally & Gardner, 2011. However, adherence technologies tend to disregard contextual cues and the habitual nature of many medication regimens, and instead alert users when it is time to take the pill (Stawarz et al., 2014. Similarly, behaviour change technologies designed specifically to support habit formation also neglect contextual cues and instead focus on behaviour tracking and reminders (Stawarz et al, 2015. By supporting the identification and reinforcement of contextual cues, technology could aid both prospective memory and habit formation: it could help patients remember the new regimen and turn it into a reliable medication habit. Aims: Previous research by Stawarz et al. (2015 suggests that contextual cues support habit formation, but because habits take time to develop, people can still forget; conversely, reminders support remembering, but they can inhibit habit development. However, their study measured the development of an artificial habit (texting the researchers, lasted only for 4 weeks, and did not account for the role of location as a contextual cue. Therefore, the aim of this study was to explore the impact of contextual cues and reminders on the development of automaticity of behaviour (representing habit strength and frequency of repetition (representing adherence to the regimen over a longer period and with behaviours participants wanted to turn into habit. The understanding of how these factors influence the process of habit formation would enable us to design more effective adherence technologies that assist patients when they start a new regimen (prospective memory support as well as over the long term (habit support. Method: 209 participants were recruited on social networks, and among students and university staff. They were 18-58 years old (mean age = 27, SD = 7.6 years; 68% were women, 74% were students. They were asked to repeat a

  18. Relationship between Risk Factor Control and Compliance with a Lifestyle Modification Program in the Stenting Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis Trial.

    Science.gov (United States)

    Turan, Tanya N; Al Kasab, Sami; Nizam, Azhar; Lynn, Michael J; Harrell, Jamie; Derdeyn, Colin P; Fiorella, David; Janis, L Scott; Lane, Bethany F; Montgomery, Jean; Chimowitz, Marc I

    2018-03-01

    Lifestyle modification programs have improved the achievement of risk factor targets in a variety of clinical settings, including patients who have previously suffered a stroke or transient ischemic attack and those with multiple risk factors. Stenting Aggressive Medical Management for Prevention of Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) was the first vascular disease prevention trial to provide a commercially available lifestyle modification program to enhance risk factor control. We sought to determine the relationship between compliance with this program and risk factor control in SAMMPRIS. SAMMPRIS aggressive medical management included a telephonic lifestyle modification program provided free of charge to all subjects (n = 451) during their participation in the study. Subjects with fewer than 3 expected lifestyle-coaching calls were excluded from these analyses. Compliant subjects (n = 201) had  greater than or equal to 78.5% of calls (median % of completed/expected calls). Noncompliant subjects (n = 200) had less than 78.5% of calls or refused to participate. Mean risk factor values or % in-target for each risk factor was compared between compliant versus noncompliant subjects, using t tests and chi-square tests. Risk factor changes from baseline to follow-up were compared between the groups to account for baseline differences. Compliant subjects had better risk factor control throughout follow-up for low-density lipoprotein, systolic blood pressure (SBP), hemoglobin A1c (HgA1c), non-high-density lipoprotein, nonsmoking, and exercise than noncompliant subjects, but there was no difference for body mass index. After adjusting for baseline differences between the groups, compliant subjects had a greater change from baseline than noncompliant subjects for SBP did at 24 months and HgA1c at 6 months. SAMMPRIS subjects who were compliant with the lifestyle modification program had better risk factor control during the study for almost

  19. Understanding rational non-adherence to medications. A discrete choice experiment in a community sample in Australia

    Directory of Open Access Journals (Sweden)

    Laba Tracey-Lea

    2012-06-01

    Full Text Available Abstract Background In spite of the potential impact upon population health and expenditure, interventions promoting medication adherence have been found to be of moderate effectiveness and cost effectiveness. Understanding the relative influence of factors affecting patient medication adherence decisions and the characteristics of individuals associated with variation in adherence will lead to a better understanding of how future interventions should be designed and targeted. This study aims to explore medication-taking decisions that may underpin intentional medication non-adherence behaviour amongst a community sample and the relative importance of medication specific factors and patient background characteristics contributing to those decisions. Methods A discrete choice experiment conducted through a web-enabled online survey was used to estimate the relative importance of eight medication factors (immediate and long-term medication harms and benefits, cost, regimen, symptom severity, alcohol restrictions on the preference to continue taking a medication. To reflect more closely what usually occurs in practice, non-disease specific medication and health terms were used to mimic decisions across multiple medications and conditions.161 general community participants, matching the national Australian census data (age, gender were recruited through an online panel provider (participation rate: 10% in 2010. Results Six of the eight factors (i.e. immediate and long-term medication harms and benefits, cost, and regimen had a significant influence on medication choice. Patient background characteristics did not improve the model. Respondents with private health insurance appeared less sensitive to cost then those without private health insurance. In general, health outcomes, framed as a side-effect, were found to have a greater influence over adherence than outcomes framed as therapeutic benefits. Conclusions Medication-taking decisions are the

  20. Understanding rational non-adherence to medications. A discrete choice experiment in a community sample in Australia.

    Science.gov (United States)

    Laba, Tracey-Lea; Brien, Jo-Anne; Jan, Stephen

    2012-06-20

    In spite of the potential impact upon population health and expenditure, interventions promoting medication adherence have been found to be of moderate effectiveness and cost effectiveness. Understanding the relative influence of factors affecting patient medication adherence decisions and the characteristics of individuals associated with variation in adherence will lead to a better understanding of how future interventions should be designed and targeted. This study aims to explore medication-taking decisions that may underpin intentional medication non-adherence behaviour amongst a community sample and the relative importance of medication specific factors and patient background characteristics contributing to those decisions. A discrete choice experiment conducted through a web-enabled online survey was used to estimate the relative importance of eight medication factors (immediate and long-term medication harms and benefits, cost, regimen, symptom severity, alcohol restrictions) on the preference to continue taking a medication. To reflect more closely what usually occurs in practice, non-disease specific medication and health terms were used to mimic decisions across multiple medications and conditions.161 general community participants, matching the national Australian census data (age, gender) were recruited through an online panel provider (participation rate: 10%) in 2010. Six of the eight factors (i.e. immediate and long-term medication harms and benefits, cost, and regimen) had a significant influence on medication choice. Patient background characteristics did not improve the model. Respondents with private health insurance appeared less sensitive to cost then those without private health insurance. In general, health outcomes, framed as a side-effect, were found to have a greater influence over adherence than outcomes framed as therapeutic benefits. Medication-taking decisions are the subject of rational choices, influenced by the attributes of

  1. Understanding key factors affecting electronic medical record implementation: a sociotechnical approach.

    Science.gov (United States)

    Cucciniello, Maria; Lapsley, Irvine; Nasi, Greta; Pagliari, Claudia

    2015-07-17

    Recent health care policies have supported the adoption of Information and Communication Technologies (ICT) but examples of failed ICT projects in this sector have highlighted the need for a greater understanding of the processes used to implement such innovations in complex organizations. This study examined the interaction of sociological and technological factors in the implementation of an Electronic Medical Record (EMR) system by a major national hospital. It aimed to obtain insights for managers planning such projects in the future and to examine the usefulness of Actor Network Theory (ANT) as a research tool in this context. Case study using documentary analysis, interviews and observations. Qualitative thematic analysis drawing on ANT. Qualitative analyses revealed a complex network of interactions between organizational stakeholders and technology that helped to shape the system and influence its acceptance and adoption. The EMR clearly emerged as a central 'actor' within this network. The results illustrate how important it is to plan innovative and complex information systems with reference to (i) the expressed needs and involvement of different actors, starting from the initial introductory phase; (ii) promoting commitment to the system and adopting a participative approach; (iii) defining and resourcing new roles within the organization capable of supporting and sustaining the change and (iv) assessing system impacts in order to mobilize the network around a common goal. The paper highlights the organizational, cultural, technological, and financial considerations that should be taken into account when planning strategies for the implementation of EMR systems in hospital settings. It also demonstrates how ANT may be usefully deployed in evaluating such projects.

  2. Understanding Experiences of Diabetes Medications Among African Americans Living With Type 2 Diabetes.

    Science.gov (United States)

    Bockwoldt, Denise; Staffileno, Beth A; Coke, Lola; Hamilton, Rebekah; Fogg, Lou; Calvin, Donna; Quinn, Lauretta

    2017-07-01

    African American (AA) adults are disproportionally affected by type 2 diabetes and are diagnosed at an earlier age, but are less adherent to diabetes medications compared with the general population. This qualitative study sought to describe the experiences of taking diabetes medications among midlife AA men and women with type 2 diabetes and to identify factors that influence these experiences. Fifteen AAs completed semistructured interviews. Using the Roy adaptation model, thematic analysis coded for both adaptive and ineffective experiences. Adaptive experiences included self-confidence in one's ability to control diabetes, a belief in the value of diabetes medication, assuming responsibility for one's health, developing a routine for taking medication, and positive relationships with the care team. Ineffective experiences for medication taking included: feeling powerless over diabetes, self-blame, and fear. One's self-concept as a person with diabetes, as well as assuming the role of "medication taker," were prominent themes.

  3. Understanding the factors associated with initiation and adherence of osteoporosis medication in Japan: An analysis of patient perceptions

    Directory of Open Access Journals (Sweden)

    Hajime Orimo

    2017-12-01

    Conclusions: Different factors were found to be associated with initiation and adherence of osteoporosis medication. Patient knowledge of their disease and the perception of barriers were found to be the most influential. Empowering patients with the knowledge to better understand their disease and decreasing the perception of barriers through education initiatives may be effective in improving patient outcomes.

  4. "What do you think I should do?": Understanding intercultural medical communication in general practice

    NARCIS (Netherlands)

    Schinkel, S.

    2015-01-01

    Adequate communication between doctors and patients is a crucial aspect of good quality health care. Research has shown that medical communication between doctors and patients from different ethnic and cultural backgrounds is less effective than medical communication between doctors and patients

  5. A positive deviance approach to understanding key features to improving diabetes care in the medical home

    NARCIS (Netherlands)

    Gabbay, R.A.; Friedberg, M.W.; Miller-Day, M.; Cronholm, P.F.; Adelman, A.; Schneider, E.C.

    2013-01-01

    PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving

  6. Understanding the types of fraud in claims to South African medical ...

    African Journals Online (AJOL)

    A cross-sectional qualitative methodology was adopted in the study, as the phenomenon ... To identify the types of fraudulent activities committed in SA medical scheme claims. ... and Banking Research Ethics Review Committee (ref. no. 2016/.

  7. The understanding of plastic and reconstructive surgery amongst Queensland medical students

    Directory of Open Access Journals (Sweden)

    Christopher Conyard

    2016-06-01

    This study has highlighted the gap between a medical student's perception and reality of the scope of Plastic and Reconstructive Surgery. It has emphasised the need for greater exposure and education in this surgical subspeciality if future medical practitioners are to better match the requirements of their patients to the skills of the specialist. If plastic surgeons wish to continue to be recognised as specialists in hand, craniofacial and reconstructive surgery, this gap between perception and reality needs to be addressed.

  8. Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient.

    Science.gov (United States)

    Cartwright, Martina M

    2004-12-01

    Eating disorders are maladaptive eating behaviors that typically develop in adolescence and early adulthood. Psychiatric maladies and comorbid conditions, especially insulin-dependent diabetes mellitus, frequently co-exist with eating disorders. Serious medical complications affecting all organs and tissues can develop and result in numerous emergent hospitalizations. This article reviews the pathophysiologies of anorexia nervosa, bulimia nervosa, and orthorexia nervosa and discusses the complexities associated with the treatment of medical complications seen in these patients.

  9. Speaking the right language: the scientific method as a framework for a continuous quality improvement program within academic medical research compliance units.

    Science.gov (United States)

    Nolte, Kurt B; Stewart, Douglas M; O'Hair, Kevin C; Gannon, William L; Briggs, Michael S; Barron, A Marie; Pointer, Judy; Larson, Richard S

    2008-10-01

    The authors developed a novel continuous quality improvement (CQI) process for academic biomedical research compliance administration. A challenge in developing a quality improvement program in a nonbusiness environment is that the terminology and processes are often foreign. Rather than training staff in an existing quality improvement process, the authors opted to develop a novel process based on the scientific method--a paradigm familiar to all team members. The CQI process included our research compliance units. Unit leaders identified problems in compliance administration where a resolution would have a positive impact and which could be resolved or improved with current resources. They then generated testable hypotheses about a change to standard practice expected to improve the problem, and they developed methods and metrics to assess the impact of the change. The CQI process was managed in a "peer review" environment. The program included processes to reduce the incidence of infections in animal colonies, decrease research protocol-approval times, improve compliance and protection of animal and human research subjects, and improve research protocol quality. This novel CQI approach is well suited to the needs and the unique processes of research compliance administration. Using the scientific method as the improvement paradigm fostered acceptance of the project by unit leaders and facilitated the development of specific improvement projects. These quality initiatives will allow us to improve support for investigators while ensuring that compliance standards continue to be met. We believe that our CQI process can readily be used in other academically based offices of research.

  10. Understanding the role of the qualified professional: a comparison of medical and dental students' attitudes.

    Science.gov (United States)

    Widdifield, H; Ryan, C A; O'Sullivan, E

    2006-10-01

    The Royal College of Physicians & Surgeons of Canada developed a competency framework to assist future specialists in responding to challenges as health care providers. The CANMEDs project described 7 essential roles of Specialist Physicians include Health Advocate, Manager, Scholar, Medical Expert, Professional, Communicator and Collaborator (HMSEPC(2)). The object of the current study was to investigate whether medical students and dental students in Ireland recognised these responsibilities as essential to a qualified doctor/dentist. Ninety-eight medical and forty-six dental students (year 1 and year 4) were asked to mind map the responsibilities of qualified doctors/dentists. The comments on the mind map were applied to one of the 7 CANMED roles. There were 484 comments from 128 students. Students had the greatest number of responses referring to the Medical and Dental Expert (257, 30.4%) and Professional (227, 26.9%) roles. This was followed by Communicator (130, 15.4%), Scholar (107, 12.7%) and Health Advocate (82, 9.7%) roles. There were relatively few responses relating to Manager (12, 1.4%) and Collaborator (i.e. teamwork) roles (30, 3.6%). There were no differences in responses between Dental Students and Medical Students and between 1 st year and 4th year students. Similarly there were no differences between the responses of Irish students (n =95; 68%) and International students (n =45; 32%) Students are aware of their responsibilities as Medical or Dental experts (diagnostic and therapeutic skills) for ethical and effective patient care (professional role). They are somewhat aware of the Communicator (therapeutic relationships and effective listening), Scholar (personal continuing education strategies) and Health Advocate (contribute to improved community health) roles. In general they have little concept of the importance of Management skills (utilising resources effectively), and of Collaboration (teamwork and consulting effectively with other

  11. Understanding barriers to medication adherence in the hypertensive population by evaluating responses to a telephone survey

    Directory of Open Access Journals (Sweden)

    Nair KV

    2011-04-01

    Full Text Available Kavita V Nair1, Daniel A Belletti3, Joseph J Doyle3, Richard R Allen4, Robert B McQueen1, Joseph J Saseen1, Joseph Vande Griend1, Jay V Patel5, Angela McQueen2, Saira Jan21School of Pharmacy, University of Colorado, Aurora, CO, USA; 2Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA; 3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 4Peakstat Statistical Services, Evergreen, CO, USA; 5Care Management International, Marlborough, MA, USABackground: Although hypertension is a major risk factor for cardiovascular disease, adherence to hypertensive medications is low. Previous research identifying factors influencing adherence has focused primarily on broad, population-based approaches. Identifying specific barriers for an individual is more useful in designing meaningful targeted interventions. Using customized telephonic outreach, we examined specific patient-reported barriers influencing hypertensive patients' nonadherence to medication in order to identify targeted interventions.Methods: A telephone survey of 8692 nonadherent hypertensive patients was conducted. The patient sample comprised health plan members with at least two prescriptions for antihypertensive medications in 2008. The telephone script was based on the "target" drug associated with greatest nonadherence (medication possession ratio [MPR] <80% during the four-month period preceding the survey.Results: The response rate was 28.2% of the total sample, representing 63.8% of commercial members and 37.2% of Medicare members. Mean age was 63.4 years. Mean MPR was 61.0% for the target drug. Only 58.2% of Medicare respondents and 60.4% of commercial respondents reported "missing a dose of medication". The primary reason given was "forgetfulness" (61.8% Medicare, 60.8% commercial, followed by "being too busy" (2.7% Medicare, 18.5% commercial and "other reasons" (21.9% Medicare, 8.1% commercial including travel, hospitalization/sickness, disruption of daily events

  12. Citizenship in a time of HIV: Understanding medical adult male circumcision in South Africa.

    Science.gov (United States)

    Howard-Payne, Lynlee; Bowman, Brett

    2018-05-01

    Medical adult male circumcision has been shown to offer men significant protection against HIV infection during peno-vaginal sex. This has resulted in calls for a national roll-out of medical adult male circumcision in South Africa, a rights-based constitutional democracy. This article explores the ways that the potential tensions between this call to circumcise as a practice of good health citizenship and the guaranteed right to bodily integrity are negotiated in interviews with 30 urban-based men in Johannesburg. The results suggest that despite its demonstrable biological efficacy, these tensions may paralyse decision- and policy-makers in grappling with the potential scaling up of medical adult male circumcision for HIV prevention in South Africa.

  13. Understanding the effects of stimulant medications on cognition in individuals with attention-deficit hyperactivity disorder: a decade of progress.

    Science.gov (United States)

    Swanson, James; Baler, Ruben D; Volkow, Nora D

    2011-01-01

    The use of stimulant drugs for the treatment of children with attention-deficit hyperactivity disorder (ADHD) is one of the most widespread pharmacological interventions in child psychiatry and behavioral pediatrics. This treatment is well grounded on controlled studies showing efficacy of low oral doses of methylphenidate and amphetamine in reducing the behavioral symptoms of the disorder as reported by parents and teachers, both for the cognitive (inattention and impulsivity) and non-cognitive (hyperactivity) domains. Our main aim is to review the objectively measured cognitive effects that accompany the subjectively assessed clinical responses to stimulant medications. Recently, methods from the cognitive neurosciences have been used to provide information about brain processes that underlie the cognitive deficits of ADHD and the cognitive effects of stimulant medications. We will review some key findings from the recent literature, and then offer interpretations of the progress that has been made over the past decade in understanding the cognitive effects of stimulant medication on individuals with ADHD.

  14. Understanding the Nonmedical Use of Prescription Medications in the U.S. High School Adolescents

    Science.gov (United States)

    Ayres, Cynthia G.; Pontes, Nancy M.; Pontes, Manuel C. F.

    2017-01-01

    The purpose of the study was to examine relationships between sleep insufficiency, depressive symptoms, demographic factors, and the nonmedical use of prescription medications (NMUPMs) in the U.S. high school students. Data from the 2013 Youth Risk Behavioral Surveillance System were used (n = 13,570) and analyzed using IBM SPSS 23™ (complex…

  15. "They Will Come to Understand": Supervisor Reflections on International Medical Electives.

    Science.gov (United States)

    Roebbelen, Erica; Dorman, Katie; Hunter, Andrea; Kraeker, Christian; O'Shea, Tim; Bozinoff, Nikki

    2018-03-22

    Phenomenon: Increasing numbers of medical students from high-income countries are undertaking international medical electives (IMEs) during their training. Much has been written about the benefits of these experiences for the student, and concerns have been raised regarding the burden of IMEs on host communities. The voices of physicians from low- and middle-income countries who supervise IMEs have not been explored in depth. The current study sought to investigate host-physician perspectives on IMEs. Host supervisors were recruited by convenience sampling through students travelling abroad for IMEs during the summer of 2012. From 2012 through 2014, 11 semistructured interviews were conducted by telephone with host supervisors from Nepal, Uganda, Ghana, Guyana, and Kenya. Participants were invited to describe their motivations for hosting IMEs and their experiences of the benefits and harms of IMEs. Interviews were transcribed verbatim and checked for accuracy. An initial coding framework was developed and underwent multiple revisions, after which analytic categories were derived using conventional qualitative content analysis. For host supervisors, visits from international medical students provided a window into the resource-rich medical practice of high-income countries, and supervisors positioned themselves, their education, and clinical expertise against perceived standards of the international students' context. Hosting IMEs also contributed to supervisors' identities as educators connected to a global community. Supervisors described the challenge of helping students navigate their distress when confronting global health inequity. Finally, the desire for increasingly reciprocal relationships was expressed as a hope for the future. Insights: IMEs can be formative for host supervisors' identities and are used to benchmark host institutions compared with international medical standards. Reciprocity was articulated as essential for IMEs moving forward.

  16. Medical Entomology: A Reemerging Field of Research to Better Understand Vector-Borne Infectious Diseases.

    Science.gov (United States)

    Laroche, Maureen; Bérenger, Jean-Michel; Delaunay, Pascal; Charrel, Remi; Pradines, Bruno; Berger, Franck; Ranque, Stéphane; Bitam, Idir; Davoust, Bernard; Raoult, Didier; Parola, Philippe

    2017-08-15

    In the last decade, the Chikungunya and Zika virus outbreaks have turned public attention to the possibility of the expansion of vector-borne infectious diseases worldwide. Medical entomology is focused on the study of arthropods involved in human health. We review here some of the research approaches taken by the medical entomology team of the University Hospital Institute (UHI) Méditerranée Infection of Marseille, France, with the support of recent or representative studies. We propose our approaches to technical innovations in arthropod identification and the detection of microorganisms in arthropods, the use of arthropods as epidemiological or diagnostic tools, entomological investigations around clinical cases or within specific populations, and how we have developed experimental models to decipher the interactions between arthropods, microorganisms, and humans. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  17. Understanding and use of phrasal verbs and idioms in medical/nursing texts.

    Science.gov (United States)

    Polackova, G

    2008-01-01

    Phrasal verbs and idioms are frequently used in everyday English. They are also used in more specific language as equivalents for special terms. The use of phrasal verbs and idioms by native patients and health care workers makes their communication easier and less confusing. Non-native medical workers often come across with English phrasal verbs (idioms) in authentic texts and communication. They should be able to recognize them and after analyzing their meaning include them into their own active vocabulary (Ref. 5).

  18. Understanding the mobile internet to develop the next generation of online medical teaching tools.

    Science.gov (United States)

    Desai, Tejas; Christiano, Cynthia; Ferris, Maria

    2011-01-01

    Healthcare providers (HCPs) use online medical information for self-directed learning and patient care. Recently, the mobile internet has emerged as a new platform for accessing medical information as it allows mobile devices to access online information in a manner compatible with their restricted storage. We investigated mobile internet usage parameters to direct the future development of mobile internet teaching websites. Nephrology On-Demand Mobile (NOD(M)) (http://www.nephrologyondemand.org) was made accessible to all mobile devices. From February 1 to December 31, 2010, HCP use of NOD(M) was tracked using code inserted into the root files. Nephrology On-Demand received 15,258 visits, of which approximately 10% were made to NOD(M), with the majority coming from the USA. Most access to NOD(M) was through the Apple iOS family of devices and cellular connections were the most frequently used. These findings provide a basis for the future development of mobile nephrology and medical teaching tools.

  19. Understanding Challenges, Strategies, and the Role of Support Networks in Medication Self-management Among Patients With Type 2 Diabetes.

    Science.gov (United States)

    Bernhard, Gerda; Ose, Dominik; Baudendistel, Ines; Seidling, Hanna M; Stützle, Marion; Szecsenyi, Joachim; Wensing, Michel; Mahler, Cornelia

    2017-04-01

    Purpose The purpose of this qualitative study was to investigate the challenges and strategies of patients with type 2 diabetes mellitus (T2DM) regarding daily management of their medication regimen focusing on the role of their support networks. Methods A purposeful sample of 25 patients with T2DM was recruited from local self-help groups, general practitioner practices, and a university hospital in southwestern Germany. Four semi-structured focus groups were conducted to identify the challenges patients experienced, the strategies they used, and their collaboration with support networks to assist them in self-managing their medication regimen. Sessions were audio- and video-recorded, fully transcribed, and subjected to computer-aided qualitative content analysis, guided by the Self- and Family Management Framework (SFMF). Results Patients with T2DM experienced numerous challenges affecting medication self-management arising from their personal situation, health status and resources, characteristics of their regimen, and how health care is currently organized. Patients' self-initiated strategies included activating health care, community, social, and online resources; taking ownership of medication-related needs; and integrating medication-taking into daily life. Patients drew on self-help groups, family, and friends to discuss concerns regarding medication safety and receive experience-based information and advice for navigating within the health care system as well as practical hands-on support with daily medication self-management. Conclusions Understanding the challenges and building on strategies patients with T2DM devised help diabetes educators to better address patients' needs and priorities and guide patient-centered interventions to support patients' self-management activities. Community and social support networks operating in patients' lives need to be engaged in the self-management support.

  20. Understanding the impact of career academy attendance: an application of the principal stratification framework for causal effects accounting for partial compliance.

    Science.gov (United States)

    Page, Lindsay C

    2012-04-01

    Results from MDRC's longitudinal, random-assignment evaluation of career-academy high schools reveal that several years after high-school completion, those randomized to receive the academy opportunity realized a $175 (11%) increase in monthly earnings, on average. In this paper, I investigate the impact of duration of actual academy enrollment, as nearly half of treatment group students either never enrolled or participated for only a portion of high school. I capitalize on data from this experimental evaluation and utilize a principal stratification framework and Bayesian inference to investigate the causal impact of academy participation. This analysis focuses on a sample of 1,306 students across seven sites in the MDRC evaluation. Participation is measured by number of years of academy enrollment, and the outcome of interest is average monthly earnings in the period of four to eight years after high school graduation. I estimate an average causal effect of treatment assignment on subsequent monthly earnings of approximately $588 among males who remained enrolled in an academy throughout high school and more modest impacts among those who participated only partially. Different from an instrumental variables approach to treatment non-compliance, which allows for the estimation of linear returns to treatment take-up, the more general framework of principal stratification allows for the consideration of non-linear returns, although at the expense of additional model-based assumptions.

  1. Primary care specialty career choice among Canadian medical students: Understanding the factors that influence their decisions.

    Science.gov (United States)

    Osborn, Heather Ann; Glicksman, Jordan T; Brandt, Michael G; Doyle, Philip C; Fung, Kevin

    2017-02-01

    To identify which factors influence medical students' decision to choose a career in family medicine and pediatrics, and which factors influence their decision to choose careers in non-front-line specialties. Survey that was created based on a comprehensive literature review to determine which factors are considered important when choosing practice specialty. Ontario medical school. An open cohort of medical students in the graduating classes of 2008 to 2011 (inclusive). The main factors that influenced participants' decision to choose a career in primary care or pediatrics, and the main factors that influenced participants' decision to choose a career in a non-front-line specialty. A total of 323 participants were included in this study. Factors that significantly influenced participants' career choice in family medicine or pediatrics involved work-life balance (acceptable hours of practice [ P = .005], acceptable on-call demands [ P = .012], and lifestyle flexibility [ P = .006]); a robust physician-patient relationship (ability to promote individual health promotion [ P = .014] and the opportunity to form long-term relationships [ P  < .001], provide comprehensive care [ P = .001], and treat patients and their families [ P = .006]); and duration of residency program ( P = .001). The career-related factors that significantly influenced participants' decision to choose a non-front-line specialty were as follows: becoming an expert ( P  < .001), maintaining a focused scope of practice ( P  < .001), having a procedure-focused practice ( P = .001), seeing immediate results from one's actions ( P  < .001), potentially earning a high income ( P  < .001), and having a perceived status among colleagues ( P  < .001). In this study, 8 factors were found to positively influence medical students' career choice in family medicine and pediatrics, and 6 factors influenced the decision to choose a career in a non-front-line specialty. Medical students can be

  2. Understanding medical travel from a source country perspective: a cross sectional study of the experiences of medical travelers from the Maldives.

    Science.gov (United States)

    Suzana, Mariyam; Walls, Helen; Smith, Richard; Hanefeld, Johanna

    2018-06-19

    The resolution adopted in 2006 by the World Health Organization on international trade and health urges Member States to understand the implications of international trade and trade agreements for health and to address any challenges arising through policies and regulations. The government of Maldives is an importer of health services (with outgoing medical travelers), through offering a comprehensive universal health care package for its people that includes subsidized treatment abroad for services unavailable in the country. By the end of the first year of the scheme approximately US$11.6 m had been spent by the government of Maldives to treat patients abroad. In this study, affordability, continuity and quality of this care were assessed from the perspective of the medical traveler to provide recommendations for safer and more cost effective medical travel policy. Despite universal health care, a substantial proportion of Maldivian travelers have not accessed the government subsidy, and a third reported not having sufficient funds for the treatment episode abroad. Among the five most visited hospitals in this study, none were JCI accredited at the time of the study period and only three from India had undergone the National Accreditation Board for Hospitals (NABH) in India. Satisfaction with treatment received was high amongst travelers but concern for the continuity of care was very high, and more than a third of the patients had experienced complications arising from the treatment overseas. Source countries can use their bargaining power in the trade of health services to offer a more comprehensive package for medical travelers. Source countries with largely public funded health systems need to ensure that medical travel is truly affordable and universal, with measures for quality control such as the use of accredited foreign hospitals to make it safer and to impose measures that ensure the continuity of care for travelers.

  3. The use of thoracoscopy to enhance medical students′ interest and understanding of thoracic anatomy

    Directory of Open Access Journals (Sweden)

    Sami A AlNassar

    2012-01-01

    Full Text Available Aim: To develop a video-based educational tool designed for teaching thoracic anatomy and to examine whether this tool would increase students′ stimulation and motivation for learning anatomy. Methods: Our video-based tool was developed by recording different thoracoscopic procedures focusing on intraoperative live thoracic anatomy. The tool was then integrated into a pre-existing program for first year medical students (n = 150, and included cadaver dissection of the thorax and review of clinical problem scenarios of the respiratory system. Students were guided through a viewing of the videotape that demonstrated live anatomy of the thorax (15 minutes and then asked to complete a 5-point Likert-type questionnaire assessing the video′s usefulness. Apart from this, a small group of entirely different set of students was divided into two groups, one group to view the 15-minute video presentation of thoracoscopy and chest anatomy and the other group to attend a 15-minute lecture of chest anatomy using radiological images. Both groups took a 10-item pretest and post-test multiple choice questions examination to assess short-term knowledge gained. Results: Of 150 medical students, 119 completed the questionnaires, 88.6% were satisfied with the thoracoscopic video as a teaching tool, 86.4% were satisfied with the quality of the images, 69.2% perceived it to be beneficial in learning anatomy, 96.2% increased their interest in learning anatomy, and 88.5% wanted this new teaching tool to be implemented to the curriculum. Majority (80.7% of the students increased their interest in surgery as a future career. Post-test scores were significantly higher in the thoracoscopy group (P = 0.0175. Conclusion: Incorporating live surgery using thoracoscopic video presentation in the gross anatomy teaching curriculum had high acceptance and satisfaction scores from first year medical students. The video increased students′ interest in learning, in clinically

  4. Radiologic intervention: patient anxiety, fear of pain, understanding of the procedure and satisfaction with the medication-a prospective study

    International Nuclear Information System (INIS)

    Kim, Tae Hoon

    2006-01-01

    I wanted to prospectively assess patients' anxiety, their understanding of the procedure being performed, the perception of the pain level and the satisfaction with the administered medication for interventional procedures. I investigated 78 patients before and after they underwent 93 interventional procedures. The patients responded to a series of questions by using a visual analogue scale (VAS). Two different procedures were performed on 15 patients at different times. Based on the patient's body weight, a combination of sedative and analgesic was intravenously administered. The mean anxiety VAS score for the interventional procedures was about 5.3. The mean anxiety score of the experienced patients was about 3.8 and that of the inexperienced patients was about 5.5 (ρ < .001). The mean score for the understanding of the procedure, which was recorded both before and after the procedure, was about 4.1 and 7.1, respectively. The mean scores for the understanding of the procedure were about 7.0 in the experienced patients and about 3.6 in the inexperienced patients (ρ < .001). The anticipated level of pain recorded before the procedure was about 5.2 and the level of pain during the procedure was 2.9, and the latter was recorded after the procedure (ρ < .001). The level of satisfaction with the medication provided during the procedure was about 8.0 on the VAS score. The patients had a moderate amount of anxiety about the interventional procedures. Most patients had a high level of satisfaction with the medication despite the amount of pain they experienced during the procedure. The patients who were experienced with a procedure tended to have less anxiety and anticipated pain, and they had a greater understanding of the procedure

  5. The Understanding of Ebola Virus Disease (EVD Among Medical Practitioners of Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    Sadia Shakeel

    2017-06-01

    Full Text Available The World Health Organization (WHO has acknowledged the large West African Ebola virus disease (EVD outbreak to be a community health disaster of global concern, and the spread of disease demands a synchronized response. Medical practitioners have an increased risk of contracting the disease as compared to others as they are directly exposed to patients’ blood or fluids. This study evaluated the knowledge of medical practitioners in Karachi regarding EVD. It was descriptive and exploratory in nature and took place over a period of 4 months, i.e., August 2016 to November 2016. The respondents were randomly selected by convenience sampling and surveyed with a 20-item questionnaire. Overall, 403 questionnaires were included in the study and a response rate of 80.6% was achieved. The majority (56.3% considered themselves to be somewhat knowledgeable; females had more knowledge as compared to male (p < 0.003. More than 80% knew about the 2014 Ebola outbreak in West Africa. Interestingly, the findings revealed that respondents’ knowledge about diagnosis and identification of EVD is good. Respondents considered EVD a severe disease and emphasized on the need for protective measures when contacting affected patients. Interventions should be tailored to focus on areas where respondents showed a lack of knowledge about the disease.

  6. Understanding women's experiences with medical abortion: In-depth interviews with women in two Indian clinics.

    Science.gov (United States)

    Ganatra, B; Kalyanwala, S; Elul, B; Coyaji, K; Tewari, S

    2010-01-01

    We explored women's perspectives on using medical abortion, including their reasons for selecting the method, their experiences with it and their thoughts regarding demedicalisation of part or all of the process. Sixty-three women from two urban clinics in India were interviewed within four weeks of abortion completion using a semi-structured in-depth interview guide. While women appreciated the non-invasiveness of medical abortion, other factors influencing method selection were family support and distance from the facility. The degree of medicalisation that women wanted or felt was necessary also depended on the way expectations were set by their providers. Confirmation of abortion completion was a source of anxiety for many women and led to unnecessary interventions in a few cases. Ultimately, experiences depended more on women's expectations about the method, and on the level of emotional and logistic support they received rather than on inherent characteristics of the method. These findings emphasise the circumstances under which women make reproductive choices and underscore the need to tailor service delivery to meet women's needs. Women-centred counselling and care that takes into consideration individual circumstances are needed.

  7. Understanding the value of mixed methods research: the Children’s Safety Initiative-Emergency Medical Services

    Science.gov (United States)

    Hansen, Matthew; O’Brien, Kerth; Meckler, Garth; Chang, Anna Marie; Guise, Jeanne-Marie

    2016-01-01

    Mixed methods research has significant potential to broaden the scope of emergency care and specifically emergency medical services investigation. Mixed methods studies involve the coordinated use of qualitative and quantitative research approaches to gain a fuller understanding of practice. By combining what is learnt from multiple methods, these approaches can help to characterise complex healthcare systems, identify the mechanisms of complex problems such as medical errors and understand aspects of human interaction such as communication, behaviour and team performance. Mixed methods approaches may be particularly useful for out-of-hospital care researchers because care is provided in complex systems where equipment, interpersonal interactions, societal norms, environment and other factors influence patient outcomes. The overall objectives of this paper are to (1) introduce the fundamental concepts and approaches of mixed methods research and (2) describe the interrelation and complementary features of the quantitative and qualitative components of mixed methods studies using specific examples from the Children’s Safety Initiative-Emergency Medical Services (CSI-EMS), a large National Institutes of Health-funded research project conducted in the USA. PMID:26949970

  8. Environmental Compliance Mechanisms

    NARCIS (Netherlands)

    Merkouris, Panagiotis; Fitzmaurice, Malgosia

    2017-01-01

    Compliance mechanisms can be found in treaties regulating such diverse issues as human rights, disarmament law, and environmental law. In this bibliography, the focus will be on compliance mechanisms of multilateral environmental agreements (MEAs). Compliance with norms of international

  9. Understanding Transgender and Medically Assisted Gender Transition: Feminism as a Critical Resource.

    Science.gov (United States)

    Nelson, Jamie Lindemann

    2016-11-01

    Feminism has fought the trivialization of women's experiences, championed women's security, and insisted on respect for women's choices. In so doing, feminism has developed important perspectives on the complicated connections between what gender means as it plays itself in people's lives, and the inequalities of power and authority that structure much of human experience. Here, I put a few of these perspectives into contact with an issue where the interactions of gender and power are squarely in play: medicine's role in assisting gender transitioning generally and, specifically, the enduring controversy between medicine and many transgender people about the pathologization of transgender and the role of clinicians as gatekeepers to gender-transition interventions. © 2016 American Medical Association. All Rights Reserved.

  10. Knowledge-based analysis and understanding of 3D medical images

    International Nuclear Information System (INIS)

    Dhawan, A.P.; Juvvadi, S.

    1988-01-01

    The anatomical three-dimensional (3D) medical imaging modalities, such as X-ray CT and MRI, have been well recognized in the diagnostic radiology for several years while the nuclear medicine modalities, such as PET, have just started making a strong impact through functional imaging. Though PET images provide the functional information about the human organs, they are hard to interpret because of the lack of anatomical information. The authors objective is to develop a knowledge-based biomedical image analysis system which can interpret the anatomical images (such as CT). The anatomical information thus obtained can then be used in analyzing PET images of the same patient. This will not only help in interpreting PET images but it will also provide a means of studying the correlation between the anatomical and functional imaging. This paper presents the preliminary results of the knowledge based biomedical image analysis system for interpreting CT images of the chest

  11. [Learning pathologic anatomy during medical formation: Understanding the contribution of the motivation].

    Science.gov (United States)

    Toquet, Claire; Normand, Adeline; Guihard, Gilles

    2018-05-26

    The motivations of medical students for Pathologic Anatomy are little known although they can strongly influence their academic performance. Our work focused on the analysis of the relationship between performance and motivation for Pathologic Anatomy. Second-year students (n=268) from the University of Nantes were contacted to complete a motivation questionnaire and to provide indicators of performance and attendance. The responses were analyzed in order to establish the psychometric reliability and the factorial structure of the questionnaire. The relationship between motivation and performance was explored by correlation and by linear regression studies. A cluster analysis was performed to specify the distribution of the two variables in our sample. The sample corresponded to 168 respondents with a F/M ratio similar to that of our population. Our data demonstrated the reliability of the questionnaire and a structure described by 5 motivation factors (self-determination, self-efficacy, career, grade and intrinsic motivation). The academic performance was not significantly correlated with the overall motivation or with student attendance. However, it was predicted by self-determination and self-efficacy. Our work revealed gender differences as well as the existence of two distinct clusters defined by the motivation and performance of the students. This work constitutes the first study of the motivations of French medical students for cyto-pathology. It validates a quantitative assessment tool for motivation. Finally, it explores the heterogeneity of the distribution of motivation and academic performance within a population of learners. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  12. Toward a better understanding of the future of the solo medical practitioner in health care industry: a conceptual review.

    Science.gov (United States)

    Erdem, S A; Lacombe, B

    1998-01-01

    Even a brief conceptual review of the current developments in the health care industry indicates that the future of independent medical practitioners is rather challenging. It may be necessary for these parties to pursue proactive and aggressive marketing strategies to be able to compete with the managed care organizations. Accordingly, this paper outlines some of the current trends in health care marketing as they relate to the ongoing changes to which solo medical practitioners need to respond. It is hoped that the review of the issues raised in this paper can provide an initial basis for a better understanding of some of the challenges to come up with more comprehensive and effective strategy decisions.

  13. Understanding the medical markers of elder abuse and neglect: physical examination findings.

    Science.gov (United States)

    Gibbs, Lisa M

    2014-11-01

    A specific foundation of knowledge is important for evaluating potential abuse from physical findings in the older adult. The standard physical examination is a foundation for detecting many types of abuse. An understanding of traumatic injuries, including patterns of injury, is important for health care providers, and inclusion of elder abuse in the differential diagnosis of patient care is essential. One must possess the skills needed to piece the history, including functional capabilities, and physical findings together. Armed with this skill set, health care providers will develop the confidence needed to identify and intervene in cases of elder abuse. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. A first step toward understanding best practices in leadership training in undergraduate medical education: a systematic review.

    Science.gov (United States)

    Webb, Allison M B; Tsipis, Nicholas E; McClellan, Taylor R; McNeil, Michael J; Xu, MengMeng; Doty, Joseph P; Taylor, Dean C

    2014-11-01

    To characterize leadership curricula in undergraduate medical education as a first step toward understanding best practices in leadership education. The authors systematically searched the PubMed, Education Resources Information Center, Academic Search Complete, and Education Full Text databases for peer-reviewed English-language articles published 1980-2014 describing curricula with interventions to teach medical students leadership skills. They characterized educational settings, curricular format, and learner and instructor types. They assessed effectiveness and quality of evidence using five-point scales adapted from Kirkpatrick's four-level training evaluation model (scale: 0-4) and a Best Evidence Medical Education guide (scale: 1-5), respectively. They classified leadership skills taught into the five Medical Leadership Competency Framework (MLCF) domains. Twenty articles describing 24 curricula met inclusion criteria. The majority of curricula (17; 71%) were longitudinal, delivered over periods of one semester to four years. The most common setting was the classroom (12; 50%). Curricula were frequently provided to both preclinical and clinical students (11; 46%); many (9; 28%) employed clinical faculty as instructors. The majority (19; 79%) addressed at least three MLCF domains; most common were working with others (21; 88%) and managing services (18; 75%). The median effectiveness score was 1.5, and the median quality of evidence score was 2. Most studies did not demonstrate changes in student behavior or quantifiable results. Aligning leadership curricula with competency models, such as the MLCF, would create opportunities to standardize evaluation of outcomes, leading to better measurement of student competency and a better understanding of best practices.

  15. [A role of motivation for treatment in the structure of compliance in psychopharmacologically treated patients].

    Science.gov (United States)

    Sorokin, M Yu; Lutova, N B; Wied, V D

    2016-01-01

    To reveal an impact of specific motivation structures on the compliance in psychiatric inpatients. The Treatment Motivation Questionnaire and the Medication Compliance Scale have been administered to 104 patients, including 67 patients with schizophrenia and schizophrenia-spectrum disorders, 15 with affective disorders, 13 with personality and neurotic disorders and 9 with organic disorders, of the department of integrative pharmaco- and psychotherapy. A motivational mechanism based on the subjective suffering from disease plays a key role in the formation of overall score of compliance. Amotivation syndrome has a negative impact on the compliance. "Passive agreement" attitude to treatment corresponds to a deficiency in both patient and physician compliance subsystems along with a reduction in insight and cognitive functions in the patient's subsystem. Extreme external motivation for treatment correlates with insufficiently constructive support on the part of significant others in patient's environment subsystem resulting in the delay of internal motivation development. Extremely low scores based on understanding of disease character leads to the deficiency of medication compliance subsystem.

  16. Understanding the medical marriage: physicians and their partners share strategies for success.

    Science.gov (United States)

    Perlman, Rachel L; Ross, Paula T; Lypson, Monica L

    2015-01-01

    Physicians and their spouses experience challenges to their relationships, some of which are shared with the general population and others of which are unique to the field of medicine. Trainees and junior faculty members remain curious about how they will balance their careers alongside marriage and family obligations. This study explores the challenges and strengths of dual- and single-physician relationships. In 2009, using appreciative inquiry as a theoretical framework, the authors conducted in-depth qualitative interviews with 25 individuals: 12 women and 13 men; 10 from dual-physician and 15 from single-physician relationships. A phenomenological analytic approach was used to arrive at the final themes. Four themes emerged during the interviews: "We rely on mutual support in our relationships," "We recognize the important roles of each family member," "We have shared values," and "We acknowledge the benefit of being a physician to our relationships." These findings illustrate that physicians identify strategies to navigate the difficult aspects of their lives. Learn ing from others' best practices can assist in managing personal relationships and work-life balance. These data can also be useful when counseling physicians on successful relationship strategies. As systems are developed that improve wellness and focus on role models for work-life balance, it will be important for this topic to be integrated into formal curricula across the continuum of medical education.

  17. Narrative approach in understanding the drivers for resilience of military combat medics.

    Science.gov (United States)

    Russell, Cristel Antonia; Gibbons, S W; Abraham, P A; Howe, E R; Deuster, P; Russell, D W

    2017-12-10

    Qualitative insights may demonstrate how combat medics (CM) deal with stressors and identify how resilience can potentially develop. Yet, qualitative research is scant in comparison to the many quantitative studies of health outcomes associated with military service. Semistructured qualitative interviews were used to collect personal narratives of US Army CMs who had previously served in Iraq or Afghanistan. Thematic analysis revealed three key driving forces for how resilience develops in the context of combat and war. The first was patriotism, which captures loyalty and full commitment to the military and its missions. The second was commitment to their family, reflecting the balance of responsibility to family of origin with the obligation one feels towards their military family. The last driving force was faith, or the drive to reach towards the transcendent to provide a moral compass and develop empathy in the face of difficult situations. An individual's commitment to country, military family and faith strengthens their resilience, and this can be used to inform future research efforts as well as current clinical practice. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. A cross-sectional survey to investigate community understanding of medical research ethics committees.

    Science.gov (United States)

    Fritschi, Lin; Kelsall, Helen L; Loff, Bebe; Slegers, Claudia; Zion, Deborah; Glass, Deborah C

    2015-07-01

    Study explanatory forms often state that an ethics committee has approved a research project. To determine whether the lay community understand the roles of ethics committees in research, we took a cross-sectional national sample from three sampling frames: the general population (n=1532); cohort study participants (n=397); and case-control study participants (n=151). About half (51.3%) of the participants had heard of ethics committees. Those who had were more likely to be those who had participated in previous surveys, older participants, those born in Australia and those with higher education. Almost all participants agreed that the roles of an ethics committee were to protect participants' privacy and ensure no harm came to study participants and most agreed that the committee's role was to ensure that the research was capable of providing answers. Case-control and cohort participants were more likely than the general population to consider that the role of an ethics committee was to design the research and obtain research funding. Overall, we found that about half of the population are aware of ethics committees and that most could correctly identify that ethics committees are there to protect the welfare and rights of research participants, although a substantial minority had some incorrect beliefs about the committees' roles. Increased education, particularly for migrants and older people, might improve understanding of the role of ethics committees in research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Physician Verbal Compliance-Gaining Strategies and Patient Satisfaction

    Science.gov (United States)

    Olynick, Janna; Iliopulos, Alexandra; Li, Han Z.

    2017-01-01

    Purpose: The patient healthcare experience is a complex phenomenon, as is encouraging patient compliance with medical advice. To address this multifaceted relationship, the purpose of this paper is to explore the ways resident physicians verbally encourage patient compliance and the relationship between these compliance-seeking strategies and…

  20. Relatively effortless listening promotes understanding and recall of medical instructions in older adults

    Directory of Open Access Journals (Sweden)

    Roberta Maria DiDonato

    2015-06-01

    Full Text Available Communication success under adverse conditions requires efficient and effective recruitment of both bottom-up (sensori-perceptual and top-down (cognitive-linguistic resources to decode the intended auditory-verbal message. Employing these limited capacity resources has been shown to vary across the lifespan, with evidence indicating that younger adults out-perform older adults for both comprehension and memory of the message. This study examined how sources of interference arising from the speaker (message spoken with conversational versus clear speech technique, the listener (hearing-listening and cognitive-linguistic factors, and the environment (in competing speech babble noise versus quiet interact and influence learning and memory performance using more ecologically valid methods than has been done previously. The results suggest that when older adults listened to complex medical prescription instructions with ‘clear speech,’ (presented at audible levels through insertion earphones their learning efficiency, immediate and delayed memory performance improved relative to their performance when they listened with a normal conversational speech rate (presented at audible levels in sound field. This better learning and memory performance for clear speech listening was maintained even in the presence of speech babble noise. The finding that there was the largest learning-practice effect on 2nd trial performance in the conversational speech when the clear speech listening condition was first is suggestive of greater experience-dependent perceptual learning or adaptation to the speaker’s speech and voice pattern in clear speech. This suggests that experience-dependent perceptual learning plays a role in facilitating the language processing and comprehension of a message and subsequent memory encoding.

  1. Relatively effortless listening promotes understanding and recall of medical instructions in older adults

    Science.gov (United States)

    DiDonato, Roberta M.; Surprenant, Aimée M.

    2015-01-01

    Communication success under adverse conditions requires efficient and effective recruitment of both bottom-up (sensori-perceptual) and top-down (cognitive-linguistic) resources to decode the intended auditory-verbal message. Employing these limited capacity resources has been shown to vary across the lifespan, with evidence indicating that younger adults out-perform older adults for both comprehension and memory of the message. This study examined how sources of interference arising from the speaker (message spoken with conversational vs. clear speech technique), the listener (hearing-listening and cognitive-linguistic factors), and the environment (in competing speech babble noise vs. quiet) interact and influence learning and memory performance using more ecologically valid methods than has been done previously. The results suggest that when older adults listened to complex medical prescription instructions with “clear speech,” (presented at audible levels through insertion earphones) their learning efficiency, immediate, and delayed memory performance improved relative to their performance when they listened with a normal conversational speech rate (presented at audible levels in sound field). This better learning and memory performance for clear speech listening was maintained even in the presence of speech babble noise. The finding that there was the largest learning-practice effect on 2nd trial performance in the conversational speech when the clear speech listening condition was first is suggestive of greater experience-dependent perceptual learning or adaptation to the speaker's speech and voice pattern in clear speech. This suggests that experience-dependent perceptual learning plays a role in facilitating the language processing and comprehension of a message and subsequent memory encoding. PMID:26106353

  2. The everyday elasticity of compliance in a symptomless disease

    DEFF Research Database (Denmark)

    Felde, Lina Hoel

    2011-01-01

    Medically, compliance refers to the extent to which a patient's response to medical advice coincides with doctors' orders. Rather than this absolute standard, this article treats compliance as an institutionally available discourse continually figured in practice. The aim of this article is to de......Medically, compliance refers to the extent to which a patient's response to medical advice coincides with doctors' orders. Rather than this absolute standard, this article treats compliance as an institutionally available discourse continually figured in practice. The aim of this article...... give-and-take. This elasticity of compliance reveals a reflexive critique of medical compliance as a moral standard and leads us to discuss how people are adequately compliant in everyday moral contexts....

  3. Environmental health and safety issues related to the use of low-level radioactive waste (LLRW) at hospitals and medical research institutions and compliance determination with the Clean Air Act standards

    International Nuclear Information System (INIS)

    Kasinathan, R.; Kanchan, A.

    1995-01-01

    Currently, the United States Nuclear Regulatory Commission (NRC) has standards for procedures, performance activities and technical specifications on storage of Low-Level Radioactive Waste (LLRW) under 10 CFR Part 20. The United States Environmental Protection Agency (EPA) is proposing environmental standards for the management, storage and disposal of LLRW. The proposed standards, which will become 40 CFR part 193 when finalized, limits the committed effective dose to members of the public from the management and storage of LLRW, committed effective doses resulting from LLRW disposal and levels of radiological contamination of underground sources of drinking water as a result of the activities subject to management, storage and disposal of LLRW. Further, under Title III of the Clean Air Act Amendments, radionuclides are required to be inventoried for all generators. For hospitals and medical research institutions, quantities of LLRW are often below the concentrations required under reporting and record keeping requirements of 10 CFR 20. However, in many instances, the facility may require NRC permits and compliance with air quality dispersion modeling requirements. This paper presents the typical radionuclides used in hospitals and medical research institutions, and strategies to evaluate their usage and steps to achieve compliance. Air quality dispersion modeling by use of the COMPLY model is demonstrated to evaluate the fate of radionuclides released from on-site incineration of LLRW. The paper concludes that no significant threat is posed from the incineration of LLRW

  4. Sources of patients' knowledge of the adverse effects of psychotropic medication and the perceived influence of adverse effects on compliance among service users attending community mental health services.

    LENUS (Irish Health Repository)

    Agyapong, Vincent I O

    2009-12-01

    Noncompliance with medication has been a complex issue with patients with severe mental illness during the last few decades, and adverse effects of medication have been identified as a major contributor to noncompliance.

  5. Understanding kidney transplant patients' treatment choices: The interaction of emotion with medical and social influences on risk preferences.

    Science.gov (United States)

    Harrington, Jean; Morgan, Myfanwy

    2016-04-01

    Following renal transplantation patients experience on-going immunosuppressant medication to reduce the risk of graft rejection. Over the long term the side effects of immunosuppressive drugs may affect graft survival and significantly increase risks of cancers, stroke and cardiovascular disease. To reduce these risks research is underway to develop a biomarker test to identify those patients who are likely to be 'tolerant' to their graft and therefore able to reduce immunosuppression. Biomarker tests may however incorrectly identify some patients as tolerant, thus jeopardising their graft. Following a quantitative assessment of risk preferences we undertook a qualitative study to investigate the range of influences that shaped the substantial variations found in the level of risk transplant recipients were hypothetically willing to take. In-depth interviews were carried out in the United Kingdom between May 2013 and July 2014 with 24 transplant recipients all of whom had stable kidney graft function. These interviews identified a range of factors that patients take into account when making risk assessments, including familial views, trust and the ritual of 'gift exchange' that permeates the social space of kidney transplantation. Our data support the notion that emotion is not part of a linear process, preceding and separate to reason, but is intertwined with personal understanding and perception of risk and involves a complex interplay between different influences on decision-making. Our data also support Lupton's view that risk judgements are shared and collective rather than located within the individual and suggests that patient choice rather than involving a purely rational weighing of medical benefit is often based on influences that may not accord with the framework nor intention of medical professionals and medical research. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Patient compliance with exercise: different theoretical approaches to short-term and long-term compliance.

    NARCIS (Netherlands)

    Sluijs, E.M.; Knibbe, J.J.

    1991-01-01

    Compliance with exercise regimens is difficult to obtain as is compliance with other medical regimens. In analyzing noncompliance, two problems exist: (I) current theories only partly explain patients’ noncompliance; (2) health care providers seldom act according to the recommendations derived from

  7. [Drug compliance of patients on anticoagulant treatment].

    Science.gov (United States)

    Gadó, Klára; Kocsis, Eszter; Zelkó, Romána; Hankó, Balázs; Kovácsné Balogh, Judit; Forczig, Mónika; Domján, Gyula

    2015-08-09

    Despite several therapeutic possibilities the morbidity and mortality of thromboembolic disorders remain high. Improving drug compliance - i. e. keeping up the doctor's prescriptions - may be an effective tool to reach better results. To improve patients' compliance, the risk factors of non-compliance should be recognized. Among these patients' fear of adverse effects of drugs, their lack of knowledge about their illness and medication, forgetfulness, and other social, economic factors may be the most important. Furthermore, adherence may be worsened when the patient feels that the decision has been made over his/her head. Sustained medical adherence is important because anticoagulation may be a life-long treatment. The new oral anticoagulants make the matter of compliance to be current. These new type of drugs do not need regular laboratory monitoring and, therefore, compliance cannot be strictly followed. There are several studies concerning drug compliance to anticoagulant medications. Improvement of adherence is based on regular patient education after reviewing the factors of non-compliance, which needs teamwork with important roles of doctors, pharmacists, dietetics and nurses. Careful and accurate work of the participants of primary care might be complemented by the activity of anticoagulant clinics.

  8. Effect of problem based approach on medical students’ learning satisfaction and understanding in the histology course topics

    Directory of Open Access Journals (Sweden)

    MJ Rezaie

    2013-05-01

    Full Text Available Background and purpose: Problem-based learning (PBL is a term used within education for a range of teaching approaches that encourage students to learn through the structured exploration of a problem. Histology comes early in the curriculum and the medical students seem unable to see the value of the content, they don't appear to be motivated to learn the content. This project used PBL to help the students make the connection between the content and clinical aspects.Methods: Thirty six undergraduate medical students, 22 female and 14 male, enrolled in the histology course during the spring semester of 2008. A survey which collected information relative to gender, course load, and workload and study time was used. The subjects were accessory glands of digestive system histology. The course is designed into four units: tree units of salivary glands, pancreas and gall bladder histology, were presented in a traditional lecture format; the fourth unit, liver was presented in a problem-based format that used clinical practice. Assessment focused on three issues of a. student engagement, b. lesson assessment in terms of clarity, interest and usefulness and c. student understanding.Results: Student comments collected during PBL class periods indicate engagement in the topic. In PBL method of teaching most of responses were consistent with the aim of teaching but in traditional classes few responses relate to the objectives at hand. Students had more active partnership in PBL class. Students found PBL class more useful, interesting and clear in terms of subject material than traditional method.Conclusions: In this project student comments collected during PBL class periods indicated more engagement in the topic. Students’ understanding of material were significantly higher and students’ partnership in PBL class was more than traditional classes.Keywords: PBL,HISTOLOGY, STUDENT PARTICIPATION

  9. Can I Count on Getting Better? Association between Math Anxiety and Poorer Understanding of Medical Risk Reductions.

    Science.gov (United States)

    Rolison, Jonathan J; Morsanyi, Kinga; O'Connor, Patrick A

    2016-10-01

    Lower numerical ability is associated with poorer understanding of health statistics, such as risk reductions of medical treatment. For many people, despite good numeracy skills, math provokes anxiety that impedes an ability to evaluate numerical information. Math-anxious individuals also report less confidence in their ability to perform math tasks. We hypothesized that, independent of objective numeracy, math anxiety would be associated with poorer responding and lower confidence when calculating risk reductions of medical treatments. Objective numeracy was assessed using an 11-item objective numeracy scale. A 13-item self-report scale was used to assess math anxiety. In experiment 1, participants were asked to interpret the baseline risk of disease and risk reductions associated with treatment options. Participants in experiment 2 were additionally provided a graphical display designed to facilitate the processing of math information and alleviate effects of math anxiety. Confidence ratings were provided on a 7-point scale. Individuals of higher objective numeracy were more likely to respond correctly to baseline risks and risk reductions associated with treatment options and were more confident in their interpretations. Individuals who scored high in math anxiety were instead less likely to correctly interpret the baseline risks and risk reductions and were less confident in their risk calculations as well as in their assessments of the effectiveness of treatment options. Math anxiety predicted confidence levels but not correct responding when controlling for objective numeracy. The graphical display was most effective in increasing confidence among math-anxious individuals. The findings suggest that math anxiety is associated with poorer medical risk interpretation but is more strongly related to confidence in interpretations. © The Author(s) 2015.

  10. It takes two to tango: A dyadic approach to understanding the medication dialogue in patient-provider relationships.

    Science.gov (United States)

    Schoenthaler, Antoinette; Basile, Melissa; West, Tessa V; Kalet, Adina

    2018-08-01

    To describe typologies of dyadic communication exchanges between primary care providers and their hypertensive patients about prescribed antihypertensive medications. Qualitative analysis of 94 audiotaped patient-provider encounters, using grounded theory methodology. Four types of dyadic exchanges were identified: Interactive (53% of interactions), divergent-traditional (24% of interactions), convergent-traditional (17% of interactions) and disconnected (6% of interactions). In the interactive and convergent-traditional types, providers adopted a patient-centered approach and used communication behaviors to engage patients in the relationship. Patients in these interactions adopted either an active role in the visit (interactive), or a passive role (convergent-traditional). The divergent-traditional type was characterized by provider verbal dominance, which inhibited patients' ability to ask questions, seek information, or check understanding of information. In the disconnected types, providers used mainly closed-ended questions and terse directives to gather and convey information, which was often disregarded by patients who instead diverted the conversation to psychosocial issues. This study identified interdependent patient-provider communication styles that can either facilitate or hinder discussions about prescribed medications. Examining the processes that underlie dyadic communication in patient-provider interactions is an essential first step to developing interventions that can improve the patient-provider relationship and patient health behaviors. Copyright © 2018 Elsevier B.V. All rights reserved.

  11. Compliance Performance: Effects of a Provider Incentive Program and Coding Compliance Plan

    National Research Council Canada - National Science Library

    Tudela, Joseph A

    2004-01-01

    The purpose of this project is to study provider and coder related performance, i.e., provider compliance rate and coder productivity/accuracy rates and average dollar difference between coder and auditor, at Brooke Army Medical Center...

  12. Association between number of doses per day, number of medications and patient's non-compliance, and frequency of readmissions in a multi-ethnic Asian population

    Directory of Open Access Journals (Sweden)

    Ming Ren Toh

    2014-01-01

    Conclusion: Complex medication regimen (i.e. multiple medications and multiple doses per day is a statistically significant predictor of number of readmissions. Simplifying therapeutic regimens with alternatives such as longer-acting or fixed-dose combination drugs may facilitate better patient adherence and reduce costly readmissions.

  13. Understanding medical symptoms

    DEFF Research Database (Denmark)

    Malterud, Kirsti; Guassora, Ann Dorrit Kristiane; Graungaard, Anette Hauskov

    2015-01-01

    is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how...... to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease...

  14. Understanding medical ethics.

    Science.gov (United States)

    Little, M

    2000-03-01

    Moral thinking is embedded within cultures, and we use ethics all the time in our dealings with one another. Many functioning communities tend to share some values that reflect a particular view of the importance of human life in quantity and quality. Rights and duties form an interconnected network of obligations that protect the security of individuals and groups. In health care, the motives and virtues of practitioners are important sources of the determination to provide care for the ill within the limits of resource constraints. Ethics and the law have similarities, but also significant differences that may cause tension between the two systems. Health care is morally grounded, and provides a bulwark against the widespread fear of disease and suffering. The way in which health care is delivered depends on both national wealth and community values. Ethical problems can be seen as dilemmas, in which there are conflicting values. Modern ethical thinking in health is complicated by the need to consider the values and interests of many stakeholders--patients, health care workers, families, politicians, administrators, health bureaucrats and many others. There are ways of ethical thinking that take account of these often countervailing interests. No universally 'right' answers can be specified. The mode and the thoroughness of ethical consideration, and the careful consideration of local community values, will help to assure that we make the best possible decisions for the time and place.

  15. Factors Affecting Compliance to Antihypertensive Treatment among Adults in a Tertiary Care Hospital in Mumbai.

    Science.gov (United States)

    Shah, Ayushi Jayesh; Singh, Vijaykumar; Patil, Subita P; Gadkari, Mithila R; Ramchandani, Varun; Doshi, Karan Janak

    2018-01-01

    Compliance to antihypertensive therapy reduces the risk of complications. It is important to understand the factors affecting compliance in patients so that the goal of successful treatment is not jeopardized. To determine the proportion of participants' compliant to treatment and various factors associated with compliance of antihypertensive treatment. A cross-sectional study of 330 hypertensive patients on treatment attending the outpatient department of a tertiary care hospital in Mumbai. It was conducted over 8 weeks using a validated, pretested questionnaire including information on the individual's sociodemographic profile, compliance to antihypertensive therapy and lifestyle advice assessed using a 4-point Likert scale. Data were entered into MS Excel 2007 and analyzed using SPSS 20. Participants' mean age was 55.2 ± 12.6 years. 39.4% were compliant to their treatment. Common reasons for frequently skipping the dose - forgetfulness (41.2%) and discontinued the medication when feeling well (30.3%). Factors positively associated with compliance were gender and illiteracy. The proportion of noncompliance among smokers and alcoholics was statistically significant. Forgetfulness and subjective feeling of wellness were the prevalent reasons for noncompliance. Controlling habits such as smoking and alcohol may prove as key factors for compliance.

  16. Factors affecting compliance to antihypertensive treatment among adults in a tertiary care hospital in Mumbai

    Directory of Open Access Journals (Sweden)

    Ayushi Jayesh Shah

    2018-01-01

    Full Text Available Background: Compliance to antihypertensive therapy reduces the risk of complications. It is important to understand the factors affecting compliance in patients so that the goal of successful treatment is not jeopardized. Objectives: To determine the proportion of participants' compliant to treatment and various factors associated with compliance of antihypertensive treatment. Settings and Design: A cross-sectional study of 330 hypertensive patients on treatment attending the outpatient department of a tertiary care hospital in Mumbai. Subjects and Methods: It was conducted over 8 weeks using a validated, pretested questionnaire including information on the individual's sociodemographic profile, compliance to antihypertensive therapy and lifestyle advice assessed using a 4-point Likert scale. Statistical Analysis: Data were entered into MS Excel 2007 and analyzed using SPSS 20. Results: Participants' mean age was 55.2 ± 12.6 years. 39.4% were compliant to their treatment. Common reasons for frequently skipping the dose – forgetfulness (41.2% and discontinued the medication when feeling well (30.3%. Factors positively associated with compliance were gender and illiteracy. The proportion of noncompliance among smokers and alcoholics was statistically significant. Conclusion: Forgetfulness and subjective feeling of wellness were the prevalent reasons for noncompliance. Controlling habits such as smoking and alcohol may prove as key factors for compliance.

  17. MO-E-18C-04: Advanced Computer Simulation and Visualization Tools for Enhanced Understanding of Core Medical Physics Concepts

    International Nuclear Information System (INIS)

    Naqvi, S

    2014-01-01

    Purpose: Most medical physics programs emphasize proficiency in routine clinical calculations and QA. The formulaic aspect of these calculations and prescriptive nature of measurement protocols obviate the need to frequently apply basic physical principles, which, therefore, gradually decay away from memory. E.g. few students appreciate the role of electron transport in photon dose, making it difficult to understand key concepts such as dose buildup, electronic disequilibrium effects and Bragg-Gray theory. These conceptual deficiencies manifest when the physicist encounters a new system, requiring knowledge beyond routine activities. Methods: Two interactive computer simulation tools are developed to facilitate deeper learning of physical principles. One is a Monte Carlo code written with a strong educational aspect. The code can “label” regions and interactions to highlight specific aspects of the physics, e.g., certain regions can be designated as “starters” or “crossers,” and any interaction type can be turned on and off. Full 3D tracks with specific portions highlighted further enhance the visualization of radiation transport problems. The second code calculates and displays trajectories of a collection electrons under arbitrary space/time dependent Lorentz force using relativistic kinematics. Results: Using the Monte Carlo code, the student can interactively study photon and electron transport through visualization of dose components, particle tracks, and interaction types. The code can, for instance, be used to study kerma-dose relationship, explore electronic disequilibrium near interfaces, or visualize kernels by using interaction forcing. The electromagnetic simulator enables the student to explore accelerating mechanisms and particle optics in devices such as cyclotrons and linacs. Conclusion: The proposed tools are designed to enhance understanding of abstract concepts by highlighting various aspects of the physics. The simulations serve as

  18. MO-E-18C-04: Advanced Computer Simulation and Visualization Tools for Enhanced Understanding of Core Medical Physics Concepts

    Energy Technology Data Exchange (ETDEWEB)

    Naqvi, S [Saint Agnes Cancer Institute, Department of Radiation Oncology, Baltimore, MD (United States)

    2014-06-15

    Purpose: Most medical physics programs emphasize proficiency in routine clinical calculations and QA. The formulaic aspect of these calculations and prescriptive nature of measurement protocols obviate the need to frequently apply basic physical principles, which, therefore, gradually decay away from memory. E.g. few students appreciate the role of electron transport in photon dose, making it difficult to understand key concepts such as dose buildup, electronic disequilibrium effects and Bragg-Gray theory. These conceptual deficiencies manifest when the physicist encounters a new system, requiring knowledge beyond routine activities. Methods: Two interactive computer simulation tools are developed to facilitate deeper learning of physical principles. One is a Monte Carlo code written with a strong educational aspect. The code can “label” regions and interactions to highlight specific aspects of the physics, e.g., certain regions can be designated as “starters” or “crossers,” and any interaction type can be turned on and off. Full 3D tracks with specific portions highlighted further enhance the visualization of radiation transport problems. The second code calculates and displays trajectories of a collection electrons under arbitrary space/time dependent Lorentz force using relativistic kinematics. Results: Using the Monte Carlo code, the student can interactively study photon and electron transport through visualization of dose components, particle tracks, and interaction types. The code can, for instance, be used to study kerma-dose relationship, explore electronic disequilibrium near interfaces, or visualize kernels by using interaction forcing. The electromagnetic simulator enables the student to explore accelerating mechanisms and particle optics in devices such as cyclotrons and linacs. Conclusion: The proposed tools are designed to enhance understanding of abstract concepts by highlighting various aspects of the physics. The simulations serve as

  19. E-Monitoring of Asthma Therapy to Improve Compliance in children using a real-time medication monitoring system (RTMM): The e-MATIC study protocol

    NARCIS (Netherlands)

    E.C. Vasbinder (Erwin); H.M. Janssens (Hettie); M.P.M.H. Rutten-van Mölken (Maureen); L. van Dijk (Liset); B.C.M. de Winter (Brenda); R.C.A. de Groot (Ruben); A.G. Vulto (Arnold); P.M.L.A. van den Bemt (Patricia)

    2013-01-01

    textabstractBackground: Many children with asthma do not have sufficient asthma control, which leads to increased healthcare costs and productivity loss of parents. One of the causative factors are adherence problems. Effective interventions improving medication adherence may therefore improve

  20. e-Monitoring of asthma therapy to improve compliance in children using a real-time medication monitoring system (RTMM): the e-MATIC study protocol.

    NARCIS (Netherlands)

    Vasbinder, E.C.; Janssens, H.M.; Rutten-van Mölken, M.P.M.H.; Dijk, L. van; Winter, B.C.M. de; Groot, R.C.A. de; Vulto, A.G.; Bemt, P.M.L.A. van den

    2013-01-01

    Background: Many children with asthma do not have sufficient asthma control, which leads to increased healthcare costs and productivity loss of parents. One of the causative factors are adherence problems. Effective interventions improving medication adherence may therefore improve asthma control

  1. Deadline Compliance Status Reports

    Data.gov (United States)

    Department of Housing and Urban Development — These monthly Deadline Compliance Status Reports assist Participating Jurisdictions and HUD Field Offices in monitoring compliance with the 2-year commitment and...

  2. Understanding Healthcare Workers Self-Reported Practices, Knowledge and Attitude about Hand Hygiene in a Medical Setting in Rural India.

    Science.gov (United States)

    Diwan, Vishal; Gustafsson, Charlotte; Rosales Klintz, Senia; Joshi, Sudhir Chandra; Joshi, Rita; Sharma, Megha; Shah, Harshada; Pathak, Ashish; Tamhankar, Ashok J; Stålsby Lundborg, Cecilia

    2016-01-01

    To describe self-reported practices and assess knowledge and attitudes regarding hand hygiene among healthcare workers in a rural Indian teaching hospital. A rural teaching hospital and its associated medical and nursing colleges in the district of Ujjain, India. The study population consisted of physicians, nurses, teaching staff, clinical instructors and nursing students. Self-administered questionnaires based on the World Health Organization Guidelines on Hand Hygiene in Healthcare were used. Out of 489 healthcare workers, 259 participated in the study (response rate = 53%). The proportion of healthcare workers that reported to 'always' practice hand hygiene in the selected situations varied from 40-96% amongst categories. Reported barriers to maintaining good hand hygiene were mainly related to high workload, scarcity of resources, lack of scientific information and the perception that priority is not given to hand hygiene, either on an individual or institutional level. Previous training on the topic had a statistically significant association with self-reported practice (p = 0.001). Ninety three per cent of the respondents were willing to attend training on hand hygiene in the near future. Self-reported knowledge and adherence varied between situations, but hand hygiene practices have the potential to improve if the identified constraints could be reduced. Future training should focus on enhancing healthcare workers' knowledge and understanding regarding the importance of persistent practice in all situations.

  3. Compliance and treatment satisfaction of post menopausal women treated for osteoporosis. Compliance with osteoporosis treatment

    Directory of Open Access Journals (Sweden)

    Huas Dominique

    2010-08-01

    Full Text Available Abstract Background Adherence to anti-osteoporosis treatments is poor, exposing treated women to increased fracture risk. Determinants of poor adherence are poorly understood. The study aims to determine physician- and patient- rated treatment compliance with osteoporosis treatments and to evaluate factors influencing compliance. Methods This was an observational, cross-sectional pharmacoepidemiological study with a randomly-selected sample of 420 GPs, 154 rheumatologists and 110 gynaecologists practicing in France. Investigators included post-menopausal women with a diagnosis of osteoporosis and a treatment initiated in the previous six months. Investigators completed a questionnaire on clinical features, treatments and medical history, and on patient compliance. Patients completed a questionnaire on sociodemographic features, lifestyle, attitudes and knowledge about osteoporosis, treatment compliance, treatment satisfaction and quality of life. Treatment compliance was evaluated with the Morisky Medication-taking Adherence Scale. Variables collected in the questionnaires were evaluated for association with compliance using multivariate logistic regression analysis. Results 785 women were evaluated. Physicians considered 95.4% of the sample to be compliant, but only 65.5% of women considered themselves compliant. The correlation between patient and physician perceptions of compliance was low (κ: 0.11 [95% CI: 0.06 to 0.16]. Patient-rated compliance was highest for monthly bisphosphonates (79.7% and lowest for hormone substitution therapy (50.0%. Six variables were associated with compliance: treatment administration frequency, perceptions of long-term treatment acceptability, perceptions of health consequences of osteoporosis, perceptions of knowledge about osteoporosis, exercise and mental quality of life. Conclusion Compliance to anti-osteoporosis treatments is poor. Reduction of dosing regimen frequency and patient education may be useful

  4. Implementation of a cloud-based electronic medical record exchange system in compliance with the integrating healthcare enterprise's cross-enterprise document sharing integration profile.

    Science.gov (United States)

    Wu, Chien Hua; Chiu, Ruey Kei; Yeh, Hong Mo; Wang, Da Wei

    2017-11-01

    In 2011, the Ministry of Health and Welfare of Taiwan established the National Electronic Medical Record Exchange Center (EEC) to permit the sharing of medical resources among hospitals. This system can presently exchange electronic medical records (EMRs) among hospitals, in the form of medical imaging reports, laboratory test reports, discharge summaries, outpatient records, and outpatient medication records. Hospitals can send or retrieve EMRs over the virtual private network by connecting to the EEC through a gateway. International standards should be adopted in the EEC to allow users with those standards to take advantage of this exchange service. In this study, a cloud-based EMR-exchange prototyping system was implemented on the basis of the Integrating the Healthcare Enterprise's Cross-Enterprise Document Sharing integration profile and the existing EMR exchange system. RESTful services were used to implement the proposed prototyping system on the Microsoft Azure cloud-computing platform. Four scenarios were created in Microsoft Azure to determine the feasibility and effectiveness of the proposed system. The experimental results demonstrated that the proposed system successfully completed EMR exchange under the four scenarios created in Microsoft Azure. Additional experiments were conducted to compare the efficiency of the EMR-exchanging mechanisms of the proposed system with those of the existing EEC system. The experimental results suggest that the proposed RESTful service approach is superior to the Simple Object Access Protocol method currently implemented in the EEC system, according to the irrespective response times under the four experimental scenarios. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Alternative Compliance: Guidelines for Preparing and Submitting a Waiver Request Application and Other Documentation Requirements (Book)

    Energy Technology Data Exchange (ETDEWEB)

    2010-11-01

    This document is designed to assist covered fleets interested in taking advantage of more flexible compliance options and to facilitate the transition from Standard Compliance to Alternative Compliance. It is designed to help fleets better understand the Alternative Compliance option and successfully complete the waiver application process.

  6. Alternative Compliance: Guidelines for Preparing and Submitting a Waiver Request Application and Other Documentation Requirements

    Energy Technology Data Exchange (ETDEWEB)

    2013-03-01

    This document is designed to assist covered fleets interested in taking advantage of more flexible compliance options and to facilitate the transition from Standard Compliance to Alternative Compliance. It is designed to help fleets better understand the Alternative Compliance option and successfully complete the waiver application process.

  7. Alternative Compliance: Guidelines for Preparing and Submitting a Waiver Request Application and Other Documentation Requirements (Brochure)

    Energy Technology Data Exchange (ETDEWEB)

    2014-06-01

    This document is designed to assist covered fleets interested in taking advantage of more flexible compliance options and to facilitate the transition from Standard Compliance to Alternative Compliance. It is designed to help fleets better understand the Alternative Compliance option and successfully complete the waiver application process.

  8. Alternative Compliance: Guidelines for Preparing and Submitting a Waiver Request Application and Other Documentation Requirements

    Energy Technology Data Exchange (ETDEWEB)

    Sears, Ted [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2014-06-01

    This document is designed to assist covered fleets interested in taking advantage of more flexible compliance options and to facilitate the transition from Standard Compliance to Alternative Compliance. It is designed to help fleets better understand the Alternative Compliance option and successfully complete the waiver application process.

  9. Association Between Loyalty to Community Pharmacy and Medication Persistence and Compliance, and the Use of Guidelines-Recommended Drugs in Type 2 Diabetes

    Science.gov (United States)

    Dossa, Anara Richi; Grégoire, Jean-Pierre; Lauzier, Sophie; Guénette, Line; Sirois, Caroline; Moisan, Jocelyne

    2015-01-01

    Abstract Pharmacists record data on all drugs claimed and may build a personal relationship with their clients. We hypothesized that loyalty to a single pharmacy could be associated with a better quality of drug use. To assess the association between pharmacy loyalty and quality of drug use among individuals treated with oral antidiabetes drugs (OADs). This is a cohort study using Quebec Health Insurance Board data. Associations were assessed using multivariable logistic regression. New OAD users, aged ≥18 years. Individuals who filled all their prescription drugs in the same pharmacy during the first year of treatment were considered loyal. During year 2 of treatment we assessed 4 quality indicators of drug use: persistence with antidiabetes treatment, compliance with antidiabetes treatment among those considered persistent, use of an angiotensin-converting enzyme inhibitor or of an angiotensin II receptor blocker (ACEi/ARB), and use of a lipid-lowering drug. Of 124,009 individuals, 59.75% were identified as loyal. Nonloyal individuals were less likely to persist with their antidiabetes treatment (adjusted odds ratio = 0.89; 95% CI: 0.86–0.91), to comply with their antidiabetes treatment (0.82; 0.79–0.84), to use an ACEi/ARB (0.85; 0.83–0.88) and to use a lipid-lowering drug (0.83; 0.80–0.85). Quality of drug use decreased as the number of different pharmacies increased (linear contrast tests loyalty are specifically due to pharmacists. PMID:26166087

  10. Association Between Loyalty to Community Pharmacy and Medication Persistence and Compliance, and the Use of Guidelines-Recommended Drugs in Type 2 Diabetes: A Cohort Study.

    Science.gov (United States)

    Dossa, Anara Richi; Grégoire, Jean-Pierre; Lauzier, Sophie; Guénette, Line; Sirois, Caroline; Moisan, Jocelyne

    2015-07-01

    Pharmacists record data on all drugs claimed and may build a personal relationship with their clients. We hypothesized that loyalty to a single pharmacy could be associated with a better quality of drug use.To assess the association between pharmacy loyalty and quality of drug use among individuals treated with oral antidiabetes drugs (OADs).This is a cohort study using Quebec Health Insurance Board data. Associations were assessed using multivariable logistic regression.New OAD users, aged ≥18 years.Individuals who filled all their prescription drugs in the same pharmacy during the first year of treatment were considered loyal. During year 2 of treatment we assessed 4 quality indicators of drug use: persistence with antidiabetes treatment, compliance with antidiabetes treatment among those considered persistent, use of an angiotensin-converting enzyme inhibitor or of an angiotensin II receptor blocker (ACEi/ARB), and use of a lipid-lowering drug.Of 124,009 individuals, 59.75% were identified as loyal. Nonloyal individuals were less likely to persist with their antidiabetes treatment (adjusted odds ratio = 0.89; 95% CI: 0.86-0.91), to comply with their antidiabetes treatment (0.82; 0.79-0.84), to use an ACEi/ARB (0.85; 0.83-0.88) and to use a lipid-lowering drug (0.83; 0.80-0.85). Quality of drug use decreased as the number of different pharmacies increased (linear contrast tests loyalty are specifically due to pharmacists.

  11. A randomised crossover trial of minimising medical terminology in secondary care correspondence in patients with chronic health conditions: impact on understanding and patient reported outcomes.

    Science.gov (United States)

    Wernick, M; Hale, P; Anticich, N; Busch, S; Merriman, L; King, B; Pegg, T

    2016-05-01

    There is little existing research on the role that secondary care letters have in ensuring patient understanding of chronic health conditions. To determine whether minimising the use of medical terminology in medical correspondence improved patient understanding and anxiety/depression scores. A single-centre, non-blinded, randomised crossover design assessed health literacy, EQ-5D scores and the impact of the 'translated' letter on the doctor's professionalism, the patient's relationship with their general practitioner (GP) and their perceived impact on chronic disease management. Patients were crossed over between their 'translated' and original letter. Sixty patients were recruited. Use of a 'translated' letter reduced mean terms not understood from 7.78 to 1.76 (t(58) = 4.706, P medical terminology in medical correspondence significantly improved patient understanding and perception of their ability to manage their chronic health condition. Although there was no impact on EQ-5D depression/anxiety scores, overwhelming patient preference for the 'translated' letter indicates a need for minimisation of medical terminology in medical correspondence for patients with chronic health conditions. © 2016 Royal Australasian College of Physicians.

  12. Management of Older Inpatients Who Refuse Nonpsychiatric Medication Within Birmingham and Solihull Mental Health NHS Foundation Trust: Audit.

    Science.gov (United States)

    Umotong, Eno

    2016-12-01

    The effects of poor medication compliance are well documented and include increased morbidity, early mortality, and financial costs to the society. According to national guidelines, when a competent patient refuses medication, the doctor on duty has a responsibility to ensure the patient understands their proposed course of action. The aims of this audit were to evaluate whether this consultation was taking place within older in-patient units across Birmingham and Solihull Mental Health NHS Foundation Trust when patients refuse nonpsychiatric medicines. Poor compliance was defined as more than five refusals of a nonpsychiatric medication over a 4-week period. A discussion with the duty doctor occurred in 75% of cases (27/36), which resulted in a change in prescription or compliance in 59% (16/27 patients). After patient refusal of medication, a consultation with the duty doctor is likely to improve compliance and uncover salient issues particularly in regards to capacity and drug suitability.

  13. MO-AB-201-03: The Alphabet Soup of Regulatory Compliance: Being Prepared for Inspections

    Energy Technology Data Exchange (ETDEWEB)

    Kroger, L. [University of California Davis (United States)

    2015-06-15

    The role of the Radiation Safety Officer at a medical facility can be complicated. The complexity of the position is based on the breadth of services provided at the institution and the nature of the radioactive materials license. Medical practices are constantly changing and the use of ionizing radiation continues to rise in this area. Some of the newer medical applications involving radiation have unique regulatory and safety issues that must be addressed. Oversight of the uses of radiation start at the local level (radiation safety officer, radiation safety committee) and are heavily impacted by outside agencies (i.e. Nuclear Regulatory Commission, State Radiologic Health, The Joint Commission (TJC), etc). This session will provide both an overview of regulatory oversight and essential compliance practices as well as practical ways to assess and introduce some of the new applications utilizing radioactive materials into your medical facility. Learning Objectives: Regulatory Compliance and Safety with New Radiotherapies: Spheres and Ra-223 (Lance Phillips) Understand the radioactive materials license amendment process to add new radiotherapies (i.e., SIR-Spheres, Therasphere, Xofigo). Understand the AU approval process for microspheres and Xofigo. Examine the training and handling requirements for new procedures. Understand the process involved with protocol development, SOP in order to define roles and responsibilities. The RSO and The RSC: Challenges and Opportunities (Colin Dimock) Understand how to form an effective Committee. Examine what the Committee does for the Program and the RSO. Understand the importance of Committee engagement. Discuss the balance of the complimentary roles of the RSO and the Committee. The Alphabet Soup of Regulatory Compliance: Being Prepared for Inspections (Linda Kroger) Recognize the various regulatory bodies and organizations with oversight or impact in Nuclear Medicine, Radiology and Radiation Oncology. Examine 10CFR35

  14. MO-AB-201-03: The Alphabet Soup of Regulatory Compliance: Being Prepared for Inspections

    International Nuclear Information System (INIS)

    Kroger, L.

    2015-01-01

    The role of the Radiation Safety Officer at a medical facility can be complicated. The complexity of the position is based on the breadth of services provided at the institution and the nature of the radioactive materials license. Medical practices are constantly changing and the use of ionizing radiation continues to rise in this area. Some of the newer medical applications involving radiation have unique regulatory and safety issues that must be addressed. Oversight of the uses of radiation start at the local level (radiation safety officer, radiation safety committee) and are heavily impacted by outside agencies (i.e. Nuclear Regulatory Commission, State Radiologic Health, The Joint Commission (TJC), etc). This session will provide both an overview of regulatory oversight and essential compliance practices as well as practical ways to assess and introduce some of the new applications utilizing radioactive materials into your medical facility. Learning Objectives: Regulatory Compliance and Safety with New Radiotherapies: Spheres and Ra-223 (Lance Phillips) Understand the radioactive materials license amendment process to add new radiotherapies (i.e., SIR-Spheres, Therasphere, Xofigo). Understand the AU approval process for microspheres and Xofigo. Examine the training and handling requirements for new procedures. Understand the process involved with protocol development, SOP in order to define roles and responsibilities. The RSO and The RSC: Challenges and Opportunities (Colin Dimock) Understand how to form an effective Committee. Examine what the Committee does for the Program and the RSO. Understand the importance of Committee engagement. Discuss the balance of the complimentary roles of the RSO and the Committee. The Alphabet Soup of Regulatory Compliance: Being Prepared for Inspections (Linda Kroger) Recognize the various regulatory bodies and organizations with oversight or impact in Nuclear Medicine, Radiology and Radiation Oncology. Examine 10CFR35

  15. Barriers to reporting child maltreatment: do emergency medical services professionals fully understand their role as mandatory reporters?

    Science.gov (United States)

    Lynne, Ellen Grace; Gifford, Elizabeth J; Evans, Kelly E; Rosch, Joel B

    2015-01-01

    Child maltreatment is underreported in the United States and in North Carolina. In North Carolina and other states, mandatory reporting laws require various professionals to make reports, thereby helping to reduce underreporting of child maltreatment. This study aims to understand why emergency medical services (EMS) professionals may fail to report suspicions of maltreatment despite mandatory reporting policies. A web-based, anonymous, voluntary survey of EMS professionals in North Carolina was used to assess knowledge of their agency's written protocols and potential reasons for underreporting suspicion of maltreatment (n=444). Results were based on descriptive statistics. Responses of line staff and leadership personnel were compared using chi-square analysis. Thirty-eight percent of respondents were unaware of their agency's written protocols regarding reporting of child maltreatment. Additionally, 25% of EMS professionals who knew of their agency's protocol incorrectly believed that the report should be filed by someone other than the person with firsthand knowledge of the suspected maltreatment. Leadership personnel generally understood reporting requirements better than did line staff. Respondents indicated that peers may fail to report maltreatment for several reasons: they believe another authority would file the report, including the hospital (52.3%) or law enforcement (27.7%); they are uncertain whether they had witnessed abuse (47.7%); and they are uncertain about what should be reported (41.4%). This survey may not generalize to all EMS professionals in North Carolina. Training opportunities for EMS professionals that address proper identification and reporting of child maltreatment, as well as cross-agency information sharing, are warranted.

  16. Understanding the health care utilization of children who require medical technology: A descriptive study of children who require tracheostomies.

    Science.gov (United States)

    Spratling, Regena

    2017-04-01

    Children who require medical technology have complex chronic illnesses. This medical technology, including ventilators, oximeters, tracheostomy tubes, and feeding tubes, allows children and their families to live at home; however, the management of the children's care by informal caregivers is complex with the need for intensive, specialized care. The purpose of this study was to examine the sociodemographic and clinical characteristics that affect health care utilization in a population of children who require medical technology. A retrospective electronic health record (EHR) review was completed on the EHR records on 171 children who require medical technology, specifically tracheostomies, at an outpatient technology dependent pulmonary clinic over a three year period (January 2010-December 2012). Descriptive statistics were used to analyze sociodemographic and clinical characteristics, including medical diagnoses, and emergency department (ED) visits and hospitalizations. Of the 171 children requiring medical technology studied, there were numerous medical diagnoses (n=791), 99% had chronic illnesses affecting two or more body systems, and 88% required two or more technologies, including a tracheostomy and a feeding tube. In addition, 91% of the children had at least one ED visit or hospitalization and were treated in the ED approximately three times over the three year period. The findings from this study noted an increased utilization of health care by these children, and identified common symptoms and medical technologies for which caregivers may need interventions, focusing on education in managing symptoms and medical technology prior to presentation to the ED or hospital. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Educational value of pocket-sized ultrasound devices to improve understanding of ultrasound examination principles and sonographic anatomy for medical student.

    Directory of Open Access Journals (Sweden)

    Eun Young Kim

    Full Text Available Medical students must understand the principles of ultrasonography (US, because US examinations are an important component of patient care in clinical practice. Pocket-sized ultrasound devices have the benefits of accessibility and ease of use. The primary objective of the present study was to evaluate the educational value of these devices in terms of improving medical student interest and understanding of US and sonographic anatomy.We added a US training program comprised of a self-study learning module and a hands-on training session to a two-week block curriculum of medical imaging for first year medical students (n = 40. Multiple pocket-sized US devices were used on a small-group basis during a single afternoon. Students were asked to complete a questionnaire before and after the US training session; these two questionnaires contained 6 and 10 questions, respectively, which were rated by students using a five-point Likert scale. In addition, understanding of sonographic anatomy was tested before and after the training program.Forty students completed the two questionnaires and the anatomy-related tests. Students found the program educationally valuable (4.37 ± 0.54 of 5 and reported that US practice was useful for improving their understanding of the principles of US examinations (4.23 ± 0.66 of 5 and sonographic anatomy (4.40 ± 0.55 of 5. Overall confidence at performing US examinations and understanding of sonographic anatomy were significantly increased after US training (increased overall confidence score, 1.87 ± 0.91 and improvement in sonographic anatomy score, 6.55 ± 1.55, p values < 0.001.US training using pocket-sized ultrasound devices was found to be educationally valuable for medical students in terms of improving understanding of US principles and familiarizing students with sonographic anatomy.

  18. Oral anticancer agent medication adherence by outpatients.

    Science.gov (United States)

    Kimura, Michio; Usami, Eiseki; Iwai, Mina; Nakao, Toshiya; Yoshimura, Tomoaki; Mori, Hiromi; Sugiyama, Tadashi; Teramachi, Hitomi

    2014-11-01

    In the present study, medication adherence and factors affecting adherence were examined in patients taking oral anticancer agents. In June 2013, 172 outpatients who had been prescribed oral anticancer agents by Ogaki Municipal Hospital (Ogaki, Gifu, Japan) completed a questionnaire survey, with answers rated on a five-point Likert scale. The factors that affect medication adherence were evaluated using a customer satisfaction (CS) analysis. For patients with good and insufficient adherence to medication, the median ages were 66 years (range, 21-85 years) and 73 years (range, 30-90 years), respectively (P=0.0004), while the median dosing time was 131 days (range, 3-3,585 days) and 219 days (24-3,465 days), respectively (P=0.0447). In 36.0% (62 out of 172) of the cases, there was insufficient medication adherence; 64.5% of those cases (40 out of 62) showed good medication compliance (4-5 point rating score). However, these patients did not fully understand the effects or side-effects of the drugs, giving a score of three points or less. The percentage of patients with good medication compliance was 87.2% (150 out of 172). Through the CS analysis, three items, the interest in the drug, the desire to consult about the drug and the condition of the patient, were extracted as items for improvement. Overall, the medication compliance of the patients taking the oral anticancer agents was good, but the medication adherence was insufficient. To improve medication adherence, a better understanding of the effectiveness and necessity of drugs and their side-effects is required. In addition, the interest of patients in their medication should be encouraged and intervention should be tailored to the condition of the patient. These steps should lead to improved medication adherence.

  19. What weighs more-low compliance with self-deferral or minor medical procedures? Explaining the high rate of hepatitis C virus window-period donations in Poland.

    Science.gov (United States)

    Czerwinski, Michal; Grabarczyk, Piotr; Stepien, Malgorzata; Kubicka-Russel, Dorota; Tkaczuk, Katarzyna; Brojer, Ewa; Rosinska, Magdalena

    2017-08-01

    Since the introduction of nucleic acid testing (NAT) for routine blood donor screening, hepatitis C virus (HCV) RNA-only detection rates reported from Poland have been higher than in most other European countries. To examine factors that likely contribute to these window-period donations, we conducted a case-control study among 47 recently HCV-infected blood donors (cases), who gave blood between July 2002 and June 2014, and 141 controls matched by age, sex, and donation dates. Firth-corrected, conditional logistic regression models were fitted to estimate adjusted odds ratios and 95% confidence intervals. Adjusted population-attributable fractions were calculated based on the distribution of exposure among the cases. On multivariate analysis, recent exposures in health care environments not routinely ascertained through predonation questionnaires were strongly associated with recently acquired HCV infection. These exposures included minor medical and dental procedures in the preceding 6 months (adjusted odds ratio, 5.77; 95 % confidence interval, 2.01-18.53). However, based on the population-attributable fraction, more important were behavioral deferrable risks that went unreported at the time of donation, such as high-risk sexual behaviors in the preceding 6 months (population-attributable fraction, 34%) or lifetime histories of drug use (population-attributable fraction, 28%). This study raises questions about the effectiveness of deferral policy in excluding high-risk individuals. In addition, it provides further evidence supporting short, temporal deferrals for small medical procedures and dental treatments in Poland. © 2017 AABB.

  20. A day in the life of third-year medical students: using an ethnographic method to understand information seeking and use

    Directory of Open Access Journals (Sweden)

    Andrea B. Twiss-Brooks, MS, MLIS

    2017-01-01

    Conclusions: Some of our results align with those of other recent studies of information use among medical students, residents, and practicing physicians. In particular, the fast-paced clinical setting favors use of information resources that are fast and easy to use. We demonstrated that the methods used are suitable to better understand clinicians’ discovery and use of information.

  1. Corporate compliance: framework and implementation.

    Science.gov (United States)

    Fowler, N

    1999-01-01

    The federal government has created numerous programs to combat fraud and abuse. The government now encourages healthcare facilities to have a corporate compliance program (CCP), a plan that reduces the chances that the facility will violate laws or regulations. A CCP is an organization-wide program comprised of a code of conduct and written policies, internal monitoring and auditing standards, employee training, feedback mechanisms and other features, all designed to prevent and detect violations of governmental laws, regulations and policies. It is a system or method ensuring that employees understand and will comply with laws that apply to what they do every day. Seven factors, based on federal sentencing guidelines, provide the framework for developing a CCP. First, a facility must establish rules that are reasonably capable of reducing criminal conduct. Second, high-level personnel must oversee the compliance effort. Third, a facility must use due care in delegating authority in the compliance initiative. Fourth, standards must be communicated effectively to employees, and fifth, a facility must take reasonable steps to achieve compliance. Sixth, standards must be enforced consistently across the organization and last, standards must be modified or changed for reported concerns, to ensure they are not repeated. PROMINA Health System, Inc. in Atlanta, Ga., designed a program to meet federal guidelines. It started with a self-assessment to define its areas or risk. Next, it created the internal structure and assigned organizational responsibility for running the CCP. PROMINA then developed standards of business and professional conduct, established vehicles of communication and trained employees on the standards. Finally, it continues to develop evidence of the program's effectiveness by monitoring and documenting its compliance activities.

  2. Understanding the impacts of medical tourism on health human resources in Barbados: a prospective, qualitative study of stakeholder perceptions

    Science.gov (United States)

    2013-01-01

    Background Medical tourism is a global health practice where patients travel internationally with the intention of receiving medical services. A range of low, middle, and high income countries are encouraging investment in the medical tourism sector, including countries in the Caribbean targeting patients in North America and Europe. While medical tourism has the potential to provide economic and employment opportunities in destination countries, there are concerns that it could encourage the movement of health workers from the public to private health sector. Methods We present findings from 19 semi-structured interviews with stakeholders across the public health care, private health care, government, allied business, and civil society sectors. These interviews were conducted in-person in Barbados and via phone. The interview transcripts were coded and a thematic analysis developed. Results Three themes were identified: 1) Stakeholder perceptions of the patterns and plans for health human resource usage by current and planned medical tourism facilities in Barbados. We found that while health human resource usage in the medical tourism sector has been limited, it is likely to grow in the future; 2) Anticipated positive impacts of medical tourism on health human resources and access to care in the public system. These benefits included improved quality control, training opportunities, and health worker retention; and 3) Anticipated negative impacts of medical tourism on health human resources and access to care in the public system. These impacts included longer wait times for care and a shift in planning priorities driven by the medical tourism sector. Conclusions Stakeholders interviewed who were connected to medical tourism expansion or the tourism sector took a generally positive view of the likely impacts of medical tourism on health human resources in Barbados. However, stakeholders associated with the public health system and health equity expressed concern

  3. Understanding the impacts of medical tourism on health human resources in Barbados: a prospective, qualitative study of stakeholder perceptions.

    Science.gov (United States)

    Snyder, Jeremy; Crooks, Valorie A; Turner, Leigh; Johnston, Rory

    2013-01-05

    Medical tourism is a global health practice where patients travel internationally with the intention of receiving medical services. A range of low, middle, and high income countries are encouraging investment in the medical tourism sector, including countries in the Caribbean targeting patients in North America and Europe. While medical tourism has the potential to provide economic and employment opportunities in destination countries, there are concerns that it could encourage the movement of health workers from the public to private health sector. We present findings from 19 semi-structured interviews with stakeholders across the public health care, private health care, government, allied business, and civil society sectors. These interviews were conducted in-person in Barbados and via phone. The interview transcripts were coded and a thematic analysis developed. Three themes were identified: 1) Stakeholder perceptions of the patterns and plans for health human resource usage by current and planned medical tourism facilities in Barbados. We found that while health human resource usage in the medical tourism sector has been limited, it is likely to grow in the future; 2) Anticipated positive impacts of medical tourism on health human resources and access to care in the public system. These benefits included improved quality control, training opportunities, and health worker retention; and 3) Anticipated negative impacts of medical tourism on health human resources and access to care in the public system. These impacts included longer wait times for care and a shift in planning priorities driven by the medical tourism sector. Stakeholders interviewed who were connected to medical tourism expansion or the tourism sector took a generally positive view of the likely impacts of medical tourism on health human resources in Barbados. However, stakeholders associated with the public health system and health equity expressed concern that medical tourism may spread

  4. Temporal trends in compliance with appropriateness criteria for stress single-photon emission computed tomography sestamibi studies in an academic medical center.

    Science.gov (United States)

    Gibbons, Raymond J; Askew, J Wells; Hodge, David; Miller, Todd D

    2010-03-01

    The purpose of this study was to apply published appropriateness criteria for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) in a single academic medical center to determine if the percentage of inappropriate studies was changing over time. In a previous study, we applied the American College of Cardiology Foundation/American Society of Nuclear Cardiology (ASNC) appropriateness criteria for stress SPECT MPI and reported that 14% of stress SPECT studies were performed for inappropriate reasons. Using similar methodology, we retrospectively examined 284 patients who underwent stress SPECT MPI in October 2006 and compared the findings to the previous cohort of 284 patients who underwent stress SPECT MPI in May 2005. The indications for testing in the 2 cohorts were very similar. The overall level of agreement in characterizing categories of appropriateness between 2 experienced cardiovascular nurse abstractors was good (kappa = 0.68), which represented an improvement from our previous study (kappa = 0.56). There was a significant change between May 2005 and October 2006 in the overall classification of categories for appropriateness (P = .024 by chi(2) statistic). There were modest, but insignificant, increases in the number of patients who were unclassified (15% in the current study vs 11% previously), appropriate (66% vs 64%), and uncertain (12% vs 11%). Only 7% of the studies in the current study were inappropriate, which represented a significant (P = .004) decrease from the 14% reported in the 2005 cohort. In the absence of any specific intervention, there was a significant change in the overall classification of SPECT appropriateness in an academic medical center over 17 months. The only significant difference in individual categories was a decrease in inappropriate studies. Additional measurements over time will be required to determine if this trend is sustainable or generalizable.

  5. ‘And you’ll suddenly realise ‘I’ve not washed my hands’: medical students’, junior doctors’ and medical educators’ narratives of hygiene behaviours

    Science.gov (United States)

    Cresswell, Penelope

    2018-01-01

    Objective Compliance to hygiene behaviours has long been recognised as important in the prevention and control of healthcare associated infections, but medical doctors still display some of the lowest rates of compliance of all healthcare workers. We aim to understand compliance to hygiene behaviours by analysing medical students’, junior doctors’ and medical educators’ narratives of these behaviours to identify their respective attitudes and beliefs around compliance and how these are learnt during training. Such an understanding can inform future interventions to improve compliance targeted to areas of greatest need. Design A qualitative study, using narrative interviews (nine focus groups and one individual interview). Data were analysed thematically using inductive framework analysis. Setting Teaching hospitals in the UK. Participants Convenience sample of 25 participants: third-year medical students in their first clinical year (n=13), junior doctors (n=6) and medical educators (n=6). Results We identified four main themes: (1) knowledge, (2) constraints, (3) role models/culture and (4) hygiene as an added extra. Knowledge varied across participant groups and appeared to influence behaviours; medical students relied on what they have been told by seniors, while medical educators relied on their own knowledge and experience. There was a strong belief that evidence for the effectiveness of good hygiene behaviours is lacking. Furthermore, medical educators’ behaviour appears to strongly influence others. Finally, hygiene was predominately viewed as an added extra rather than an integral part of the process. Conclusions Awareness of the evidence around good hygiene needs to be improved at all levels. Medical students and junior doctors should be encouraged to consider why they are asked to perform certain hygiene behaviours in order to improve ownership of those behaviours. Medical educators need to recognise their responsibilities as role models for their

  6. review of compliance to anti tuberculosis treatment and risk factors ...

    African Journals Online (AJOL)

    Background: The aim of this study is to assess anti TB treatment compliance and the factors predictive for poor adherence in Sub-Saharan Africa in the last 10 years. Methods: We searched Medline for articles written in English using the terms: "Patient Compliance"[Mesh] OR "Medication Adherence"[Mesh])) AND ...

  7. Understanding the Factors That Influence the Adoption and Meaningful Use of Social Media by Physicians to Share Medical Information

    OpenAIRE

    McGowan, Brian S; Wasko, Molly; Vartabedian, Bryan Steven; Miller, Robert S; Freiherr, Desirae D; Abdolrasulnia, Maziar

    2012-01-01

    Background Within the medical community there is persistent debate as to whether the information available through social media is trustworthy and valid, and whether physicians are ready to adopt these technologies and ultimately embrace them as a format for professional development and lifelong learning. Objective To identify how physicians are using social media to share and exchange medical information with other physicians, and to identify the factors that influence physicians’ use of soc...

  8. Does a summative portfolio foster the development of capabilities such as reflective practice and understanding ethics? An evaluation from two medical schools.

    Science.gov (United States)

    O'Sullivan, Anthony J; Howe, Amanda C; Miles, Susan; Harris, Peter; Hughes, Chris S; Jones, Philip; Scicluna, Helen; Leinster, Sam J

    2012-01-01

    Portfolios need to be evaluated to determine whether they encourage students to develop in capabilities such as reflective practice and ethical judgment. The aims of this study were (i) to determine whether preparing a portfolio helps promote students' development in a range of capabilities including understanding ethical and legal principles, reflective practice and effective communication, and (ii) to determine to what extent the format of the portfolio affected the outcome by comparing the experiences of students at two different medical schools. A questionnaire was designed to evaluate undergraduate medical students' experiences of completing a portfolio at two medical schools. A total of 526 (45% response rate) students answered the on-line questionnaire. Students from both medical schools gave the highest ranking for the portfolio as a trigger for reflective practice. 63% of students agreed their portfolio helped them develop reflective practice skills (p portfolios helped them understand ethical and legal principles whereas 29% disagreed (p portfolio helped them to develop effective communication. Students perceive portfolio preparation as an effective learning tool for the development of capabilities such as understanding ethical and legal principles and reflective practice, whereas other capabilities such as effective communication require complementary techniques and other modes of assessment.

  9. Architecture-based regulatory compliance argumentation

    DEFF Research Database (Denmark)

    Mihaylov, Boyan; Onea, Lucian; Hansen, Klaus Marius

    2016-01-01

    Standards and regulations are difficult to understand and map to software, which makes compliance with them challenging to argue for software products and development process. This is problematic since lack of compliance may lead to issues with security, safety, and even to economic sanctions....... An increasing number of applications (for example in healthcare) are expected to have to live up to regulatory requirements in the future, which will lead to more software development projects having to deal with such requirements. We present an approach that models regulations such that compliance arguments...... the approach on the migration of the telemedicine platform Net4Care to the cloud, where certain regulations (for example privacy) should be concerned. The approach has the potential to support simpler compliance argumentation with the eventual promise of safer and more secure applications....

  10. Hands in medicine: understanding the impact of competency-based education on the formation of medical students' identities in the United States.

    Science.gov (United States)

    Gonsalves, Catherine; Zaidi, Zareen

    2016-01-01

    There have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on 'doing the work of a physician' rather than identity formation and 'being a physician.' This study aims to understand how competency-based education impacts the development of a medical student's identity. Three ceramic models representing three core competencies 'medical knowledge,' 'patient care,' and 'professionalism' were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes. Students across all four years of medical school related to the 'professionalism' competency domain (50%). They reflected that 'being an empathetic physician' was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized 'professionalism' as a competency. Students perceive 'professionalism' as a competency that impacts their identity formation in the social role of 'being a doctor,' albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.

  11. Choices that increase compliance

    International Nuclear Information System (INIS)

    Edwards, P.R.

    1991-01-01

    A compliance model is developed and tested using a survey of corporate officials and the regulatory arena of equal employment opportunity. Findings support the economic model of compliance in its conclusion that probability of detection and probable level of sanctions influence compliance decisions. Results also indicate that adjustments to the model that account for bounded rationality are valid. The key outcome, however, is that although all types of investigations play some role in enhancing compliance, those that stress sanctions and thus severity rather than certainty of detection may have the greatest positive influence on compliance. Enforcement programs attempting to operate simply as investigators of small-scale complaints will have less success than those with different types of investigations or a balanced type of single investigation. The results also suggest a more complex cognitive process on the part of regulated individuals than initially theorized. 34 refs., 3 tabs

  12. Implementing the patient-centered medical home model for chronic disease care in small medical practices: practice group characteristics and physician understanding.

    Science.gov (United States)

    Baxter, Louisa; Nash, David B

    2013-01-01

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

  13. Relationship between sensory results and compliance scores in grated Parmigiano-Reggiano cheese

    Directory of Open Access Journals (Sweden)

    Mario Zannoni

    2015-12-01

    Full Text Available The regulations for Protected Designation of Origin require a certification body to verify compliance with the provisions of the product specification. The grated Parmigiano-Reggiano is evaluated with a scorecard containing 21 quantitative descriptors and 4 qualitative evaluations of compliance with the regulations. To better understand the relationship between sensory compliance and quantitative descriptors we have tested 24 samples of grated Parmigiano-Reggiano. Correlations and Partial Least Squares gave us a better understanding of compliance evaluation. The work allowed us to define the most important descriptors in relationship with compliance and showed that it is possible to predict compliance values using descriptor values.

  14. Understanding Postdisaster Substance Use and Psychological Distress Using Concepts from the Self-Medication Hypothesis and Social Cognitive Theory.

    Science.gov (United States)

    Alexander, Adam C; Ward, Kenneth D

    2017-11-10

    This article applies constructs from the Self-Medication Hypothesis and Social Cognitive Theory to explain the development of substance use and psychological distress after a disaster. A conceptual model is proposed, which employs a sequential mediation model, identifying perceived coping self-efficacy, psychological distress, and self-medication as pathways to substance use after a disaster. Disaster exposure decreases perceived coping self-efficacy, which, in turn, increases psychological distress and subsequently increases perceptions of self-medication in vulnerable individuals. These mechanisms lead to an increase in postdisaster substance use. Last, recommendations are offered to encourage disaster researchers to test more complex models in studies on postdisaster psychological distress and substance use.

  15. Dietary supplement good manufacturing practices: preparing for compliance

    National Research Council Canada - National Science Library

    Mead, William J

    2012-01-01

    .... Based on broad experience with GMP compliance techniques worked out over the years in the food, drug, and medical device industries, it is a must-have guide for all DS companies, especially the many...

  16. Compliance and Enforcement Actions (CEA) -

    Data.gov (United States)

    Department of Transportation — Compliance and Enforcement Actions application provides process assistance / improvements for conducting investigation and enforcement activities. The Compliance and...

  17. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59.

    Science.gov (United States)

    Ten Cate, Th J; Kusurkar, Rashmi A; Williams, Geoffrey C

    2011-01-01

    Self-determination Theory (SDT), designed by Edward Deci and Richard Ryan, serves among the current major motivational theories in psychology. SDT research has been conducted in many areas, among which are education and health care, but its applications in medical education are rare. The potential of SDT to help understand processes in medical education justifies this Guide. SDT is explained in seven principles, one of which is the distinction of three innate psychological needs of human beings: for competence, for autonomy and for relatedness. Further, SDT elaborates how humans tend to internalise regulation of behaviour that initially has been external, in order to develop autonomous, self-determined behaviour. Implications of SDT for medical education are discussed with reference to preparation and selection, curriculum structure, classroom teaching, assessments and examinations, self-directed learning, clinical teaching, students as teachers and researchers, continuing professional development, faculty development and stress among trainees.

  18. Understanding the Connection Between Traumatic Brain Injury and Alzheimer’s Disease: A Population-Based Medical Record Review Analysis

    Science.gov (United States)

    2017-10-01

    Medical Record Review Analysis PRINCIPAL INVESTIGATOR: Allen W. Brown, MD CONTRACTING ORGANIZATION: Mayo Clinic Rochester, MN 55905 REPORT DATE...response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and... reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information

  19. Use of e-learning to enhance medical students' understanding and knowledge of healthcare-associated infection prevention and control.

    LENUS (Irish Health Repository)

    O'Neill, E

    2011-12-01

    An online infection prevention and control programme for medical students was developed and assessed. There was a statistically significant improvement (P<0.0001) in the knowledge base among 517 students after completing two modules. The majority of students who completed the evaluation were positive about the learning experience.

  20. How to Achieve Synergy between Medical Education and Cognitive Neuroscience? An Exercise on Prior Knowledge in Understanding

    Science.gov (United States)

    Ruiter, Dirk J.; van Kesteren, Marlieke T. R.; Fernandez, Guillen

    2012-01-01

    A major challenge in contemporary research is how to connect medical education and cognitive neuroscience and achieve synergy between these domains. Based on this starting point we discuss how this may result in a common language about learning, more educationally focused scientific inquiry, and multidisciplinary research projects. As the topic of…

  1. Can the Tools of Activity Theory Help Us in Advancing Understanding and Organisational Change in Undergraduate Medical Education?

    Science.gov (United States)

    Reid, Anne-Marie; Ledger, Alison; Kilminster, Sue; Fuller, Richard

    2015-01-01

    Continued changes to healthcare delivery in the UK, and an increasing focus on patient safety and quality improvement, require a radical rethink on how we enable graduates to begin work in challenging, complex environments. Professional regulatory bodies now require undergraduate medical schools to implement an "assistantship" period in…

  2. Understanding the factors that influence the adoption and meaningful use of social media by physicians to share medical information.

    Science.gov (United States)

    McGowan, Brian S; Wasko, Molly; Vartabedian, Bryan Steven; Miller, Robert S; Freiherr, Desirae D; Abdolrasulnia, Maziar

    2012-09-24

    Within the medical community there is persistent debate as to whether the information available through social media is trustworthy and valid, and whether physicians are ready to adopt these technologies and ultimately embrace them as a format for professional development and lifelong learning. To identify how physicians are using social media to share and exchange medical information with other physicians, and to identify the factors that influence physicians' use of social media as a component of their lifelong learning and continuing professional development. We developed a survey instrument based on the Technology Acceptance Model, hypothesizing that technology usage is best predicted by a physician's attitudes toward the technology, perceptions about the technology's usefulness and ease of use, and individual factors such as personal innovativeness. The survey was distributed via email to a random sample of 1695 practicing oncologists and primary care physicians in the United States in March 2011. Responses from 485 physicians were analyzed (response rate 28.61%). Overall, 117 of 485 (24.1%) of respondents used social media daily or many times daily to scan or explore medical information, whereas 69 of 485 (14.2%) contributed new information via social media on a daily basis. On a weekly basis or more, 296 of 485 (61.0%) scanned and 223 of 485 (46.0%) contributed. In terms of attitudes toward the use of social media, 279 of 485 respondents (57.5%) perceived social media to be beneficial, engaging, and a good way to get current, high-quality information. In terms of usefulness, 281 of 485 (57.9%) of respondents stated that social media enabled them to care for patients more effectively, and 291 of 485 (60.0%) stated it improved the quality of patient care they delivered. The main factors influencing a physician's usage of social media to share medical knowledge with other physicians were perceived ease of use and usefulness. Respondents who had positive

  3. Understanding the Role of Medical Experts during a Public Health Crisis Digital Tools and Library Resources for Research on the 1918 Spanish Influenza.

    Science.gov (United States)

    Ewing, E Thomas; Gad, Samah; Ramakrishnan, Naren; Reznick, Jeffrey S

    2014-10-01

    Humanities scholars, particularly historians of health and disease, can benefit from digitized library collections and tools such as topic modeling. Using a case study from the 1918 Spanish Flu epidemic, this paper explores the application of a big humanities approach to understanding the impact of a public health official on the course of the disease and the response of the public, as documented through digitized newspapers and medical periodicals.

  4. Translation and psychometric analysis of the Malaysian version of medication understanding and use self-efficacy scale (m-muse) for diabetes mellitus

    OpenAIRE

    Safaa A Al Abboud; Sohail Ahmad; Mohamed B.L Bidin; Nahlah E Ismail

    2017-01-01

    Introduction: Enhancing diabetes self-efficacy (SE) level can improve the self-management behaviour in patients living with diabetes mellitus (DM). This study aimed to translate and assess the psychometric properties of Malaysian version of diabetes Medication Understanding and Use Self-Efficacy Scale (M-MUSE). Methods: Following the translation of English version of MUSE to Malay language using established international standard translation guidelines, 252 adult diabetics (≥ 18 years old; DM...

  5. 28 CFR 73.4 - Partial compliance not deemed compliance.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Partial compliance not deemed compliance. 73.4 Section 73.4 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) NOTIFICATIONS TO THE ATTORNEY GENERAL BY AGENTS OF FOREIGN GOVERNMENTS § 73.4 Partial compliance not deemed compliance. The fact...

  6. Understanding the foundation: the state of generalist search education in library schools as related to the needs of expert searchers in medical libraries.

    Science.gov (United States)

    Nicholson, Scott

    2005-01-01

    The paper explores the current state of generalist search education in library schools and considers that foundation in respect to the Medical Library Association's statement on expert searching. Syllabi from courses with significant searching components were examined from ten of the top library schools, as determined by the U.S. News & World Report rankings. Mixed methods were used, but primarily quantitative bibliometric methods were used. The educational focus in these searching components was on understanding the generalist searching resources and typical users and on performing a reflective search through application of search strategies, controlled vocabulary, and logic appropriate to the search tool. There is a growing emphasis on Web-based search tools and a movement away from traditional set-based searching and toward free-text search strategies. While a core set of authors is used in these courses, no core set of readings is used. While library schools provide a strong foundation, future medical librarians still need to take courses that introduce them to the resources, settings, and users associated with medical libraries. In addition, as more emphasis is placed on Web-based search tools and free-text searching, instructors of the specialist medical informatics courses will need to focus on teaching traditional search methods appropriate for common tools in the medical domain.

  7. How Do Surgery Students Use Written Language to Say What They See? A Framework to Understand Medical Students' Written Evaluations of Their Teachers.

    Science.gov (United States)

    Lim, David W; White, Jonathan S

    2015-11-01

    There remains debate regarding the value of the written comments that medical students are traditionally asked to provide to evaluate the teaching they receive. The purpose of this study was to examine written teaching evaluations to understand how medical students conceptualize teachers' behaviors and performance. All written comments collected from medical students about teachers in the two surgery clerkships at the University of Alberta in 2009-2010 and 2010-2011 were collated and anonymized. A grounded theory approach was used for analysis, with iterative reading and open coding to identify recurring themes. A framework capturing variations observed in the data was generated until data saturation was achieved. Domains and subdomains were named using an in situ coding approach. The conceptual framework contained three main domains: "Physician as Teacher," "Physician as Person," and "Physician as Physician." Under "Physician as Teacher," students commented on specific acts of teaching and subjective perceptions of an educator's teaching values. Under the "Physician as Physician" domain, students commented on elements of their educator's physicianship, including communication and collaborative skills, medical expertise, professionalism, and role modeling. Under "Physician as Person," students commented on how both positive and negative personality traits impacted their learning. This framework describes how medical students perceive their teachers and how they use written language to attach meaning to the behaviors they observe. Such a framework can be used to help students provide more constructive feedback to teachers and to assist in faculty development efforts aimed at improving teaching performance.

  8. Environmental Compliance Guide

    International Nuclear Information System (INIS)

    1981-02-01

    The Guide is intended to assist Department of Energy personnel by providing information on the NEPA process, the processes of other environmental statutes that bear on the NEPA process, the timing relationships between the NEPA process and these other processes, as well as timing relationships between the NEPA process and the development process for policies, programs, and projects. This information should be helpful not only in formulating environmental compliance plans but also in achieving compliance with NEPA and various other environmental statutes. The Guide is divided into three parts with related appendices: Part I provides guidance for developing environmental compliance plans for DOE actions; Part II is devoted to NEPA with detailed flowcharts depicting the compliance procedures required by CEQ regulations and Department of Energy NEPA Guidelines; and Part III contains a series of flowcharts for other Federal environmental requirements that may apply to DOE projects

  9. 340 Facility compliance assessment

    International Nuclear Information System (INIS)

    English, S.L.

    1993-10-01

    This study provides an environmental compliance evaluation of the RLWS and the RPS systems of the 340 Facility. The emphasis of the evaluation centers on compliance with WAC requirements for hazardous and mixed waste facilities, federal regulations, and Westinghouse Hanford Company (WHC) requirements pertinent to the operation of the 340 Facility. The 340 Facility is not covered under either an interim status Part A permit or a RCRA Part B permit. The detailed discussion of compliance deficiencies are summarized in Section 2.0. This includes items of significance that require action to ensure facility compliance with WAC, federal regulations, and WHC requirements. Outstanding issues exist for radioactive airborne effluent sampling and monitoring, radioactive liquid effluent sampling and monitoring, non-radioactive liquid effluent sampling and monitoring, less than 90 day waste storage tanks, and requirements for a permitted facility

  10. Environmental Compliance Issue Coordination

    Science.gov (United States)

    An order to establish the Department of Energy (DOE) requirements for coordination of significant environmental compliance issues to ensure timely development and consistent application of Departmental environmental policy and guidance

  11. Environmental Compliance Guide

    Energy Technology Data Exchange (ETDEWEB)

    None

    1981-02-01

    The Guide is intended to assist Department of Energy personnel by providing information on the NEPA process, the processes of other environmental statutes that bear on the NEPA process, the timing relationships between the NEPA process and these other processes, as well as timing relationships between the NEPA process and the development process for policies, programs, and projects. This information should be helpful not only in formulating environmental compliance plans but also in achieving compliance with NEPA and various other environmental statutes. The Guide is divided into three parts with related appendices: Part I provides guidance for developing environmental compliance plans for DOE actions; Part II is devoted to NEPA with detailed flowcharts depicting the compliance procedures required by CEQ regulations and Department of Energy NEPA Guidelines; and Part III contains a series of flowcharts for other Federal environmental requirements that may apply to DOE projects.

  12. Undergraduate medical students' perceptions, attitudes, and competencies in evidence-based medicine (EBM), and their understanding of EBM reality in Syria.

    Science.gov (United States)

    Alahdab, Fares; Firwana, Belal; Hasan, Rim; Sonbol, Mohamad Bassam; Fares, Munes; Alnahhas, Iyad; Sabouni, Ammar; Ferwana, Mazen

    2012-08-12

    Teaching evidence-based medicine (EBM) should be evaluated and guided by evidence of its own effectiveness. However, no data are available on adoption of EBM by Syrian undergraduate, postgraduate, or practicing physicians. In fact, the teaching of EBM in Syria is not yet a part of undergraduate medical curricula. The authors evaluated education of evidence-based medicine through a two-day intensive training course. The authors evaluated education of evidence-based medicine through a two-day intensive training course that took place in 2011. The course included didactic lectures as well as interactive hands-on workshops on all topics of EBM. A comprehensive questionnaire, that included the Berlin questionnaire, was used to inspect medical students' awareness of, attitudes toward, and competencies' in EBM. According to students, problems facing proper EBM practice in Syria were the absence of the following: an EBM teaching module in medical school curriculum (94%), role models among professors and instructors (92%), a librarian (70%), institutional subscription to medical journals (94%), and sufficient IT hardware (58%). After the course, there was a statistically significant increase in medical students' perceived ability to go through steps of EBM, namely: formulating PICO questions (56.9%), searching for evidence (39.8%), appraising the evidence (27.3%), understanding statistics (48%), and applying evidence at point of care (34.1%). However, mean increase in Berlin scores after the course was 2.68, a non-statistically significant increase of 17.86%. The road to a better EBM reality in Syria starts with teaching EBM in medical school and developing the proper environment to facilitate transforming current medical education and practice to an evidence-based standard in Syria.

  13. Undergraduate medical students’ perceptions, attitudes, and competencies in evidence-based medicine (EBM), and their understanding of EBM reality in Syria

    Science.gov (United States)

    2012-01-01

    Background Teaching evidence-based medicine (EBM) should be evaluated and guided by evidence of its own effectiveness. However, no data are available on adoption of EBM by Syrian undergraduate, postgraduate, or practicing physicians. In fact, the teaching of EBM in Syria is not yet a part of undergraduate medical curricula. The authors evaluated education of evidence-based medicine through a two-day intensive training course. Methods The authors evaluated education of evidence-based medicine through a two-day intensive training course that took place in 2011. The course included didactic lectures as well as interactive hands-on workshops on all topics of EBM. A comprehensive questionnaire, that included the Berlin questionnaire, was used to inspect medical students’ awareness of, attitudes toward, and competencies’ in EBM. Results According to students, problems facing proper EBM practice in Syria were the absence of the following: an EBM teaching module in medical school curriculum (94%), role models among professors and instructors (92%), a librarian (70%), institutional subscription to medical journals (94%), and sufficient IT hardware (58%). After the course, there was a statistically significant increase in medical students' perceived ability to go through steps of EBM, namely: formulating PICO questions (56.9%), searching for evidence (39.8%), appraising the evidence (27.3%), understanding statistics (48%), and applying evidence at point of care (34.1%). However, mean increase in Berlin scores after the course was 2.68, a non-statistically significant increase of 17.86%. Conclusion The road to a better EBM reality in Syria starts with teaching EBM in medical school and developing the proper environment to facilitate transforming current medical education and practice to an evidence-based standard in Syria. PMID:22882872

  14. Undergraduate medical students’ perceptions, attitudes, and competencies in evidence-based medicine (EBM, and their understanding of EBM reality in Syria

    Directory of Open Access Journals (Sweden)

    Alahdab Fares

    2012-08-01

    Full Text Available Abstract Background Teaching evidence-based medicine (EBM should be evaluated and guided by evidence of its own effectiveness. However, no data are available on adoption of EBM by Syrian undergraduate, postgraduate, or practicing physicians. In fact, the teaching of EBM in Syria is not yet a part of undergraduate medical curricula. The authors evaluated education of evidence-based medicine through a two-day intensive training course. Methods The authors evaluated education of evidence-based medicine through a two-day intensive training course that took place in 2011. The course included didactic lectures as well as interactive hands-on workshops on all topics of EBM. A comprehensive questionnaire, that included the Berlin questionnaire, was used to inspect medical students’ awareness of, attitudes toward, and competencies’ in EBM. Results According to students, problems facing proper EBM practice in Syria were the absence of the following: an EBM teaching module in medical school curriculum (94%, role models among professors and instructors (92%, a librarian (70%, institutional subscription to medical journals (94%, and sufficient IT hardware (58%. After the course, there was a statistically significant increase in medical students' perceived ability to go through steps of EBM, namely: formulating PICO questions (56.9%, searching for evidence (39.8%, appraising the evidence (27.3%, understanding statistics (48%, and applying evidence at point of care (34.1%. However, mean increase in Berlin scores after the course was 2.68, a non-statistically significant increase of 17.86%. Conclusion The road to a better EBM reality in Syria starts with teaching EBM in medical school and developing the proper environment to facilitate transforming current medical education and practice to an evidence-based standard in Syria.

  15. Compliance with occlusion therapy for childhood amblyopia.

    Science.gov (United States)

    Wallace, Michael P; Stewart, Catherine E; Moseley, Merrick J; Stephens, David A; Fielder, Alistair R

    2013-09-17

    Explore compliance with occlusion treatment of amblyopia in the Monitored and Randomized Occlusion Treatment of Amblyopia Studies (MOTAS and ROTAS), using objective monitoring. Both studies had a three-phase protocol: initial assessment, refractive adaptation, and occlusion. In the occlusion phase, participants were instructed to dose for 6 hours/day (MOTAS) or randomized to 6 or 12 hour/day (ROTAS). Dose was monitored continuously using an occlusion dose monitor (ODM). One hundred and fifty-two patients (71 male, 81 female; 122 Caucasian, 30 non-Caucasian) of mean ± SD age 68 ± 18 months participated. Amblyopia was defined as an interocular acuity difference of at least 0.1 logMAR and was associated with anisometropia in 50, strabismus in 44, and both (mixed) in 58. Median duration of occlusion was 99 days (interquartile range 72 days). Mean compliance was 44%, mean proportion of days with no patch worn was 42%. Compliance was lower (39%) on weekends compared with weekdays (46%, P = 0.04), as was the likelihood of dosing at all (52% vs. 60%, P = 0.028). Compliance was lower when attendance was less frequent (P amblyopia type, and severity were not associated with compliance. Mixture modeling suggested three subpopulations of patch day doses: less than 30 minutes; doses that achieve 30% to 80% compliance; and doses that achieve around 100% compliance. This study shows that compliance with patching treatment averages less than 50% and is influenced by several factors. A greater understanding of these influences should improve treatment outcome. (ClinicalTrials.gov number, NCT00274664).

  16. Satisfactions, Self-Efficacy, and Compliance in Mandatory Technology Settings

    Science.gov (United States)

    Devgan, Vipan

    2012-01-01

    Many organizations recognize employees as great assets in the efforts to reduce risk related to information security. Employee's compliance with information security rules and regulations of organization is the key to strengthening information security. It is crucial for organizations to understand factors affecting technology compliance to…

  17. The effective compliance of spatially evolving planar wing-cracks

    Science.gov (United States)

    Ayyagari, R. S.; Daphalapurkar, N. P.; Ramesh, K. T.

    2018-02-01

    We present an analytic closed form solution for anisotropic change in compliance due to the spatial evolution of planar wing-cracks in a material subjected to largely compressive loading. A fully three-dimensional anisotropic compliance tensor is defined and evaluated considering the wing-crack mechanism, using a mixed-approach based on kinematic and energetic arguments to derive the coefficients in incremental compliance. Material, kinematic and kinetic parametric influences on the increments in compliance are studied in order to understand their physical implications on material failure. Model verification is carried out through comparisons to experimental uniaxial compression results to showcase the predictive capabilities of the current study.

  18. Hands in medicine: understanding the impact of competency-based education on the formation of medical students’ identities in the United States

    Science.gov (United States)

    2016-01-01

    Purpose There have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on ‘doing the work of a physician’ rather than identity formation and ‘being a physician.’ This study aims to understand how competency-based education impacts the development of a medical student’s identity. Methods Three ceramic models representing three core competencies ‘medical knowledge,’ ‘patient care,’ and ‘professionalism’ were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes. Results Students across all four years of medical school related to the ‘professionalism’ competency domain (50%). They reflected that ‘being an empathetic physician’ was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized ‘professionalism’ as a competency. Conclusion Students perceive ‘professionalism’ as a competency that impacts their identity formation in the social role of ‘being a doctor,’ albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception. PMID:27572244

  19. Hands in medicine: understanding the impact of competency-based education on the formation of medical students’ identities in the United States

    Directory of Open Access Journals (Sweden)

    Catherine Gonsalves

    2016-08-01

    Full Text Available Purpose There have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on ‘doing the work of a physician’ rather than identity formation and ‘being a physician.’ This study aims to understand how competency-based education impacts the development of a medical student’s identity. Methods Three ceramic models representing three core competencies ‘medical knowledge,’ ‘patient care,’ and ‘professionalism’ were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes. Results Students across all four years of medical school related to the ‘professionalism’ competency domain (50%. They reflected that ‘being an empathetic physician’ was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized ‘professionalism’ as a competency. Conclusion Students perceive ‘professionalism’ as a competency that impacts their identity formation in the social role of ‘being a doctor,’ albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.

  20. MO-AB-201-01: Regulatory Compliance and Safety with New Radiotherapies: Spheres and Ra-223

    Energy Technology Data Exchange (ETDEWEB)

    Phillips, L. [Stanford University (United States)

    2015-06-15

    The role of the Radiation Safety Officer at a medical facility can be complicated. The complexity of the position is based on the breadth of services provided at the institution and the nature of the radioactive materials license. Medical practices are constantly changing and the use of ionizing radiation continues to rise in this area. Some of the newer medical applications involving radiation have unique regulatory and safety issues that must be addressed. Oversight of the uses of radiation start at the local level (radiation safety officer, radiation safety committee) and are heavily impacted by outside agencies (i.e. Nuclear Regulatory Commission, State Radiologic Health, The Joint Commission (TJC), etc). This session will provide both an overview of regulatory oversight and essential compliance practices as well as practical ways to assess and introduce some of the new applications utilizing radioactive materials into your medical facility. Learning Objectives: Regulatory Compliance and Safety with New Radiotherapies: Spheres and Ra-223 (Lance Phillips) Understand the radioactive materials license amendment process to add new radiotherapies (i.e., SIR-Spheres, Therasphere, Xofigo). Understand the AU approval process for microspheres and Xofigo. Examine the training and handling requirements for new procedures. Understand the process involved with protocol development, SOP in order to define roles and responsibilities. The RSO and The RSC: Challenges and Opportunities (Colin Dimock) Understand how to form an effective Committee. Examine what the Committee does for the Program and the RSO. Understand the importance of Committee engagement. Discuss the balance of the complimentary roles of the RSO and the Committee. The Alphabet Soup of Regulatory Compliance: Being Prepared for Inspections (Linda Kroger) Recognize the various regulatory bodies and organizations with oversight or impact in Nuclear Medicine, Radiology and Radiation Oncology. Examine 10CFR35

  1. MO-AB-201-01: Regulatory Compliance and Safety with New Radiotherapies: Spheres and Ra-223

    International Nuclear Information System (INIS)

    Phillips, L.

    2015-01-01

    The role of the Radiation Safety Officer at a medical facility can be complicated. The complexity of the position is based on the breadth of services provided at the institution and the nature of the radioactive materials license. Medical practices are constantly changing and the use of ionizing radiation continues to rise in this area. Some of the newer medical applications involving radiation have unique regulatory and safety issues that must be addressed. Oversight of the uses of radiation start at the local level (radiation safety officer, radiation safety committee) and are heavily impacted by outside agencies (i.e. Nuclear Regulatory Commission, State Radiologic Health, The Joint Commission (TJC), etc). This session will provide both an overview of regulatory oversight and essential compliance practices as well as practical ways to assess and introduce some of the new applications utilizing radioactive materials into your medical facility. Learning Objectives: Regulatory Compliance and Safety with New Radiotherapies: Spheres and Ra-223 (Lance Phillips) Understand the radioactive materials license amendment process to add new radiotherapies (i.e., SIR-Spheres, Therasphere, Xofigo). Understand the AU approval process for microspheres and Xofigo. Examine the training and handling requirements for new procedures. Understand the process involved with protocol development, SOP in order to define roles and responsibilities. The RSO and The RSC: Challenges and Opportunities (Colin Dimock) Understand how to form an effective Committee. Examine what the Committee does for the Program and the RSO. Understand the importance of Committee engagement. Discuss the balance of the complimentary roles of the RSO and the Committee. The Alphabet Soup of Regulatory Compliance: Being Prepared for Inspections (Linda Kroger) Recognize the various regulatory bodies and organizations with oversight or impact in Nuclear Medicine, Radiology and Radiation Oncology. Examine 10CFR35

  2. Do medical students with A-level mathematics have a better understanding of the principles behind evidence-based medicine?

    Science.gov (United States)

    Ben-Shlomo, Y; Fallon, U; Sterne, J; Brookes, S

    2004-12-01

    With the advent of evidence-based medicine, medical students, doctors and other healthcare professionals are required to be more skilled in the interpretation and manipulation of numerical data. The authors observed that undergraduate students without A-level mathematics expressed concern as to their ability to cope with an epidemiology and biostatistics course. It was hypothesized that these anxieties reflected differences in attitudes to numerical manipulation rather than any real lack of competence. Mean exam performance scores were compared for 498 first-year medical students between 2000 and 2002 depending on whether the students did or did not have A-level mathematics. The data revealed no difference in performance. Students without mathematics A-level scored marginally worse (-1.1%, 95% CI -3.1% to 0.8%, p=0.20) but were no more likely to fail the exam (odds ratio=0.98, 95% CI 0.40 to 2.6, p=0.9). It is concluded that some students experience 'numerophobia'-- a perceived and, it is thought, disproportionate fear of numbers and simple mathematical manipulation. This may act as a psychological barrier for future evidence-based practitioners.

  3. Avoiding genetic genocide: understanding good intentions and eugenics in the complex dialogue between the medical and disability communities.

    Science.gov (United States)

    Miller, Paul Steven; Levine, Rebecca Leah

    2013-02-01

    The relationship between the medical and disability communities is complex and is influenced by historical, social, and cultural factors. Although clinicians, health-care researchers, and people with disabilities all work from the standpoint of the best interest of disabled individuals, the notion of what actually is "best" is often understood quite differently among these constituencies. Eugenics campaigns, legal restrictions on reproductive and other freedoms, and prenatal testing recommendations predicated on the lesser worth of persons with disabilities have all contributed toward the historic trauma experienced by the disability community, particularly with respect to medical genetics. One premise of personalized medicine is that different individuals require different solutions. Disabled persons' experiences are a reminder that these solutions can be best realized by maintaining awareness and sensitivity in a complex ethical and moral terrain. Geneticists should recognize that their research may have implications for those with disabilities; they should recognize the impact of the historical trauma of the eugenics movement, and seek to involve people with disabilities in discussions about policies that affect them. Dialogue can be messy and uncomfortable, but it is the only way to avoid the mistakes of the past and to ensure a more equitable, and healthful, future.

  4. Understanding the implementation and adoption of a technological intervention to improve medication safety in primary care: a realist evaluation.

    Science.gov (United States)

    Jeffries, Mark; Phipps, Denham L; Howard, Rachel L; Avery, Anthony J; Rodgers, Sarah; Ashcroft, Darren M

    2017-03-14

    Monitoring for potentially hazardous prescribing is increasingly important to improve medication safety. Healthcare information technology can be used to achieve this aim, for example by providing access to prescribing data through surveillance of patients' electronic health records. The aim of our study was to examine the implementation and adoption of an electronic medicines optimisation system that was intended to facilitate clinical audit in primary care by identifying patients at risk of an adverse drug event. We adopted a sociotechnical approach that focuses on how complex social, organisational and institutional factors may impact upon the use of technology within work settings. We undertook a qualitative realist evaluation of the use of an electronic medicines optimisation system in one Clinical Commissioning Group in England. Five semi-structured interviews, four focus groups and one observation were conducted with a range of stakeholders. Consistent with a realist evaluation methodology, the analysis focused on exploring the links between context, mechanism and outcome to explain the ways the intervention might work, for whom and in what circumstances. Using the electronic medicines optimisation system could lead to a number of improved patient safety outcomes including pre-emptively reviewing patients at risk of adverse drug events. The effective use of the system depended upon engagement with the system, the flow of information between different health professionals centrally placed at the Clinical Commissioning Group and those locally placed at individual general practices, and upon variably adapting work practices to facilitate the use of the system. The use of the system was undermined by perceptions of ownership, lack of access, and lack of knowledge and awareness. The use of an electronic medicines optimisation system may improve medication safety in primary care settings by identifying those patients at risk of an adverse drug event. To fully

  5. Hand hygiene compliance rates: Fact or fiction?

    Science.gov (United States)

    McLaws, Mary-Louise; Kwok, Yen Lee Angela

    2018-05-16

    The mandatory national hand hygiene program requires Australian public hospitals to use direct human auditing to establish compliance rates. To establish the magnitude of the Hawthorne effect, we compared direct human audit rates with concurrent automated surveillance rates. A large tertiary Australian teaching hospital previously trialed automated surveillance while simultaneously performing mandatory human audits for 20 minutes daily on a medical and a surgical ward. Subtracting automated surveillance rates from human audit rates provided differences in percentage points (PPs) for each of the 3 quarterly reporting periods for 2014 and 2015. Direct human audit rates for the medical ward were inflated by an average of 55 PPs in 2014 and 64 PPs in 2015, 2.8-3.1 times higher than automated surveillance rates. The rates for the surgical ward were inflated by an average of 32 PPs in 2014 and 31 PPs in 2015, 1.6 times higher than automated surveillance rates. Over the 6 mandatory reporting quarters, human audits collected an average of 255 opportunities, whereas automation collected 578 times more data, averaging 147,308 opportunities per quarter. The magnitude of the Hawthorne effect on direct human auditing was not trivial and produced highly inflated compliance rates. Mandatory compliance necessitates accuracy that only automated surveillance can achieve, whereas daily hand hygiene ambassadors or reminder technology could harness clinicians' ability to hyperrespond to produce habitual compliance. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

  6. Medically-derived I-131: a potential tool for understanding the fate of wastewater nitrogen in aquatic systems

    Science.gov (United States)

    Rose, P. S.; Smith, J. P.; Aller, R. C.; Cochran, J. K.; Swanson, R. L.; Murthy, S. N.; Coffin, R. B.

    2010-12-01

    Iodine-131(t1/2 = 8 days) has been measured in Potomac River water and sediments in the vicinity of the Blue Plains Water Pollution Control Plant (WPCP), Washington, DC. The source of I-131 is medical, where it is commonly used to treat thyroid cancer and hyperthyroidism. Iodine is metabolized by patients and eliminated primarily in urine. While other medical radioisotopes may enter the environment via sewage effluent, the nature and quantity of treatments using I-131 cause it to account for much of the radioactivity in sewage effluent. Natural iodine in aquatic systems is biologically cycled similar to other nutrients, such as nitrogen. Iodine-131 concentrations measured in sewage effluent from Blue Plains WPCP and in the Potomac River suggest a relatively continuous discharge of this isotope. Dissolved I-131 shows a strong, positive correlation with δ15N values of nitrate in the river. The range of I-131 concentrations detected in surface waters is 0.18 ± 0.01 to 0.68 ± 0.02 Bq/L. Surface water δ15NO3 values ranged from 8.7 ± 0.3 to 33.4 ± 7.3 ‰ with NO3+NO2 concentrations between 0.38 ± 0.02 and 2.79 ± 0.13 mgN/L. Sediment profiles of particulate I-131 and δ15N indicate rapid mixing or sedimentation and in many cases remineralization of a heavy nitrogen source consistent with wastewater nitrogen. Iodine-131 concentrations in sediments ranged from 1.31 ± 0.8 to 117 ± 2 Bq/kg dry weight. Values of δ15N in sediments ranged from 4.7 ± 0.1 ‰ to 9.3 ± 0.1 ‰. We propose that I-131 coupled with δ15N can be an excellent tracer for the short-term fate of wastewater nitrogen in this system. However, the utility of I-131 as a tracer is not limited to use in the Potomac River. Other studies have documented the presence of I-131 in several aquatic systems and continuous discharges of this radioisotope in sewage effluent are likely to be widespread in urban environments.

  7. Translation and psychometric analysis of the Malaysian version of medication understanding and use self-efficacy scale (m-muse for diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Safaa A Al Abboud

    2017-01-01

    Full Text Available Introduction: Enhancing diabetes self-efficacy (SE level can improve the self-management behaviour in patients living with diabetes mellitus (DM. This study aimed to translate and assess the psychometric properties of Malaysian version of diabetes Medication Understanding and Use Self-Efficacy Scale (M-MUSE. Methods: Following the translation of English version of MUSE to Malay language using established international standard translation guidelines, 252 adult diabetics (≥ 18 years old; DM type 1 or 2 attending the Endocrine Clinic at Hospital Kuala Lumpur, Malaysia, were recruited in this cross-sectional study. After testing the face and content validity, the psychometric properties of the final M-MUSE were evaluated using the Classical Test Theory (CTT for reliability (Cronbach’s alpha (α and intra-class correlation coefficient (ICC and construct validity (factor analysis (FA. Results: The semantic and conceptual problems in M-MUSE were identified and modified by a qualified professional translation committee. The final version showed good reliability values for internal consistency (Cronbach’s α = 0.89 and one month test-retest reliability (ICC = 0.72. The Bartlett’s test of sphericity and the Kaiser-Meyer-Olkin tests proved the suitability of M-MUSE for factor analysis. The extracted single component M-MUSE (eigenvalue > 1 explained a total variance of 57.58% with an eigenvalue of 4.60. The two factor structures; namely taking medication (item # 1, 6, 7 and 8 and learning about medication (item # 2, 3, 4 and 5 explained a total variance of 59.25% with good factor loading values (ranged from 0.63 to 0.89 for taking medication, and 0.66 to 0.83 for learning about medication. Conclusion: The M-MUSE appears to be a linguistically reliable and valid measure that is conceptually equivalent to the original version. The M-MUSE can be used in Malaysian healthcare settings to evaluate the SE in understanding and using prescribed

  8. Compliance with physical exercise

    DEFF Research Database (Denmark)

    Gram, Anne Sofie; Bønnelycke, Julie; Rosenkilde Larsen, Mads

    2014-01-01

    Aims: Sixty-one healthy, sedentary, moderately overweight young men participated in a randomised controlled trial to examine the effects of two different doses of endurance exercise on health behaviour and exercise compliance. Methods: Participants were randomised to a sedentary control group......), a post hoc thematic analysis was conducted to connect qualitative and quantitative data in a joint analysis. Results: Of the subjects interviewed, exercise compliance expressed as 95% CI was [96.8; 103%] in the MOD group and [82.9; 99.6%] in the HIGH group. The different doses of daily exercise equally...... or quantitative methodology alone. The preconditions of the TBP were fulfilled, and it represents a methodological model to explain the high degree of compliance and motivation to exercise....

  9. Understanding Faculty and Trainee Needs Related to Scholarly Activity in a Large, Nonuniversity Graduate Medical Education Program.

    Science.gov (United States)

    Becker, Davida; Garth, Hanna; Hollander, Rachel; Klein, Felice; Klau, Marc

    2017-01-01

    Graduate medical education (GME) programs must develop curriculum to ensure scholarly activity among trainees and faculty to meet accreditation requirements and to support evidence-based medicine. Test whether research-related needs and interests varied across four groups: primary care trainees, specialty trainees, primary care faculty, and specialty faculty. We surveyed a random sample of trainees and faculty in Kaiser Permanente Southern California's GME programs. We investigated group differences in outcomes using Fisher exact and Kruskal-Wallis tests. Research experiences, skills, barriers, motivators, and interests in specific research skills development. Participants included 47 trainees and 26 faculty (response rate = 30%). Among primary care faculty, 12 (71%) reported little or no research experience vs 1 (11%) for specialty faculty, 14 (41%) for primary care trainees, and 1 (8%) for specialty trainees (p work roles taking priority; desire for work-life balance; and lack of managerial support, research equipment, administrative support, and funding. Faculty and trainees in primary care and specialties have differing research-related needs that GME programs should consider when designing curricula to support scholarly activity. Developing research skills of primary care faculty is a priority to support trainees' scholarly activity.

  10. Medical marijuana programs - Why might they matter for public health and why should we better understand their impacts?

    Science.gov (United States)

    Fischer, Benedikt; Murphy, Yoko; Kurdyak, Paul; Goldner, Elliot; Rehm, Jürgen

    2015-01-01

    Although cannabis is an illegal drug, 'medical marijuana programs' (MMPs) have proliferated (e.g., in Canada and several US states), allowing for legal cannabis use for therapeutic purposes. While both health risks and potential therapeutic benefits for cannabis use have been documented, potential public health impacts of MMPs - also vis-à-vis other psychoactive substance use - remain under-explored. We briefly reviewed the emerging evidence on MMP participants' health status, and specifically other psychoactive substance use behaviors and outcomes. While data are limited in amount and quality, MMP participants report improvements in overall health status, and specifically reductions in levels of risky alcohol, prescription drug and - to some extent - tobacco or other illicit drug use; at the same time, increases in cannabis use and risk/problem patterns may occur. MMP participation may positively impact - for example, by way of possible 'substitution effects' from cannabis use - other psychoactive substance use and risk patterns at a scale relevant for public health, also influenced by the increasing population coverage of MMPs. Yet, net overall MMP-related population health effects need to be more rigorously and comprehensively assessed, including potential increases in cannabis use related risks and harms.

  11. The Patient-Centered Medical Home (PCMH) Framing Typology for Understanding the Structure, Function, and Outcomes of PCMHs.

    Science.gov (United States)

    Kieber-Emmons, Autumn M; Miller, William L

    2017-01-01

    Patient-centered medical homes (PCHMs) aspire to transform today's challenged primary care services. However, it is unclear which PCMH characteristics produce specific outcomes of interest for care delivery. This study tested a novel typology of PCMH practice transformation, the PCMH framing typology, and evaluated measurable outcomes by each type. Using the Patient-Centered Primary Care Collaborative 2012 to 2013 Annual Review, this secondary analysis of the published PCMH literature extracted data from publications of 59 PCMHs. Each of the 59 sites was categorized as 1 of 4 PCMH types: add-on, renovated, hybrid, or integrated. Six outcome measures (cost reductions, decreased emergency department/hospital utilization, improved quality, improved access, increased preventive services, and improved patient satisfaction) were independently coded for each site. Practices were combined based on type, and mean outcomes scores for each measure were displayed on radar graphs for comparison. While each type showed a characteristic pattern of success, only the integrated type improved in all 6 outcomes. No type achieved high success in all measures. There seem to be 4 types of PCMH, each of which shows a distinctive outcomes profile. Within the PCMH framing typology, direction is emerging for how best to transform primary care to achieve the greatest success. © Copyright 2017 by the American Board of Family Medicine.

  12. Medical marijuana programs — Why might they matter for public health and why should we better understand their impacts?

    Science.gov (United States)

    Fischer, Benedikt; Murphy, Yoko; Kurdyak, Paul; Goldner, Elliot; Rehm, Jürgen

    2015-01-01

    Objective Although cannabis is an illegal drug, ‘medical marijuana programs’ (MMPs) have proliferated (e.g., in Canada and several US states), allowing for legal cannabis use for therapeutic purposes. While both health risks and potential therapeutic benefits for cannabis use have been documented, potential public health impacts of MMPs — also vis-à-vis other psychoactive substance use — remain under-explored. Methods We briefly reviewed the emerging evidence on MMP participants' health status, and specifically other psychoactive substance use behaviors and outcomes. Results While data are limited in amount and quality, MMP participants report improvements in overall health status, and specifically reductions in levels of risky alcohol, prescription drug and — to some extent — tobacco or other illicit drug use; at the same time, increases in cannabis use and risk/problem patterns may occur. Conclusion MMP participation may positively impact — for example, by way of possible ‘substitution effects’ from cannabis use — other psychoactive substance use and risk patterns at a scale relevant for public health, also influenced by the increasing population coverage of MMPs. Yet, net overall MMP-related population health effects need to be more rigorously and comprehensively assessed, including potential increases in cannabis use related risks and harms. PMID:26844050

  13. Community understanding of Respondent-Driven Sampling in a medical research setting in Uganda: importance for the use of RDS for public health research.

    Science.gov (United States)

    McCreesh, Nicky; Tarsh, Matilda Nadagire; Seeley, Janet; Katongole, Joseph; White, Richard G

    2013-01-01

    Respondent-driven sampling (RDS) is a widely-used variant of snowball sampling. Respondents are selected not from a sampling frame, but from a social network of existing members of the sample. Incentives are provided for participation and for the recruitment of others. Ethical and methodological criticisms have been raised about RDS. Our purpose was to evaluate whether these criticisms were justified. In this study RDS was used to recruit male household heads in rural Uganda. We investigated community members' understanding and experience of the method, and explored how these may have affected the quality of the RDS survey data. Our findings suggest that because participants recruit participants, the use of RDS in medical research may result in increased difficulties in gaining informed consent, and data collected using RDS may be particularly susceptible to bias due to differences in the understanding of key concepts between researchers and members of the community.

  14. Applications of condensed matter understanding to medical tissues and disease progression: Elemental analysis and structural integrity of tissue scaffolds

    Energy Technology Data Exchange (ETDEWEB)

    Bradley, D.A., E-mail: d.a.bradley@surrey.ac.u [Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford GU2 7XH (United Kingdom); Farquharson, M.J. [Department of Radiography, School of Community and Health Sciences, City University, London (United Kingdom); Gundogdu, O. [Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford GU2 7XH (United Kingdom); Al-Ebraheem, Alia [Department of Radiography, School of Community and Health Sciences, City University, London (United Kingdom); Che Ismail, Elna [Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford GU2 7XH (United Kingdom); Kaabar, W., E-mail: w.kaabar@surrey.ac.u [Centre for Nuclear and Radiation Physics, Department of Physics, University of Surrey, Guildford GU2 7XH (United Kingdom); Bunk, O. [Paul Scherrer Institute, CH-5232 Villigen (Switzerland); Pfeiffer, F. [Paul Scherrer Institute, CH-5232 Villigen (Switzerland); Ecole Polytechnique Federale de Lausanne, CH-1015 Lausanne (Switzerland); Falkenberg, G. [Hamburger Synchrotronstrahlungslabor HASYLAB at Deutsches Elektronensynchrotron DESY, Notkestr. 85, D-22603 Hamburg (Germany); Bailey, M. [Surrey Ion Beam Centre, Advanced Technology Institute, University of Surrey, Guildford GU2 7XH (United Kingdom)

    2010-02-15

    The investigations reported herein link tissue structure and elemental presence with issues of environmental health and disease, exemplified by uptake and storage of potentially toxic elements in the body, the osteoarthritic condition and malignancy in the breast and other soft tissues. Focus is placed on application of state-of-the-art ionizing radiation techniques, including, micro-synchrotron X-ray fluorescence (mu-SXRF) and particle-induced X-ray emission/Rutherford backscattering mapping (mu-PIXE/RBS), coherent small-angle X-ray scattering (cSAXS) and X-ray phase-contrast imaging, providing information on elemental make-up, the large-scale organisation of collagen and anatomical features of moderate and low atomic number media. For the particular situations under investigation, use of such facilities is allowing information to be obtained at an unprecedented level of detail, yielding new understanding of the affected tissues and the progression of disease.

  15. Applications of condensed matter understanding to medical tissues and disease progression: Elemental analysis and structural integrity of tissue scaffolds

    International Nuclear Information System (INIS)

    Bradley, D.A.; Farquharson, M.J.; Gundogdu, O.; Al-Ebraheem, Alia; Che Ismail, Elna; Kaabar, W.; Bunk, O.; Pfeiffer, F.; Falkenberg, G.; Bailey, M.

    2010-01-01

    The investigations reported herein link tissue structure and elemental presence with issues of environmental health and disease, exemplified by uptake and storage of potentially toxic elements in the body, the osteoarthritic condition and malignancy in the breast and other soft tissues. Focus is placed on application of state-of-the-art ionizing radiation techniques, including, micro-synchrotron X-ray fluorescence (μ-SXRF) and particle-induced X-ray emission/Rutherford backscattering mapping (μ-PIXE/RBS), coherent small-angle X-ray scattering (cSAXS) and X-ray phase-contrast imaging, providing information on elemental make-up, the large-scale organisation of collagen and anatomical features of moderate and low atomic number media. For the particular situations under investigation, use of such facilities is allowing information to be obtained at an unprecedented level of detail, yielding new understanding of the affected tissues and the progression of disease.

  16. Using mathematical models to understand the effect of nanoscale roughness on protein adsorption for improving medical devices

    Directory of Open Access Journals (Sweden)

    Ercan B

    2013-09-01

    Full Text Available Batur Ercan,1 Dongwoo Khang,2 Joseph Carpenter,3 Thomas J Webster1 1Department of Chemical Engineering, Northeastern University, Boston, MA, USA; 2School of Materials Science and Engineering and Center for PRC and RIGET, Gyeongsang National University, Jinju, South Korea; 3School of Medicine, Stanford University, Stanford, CA, USA Abstract: Surface roughness and energy significantly influence protein adsorption on to biomaterials, which, in turn, controls select cellular adhesion to determine the success and longevity of an implant. To understand these relationships at a fundamental level, a model was originally proposed by Khang et al to correlate nanoscale surface properties (specifically, nanoscale roughness and energy to protein adsorption, which explained the greater cellular responses on nanostructured surfaces commonly reported in the literature today. To test this model for different surfaces from what was previously used to develop that model, in this study we synthesized highly ordered poly(lactic-co-glycolic acid surfaces of identical chemistry but altered nanoscale surface roughness and energy using poly(dimethylsiloxane molds of polystyrene beads. Fibronectin and collagen type IV adsorption studies showed a linear adsorption behavior as the surface nanoroughness increased. This supported the general trends observed by Khang et al. However, when fitting such data to the mathematical model established by Khang et al, a strong correlation did not result. Thus, this study demonstrated that the equation proposed by Khang et al to predict protein adsorption should be modified to accommodate for additional nanoscale surface property contributions (ie, surface charge to make the model more accurate. In summary, results from this study provided an important step in developing future mathematical models that can correlate surface properties (such as nanoscale roughness and surface energy to initial protein adsorption events important to

  17. Acid rain compliance planning using decision analysis

    International Nuclear Information System (INIS)

    Norris, C.; Sweet, T.; Borison, A.

    1991-01-01

    Illinois Power Company (IP) is an investor-owned electric and natural gas utility serving portions of downstate Illinois. In addition to one nuclear unit and several small gas and/or oil-fired units, IP has ten coal-fired units. It is easy to understand the impact the Clean Air Act Amendments of 1990 (CAAA) could have on IP. Prior to passage of the CAAA, IP formed several teams to evaluate the specific compliance options at each of the high sulfur coal units. Following that effort, numerous economic analyses of compliance strategies were conducted. The CAAA have introduced a new dimension to planning under uncertainty. Not only are many of the familiar variables uncertain, but the specific form of regulation, and indeed, the compliance goal itself is hard to define. For IP, this led them to use techniques not widely used within their corporation. This paper summarizes the analytical methods used in these analyses and the preliminary results as of July, 1991. The analysis used three approaches to examine the acid rain compliance decision. These approaches were: (1) the 'most-likely,' or single-path scenario approach; (2) a multi-path strategy analysis using the strategies defined in the single-scenario analysis; and (3) a less constrained multi-path option analysis which selects the least cost compliance option for each unit

  18. The practical outfall of DOE compliance agreements

    International Nuclear Information System (INIS)

    Smith, Leanne; Henrie, Gregory O.

    1992-01-01

    Perhaps the significant regulatory issue facing the Department of Energy (DOE or the Department) is the compliant treatment, storage, and disposal of mixed (radioactive and hazardous) waste. Since DOE'S By-Product Rulemaking in 1987, when the Department acknowledged that the Resource Conservation and Recovery Act (RCRA) applied to the hazardous component of mixed waste, DOE has repeatedly communicated to the Environmental Protection Agency (EPA) and host States that, for mixed waste, DOE is not always able to strictly comply with RCRA standards and that bringing treatment on-line in an expeditious manner is proving very difficult. One of the most effective methods used between DOE and its regulators to address mixed waste management issues is the negotiation of compliance agreements. These agreements establish formal mile stones for bringing DOE sites into compliance. The milestones are not completed without overcoming technical roadblocks and a struggle for funding. However, agreements can establish technically attainable compliance methods that take into account the special problems radiation introduces into RCRA waste management. Compliance agreements help promote a cooperative relationship within the Department and between DOE and its regulators in that all parties have reached agreement and have a stake in attaining the same goal. Where agreements exist, mixed waste compliance efforts can proceed in a situation where all parties have a full understanding of each other's needs and expectations. (author)

  19. Towards a Molecular Understanding of the Biosynthesis of Amaryllidaceae Alkaloids in Support of Their Expanding Medical Use

    Directory of Open Access Journals (Sweden)

    Adam M. Takos

    2013-05-01

    Full Text Available The alkaloids characteristically produced by the subfamily Amaryllidoideae of the Amaryllidaceae, bulbous plant species that include well know genera such as Narcissus (daffodils and Galanthus (snowdrops, are a source of new pharmaceutical compounds. Presently, only the Amaryllidaceae alkaloid galanthamine, an acetylcholinesterase inhibitor used to treat symptoms of Alzheimer’s disease, is produced commercially as a drug from cultivated plants. However, several Amaryllidaceae alkaloids have shown great promise as anti-cancer drugs, but their further clinical development is restricted by their limited commercial availability. Amaryllidaceae species have a long history of cultivation and breeding as ornamental bulbs, and phytochemical research has focussed on the diversity in alkaloid content and composition. In contrast to the available pharmacological and phytochemical data, ecological, physiological and molecular aspects of the Amaryllidaceae and their alkaloids are much less explored and the identity of the alkaloid biosynthetic genes is presently unknown. An improved molecular understanding of Amaryllidaceae alkaloid biosynthesis would greatly benefit the rational design of breeding programs to produce cultivars optimised for the production of pharmaceutical compounds and enable biotechnology based approaches.

  20. Compliance of amblyopic patients with occlusion therapy: A pilot study

    Directory of Open Access Journals (Sweden)

    Sana Al-Zuhaibi

    2009-01-01

    Materials and Methods: A total of 31 families with a child (aged 2-12 years, undergoing unilateral amblyopia treatment at the pediatric ophthalmology clinic of Sultan Qaboos University Hospital, Oman, were recruited for this one month study. Parents were interviewed and completed a closed-ended questionnaire. Clinical data including, visual acuity, refraction, diagnosis and treatment, for each patient was collected from the hospital chart and was entered in a data collection sheet. Compliance with occlusion therapy was assessed by self-report accounts of parents and was graded into good, partial, or poor. Association between various factors and degree of compliance was studied using logistic regression modeling. Results: Only 14 (45% patients showed good compliance to occlusion therapy. 17 (55% patients were noncompliant. Improvement in visual acuity strongly correlated with compliance to patching (P = 0.008. Other variables that were studied included, age at onset of therapy; gender; degree of amblyopia; type of amblyopia; use of glasses; and compliance with glasses. These did not emerge as significant predictors of compliance. All but one family with poor compliance stated that the main challenge in following the recommendation to patch for requisite hours was in getting their child to cooperate. Only in one instance, the family cited nonavailability of patches as the main hindrance to compliance. 10/31 (32% families expressed a desire for more information and 18/31 (58% parents did not understand that amblyopia meant decreased vision. Conclusion: Poor compliance is a barrier to successful amblyopia therapy in our practice. Improvement in visual acuity is associated with better compliance with patching. Parents find it difficult to comprehend and retain verbal explanations of various components regarding occlusion therapy for amblyopia. Future study with a larger sample of patients is recommended to investigate the factors affecting compliance with amblyopia

  1. ENA study cites barriers to NPSG compliance.

    Science.gov (United States)

    2009-04-01

    There are many barriers to compliance with the National Patient Safety Goals, as a recent study shows. However, emergency medicine experts say there are several strategies you can adopt to help overcome those barriers. Send the right message to your staff by establishing a culture of shared responsibility for safety. Establish scripts for talking with patients. Standardization will help ensure they are getting the correct information. Put standardized abbreviations on posters in your department, and list them on your medication reconciliation form.

  2. Control-value theory: using achievement emotions to improve understanding of motivation, learning, and performance in medical education: AMEE Guide No. 64.

    Science.gov (United States)

    Artino, Anthony R; Holmboe, Eric S; Durning, Steven J

    2012-01-01

    In this AMEE Guide, we consider the emergent theoretical and empirical work on human emotion and how this work can inform the theory, research, and practice of medical education. In the Guide, we define emotion, in general, and achievement emotions, more specifically. We describe one of the leading contemporary theories of achievement emotions, control-value theory (Pekrun 2006), and we distinguish between different types of achievement emotions, their proximal antecedents, and their consequences for motivation, learning, and performance. Next, we review the empirical support for control-value theory from non-medical fields and suggest several important implications for educational practice. In this section, we highlight the importance of designing learning environments that foster a high degree of control and value for students. Finally, we end with a discussion of the need for more research on achievement emotions in medical education, and we propose several key research questions we believe will facilitate our understanding of achievement emotions and their impact on important educational outcomes.

  3. The Amsterdam Hip Protector Study: Compliance and determinants of compliance

    NARCIS (Netherlands)

    van Schoor, N.M.; Asma, G.; Smit, J.H.; Bouter, L.M.; Lips, P.T.A.M.

    2003-01-01

    Hip protectors appear to be effective in reducing the incidence of hip fractures. However, compliance is often poor. Therefore, the objective of this study was to examine the compliance and determinants of compliance with external hip protectors. A prospective study was performed in residents from

  4. Analysis of variables affecting drug compliance in schizophrenia

    Directory of Open Access Journals (Sweden)

    Shakeel Ansari

    2014-01-01

    Full Text Available Context: As compliance of the patient during management of schizophrenia is crucial, the current study was conducted to find out the factors that affected compliance. Aims: The aim of the study was to analyze the prevalence of noncompliance and to find out different factors affecting compliance in schizophrenic patients. Materials and Methods: Observational cross-sectional study was conducted on 100 adult schizophrenic patients. Noncompliance was assessed using the rating of medication influence (ROMI scale. Severity of illness was measured using positive and negative syndrome scale (PANSS. Results: Prevalence of noncompliance was 37%. Using ROMI scale; positive relationship with psychiatrist, family pressure for taking medications, stigma, and substance abuse were found to be significant factors. Severity of illness was also found as determining factor. Conclusion: To improve the compliance in schizophrenia patients, roles of both psychiatrists and family members are crucial.

  5. Rocky Flats Compliance Program

    International Nuclear Information System (INIS)

    1994-02-01

    The Department of Energy (DOE) established the Office of Technology Development (EM-50) (OTD) as an element of Environmental Restoration and Waste Management (EM) in November 1989. The primary objective of the Office of Technology Development, Rocky Flats Compliance Program (RFCP), is to develop altemative treatment technologies for mixed low-level waste (wastes containing both hazardous and radioactive components) to use in bringing the Rocky Flats Plant (RFP) into compliance with Federal and state regulations and agreements. Approximately 48,000 cubic feet of untreated low-level mixed waste, for which treatment has not been specified, are stored at the RFP. The cleanup of the Rocky Flats site is driven by agreements between DOE, the Environmental Protection Agency (EPA), and the Colorado Department of Health (CDH). Under these agreements, a Comprehensive Treatment and Management Plan (CTMP) was drafted to outline the mechanisms by which RFP will achieve compliance with the regulations and agreements. This document describes DOE's strategy to treat low-level mixed waste to meet Land Disposal Restrictions and sets specific milestones related to the regulatory aspects of technology development. These milestones detail schedules for the development of technologies to treat all of the mixed wastes at the RFP. Under the Federal Facilities Compliance Act (FFCA), the CTMP has been incorporated into Rocky Flats Plant Conceptual Site Treatment Plan (CSTP). The CSTP will become the Rocky Flats Plant site Treatment Plan in 1995 and will supersede the CTMP

  6. Environmental compliance and cleanup

    Energy Technology Data Exchange (ETDEWEB)

    Black, D.G.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the roles of the principal agencies, organizations, and public in environmental compliance and cleanup of the Hanford Site. Regulatory oversight, the Federal Facility Agreement and Consent Order, the role of Indian tribes, public participation, and CERCLA Natural Resource Damage Assessment Trustee Activities are all discussed.

  7. Validating year 2000 compliance

    NARCIS (Netherlands)

    A. van Deursen (Arie); P. Klint (Paul); M.P.A. Sellink

    1997-01-01

    textabstractValidating year 2000 compliance involves the assessment of the correctness and quality of a year 2000 conversion. This entails inspecting both the quality of the conversion emph{process followed, and of the emph{result obtained, i.e., the converted system. This document provides an

  8. Strategisk compliance og regulering

    DEFF Research Database (Denmark)

    Kühn Pedersen, Mogens

    2016-01-01

    Denne artikel introducerer strategisk compliance og påpeger dens samspil med klassiske og nyere former for reguleringer i digital værdiskabelse. Konteksten er den digitale økonomi, som vokser frem imellem den materielle økonomis bærepiller: Virksomheder og markeder, men består af en helt ny...... materialitet, som er det digitale univers og dets modsvarighed i nye krav til compliance. Den nye materialitet stiller nye krav, hvad angår digitale processer og transaktioner. Klassisk regulering, som aktører ikke selv kan ændre, støder på egenregulering, hvor aktørerne selv opsætter regler for at skabe...... digital værdi. Dette kalder på strategisk compliance. Med digitalisering er strategisk compliance sat på dagsordnen i reguleringsdebatten. Vi hævder, at regulering og egenregulering kan komme til at virke komplementært i det post-industrielle, digitaliserede samfund....

  9. Environmental compliance and cleanup

    International Nuclear Information System (INIS)

    Black, D.G.

    1995-01-01

    This section of the 1994 Hanford Site Environmental Report summarizes the roles of the principal agencies, organizations, and public in environmental compliance and cleanup of the Hanford Site. Regulatory oversight, the Federal Facility Agreement and Consent Order, the role of Indian tribes, public participation, and CERCLA Natural Resource Damage Assessment Trustee Activities are all discussed

  10. Financial Markets and Compliance

    NARCIS (Netherlands)

    van de Laar, T.A.H.M.; Bleker, Sylvie; Houben, Raf

    2017-01-01

    This chapter will focus on the goals of financial market regulation through the rules of economics, the strategies financial regulation employs to achieve these goals and the insights this provides for the compliance profession. For an overview of the goals and strategies of financial regulation

  11. The USAID Environmental Compliance Database

    Data.gov (United States)

    US Agency for International Development — The Environmental Compliance Database is a record of environmental compliance submissions with their outcomes. Documents in the database can be found by visiting the...

  12. Science to compliance: The WIPP success story

    International Nuclear Information System (INIS)

    Howarth, S.M.; Chu, M.S.; Shephard, L.E.

    1997-01-01

    The Waste Isolation Pilot Plant (WIPP) in southeast New Mexico has been studied as a transuranic waste repository for the past 23 years. During this time, an extensive site characterization, design, construction, and experimental program was completed to provide in-depth understanding of the dominant processes that are most likely to influence the containment of radionuclides for 10,000 years. The success of the program, however, is defined by the regulator in the context of compliance with performance criteria, rather than by the in-depth technical understanding typical of most scientific programs. The WIPP project was successful in making a transformation from science to compliance by refocusing and redirecting programmatic efforts toward the singular goal of meeting regulatory compliance requirements while accelerating the submittal of the Compliance Certification Application (CCA) by two months from the April 1994 Disposal Decision Plan (DDP) date of December 1996, and by reducing projected characterization costs by more than 40%. This experience is unparalleled within the radioactive waste management community and has contributed to numerous lessons learned from which the entire community can benefit

  13. TU-AB-204-02: Device Adverse Events and Compliance

    International Nuclear Information System (INIS)

    Gonzales, S.

    2016-01-01

    The responsibilities of the Food and Drug Administration (FDA) have increased since the inception of the Food and Drugs Act in 1906. Medical devices first came under comprehensive regulation with the passage of the 1938 Food, Drug, and Cosmetic Act. In 1971 FDA also took on the responsibility for consumer protection against unnecessary exposure to radiation-emitting devices for home and occupational use. However it was not until 1976, under the Medical Device Regulation Act, that the FDA was responsible for the safety and effectiveness of medical devices. This session will be presented by the Division of Radiological Health (DRH) and the Division of Imaging, Diagnostics, and Software Reliability (DIDSR) from the Center for Devices and Radiological Health (CDRH) at the FDA. The symposium will discuss on how we protect and promote public health with a focus on medical physics applications organized into four areas: pre-market device review, post-market surveillance, device compliance, current regulatory research efforts and partnerships with other organizations. The pre-market session will summarize the pathways FDA uses to regulate the investigational use and commercialization of diagnostic imaging and radiation therapy medical devices in the US, highlighting resources available to assist investigators and manufacturers. The post-market session will explain the post-market surveillance and compliance activities FDA performs to monitor the safety and effectiveness of devices on the market. The third session will describe research efforts that support the regulatory mission of the Agency. An overview of our regulatory research portfolio to advance our understanding of medical physics and imaging technologies and approaches to their evaluation will be discussed. Lastly, mechanisms that FDA uses to seek public input and promote collaborations with professional, government, and international organizations, such as AAPM, International Electrotechnical Commission (IEC

  14. TU-AB-204-02: Device Adverse Events and Compliance

    Energy Technology Data Exchange (ETDEWEB)

    Gonzales, S. [Food & Drug Administration (United States)

    2016-06-15

    The responsibilities of the Food and Drug Administration (FDA) have increased since the inception of the Food and Drugs Act in 1906. Medical devices first came under comprehensive regulation with the passage of the 1938 Food, Drug, and Cosmetic Act. In 1971 FDA also took on the responsibility for consumer protection against unnecessary exposure to radiation-emitting devices for home and occupational use. However it was not until 1976, under the Medical Device Regulation Act, that the FDA was responsible for the safety and effectiveness of medical devices. This session will be presented by the Division of Radiological Health (DRH) and the Division of Imaging, Diagnostics, and Software Reliability (DIDSR) from the Center for Devices and Radiological Health (CDRH) at the FDA. The symposium will discuss on how we protect and promote public health with a focus on medical physics applications organized into four areas: pre-market device review, post-market surveillance, device compliance, current regulatory research efforts and partnerships with other organizations. The pre-market session will summarize the pathways FDA uses to regulate the investigational use and commercialization of diagnostic imaging and radiation therapy medical devices in the US, highlighting resources available to assist investigators and manufacturers. The post-market session will explain the post-market surveillance and compliance activities FDA performs to monitor the safety and effectiveness of devices on the market. The third session will describe research efforts that support the regulatory mission of the Agency. An overview of our regulatory research portfolio to advance our understanding of medical physics and imaging technologies and approaches to their evaluation will be discussed. Lastly, mechanisms that FDA uses to seek public input and promote collaborations with professional, government, and international organizations, such as AAPM, International Electrotechnical Commission (IEC

  15. Agent Architectures for Compliance

    Science.gov (United States)

    Burgemeestre, Brigitte; Hulstijn, Joris; Tan, Yao-Hua

    A Normative Multi-Agent System consists of autonomous agents who must comply with social norms. Different kinds of norms make different assumptions about the cognitive architecture of the agents. For example, a principle-based norm assumes that agents can reflect upon the consequences of their actions; a rule-based formulation only assumes that agents can avoid violations. In this paper we present several cognitive agent architectures for self-monitoring and compliance. We show how different assumptions about the cognitive architecture lead to different information needs when assessing compliance. The approach is validated with a case study of horizontal monitoring, an approach to corporate tax auditing recently introduced by the Dutch Customs and Tax Authority.

  16. Managing quality and compliance.

    Science.gov (United States)

    McNeil, Alice; Koppel, Carl

    2015-01-01

    Critical care nurses assume vital roles in maintaining patient care quality. There are distinct facets to the process including standard setting, regulatory compliance, and completion of reports associated with these endeavors. Typically, multiple niche software applications are required and user interfaces are varied and complex. Although there are distinct quality indicators that must be tracked as well as a list of serious or sentinel events that must be documented and reported, nurses may not know the precise steps to ensure that information is properly documented and actually reaches the proper authorities for further investigation and follow-up actions. Technology advances have permitted the evolution of a singular software platform, capable of monitoring quality indicators and managing all facets of reporting associated with regulatory compliance.

  17. A day in the life of third-year medical students: using an ethnographic method to understand information seeking and use.

    Science.gov (United States)

    Twiss-Brooks, Andrea B; Andrade, Ricardo; Bass, Michelle B; Kern, Barbara; Peterson, Jonna; Werner, Debra A

    2017-01-01

    The authors undertook this project to learn how third-year medical students seek and use information in the course of daily activities, especially activities conducted in clinical settings in a variety of institutions. We recruited sixty-eight third-year undergraduate medical school students to create a mapping diary of a day that included clinical activities. We conducted semi-structured interviews based on the mapping diaries. Using content and thematic analyses of the resulting interview transcripts, we developed an ethnographic case study for each participant. In the studied sample, we identified a broad range of information resources used for personal, clinical, and educational use. Participants relied heavily on technology throughout their day, including desktop computers, smart phones, handheld tablets, and laptops. Time management was a pervasive theme in the interviews, with participants squeezing in time to study for exams wherever and whenever they could. Selection of a particular information resource or technology to use was governed largely by the convenience of using that resource or technology. When obstacles were encountered, workarounds might be sought, but in many cases, the resource or technology would be abandoned in favor of a more convenient solution. Convenience was also a consideration in choosing spaces to use for clinical duties or for study, with specific considerations of available technology, proximity to clinical areas, and security for belongings contributing to choices made. Some of our results align with those of other recent studies of information use among medical students, residents, and practicing physicians. In particular, the fast-paced clinical setting favors use of information resources that are fast and easy to use. We demonstrated that the methods used are suitable to better understand clinicians' discovery and use of information.

  18. The elderly on dialysis: some considerations in compliance.

    Science.gov (United States)

    McKevitt, P M; Jones, J F; Lane, D A; Marion, R R

    1990-10-01

    Compliance with scheduled treatments, dietary and fluid restrictions, and multiple medications is an important component in the care and well-being of end-stage renal disease (ESRD) patients. Given the rigorus and complex demands of dialysis, it is important to examine the issue of compliance, focusing on a large and ever-increasing segment of our patient population, the elderly. The ESRD literature reflects efforts to define and measure levels of compliance, identify factors that influence and predict compliance, and develop intervention strategies to improve adherence to treatment regimens. While limited attention has been focused specifically on the elderly, there are studies suggesting that age may be a factor associated with improved adherence and that social support may be a significant contributor to compliance in this patient group. In an effort to examine the current status and needs of the dialysis elderly, research is in progress at Chromalloy American Kidney Center, Washington University, which replicates a study of 5 years ago. Eighty-four patients age 60 and over, on dialysis for a minimum of 6 months, were identified. Sociodemographic, treatment, compliance, and functional capacity data were collected; additional mental and psychological testing was completed on patients willing and able to participate. Preliminary data suggest the current elderly population is larger and significantly older than that of 5 years ago. Other sociodemographic data indicate the population is increasingly female, black, and more socioeconomically disadvantaged. In regard to compliance, the vast majority of elderly demonstrate good compliance as measured by serum potassium, fair to good compliance with phosphorus, and fair to poor compliance with fluid restrictions.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Medication Errors - A Review

    OpenAIRE

    Vinay BC; Nikhitha MK; Patel Sunil B

    2015-01-01

    In this present review article, regarding medication errors its definition, medication error problem, types of medication errors, common causes of medication errors, monitoring medication errors, consequences of medication errors, prevention of medication error and managing medication errors have been explained neatly and legibly with proper tables which is easy to understand.

  20. Pediatric Nurses' Perceptions of Medication Safety and Medication Error: A Mixed Methods Study.

    Science.gov (United States)

    Alomari, Albara; Wilson, Val; Solman, Annette; Bajorek, Beata; Tinsley, Patricia

    2017-05-30

    This study aims to outline the current workplace culture of medication practice in a pediatric medical ward. The objective is to explore the perceptions of nurses in a pediatric clinical setting as to why medication administration errors occur. As nurses have a central role in the medication process, it is essential to explore nurses' perceptions of the factors influencing the medication process. Without this understanding, it is difficult to develop effective prevention strategies aimed at reducing medication administration errors. Previous studies were limited to exploring a single and specific aspect of medication safety. The methods used in these studies were limited to survey designs which may lead to incomplete or inadequate information being provided. This study is phase 1 on an action research project. Data collection included a direct observation of nurses during medication preparation and administration, audit based on the medication policy, and guidelines and focus groups with nursing staff. A thematic analysis was undertaken by each author independently to analyze the observation notes and focus group transcripts. Simple descriptive statistics were used to analyze the audit data. The study was conducted in a specialized pediatric medical ward. Four key themes were identified from the combined quantitative and qualitative data: (1) understanding medication errors, (2) the busy-ness of nurses, (3) the physical environment, and (4) compliance with medication policy and practice guidelines. Workload, frequent interruptions to process, poor physical environment design, lack of preparation space, and impractical medication policies are identified as barriers to safe medication practice. Overcoming these barriers requires organizations to review medication process policies and engage nurses more in medication safety research and in designing clinical guidelines for their own practice.

  1. The role of the psychiatrist in improving patient compliance.

    Science.gov (United States)

    Hotujac, Ljubomir

    2007-02-01

    Compliance, usually referring to how well the patient takes the medication as prescribed, is an important issue in clinical practice. However, many patients, especially those with a psychiatric illness, stop taking their medications despite physician advice to continue. This cessation can lead to a deterioration in the condition, a relapse, or a recurrence of the illness. In the literature, many different factors contributing to poor compliance have been described, but the doctor's role and responsibilities are hardly mentioned. These factors will be discussed here with special emphasis on what a doctor should do and what a doctor should avoid.

  2. The impact of an electronic monitoring and reminder device on patient compliance with antihypertensive therapy

    DEFF Research Database (Denmark)

    Christensen, Arne; Christrup, Lona Louring; Fabricius, Paul Erik

    2010-01-01

    . In the first half of the study, patients using the device reported 91% compliance versus 85% in the control group. This difference diminished after crossover (88 versus 86%). BP was not affected. Electronic monitoring data on compliance revealed taking, dosing and timing compliance between 45 and 52% in study...... to be effective in improving patient compliance to some extent, but the combined effect has not been documented. OBJECTIVE: To assess the impact of an electronic reminder and monitoring device on patient compliance and BP control. METHODS: All patients received medical treatment with telmisartan once daily...... and were randomized to either electronic compliance monitoring with a reminder and monitoring device or standard therapy for 6 months. Both groups were crossed over after 6 months. Intervention effectiveness was assessed using self-reported compliance and BP. RESULTS: Data from 398 patients were analysed...

  3. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Managing Cancer Care Finding Health Care Services Costs & Medical Information Advance Directives Using Trusted Resources Understanding Cancer ... Care Finding Health Care Services Managing Costs and Medical Information Advance Directives Using Trusted Resources Cancer Types ...

  4. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Research Managing Cancer Care Finding Health Care Services Costs & Medical Information Advance Directives Using Trusted Resources Understanding ... Managing Cancer Care Finding Health Care Services Managing Costs and Medical Information Advance Directives Using Trusted Resources ...

  5. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Care Finding Health Care Services Costs & Medical Information Advance Directives Using Trusted Resources Understanding Cancer What Is ... Health Care Services Managing Costs and Medical Information Advance Directives Using Trusted Resources Cancer Types Adolescents and ...

  6. Improving compliance in remote healthcare systems through smartphone battery optimization.

    Science.gov (United States)

    Alshurafa, Nabil; Eastwood, Jo-Ann; Nyamathi, Suneil; Liu, Jason J; Xu, Wenyao; Ghasemzadeh, Hassan; Pourhomayoun, Mohammad; Sarrafzadeh, Majid

    2015-01-01

    Remote health monitoring (RHM) has emerged as a solution to help reduce the cost burden of unhealthy lifestyles and aging populations. Enhancing compliance to prescribed medical regimens is an essential challenge to many systems, even those using smartphone technology. In this paper, we provide a technique to improve smartphone battery consumption and examine the effects of smartphone battery lifetime on compliance, in an attempt to enhance users' adherence to remote monitoring systems. We deploy WANDA-CVD, an RHM system for patients at risk of cardiovascular disease (CVD), using a wearable smartphone for detection of physical activity. We tested the battery optimization technique in an in-lab pilot study and validated its effects on compliance in the Women's Heart Health Study. The battery optimization technique enhanced the battery lifetime by 192% on average, resulting in a 53% increase in compliance in the study. A system like WANDA-CVD can help increase smartphone battery lifetime for RHM systems monitoring physical activity.

  7. Compliance. Regulatory policy P-211

    International Nuclear Information System (INIS)

    2001-05-01

    This regulatory policy describes the basic principles and directives for establishing and conducting the Canadian Nuclear Safety Commission (CNSC) Compliance Program. The program is aimed at securing compliance by regulated persons with regulatory requirements made under the Nuclear Safety and Control Act ('the Act'). The policy applies to persons who are regulated by the CNSC through the Act, regulations and licences, as well as by decisions and orders made under the Act. The policy applies to officers and employees of the CNSC, and its authorized representatives or agents, who are involved in developing and carrying out compliance activities. Compliance, in the context of this policy, means conformity by regulated persons with the legally binding requirements of the Act, and the CNSC regulations, licences, decisions, and orders made under the Act. Compliance activities are CNSC measures of promotion, verification and enforcement aimed at securing compliance by regulated person with the applicable legally binding requirements. (author)

  8. Patient compliance with a health care provider referral for an occupational therapy lymphedema consult.

    Science.gov (United States)

    Dominick, Sally A; Natarajan, Loki; Pierce, John P; Madanat, Hala; Madlensky, Lisa

    2014-07-01

    Limited information exists on breast cancer patients' compliance to attend outpatient appointments with an occupational therapy (OT) lymphedema specialist. The objectives of this study were (1) to examine patient compliance with a health care provider referral for an OT lymphedema consult and (2) to identify potential barriers to compliance. A retrospective chart review of female breast cancer patients at the UC San Diego Health System was conducted. Electronic medical records were queried for breast cancer patients, who received a health care provider referral for an OT lymphedema consult between June 1, 2010 and December 31, 2011. Descriptive statistics and Fisher's exact chi-square tests were used to examine how specific participant characteristics were associated with attending an OT appointment. A total of 210 female patients received an OT referral from a health care provider related to their breast cancer diagnosis. Forty-three (20.5%) patients did not attend an OT appointment. Non-attenders were more likely to have had fewer lymph nodes removed (Pcancer patients attended recommended OT lymphedema consults, a substantial number of women might benefit from further education about OT for lymphedema prevention following breast cancer treatment. Further research to understand barriers to attendance is recommended, particularly among women with only sentinel nodes removed.

  9. Compliance to antihypertensive therapy

    International Nuclear Information System (INIS)

    Almas, A.; Hameed, A.; Ahmed, B.; Islam, M.

    2006-01-01

    Objective: To determine compliance, factors affecting compliance to antihypertensive therapy and to compare compliant and non-compliant groups, in a tertiary care setting. Study Design: Analytical (cross-sectional) study. Place and Duration of Study: The outpatient clinics at the Aga Khan University from May 2004 to February 2005. Patients and Methods: Two hundred patients presenting to the outpatients clinic were included. All patients 18 years and above, who had stage 1 and 2 hypertension, had one clinic visit to a medicine clinic, 6 months prior to presentation and started on antihypertensive medicines, were included. Results: Sixty-six percent were males and 33.5 % were females. Mean age was 58.1 ( +- 12) years and mean duration of hypertension was 7.2 (+- 6.7) years. Fifty-seven percent were compliant and 43% were noncompliant. In the noncompliant group, 53.4 % had mild noncompliance, 24.4 % had severe non-compliance, while 22% had moderate noncompliance. Factors of noncompliance were 56.8% missed doses due to forgetfulness, 12.7% deliberately missed their doses, 11.6% could not take the medicine due to side effects, 10.4% did not take the dose due to increased number of tablets, 4.6% were not properly counseled by the physician and 3.48% did not take medicines due to cost issues. The mean systolic blood pressure was 126 +- 19.2 mmHg in the compliant group while it was 133 +- 16.5 mmHg in the noncompliant group (p-value 0.004). The mean diastolic blood pressure in the compliant group was 76 +- 11.9 mmHg, while in the noncompliant group it was 81.9 +- 10.9 mmHg (p-value 0.001). Conclusion: Compliance to antihypertensive therapy in a tertiary care center is significantly good. Forgetfulness was the major reason for noncompliance. The mean blood pressure control was better in the compliant group. (author)

  10. Extrinsic incentives and tax compliance

    OpenAIRE

    Sour, Laura; Gutiérrez Andrade, Miguel Ángel

    2011-01-01

    This paper models the impact of extrinsic incentives in a tax compliance model. It also provides experimental evidence that confirms the existence of a positive relationship between rewards and tax compliance. If individuals are audited, rewards for honest taxpayers are effective in increasing the level of tax compliance. These results are particularly relevant in countries where there is little respect for tax law since rewards can contribute to crowding in the intrinsic motivation to comply.

  11. Managing compliance risk after Mifid

    OpenAIRE

    P. Musile Tanzi; G. Gabbi; D. Previati; P. Schwizer

    2013-01-01

    Purpose – The purpose of this paper is to focus on changes in the compliance function within major European banks and other financial intermediaries and on the effects of Markets in Financial Instruments Directive (MiFID) implementation. Design/methodology/approach – The four areas of research seek to answer the following questions: Is the positioning of the compliance function “at the top” of the organizational structure? Are the roles attributed to the compliance function, th...

  12. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best used in ... Agents Antidepressant Medications Newer IBS Medications Probiotics and ... Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation ...

  13. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS Medications ... Psychological Treatments Understanding Stress Cognitive Behavioral ...

  14. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best used in ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation ...

  15. Quality beyond compliance.

    Science.gov (United States)

    Centanni, N; Monroe, M; White, L; Larson, R

    1999-01-01

    The service sector within the biopharmaceutical industry has experienced phenomenal growth over the past decade. In the highly regulated Good Laboratory Practices environment, the need for timely, high-quality service, accurate results, and on-time deliverables becomes paramount for the success and profitability of biopharmaceutical companies. The quality assurance process is a vital component of this drug product-development cycle and ensures compliance to the highest domestic and international regulatory standards. Quality-assurance professionals historically have held the role of independent auditors of the processes, who certify that results meet current standards of practice. Covance, a contract research organization that includes Good Laboratory Practices laboratories, reorganized and expanded the functional responsibilities of its quality assurance team in 1997. Auditors and quality assurance professionals have assumed roles beyond traditional compliance auditing and are forging new leadership and mentoring roles as process-improvement specialists. The results have been tangible, measurable benefits for clients and the Covance organization. This article provides an overview of this cultural change and the processes put in place to improve efficiency, productivity, and customer and employee satisfaction.

  16. Proactive compliance report 2004

    International Nuclear Information System (INIS)

    2005-01-01

    The Alberta Energy and Utilities Board (EUB) stipulates requirements to protect public safety, minimize environmental impacts, improve conservation, and ensure equity by promoting orderly and responsible energy development. Surveillance activities by the EUB, such as inspections and audits, ensures compliance with these requirements. This report presents statistical results of the enforcement ladder process (inspections, complaints, activities, major initiatives, and enforcement) for 2004 across ten EUB groups, including, Field Surveillance, Resources Applications Group, Operations Group, Environment Group, Utilities Branch, Facilities Applications Group, Corporate Compliance Group, Fort McMurray, Information and Dissemination Group, and Financial Management Group. When a noncompliance is identified, the EUB uses a process that has an established policy for EUB enforcement actions. Enforcement actions are determined by the severity of the noncompliance event and are escalated for subsequent noncompliance or failure to comply with the EUB's corrective order. Within the process, the EUB provides a grace period after an initial enforcement action. During this period, the EUB will take appropriate enforcement actions for subsequent noncompliances but will not escalate enforcement consequences. Enforcement consequences are escalated after the grace period has expired. 72 tabs

  17. Electronic compliance monitoring of topical treatment after ophthalmic surgery.

    Science.gov (United States)

    Hermann, Manuel Marcel; Ustündag, Can; Diestelhorst, Michael

    2010-08-01

    The success of many medical treatments is built on compliance. Electronic monitoring is the most accurate tool to quantify compliance by measuring adherence. In order to assess the efficiency of a recently introduced miniature monitoring device for eye drop application, we evaluated adherence in ophthalmic patients undergoing post-operative short-term topical treatment. This pilot study enrolled 30 outpatients (mean age 61.8 +/- 18.5 years) after cataract (n = 24) and glaucoma filtration surgery (n = 6) applying fixed-combination eye drops containing prednisolone and gentamicin five times daily for 2 weeks. Patients received eye drops in conventional bottles each equipped with a miniature monitoring device recording events of application. Two patients failed to bring back the monitoring device; therefore data collected from only 28 patients could be examined. Data showed highly variable results with a mean dose compliance of 50.2%. Dose compliance was below 25% in approximately one out of five patients. Four cataract patients, but no glaucoma patient, discontinued therapy prematurely. The observed mean dosage interval was calculated for each patient and ranged 4.6-19.7 h. Thirty percent of analysed dosage intervals exceeded 12.0 h. Different patterns of compliance behaviour-like early non-persistence, drug holiday and low treatment frequency could be identified and illustrated using electronic data. Age or gender did not significantly influence compliance rates. Our pilot study demonstrates successful electronic compliance monitoring using a technology capable of continuous data recording over weeks of treatment. The low compliance rate for a relevant part of the patients demonstrates the necessity to study and improve compliance in ophthalmology. In future, new application methods and electronic application devices may improve treatment response in eye care.

  18. Formalizing and appling compliance patterns for business process compliance

    NARCIS (Netherlands)

    Elgammal, A.; Turetken, O.; van den Heuvel, W.; Papazoglou, M.

    2016-01-01

    Today’s enterprises demand a high degree of compliance of business processes to meet diverse regulations and legislations. Several industrial studies have shown that compliance management is a daunting task, and organizations are still struggling and spending billions of dollars annually to ensure

  19. Formalizing and applying compliance patterns for business process compliance

    NARCIS (Netherlands)

    Elgammal, A.F.S.A.; Türetken, O.; van den Heuvel, W.J.A.M.; Papazoglou, M.

    Today’s enterprises demand a high degree of compliance of business processes to meet diverse regulations and legislations. Several industrial studies have shown that compliance management is a daunting task, and organizations are still struggling and spending billions of dollars annually to ensure

  20. Diagnostic information for compliance checking of temporal compliance requirements

    NARCIS (Netherlands)

    Ramezani Taghiabadi, E.; Fahland, D.; Dongen, van B.F.; Aalst, van der W.M.P.; Salinesi, C.; Norrie, M.C.; Pastor, O.

    2013-01-01

    Compliance checking is gaining importance as today’s organizations need to show that operational processes are executed in a controlled manner while satisfying predefined (legal) requirements or service level agreements. Deviations may be costly and expose an organization to severe risks. Compliance

  1. Compliance/adherence and care management in HIV disease.

    Science.gov (United States)

    Crespo-Fierro, M

    1997-01-01

    With the changing perspectives of the HIV epidemic and the introduction of protease inhibitors to treat human immunodeficiency virus (HIV) disease, the issue of compliance has gained considerable interest among health care providers. The idea that clients with HIV disease should succumb to a patriarchal system of medical care has been challenged by AIDS activists since the beginning of the epidemic. The concept that there is only one explanation for "noncompliance" is outdated. The reasons for noncompliance are multifaceted in nature and include psychosocial factors, complex medication and treatment regimens, ethnocultural concerns, and in many instances substance use. Therefore, the notion that there is one intervention to resolve noncompliance is at best archaic. Interventions to enhance compliance include supervised therapy, improving the nurse-client relationship, and patient education, all of which should be combined with ethnocultural interventions. Plans to enhance compliance must incorporate person-specific variables and should be tailored to individualized needs.

  2. Compliance in rheumatoid arthritis and the role of formal patient education

    NARCIS (Netherlands)

    Brus, H.L.M.; Brus, Herman; van de Laar, Mart A F J; Taal, Erik; Rasker, Johannes J.; Wiegman, O.

    1997-01-01

    Objective: This study was performed to determine the compliance with the basic treatments for rheumatoid arthritis (RA; medication, physical therapy, and ergonomic measures), to study psychological factors that influence compliance in light of the social learning theory, to learn whether patient

  3. 76 FR 28308 - Compliance Policy Guide: Surgeons' Gloves and Patient Examination Gloves; Defects-Criteria for...

    Science.gov (United States)

    2011-05-17

    .... FDA-2011-D-0258] Compliance Policy Guide: Surgeons' Gloves and Patient Examination Gloves; Defects... Compliance Policy Guide Sec. 335.700, Surgeons' Gloves and Patient Examination Gloves; Defects--Criteria for... FDA staff on the submission of seizure recommendations for medical gloves that exceed the defect...

  4. Teaching Teaching & Understanding Understanding

    DEFF Research Database (Denmark)

    2006-01-01

    "Teaching Teaching & Understanding Understanding" is a 19-minute award-winning short-film about teaching at university and higher-level educational institutions. It is based on the "Constructive Alignment" theory developed by Prof. John Biggs. The film delivers a foundation for understanding what...

  5. Diagnostic information in compliance checking

    NARCIS (Netherlands)

    Ramezani Taghiabadi, E.; Fahland, D.; Aalst, van der W.M.P.

    2012-01-01

    Compliance checking is gaining importance as today's organizations need to show that operational processes are executed in a controlled manner while satisfying predefined (legal) requirements. Deviations may be costly and expose the organization to severe risks. Compliance checking is of growing

  6. 'And you'll suddenly realise 'I've not washed my hands': medical students', junior doctors' and medical educators' narratives of hygiene behaviours.

    Science.gov (United States)

    Cresswell, Penelope; Monrouxe, Lynn V

    2018-03-22

    Compliance to hygiene behaviours has long been recognised as important in the prevention and control of healthcare associated infections, but medical doctors still display some of the lowest rates of compliance of all healthcare workers. We aim to understand compliance to hygiene behaviours by analysing medical students', junior doctors' and medical educators' narratives of these behaviours to identify their respective attitudes and beliefs around compliance and how these are learnt during training. Such an understanding can inform future interventions to improve compliance targeted to areas of greatest need. A qualitative study, using narrative interviews (nine focus groups and one individual interview). Data were analysed thematically using inductive framework analysis. Teaching hospitals in the UK. Convenience sample of 25 participants: third-year medical students in their first clinical year (n=13), junior doctors (n=6) and medical educators (n=6). We identified four main themes: (1) knowledge, (2) constraints, (3) role models/culture and (4) hygiene as an added extra. Knowledge varied across participant groups and appeared to influence behaviours; medical students relied on what they have been told by seniors, while medical educators relied on their own knowledge and experience. There was a strong belief that evidence for the effectiveness of good hygiene behaviours is lacking. Furthermore, medical educators' behaviour appears to strongly influence others. Finally, hygiene was predominately viewed as an added extra rather than an integral part of the process. Awareness of the evidence around good hygiene needs to be improved at all levels. Medical students and junior doctors should be encouraged to consider why they are asked to perform certain hygiene behaviours in order to improve ownership of those behaviours. Medical educators need to recognise their responsibilities as role models for their junior counterparts, thereby understanding their role in

  7. Exploring medical identity theft.

    Science.gov (United States)

    Mancilla, Desla; Moczygemba, Jackie

    2009-09-16

    The crime of medical identity theft is a growing concern in healthcare institutions. A mixed-method study design including a two-stage electronic survey, telephone survey follow-up, and on-site observations was used to evaluate current practices in admitting and registration departments to reduce the occurrence of medical identity theft. Survey participants were chief compliance officers in acute healthcare organizations and members of the Health Care Compliance Association. Study results indicate variance in whether or how patient identity is confirmed in healthcare settings. The findings of this study suggest that information systems need to be designed for more efficient identity management. Admitting and registration staff must be trained, and compliance with medical identity theft policies and procedures must be monitored. Finally, biometric identity management solutions should be considered for stronger patient identification verification.

  8. Environmental compliance assessment review

    International Nuclear Information System (INIS)

    Hilliday, G.H.

    1991-01-01

    During the period 1972-1991, The United States Congress passed stringent environmental statues which the Environment Protection Agency implemented via regulations. The statues and regulations contain severe civil and criminal penalties. Civil violations resulted in fines, typically payable by the company. The act of willfully and knowingly violating the permit conditions or regulations can result in criminal charges being imposed upon the responsible part, i.e., either the company or individual. Criminal charges can include fines, lawyer fees, court costs and incarceration. This paper describes steps necessary to form an effective Environmental Compliance Assessment Review [CAR] program, train field and engineering personnel and perform a CAR audit. Additionally, the paper discusses the findings of a number of Exploration and Production [E and P] field audits

  9. Understanding the information dynamics of medication administration in residential aged care facilities (RACFs): a prerequisite for design of effective ICT systems.

    Science.gov (United States)

    Tariq, Amina; Georgiou, Andrew; Westbrook, Johanna

    2013-01-01

    Medication information is a critical part of the information required to ensure residents' safety in the highly collaborative care context of RACFs. Studies report poor medication information as a barrier to improve medication management in RACFs. Research exploring medication work practices in aged care settings remains limited. This study aimed to identify contextual and work practice factors contributing to breakdowns in medication information exchange in RACFs in relation to the medication administration process. We employed non-participant observations and semi-structured interviews to explore information practices in three Australian RACFs. Findings identified inefficiencies due to lack of information timeliness, manual stock management, multiple data transcriptions, inadequate design of essential documents such as administration sheets and a reliance on manual auditing procedures. Technological solutions such as electronic medication administration records offer opportunities to overcome some of the identified problems. However these interventions need to be designed to align with the collaborative team based processes they intend to support.

  10. Medical Practitioners Act 2007: the increased medical record burden.

    LENUS (Irish Health Repository)

    Byrne, D

    2010-03-01

    New medical record keeping obligations are implemented by the Medical Practitioners Act (2007), effective July 2009. This audit, comprising review of 347 medical entries in 257 charts on one day, investigated compliance with the Act together with the general standard of medical record keeping. The Medical Council requirement was absent all but 3 (0.9%) of entries; there was no unique identifier or signature in 28 (8%) and 135 (39%) of entries respectively. The case for change is discussed.

  11. The Mental Health Care Act: Stakeholder compliance with Section ...

    African Journals Online (AJOL)

    Objective. To determine compliance with Section 40 (1-3) of the Mental Health Care Act (MHCA) No 17 of 2002, viz. handing over custody by the South African Police Service (SAPS) of suspected mentally ill patients to medical services at Chris Hani Baragwanath Hospital (CHBH). Methods. The study was a retrospective ...

  12. 40 CFR 60.39e - Compliance times.

    Science.gov (United States)

    2010-07-01

    ... PERFORMANCE FOR NEW STATIONARY SOURCES Emission Guidelines and Compliance Times for Hospital/Medical... site preparation for installation of the air pollution control device(s); (7) Date for initiation of installation of the air pollution control device(s); (8) Date for initial startup of the air pollution control...

  13. Dietary compliance among diabetes patients attending clinic at new ...

    African Journals Online (AJOL)

    Background: Diabetes Mellitus is a major public health issue. It is one of the most prevalent medical conditions affecting people and is responsible for high mortality and large amount of potential years of life lost. Diet is the cornerstone of diabetes management, without which its control is impossible. However, compliance to ...

  14. Veterinary decision making in relation to metritis - a qualitative approach to understand the background for variation and bias in veterinary medical records

    Directory of Open Access Journals (Sweden)

    Enevoldsen Carsten

    2009-08-01

    Full Text Available Abstract Background Results of analyses based on veterinary records of animal disease may be prone to variation and bias, because data collection for these registers relies on different observers in different settings as well as different treatment criteria. Understanding the human influence on data collection and the decisions related to this process may help veterinary and agricultural scientists motivate observers (veterinarians and farmers to work more systematically, which may improve data quality. This study investigates qualitative relations between two types of records: 1 'diagnostic data' as recordings of metritis scores and 2 'intervention data' as recordings of medical treatment for metritis and the potential influence on quality of the data. Methods The study is based on observations in veterinary dairy practice combined with semi-structured research interviews of veterinarians working within a herd health concept where metritis diagnosis was described in detail. The observations and interviews were analysed by qualitative research methods to describe differences in the veterinarians' perceptions of metritis diagnosis (scores and their own decisions related to diagnosis, treatment, and recording. Results The analysis demonstrates how data quality can be affected during the diagnostic procedures, as interaction occurs between diagnostics and decisions about medical treatments. Important findings were when scores lacked consistency within and between observers (variation and when scores were adjusted to the treatment decision already made by the veterinarian (bias. The study further demonstrates that veterinarians made their decisions at 3 different levels of focus (cow, farm, population. Data quality was influenced by the veterinarians' perceptions of collection procedures, decision making and their different motivations to collect data systematically. Conclusion Both variation and bias were introduced into the data because of

  15. Impact of physician empathy on migraine disability and migraineur compliance

    Directory of Open Access Journals (Sweden)

    Hatim S Attar

    2012-01-01

    Full Text Available Aims: We aim to establish the role that perceived physician empathy plays in determining migraineurs′ outcomes and compliance with migraine management plans. We checked for associations between perceived physician empathy and clinical outcomes as well as compliance with management plans. Materials and Methods: 63 migraineurs were enrolled between July and September 2011. Questionnaire administered at the time of inclusion into the study included self-assessment of disability due to migraine (Migraine Disability Assessment Test followed by migraineurs′ assessment of physician empathy (Consultation and Relational Empathy Measure. Three months later, a telephonic questionnaire ascertained changes in disability due to migraine and compliance with migraine treatment. Statistical Analysis: Data was entered in Microsoft Excel 2010 and analyzed using SPSS 17. Pearson′s correlation was employed to analyze the significance of relationship between variables. P-value of less than 0.05 has been considered statistically significant. Results: Statistically significant positive Pearson′s correlations are seen between perceived empathy and decrease in migraine disability and symptoms over three months (P < 0.05. Significant positive relationships are also seen between perceived empathy and compliance with diet/meal timings, exercising, de-stressing/sleep pattern modification and medications (P < 0.05. Self-reported compliance is significantly correlated with improved patient outcomes (P < 0.05. Conclusions: Substantial positive associations are found between perceived physician empathy and migraineurs′ outcomes and compliance with management plans. This emphasizes the importance of empathy in migraineur-physician communication.

  16. A cross-sectional survey of pharmacists to understand their personal preference of brand and generic over-the-counter medications used to treat common health conditions.

    Science.gov (United States)

    Patel, Mira; Slack, Marion; Cooley, Janet; Bhattacharjee, Sandipan

    2016-01-01

    Consumers are hesitant in choosing generic medications as they are under the assumption that they are not as safe nor effective as brand medications. However, pharmacists do have the education and training to know that this is not the case. The aim of this study was to determine pharmacists' preference of generic versus brand over-the-counter (OTC) medication for their personal use as self-treatment for various health symptoms. A prospective, cross sectional study was conducted on 553 licensed pharmacists who were presumed to have expertise in the use of generic and brand name OTC medications. In a single Southwestern state in the United States, from December 2014 to January 2015, a web-based questionnaire was sent to pharmacists to explore their preference of brand and generic medications based on various health symptoms. Thirty-one brand-generic medication pairs were used to identify which medication type pharmacists preferred when asked about nine health symptoms. Frequency counts of pharmacists' preference of a brand medication or a generic OTC medication overall and for each of the nine health symptoms were determined. Chi-squared analyses and one-way ANOVA were conducted to determine if there were any differences between the preferences of brand and generic OTC medications across each symptom. The study overall showed that pharmacists preferred generic OTC medications to brand OTC medications (62 to 5 %, respectively). Based on an 11-point rating scale, pharmacists were likely to take OTC generic medications (as their choice of self-treatment) when presented with health symptoms (mean = 7.32 ± 2.88). In addition, pharmacists chose generic OTC medications over brand medications regardless of health symptoms (p brand name OTC medications for self-treating a variety of health symptoms. These study findings support the theory that expertise affects preference for generic versus brand name OTC medications. This information can be used to provide

  17. Medications (for IBS)

    Medline Plus

    Full Text Available ... Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation Techniques for IBS Take Part in Online ...

  18. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation Techniques for ...

  19. Aortic compliance in patients with aortic regurgitation. Evaluation with magnetic resonance imaging

    International Nuclear Information System (INIS)

    Murai, Sachiko; Hamada, Seiki; Ueguchi, Takashi

    2005-01-01

    The purpose of this study was to assess by means of cine magnetic resonance imaging (MRI) aortic compliance before and after aortic valve replacement (AVR with SJM (St. Jude Medical, St paul, MN) valve) in patients with aortic regurgitation (AR). Two groups (healthy controls and patients with severe isolated AR) of 10 subjects each were included in this study. Cine MRI was performed at three locations of the aorta, and aortic compliance was calculated by dividing the maximum change in the aortic area by pulse pressure. Cine MRI is useful to assess abnormalities of aortic compliance in patients with AR. Compared with the control group, aortic compliance in the AR group was significantly less in the ascending aorta (p<0.05), decreasing in order of aortic location. After AVR, aortic compliance improved for all locations. Cine MRI enables assessment of aortic biophysical properties such as a compliance for evaluating the progression of AR and the efficacy of treatment. (author)

  20. Oil Mist Compliance

    International Nuclear Information System (INIS)

    Lazarus, Lloyd

    2009-01-01

    This report summarizes activities at the KCP related to evaluating and modifying machine tools in order to be in compliance with Section 23 of DOE 10 CFR 851, Worker Safety and Health Program. Section 851.23 (a) states that 'Contractors must comply with the following safety and health standards that are applicable to the hazards in their covered workplace', and subsection 9 contains the following applicable standard: 'American Congress of Governmental Industrial Hygienists (ACGIH), 'Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices,' (2005) (incorporated by reference, see (section)851.27) when the ACGIH Threshold Limit Values are lower (more protective) than permissible exposure limits in 29 CFR 1910'. In the 2005 ACGIH Threshold Limit Value book a Notice of Change was issued for exposure to mineral oil mist used in metalworking fluids (MWFs). The effects of planning for the new facility and which machine tools would be making the transition to the new facility affected which machine tools were modified

  1. Oil Mist Compliance

    Energy Technology Data Exchange (ETDEWEB)

    Lazarus, Lloyd

    2009-02-02

    This report summarizes activities at the KCP related to evaluating and modifying machine tools in order to be in compliance with Section 23 of DOE 10 CFR 851, Worker Safety and Health Program. Section 851.23 (a) states that “Contractors must comply with the following safety and health standards that are applicable to the hazards in their covered workplace”, and subsection 9 contains the following applicable standard: “American Congress of Governmental Industrial Hygienists (ACGIH), ‘Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices,’ (2005) (incorporated by reference, see §851.27) when the ACGIH Threshold Limit Values are lower (more protective) than permissible exposure limits in 29 CFR 1910.” In the 2005 ACGIH – Threshold Limit Value book a Notice of Change was issued for exposure to mineral oil mist used in metalworking fluids (MWFs). The effects of planning for the new facility and which machine tools would be making the transition to the new facility affected which machine tools were modified.

  2. Environmental Compliance Management System

    International Nuclear Information System (INIS)

    Brownson, L.W.; Krsul, T.; Peralta, R.A.; Knudson, D.A.; Rosignolo, C.L.

    1992-01-01

    Argonne National Laboratory (ANL) is developing the Environmental Compliance Management System (ECMS) as a comprehensive, cost-effective tool to ensure (1) that the Laboratory complies with all applicable federal and state environmental laws and regulations, (2) that environmental issues and concerns are recognized and considered in the early phases of projects; and (3) that Laboratory personnel conduct Laboratory operations in the most environmentally acceptable manner. The ECMS is an expert computer system which is designed to allow project engineers to perform an environmental evaluation of their projects. The system includes a Master Program which collects basic project information, provide utility functions, and access the environmental expert modules, environmental expert system modules for each federal and state environmental law which allows the user to obtain specific information on how an individual law may affect his project; and site-specific databases which contain information necessary for effective management of the site under environmental regulations. The ECMS will have the capability to complete and print many of the necessary environmental forms required by federal and state agencies, including the Department of Energy

  3. [Accreditation of medical laboratories].

    Science.gov (United States)

    Horváth, Andrea Rita; Ring, Rózsa; Fehér, Miklós; Mikó, Tivadar

    2003-07-27

    In Hungary, the National Accreditation Body was established by government in 1995 as an independent, non-profit organization, and has exclusive rights to accredit, amongst others, medical laboratories. The National Accreditation Body has two Specialist Advisory Committees in the health care sector. One is the Health Care Specialist Advisory Committee that accredits certifying bodies, which deal with certification of hospitals. The other Specialist Advisory Committee for Medical Laboratories is directly involved in accrediting medical laboratory services of health care institutions. The Specialist Advisory Committee for Medical Laboratories is a multidisciplinary peer review group of experts from all disciplines of in vitro diagnostics, i.e. laboratory medicine, microbiology, histopathology and blood banking. At present, the only published International Standard applicable to laboratories is ISO/IEC 17025:1999. Work has been in progress on the official approval of the new ISO 15189 standard, specific to medical laboratories. Until the official approval of the International Standard ISO 15189, as accreditation standard, the Hungarian National Accreditation Body has decided to progress with accreditation by formulating explanatory notes to the ISO/IEC 17025:1999 document, using ISO/FDIS 15189:2000, the European EC4 criteria and CPA (UK) Ltd accreditation standards as guidelines. This harmonized guideline provides 'explanations' that facilitate the application of ISO/IEC 17025:1999 to medical laboratories, and can be used as a checklist for the verification of compliance during the onsite assessment of the laboratory. The harmonized guideline adapted the process model of ISO 9001:2000 to rearrange the main clauses of ISO/IEC 17025:1999. This rearrangement does not only make the guideline compliant with ISO 9001:2000 but also improves understanding for those working in medical laboratories, and facilitates the training and education of laboratory staff. With the

  4. The Use of Three Dimensional Printed Interactive Models and a Digital Anatomy Case Study to Improve Medical Student Understanding of Pelvic and Perineal Anatomy

    Science.gov (United States)

    Solis, Laura de Jesus

    The anatomy of the pelvis and perineum is especially complex for novice students. In the Language of Medicine Module (Gross Anatomy and Embryology), medical students are expected to learn a high volume of material in a short time. The study of these regions is especially challenging due to the limited visibility of structures and difficulty of dissection. Understanding of the spatial relationships of the pelvic and perineal structures is important to acquire the foundational knowledge for future clinical application. Traditional methods such as dissection, prosected specimens, peer teaching, and radiological images are used at UT Health San Antonio to teach these regions. Emerging three dimensional technologies applied in computer based models and printed physical models serve as alternative ways to teach Anatomy. This study examines the effectiveness of adding two active learning methods that use these technologies to teach the anatomy of the pelvis and perineum in the Language of Medicine module, as assessed by exam performance and a satisfaction survey. The learning methods included female pelvic and perineal printed models with simulated anatomical contents made with arts and crafts material, and a digital anatomy case study using BodyVizRTM. In 2016, 220 medical students in four groups (A-D) rotated between demonstrations on prosected cadavers and interactive sessions with each 3D learning tool. Student exam performance was assessed as the percentage of points obtained on select written and practical exam questions relevant to the anatomy of the pelvis and perineum. Across four years, practical exam performance for all relevant pelvic and perineal tags (structures tagged with a string or pin) shows a consistent decline of averages from 2013 (83%) to 2015 (75.7%). This decline was slightly reversed in 2016 (76.6%) following the integration of the 3D learning tools. The analysis of the obturator internus muscle tag, a tag included in the practical exams across

  5. Y2K compliance countdown.

    Science.gov (United States)

    Arlotto, P W

    1999-01-01

    The new century brings unique challenges--especially Y2K compliance. This article presents nurse managers and executives with an overview of the issues and action steps to keep their organizations on track.

  6. Air Compliance Complaint Database (ACCD)

    Data.gov (United States)

    U.S. Environmental Protection Agency — THIS DATA ASSET NO LONGER ACTIVE: This is metadata documentation for the Region 7 Air Compliance Complaint Database (ACCD) which logs all air pollution complaints...

  7. The Italian compliance assurance programme

    International Nuclear Information System (INIS)

    Trivelloni, S.

    1999-01-01

    An overview is given of the compliance assurance programme that is applied in Italy and the role of the different competent authorities that have responsibilities for the transport of radioactive materials is described. (author)

  8. Integrated Compliance Information System (ICIS)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The purpose of ICIS is to meet evolving Enforcement and Compliance business needs for EPA and State users by integrating information into a single integrated data...

  9. The Strategic Nature of Compliance

    DEFF Research Database (Denmark)

    König, Thomas; Mäder, Lars Kai

    2014-01-01

    by the anticipated enforcement decision of the monitoring agency and whether this agency is responsive to the probability of enforcement success and the potential sanctioning costs produced by noncomplying implementers. Compared to other monitoring systems, the centralized monitoring system of the European Union (EU......This compliance study models correct and timely implementation of policies in a multilevel system as a strategic game between a central monitoring agency and multiple implementers and evaluates statistically the empirical implications of this model. We test whether compliance is determined......) is praised for exemplary effectiveness, but our findings reveal that the monitoring agency refrains from enforcing compliance when the probability of success is low, and the sanctioning costs are high. This results in a compliance deficit, even though the selective enforcement activities of the monitoring...

  10. Compliance with removable orthodontic appliances.

    Science.gov (United States)

    Shah, Nirmal

    2017-12-22

    Data sourcesMedline via OVID, PubMed, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, LILACS and BBO databases. Unpublished clinical trials accessed using ClinicalTrials.gov, National Research Register, ProQuest Dissertation and Thesis database.Study selectionTwo authors searched studies from inception until May 2016 without language restrictions. Quantitative and qualitative studies incorporating objective data on compliance with removable appliances, barriers to appliance wear compliance, and interventions to improve compliance were included.Data extraction and synthesisQuality of research was assessed using the Cochrane Collaboration's risk of bias tool, the risk of bias in non-randomised studies of interventions (ROBINS-I), and the mixed methods appraisal tool. Statistical heterogeneity was investigated by examining a graphic display of the estimated compliance levels in conjunction with 95% confidence intervals and quantified using the I-squared statistic. A weighted estimate of objective compliance levels for different appliances in relation to stipulated wear and self-reported levels was also calculated. Risk of publication bias was assessed using funnel plots. Meta-regression was undertaken to assess the relative effects of appliance type on compliance levels.ResultsTwenty-four studies met the inclusion criteria. Of these, 11 were included in the quantitative synthesis. The mean duration of objectively measured wear was considerably lower than stipulated wear time amongst all appliances. Headgear had the greatest discrepancy (5.81 hours, 95% confidence interval, 4.98, 6.64). Self-reported wear time was consistently higher than objectively measured wear time amongst all appliances. Headgear had the greatest discrepancy (5.02 hours, 95% confidence interval, 3.64, 6.40). Two studies found an increase in compliance with headgear and Hawley retainers when patients were aware of monitoring. Five studies found younger age groups to

  11. Are the effects of drugs to prevent and to treat heart failure always concordant? The statin paradox and its implications for understanding the actions of antidiabetic medications.

    Science.gov (United States)

    Packer, Milton

    2018-03-22

    Most treatments for chronic heart failure are effective both in preventing its onset and reducing its progression. However, statins prevent the development of heart failure, but they do not decrease morbidity and mortality in those with established heart failure. This apparent discordance cannot be explained by an effect to prevent interval myocardial infarctions. Instead, it seems that the disease that statins were preventing in trials of patients with a metabolic disorder was different from the disease that they were treating in trials of chronic heart failure. The most common phenotype of heart failure in patients with obesity and diabetes is heart failure with a preserved ejection fraction (HFpEF). In this disorder, the anti-inflammatory effects of statins might ameliorate myocardial fibrosis and cardiac filling abnormalities, but these actions may have little relevance to patients with heart failure and a reduced ejection fraction (HFrEF), whose primary derangement is cardiomyocyte loss and stretch. These distinctions may explain why statins were ineffective in trials that focused on HFrEF, but have been reported to produce with favourable effects in observational studies of HFpEF. Similarly, selective cytokine antagonists were ineffective in HFrEF, but have been associated with benefits in HFpEF. These observations may have important implications for our understanding of the effects of antihyperglycaemic medications. Glucagon-like peptide-1 receptor agonists have had neutral effects on heart failure events in people at risk for HFpEF, but have exerted deleterious actions in HFrEF. Similarly, sodium-glucose co-transporter 2 inhibitors, which exert anti-inflammatory effects and reduce heart failure events in patients who are prone to HFpEF, may not be effective in HFrEF. The distinctions between HFrEF and HFpEF may explain why the effects of drugs on heart failure events in diabetes trials may not be relevant to their use in patients with systolic dysfunction

  12. Awareness and compliance to anti-smoking law in South Bengaluru, India

    Directory of Open Access Journals (Sweden)

    Pradeep S. Banandur

    2017-09-01

    This is the first representative survey of awareness and compliance of COTPA in Bengaluru City. Low compliance, coupled with the lack of appropriate awareness among PRCs and AOs about COTPA, demands a comprehensive strategy to enhance awareness. Comprehensive efforts towards making all stakeholders understand the health impacts of smoking, and strict enforcement, might facilitate effective implementation of COTPA.

  13. Cardiac Medications

    Science.gov (United States)

    ... cholesterol from circulating in the blood. Watch an animation of how statins work. Reason for Medication Used ... Kindle Fire Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  14. Compliance with air quality regulations

    International Nuclear Information System (INIS)

    Steen, D.V.; Tackett, D.L.

    1990-01-01

    Due to the probable passage of Clean Air Act Amendments in 1990, electric utilities throughout the United States are faced with numerous choices to comply with the new acid rain regulations, expected in 1991. The choice of a compliance plan is not a simple task. Every compliance option will be costly. At Ohio Edison, deliberations are quite naturally influenced by past compliance with air quality regulations. This paper discusses compliance with air quality regulations in the 1970's, clean coal technologies and advanced scrubbers, and compliance with air quality regulations in 1995 - 2000. The choice of a compliance strategy for many utilities will involve serving customer loads through some combination of scrubbers, clean coal technologies, fuel switching, fuel blending, redispatch of units, and emissions trading. Whatever the final choice, it must be economic while providing sufficient flexibility to accommodate the critical uncertainties of load growth, state regulatory treatment, markets for emission allowances, advancements in control technologies, additional federal requirements for air emissions, equipment outages and fuel supply disruptions.s

  15. Emission trading in Ontario : Understanding and managing compliance risk

    Energy Technology Data Exchange (ETDEWEB)

    White, A. [Mirant Canada Energy Marketing ltd., Toronto, ON (Canada)

    2002-07-01

    Mirant is one of the top five American energy marketer of power and gas, with more than 20,700 megawatts (MW) of electric generating capacity worldwide, of which 13,600 is in North America. The author presented a chart displaying nitrogen oxide emissions in Ontario, followed by another chart with the emissions of sulphur dioxide also in Ontario. The emission targets for the power sector were reviewed, as were the nitrogen oxide emission limits from 2002 to 2010. The major features of the Ontario legislation were discussed, covering allowance allocation, unlimited banking and limited provisions for credit. Ontario fossil capacity was reviewed, followed by emission allowance allocation. The issues and risks for Independent Power Producers were discussed. They included the emission rate compared to that of the competition, how much the facility was run last year and how much you expect to run it next year, the possibility of buying allowances or credits and at what cost. Looking to the future, the government of Ontario has announced bold actions on industry emissions. The initiatives include consultations, emission limits for both nitrogen oxide and sulphur dioxide from all major industrial emitters, and tighter province-wide targets and timelines for nitrogen oxide and sulphur dioxide. refs., tabs., figs.

  16. Emission trading in Ontario : Understanding and managing compliance risk

    International Nuclear Information System (INIS)

    White, A.

    2002-01-01

    Mirant is one of the top five American energy marketer of power and gas, with more than 20,700 megawatts (MW) of electric generating capacity worldwide, of which 13,600 is in North America. The author presented a chart displaying nitrogen oxide emissions in Ontario, followed by another chart with the emissions of sulphur dioxide also in Ontario. The emission targets for the power sector were reviewed, as were the nitrogen oxide emission limits from 2002 to 2010. The major features of the Ontario legislation were discussed, covering allowance allocation, unlimited banking and limited provisions for credit. Ontario fossil capacity was reviewed, followed by emission allowance allocation. The issues and risks for Independent Power Producers were discussed. They included the emission rate compared to that of the competition, how much the facility was run last year and how much you expect to run it next year, the possibility of buying allowances or credits and at what cost. Looking to the future, the government of Ontario has announced bold actions on industry emissions. The initiatives include consultations, emission limits for both nitrogen oxide and sulphur dioxide from all major industrial emitters, and tighter province-wide targets and timelines for nitrogen oxide and sulphur dioxide. refs., tabs., figs

  17. A Study on Corporate Security Awareness and Compliance Behavior Intent

    Science.gov (United States)

    Clark, Christine Y.

    2013-01-01

    Understanding the drivers to encourage employees' security compliance behavior is increasingly important in today's highly networked environment to protect computer and information assets of the company. The traditional approach for corporations to implement technology-based controls, to prevent security breaches is no longer sufficient.…

  18. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS ... Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral ...

  19. Case outsourcing medical device reprocessing.

    Science.gov (United States)

    Haley, Deborah

    2004-04-01

    IN THE INTEREST OF SAVING MONEY, many hospitals are considering extending the life of some single-use medical devices by using medical device reprocessing programs. FACILITIES OFTEN LACK the resources required to meet the US Food and Drug Administration's tough quality assurance standards. BY OUTSOURCING, hospitals can reap the benefits of medical device reprocessing without assuming additional staffing and compliance burdens. OUTSOURCING enables hospitals to implement a medical device reprocessing program quickly, with no capital investment and minimal effort.

  20. [Compliance with antismoking laws in official institutions].

    Science.gov (United States)

    Cordovilla, R; Barrueco, M; González Ruiz, J M; Hernández, M A; de Castro, J; Gómez, F

    1997-01-01

    The prevention of nicotine addiction involves a wide range of measures, including writing laws to preserve public health by protecting nonsmokers from smoke and discouraging smokers from consumption. Also important are campaigns to educate both parties (smokers and nonsmokers) about the negative effects of tobacco. The main antismoking law in Spain is the Health and Consumer Ministry's Royal Decree 192/1988 limiting the sale and use of tobacco with the aim of protecting public health. Other regulations have since been enacted by public administrations to complement that law. Research finding published in recent years have been the basis for major legal changes leading in two directions; toward standardizing laws existing in different countries and toward increasing restrictions on the advertising and sale of tobacco. Various scientific and social groups have demanded that current laws be made stricter. Little has been done, however, to assess the degree of vigilance and compliance, and consequently the efficacy, of current legislation. The aim of this study was to determine the level of compliance with the law in governmental institutions in Salamanca. We visited 30 centers and saw that while notices prohibiting smoking were visible in 80%, the number of smokers was high: 43% among workers (none of whom was in educational or medical centers) and 37% among the public. No posters warning of the dangers of tobacco were seen in any of the centers visited. It appears necessary to further restrict the sale and use of tobacco in public places, to enforce compliance with existing regulations and to increase the amount of information on the toxic effects of tobacco in order to gain the cooperation of both smokers and nonsmokers toward achieving smoke-free environments.

  1. Compliance with therapy in children with respiratory diseases.

    Science.gov (United States)

    Schöni, M H; Horak, E; Nikolaizik, W H

    1995-01-01

    Compliance with medical treatment was evaluated in 89 children and adolescents with respiratory diseases using two methods of assessment: a double blinded covert recording of the use of an air compressor for nebulization of drugs and the determination of theophylline levels in serum. In the covert monitoring of inhalation the overall compliance with the prescribed medication was 47.6%. In the open randomized theophylline trial, 56%-71% of the patients (according to uncontrolled or controlled intake of the drug) received a dosage of theophylline which was too low to achieve a sufficient serum level in the range of 10-20 mg/l. This, however, was also due to the fact that in 72% of the cases physicians prescribed doses which were substantially below the recommended amount of drug according to age and weight. It is, therefore, concluded that compliance of medication is based on the patients adherence to the medication, to the efficacy of the drug itself and the attitude of the physician.

  2. ICF's Plant Compliance Assessment System

    International Nuclear Information System (INIS)

    Baker, S.M.

    1989-01-01

    Government and private industrial facilities must manage wastes that are both radioactive and (chemically) hazardous. Until recently, these mixed wastes have been managed under rules established under the Atomic Energy Act (AEA) and the Low-Level Waste Policy At, and rules that derive from environmental legislation have not been applied. Both sets of rules now apply to mixed wastes, creating situations in which significant changes to waste steams must be made in order to bring them into compliance with environmental regulations. The first step in bringing waste streams into compliance is to determine their status with respect to the newly-applicable regulations. This process of compliance assessment is difficult because requirements to minimize human exposure to radiation can conflict with requirements of environmental regulations, many regulations are potentially applicable, the regulations are changing rapidly, and because waste streams designed to operate under AEA rules frequently cannot be easily modified to incorporate the additional regulations. Modern personal computer (PC) tools are being developed to help regulatory analysts manage the large amounts of information required to asses the compliance status of complex process plants. This paper presents the Plant Compliance Assessment System (PCAS), which performs this function by relating a database containing references to regulatory requirements to databases created to describe relevant aspects of the facility to be assessed

  3. Patient compliance with drug therapy for postmenopausal osteoporosis

    International Nuclear Information System (INIS)

    Ahmad, A.; Khan, M.Y.

    2007-01-01

    To determine compliance and factors affecting compliance to antiresorptive drugs in osteoporosis, and to compare compliant and non compliant groups in a tertiary care setting. A total of 800 patients with postmenopausal osteoporosis were included in the study. The demographic and reproductive characteristics of all the patients were recorded. Type of antiresorptive drugs prescribed, degree of compliance, time and reasons for discontinuation were studied and analyzed. The mean age of the patients was 64 (+-9) years and their mean duration of follow-up 18 (+-5) months. The prevalence of risk factors for osteoporosis were evenly distributed among treatment groups; 73% patients had a co-morbidity besides osteoporosis while 27% were osteoporotic alone. One or more previous vertebral fractures due to osteoporosis was reported by 14.5% of patients, whereas 35.5% had at least one non-vertebral fracture in their medical history. Out of the total patients 21.5% discontinued the prescribed drug before attending the bone mass re-evaluations, more than half of these within first six months of starting the drugs. The medication that was most frequently discontinued within one year was calcium and vitamin-D (33.7%, p<0.01) while the least discontinued medication was Alendronate (5.9%, p < 0.01) which is taken once a week. In this study the most important determinant of compliance was the type of drug prescribed and its dose frequency, with a definite preference for Alendronate once a week. Treatment compliance was particularly poor for calcium and vitamin-D regimen, thereby emphasizing the need to find new ways of administering supplements, particularly for vitamin-D. (author)

  4. Improving ambulatory saliva-sampling compliance in pregnant women: a randomized controlled study.

    Directory of Open Access Journals (Sweden)

    Julian Moeller

    Full Text Available OBJECTIVE: Noncompliance with scheduled ambulatory saliva sampling is common and has been associated with biased cortisol estimates in nonpregnant subjects. This study is the first to investigate in pregnant women strategies to improve ambulatory saliva-sampling compliance, and the association between sampling noncompliance and saliva cortisol estimates. METHODS: We instructed 64 pregnant women to collect eight scheduled saliva samples on two consecutive days each. Objective compliance with scheduled sampling times was assessed with a Medication Event Monitoring System and self-reported compliance with a paper-and-pencil diary. In a randomized controlled study, we estimated whether a disclosure intervention (informing women about objective compliance monitoring and a reminder intervention (use of acoustical reminders improved compliance. A mixed model analysis was used to estimate associations between women's objective compliance and their diurnal cortisol profiles, and between deviation from scheduled sampling and the cortisol concentration measured in the related sample. RESULTS: Self-reported compliance with a saliva-sampling protocol was 91%, and objective compliance was 70%. The disclosure intervention was associated with improved objective compliance (informed: 81%, noninformed: 60%, F(1,60  = 17.64, p<0.001, but not the reminder intervention (reminders: 68%, without reminders: 72%, F(1,60 = 0.78, p = 0.379. Furthermore, a woman's increased objective compliance was associated with a higher diurnal cortisol profile, F(2,64  = 8.22, p<0.001. Altered cortisol levels were observed in less objective compliant samples, F(1,705  = 7.38, p = 0.007, with delayed sampling associated with lower cortisol levels. CONCLUSIONS: The results suggest that in pregnant women, objective noncompliance with scheduled ambulatory saliva sampling is common and is associated with biased cortisol estimates. To improve sampling compliance, results suggest

  5. Caregivers' compliance with referral advice

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy

    2018-01-01

    BACKGROUND: Several malaria endemic countries have implemented community health worker (CHW) programmes to increase access to populations underserved by health care. There is considerable evidence on CHW adherence to case management guidelines, however, there is limited evidence on the compliance...... in the control arm were trained to treat malaria with ACTs based on fever symptoms. Caregivers' referral forms were linked with CHW treatment forms to determine whether caregivers complied with the referral advice. Factors associated with compliance were examined with logistic regression. RESULTS: CHW saw 18......,497 child visits in the moderate-to-high transmission setting and referred 15.2% (2815/18,497) of all visits; in the low-transmission setting, 35.0% (1135/3223) of all visits were referred. Compliance to referral was low, in both settings

  6. Compliance als Schutz vor Verbandsverantwortlichkeit?

    Directory of Open Access Journals (Sweden)

    Alexander Tipold

    2016-05-01

    Full Text Available Compliance bedeutet nicht nur Einhaltung und Beachtung von Vorschriften, sondern betrifft auch Maßnahmen, die die Einhaltung der Rechtsnormen absichern sollen und läuft somit auf eine Übererfüllung von Verpflichtungen hinaus. Wenn es keinen klaren Maßstab für Kontroll- und Überwachungspflichten gibt, besteht die Gefahr, dass Strafverfolgungsbehörden die Compliance-Maßnahmen als Maßstab heranziehen und so eine Verschärfung der Pflichten erzeugen. Nach den Regeln des Verbandsverantwortlichkeitsgesetzes schließt im Übrigen das beste Compliance-System nicht zwingend die Verbandsverantwortlichkeit aus, steht aber unter Umständen einem Verfahren gegen den Verband entgegen.

  7. Contemplating compliance: European compliance mechanisms in international perspective

    NARCIS (Netherlands)

    Koops, C.E.

    2014-01-01

    How can international organizations make their Member States comply with the rules of the organization? Which is the more effective method: to coax and entice, to argue and persuade, or to threaten and punish? On the basis of which criteria should a compliance mechanism be construed and applied,

  8. Effect of a system-oriented intervention on compliance problems in schizophrenia

    DEFF Research Database (Denmark)

    Skarsholm, Hanne; Støvring, Henrik; Nielsen, Bent

    2014-01-01

    Background. Numerous studies have been conducted with a view to developing strategies for improvement of medical compliance in patients with schizophrenia. All of the studies conducted so far have had an individual approach to compliance based on the assumption that noncompliance is determined...... individually due to inappropriate behavior in the patient. We conducted a pragmatic controlled trial with a system-oriented approach, to provide a new perspective on compliance and test the efficacy of a multifactorial intervention at the system level in a routine clinical setting, an approach that has...... not previously been used for the improvement of compliance. Methods. 30 patients were allocated to the system-oriented therapy and 40 patients were allocated to the reference intervention, which consisted of individually based compliance therapy. The follow-up period was six months. Primary endpoint...

  9. THE ROLE OF LOCAL WISDOM TO TAX COMPLIANCE

    Directory of Open Access Journals (Sweden)

    I Nyoman Darmayasa

    2016-04-01

    Full Text Available Abstrak: Peran Kearifan Lokal Terhadap Kepatuhan Pajak. Penelitian ini bertujuan untuk memahami peran kearifan lokal terhadap kepatuhan pajak berdasar Self Assessment System (SAS di Lembaga Perkreditan Desa (LPD Legian Bali. Melalui paradigma interpretif dengan metode studi kasus, hasil penelitian menunjukkan bahwa makna kepatuhan pajak dideskripsikan sebagai kesadaran LPD untuk membayar pajak yang ditunjukkan melalui CSR berdasar Tri Hita Karana (THK. Implikasi teoretis dari penelitian ini terkait dengan makna dan perilaku kepatuhan pajak dari perspektif kearifan lokal. Hasil penelitian dapat dijadikan pertimbangan pembuat kebijakan untuk mempertimbangkan kearifan lokal dalam rangka meningkatkan kepatuhan pajak. Abstract: The Role of Local Wisdom on Tax Compliance. This study is intended to deepen our understanding about the meaning of the role of local wisdom on tax compliance in a village financing institution (LPD at Legian Bali. The research employed interpretive paradigm through case study. Results show that the meaning of tax compliance is described as awareness of LPD to pay taxes that is manifested in the implementation of CSR based on Tri Hita Karana (THK as local wisdom. Theoretical implications of this research is an alternative meaning and behavior of tax compliance from the perspective of local wisdom. The results can be used as consideration for taxation policy makers to raise local wisdom to encourage tax compliance.

  10. Tax Compliance Inventory: TAX-I Voluntary tax compliance, enforced tax compliance, tax avoidance, and tax evasion.

    Science.gov (United States)

    Kirchler, Erich; Wahl, Ingrid

    2010-06-01

    Surveys on tax compliance and non-compliance often rely on ad hoc formulated items which lack standardization and empirical validation. We present an inventory to assess tax compliance and distinguish between different forms of compliance and non-compliance: voluntary versus enforced compliance, tax avoidance, and tax evasion. First, items to measure voluntary and enforced compliance, avoidance, and evasion were drawn up (collected from past research and newly developed), and tested empirically with the aim of producing four validated scales with a clear factorial structure. Second, findings from the first analyses were replicated and extended to validation on the basis of motivational postures. A standardized inventory is provided which can be used in surveys in order to collect data which are comparable across research focusing on self-reports. The inventory can be used in either of two ways: either in its entirety, or by applying the single scales independently, allowing an economical and fast assessment of different facets of tax compliance.

  11. WIPP Regulatory Compliance Strategy and Management Plan for demonstrating compliance to long-term disposal standards

    International Nuclear Information System (INIS)

    1994-05-01

    The primary purpose of this document is to provide a strategy by which the WIPP will demonstrate its ability to perform as a deep geologic repository. The document communicates the DOE's understanding of the regulations related to long-term repository performance; and provides the most efficient strategy that intergrates WIPP Project elements, ensures the sufficiency of information, and provides flexibility for changes in the TRU waste generation system to facilitate the disposal of defense-generated TRU wastes. In addition, this document forms a focal point between the DOE and its various external regulators as well as other stakeholders for the purpose of arriving at compliance decisions that consider all relevant input

  12. Prediction of compliance with MRI procedures among children of ages 3 years to 12 years

    International Nuclear Information System (INIS)

    Cahoon, Glenn D.; Davison, Tanya E.

    2014-01-01

    A number of children are unable to comply with an MRI procedure and require general anesthetic. However, we lack information about which factors are associated with MRI compliance in young children. To determine the strongest predictors of MRI compliance, focusing on variables that can be easily rated by patients' parents. A sample of 205 children ages 3-11 years (mean age 6.6 years) who were at risk of non-compliance were recruited from a children's hospital. Their parents completed a behavior assessment scale for children as well as a questionnaire that assessed their expectations of compliance and perception of their child's typical medical compliance. The children subsequently completed a mock MRI with an educational play therapist and a clinical MRI, with the quality of the scan scored by the MRI technologist. Overall, 88.3% of children complied with the clinical scan and achieved diagnostic images, with age unrelated to compliance in this well-prepared patient group. The strongest predictors of MRI compliance were parental expectations and ratings of how well the child typically copes with medical procedures. Non-compliance was related to child attention problems and to poor adaptability among children. A total of 64 preschool-age children (91.4%) and 110 school-age children (95.7%) were correctly classified as compliant or non-compliant based on these predictor variables. A child's temperament, medical experiences and parental expectations provide important information in predicting which children successfully comply with an MRI procedure and which require general anesthesia. Further study is needed to explore the utility of these variables in predicting compliance at sites that do not have access to an MRI simulator. (orig.)

  13. Prediction of compliance with MRI procedures among children of ages 3 years to 12 years

    Energy Technology Data Exchange (ETDEWEB)

    Cahoon, Glenn D. [The Royal Children' s Hospital Melbourne, Medical Imaging Department, Parkville (Australia); Davison, Tanya E. [Monash University, Melbourne (Australia)

    2014-10-15

    A number of children are unable to comply with an MRI procedure and require general anesthetic. However, we lack information about which factors are associated with MRI compliance in young children. To determine the strongest predictors of MRI compliance, focusing on variables that can be easily rated by patients' parents. A sample of 205 children ages 3-11 years (mean age 6.6 years) who were at risk of non-compliance were recruited from a children's hospital. Their parents completed a behavior assessment scale for children as well as a questionnaire that assessed their expectations of compliance and perception of their child's typical medical compliance. The children subsequently completed a mock MRI with an educational play therapist and a clinical MRI, with the quality of the scan scored by the MRI technologist. Overall, 88.3% of children complied with the clinical scan and achieved diagnostic images, with age unrelated to compliance in this well-prepared patient group. The strongest predictors of MRI compliance were parental expectations and ratings of how well the child typically copes with medical procedures. Non-compliance was related to child attention problems and to poor adaptability among children. A total of 64 preschool-age children (91.4%) and 110 school-age children (95.7%) were correctly classified as compliant or non-compliant based on these predictor variables. A child's temperament, medical experiences and parental expectations provide important information in predicting which children successfully comply with an MRI procedure and which require general anesthesia. Further study is needed to explore the utility of these variables in predicting compliance at sites that do not have access to an MRI simulator. (orig.)

  14. Matrix compliance and the regulation of cytokinesis

    Directory of Open Access Journals (Sweden)

    Savitha Sambandamoorthy

    2015-07-01

    Full Text Available Integrin-mediated cell adhesion to the ECM regulates many physiological processes in part by controlling cell proliferation. It is well established that many normal cells require integrin-mediated adhesion to enter S phase of the cell cycle. Recent evidence indicates that integrins also regulate cytokinesis. Mechanical properties of the ECM can dictate entry into S phase; however, it is not known whether they also can affect the successful completion of cell division. To address this issue, we modulated substrate compliance using fibronectin-coated acrylamide-based hydrogels. Soft and hard substrates were generated with approximate elastic moduli of 1600 and 34,000 Pascals (Pa respectively. Our results indicate that dermal fibroblasts successfully complete cytokinesis on hard substrates, whereas on soft substrates, a significant number fail and become binucleated. Cytokinesis failure occurs at a step following the formation of the intercellular bridge connecting presumptive daughter cells, suggesting a defect in abscission. Like dermal fibroblasts, mesenchymal stem cells require cell-matrix adhesion for successful cytokinesis. However, in contrast to dermal fibroblasts, they are able to complete cytokinesis on both hard and soft substrates. These results indicate that matrix stiffness regulates the successful completion of cytokinesis, and does so in a cell-type specific manner. To our knowledge, our study is the first to demonstrate that matrix stiffness can affect cytokinesis. Understanding the cell-type specific contribution of matrix compliance to the regulation of cytokinesis will provide new insights important for development, as well as tissue homeostasis and regeneration.

  15. Tuberculosis in Canada: Detection, Intervention and Compliance

    Directory of Open Access Journals (Sweden)

    Katya Richardson

    2014-11-01

    Full Text Available This paper provides an overview of the current state of TB in Canada by referencing information presented at the workshop, “Tuberculosis: Detection, Prevention, and Compliance.” The workshop took place on November 14 and 15, 2012 in Ottawa. The workshop was organized by the Centre for Disease Modeling and the Public Health Agency of Canada as a two-day knowledge translation event that was comprised of scientific and policy focused presentations designed to address four key objectives: (1 Evaluate the success of current tuberculosis (TB health policies and control strategies in Canada and for specific Canadian sub-populations; (2 Determine the impact of detection, intervention, compliance, and education strategies in terms of TB incidence and prevalence; (3 Develop targets for future interventions by identifying key characteristics of TB epidemics that impact the success of TB health policies and control strategies; (4 Leverage our existing ties with public health decision makers, aboriginal health organizations, and organizations serving the homeless to develop a research community that is based on close collaboration, and will foster national TB control efforts. The workshop elicited robust discussions between experts from a variety of academic disciplines and government officials. A summary of the information presented, comments shared, and questions posed, will provide a comprehensive understanding of the status of TB in Canada and future directions to be taken for improved control of the disease.

  16. Project Compliance with Enterprise Architecture

    NARCIS (Netherlands)

    Foorthuis, R.M.

    2012-01-01

    This research project set out to identify effective practices and models for working with projects that are required to comply with Enterprise Architecture (EA), and investigate the benefits and drawbacks brought about by compliance. Research methods used are canonical action research, a statistical

  17. ETHICS AND COMPLIANCE IN BUSINESS

    Directory of Open Access Journals (Sweden)

    ANDREESCU Nicoleta Alina

    2015-05-01

    Full Text Available In this paper, we have studied the evolution of the business ethics concept through the prism of definitions from some renowned authors in the field and through the approach model of the business ethics and by implementing it in the company level. We have found out that in the last 40 years this concept has evolved from a theoretical aspect, as well as a practical one. Companies are motivated to implement ethics and compliance programs in business so that they can manage the changes that come from society. If, until recently, all that mattered for a company was profit, in the last decades, the situation changed. In order to develop a durable business, it is essential to have a good reputation. Owning and implementing an ethics and compliance program in business has become an imperative for companies, regardless of their activity sector. The role of the compliance department becomes more pregnant in each company: the employees need safety, the existence of communication lines provides comfort. From the partners in business’ point of view, owning such a program is a necessity, a condition, and not conforming to the principles of business ethics can lead to the isolation of the company. The ethics and compliance programs in business are instruments that protect the company by implementing certain proactive identification mechanisms that ensure the development of an ethical organizational culture.

  18. Audit-based compliance control

    NARCIS (Netherlands)

    Cederquist, J.G.; Dimitrakos, T.; Corin, R.J.; Martinelli, F.; Ryan, P.Y.A.; Dekker, M.A.C.; Etalle, Sandro; Schneider, S.; den Hartog, Jeremy; Lenzini, Gabriele

    2007-01-01

    In this paper we introduce a new framework for controlling compliance to discretionary access control policies [Cederquist et al. in Proceedings of the International Workshop on Policies for Distributed Systems and Networks (POLICY), 2005; Corin et al. in Proceedings of the IFIP Workshop on Formal

  19. Context-aware compliance checking

    NARCIS (Netherlands)

    Werf, van der J.M.E.M.; Verbeek, H.M.W.; Aalst, van der W.M.P.; Barros, A.; Gal, A.; Kindler, E.

    2012-01-01

    Organizations face more and more the burden to show that their business is compliant with respect to many different boundaries. The activity of compliance checking is commonly referred to as auditing. As information systems supporting the organization’s business record their usage, process mining

  20. A compliance testing program for diagnostic X-ray equipment

    International Nuclear Information System (INIS)

    Hutchinson, D.E.; Cobb, B.J.; Jacob, C.S.

    1999-01-01

    Compliance testing is nominally that part of a quality assurance program dealing with those aspects of X-ray equipment performance that are subject to radiation control legislation. Quality assurance programs for medical X-ray equipment should be an integral part of the quality culture in health care. However while major hospitals and individual medical centers may implement such programs with some diligence, much X-ray equipment can remain unappraised unless there is a comprehensive regulatory inspection program or some form of compulsion on the equipment owner to implement a testing program. Since the late 1950s all X-ray equipment in the State of Western Australia has been inspected by authorized officers acting on behalf of the Radiological Council, the regulatory authority responsible for administration of the State's Radiation Safety Act. However, economic constraints, coupled with increasing X-ray equipment numbers and a geographically large State have significantly affected the inspection rate. Data available from inspections demonstrate that regular compliance and performance checks are essential in order to ensure proper performance and to minimize unnecessary patient and operator dose. To ensure that diagnostic X-ray equipment complies with accepted standards and performance criteria, the regulatory authority introduced a compulsory compliance testing program for all medical, dental and chiropractic diagnostic X-ray equipment effective from 1 January 1997

  1. Noninfectious uveitis: strategies to optimize treatment compliance and adherence

    Directory of Open Access Journals (Sweden)

    Dolz-Marco R

    2015-08-01

    Full Text Available Rosa Dolz-Marco,1 Roberto Gallego-Pinazo,1 Manuel Díaz-Llopis,2 Emmett T Cunningham Jr,3–6 J Fernando Arévalo7,8 1Unit of Macula, Department of Ophthalmology, University and Polytechnic Hospital La Fe, 2Faculty of Medicine, University of Valencia, Spain; 3Department of Ophthalmology, California Pacific Medical Center, San Francisco, 4Department of Ophthalmology, Stanford University School of Medicine, Stanford, 5The Francis I Proctor Foundation, University of California San Francisco Medical Center, 6West Coast Retina Medical Group, San Francisco, CA, USA; 7Vitreoretina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 8Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Noninfectious uveitis includes a heterogenous group of sight-threatening ocular and systemic disorders. Significant progress has been made in the treatment of noninfectious uveitis in recent years, particularly with regard to the effective use of corticosteroids and non-corticosteroid immunosuppressive drugs, including biologic agents. All of these therapeutic approaches are limited, however, by any given patient’s ability to comply with and adhere to their prescribed treatment. In fact, compliance and adherence are among the most important patient-related determinants of treatment success. We discuss strategies to optimize compliance and adherence. Keywords: noninfectious uveitis, intraocular inflammation, immunosuppressive treatment, adherence, compliance, therapeutic failure

  2. Clean Air Markets - Compliance Query Wizard

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Compliance Query Wizard is part of a suite of Clean Air Markets-related tools that are accessible at http://ampd.epa.gov/ampd/. The Compliance module provides...

  3. 300 area TEDF permit compliance monitoring plan

    International Nuclear Information System (INIS)

    BERNESKI, L.D.

    1998-01-01

    This document presents the permit compliance monitoring plan for the 300 Area Treated Effluent Disposal Facility (TEDF). It addresses the compliance with the National Pollutant Discharge Elimination System (NPDES) permit and Department of Natural Resources Aquatic Lands Sewer Outfall Lease

  4. Mobile Source Emissions Regulatory Compliance Data Inventory

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Mobile Source Emissions Regulatory Compliance Data Inventory data asset contains measured summary compliance information on light-duty, heavy-duty, and non-road...

  5. 300 area TEDF permit compliance monitoring plan

    Energy Technology Data Exchange (ETDEWEB)

    BERNESKI, L.D.

    1998-11-20

    This document presents the permit compliance monitoring plan for the 300 Area Treated Effluent Disposal Facility (TEDF). It addresses the compliance with the National Pollutant Discharge Elimination System (NPDES) permit and Department of Natural Resources Aquatic Lands Sewer Outfall Lease.

  6. Mobile Source Emissions Regulatory Compliance Data

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Engine and Vehicle Compliance Certification and Fuel Economy Inventory contains measured emissions and fuel economy compliance information for all types of...

  7. Development, Implementation and Compliance of Treatment Pathways in Radiation Medicine

    Directory of Open Access Journals (Sweden)

    Louis ePotters

    2013-05-01

    Full Text Available INTRODUCTION: While much emphasis on safety in the radiation oncology clinic is placed on process, there remains considerable opportunity to increase safety, enhance outcomes and avoid ad-hoc care by instituting detailed treatment pathways. The purpose of this study was to review the process of developing evidence and consensus-based, outcomes-oriented treatment pathways that standardize treatment and patient management in a large multicenter radiation oncology practice. Further, we reviewed our compliance in incorporating these directives into our day-to-day clinical practice. METHODS: Using the Institute of Medicine guideline for developing treatment pathways, 87 disease specific pathways were developed and incorporated into the electronic medical system in our multi-facility radiation oncology department. Compliance in incorporating treatment pathways was assessed by mining our EMR data from January 1, 2010 through February 2012 for patients with breast and prostate cancer. RESULTS: This retrospective analysis of data from electronic medical records found overall compliance to breast and prostate cancer treatment pathways to be 97% and 99%, respectively. The reason for non-compliance proved to be either a failure to complete the prescribed care based on grade II or III toxicity (n=1 breast, 3 prostate or patient elected discontinuance of care (n=1 prostate or the physician chose a higher dose for positive/close margins (n=3 breast. CONCLUSION: This study demonstrates that consensus and evidence-based treatment pathways can be developed and implemented in a multi-center department of radiation oncology. And that for prostate and breast cancer there was a high degree of compliance using these directives. The development and implementation of these pathways serve as a key component of our safety program, most notably in our effort to facilitate consistent decision-making and reducing variation between physicians.

  8. Post Implementation of Goods and Services Tax (GST) in Malaysia: Tax Agents’ Perceptions on Clients’ Compliance Behaviour and Tax Agents’ Roles in Promoting Compliance

    OpenAIRE

    Muhammad Izlawanie

    2017-01-01

    The Malaysian government introduced the Goods and Services Tax (GST) starting from 1 April 2015 to enhance the revenue collections and mitigate the transfer pricing manipulation. Tax agents play a significant role to help businesses to comply with GST law and regulations. After one year of GST implementation, it is vital to understand tax agents’ perceptions on clients’ compliance behaviour and tax agents’ roles in influencing compliance. A total of 30 registered tax agents completed a survey...

  9. 14 CFR 26.49 - Compliance plan.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Compliance plan. 26.49 Section 26.49... Data for Repairs and Alterations § 26.49 Compliance plan. (a) Compliance plan. Except for applicants... January 11, 2008, each person identified in §§ 26.43, 26.45, and 26.47, must submit a compliance plan...

  10. GENDER AND ETHNICITY DIFFERENCES IN TAX COMPLIANCE

    OpenAIRE

    Jeyapalan Kasipillai; Hijattulah Abdul Jabbar

    2006-01-01

    The purpose of this study is to investigate whether gender and ethnicity differences occur in relation to tax compliance attitude and behavior. Prior studies on tax compliance have focused little on gender as a predictor of compliance. In Malaysia, ethnic background of a taxpayer could be a major determinant of tax compliance. A personal interview approach is used to obtain information from taxpayers in urban towns. A t-test suggests that males and females were found to have similar compliant...

  11. State regulatory issues in acid rain compliance

    International Nuclear Information System (INIS)

    Solomon, B.D.; Brick, S.

    1992-01-01

    This article discusses the results of a US EPA workshop for state regulators and commission staff on acid rain compliance concerns. The topics of the article include the results of market-based emissions control, how emissions trading is expected to reduce emissions, public utility commissions approval of compliance plans, the purposes of the workshop, market information, accounting issues, regulatory process and utility planning, multi-state compliance planning, and relationship to other compliance issues

  12. State and Alternative Fuel Provider Fleets Alternative Compliance; U.S. Department of Energy (DOE), Energy Efficiency & Renewable Energy (EERE)

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-08-01

    The final rule of the Energy Policy Act of 2005 and its associated regulations enable covered state and alternative fuel provider fleets to obtain waivers from the alternative fuel vehicle (AFV)-acquisition requirements of Standard Compliance. Under Alternative Compliance, covered fleets instead meet a petroleum-use reduction requirement. This guidance document is designed to help fleets better understand the Alternative Compliance option and successfully complete the waiver application process.

  13. Compliance with pharmacological treatment in outpatients from a Brazilian cardiology referral center

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Chizzola

    Full Text Available To evaluate the degree of compliance with pharmacological therapy, and to identify predictors of non-compliance in outpatients from a cardiology referral center in São Paulo, Brazil, we studied 485 outpatients, 230 (47.4 percent males and 255 (52.6 percent females, through an interview guided by a questionnaire during medical consultation. The ages ranged between 17 and 86 (mean 54, standard deviation 15 years. Heart disease and socioeconomic factors (residence, means of transport, educational level and professional status were studied. In addition, we examined the drugs prescribed including: difficulties in taking them; the source of supply; and the patient's knowledge of the drugs. Assessment of compliance was based on the patients' response. The patients' answers were compared with the prescription and progress notes. Errors were recorded if the patient reported using one or more nonprescribed medicines. Compliance with therapy was recorded if the patient said the prescription was taken correctly without interruption and without error. The variables with significant differences in univariate analysis were further analyzed by multivariate log-linear regression analysis. Noncompliance occurred in 286 (59 percent of the patients, and was predicted by the reported difficulty in taking medication (P<0.001, and by the lack of knowledge of medication names (P<0.001.Thus, noncompliance with medical therapy was common. The main predictors of non-compliance were the reported difficulty in taking medication and inability to identify medicines' names.

  14. 42 CFR 124.503 - Compliance level.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Compliance level. 124.503 Section 124.503 Public... Unable To Pay § 124.503 Compliance level. (a) Annual compliance level. Subject to the provisions of this... persons unable to pay if it provides for the fiscal year uncompensated services at a level not less than...

  15. 24 CFR 107.40 - Compliance meeting.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Compliance meeting. 107.40 Section... NONDISCRIMINATION AND EQUAL OPPORTUNITY IN HOUSING UNDER EXECUTIVE ORDER 11063 § 107.40 Compliance meeting. (a... allegedly in violation (respondent) shall be sent a Notice of Compliance Meeting and requested to attend a...

  16. 24 CFR 108.25 - Compliance meeting.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Compliance meeting. 108.25 Section... COMPLIANCE PROCEDURES FOR AFFIRMATIVE FAIR HOUSING MARKETING § 108.25 Compliance meeting. (a) Scheduling meeting. If an applicant fails to comply with requirements under § 108.15 or § 108.20 or it appears that...

  17. 22 CFR 209.6 - Compliance information.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Compliance information. 209.6 Section 209.6... § 209.6 Compliance information. (a) Cooperation and assistance. The Administrator shall to the fullest... and accurate compliance reports at such times, and in such form and containing such information, as...

  18. Type B Package Radioactive Material Contents Compliance

    International Nuclear Information System (INIS)

    HENSEL, STEVE

    2006-01-01

    Implementation of packaging and transportation requirements can be subdivided into three categories; contents compliance, packaging closure, and transportation or logistical compliance. This paper addresses the area of contents compliance within the context of regulations, DOE Orders, and appropriate standards. Common practices and current pitfalls are also discussed

  19. Effects of Long Duration Spaceflight on Venous and Arterial Compliance in Astronants

    Science.gov (United States)

    Platts, Steven; Ribeiro, L. Christine

    2014-01-01

    1. Project Overview Visual impairment and intracranial pressure (VIIP) is a spaceflight-associated medical condition affecting at least a third of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures. In some astronauts, eye-related changes do not revert back to the preflight state upon return to Earth. Our team will study some of the possible causes for this syndrome. This will be achieved by reviewing previous astronaut data for factors that may predispose astronauts to higher rates of developing this syndrome or greater severity of symptoms. Additionally, we will conduct 3 separate experiments that will characterize vessels in the head and neck and measure the effects of the experimental conditions on ocular structures and function. 2. Technical Summary The primary objective of this study is to determine whether vascular compliance is altered by spaceflight and whether such adaptations are related to the incidence of the VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no spaceflight experience (Ground), in astronauts before, during, and after spaceflight (Flight), and in bed rest subjects with conditions similar to spaceflight (Bed Rest). Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archives to determine which factors might be predictive of the development of VIIP (Data Mining). The project will be conducted in four separate, but related parts. Hypothesis The central hypothesis of this proposal is that exposure to the spaceflight environment aboard the ISS may lead to development of the VIIP syndrome (increased intracranial pressure and impaired visual acuity) and that this may be related to alterations in venous and/or arterial compliance in the head and neck. Specific Aims 1. To determine whether

  20. Tax Compliance Models: From Economic to Behavioral Approaches

    Directory of Open Access Journals (Sweden)

    Larissa Margareta BĂTRÂNCEA

    2012-06-01

    Full Text Available The paper reviews the models of tax compliance with an emphasis on economic and behavioral perspectives. Although the standard tax evasion model of Allingham and Sandmo and other similar economic models capture some important aspects of tax compliance (i.e., taxpayers’ response to increases in tax rate, audit probability, penalty rate they do not suffice the need for an accurate prediction of taxpayers’ behavior. The reason is that they do not offer a comprehensive perspective on the sociological and psychological factors which shape compliance (i.e., attitudes, beliefs, norms, perceptions, motivations. Therefore, the researchers have considered examining taxpayers’ inner motivations, beliefs, perceptions, attitudes in order to accurately predict taxpayers’ behavior. As a response to their quest, behavioral models of tax compliance have emerged. Among the sociological and psychological factors which shape tax compliance, the ‘slippery slope’ framework singles out trust in authorities and the perception of the power of authorities. The aim of the paper is to contribute to the understanding of the reasons for which there is a need for a tax compliance model which incorporates both economic and behavioral features and why governments and tax authorities should consider these models when designing fiscal policies.

  1. Monitoring compliance with standards of care for chronic diseases using healthcare administrative databases in Italy: Strengths and limitations.

    Directory of Open Access Journals (Sweden)

    Rosa Gini

    Full Text Available A recent comprehensive report on healthcare quality in Italy published by the Organization of Economic Co-operation and Development (OECD recommended that regular monitoring of quality of primary care by means of compliance with standards of care for chronic diseases is performed. A previous ecological study demonstrated that compliance with standards of care could be reliably estimated on regional level using administrative databases. This study compares estimates based on administrative data with estimates based on GP records for the same persons, to understand whether ecological fallacy played a role in the results of the previous study.We compared estimates of compliance with diagnostic and therapeutic standards of care for type 2 diabetes (T2DM, hypertension and ischaemic heart disease (IHD from administrative data (IAD with estimates from medical records (MR for the same persons registered with 24 GP's in 2012. Data were linked at an individual level.32,688 persons entered the study, 12,673 having at least one of the three diseases according to at least one data source. Patients not detected by IAD were many, for all three conditions: adding MR increased the number of cases of T2DM, hypertension, and IHD by +40%, +42%, and +104%, respectively. IAD had imperfect sensitivity in detecting population compliance with therapies (adding MR increased the estimate, from +11.5% for statins to +14.7% for antithrombotics, and, more substantially, with diagnostic recommendations (adding MR increased the estimate, from +23.7% in glycated hemoglobin tests, to +50.5% in electrocardiogram. Patients not detected by IAD were less compliant with respect to those that IAD correctly identified (from -4.8 percentage points in proportion of IHD patients compliant with a yearly glycated hemoglobin test, to -40.1 points in the proportion of T2DM patients compliant with the same recommendation. IAD overestimated indicators of compliance with therapeutic standards

  2. Exploring topical anti-glaucoma medication effects on the ocular surface in the context of the current understanding of dry eye.

    Science.gov (United States)

    Wong, Aaron B C; Wang, Michael T M; Liu, Kevin; Prime, Zak J; Danesh-Meyer, Helen V; Craig, Jennifer P

    2018-07-01

    To assess tear film parameters, ocular surface characteristics, and dry eye symptomology in patients receiving topical anti-glaucoma medications. Thirty-three patients with a diagnosis of open angle glaucoma or ocular hypertension, receiving unilateral topical anti-glaucoma medication for at least 6 months, were recruited in a cross-sectional, investigator-masked, paired-eye comparison study. Tear film parameters, ocular surface characteristics, and dry eye symptomology of treated and fellow eyes were evaluated and compared. The mean ± SD age of the participants was 67 ± 12 years, and the mean ± SD treatment duration was 5.3 ± 4.4 years. Treated eyes had poorer non-invasive tear film breakup time (p = 0.03), tear film osmolarity (p = 0.04), bulbar conjunctival hyperaemia (p = 0.04), eyelid margin abnormality grade (p = 0.01), tear meniscus height (p = 0.03), and anaesthetised Schirmer value (p = 0.04) than fellow eyes. There were no significant differences in dry eye symptomology, meibomian gland assessments, and ocular surface staining between treated and fellow eyes (all p > 0.05). Adverse changes in tear film stability, tear osmolarity, conjunctival hyperaemia, and eyelid margins were observed in treated eyes. This suggests that inflammatory mechanisms may be implicated in the development of dry eye in patients receiving long term topical anti-glaucoma therapy. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Motivation for Compliance with Environmental Regulation

    DEFF Research Database (Denmark)

    Winter, Søren; May, Peter J.

    2001-01-01

    A combination of calculated, normative, and social motivations as well as awareness of rules and capacity to comply are thought to foster compliance with regulations. Hypotheses about these factors were tested with data concerning Danish farmers’ compliance with agro-environmental regulations....... Three key findings emerge: that farmers’ awareness of rules plays a critical role; that normative and social motivations are as influential as calculated motivations in enhancing compliance; and that inspectors’ enforcement style affects compliance differently from that posited in much of the literature...... compliance with social and environmental regulations....

  4. Accelerators: radiation safety and regulatory compliance

    International Nuclear Information System (INIS)

    Bandyopadhyay, Tapas

    2013-01-01

    Growth of accelerators, both positive ions and electron, is very high in India. This may be because of the wide acceptance of these machines in the industrial purposes, medical uses, material science studies, upcoming ADSS facility and many other reasons. Most of cases for societal uses, accelerators have to be installed in the dense public domain. Accelerators for basic research and development purposes to be installed may in public domain or in isolated site. These accelerators are to be classified into different categories in terms of regulatory compliance. Radiation shield design, HVAC system required to be in place with design so that the dose and effluent discharge in the public domain is within a limit considering different pathways. INDUS I and II at Indore, K-130 and K500 machine at VECC, Pelletron at TIFR, IUAC, BARC, EBC at Mumbai are in operation. Apart from this accelerators, a series of medical accelerators in operation and yet to be operational which are generally producing PET isotopes for the diagnosis purposes. VECC is aiming to operate 30 MeV proton machine with about 500 μA beam current for the production of PET, SPECT isotopes for diagnosis purposes and also therapeutic use in near future. Detail requirement in terms of choice of sites, source term estimation for achieving optimum shield thickness, ventilation system, site layout and planning , radioactive effluent handling both gaseous and liquid, decommission aspects will be discussed. (author)

  5. A Retrospective Longitudinal Database Study of Persistence and Compliance with Treatment of Osteoporosis in Hungary.

    Science.gov (United States)

    Lakatos, Péter; Takács, István; Marton, István; Tóth, Emese; Zoltan, Cina; Lang, Zsolt; Psachoulia, Emi; Intorcia, Michele

    2016-03-01

    This study assessed persistence and compliance with anti-osteoporosis therapies, and associations between compliance and clinical outcomes (fracture, fracture-related hospitalization and death), in Hungarian women with postmenopausal osteoporosis. The study used the Hungarian National Health Insurance Fund Administration database and included women with PMO aged at least 50 years, for whom a prescription for anti-osteoporosis medication had been filled between 1 January 2004 and 31 December 2013 (index event). Persistence (prescription refilled within 8 weeks of the end of the previous supply) was evaluated over 2 years; good compliance (medication possession ratio ≥ 80 %) was evaluated at 1 year. Associations between compliance and clinical outcomes (data collected for up to 6 years) were assessed with adjustment for baseline covariates. A total of 296,300 women met the inclusion criteria (524,798 index events). Persistence and compliance were higher for less frequent and parenteral therapies (1- and 2-year persistence: half-yearly [parenteral] vs. daily/weekly/monthly [oral and parenteral], 81 and 38 % vs. 21-34 and 10-18 %, respectively; parenteral vs. oral, 75 and 36 % vs. 32 and 16 %; good compliance: half-yearly vs. daily/weekly/monthly, 70 vs. 24-39 %; parenteral vs. oral 78 vs. 36 %). Good compliance significantly reduced the risks of fracture, fracture-related hospitalization and death (relative risk vs. non-compliance [95 % confidence interval]: 0.77 [0.70-0.84], 0.72 [0.62-0.85] and 0.57 [0.51-0.64], respectively; P < 0.01). Improving compliance through long-interval parenteral therapies may result in clinical benefits for patients.

  6. Narratives of empowerment and compliance

    DEFF Research Database (Denmark)

    Wentzer, Helle; Bygholm, Ann

    2013-01-01

    Purpose: New technologies enable new forms of patient participation in health care. Thearticle discusses whether communication in online patient support groups is a source ofindividual as well as collective empowerment or to be understood within the tradition ofcompliance. The discussion is based...... of empowerment and compliance in patient care. On a collective level, the site isempowering the individual users to comply with ‘doctor’s recommendations’ as a group....

  7. Revisiting the generalized scaling law for adhesion: role of compliance and extension to progressive failure.

    Science.gov (United States)

    Mojdehi, Ahmad R; Holmes, Douglas P; Dillard, David A

    2017-10-25

    A generalized scaling law, based on the classical fracture mechanics approach, is developed to predict the bond strength of adhesive systems. The proposed scaling relationship depends on the rate of change of debond area with compliance, rather than the ratio of area to compliance. This distinction can have a profound impact on the expected bond strength of systems, particularly when the failure mechanism changes or the compliance of the load train increases. Based on the classical fracture mechanics approach for rate-independent materials, the load train compliance should not affect the force capacity of the adhesive system, whereas when the area to compliance ratio is used as the scaling parameter, it directly influences the bond strength, making it necessary to distinguish compliance contributions. To verify the scaling relationship, single lap shear tests were performed for a given pressure sensitive adhesive (PSA) tape specimens with different bond areas, number of backing layers, and load train compliance. The shear lag model was used to derive closed-form relationships for the system compliance and its derivative with respect to the debond area. Digital image correlation (DIC) is implemented to verify the non-uniform shear stress distribution obtained from the shear lag model in a lap shear geometry. The results obtained from this approach could lead to a better understanding of the relationship between bond strength and the geometry and mechanical properties of adhesive systems.

  8. Psychological causes of non-compliance with electronically monitored occlusion therapy for amblyopia.

    Science.gov (United States)

    Loudon, S E; Passchier, J; Chaker, L; de Vos, S; Fronius, M; Harrad, R A; Looman, C W N; Simonsz, B; Simonsz, H J

    2009-11-01

    To analyse psychological causes for low compliance with occlusion therapy for amblyopia. In a randomised trial, the effect of an educational programme on electronically measured compliance had been assessed. 149 families who participated in this trial completed a questionnaire based on the Protection Motivation Theory after 8 months of treatment. Families with compliance less than 20% of prescribed occlusion hours were interviewed to better understand their cause for non-compliance. Poor compliance was most strongly associated with a high degree of distress (p<0.001), followed by low perception of vulnerability (p = 0.014), increased stigma (p = 0.017) and logistical problems with treatment (p = 0.044). Of 44 families with electronically measured compliance less than 20%, 28 could be interviewed. The interviews confirmed that lack of knowledge, distress and logistical problems resulted in non-compliance. Poor parental knowledge, distress and difficulties implementing treatment seemed to be associated with non-compliance. For the same domains, the scores were more favourable for families who had received the educational programme than for those who had not.

  9. Correlates of Tax Compliance of Small and Medium Size Businesses in Cameroon

    Directory of Open Access Journals (Sweden)

    Oludele Akinloye Akinboade

    2015-12-01

    Full Text Available Taxation provides a predictable and stable flow of revenue to finance development objectives. This is important in a country like Cameroon that has serious challenges with meeting its development objectives. Small and medium enterprises (SMEs are significant for economic growth in the country, contributing as much as about 22 percent of the gross domestic product. SMEs generate taxable incomes. They also collect employment and value added taxes on behalf of the government. Taxation, however, imposes high cost to small businesses. SMEs are less tax compliant in comparison to large businesses. SMEs are considered the ‘hard to tax group from the informal sector.’ As such, the literature suggests that only a fraction of their taxable incomes is reported to tax authorities. Against this background, factors that correlate with tax compliance of 575 small and medium size companies in Cameroon are discussed from a survey of companies in the manufacturing and wholesale sectors. High registration cost and time-consuming processes promote tax non-compliance. The perception that tax system is corrupt discourages registration and filing compliance. When there are too many compliance hurdles, the probability of filing compliance is reduced. However, a fair and static system encourages filing and registration compliance. A clear and consistent tax system promotes filing compliance. Authorities that understand their responsibilities and are willing to respond to enquiries during the registration process promote tax compliance in general.

  10. Compliance with periodic surveillance for Von-Hippel-Lindau disease.

    Science.gov (United States)

    Lammens, Chantal R M; Aaronson, Neil K; Hes, Frederik J; Links, Thera P; Zonnenberg, Bernard A; Lenders, Jacques W M; Majoor-Krakauer, Danielle; Van Os, Theo A M; Gomez-Garcia, Encarna B; de Herder, Wouter; van der Luijt, Rob B; van den Ouweland, Ans M W; Van Hest, Liselot P; Verhoef, Senno; Bleiker, Eveline M A

    2011-06-01

    To assess compliance with a periodic surveillance regimen for Von Hippel-Lindau disease. In this nationwide study, Von Hippel-Lindau disease mutation carriers and those at 50% risk were invited to complete a questionnaire assessing (compliance with) advice given for periodic surveillance. Medical record data on compliance with recommended radiologic surveillance examinations were also collected. Of the 84 (77%) participants, 78 indicated having received advice to undergo periodic surveillance. Of these, 71 reported being fully compliant with that advice. In 64% of the cases, this advice was only partially consistent with published guidelines. Based on medical record data, between one quarter and one third of individuals did not undergo surveillance as recommended in the guidelines for central nervous system lesions and one half for visceral lesions. Screening delay for central nervous system lesions was significantly higher in one hospital and in those cases where "the advice given" deviated from the guidelines. The majority of those with or at risk of Von Hippel-Lindau disease reported having received and being fully compliant with screening advice. However, in many cases, the advice given was only partially consistent with published guidelines, and screening delays were observed. Efforts should be undertaken to stimulate guideline-based surveillance advice and to minimize screening delay.

  11. Environmental Compliance by Firms in the Manufacturing Sector in Mexico

    OpenAIRE

    Lata Gangadharan

    2003-01-01

    To date, little empirical evidence exists to help regulators understand why some firms comply even when there is little financial incentive to do so and others continually violate environmental regulations. This paper examines data on compliance with environmental regulations within the manufacturing sector in Mexico. The probability of complying depends, among other factors, on the kind of management practices of the firm and the level of environmental training. Some firms in the manufacturi...

  12. Psychosocial framework for understanding psychological distress among survivors of the November 26, 2008 Mumbai terror attack: beyond traumatic experiences and emergency medical care.

    Science.gov (United States)

    Joseph, Jacquleen; Jaswal, Surinder

    2014-06-01

    The field of "Public Health in Disasters and Complex Emergencies" is replete with either epidemiological studies or studies in the area of hospital preparedness and emergency care. The field is dominated by hospital-based or emergency phase-related literature, with very little attention on long-term health and mental health consequences. The social science, or the public mental health perspective, too, is largely missing. It is in this context that the case report of the November 26, 2008 Mumbai terror attack survivors is presented to bring forth the multi-dimensional and dynamic long-term impacts, and their consequences for psychological well-being, two years after the incident. Based on literature, the report formulates a theoretical framework through which the lived experiences of the survivors is analyzed and understood from a social science perspective. This report is an outcome of the ongoing work with the survivors over a period of two years. A mixed methodology was used. It quantitatively captures the experience of 231 families following the attack, and also uses a self-reporting questionnaire (SRQ), SRQ20, to understand the psychological distress. In-depth qualitative case studies constructed from the process records and in-depth interviews focus on lived experiences of the survivors and explain the patterns emerging from the quantitative analysis. This report outlines the basic profile of the survivors, the immediate consequences of the attack, the support received, psychological consequences, and the key factors contributing to psychological distress. Through analysis of the key factors and the processes emerging from the lived experiences that explain the progression of vulnerability to psychological distress, this report puts forth a psychosocial framework for understanding psychological distress among survivors of the November 26, 2008 Mumbai terror attack.

  13. Bringing it all back home: Understanding the medical difficulties encountered by newly released prisoners in New Orleans, Louisiana - a qualitative study.

    Science.gov (United States)

    Vail, William Lee; Niyogi, Anjali; Henderson, Norris; Wennerstrom, Ashley

    2017-07-01

    Formerly incarcerated persons (FIPs) face a disproportionate risk of death and serious illness in the immediate post-release period. Therefore, it is a critical time to initiate community-based care for chronic illnesses and behavioural disorders. Little is known about the unique transitional health and social support needs of FIPs in Louisiana, which has the highest incarceration rate in the world. As the average age of prisoners in the United States rises, the release of older prisoners with chronic conditions will become increasingly common. The aim of this study was to explore the healthcare experiences of FIPs in Louisiana in order to inform delivery of services tailored to this population. This research was done in partnership with a community organisation that advocates for restoration of voting rights to FIPs and helps newly released individuals transition back into society. This organisation identified FIPs in the Greater New Orleans area, and from January to May 2015, we conducted 24 semi-structured, in-person, audio-recorded interviews at the community organisation's transitional living facility. The interviews assessed FIPs' experiences with and barriers to receiving healthcare during and after incarceration. These discussions also explored FIPs' desires for services and attitudes towards health and healthcare. Interviews were transcribed and independently coded by two researchers. Interviewees reported negative experiences with healthcare during incarceration, and limited health guidance during the pre-release process. Post-release concerns included lack of insurance, difficulty accessing care and medication, and interest in learning about healthy lifestyles. Results suggest a need for a formalised system of transitional healthcare for FIPs. Findings are being used to inform a pilot transitional care clinic in New Orleans, Louisiana. © 2017 John Wiley & Sons Ltd.

  14. Medical Malpractice

    DEFF Research Database (Denmark)

    Grembi, Veronica

    2014-01-01

    MM first came to the attention of policy makers primarily in the USA where, from the 1970s, healthcare providers denounced problems in getting insurance for medical liability, pointing out to a crisis in the MM insurance market (Sage WM (2003) Understanding the first malpractice crisis of the 21th...

  15. A quasi-experimental study to determine the effects of a multifaceted educational intervention on hand hygiene compliance in a radiography unit.

    Science.gov (United States)

    O'Donoghue, Margaret; Ng, Suk-Hing; Suen, Lorna Kp; Boost, Maureen

    2016-01-01

    Whilst numerous studies have investigated nurses' compliance with hand hygiene and use of alcohol-based hand rub (ABHR), limited attention has been paid to these issues in allied health staff. Reports have linked infections to breaches in infection control in the radiography unit (RU). With advances in medical imaging, a higher proportion of patients come into contact with RU staff increasing the need for good hand hygiene compliance. This study aimed to evaluate effectiveness on compliance of an intervention to improve awareness of hand hygiene in the RU of a district hospital. A quasi-experimental study design including questionnaires assessing knowledge and attitudes of hand hygiene and direct observation of participants was used to evaluate an educational programme on hand hygiene of the RU of a large district hospital. All healthcare workers (HCW), comprising 76 radiographers, 17 nurses, and nine healthcare assistants (HCA), agreed to participate in the study. Of these, 85 completed the initial and 76 the post-test anonymous questionnaire. The hand hygiene compliance of all 102 HCW was observed over a 3-week period prior to and after the intervention. The 2-month intervention consisted of talks on hand hygiene and benefits of ABHR, provision of visual aids, wall-mounted ABHR dispensers, and personal bottles of ABHR. Before the intervention, overall hand hygiene compliance was low (28.9 %). Post-intervention, compliance with hand hygiene increased to 51.4 %. This improvement was significant for radiographers and HCA. Additionally, knowledge and attitudes improved in particular, understanding that ABHR can largely replace handwashing and there is a need to perform hand hygiene after environmental contact. The increased use of ABHR allowed HCW to feel they had enough time to perform hand hygiene. The educational intervention led to increased awareness of hand hygiene opportunities and better acceptance of ABHR use. The reduced time needed to perform hand

  16. A quasi-experimental study to determine the effects of a multifaceted educational intervention on hand hygiene compliance in a radiography unit

    Directory of Open Access Journals (Sweden)

    Margaret O’Donoghue

    2016-10-01

    Full Text Available Abstract Background Whilst numerous studies have investigated nurses’ compliance with hand hygiene and use of alcohol-based hand rub (ABHR, limited attention has been paid to these issues in allied health staff. Reports have linked infections to breaches in infection control in the radiography unit (RU. With advances in medical imaging, a higher proportion of patients come into contact with RU staff increasing the need for good hand hygiene compliance. This study aimed to evaluate effectiveness on compliance of an intervention to improve awareness of hand hygiene in the RU of a district hospital. Methods A quasi-experimental study design including questionnaires assessing knowledge and attitudes of hand hygiene and direct observation of participants was used to evaluate an educational programme on hand hygiene of the RU of a large district hospital. All healthcare workers (HCW, comprising 76 radiographers, 17 nurses, and nine healthcare assistants (HCA, agreed to participate in the study. Of these, 85 completed the initial and 76 the post-test anonymous questionnaire. The hand hygiene compliance of all 102 HCW was observed over a 3-week period prior to and after the intervention. The 2-month intervention consisted of talks on hand hygiene and benefits of ABHR, provision of visual aids, wall-mounted ABHR dispensers, and personal bottles of ABHR. Results Before the intervention, overall hand hygiene compliance was low (28.9 %. Post-intervention, compliance with hand hygiene increased to 51.4 %. This improvement was significant for radiographers and HCA. Additionally, knowledge and attitudes improved in particular, understanding that ABHR can largely replace handwashing and there is a need to perform hand hygiene after environmental contact. The increased use of ABHR allowed HCW to feel they had enough time to perform hand hygiene. Conclusions The educational intervention led to increased awareness of hand hygiene opportunities and better

  17. Medications (for IBS)

    Medline Plus

    Full Text Available ... by a physician who specializes in motility or stress-related gastrointestinal disorders. More complex medication regimens, and ... IBS Medications Probiotics and Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation Techniques for IBS Take ...

  18. Compliance management and corporate governance; Compliance Management und Corporate Governance

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Uwe [Stadt Frankfurt am Main (Germany); Alsheimer, Constantin; Kassebohm, Kristian; Reutler, Susanne [Mainova AG, Frankfurt (Germany)

    2009-08-15

    Starting in the year 2009, numerous changes in the financial system and accountancy a well as in the corporate law come into effect for enterprises. Thereby, the requirements substantially are intensified to their corporate governance. The actual well-known reproaches of bribery, corruption and injuries of data protection intensify the pressure on executive committees and supervisory boards in order to meet normative and ethical requirements. All the more is valid for power suppliers whose reputation can already carry damage out with the first suspicion. Already in 2008, Mainova AG (Frnkfurt/Main, Federal Republic of Germany) implemented a compliance management.

  19. 76 FR 66074 - Small Entity Compliance Guide: Required Warnings for Cigarette Packages and Advertisements...

    Science.gov (United States)

    2011-10-25

    ...The Food and Drug Administration (FDA) is announcing the availability of a guidance for industry entitled ``Required Warnings for Cigarette Packages and Advertisements--Small Entity Compliance Guide'' for a final rule published in the Federal Register on June 22, 2011. This small entity compliance guide (SECG) is intended to set forth in plain language the requirements of the regulation and to help small businesses understand and comply with the regulation.

  20. The Relationship between Stroke Patients Characteristics and Family Support with Compliance Rehabilitation

    Directory of Open Access Journals (Sweden)

    Irma Okta Wardhani

    2015-01-01

    Full Text Available Stroke is a cerebrovascular disease, it is brain function disorders associated with the disease of the blood vessels that supply the brain. The impact of stroke is paralysis. Family support is things that are needed to be considered in the treatment of stroke patients. It is very involved in the compliance rehabilitation of patients to prevent the re-occurrence of stroke. Characteristics of stroke patients may also affect the compliance rehabilitation. The purpose of this research is to determine the relationship between stroke patients characteristics and family support to compliance rehabilitation at the Medical Rehabilitation Unit RSU Haji Surabaya. This research was an analytic observational research with cross sectional design. The subjects of this research are taken using total population technique. The independent variables in this research is family support. The dependent variable is compliance rehabilitation. The results of this research are presented in the form of frequency distributions and calculate the strength of the relationship with Phi coefficient. The result of this research shows that there is a strong relationship between family support and compliance rehabilitation (r=0.582. There are weak relationship between ages (r=-0,027, gender (r=0,092, level of education (r= -0,295, work (r=0,098, and marital status (r=0,319. The conclusion is family support may affect compliance rehabilitation of stroke patients. It is recommended for health workers to provide counseling to improve family support in curing stroke patients. Keywords: depression, family support, compliance rehabilitation

  1. Determinants of compliance with malaria chemoprophylaxis among French soldiers during missions in inter-tropical Africa

    Directory of Open Access Journals (Sweden)

    Pradines Bruno

    2010-02-01

    Full Text Available Abstract Background The effectiveness of malaria chemoprophylaxis is limited by the lack of compliance whose determinants are not well known. Methods The compliance with malaria chemoprophylaxis has been estimated and analysed by validated questionnaires administered before and after the short-term missions (about four months in five tropical African countries of 2,093 French soldiers from 19 military companies involved in a prospective cohort study. "Correct compliance" was defined as "no missed doses" of daily drug intake during the entire mission and was analysed using multiple mixed-effect logistic regression model. Results The averaged prevalence rate of correct compliance was 46.2%, ranging from 9.6%to 76.6% according to the companies. Incorrect compliance was significantly associated with eveningness (p = 0.028, a medical history of clinical malaria (p Conclusions The identification of circumstances and profiles of persons at higher risk of lack of compliance would pave the way to specifically targeted strategies aimed to improve compliance with malaria chemoprophylaxis and, therefore, its effectiveness.

  2. Applying the Analytic Hierarchy Process to Oil Sands Environmental Compliance Risk Management

    Science.gov (United States)

    Roux, Izak Johannes, III

    Oil companies in Alberta, Canada, invested $32 billion on new oil sands projects in 2013. Despite the size of this investment, there is a demonstrable deficiency in the uniformity and understanding of environmental legislation requirements that manifest into increased project compliance risks. This descriptive study developed 2 prioritized lists of environmental regulatory compliance risks and mitigation strategies and used multi-criteria decision theory for its theoretical framework. Information from compiled lists of environmental compliance risks and mitigation strategies was used to generate a specialized pairwise survey, which was piloted by 5 subject matter experts (SMEs). The survey was validated by a sample of 16 SMEs, after which the Analytic Hierarchy Process (AHP) was used to rank a total of 33 compliance risks and 12 mitigation strategy criteria. A key finding was that the AHP is a suitable tool for ranking of compliance risks and mitigation strategies. Several working hypotheses were also tested regarding how SMEs prioritized 1 compliance risk or mitigation strategy compared to another. The AHP showed that regulatory compliance, company reputation, environmental compliance, and economics ranked the highest and that a multi criteria mitigation strategy for environmental compliance ranked the highest. The study results will inform Alberta oil sands industry leaders about the ranking and utility of specific compliance risks and mitigations strategies, enabling them to focus on actions that will generate legislative and public trust. Oil sands leaders implementing a risk management program using the risks and mitigation strategies identified in this study will contribute to environmental conservation, economic growth, and positive social change.

  3. Poster — Thur Eve — 50: Common Regulatory Non-Compliances and How to Avoid Them

    Energy Technology Data Exchange (ETDEWEB)

    Heimann, M.

    2014-08-15

    The Accelerators and Class II Facilities Division (ACFD) of the Canadian Nuclear Safety Commission (CNSC), is responsible for the oversight of radiotherapy facilities containing Class II prescribed equipment in Canada. Over the past several years, ACFD has been performing compliance inspections of Class II nuclear facilities across the country (medical and otherwise), and in that time, has issued several hundred corrective actions to licensees due to non-compliance with regulatory requirements. Recently, a study was done to determine the most common regulatory non-compliances. The purpose of this poster presentation is to disseminate information to the licensee community about the nature of these non-compliances, and how they can be avoided by licensees in the future.

  4. Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique analysis.

    Science.gov (United States)

    Strömberg, A; Broström, A; Dahlström, U; Fridlund, B

    1999-01-01

    The aim of this study was to identify factors influencing compliance with prescribed treatment in patients with chronic heart failure. A qualitative design with a critical incident technique was used. Incidents were collected through interviews with 25 patients with heart failure strategically selected from a primary health care clinic, a medical ward, and a specialist clinic. Two hundred sixty critical incidents were identified in the interviews and 2 main areas emerged in the analysis: inward factors and outward factors. The inward factors described how compliance was influenced by the personality of the patient, the disease, and the treatment. The outward factors described how compliance was influenced by social activities, social relationships, and health care professionals. By identifying the inward and outward factors influencing patients with chronic heart failure, health care professionals can assess whether intervention is needed to increase compliance.

  5. Dietary compliance in Iranian children and adolescents with celiac disease

    Directory of Open Access Journals (Sweden)

    Taghdir M

    2016-08-01

    Full Text Available Maryam Taghdir,1 Naser Honar,2 Seyed Mohammad Mazloomi,3 Mojtaba Sepandi,4 Mahkameh Ashourpour,1 Musa Salehi5 1Student Research Committee, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; 2Department of Pediatric Gastroenterology and Hepatology, Shiraz University of Medical Sciences, Shiraz, Iran; 3Nutrition Research Center, Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; 4Department of Epidemiology and Biostatistics, Baqyiatallah University of Medical Sciences, Tehran, Iran; 5Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Introduction: Celiac disease (CD is caused due to intake of gluten, a protein component in wheat, barley, and rye. The only treatment currently available for CD is strict lifetime adherence to a gluten-free diet (GFD which is a diet that excludes wheat, barley, and rye. There is limited information on barriers to following a GFD. The present study aimed to investigate the compliance with a GFD, barriers to compliance, and the impact of compliance on the quality of life (QOL in Iranian children and adolescents suffering from CD.Methods: In this cross-sectional study, a total of 65 known cases of CD (both males and females, diagnosed in Namazi Hospital, a large referral center in south of Iran, selected by census were studied in 2014. Dietary compliance was assessed using a questionnaire. A disease-specific QOL questionnaire for children with CD (the celiac disease DUX [CDDUX] was used. Comparisons between categorical variables were performed using chi-square test.Results: Sixty-five patients, 38 females (58.5% and 27 (41.5% males, were surveyed. Mean (± standard deviation [SD] age of the respondents was 11.3 (±3.8 years. Dietary compliance was reported by

  6. Can't get no satisfaction? Will pay for performance help?: toward an economic framework for understanding performance-based risk-sharing agreements for innovative medical products.

    Science.gov (United States)

    Towse, Adrian; Garrison, Louis P

    2010-01-01

    This article examines performance-based risk-sharing agreements for pharmaceuticals from a theoretical economic perspective. We position these agreements as a form of coverage with evidence development. New performance-based risk sharing could produce a more efficient market equilibrium, achieved by adjustment of the price post-launch to reflect outcomes combined with a new approach to the post-launch costs of evidence collection. For this to happen, the party best able to manage or to bear specific risks must do so. Willingness to bear risk will depend not only on ability to manage it, but on the degree of risk aversion. We identify three related frameworks that provide relevant insights: value of information, real option theory and money-back guarantees. We identify four categories of risk sharing: budget impact, price discounting, outcomes uncertainty and subgroup uncertainty. We conclude that a value of information/real option framework is likely to be the most helpful approach for understanding the costs and benefits of risk sharing. There are a number of factors that are likely to be crucial in determining if performance-based or risk-sharing agreements are efficient and likely to become more important in the future: (i) the cost and practicality of post-launch evidence collection relative to pre-launch; (ii) the feasibility of coverage with evidence development without a pre-agreed contract as to how the evidence will be used to adjust price, revenues or use, in which uncertainty around the pay-off to additional research will reduce the incentive for the manufacturer to collect the information; (iii) the difficulty of writing and policing risk-sharing agreements; (iv) the degree of risk aversion (and therefore opportunity to trade) on the part of payers and manufacturers; and (v) the extent of transferability of data from one country setting to another to support coverage with evidence development in a risk-sharing framework. There is no doubt that

  7. Tax compliance costs: a business administration perspective

    OpenAIRE

    Eichfelder, Sebastian; Schorn, Michael

    2009-01-01

    The paper analyses the relationship of tax compliance costs and business strategy. Due to instruments, like information technology, simplified cash accounting or outsourcing compliance activities to tax advisers, private businesses have a set of strategies to optimize their tax compliance cost burden. Under the assumption of rational choice a private business should choose a cost-optimal administration strategy. In spite of that we find empirical evidence for small German businesses using onl...

  8. The creep compliance, the relaxation modulus and the complex compliance of linear viscoelastic, homogeneous, isotropic materials

    International Nuclear Information System (INIS)

    Wong, P.K.

    1989-01-01

    This paper reports on a study to obtain the creep compliance, the relaxation modulus and the complex compliance derived from the concept of mechanical resistance for the constitutive equation of a class of linear viscoelastic, homogeneous, isotropic materials

  9. 12 CFR 1710.19 - Compliance and risk management programs; compliance with other laws.

    Science.gov (United States)

    2010-01-01

    ... OVERSIGHT, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SAFETY AND SOUNDNESS CORPORATE GOVERNANCE Corporate Practices and Procedures § 1710.19 Compliance and risk management programs; compliance with other laws. (a...

  10. Utilization of handheld computing to simplify compliance

    International Nuclear Information System (INIS)

    Galvin, G.; Rasmussen, J.; Haines, A.

    2008-01-01

    Monitoring job site performance and building a continually improving organization is an ongoing challenge for operators of process and power generation facilities. Stakeholders need to accurately capture records of quality and safety compliance, job progress, and operational experiences (OPEX). This paper explores the use of technology-enabled processes as a means for simplifying compliance to quality, safety, administrative, maintenance and operations activities. The discussion will explore a number of emerging technologies and their application to simplifying task execution and process compliance. This paper will further discuss methodologies to further refine processes through trending improvements in compliance and continually optimizing and simplifying through the use of technology. (author)

  11. EPA Enforcement and Compliance History Online

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Environmental Protection Agency's Enforcement and Compliance History Online (ECHO) website provides customizable and downloadable information about environmental...

  12. Compliance and Caregiver Satisfaction in Alzheimer’s Disease: Results from the AXEPT Study

    Directory of Open Access Journals (Sweden)

    Roberto Bernabei

    2012-10-01

    Full Text Available Background/Aims: According to experimental data, a transdermal application is preferred by caregivers of Alzheimer’s disease (AD patients compared with oral medications. The AXEPT study compared compliance to treatment among community-dwelling patients with mild-to-moderate AD treated with transdermal application compared to oral medications and caregiver satisfaction in a real clinical setting. Methods: Data from 45 memory clinics in Italy were collected between September 8, 2010 and January 31, 2011. Compliance to treatment and caregiver satisfaction were measured using the Caregiver Medication Interview. Results: A total of 855 AD patients and their caregivers participated in the study. Nearly 80% of caregivers of patients on patch were not concerned about adherence to treatment compared with 64% of caregivers of patients on oral drugs. Among caregivers of patients on patch, 94% did not report any difficulties in remembering to administer treatment compared with 73% of caregivers of patients on oral medications. The highest level of compliance and satisfaction was reported by caregivers of patients on transdermal application. Conclusion: Caregivers of patients treated with a transdermal application appeared to be more satisfied and reported a higher level of compliance than caregivers of patients receiving anti-AD oral medications.

  13. Cure or curse? Ambivalent attitudes towards neuroleptic medication in schizophrenia and non-schizophrenia patients

    OpenAIRE

    Dieter Naber; Peter Tonn; Azra Deljkovic; Anne Karow; Maarten J.V. Peters; Steffen Moritz

    2009-01-01

    Neuroleptic non-compliance remains a serious challenge for the treatment of psychosis. Non-compliance is predominantly attributed to side effects, lack of illness insight, reduced well-being or poor therapeutic alliance. However, other still neglected factors may also play a role. Further, little is known about whether psychiatric patients without psychosis who are increasingly prescribed neuroleptics differ in terms of medication compliance or about reasons for non-compliance by psychosis pa...

  14. Drug Brand Response and Its Impact on Compliance and Efficacy in Depression Patients.

    Science.gov (United States)

    Li, Mingming; Cai, Jian; Zhang, Ping; Fei, Chunhua; Xu, Feng

    2016-01-01

    Introduction: Patient's response to drug brand is a comprehensive physiological and psychological effect which might impact the compliance and efficacy of drugs. Whether the therapeutic outcome altered on patients with brand response after they experience drug switch is not clear. Methods: 459 outpatients with mild-to-moderate depression were divided into the imported (joint venture) drug group and the domestic drug group according to their current drug application. Two groups of patients were assessed by drug brand preference questionnaire and medication compliance questionnaire. Patients with brand preference in imported (joint venture) drugs group received rational use of limited medical resource and pharmacoeconomics education, and then switched with domestic drug for 8 weeks. Safety and efficacy were evaluated both before and after the drug switch. Results: Overall, there were 27% of patients in imported drug group and 35% of patients in domestic drug group have brand response, respectively. About 2/3 patients in both groups showed low or no brand response. The compliance was similar in both groups with no significant difference (6.04 ± 2.08 vs. 4.74 ± 2.13, respectively, P > 0.05). The efficacy of imported drug group was significantly better than of the domestic drug group. Correlation analysis showed that in imported (joint venture) drugs group, medication compliance was closely related with brand response, but negatively correlated with age and duration. In domestic drugs group, medication compliance was independent of brand response, but closely related with education, age, and duration. After drug switch with domestic drug on patients with brand response, patients continued to maintain good antidepressant effect, and no severe adverse reaction occurred. Conclusion: The results suggested that domestic drugs switch might be feasible for patients using imported drugs with brand response, while providing patients with rational use of drug education and

  15. ENHANCING VOLUNTARY COMPLIANCE BY REDUCING COMPLIANCE COSTS: A TAXPAYER SERVICE APPROACH

    OpenAIRE

    Glenn Jenkins; EDWIN FORLEMU

    1993-01-01

    In this paper an overview is made of the determinants of voluntary tax compliance. Unlike previous treatments of this subject, the cost of taxpayer compliance is considered as an important determinant of overall level of voluntary compliance in a country. A number of ways that tax authorities reduce compliance are discussed, and the most common uses of information technology in providing taxpayer service is described. Finally, the paper considers some of the ways that such activities might be...

  16. Perspectives on compliance: non-compliance with environmental licenses in the Netherlands

    NARCIS (Netherlands)

    van Snellenberg, A.H.L.M.; van de Peppel, R.A.

    2002-01-01

    Compliance with environmental law is not self-evident. In many instances enforcement of environmental regulations is a necessary means for achieving compliance. Assuming that an enforcement strategy, in order to be effective, has to fit the type of non-compliance, we integrate six different

  17. Tax Compliance Inventory: TAX-I Voluntary tax compliance, enforced tax compliance, tax avoidance, and tax evasion

    Science.gov (United States)

    Kirchler, Erich; Wahl, Ingrid

    2010-01-01

    Surveys on tax compliance and non-compliance often rely on ad hoc formulated items which lack standardization and empirical validation. We present an inventory to assess tax compliance and distinguish between different forms of compliance and non-compliance: voluntary versus enforced compliance, tax avoidance, and tax evasion. First, items to measure voluntary and enforced compliance, avoidance, and evasion were drawn up (collected from past research and newly developed), and tested empirically with the aim of producing four validated scales with a clear factorial structure. Second, findings from the first analyses were replicated and extended to validation on the basis of motivational postures. A standardized inventory is provided which can be used in surveys in order to collect data which are comparable across research focusing on self-reports. The inventory can be used in either of two ways: either in its entirety, or by applying the single scales independently, allowing an economical and fast assessment of different facets of tax compliance. PMID:20502612

  18. Georgia Compliance Review Self-Study FY 01.

    Science.gov (United States)

    Georgia State Dept. of Education, Atlanta.

    Intended for evaluation of local compliance with special education federal and state legal requirements, this compliance review document includes both the compliance requirements and the criteria by which compliance is determined during the onsite compliance review of Georgia local school systems and state-operated programs. Each legal requirement…

  19. Explaining G20 and BRICS Compliance

    Directory of Open Access Journals (Sweden)

    Marina Larionova

    2016-11-01

    Full Text Available This article explores the internal and external factors influencing the compliance performance of the Group of 20 (G20 and the BRICS. The authors start with an overview of the G20 and BRICS compliance patterns using comparative data onthe number of commitments made by the two institutions, the level of institutional compliance, and distribution of commitments and compliance across issue areas. G20 compliance is traced since the leaders’ first 2008 summit in Washington. The BRICS compliance performance record includes data since the third stand alone summit in Sanya in 2011.The study then takes stock of compliance catalysts embedded in the summits’ discourse: priority placements, numerical targets, timelines, self-accountability pledges and mandates to implement and/or monitor implementation. The authors review trends in the use of catalysts in different years and issue areas and identify commonalities and differences.The analysis then turns to external causes of compliance and focuses on demand for collective actions and members’ collective power to respond and deliver on their pledges. Here the study explores whether the self-accountability mechanisms created by the institutions in response to the demand for effectiveness and legitimacy facilitate compliance.The article concludes by highlighting catalysts, causes of compliance and their combinations with the greatest power to encourage implementation, explaining trends in G20 and BRICS compliance performance. The data sets on G20 and BRICS differ in terms of scale. The G20 data set contains 1,511 commitments of which 114 have been monitored, and the BRICS data set contains 231 commitments of which 23 have been monitored.

  20. Patient's perception, compliance to treatment and health education of antiretroviral therapy among HIV patients at a tertiary healthcare setting

    International Nuclear Information System (INIS)

    Hussain, A.R.; Abbas, S.M.; Reza, T.E

    2013-01-01

    Objective: To illustrate perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy among HIV and AIDS patients. Methods: The cross-sectional survey was carried out at the HIV Treatment Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from September 2009 to February 2010 in which patients were interviewed separately regarding their perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy. All data collected was entered into SPSS version 15.0. The data was re-validated and analysed. Results: One hundred and forty patients were interviewed; there were 99 (70.7%) males.. Of the total, 28 (20%) had no knowledge about the beneficial effects of the therapy, and 45 (32 %) ranked health education services extremely beneficial in understanding the anti-retrovival therapy. Conclusion: While a significant proportion of patients considered ART either somewhat beneficial or beneficial in treating their ailment, they were unclear about the impact of health education provided at the treatment centre and different forms of print media. (author)

  1. Determining next steps in a hand hygiene improvement initiative by examining variation in hand hygiene compliance rates.

    Science.gov (United States)

    Homa, Karen; Kirkland, Kathryn B

    2011-01-01

    Health care worker hand hygiene (HH) is a major quality and safety concern since poor hand hygiene has been linked with hospital associated infections. Dartmouth-Hitchcock Medical Center has been involved in a 4-year initiative to improve hand hygiene. In 2006, HH compliance occurred 41% of the time and by 2009, it had improved to 91%. We wanted to understand some of the unexplained variability in HH to help determine where to target more specific strategies. To help determine where some of the variability in HH compliance rates occurred, an analysis of means chart was used to determine whether role type of the health care worker and hospital areas had significantly different HH rates compared with the overall HH rate. The overall HH rate between March 2008 and December 2009 was 87%. There was a wide and significant variation between the 16 groups of 2 types of health care workers in 8 hospital areas from the lowest rate of 64% to a high of 96%. Analysis of means revealed significant differences in HH rates relative to the type of worker and hospital areas. Although the method does not inform the organization of what type of intervention will work where and why, it allows high and low performing groups to be identified, so that organizations can learn from them to generate and test theories.

  2. Patient's perception, compliance to treatment and health education of antiretroviral therapy among HIV patients at a tertiary healthcare setting.

    Science.gov (United States)

    Hussain, Aleem Raza; Abbas, Syed Muslim; Uzma, Qudsia; Reza, Tahira Ezra

    2013-07-01

    To illustrate perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy among HIV and AIDS patients. The cross-sectional survey was carried out at the HIV Treatment Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from September 2009 to February 2010 in which patients were interviewed separately regarding their perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy. All data collected was entered into SPSS version 15.0. The data was revalidated and analysed. One hundred and forty patients were interviewed; there were 99 (70.7%) males.. Of the total, 28 (20%) had no knowledge about the beneficial effects of the therapy, and 45 (32 %) ranked health education services extremely beneficial in understanding the anti-retrovival therapy. While a significant proportion of patients considered ART either somewhat beneficial or beneficial in treating their ailment, they were unclear about the impact of health education provided at the treatment centre and different forms of print media.

  3. Understanding Masturbation

    Science.gov (United States)

    Renshaw, Domeena C.

    1976-01-01

    Masturbation, once thought evil and the cause of many diseases, has been proven medically not to cause mental illness, physical weakness, or any type of disease or death; it is a normal aspect of human sexual development. (SK)

  4. MULTIDISCIPLINARY APPROACH TO SUPPORTING TREATMENT COMPLIANCE IN TUBERCULOSIS PATIENTS

    Directory of Open Access Journals (Sweden)

    T. V. Sherstneva

    2017-01-01

    Full Text Available The article presents the algorithm for working with tuberculosis patients in TB hospital, providing implementation of multidisciplinary patient-centered activities for early diagnostics of psychiatric and social disorders, therapy and rehabilitation of concurrent psychiatric disorders and addictions. Multidisciplinary approach to activities within TB unit is aimed at improvement of treatment compliance of tuberculosis patients. The training programme has been developed in order to improve competency of medical personnel on the issue of treatment interruption prevention and motivating patients to undergo the continuous treatment.

  5. Compliance with carbapenem guidelines in a university hospital.

    Science.gov (United States)

    Van Hollebeke, M; Chapuis, C; Bernard, S; Foroni, L; Stahl, J P; Bedouch, P; Pavese, P

    2016-03-01

    We aimed to evaluate carbapenem prescription compliance with guidelines for nosocomial and community-acquired infections. We conducted a prospective study over a four-month period at our university hospital. We included all adult and pediatric hospitalized patients who had received at least one dose of carbapenem. Data was collected from patients' medical records (hard copy and computerized data; CristalLink software). Compliance with guidelines was assessed by two infectious disease specialists. Assessment criteria included indication, antibiotic choice, dosage, and treatment duration. We included 152 patients in the study (65.4% of men). Carbapenem prescription was appropriate for 76.3% of prescriptions. The use of carbapenems was considered appropriate for 73.9% of empirical prescriptions and for 77.8% of documented prescriptions. Non-compliance with guidelines was mainly due to prescriptions for community-acquired infections. Antibiotic de-escalation could not be initiated in 40.3% of patients and was only initiated in 51.7% of patients for whom it could be considered. Although the average treatment duration was 7.5 days, 23.7% of patients received carbapenems for more than 10 days. These results highlight the need for a strong carbapenem stewardship program in our hospital. Copyright © 2016. Published by Elsevier SAS.

  6. Understanding Cancer Prognosis

    Medline Plus

    Full Text Available ... Español 1-800-4-CANCER Live Chat Publications Dictionary Menu Contact Dictionary Search About Cancer Causes and Prevention Risk Factors ... Managing Cancer Care Finding Health Care Services Costs & Medical Information Advance Directives Using Trusted Resources Understanding Cancer ...

  7. Type 2 diabetes patients' and providers' differing perspectives on medication nonadherence: a qualitative meta-synthesis.

    Science.gov (United States)

    Brundisini, Francesca; Vanstone, Meredith; Hulan, Danielle; DeJean, Deirdre; Giacomini, Mita

    2015-11-23

    Poor adherence to medication regimens increases adverse outcomes for patients with Type 2 diabetes. Improving medication adherence is a growing priority for clinicians and health care systems. We examine the differences between patient and provider understandings of barriers to medication adherence for Type 2 diabetes patients. We searched systematically for empirical qualitative studies on the topic of barriers to medication adherence among Type 2 diabetes patients published between 2002-2013; 86 empirical qualitative studies qualified for inclusion. Following qualitative meta-synthesis methods, we coded and analyzed thematically the findings from studies, integrating and comparing findings across studies to yield a synthetic interpretation and new insights from this body of research. We identify 7 categories of barriers: (1) emotional experiences as positive and negative motivators to adherence, (2) intentional non-compliance, (3) patient-provider relationship and communication, (4) information and knowledge, (5) medication administration, (6) social and cultural beliefs, and (7) financial issues. Patients and providers express different understandings of what patients require to improve adherence. Health beliefs, life context and lay understandings all inform patients' accounts. They describe barriers in terms of difficulties adapting medication regimens to their lifestyles and daily routines. In contrast, providers' understandings of patients poor medication adherence behaviors focus on patients' presumed needs for more information about the physiological and biomedical aspect of diabetes. This study highlights key discrepancies between patients' and providers' understandings of barriers to medication adherence. These misunderstandings span the many cultural and care contexts represented by 86 qualitative studies. Counseling and interventions aimed at improving medication adherence among Type 2 diabetes might become more effective through better integration of

  8. 75 FR 61706 - Request for Public Comments Regarding Small and Medium Enterprises' Understanding of and...

    Science.gov (United States)

    2010-10-06

    ... Public Comments Regarding Small and Medium Enterprises' Understanding of and Compliance With the Export... the public regarding small and medium enterprises' (SMEs) understanding of and compliance with export... report, Small and Medium-Sized Enterprises: Overview of Participation in U.S. Exports (USITC Publication...

  9. Compliance with Private Food Safety Standards among ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... and the livelihood impact of compliance. In addition, the project aims to build the capacity of farmers and other locally based actors to enhance compliance and thereby contribute to increased welfare in the project area. Expected outputs include one PhD thesis, five master's theses, and various journal publications and ...

  10. 14 CFR 431.83 - Compliance monitoring.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Compliance monitoring. 431.83 Section 431.83 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT... Requirements-Reusable Launch Vehicle Mission License Terms and Conditions § 431.83 Compliance monitoring. A...

  11. 14 CFR 417.23 - Compliance monitoring.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Compliance monitoring. 417.23 Section 417... Compliance monitoring. (a) A launch operator must allow access by, and cooperate with, Federal officers or... launch operator must provide the FAA with a console for monitoring the progress of the countdown and...

  12. 14 CFR 437.93 - Compliance monitoring.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Compliance monitoring. 437.93 Section 437.93 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT....93 Compliance monitoring. A permittee must allow access by, and cooperate with, federal officers or...

  13. 14 CFR 420.49 - Compliance monitoring.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Compliance monitoring. 420.49 Section 420.49 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION ADMINISTRATION, DEPARTMENT... Compliance monitoring. A licensee shall allow access by and cooperate with federal officers or employees or...

  14. 49 CFR 21.9 - Compliance information.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Compliance information. 21.9 Section 21.9 Transportation Office of the Secretary of Transportation NONDISCRIMINATION IN FEDERALLY-ASSISTED PROGRAMS OF THE DEPARTMENT OF TRANSPORTATION-EFFECTUATION OF TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 § 21.9 Compliance information. (a) Cooperation and...

  15. 49 CFR 27.121 - Compliance information.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Compliance information. 27.121 Section 27.121 Transportation Office of the Secretary of Transportation NONDISCRIMINATION ON THE BASIS OF DISABILITY IN PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Enforcement § 27.121 Compliance information. (a) Cooperation and assistance. The...

  16. 40 CFR 425.05 - Compliance dates.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Compliance dates. 425.05 Section 425.05 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS LEATHER TANNING AND FINISHING POINT SOURCE CATEGORY General Provisions § 425.05 Compliance dates...

  17. Patient compliance and effect of orthopaedic shoes

    DEFF Research Database (Denmark)

    Philipsen, A B; Ellitsgaard, N; Krogsgaard, M R

    1999-01-01

    Orthopaedic shoes are individually handmade after a prescription from an orthopaedic surgeon, hence relatively expensive. Bad compliance is mentioned in the literature but not investigated. In order to evaluate patient compliance and the effect of orthopaedic shoes, 85 patients who were prescribed...

  18. Diagnostic information in temporal compliance checking

    NARCIS (Netherlands)

    Ramezani Taghiabadi, E.; Fahland, D.; Dongen, van B.F.; Aalst, van der W.M.P.

    2012-01-01

    Compliance checking is gaining importance as today’s organizations need to show that operational processes are executed in a controlled manner while satisfying prede¿ned (legal) requirements. Deviations may be costly and expose the organization to severe risks. Compliance checking is of growing

  19. 7 CFR 772.3 - Compliance.

    Science.gov (United States)

    2010-01-01

    ... SPECIAL PROGRAMS SERVICING MINOR PROGRAM LOANS § 772.3 Compliance. (a) Requirements. No Minor Program... parts 15d and 15e. (b) Reviews. In accordance with Title VI of the Civil Rights Act of 1964, the Agency will conduct a compliance review of all Minor Program borrowers, to determine if a borrower has...

  20. 30 CFR 90.207 - Compliance sampling.

    Science.gov (United States)

    2010-07-01

    ... MANDATORY HEALTH STANDARDS-COAL MINERS WHO HAVE EVIDENCE OF THE DEVELOPMENT OF PNEUMOCONIOSIS Sampling Procedures § 90.207 Compliance sampling. (a) The operator shall take five valid respirable dust samples for... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Compliance sampling. 90.207 Section 90.207...

  1. 5 CFR 900.406 - Compliance information.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Compliance information. 900.406 Section... Compliance information. (a) Cooperation and assistance. OPM, to the fullest extent practicable, shall seek... at the times, and in the form and containing the information OPM may determine necessary to enable it...

  2. 22 CFR 141.5 - Compliance information.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Compliance information. 141.5 Section 141.5... DEPARTMENT OF STATE-EFFECTUATION OF TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 § 141.5 Compliance information... such information, as a responsible Departmental official or his designee may determine to be necessary...

  3. 45 CFR 80.6 - Compliance information.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Compliance information. 80.6 Section 80.6 Public... THE CIVIL RIGHTS ACT OF 1964 § 80.6 Compliance information. (a) Cooperation and assistance. The... reports at such times, and in such form and containing such information, as the responsible Department...

  4. 34 CFR 1200.170 - Compliance procedures.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false Compliance procedures. 1200.170 Section 1200.170 Education Regulations of the Offices of the Department of Education (Continued) NATIONAL COUNCIL ON... agency shall notify the Architectural and Transportation Barriers Compliance Board upon receipt of any...

  5. 49 CFR 28.170 - Compliance procedures.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Compliance procedures. 28.170 Section 28.170 Transportation Office of the Secretary of Transportation ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE DEPARTMENT OF TRANSPORTATION § 28.170 Compliance...

  6. 40 CFR 73.35 - Compliance.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Compliance. 73.35 Section 73.35... ALLOWANCE SYSTEM Allowance Tracking System § 73.35 Compliance. (a) Allowance transfer deadline. No allowance... in § 73.34(a) of this part, the Administrator will deduct allowances for each source with excess...

  7. [Compliance of long-acting atypical antipsychotics: from an image problem to a question of indication].

    Science.gov (United States)

    Naudin, J; Dassa, D; Cermolacce, M

    2009-09-01

    This paper focuses on the questions asked to practitioners regarding compliance to new long-acting atypical antipsychotics (LAAA): how does the comprehensive approach of patients' and carers' attitudes facing treatment challenge it? A review of recent literature shows that LAAA, are still suffering from an "image problem". We aim to describe these negative beliefs and suggest that LAAA indications be reconsidered. Following a comprehensive approach, we interpreted our review on the basis of anthropological criteria. We focused on value-based health and disease models that organize the attitude of patients and carers regarding the depot injection. Multiple negative beliefs attached to the pain, side-effects, and stigmas are well-known to impair adhesion to treatment. Carers understand disease as a lack of insight. Patients experience it as a threat for the Self and a loss of autonomy. The nurse-patient relationship involving injections is an important factor of compliance. When time is devoted by the carer to paying attention to the patient's experience, in order to perceive the patient as a participant, patients are more likely to adopt the injectable route themselves. By doing so, the patient considers the injection as a "protective net" a "lesser evil" by integrating it within his(her) biography. A comprehensive approach links the lack of insight to the patient's perception of stigma. Hope for recovery is related by the person him(her)self to his(her) own ability for autonomy. Persons with schizophrenia usually struggle for norms (agonomia). This trend has to be taken into account. LAAA are better indicated when patients are compliant. There is no indication when patients are "pure agonomics" and fight to deny both stigma and medication.

  8. Compliance with Segment Disclosure Initiatives

    DEFF Research Database (Denmark)

    Arya, Anil; Frimor, Hans; Mittendorf, Brian

    2013-01-01

    Regulatory oversight of capital markets has intensified in recent years, with a particular emphasis on expanding financial transparency. A notable instance is efforts by the Financial Accounting Standards Board that push firms to identify and report performance of individual business units...... (segments). This paper seeks to address short-run and long-run consequences of stringent enforcement of and uniform compliance with these segment disclosure standards. To do so, we develop a parsimonious model wherein a regulatory agency promulgates disclosure standards and either permits voluntary...... by increasing transparency and leveling the playing field. However, our analysis also demonstrates that in the long run, if firms are unable to use discretion in reporting to maintain their competitive edge, they may seek more destructive alternatives. Accounting for such concerns, in the long run, voluntary...

  9. A Review of Factors for Tax Compliance

    Directory of Open Access Journals (Sweden)

    Nicoleta BARBUTA-MISU

    2011-03-01

    Full Text Available The aim of this paper is to identify the variables of tax compliance analysed by researchers from various countries and adapting them to the Romanian conditions to create a model to include factors that influence decision of tax compliance. Tax compliance has been studied in economics by analysing the individual decision of a representative person between paying taxes and evading taxes. In the research of tax compliance have been done many empirical studies that emphasized the impact of a wide variety of potential determinants of voluntary compliance with individual income/profit tax filing and reporting obligations. The most important determinants identified are: economic factors as the level of income, audit probabilities, tax audit, tax rate, tax benefits, penalties, fines and other non-economic factors as attitudes toward taxes, personal, social and national norms, perceived fairness etc.

  10. Monitoring compliance with requirements during site characterization

    International Nuclear Information System (INIS)

    Herrington, C.C.; Jennetta, A.R.; Dobson, D.C.

    1991-01-01

    The question of when a program of Regulatory Compliance should be applied and what it should be applied to, when the subject of compliance is a High Level Radioactive Waste Repository, defies resolution by merely relating to past practices of licensees of the US Nuclear Regulatory Commission (NRC). NRC regulations governing the disposal of High Level Waste include interactions with the potential applicant (US DOE) during the pre-license application phase of the program when the basis for regulatory compliance is not well defined. To offset this shortcoming, the DOE will establish an expanded basis for regulatory compliance, keeping the NRC apprised of the basis as it develops. As a result, the preapplication activities of DOE will assume the added benefit of qualification to a suitable Regulatory Compliance monitoring and maintenance plan

  11. The impact of cost recovery on electric utilities' Clean Air Act compliance strategies

    International Nuclear Information System (INIS)

    Bensinger, D.L.

    1993-01-01

    By 1995, over 200 electric power plant units in twenty one states must comply with Phase I of the acid rain requirements in Title IV of the 1990 Clean Air Act Amendments (CAAA). By the year 2000, an additional 2200 units must comply with the Title IV. Compliance costs are expected to necessitate significant electricity rate increases. In order to recover their compliance costs, utilities must file rate increase requests with state public utility commissions (PUC's), and undergo a rate proceeding involving public heatings. Because of the magnitude of cost and the complexity of compliance options, including interaction with Titles I and III of the CAAA, extensive PUC reviews of compliance strategies are likely. These reviews could become as adversarial as the nuclear prudence reviews of the 1980's. A lack of understanding of air pollution and the CAA by much of the general public and the flexibility of compliance options creates an environment conducive to adverse public reaction to the cost of complying with the Clean Air Act. Public attitudes toward pollution control technologies will be greatly affected by these hearings, and the early plant hearings will shape the utility rate making process under the Clean Air Act. Inadequate cost recovery due to constrained compliance strategies or adverse hearings could significantly inhibit industry willingness to invest in certain control technologies or advanced combustion technologies. There are already signs that Clean Air Act compliance will be the prudence issue of the 1990's for utilities, even where state statutes mandate particular compliance approaches. Specific actions should be undertaken now by the utility industry to improve the probability of sound cost recovery decisions, preserve compliance options, including multimedia strategies, and avoid the social- and cost-acceptance problems of nuclear power

  12. 77 FR 31371 - Public Workshop: Privacy Compliance Workshop

    Science.gov (United States)

    2012-05-25

    ... presentations, including the privacy compliance fundamentals, privacy and data security, and the privacy... DEPARTMENT OF HOMELAND SECURITY Office of the Secretary Public Workshop: Privacy Compliance... Homeland Security Privacy Office will host a public workshop, ``Privacy Compliance Workshop.'' DATES: The...

  13. International Criminal Justice and the Politics of Compliance

    NARCIS (Netherlands)

    Lamont, Christopher

    2010-01-01

    International Criminal Justice and the Politics of Compliance provides a comprehensive study of compliance with legal obligations derived from the International Criminal Tribunal for the former Yugoslavia's (ICTY) Statute and integrates theoretical debates on compliance into international justice

  14. 78 FR 4848 - Social Media: Consumer Compliance Risk Management Guidance

    Science.gov (United States)

    2013-01-23

    ...: Consumer Compliance Risk Management Guidance AGENCY: Federal Financial Institutions Examination Council... Media: Consumer Compliance Risk Management Guidance'' (guidance). Upon completion of the guidance, and... management practices adequately address the consumer compliance and legal risks, as well as related risks...

  15. Assessing Compliance With Mercaptopurine Treatment in Younger Patients With Acute Lymphoblastic Leukemia in First Remission | Division of Cancer Prevention

    Science.gov (United States)

    This randomized phase III trial studies compliance to a mercaptopurine treatment intervention compared to standard of care in younger patients with acute lymphoblastic leukemia in remission. Assessing ways to help patients who have acute lymphoblastic leukemia to take their medications as prescribed may help them in taking their medications more consistently and may improve

  16. Understanding Disadvantage among Medical School Applicants

    Science.gov (United States)

    Espinoza-Shanahan, Crystal C.

    2016-01-01

    The United States is a nation of peoples with highly stratified degrees of healthcare access and coverage, including many individuals with none at all. Exacerbating the problem of widespread health disparities is a persistent shortage of physicians over recent decades. Of most urgency is the need for doctors within already underserved minority…

  17. Medical Imaging for Understanding Sleep Regulation

    Science.gov (United States)

    Wong, Kenneth

    2011-10-01

    Sleep is essential for the health of the nervous system. Lack of sleep has a profound negative effect on cognitive ability and task performance. During sustained military operations, soldiers often suffer from decreased quality and quantity of sleep, increasing their susceptibility to neurological problems and limiting their ability to perform the challenging mental tasks that their missions require. In the civilian sector, inadequate sleep and overt sleep pathology are becoming more common, with many detrimental impacts. There is a strong need for new, in vivo studies of human brains during sleep, particularly the initial descent from wakefulness. Our research team is investigating sleep using a combination of magnetic resonance imaging (MRI), positron emission tomography (PET), and electroencephalography (EEG). High resolution MRI combined with PET enables localization of biochemical processes (e.g., metabolism) to anatomical structures. MRI methods can also be used to examine functional connectivity among brain regions. Neural networks are dynamically reordered during different sleep stages, reflecting the disconnect with the waking world and the essential yet unconscious brain activity that occurs during sleep.[4pt] In collaboration with Linda Larson-Prior, Washington University; Alpay Ozcan, Virginia Tech; Seong Mun, Virginia Tech; and Zang-Hee Cho, Gachon University.

  18. Understanding Medical Words Tutorial: Download Instructions

    Science.gov (United States)

    ... the downloadable files are compressed into a zip format, not all software packages will follow the step-by-step directions below. Save the "zip" file to your hard drive or disk, noting where you saved it. ...

  19. Student manual, Book 2: Orientation to occupational safety compliance in DOE

    Energy Technology Data Exchange (ETDEWEB)

    Colley, D.L.

    1993-10-01

    This is a student hand-book an Occupational Safety Compliance in DOE. Topics include the following: Electrical; materials handling & storage; inspection responsibilities & procedures; general environmental controls; confined space entry; lockout/tagout; office safety, ergonomics & human factors; medical & first aid, access to records; construction safety; injury/illness reporting system; and accident investigation procedures.

  20. Patient compliance in hypertension: role of illness perceptions and treatment beliefs.

    Science.gov (United States)

    Ross, S; Walker, A; MacLeod, M J

    2004-09-01

    Despite many years of study, questions remain about why patients do or do not take medicines and what can be done to change their behaviour. Hypertension is poorly controlled in the UK and poor compliance is one possible reason for this. Recent questionnaires based on the self-regulatory model have been successfully used to assess illness perceptions and beliefs about medicines. This study was designed to describe hypertensive patients' beliefs about their illness and medication using the self-regulatory model and investigate whether these beliefs influence compliance with antihypertensive medication. We recruited 514 patients from our secondary care population. These patients were asked to complete a questionnaire that included the Beliefs about Medicines and Illness Perception Questionnaires. A case note review was also undertaken. Analysis shows that patients who believe in the necessity of medication are more likely to be compliant (odds ratio (OR)) 3.06 (95% CI 1.74-5.38), Pcompliance influence it indirectly. The self-regulatory model is useful in assessing patients health beliefs. Beliefs about specific medications and about hypertension are predictive of compliance. Information about health beliefs is important in achieving concordance and may be a target for intervention to improve compliance.