Hurley, R E; Brewer, K P
The continuing care retirement community industry is a growing source of residential and health care services for the elderly population. It is also a relatively new and expanding career path for both health care and hospitality managers. Using in-depth interviews with executives in a sample of 26 communities, this study provides one of the most complete portraits to date of the nature of managing these communities. The findings indicate that these organizations are complex and multifaceted, demanding versatile skills and abilities. Most critical are those skills that enable a manager to interact effectively with residents and staff to build and maintain a hospitable, accommodating community environment. As competition in the industry intensifies, community viability may become synonymous with customer satisfaction. Management training and development will need to be highly attentive to the distinctive features of these intriguing organizations.
The study evaluated the concept of autonomy from the perspective of older adults and their adult children following a transition of the older adult to a continuing care retirement community (CCRC). Overall, 70 interviews (with older adults and their adult children; 34 dyads) were analyzed, using a line-by-line open coding, followed by dyadic analysis. Autonomy was not portrayed as a uniform, homogenous construct, but rather encompassed four different domains: (a) the focus of one's attention or concerns: on others, on self, or not at all; (b) the ability to exercise decisions and make independent choices; (c) the degree of physical functioning and ability of the older adult; and (d) the financial ability of the older adult. The duality in the relationships between older adults and their adult children is discussed in relation to the give and take of autonomy that occur following a transition to a CCRC. © The Author(s) 2015.
Courtney, Karen L; Demiris, George; Rantz, Marilyn; Skubic, Marjorie
At present, the vast majority of older adults reside in the community. Though many older adults live in their own homes, increasing numbers are choosing continuing care retirement communities (CCRCs), which range from independent apartments to assisted living and skilled-nursing facilities. With predictions of a large increase in the segment of the population aged 65 and older, a subsequent increase in demand on CCRCs can be anticipated. With these expectations, researchers have begun exploring the use of smart home information-based technologies in these care facilities to enhance resident quality of life and safety, but little evaluation research exists on older adults' acceptance and use of these technologies. This study investigated the factors that influence the willingness of older adults living in independent and assisted living CCRCs to adopt smart home technology. Participants (n = 14) were recruited from community-dwelling older adults, aged 65 or older, living in one of two mid-western US CCRC facilities (independent living and assisted living type facilities). This study used a qualitative, descriptive approach, guided by principles of grounded theory research. Data saturation (or when no new themes or issues emerged from group sessions) occurred after four focus groups (n = 11 unique respondents) and was confirmed through additional individual interviews (n = 3). The findings from this study indicate that although privacy can be a barrier for older adults' adoption of smart home technology their own perception of their need for the technology can override their privacy concerns. Factors influencing self-perception of need for smart home technology, including the influence of primary care providers, are presented. Further exploration of the factors influencing older adults' perceptions of smart home technology need and the development of appropriate interventions is necessary.
Conclusions Factors influencing self-perception of need for smart home technology, including the influence of primary care providers, are presented. Further exploration of the factors influencing older adults' perceptions of smart home technology need and the development of appropriate interventions is necessary.
Rikard, R V; Berkowsky, Ronald W; Cotten, Shelia R
Older adults are increasingly using information and communication technologies (ICTs). Recent studies show beneficial effects of using ICTs for older adults, particularly in terms of reducing loneliness and depression. However, little is known about the factors that may prevent discontinued ICT use in populations that may be at greater risk, such as those in continuing care retirement communities (CCRCs). The purpose of this study is to examine a range of factors that may influence discontinued (1) ICT use, (2) searching for health information, and (3) searching for general information over time among CCRC residents. We use longitudinal data from a randomized controlled trial conducted with residents of 19 CCRCs. We use flexible parametric models to estimate the hazard ratio or hazard rate over 5 waves of data to determine what factors significantly predict discontinued (1) ICT use, (2) health information searching, and (3) general information searching. The analysis reveals that independent living residents who took part in an 8-week ICT training intervention were less likely to stop using ICTs. Age and the number of instrumental activities of daily living (IADL) impairments significantly predicted an increased likelihood of stopping ICT use. When examining specific ICT-related activities, the analysis reveals that independent living residents who took part in the ICT training intervention were less likely to stop searching for health information and general information online. In addition, age and the number of IADL impairments were associated with increased likelihood of discontinued health information searches and discontinued general information searches. ICT training interventions may motivate residents of CCRCs to stay connected by increasing the ICT skill level and promoting confidence, thus decreasing the probability that they will discontinue using ICTs and searching for general information. However, the effects of ICT training on motivating continued ICT
... Can’t Grandma Remember My Name? Artwork for Purchase Support Articles Ten Signs of Caregiver Stress Therapeutic ... loved one with Alzheimer’s may be a difficult decision. It is best to make decisions about care ...
Ward, Richard M; Weinman, Robert B
Health care expenses in retirement are the proverbial elephant in the room. Most employees don't know how big the elephant is. As Medicare solvency and retiree health care issues receive increasing attention, it is time to rethink overall benefit approaches and assess what is appropriate and affordable for an organization to help achieve workforce renewal goals and solve delayed retirement challenges. Just as Medicare was never designed to cover all of the post-65 retiree health care costs, neither is a workplace retirement plan designed to cover 100% of preretiree income. Now employers can consider strategies that may better equip retirees to meet both income needs and health care expenses in the most tax-efficient way. By combining defined contribution retirement and health care plans, employers have the power to increase benefits for employees while maintaining total benefits cost.
Rappaport, Anna M
Retirement wellness is the result of retiring at an appropriate age, saving enough and managing risks appropriately. One of the major risks that often is not addressed effectively is the long-term care (LTC) risk, i.e., the risk of needing help due to physical or cognitive limitations. In 2014, the Society of Actuaries issued a call for papers on the link between LTC and retirement security. This article will discuss the topic of LTC and retirement security broadly, drawing from several of the papers. Some of the topics include the impact of LTC on the individual, family members and caregivers; modeling results showing the impact of LTC on assets needed for a secure retirement; alternative methods of financing LTC; the link between housing decisions and LTC; and some ideas for the future.
the child-to-teacher ratio or the size of the institution and early retirement (ERP). However, working conditions measured by the social background of the children and the share of trained day-care teachers have a significant effect on the probability of early retirement. Finally, a poor health condition......This paper studies the role of working conditions and health for elderly female day-care teachers’ decision to enter early retirement. Entry into retirement is analysed in a duration framework that allows for unobserved heterogeneity in the baseline hazard. Data are from a Danish longitudinal data...... set based on administrative register records for 1997-2006. Working conditions is measured by four indicators. First, work pressure is measured by the child-to-teacher ratio, which varies across municipalities and over time. Second, working conditions is measured by the proportion of children...
Leopold, T.; Skopek, J.
This research examined 2 hypotheses about the effect of retirement on couples' division of household labor. The continuity hypothesis posits that the gender gap in household labor remains unaffected by retirement, whereas the convergence hypothesis expects it to close. The authors tested these
Bennett, Misty M; Beehr, Terry A; Lepisto, Lawrence R
Older employees are increasingly accepting bridge employment, which occurs when older workers take employment for pay after they retire from their main career. This study examined predictors of workers' decisions to engage in bridge employment versus full retirement and career employment. A national sample of 482 older people in the United States was surveyed regarding various work-related and nonwork related predictors of retirement decisions, and their retirement status was measured 5 years later. In bivariate analyses, both work-related variables (career goal achievement and experienced pressure to retire) and nonwork-related variables (psychological distress and traditional gender role orientation) predicted taking bridge employment, but in multinomial logistic regression, only nonwork variables had unique effects. Few predictors differentiated the bridge employed and fully retired groups. Nonwork variables were salient in making the decision to retire, and bridge employment may be conceptually more similar to full retirement than to career employment. © The Author(s) 2016.
McDonald, Glenda; Mohan, Shantala; Jackson, Debra; Vickers, Margaret H; Wilkes, Lesley
This paper reports the benefits and challenges of a mentoring programme through which retired and senior nurses continued to support and nurture nurses and midwives currently working in the health system. Nursing has an ageing workforce and faces significant loss of expertise because of retirements. Previously, mentoring programmes have been instituted in a range of nursing contexts and they have been a retention strategy for older nurses and midwives. Mentors and their mentees worked together towards mutually agreed on professional and personal goals. They were asked to meet or speak together a minimum of twice per month for at least six months. As part of a collective case study, 15 mentoring dyads were established. Participants and mentors took part in qualitative, semi-structured interviews about their perceptions and experiences of the mentoring programme. Interviews were audio-taped, transcribed and analysed thematically. Mentors reported the mentoring experience to be rewarding experience that enabled them to re-connect with nursing-related activities and brought new challenges in retirement. They perceived the mentees were visibly helped by their support and influence. The mentors studied reinforced a positive self-concept as nurses and midwives in their mentees and assisted their development. Retired nurses and midwives in particular may have several characteristics that make them effective mentors. Potential benefits are demonstrated for nurses and midwives vulnerable to workplace adversity, especially those new to Australia who may have limited professional and social networks. For health organisations, mentoring programmes may be an innovative method of retention that engages both mid-career nurses and midwives and those recently retired. © 2010 Blackwell Publishing Ltd.
Gupta, Aparna; Li, Lepeng
The level of need and costs of obtaining long-term care (LTC) during retired life require that planning for it is an integral part of retirement planning. In this paper, we divide retirement planning into two phases, pre-retirement and post-retirement. On the basis of four interrelated models for health evolution, wealth evolution, LTC insurance premium and coverage, and LTC cost structure, a framework for optimal LTC insurance purchase decisions in the pre-retirement phase is developed. Optimal decisions are obtained by developing a trade-off between post-retirement LTC costs and LTC insurance premiums and coverage. Two-way branching models are used to model stochastic health events and asset returns. The resulting optimization problem is formulated as a dynamic programming problem. We compare the optimal decision under two insurance purchase scenarios: one assumes that insurance is purchased for good and other assumes it may be purchased, relinquished and re-purchased. Sensitivity analysis is performed for the retirement age.
Wargo-Sugleris, Michele; Robbins, Wendie; Lane, Christianne Joy; Phillips, Linda R
To determine the relationships between job satisfaction, work environment and successful ageing and how these factors relate to Registered Nurses' intent to retire. Although little studied, retention of older nurses by delaying early retirement, before age 65, is an important topic for research. Qualitative and quantitative studies have indicated that job satisfaction work environment and successful ageing are key motivators in acute care Registered Nurses retention and/or delaying retirement. This study was designed to provide information to administrators and policy makers about retaining older, experienced RNs longer and more productively. This was a correlational, descriptive, cross-sectional study. An online survey of acute care Registered Nurses (N = 2,789) aged 40 years or older working in Florida was conducted from September - October 2013. Participants completed items related to job satisfaction, work environment, successful ageing and individual characteristics. Hypotheses derived from the modified Ellenbecker's Job Retention Model were tested using regression analysis. Job satisfaction scores were high. Highest satisfaction was with scheduling issues and co-workers; lowest with advancement opportunities. Successful ageing scores were also high with 81% reporting excellent or good health. Work environment explained 55% of the variance in job satisfaction. Years to retirement were significantly associated with successful ageing (p income (p job satisfaction and delay of retirement in older nurses and further studies in these areas are warranted to expand on this knowledge. © 2017 John Wiley & Sons Ltd.
Full Text Available Olle Söderhamn1–3, Anne Skisland1,2, Margaretha Herrman31Department of Health and Nursing Sciences, Faculty of Health and Sport Sciences, University of Agder, Grimstad and Kristiansand, Norway; 2Centre for Caring Research – Southern Norway, Grimstad, Norway; 3Department of Nursing, Health and Culture, University West, Trollhättan, SwedenAbstract: Few studies have appeared in the health care literature on the meaning of transition into retirement and later life. However, this predictable-involuntary transition may influence personal health and well-being, and studying it from a self-care perspective could be useful. The aim of this study was to illuminate aspects of self-care in a group of middle-aged individuals in relation to their anticipated transition into retirement in the Nordic welfare context. A total of 13 individuals, aged 55 to 65 years, were randomly chosen from the total number of inhabitants in three municipalities in mid-west Sweden. Conversational interviews took place, during which the informants shared important events in their lives that had occurred from early childhood until the present time, together with thoughts about their anticipated future developmental transition into later life. The interviews were tape recorded and transcribed verbatim. After content analyses and interpretation, a comprehensive picture of the phenomenon was revealed. The results showed that there were opportunities, expectations, wishes, concerns, and worries related to the transition into retirement and old age among informants from both rural and urban municipalities. Self-care, in connection with this, depended on motivating and demotivating factors. Autonomy and mature dependence seemed to be positive driving forces for reaching a successful transition into later life. Supporting autonomy should be a way of facilitating the transition into retirement and later life.Keywords: aging, autonomy, motivation, older people, successful aging
... 42 Public Health 4 2010-10-01 2010-10-01 false Continuing care. 441.60 Section 441.60 Public... Periodic Screening, Diagnosis, and Treatment (EPSDT) of Individuals Under Age 21 § 441.60 Continuing care. (a) Continuing care provider. For purposes of this subpart, a continuing care provider means a...
DiCenzo, Jodi; Fronstin, Paul
Employment-based health and retirement benefit programs have followed a similar path of evolution. The relative decision-making roles of the employer and the worker have shifted from the employer to the worker, and workers are more responsible than perhaps they ever have been for their well being--both in terms of their health in general and their financial security during retirement. This shift has been supported, in part, by legislation--namely ERISA, the HMO Act of 1973, the Revenue Act of 1978, and most recently, the Pension Protection Act. This Issue Brief does not pass judgment on this development or address who should bear the responsibilities of preparing workers for retirement or of rationing health care services. The current trend in health care design is toward increased "consumerism." Consumer-driven health is based on the assumption that the combination of greater cost sharing (by workers) and better information about the cost and quality of health care will engage workers to become better health care decision makers. It is hoped that workers will seek important, necessary, high-quality, cost-effective care and services, and become less likely to engage providers and services that are unnecessary and ineffective from either a quality or cost perspective. As employers look ahead toward continually improved plan design, there may be benefits in considering the lessons learned from studying worker behaviors. Specifically, there is evidence about the effects of choice, financial incentives, and information on worker decision making. As a result of research in this area, many retirement plan sponsors have moved toward plan designs and programs that recognize the benefits of well-designed defaults, simplified choices, required active decision making, framing, and commitment to future improvements. With respect to choice, it is now known that more is not always better and may even be worse in some cases. Just as fewer shoppers actually bought a jar of jelly
Hall, Kelly; Hardill, Irene
Recent years have seen a growth in research on retirement/lifestyle migration to Spain, however this has tended to focus on the reasons for moving, as well as the lifestyles adopted as part of a healthy and active retirement. However, ageing in Spain can bring challenges as a person's resources for independent living diminish. This paper draws on narrative interviews with vulnerable older British people in Spain, focusing on those who have encountered a severe decline in health, are frail and in need of care. It looks at the formal and informal networks and agencies that support these individuals, in particular the resources and strategies they employ to access care. Drawing on a framework of care provision developed by Glucksmann and Lyons, four broad modes of provision for old age care used by older British people in Spain are identified: state/public, family/community, voluntary/not-for-profit and market/for-profit. The paper argues that there are language, cultural, spatial and financial barriers when accessing care in Spain as an older British citizen. It is concluded that there are some frail, vulnerable people that may fall through a support gap, whereby they are no longer the responsibility of UK welfare services, yet not fully recognised in their new country of residence, and asks if more should be done to support this population.
The paper investigated the positive impact of retirement education on the future lives of the adult workers who are .... relationships, assume personal and civic responsibilities, care ... devastating phenomenon and a route to poverty. The retired ...
Full Text Available This study examined retirement decisions among people who had left working life before 65 years of age and those working beyond 65 years in an extended working life. The results were used to make a model about their considerations, weighting and decision making, and important factors and themes in working beyond 65 years of age or retiring before 65. The interviewees seemed to have considered and weighed their own best life balance to finally result in their identity as (older worker or early retiree. They included their work situation and social surroundings in descriptions of their planning and retirement decision making. The most important themes in these descriptions were (i personal health and well-being; (ii personal finances; (iii possibilities for social inclusion; and (iv possibilities for self-crediting by meaningful activities. Those identifying themselves as older workers had possibilities in their life situation to manage their work in relation to their functional ageing and health situation; felt important to others and socially included in the workplace; and did meaningful tasks and felt empowered in their working life. Those who had left the working life before 65 years of age describe a better possibility to this outside the working life and left as soon as they acquire a sufficient pension. The results and model presented here on how people perceive their identity as older worker or early retiree will hopefully contribute to understanding retirement planning and to the formulation of strategies to extend working life.
Rojas-Fernandez, Carlos; Dadfar, Farzan; Wong, Andrea; Brown, Susan G
Falls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) settings and are associated with significant morbidity and health care use. Fall-risk increasing drugs (FRIDs) are known to increase fall risk and represent modifiable risk factors. There are limited data regarding the use of FRIDs in contemporary LTC and RH settings, and it has not been well documented to what extent medication regimens are reviewed and modified for those who have sustained falls. The objective of this study is to characterize medication related fall risk factors in LTC and RH residents and on-going use of medications known to increase fall risk. Retrospective chart review of residents aged >65 who sustained one or more falls living in LTC or RH settings. 105 residents who fell one or more times during 2009-2010 were identified with a mean age of 89 years, a mean of nine scheduled medications and seven diagnoses, and 83% were women. Residents in LTC were ostensibly at higher risk for falls relative to those in RH settings as suggested by higher proportion of residents with multiple falls, multiple comorbidities, comorbidities that increase fall risk and visual impairment. Post fall injuries were sustained by 42% of residents, and residents in RH sustained more injuries relative to LTC residents (47 vs 34%). Use of FRIDs such as benzodiazepines, antipsychotic, antidepressant and various antihypertensive drugs was common in the present sample. No medication regimen changes were noted in the 6-month post fall period. The present study documented common use FRIDs by LTC and RH residents with multiple falls. These potentially modifiable falls risk factors are not being adequately addressed in contemporary practice, demonstrating that there is much room for improvement with regards to the safe and appropriate use of medications in LTC and RH residents.
Poss, Jeffrey W; Sinn, Chi-Ling Joanna; Grinchenko, Galina; Blums, Jane; Peirce, Tom; Hirdes, John
We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients. Copyright © 2017 Longwoods Publishing.
Zvárová, Jana; Hanzlíček, Petr
Roč. 13, č. 5 (2005), s. 451-452 ISSN 0928-7329. [MedNet 2005. World Congress on the Internet in Medicine /10./. 04.12.2005-07.12.2005, Prague] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : Internet * health care * technology Subject RIV: BD - Theory of Information
Brown, J.R.; Coe, N.B.; Finkelstein, A.
This paper provides empirical evidence of Medicaid crowd out of demand for private long-term care insurance. Using data on the near- and young-elderly in the Health and Retirement Survey, our central estimate suggests that a $10,000 decrease in the level of assets an individual can keep while
Volpe, F J
Continuity of health care is a goal to be achieved. Most are for it. Many claim to provide it. But how do we know we have it? What are the key features of continuity? While dictionaries do not define the phrase "continuity of health care," we do find definitions of "continuity." The Oxford English Dictionary, Second Edition, includes in its definitions: "the state or quality of being uninterrupted in sequence or succession, or in essence or idea; connectedness, coherence, unbroken..." Stedman's Medical Dictionary includes: "absence of interruption, a succession of parts intimately united..." These definitions stress an uninterrupted succession and include the concept that there needs to be a connection to the parts. Without that connection, continuity, in health care delivery or elsewhere, does not exist.
A frailty paradigm would be useful in primary care to identify older people at risk, but appropriate metrics at that level are lacking. We created and validated a simple instrument for frailty screening in Europeans aged ≥50. Our study is based on the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE, http:\\/\\/www.share-project.org), a large population-based survey conducted in 2004-2005 in twelve European countries.
Dychtwald, Ken; Erickson, Tamara; Morison, Bob
Companies have been so focused on down-sizing to contain costs that they've largely neglected a looming threat to their competitiveness: a severe shortage of talented workers. The general population is aging and with it, the labor pool. People are living longer, healthier lives, and the birthrate is at a historical low. During the next 15 years, 80% of the native-born workforce growth in North America--and even more in much of Western Europe--is going to be in the over-50 age cohort. When these mature workers begin to retire, there won't be nearly enough young people entering the workforce to compensate. The Bureau of Labor Statistics projects a shortfall of 10 million workers in the United States in 2010, and in countries where the birthrate is well below the population replacement level (particularly in Western Europe), the shortage will hit sooner, be more severe, and remain chronic. The problem won't just be a lack of bodies. Skills, knowledge, experience, and relationships walk out the door every time somebody retires--and they take time and money to replace. And while the brain drain is beginning now, the problem is going to become much more acute in the next decade or so, when baby boomers--more than one-quarter of all Americans, amounting to 76 million people--start hitting their mid sixties. Based on the results of their yearlong research project, the authors of this article offer recommendations for gaining the loyalty of older workers and creating a more flexible approach to retirement that allows people to continue contributing well into their sixties and seventies. Companies can no longer afford to think of retirement as a onetime event, permanently dividing work life from leisure.
Davies, Eleanor M. M.; Van der Heijden, Beatrice I. J. M.; Flynn, Matt
In the contemporary workplace, insight into retirement behaviors is of crucial importance. Previous empirical evidence has found mixed results regarding the relationship between work attitudes, such as job satisfaction, and retirement behaviors, suggesting that further scholarly examination incorporating moderating and mediating variables into retirement models is needed. Drawing on comparative models of attitude to retirement, we hypothesized a direct relationship between job satisfaction and intended retirement age for workers with a high household income and an indirect relationship between job satisfaction and intended retirement age, via retirement attitude, for workers with a low or mean household income. We collected data from a sample of 590 United Kingdom workers aged 50+. Using conditional process analysis, we found that the underlying mechanisms in our research model differ according to socio-economic status. We found no direct effect between job satisfaction and intended retirement age. However, an indirect effect was observed between job satisfaction and intended retirement age, via retirement attitude, for both low- and mean-household income individuals. Specifically, the relationship between job satisfaction and retirement attitude differed according to socio-economic group: for high-household income older workers, there was no relationship between job satisfaction and retirement attitude. However, for low- and mean-household income older workers, we observed a negative relationship between job satisfaction and retirement attitude. Otherwise stated, increases in job satisfaction for mean and low household income workers are likely to make the prospect of retirement less attractive. Therefore, we argue that utmost care must be taken around the conditions under which lower income employees will continue their work when getting older in order to protect their sustainable employability. PMID:28620329
Eleanor M. M. Davies
Full Text Available In the contemporary workplace, insight into retirement behaviors is of crucial importance. Previous empirical evidence has found mixed results regarding the relationship between work attitudes, such as job satisfaction, and retirement behaviors, suggesting that further scholarly examination incorporating moderating and mediating variables into retirement models is needed. Drawing on comparative models of attitude to retirement, we hypothesized a direct relationship between job satisfaction and intended retirement age for workers with a high household income and an indirect relationship between job satisfaction and intended retirement age, via retirement attitude, for workers with a low or mean household income. We collected data from a sample of 590 United Kingdom workers aged 50+. Using conditional process analysis, we found that the underlying mechanisms in our research model differ according to socio-economic status. We found no direct effect between job satisfaction and intended retirement age. However, an indirect effect was observed between job satisfaction and intended retirement age, via retirement attitude, for both low- and mean-household income individuals. Specifically, the relationship between job satisfaction and retirement attitude differed according to socio-economic group: for high-household income older workers, there was no relationship between job satisfaction and retirement attitude. However, for low- and mean-household income older workers, we observed a negative relationship between job satisfaction and retirement attitude. Otherwise stated, increases in job satisfaction for mean and low household income workers are likely to make the prospect of retirement less attractive. Therefore, we argue that utmost care must be taken around the conditions under which lower income employees will continue their work when getting older in order to protect their sustainable employability.
Davies, Eleanor M M; Van der Heijden, Beatrice I J M; Flynn, Matt
In the contemporary workplace, insight into retirement behaviors is of crucial importance. Previous empirical evidence has found mixed results regarding the relationship between work attitudes, such as job satisfaction, and retirement behaviors, suggesting that further scholarly examination incorporating moderating and mediating variables into retirement models is needed. Drawing on comparative models of attitude to retirement, we hypothesized a direct relationship between job satisfaction and intended retirement age for workers with a high household income and an indirect relationship between job satisfaction and intended retirement age, via retirement attitude, for workers with a low or mean household income. We collected data from a sample of 590 United Kingdom workers aged 50+. Using conditional process analysis, we found that the underlying mechanisms in our research model differ according to socio-economic status. We found no direct effect between job satisfaction and intended retirement age. However, an indirect effect was observed between job satisfaction and intended retirement age, via retirement attitude, for both low- and mean-household income individuals. Specifically, the relationship between job satisfaction and retirement attitude differed according to socio-economic group: for high-household income older workers, there was no relationship between job satisfaction and retirement attitude. However, for low- and mean-household income older workers, we observed a negative relationship between job satisfaction and retirement attitude. Otherwise stated, increases in job satisfaction for mean and low household income workers are likely to make the prospect of retirement less attractive. Therefore, we argue that utmost care must be taken around the conditions under which lower income employees will continue their work when getting older in order to protect their sustainable employability.
Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Alsina-Ribas, Anna; Puigoriol-Juvanteny, Emma; Oriol-Ruscalleda, Margarita; Subirana-Casacuberta, Mireia
To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Bertocchi, Marida; Ziemba, William T.
A straightforward guide focused on life cycle investing-namely aging, retirement, and pensions Life cycle investing and the implications of aging, retirement, and pensions continues to grow in importance. With people living longer, the relative and absolute number of retirees is growing while the number of workers contributing to pension funds is declining. This reliable resource develops a detailed economic analysis-at the micro (individual) and macro (economy wide) levels-which addresses issues regarding the economics of an aging population. Topics touched upon include retirement and the associated health care funding of the aged as well as social security and the asset classes that are considered asset-liability choices over time. The probability of achieving adequate return patterns from various investment strategies and asset classes is reviewed Shares rich insights on the aging, retirement, and pensions dilemma An assessment of the resources the real economy will be able to commit to non-workers is prov...
Krause, N; Lynch, J; Kaplan, G A; Cohen, R D; Goldberg, D E; Salonen, J T
Disability retirement may increase as the work force ages, but there is little information on factors associated with retirement because of disability. This is the first prospective population-based study of predictors of disability retirement including information on workplace, socioeconomic, behavioral, and health-related factors. The subjects were 1038 Finnish men who were enrolled in the Kuopio Ischemic Heart Disease Risk Factor Study, who were 42, 48, 54, or 60 years of age at the beginning of the study, and who participated in a 4-year follow-up medical examination. Various job characteristics predicted disability retirement. Heavy work, work in uncomfortable positions, long workhours, noise at work, physical job strain, musculoskeletal strain, repetitive or continuous muscle strain, mental job strain, and job dissatisfaction were all significantly associated with the incidence of disability retirement. The ability to communicate with fellow workers and social support from supervisors tended to reduce the risk of disability retirement. The relationships persisted after control for socioeconomic factors, prevalent disease, and health behavior, which were also associated with disability retirement. The strong associations found between workplace factors and the incidence of disability retirement link the problem of disability retirement to the problem of poor work conditions.
Full Text Available As EU citizens, Dutch retirement migrants can move and reside freely within the European Union. This enables their fluid migratory pattern and the formation of transnational ties between the Netherlands and Spain. However, national laws and nationally organised welfare systems within the EU may bind some retirement migrants to one of the two countries. Retirement migrants move at a stage in their lifecycle associated with a possible deterioration of health, therefore they are forced to think about accessing care provisions in the Netherlands and/or Spain. By focusing on the ways Dutch retirement migrants talk about and seek access to long-term care in both countries, this contribution explores the legal consciousness of Dutch retirement migrants in a transnational setting. Since legal consciousness research mainly focuses on a nation-state setting, this contribution argues that theories on legal consciousness should develop further in order to open its analysis frame to include transnational migrants who have to deal with more than one legal system. Como ciudadanos de la UE, los emigrantes jubilados holandeses pueden circular y residir libremente en la Unión Europea. Esto permite un patrón migratorio fluido y la formación de lazos transnacionales entre los Países Bajos y España. Sin embargo, las leyes nacionales y los sistemas de bienestar social organizados a nivel nacional dentro de la UE pueden obligar a algunos emigrantes jubilados hacia uno de los dos países. Los emigrantes jubilados se mueven en una etapa de su ciclo de vida asociada a un posible deterioro de la salud, por lo tanto, se ven obligados a pensar y organizar el acceso a los cuidados sanitarios en los Países Bajos y/o España. Al centrarse en los modos en los que los emigrantes jubilados holandeses hablan y buscan acceso a los cuidados a largo plazo en ambos países, esta contribución explora la conciencia jurídica de los emigrantes jubilados holandeses en un entorno
Brown, A K; Liu-Ambrose, T; Tate, R; Lord, S R
To determine the effect of a general group-based exercise programme on cognitive performance and mood among seniors without dementia living in retirement villages. Randomised controlled trial. Four intermediate care and four self-care retirement village sites in Sydney, Australia. 154 seniors (19 men, 135 women; age range 62 to 95 years), who were residents of intermediate care and self-care retirement facilities. Participants were randomised to one of three experimental groups: (1) a general group-based exercise (GE) programme composed of resistance training and balance training exercises; (2) a flexibility exercise and relaxation technique (FR) programme; or (3) no-exercise control (NEC). The intervention groups (GE and FR) participated in 1-hour exercise classes twice a week for a total period of 6 months. Using standard neuropsychological tests, we assessed cognitive performance at baseline and at 6-month re-test in three domains: (1) fluid intelligence; (2) visual, verbal and working memory; and (3) executive functioning. We also assessed mood using the Geriatric Depression Scale (GDS) and the Positive and Negative Affect Schedule (PANAS). The GE programme significantly improved cognitive performance of fluid intelligence compared with FR or NEC. There were also significant improvements in the positive PANAS scale within both the GE and FR groups and an indication that the two exercise programmes reduced depression in those with initially high GDS scores. Our GE programme significantly improved cognitive performance of fluid intelligence in seniors residing in retirement villages compared with our FR programme and the NEC group. Furthermore, both group-based exercise programmes were beneficial for certain aspects of mood within the 6-month intervention period.
Reeuwijk, Kerstin G; de Wind, Astrid; Westerman, Marjan J; Ybema, Jan Fekke; van der Beek, Allard J; Geuskens, Goedele A
Due to the aging of the population and subsequent higher pressure on public finances, there is a need for employees in many European countries to extend their working lives. One way in which this can be achieved is by employees refraining from retiring early. Factors predicting early retirement have been identified in quantitative research, but little is known on why and how these factors influence early retirement. The present qualitative study investigated which non-health related factors influence early retirement, and why and how these factors influence early retirement. A qualitative study among 30 Dutch employees (60-64 years) who retired early, i.e. before the age of 65, was performed by means of face-to-face interviews. Participants were selected from the cohort Study on Transitions in Employment, Ability and Motivation (STREAM). For most employees, a combination of factors played a role in the transition from work to early retirement, and the specific factors involved differed between individuals. Participants reported various factors that pushed towards early retirement ('push factors'), including organizational changes at work, conflicts at work, high work pressure, high physical job demands, and insufficient use of their skills and knowledge by others in the organization. Employees who reported such push factors towards early retirement often felt unable to find another job. Factors attracting towards early retirement ('pull factors') included the wish to do other things outside of work, enjoy life, have more flexibility, spend more time with a spouse or grandchildren, and care for others. In addition, the financial opportunity to retire early played an important role. Factors influenced early retirement via changes in the motivation, ability and opportunity to continue working or retire early. To support the prolongation of working life, it seems important to improve the fit between the physical and psychosocial job characteristics on the one hand, and
Full Text Available Background: There is no documented evidence regarding elderly day care centers in Iran. This needs analysis study was conducted to investigate the demand for elderly day care centers in Tehran. Methods: This cross-sectional study was conducted recruiting 210 participants aged over 60 who were members of the elderly retirement centers in Tehran in 2012. Data were gathered by Kansas state university questionnaire and analyzed using Mann-Whitney and Kruskal-Wallis tests. Results: About 80% of participants were men with the mean age of 67.5±5.23 years. Results showed that male (P<0.001, married (P=0.01 and literate elderly (P<0.001, and those living in rental homes (P<0.001 expressed a greater need for elderly day care centers. There was no statistically significant relationship between the lifestyle (P=0.051 and income (P=0.08 of the participants and demand for elderly day care centers. Conclusion: Given the rising population of the elderly and their high demand for day care centers, it is necessary to establish well-equipped day care centers for this group of people. Also, these centers may reduce the burden of care for the aged people on public services and family care givers.
. 3. Drag LL, et al. Cognitive functioning, retirement status, and age: results from the Cognitive Changes and Retirement among. Senior Surgeons study. J Am Coll Surg. 2010;211(3):303-7. 4. Wang DS, Winfield HN. Survey of urological laparoscopic practice patterns in the Midwest.
Siegenthaler, J K; Brenner, A M
Older workers in the United States indicate that they would prefer flexible work arrangements rather than abrupt retirement, yet management has done very little to make this possible. A review of two bodies of literature from the late 1980s is presented: social science writings including sociological, gerontological, and economic literature, and business and management literature. There is a clash between the way jobs are traditionally scheduled and the needs of growing numbers of older workers. Workers continue to be subject to obstacles to phased retirement due to the structuring of health care and pension benefits, downsizing, organizational inflexibility, and "corporate culture." Thus, general views among social scientists regarding the desirability of flexible schedules toward retirement will not produce real changes unless management becomes committed to such changes and they are securely embedded in company policies.
Purpose: To evaluate the impact of educational intervention by health care providers on clinical outcomes in type 2 diabetes patients in a Yemeni health facility. Methods: A prospective, one-group and pre- and post-test design to assess the effects of health care providers' education on clinical patient outcomes was ...
Fronstin, Paul; Salisbury, Dallas; VanDerhei, Jack
MODELING RETIREE HEALTH COSTS: This Issue Brief examines the uncertainty of health care expenses in retirement by using a Monte Carlo simulation model to estimate the amount of savings needed to cover health insurance premiums and out-of-pocket health care expenses. This type of simulation is able to account for the uncertainty related to individual mortality and rates of return, and computes the present value of the savings needed to cover health insurance premiums and out-of-pocket expenses in retirement. These observations were used to determine asset targets for having adequate savings to cover retiree health costs 50, 75, and 90 percent of the time. NOT ENOUGH SAVINGS: Many individuals will need more money than the amounts reported in this Issue Brief because this analysis does not factor in the savings needed to cover long-term care expenses, nor does it take into account the fact that many individuals retire prior to becoming eligible for Medicare. However, some workers will need to save less than what is reported if they keep working in retirement and receive health benefits as active workers. WHO HAS RETIREE HEALTH BENEFITS BEYOND MEDICARE?: About 12 percent of private-sector employers report offering any Medicare supplemental health insurance. This increases to about 40 percent among large employers. Overall, nearly 22 percent of retirees age 65 and older had retiree health benefits in 2005 to supplement Medicare coverage. As recently as 2006, 53 percent of retirees age 65 and older were covered by Medicare Part D, 24 percent had outpatient prescription drug coverage through an employment-based plan. Only 10 percent had no prescription drug coverage. INDIVIDUALLY PURCHASED MEDICARE SUPPLEMENTS, 2008: Among those who purchase Medigap and Medicare Part D prescription drug coverage at age 65 in 2008, men would need between $79,000 and $159,000 with median prescription drug expenses (50th percentile and 90th percentiles, respectively), and between $156
Purpose: To evaluate the impact of educational intervention by health care providers on clinical outcomes in type 2 diabetes patients in a Yemeni health facility. Methods: A .... compliance, exercise and diets recommended for diabetes patients.
Hardy, M A; Quadagno, J
In recent decades, the expanded availability of early retirement incentive plans has allowed an increasing number of workers to retire at an age younger than normally allowed by their pension plans. On the surface, these retirement incentives appear to offer older workers more flexibility in deciding when to retire. However, the offer of early retirement incentives frequently occurs when employers are attempting to reduce employment; therefore, the opportunity for early retirement may be counterbalanced by downsizing goals that place older workers' continued employment in jeopardy. Early retirement incentive programs are thereby characterized by an unusual combination of inducement and coercion. In this study, we examined how the structure of the early retirement program shapes the way older male auto workers evaluate their retirement transitions. We conclude that the structure of the early retirement program, the timing of the retirement decision, and job security are important in framing the retirement transition and in distinguishing levels of satisfaction with the retirement experience.
Walter Louise C
Full Text Available Abstract Background Individualized decision making has been recommended for cancer screening decisions in older adults. Because older adults' preferences are central to individualized decisions, we assessed older adults' perspectives about continuing cancer screening later in life. Methods Face to face interviews with 116 residents age 70 or over from two long-term care retirement communities. Interview content included questions about whether participants had discussed cancer screening with their physicians since turning age 70, their attitudes about information important for individualized decisions, and their attitudes about continuing cancer screening later in life. Results Forty-nine percent of participants reported that they had an opportunity to discuss cancer screening with their physician since turning age 70; 89% would have preferred to have had these discussions. Sixty-two percent believed their own life expectancy was not important for decision making, and 48% preferred not to discuss life expectancy. Attitudes about continuing cancer screening were favorable. Most participants reported that they would continue screening throughout their lives and 43% would consider getting screened even if their doctors recommended against it. Only 13% thought that they would not live long enough to benefit from cancer screening tests. Factors important to consider stopping include: age, deteriorating or poor health, concerns about the effectiveness of the tests, and doctors recommendations. Conclusion This select group of older adults held positive attitudes about continuing cancer screening later in life, and many may have had unrealistic expectations. Individualized decision making could help clarify how life expectancy affects the potential survival benefits of cancer screening. Future research is needed to determine whether educating older adults about the importance of longevity in screening decisions would be acceptable, affect older adults
Psychiatric diseases are common. The effective treatment of a psychiatric disease, its (somatic) side effects and any concurrent somatic diseases is important for the patient’s overall health and wellbeing. The studies conducted in psychiatric patients generally focus on the continuation of
... Improvement Access Standards § 438.208 Coordination and continuity of care. (a) Basic requirement—(1) General... MCO must meet the primary care coordination, identification, assessment, and treatment planning... those activities. (4) Ensure that in the process of coordinating care, each enrollee's privacy is...
Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den
BACKGROUND: The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. OBJECTIVE: In order to clarify the confusion of
Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; van den Bosch, W.J.H.M.
Background: The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. Objective: In order to clarify the confusion of
H. Jay Biem
Full Text Available Continuity of care, defined as the patient experiencing coherent care over time and place, is challenged when a rural senior with multiple medical problems is transferred to a regional hospital for acute care. From an illustrative case of an older patient with pneumonia and atrial fibrillation, we catalogue potential breaks in continuity of care. Optimal continuity of care is characterised not only by regular contact with the providers who establish collaboration with patients and their caregivers, but also by communication, co-ordination, contingency, convenience, and consistency. Because it is not possible to have the same providers continuously available (relational continuity, for continuity of care, there is a need for integrative system approaches, such as: (1 policy and standards, disease management programs, integrated clinical pathways (management continuity, (2 electronic health information systems and telecommunications technology (communication continuity. The evaluation of these approaches requires measures that account for the multi-faceted nature of continuity of care.
Mills, Andrew D. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Wiser, Ryan H. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Seel, Joachim [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)
This paper synthesizes available data on historical and planned power plant retirements. Specifically, we present data on historical generation capacity additions and retirements over time, and the types of plants recently retired and planned for retirement. We then present data on the age of plants that have recently retired or that have plans to retire. We also review the characteristics of plants that recently retired or plan to retire vs. those that continue to operate, focusing on plant size, age, heat rate, and SO2 emissions. Finally, we show the level of recent thermal plant retirements on a regional basis and correlate those data with a subset of possible factors that may be contributing to retirement decisions. This basic data synthesis cannot be used to precisely estimate the relative magnitude of retirement drivers. Nor do we explore every possible driver for retirement decisions. Moreover, future retirement decisions may be influenced by different factors than those that have affected past decisions. Nonetheless, it is clear that recently retired plants are relatively old, and that plants with stated planned retirement dates are—on average—no younger. We observe that retired plants are smaller, older, less efficient, and more polluting than operating plants. Based on simple correlation graphics, the strongest predictors of regional retirement differences appear to include SO2 emissions rates (for coal), planning reserve margins (for all thermal units), variations in load growth or contraction (for all thermal units), and the age of older thermal plans (for all thermal units). Additional apparent predictors of regional retirements include the ratio of coal to gas prices and delivered natural gas prices. Other factors appear to have played lesser roles, including the penetration variable renewable energy (VRE), recent non-VRE capacity additions, and whether the region hosts an ISO/RTO.
Iranmanesh, Mohammad; Zailani, Suhaiza; Nikbin, Davoud
Radio-frequency identification (RFID) has been proved to be an effective tool both for improving operational efficiency and for gaining competitive advantage in the health care industry despite its relatively low-usage rate in hospitals. The sustained use of RFID by health care professionals will promote its development in the long term. This study evaluates the acceptance continuance of RFID among health care professionals through technology continuance theory (TCT). Data were collected from 178 medical professionals in Malaysia and were then analyzed using the partial least squares technique. The analysis showed that the TCT model provided not only a thorough understanding of the continuance behavior of health care professionals toward RFID but also the attitudes, satisfaction, and perceived usefulness of professionals toward it. The results of this study are expected to assist policy makers and managers in the health care industry in implementing the RFID technology in hospitals by understanding the determinants of continuance of RFID usage intention.
Care is better coordinated when doctors have personal responsibility for their patients. Continuity and a sense of personal responsibility are becoming more difficult to provide in hospitals, in part because of the European Working Time Directive. However, in many countries general practitioners are self-employed and able to organise their practices as they wish. In the UK, they increasingly do so in ways that make it difficult for patients to get continuity of care. This is despite most patients being clear that they want to see a regular doctor, and professional bodies in primary care consistently promoting continuity as a core value. General practitioners need to decide whether continuity of care matters. If it does, then they need to take a lead in ensuring that care is organised so that patients who want to see a regular doctor are able to do so. Suggestions are included for how contemporary practice can be organised to promote this traditional but still highly relevant value.
Uijen, Annemarie A; Schers, Henk J; Schellevis, François G; van den Bosch, Wil J H M
The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. In order to clarify the confusion of tongues and to identify core values of these patient-centred concepts, we provide a historical overview of continuity of care and four related concepts: coordination of care, integration of care, patient-centred care and case management. We identified and reviewed articles including a definition of one of these concepts by performing an extensive literature search in PubMed. In addition, we checked the definition of these concepts in the Oxford English Dictionary. Definitions of continuity, coordination, integration, patient-centred care and case management vary over time. These concepts show both great entanglement and also demonstrate differences. Three major common themes could be identified within these concepts: personal relationship between patient and care provider, communication between providers and cooperation between providers. Most definitions of the concepts are formulated from the patient's perspective. The identified themes appear to be core elements of care to patients. Thus, it may be valuable to develop an instrument to measure these three common themes universally. In the patient-centred medical home, such an instrument might turn out to be an important quality measure, which will enable researchers and policy makers to compare care settings and practices and to evaluate new care interventions from the patient perspective.
Beardsall, K; Ogilvy-Stuart, A; Ahluwalia, J; Thompson, M; Dunger, D
Objective: To determine the feasibility of continuous glucose monitoring in the very low birthweight baby requiring intensive care, as these infants are known to be at high risk of abnormalities of glucose control.
... type. (d) OPM also considers a disability retirement application to be withdrawn when the agency... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Withdrawal of disability retirement...) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Disability Retirement § 831.1207 Withdrawal of...
Galama, Titus; Kapteyn, Arie; Fonseca, Raquel; Michaud, Pierre-Carl
We formulate a stylized structural model of health, wealth accumulation and retirement decisions building on the human capital framework of health and derive analytic solutions for the time paths of consumption, health, health investment, savings and retirement. We argue that the literature has been unnecessarily restrictive in assuming that health is always at the “optimal” health level. Exploring the properties of corner solutions we find that advances in population health decrease the retirement age, while at the same time individuals retire when their health has deteriorated. This potentially explains why retirees point to deteriorating health as an important reason for early retirement, while retirement ages have continued to fall in the developed world, despite continued improvements in population health and mortality. In our model, workers with higher human capital invest more in health and because they stay healthier retire later than those with lower human capital whose health deteriorates faster. PMID:22888062
Purpose: To evaluate the impact of a continuing education (CE) program on the attitudes of health care professionals (HCPs) towards diabetes care in Yemen. Methods: A pre- and post-intervention study was carried out in Mukalla City, Hadramout, Yemen and was offered to all physicians, pharmacists, and nurses ...
Full Text Available The United States federal animal welfare regulations and the Public Health Service Policy on Humane Care and Use of Laboratory Animals require that institutional animal care and use committees (IACUCs conduct continuing reviews of all animal research activities. However, little is known about the lapse rate of IACUC continuing reviews, and how frequently investigators continue research activities during the lapse. It is also not clear what factors may contribute to an institution's lapse in IACUC continuing reviews. As part of the quality assurance program, the Department of Veterans Affairs (VA has collected performance metric data for animal care and use programs since 2011. We analyzed IACUC continuing review performance data at 74-75 VA research facilities from 2011 through 2015. The IACUC continuing review lapse rates improved from 5.6% in 2011 to 2.7% in 2015. The rate of investigators continuing research activities during the lapse also decreased from 47.2% in 2012 to 7.4% in 2015. The type of IACUCs used and the size of animal research programs appeared to have no effect in facility's rates of lapse in IACUC continuing reviews. While approximately 80% of facilities reported no lapse in IACUC continuing reviews, approximately 14% of facilities had lapse rates of >10% each year. Some facilities appeared to be repeat offenders. Four facilities had IACUC lapse rates of >10% in at least 3 out of 5 years, suggesting a system problem in these facilities requiring remedial actions to improve their IACUC continuing review processes.
Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den
Background: The concept of ‘continuity of care’ has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. Objective: In order to clarify the confusion of
Uijen, Annemarie A.; Schers, Henk J.; Schene, Aart H.; Schellevis, Francois G.; Lucassen, Peter; van den Bosch, Wil J. H. M.
Existing studies about continuity of care focus on patients with a severe mental illness. Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. Explorative study comparing patients at risk
Uijen, A.A.; Schers, H.J.; Schene, A.H.; Schellevis, F.G.; Lucassen, P.; Bosch, W.J.H.M. van den
Background: Existing studies about continuity of care focus on patients with a severe mental illness. Objectives: Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. Methods: Explorative
Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne
Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse...... migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry......, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups...
Full Text Available Abstract Background A frailty paradigm would be useful in primary care to identify older people at risk, but appropriate metrics at that level are lacking. We created and validated a simple instrument for frailty screening in Europeans aged ≥50. Our study is based on the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE, http://www.share-project.org, a large population-based survey conducted in 2004-2005 in twelve European countries. Methods Subjects: SHARE Wave 1 respondents (17,304 females and 13,811 males. Measures: five SHARE variables approximating Fried's frailty definition. Analyses (for each gender: 1 estimation of a discreet factor (DFactor model based on the frailty variables using LatentGOLD®. A single DFactor with three ordered levels or latent classes (i.e. non-frail, pre-frail and frail was modelled; 2 the latent classes were characterised against a biopsychosocial range of Wave 1 variables; 3 the prospective mortality risk (unadjusted and age-adjusted for each frailty class was established on those subjects with known mortality status at Wave 2 (2007-2008 (11,384 females and 9,163 males; 4 two web-based calculators were created for easy retrieval of a subject's frailty class given any five measurements. Results Females: the DFactor model included 15,578 cases (standard R2 = 0.61. All five frailty indicators discriminated well (p N = 10,420; 66.9%, pre-frail (N = 4,025; 25.8%, and frail (N = 1,133; 7.3%. Relative to the non-frail class, the age-adjusted Odds Ratio (with 95% Confidence Interval for mortality at Wave 2 was 2.1 (1.4 - 3.0 in the pre-frail and 4.8 (3.1 - 7.4 in the frail. Males: 12,783 cases (standard R2 = 0.61, all frailty indicators had p N = 10,517; 82.3%, pre-frail (N = 1,871; 14.6%, and frail (N = 395; 3.1%; age-adjusted OR (95% CI for mortality: 3.0 (2.3 - 4.0 in the pre-frail, 6.9 (4.7 - 10.2 in the frail. Conclusions The SHARE Frailty Instrument has sufficient construct and
Full Text Available Care is better coordinated when doctors have personal responsibility for their patients. Continuity and a sense of personal responsibility are becoming more difficult to provide in hospitals, in part because of the European Working Time Directive. However, in many countries general practitioners are self-employed and able to organise their practices as they wish. In the UK, they increasingly do so in ways that make it difficult for patients to get continuity of care. This is despite most patients being clear that they want to see a regular doctor, and professional bodies in primary care consistently promoting continuity as a core value. General practitioners need to decide whether continuity of care matters. If it does, then they need to take a lead in ensuring that care is organised so that patients who want to see a regular doctor are able to do so. Suggestions are included for how contemporary practice can be organised to promote this traditional but still highly relevant value.
We estimate the effect of benefit rates on individuals’ retirement behaviour. Compared to most other studies in the field, the characterising feature of this paper is to use a cross-country panel data set of individuals (the European Community Household Panel, ECHP) to estimate economic effects...... across countries. A descriptive part of the paper makes clear that retirement via a period of unemployment prior to retirement programmes is quantitatively very important. We find econometric evidence that benefit rates affect retirement and the magnitude of this effect is relatively low if retirement...
Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 21, No 5 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Opioid use in palliative care. M Hosking. Abstract.
Caris-Verhallen, W.M.C.M.; Kerkstra, A.
The aim of this study was to examine patients' satisfaction with continuity of care while on a waiting list for residential care or nursing home care. Two hundred and seventy-eight patients participated in the study, all living in the community setting of two cities in the Netherlands. These
Full Text Available Aims: This study attempted to determine the effects of continued care on subjects with alcohol dependence. Materials and Methods: Study patients were recruited from a slum in Bangalore. The control group comprised individuals from a lower socio-economic status. Both groups received identical treatment from a specialised de-addiction facility. The study group also received weekly continued care in the community, either at a clinic located within the slum or through home visits. Those patients without stable jobs were referred for employment. The control group was given routine hospital follow-up visits. Both groups were evaluated on the Alcohol Problem Questionnaire and quantity/frequency of drinking at baseline and every 3 month interval for one year after discharge. Results: Both groups showed improvement in terms of reduction of drinking at 3 months, with the study group showing a 64% improvement with respect to the number of non drinking days and the control group showed a 50% improvement. However, at 6 months, 9 months, and 12 months, the study group continued to maintain these gains while the control group showed a downward slide (differences significant at P < 0.05. At the end of 12 months, the study group maintained a 53% improvement with respect to the number of non drinking days as compared with baseline, while the control group had an improvement of only 28%. Conclusions: Follow-up support and continued care appear to significantly improve longer-term recovery in alcohol dependents.
Häkkinen, Unto; Lehto, Juhani
This article describes some essential aspects of the Finnish political and governmental system and the evolution of the basic institutional elements of the health care system. We examine the developments that gave rise to a series of health care reforms and reform proposals in the late 1980s and early 1990s and relate them to changes in health care expenditure, structure, and performance. Finally, we discuss the relationship between policy changes, reforms, and health system changes and the strength of neo-institutional theory in explaining both continuity and change. Much of the change in Finnish health care can be explained by institutional path dependency. The tradition of strong but small local authorities and the lack of legitimate democratic regional authorities as well as the coexistence of a dominant Beveridge-style health system with a marginal Bismarckian element explain the specific path of Finnish health care reform. Public responsibility for health care has been decentralized to smaller local authorities (known as municipalities) more than in any other country. Even an exceptionally deep economic recession in the early 1990s did not lead to systems change; rather, the economic imperative was met by the traditional centralized policy pattern. Some of the developments of the 1990s are, however, difficult to explain by institutional theory. Thus, there is a need for testing alternative theories as well.
Cocca-Bates, Katherine C; Neal-Boylan, Leslie
A qualitative study was done to explore the perceptions of volunteering among retired registered nurses (RNs) in Kansas. Participants were volunteers in formal nursing roles or were using their nursing knowledge and experience in non-nursing roles, such as church work. Regardless of the type of volunteer position, retired RNs reported that they use what they have learned as nurses when they volunteer. Volunteering benefits include enhanced self-worth, intellectual stimulation, reduced social isolation, and opportunities to help others. Increased paperwork, new technology, difficulty finding nursing-specific volunteer opportunities, resistance from health care organizations, and a lack of respect for what these nurses know are challenges and barriers to volunteering. Retired RNs have accumulated years of clinical nursing experience and can be helpful to employed nurses. Health care organizations should launch targeted efforts to recruit and utilize retired RN volunteers. Health care professionals who care for older adults should recommend volunteering as a healthful endeavor. Copyright © 2011 Mosby, Inc. All rights reserved.
Rolfe, Ben; Leshabari, Sebalda; Rutta, Fredrik; Murray, Susan F
The human resource crisis in health care is an important obstacle to attainment of the health-related targets for the Millennium Development Goals. One suggested strategy to alleviate the strain upon government services is to encourage new forms of non-government provision. Detail on implementation and consequences is often lacking, however. This article examines one new element of non-government provision in Tanzania: small-scale independent midwifery practices. A multiple case study analysis over nine districts explored their characteristics, and the drivers and inhibitors acting upon their development since permitted by legislative change. Private midwifery practices were found concentrated in a 'new' workforce of 'later life entrepreneurs': retired, or approaching retirement, government-employed nursing officers. Provision was entirely facility-based due to regulatory requirements, with approximately 60 'maternity homes' located mainly in rural or peri-urban areas. Motivational drivers included fear of poverty, desire to maintain professional status, and an ethos of community service. However, inhibitors to success were multiple. Start-up loans were scarce, business training lacking and registration processes bureaucratic. Cost of set-up and maintenance were prohibitively high, registration required levels of construction and equipping similar to government sector dispensaries. Communities were reluctant to pay for services that they expected from government. Thus, despite offering a quality of basic maternity care comparable to that in government facilities, often in poorly-served areas, most private maternity homes were under-utilized and struggling for sustainability. Because of their location and emphasis on personalized care, small-scale independent practices run by retired midwives could potentially increase rates of skilled attendance at delivery at peripheral level. The model also extends the working life of members of a professional group at a time of
Ana Rita dos Santos de Pina Duarte
Full Text Available The Social Worker is a qualified professional who, by proper training intervention and by research and analysis of social reality, is ready to act, execute and evaluate services, programs and social policies aiming to preserve, protect and expand human rights and social justice. The Portuguese National Network of Integrated Continuous Care (RNCCI emerged in 2006 considering the health care needs with the recognition that the system could not cope with the rehabilitation needs of the different groups of patients. Thus, this health structure was created to establish an intermediary between health and social care and as a way to connect hospitalization and clinical discharge, as well as re-integration into the community. The primary goal was to clearly assess the importance of the social service in one Continuous Care Unit by using, as methodology, questioner applications for different professionals (social service team and other health team members. The results were helpful and positive, allowing us to conclude that the social service area is valued by the team members at different levels with a fundamental goal of supporting patients, families / caregivers and the other health professionals in their interventions.
Modernization policies in primary care, such as the introduction of out-of-hours general practice cooperatives, signify a marked departure from many service users\\' traditional experiences of continuity of care. We report on a case study of accounts of service users with chronic conditions and their caregivers of continuity of care in an out-of-hours general practice cooperative in Ireland. Using Strauss and colleagues\\' Chronic Illness Trajectory Framework, we explored users\\' and caregivers\\' experiences of continuity in this context. Whereas those dealing with "routine trajectories" were largely satisfied with their experiences, those dealing with "problematic trajectories" (characterized by the presence of, for example, multimorbidity and complex care regimes) had considerable concerns about continuity of experiences in this service. Results highlight that modernization policies that have given rise to out-of-hours cooperatives have had a differential impact on service users with chronic conditions and their caregivers, with serious consequences for those who have "problematic" trajectories.
Collins, Courtney E; Pringle, Patricia L; Santry, Heena P
Patterns of adoption of acute care surgery (ACS) as a strategy for emergency general surgery (EGS) care are unknown. We conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for ACS at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment (three practice types [community, public or charity, and university] in each of six geographic regions [Mid-Atlantic, Midwest, New England, Northeast, South, and West]). Interviews were recorded, transcribed, and analyzed using NVivo (QSR International, Melbourne, Australia). We applied the methods of investigator triangulation using an inductive approach to develop a final taxonomy of codes organized by themes related to respondents' views on the future of ACS as a strategy for EGS. We applied our findings to a conceptual model on diffusion of innovation. We found a paradox between ACS viewed as a health care delivery innovation versus a rebranding of comprehensive general surgery. Optimism for the future of ACS because of increased desirability for trauma and critical care careers as well as improved EGS outcomes was tempered by fear over lack of continuity, poor institutional resources, and uncertainty regarding financial viability. Our analysis suggests that the implementation of ACS, whether a true health care delivery innovation or an innovative rebranding, fits into the Rogers' diffusion of innovation theory. Despite concerns over resource allocation and the definition of the specialty, from the perspective of senior surgeons deeply entrenched in executing this care delivery model, ACS represents the new face of general surgery that will likely continue to diffuse from these early adopters. Published by Elsevier Inc.
Lavoie-Tremblay, Mélanie; Aubry, Monique; Richer, Marie-Claire; Cyr, Guylaine
Health care organizations need project and change management support in order to achieve successful transformations. A project management office (PMO) helps support the organizations through their transformations along with increasing their capabilities in project and change management. The aim of the present study was to extend understanding of the continuous improvement mechanisms used by PMOs and to describe PMO's strategies for continual change and continuous improvement in the context of major transformation in health care. This study is a descriptive case study design with interviews conducted from October to December 2015 with PMO's members (3 managers and 1 director) and 3 clients working with the PMO after a major redevelopment project ended (transition to the new facility). Participants suggested a number of elements including carefully selecting the members of the PMO, having a clear mandate for the PMO, having a method and a discipline at the same time as allowing openness and flexibility, clearly prioritizing projects, optimizing collaboration, planning for everything the PMO will need, not overlooking organizational culture, and retaining the existing support model. This study presents a number of factors ensuring the sustainability of changes.
Howell, Raelina S; Kohan, Lauren S; Woods, Jon S; Criscitelli, Theresa; Gillette, Brian M; Donovan, Virginia; Gorenstein, Scott
To provide information about a study using a new process for continuous monitoring to improve chronic wound care quality.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After completing this continuing education activity, you should be better able to:1. Recognize problems associated with chronic wound care.2. Identify methods used in this project to improve care.3. Illustrate the findings from this and similar projects and implications for providing improved wound care.Patients with chronic wounds require complex care because of comorbidities that can affect healing. Therefore, the goal of this project was to develop a system of reviewing all hospitalized patients seen by the study authors' wound care service on a weekly basis to decrease readmissions, morbidity, and mortality. Weekly multidisciplinary conferences were conducted to evaluate patient data and systematically assess for adherence to wound care protocols, as well as to create and modify patient care plans. This review of pathology and the performance of root-cause analyses often led to improved patient care.
James R Warren
Full Text Available Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR and usual provider continuity index (UPI for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR and 95% confidence interval (CI for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06 for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54.Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.
Warren, James R; Falster, Michael O; Tran, Bich; Jorm, Louisa
Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins. We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR) and usual provider continuity index (UPI) for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR) and 95% confidence interval (CI) for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample. 36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06) for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54). Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.
Coombs, Jennifer; Hooker, Roderick S; Brunisholz, Kim
To determine predictors of physician assistants (PAs) to retire or to permanently leave clinical practice. The intent was to create a measure of retention and attrition for purposes of forecasting PA supply. All PAs 55 years or older who were nationally certified in 2011 were surveyed. Statistical analysis included descriptive measures utilizing means, standard deviations, range, and proportions for all survey questions. Univariable analysis using χ² test for the categorical variables determined gender differences in participants' intent to retire. A studentized t test analysis for continuous variables was used to compare differences across genders. The estimated time interval until retirement was calculated using reported values from participants and then subtracting their projected retirement age from current age. The same calculation was used for estimating PA career length from date of graduation to retirement. For all analyses, a P value surveyed online; 4767 responded (38%). The mean age was 60 years and the years in clinical practice was 25. When asked to predict a retirement date or age, the mean duration of working beyond age 55 years was 12 years (range 5 to 21). Most respondents reported being confident they were on track to retire with an adequate income. The significant differences that emerged were that men were more confident than women in preparing to retire, having enough money for medical expenses, and being able to live comfortably in retirement. Men more than women stated that, if forced to retire, they were more confident in the preparation to do so. PAs 55 years and older report they are likely to delay retirement from practice until age 67 years, on average. Women were less confident than men in retirement preparation. This age prediction expands career projections and refines forecasting models for the profession. Correlations based on expectation-action chain of events should be developed by periodically measuring how often intent and
... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Individual retirement annuities. 1.408-3 Section... (CONTINUED) INCOME TAXES Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.408-3 Individual retirement annuities. (a) In general. An individual retirement annuity is an annuity contract or endowment contract...
Ongenae, Femke; Famaey, Jeroen; Verstichel, Stijn; De Zutter, Saar; Latré, Steven; Ackaert, Ann; Verhoeve, Piet; De Turck, Filip
The ultimate ambient-intelligent care room contains numerous sensors and devices to monitor the patient, sense and adjust the environment and support the staff. This sensor-based approach results in a large amount of data, which can be processed by current and future applications, e.g., task management and alerting systems. Today, nurses are responsible for coordinating all these applications and supplied information, which reduces the added value and slows down the adoption rate.The aim of the presented research is the design of a pervasive and scalable framework that is able to optimize continuous care processes by intelligently reasoning on the large amount of heterogeneous care data. The developed Ontology-based Care Platform (OCarePlatform) consists of modular components that perform a specific reasoning task. Consequently, they can easily be replicated and distributed. Complex reasoning is achieved by combining the results of different components. To ensure that the components only receive information, which is of interest to them at that time, they are able to dynamically generate and register filter rules with a Semantic Communication Bus (SCB). This SCB semantically filters all the heterogeneous care data according to the registered rules by using a continuous care ontology. The SCB can be distributed and a cache can be employed to ensure scalability. A prototype implementation is presented consisting of a new-generation nurse call system supported by a localization and a home automation component. The amount of data that is filtered and the performance of the SCB are evaluated by testing the prototype in a living lab. The delay introduced by processing the filter rules is negligible when 10 or fewer rules are registered. The OCarePlatform allows disseminating relevant care data for the different applications and additionally supports composing complex applications from a set of smaller independent components. This way, the platform significantly reduces
van Marum, R J; de Vogel, E M; Zylicz, Z
Three patients, 2 men aged 55 and 54 years and a woman aged 86 years, were admitted to hospital for treatment of symptoms resulting from terminal disease (pain, agitation, nausea etc.). In all three patients, continuous subcutaneous infusion (CSI) of medication was successfully used to control the symptoms. Compared with intravenous infusion, the technique of CSI is easy to learn and is associated with fewer complications. Its reliability and ease-of-use make it a technique that can be used not only in a hospital setting, but also in general practice and nursing homes. Medication used in palliative care (e.g. morphine, haloperidol, metoclopramide, levomepromazine, midazolam) can often be administered safely by CSI. In palliative care, where goals should be accomplished with minimal burden to the patient, CSI must be considered the technique of choice in patients who are unable to swallow their medication.
Harrington, W.; Sawyer, J.W. Jr.
A critique of recently enacted legislation authorizing the New Mexico Environmental Improvement Agency to regulate uranium mills in the state is presented. Under this new legislation, the Agency is authorized to require payment of up to 10 cents per pound of yellowcake from each licensed mill in the state until a total of $1 million has been deposited by that mill. The continued care fund thus created will provide for maintenance in perpetuity of mill sites after being decommissioned. Arguments are presented, based on calculations for a typical 5,000 ton per day mill, that even the maximum amount is not likely to generate sufficient income to support an adequate maintenance program. The matter is further aggravated by the rate of inflation which will increase costs beyond the coverage provided by a fixed funding system. To correct this situation, it is proposed that (1) the fund should generate an income stream sufficient to meet all maintenance costs based on currently available information on costs, interest, and inflation rates, and (2) the terms of the continued care contribution should be readily alterable as new information becomes available. The latter condition should be coupled with removal of the upper statutory limit now established for the fund
Joannah Caborn Wengler
As the LHC celebrates a highly successful year so far, the world accelerator community is already looking ahead to the next collider. It has appointed a CERN past master of accelerator building to coordinate the development of future linear collider efforts. Lyn Evans at SM-18. Lyn Evans, former LHC project leader, has just been appointed director of the new Linear Collider organisation which brings together the two existing linear collider programmes under one roof. “We will initially continue to work in parallel on both CLIC and the ILC,” says Evans. The two proposed accelerators have a number of elements in common, from the damping rings to the final focus systems. Both have very similar detector designs, with the exception of the data acquisition systems as the machines have very different time structures. “The technologies for the two accelerators are at very different levels of maturity,” summarises Evans. When the time comes to make t...
compensation in their decisions on how long to remain in the service, but financial compensation is not the most important factor. In order to continue...their Thrift Savings Plan (TSP) retirement account to provide members departing the service prior to 20 year retirement eligibility with some portable...employment and promotion/ advancement opportunities. Thus, the BRS will have a neutral effect on gender 4 retention. In order to continue to close
Maria Denise Schimith
Full Text Available This study aimed to identify the negotiation and shared decision-making between professionals and users in a Family Health Unit and its influence on the continuity of care in the Health Care Network. Qualitative research created from a case study. One conducted 19 interviews, observation and document research. It was developed in a city in the countryside of Rio Grande do Sul, Brazil, in 2012. The results show that decisions used to happen unilaterally and that users and professionals looked for alternative ways to the continuity of care. It was not possible to identify the negotiation between professional and users and it was noticed that the user was alone looking for access. It is understood that primary care in the city researched needs to take responsibility for users and their access.
de Bresser, Jochem; van Soest, Arthur
This paper investigates the relationship between subjective expectations regarding the replacement rate of income at retirement and several measures of pension satisfaction. We use panel data on Dutch employees, analyzed with fixed effects models, allowing for correlation between unobserved
Full Text Available One consequence of demographic change is a longer average remaining lifetime after retirement. Many people, however, remain able and willing to continue work after reaching the statutory retirement age. Given the predicted shortage of skilled workers in the future, post-retirement activities have the potential to contribute to both organisations and society. This article elaborates the prerequisites for productivity in retirement age and the changed nature of retirement at present.It also quantifies the extent to which activities are continued at retirement age. Paid employment still occurs beyond the applicable retirement age, whereby with increasing age, self-employed persons and assistant family members make up the lion’s share of the statistics. An empirical study shows the concrete situation of active retirees and the prerequisites for post-retirement activities. At the explorative level, individual experiences of the transition into retirement, the reasons for and the framework of post-retirement activities, motivational factors in job design, and physical and intellectual demands before and after retirement are characterised. The qualitative data indicate that retirement entails changes towards more flexible structures in everyday life. Decisive reasons for taking up post-retirement activities are the desire to help, pass on knowledge or remain active; personal development and contact with others; and gaining appreciation and recognition. Flexible job design and freedom to make decisions constitute major elements in shaping post-retirement working activities. Offering autonomy, skill variety, and task significance is important for the design of post-retirement activities. The paper closes with identifying relevant research fields and the concrete need to take action at individual, organisational, and societal levels. All in all, the transition from working life to retirement should be made flexible enough to do greater justice to the
Ellison, S; Lamb, J; Haines, A; O'Dell, S; Thomas, G; Sethi, S; Ratcliffe, J; Chisholm, S; Vaughan, J; Mahadevan, V S
Surgical and other advances in the treatment and care of congenital heart disease have resulted in a significant increase in the number of adults with congenital heart disease (ACHD), many of whom have no regular cardiology follow-up. Optimised care for ACHD patients requires continuity of specialist and shared care and education of practitioners and patients. The challenges for managing ACHD were identified by a Health Needs Assessment in the North West and are addressed within the UK Department of Health's ACHD Commissioning Guide. An ACHD model of care was recommended in the North West of England and developed by the three North West Cardiac & Stroke Networks. Within this, a Task Group focused on the role of primary care in the identification and continuing care of ACHD patients. A feasibility study demonstrated that existing diagnostic Read Codes can identify ACHD patients on general practice registers. An ACHD Toolkit was developed to provide algorithms to guide the appropriate management of ACHD patients through primary, secondary and/or specialist ACHD care and to improve education/knowledge amongst primary care staff about ACHD and its wider implications. Early findings during the development of this Toolkit illustrate a wide disparity of provision between current and optimal management strategies. Patients lost to follow-up have already been identified and their management modified. By focusing on identifying ACHD patients in primary care and organising/delivering ACHD services, the ACHD Toolkit could help to improve quality, timeliness of care, patient experience and wellbeing. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
et al.’s findings indicate that HDHPs may not be as adept at curbing unhealthy lifestyle choices as previously argued by Herzlinger (2004) and...price” for care The incentive structure might encourage healthier lifestyles , reducing the need for care. (1998, p. 446). There may be potential for...ability to affect behavior has a number of academics believing HDHPs will provide enough incentive to alter peoples’ health and lifestyle choices
Costa, Nadia Pinheiro da; Polaro, Sandra Helena Isse; Vahl, Eloá Aparecida Caliari; Gonçalves, Lucia Hisako Takase
assessing relevance and effectiveness of care/educational technology in the form of "storytelling" as a strategy in the cultivation of active ageing (AA) for elderly users of a Basic Health Unit (BHU), from the Amazon region. convergent care research (CCR) held in a BHU in Belém, state of Pará, with eight elderly ladies for testing this technology. An active ageing assessment questionnaire and WHOQOL-BREF - quality of life assessment were applied. After training with a view to continuing education, elderly ladies told stories for an audience that addressed the question: "What did you learn from it for your life?" tThe popular stories elicited reactions from which the following categories emerged: solidarity; respect for the other; imagination, dreams, hopes and culture of the Amazonian. This practice had a positive result, producing changes in the quality of life of the elderly, particularly in the psychological domain. "storytelling" proved to be an innovative technology, a relevant and effective resource in health education, especially for active ageing.
Cooley, Eileen L; Adorno, Gail
in the 21st century, as more women are employed full-time and couples increasingly share egalitarian values, more women continue employment after their partners have voluntarily retired. However, we know very little about the experiences of this growing population of women. We asked working women with retired partners to share their advice for other women who may face this developmental transition. Open-ended responses from 97 women were analyzed to identify pertinent issues and themes. Four primary content areas were identified: time management, division of household labor, financial planning, and communication. Communication between partners was both a topic of concern as well as the solution suggested to resolve conflicts or differences that may arise when women live with a retired partner. It is expected that future changes in the workforce and improvements in the gender balance within relationships will continue to impact experiences for working women with retired partners.
Sheaff, WR; Halliday, J; Øvretveit, J; Byng, R; Exworthy, M; Peckham, S; Asthana, S
Background\\ud An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by pa...
Lee, Ayoung; Cho, Joonmo
We examined the effects of the differences in the retirement sequence (i.e., who retires first between spouses) on satisfaction in Korea of patriarchal culture. Our empirical study demonstrates that households where men retired first had a much lower satisfaction than households where women retired first. In addition, men were found to show lower satisfaction than wives in both households where women retire first and the households where men retire first. Retirement sequence affecting their satisfaction at the point when only one of the spouses is retired continues to affect their satisfaction after both of them are retired. This means that the difference in the couple's retirement sequence has an ongoing effect on their later happiness. The analysis of the effect of a couple's retirement sequence on the satisfaction in their old life may be useful for improving an individual and couples' quality of life in countries with similar cultures.
Background Due to the aging of the population and subsequent higher pressure on public finances, there is a need for employees in many European countries to extend their working lives. One way in which this can be achieved is by employees refraining from retiring early. Factors predicting early retirement have been identified in quantitative research, but little is known on why and how these factors influence early retirement. The present qualitative study investigated which non-health related factors influence early retirement, and why and how these factors influence early retirement. Methods A qualitative study among 30 Dutch employees (60–64 years) who retired early, i.e. before the age of 65, was performed by means of face-to-face interviews. Participants were selected from the cohort Study on Transitions in Employment, Ability and Motivation (STREAM). Results For most employees, a combination of factors played a role in the transition from work to early retirement, and the specific factors involved differed between individuals. Participants reported various factors that pushed towards early retirement (‘push factors’), including organizational changes at work, conflicts at work, high work pressure, high physical job demands, and insufficient use of their skills and knowledge by others in the organization. Employees who reported such push factors towards early retirement often felt unable to find another job. Factors attracting towards early retirement (‘pull factors’) included the wish to do other things outside of work, enjoy life, have more flexibility, spend more time with a spouse or grandchildren, and care for others. In addition, the financial opportunity to retire early played an important role. Factors influenced early retirement via changes in the motivation, ability and opportunity to continue working or retire early. Conclusion To support the prolongation of working life, it seems important to improve the fit between the physical and
Luecke, Randall W; Reinstein, Alan
Statement of Financial Accounting Standards (SFAS) No. 143 requires organizations to recognize a liability for an asset retirement obligation when it is incurred--even if that occurs far in advance of the asset's planned retirement. For example, organizations must recognize future costs associated with medical equipment disposal that carries hazardous material legal obligations.
Fitzpatrick, Maria D.; Lovenheim, Michael F.
As public budgets have grown tighter over the past decade, states and school districts have sought ways to control the growth of spending. One increasingly common strategy employed to rein in costs is to offer experienced teachers with high salaries financial incentives to retire early. Although early retirement incentive (ERI) programs have been…
The five essays in this dissertation address a range of topics in the micro-economic literature on partial retirement. The focus is on the labor market behavior of older age groups. The essays examine the economic and non-economic determinants of partial retirement behavior, the effect of partial
Silvana Pozzebon; Olivia S. Mitchell
In this paper we examine the economic and family determinants of married women's retirement behavior. A model of wives' retirement decisions is developed and tested empirically using data on working married women. Estimated response parameters are compared to those obtained previously for male workers. Our findings are directly relevant to policy questions regarding pension and Social Security reform.
Datta Gupta, Nabanita; Larsen, Mona
We investigate the effect of an acute health shock on retirement among elderly male workers in Denmark, 1991-1999, and in particular whether various welfare state programs and institutions impinge on the retirement effect. The results show that an acute health event increases the retirement chances...... significant. For the most part, the retirement effect following a health shock seems to be immune to the availability of a multitude of government programs for older workers in Denmark....... benefits in Denmark nor by the promotion of corporate social responsibility initiatives since the mid-1990s. In the late 1990s, however, the retirement rate following a health shock is reduced to 3% with the introduction of the subsidized employment program (fleksjob) but this effect is not strongly...
Fairbrother, Peter; Pinnock, Hilary; Hanley, Janet; McCloughan, Lucy; Sheikh, Aziz; Pagliari, Claudia; McKinstry, Brian
Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions. New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways. A telemonitoring service for patients with chronic obstructive pulmonary disease (COPD) was introduced in Lothian, Scotland, in 2009. A qualitative study, nested within the TELESCOT COPD randomised control trial, was undertaken to explore the views of patients and professionals on telemonitoring. The perceived impact of telemonitoring on continuity of care was investigated as part of the research. Semi-structured interviews were undertaken with 38 patients (47% male, mean age 67.5 years). A maximum variation sample in relation to age, sex, socio-economic background, disease severity, and compliance with telemonitoring was recruited. Thirty-two stakeholders (healthcare professionals and managers) were interviewed. Transcribed coded data were analysed thematically using the framework approach. Interpretation was supported by multidisciplinary discussion. Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services. Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs. However, professionals described many operational challenges arising from the 'bolting-on' of telemonitoring provision to existing usual care provision which, they considered, resulted in the proliferation of additional managerial discontinuities. Managers and healthcare professionals face major challenges in meeting demands for both relationship continuity and continuity of clinical management in the development of telemonitoring services.
Rebmann, Terri; Wang, Jing; Swick, Zachary; Reddick, David; delRosario, John Leon
Only limited data are available on US business continuity activities related to biologic events. A questionnaire was administered to human resource professionals during May-July 2011 to assess business continuity related to biologic events, incentives businesses are providing to maximize worker surge capacity, and seasonal influenza vaccination policy. Linear regressions were used to describe factors associated with higher business continuity and pandemic preparedness scores. The χ(2) and Fisher exact tests compared health care versus non-health care businesses on preparedness indicators. Possible business continuity and pandemic preparedness scores ranged from 0.5 to 27 and 0 to 15, with average resulting scores among participants at 13.2 and 7.3, respectively. Determinants of business continuity and pandemic preparedness were (1) business size (larger businesses were more prepared), (2) type of business (health care more prepared), (3) having human resource professional as company disaster planning committee member, and (4) risk perception of a pandemic in the next year. Most businesses (63.3%, n = 298) encourage staff influenza vaccination; 2.1% (n = 10) mandate it. Only 10% of businesses (11.0%, n = 52) provide employee incentives, and fewer than half (41.0%, n = 193) stockpile personal protective equipment. Despite the recent H1N1 pandemic, many US businesses lack adequate pandemic plans. It is critical that businesses of all sizes and types become better prepared for a biologic event. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Moss, Arthur J; Greenberg, Henry; Dwyer, Edward M; Klein, Helmut; Ryan, Daniel; Francis, Charles; Marcus, Frank; Eberly, Shirley; Benhorin, Jesaia; Bodenheimer, Monty; Brown, Mary; Case, Robert; Gillespie, John; Goldstein, Robert; Haigney, Mark; Krone, Ronald; Lichstein, Edgar; Locati, Emanuela; Oakes, David; Thomsen, Poul Erik Bloch; Zareba, Wojciech
An increasing number of academic senior physicians are approaching their potential retirement in good health with accumulated clinical and research experience that can be a valuable asset to an academic institution. Considering the need to let the next generation ascend to leadership roles, when and how should a medical career be brought to a close? We explore the roles for academic medical faculty as they move into their senior years and approach various retirement options. The individual and institutional considerations require a frank dialogue among the interested parties to optimize the benefits while minimizing the risks for both. In the United States there is no fixed age for retirement as there is in Europe, but European physicians are initiating changes. What is certain is that careful planning, innovative thinking, and the incorporation of new patterns of medical practice are all part of this complex transition and timing of senior academic physicians into retirement. Copyright © 2013 Elsevier Inc. All rights reserved.
Social Security Administration — This dataset contains information about the Retirement Applicant Survey (RAS). The survey measured satisfaction results with the retirement application process. The...
... 26 Internal Revenue 5 2010-04-01 2010-04-01 false Taxation of retirement bonds. 1.405-3 Section 1.405-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES Pension, Profit-Sharing, Stock Bonus Plans, Etc. § 1.405-3 Taxation of retirement...
Hamze, Fernanda Luiza; de Souza, Cristiane Chaves; Chianca, Tânia Couto Machado
to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit. descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software. 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8%) caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients. it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.
Fernanda Luiza Hamze
Full Text Available Objective: to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit.Method: descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software.Results: 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8% caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients.Conclusion: it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.
Panattoni, Laura; Stone, Ashley; Chung, Sukyung; Tai-Seale, Ming
The growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes. We aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician. We used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010. The study included family medicine (n = 104) and internal medicine (n = 101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n = 12,688). Physician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third next-available appointment. Physician FTE was directly associated with better continuity of care received (0.172% per FTE, p part-time PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.
Lars Henrik Myklebust
Full Text Available Background: The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention.Aims: To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. Method: The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Results: Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Conclusion: Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a
Lars Henrik Myklebust
Full Text Available Background: The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. Aims: To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. Method: The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Results: Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Conclusion: Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore
Myklebust, Lars Henrik; Olstad, Reidun; Bjorbekkmo, Svein; Eisemann, Martin; Wynn, Rolf; Sørgaard, Knut
Background The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. Aims To study whether inpatients’ utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. Method The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Results Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients’ utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Conclusion Inpatients’ utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative
MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION...retirement choice in 2016. We start by describing the $30,000 bonus as an early, partial cash -out of the servicemember’s retirement pension. This...30,000 cash -out will be “paid back” later in the form of reduced retirement checks. By providing information on how much this cash -out will cost in
Staats, Sara; Pierfelice, Loretta
The authors surveyed retired persons (predominately women) with regard to their immediate, intermediate, and long-range activities following retirement. As predicted, leisure travel emerged as a frequent long-range goal for persons retired more than 5 years. The travel activity preferences of long-retired older women present challenges and opportunities to both researchers and marketers. Length of trips and frequency of trips have been predicted from regression models, with trip length in particular being well predicted by the problem of daily life hassles. A theoretical model of continued post-retirement travel is presented as a variant of Solomon's opponent process theory of affect (R. L. Solomon, 1980). The authors suggest that to the degree that places traveled to are varied and different, older people may remain stimulated and continue to enjoy retirement.
Continuity of care is an important and distinct aspect of childbirth experience : Findings of a survey evaluating experienced continuity of care, experienced quality of care and women's perception of labor
Perdok, Hilde; Verhoeven, Corine J.; van Dillen, Jeroen; Schuitmaker, Tjerk Jan; Hoogendoorn, Karla; Colli, Jolanda; Schellevis, François G.; de Jonge, Ank
Background: To compare experienced continuity of care among women who received midwife-led versus obstetrician-led care. Secondly, to compare experienced continuity of care with a. experienced quality of care during labor and b. perception of labor. Methods: We conducted a questionnaire survey in a
Kristjansson, Elizabeth; Hogg, William; Dahrouge, Simone; Tuna, Meltem; Mayo-Bruinsma, Liesha; Gebremichael, Goshu
Continuity is a fundamental tenet of primary care, and highly valued by patients; it may also improve patient outcomes and lower cost of health care. It is thus important to investigate factors that predict higher continuity. However, to date, little is known about the factors that contribute to continuity. The purpose of this study was to analyse practice, provider and patient predictors of continuity of care in a large sample of primary care practices in Ontario, Canada. Another goal was to assess whether there was a difference in the continuity of care provided by different models of primary care. This study is part of the larger a cross-sectional study of 137 primary care practices, their providers and patients. Several performance measures were evaluated; this paper focuses on relational continuity. Four items from the Primary Care Assessment Tool were used to assess relational continuity from the patient's perspective. Multilevel modeling revealed several patient factors that predicted continuity. Older patients and those with chronic disease reported higher continuity, while those who lived in rural areas, had higher education, poorer mental health status, no regular provider, and who were employed reported lower continuity. Providers with more years since graduation had higher patient-reported continuity. Several practice factors predicted lower continuity: number of MDs, nurses, opening on weekends, and having 24 hours a week or less on-call. Analyses that compared continuity across models showed that, in general, Health Service Organizations had better continuity than other models, even when adjusting for patient demographics. Some patients with greater health needs experience greater continuity of care. However, the lower continuity reported by those with mental health issues and those who live in rural areas is concerning. Furthermore, our finding that smaller practices have higher continuity suggests that physicians and policy makers need to consider
.... Military retirement health benefits are post-retirement benefits that DoD provides to military retirees and other eligible beneficiaries through the Civilian Health and Medical Program of the Uniformed Services (Purchased Care...
Schaller, Philippe; Gaspoz, Jean-Michel
If the Swiss health care system has reached several important objectives, fragmentation of its organization alter its efficacy, its effectiveness and its quality. Numerous experts put forward the necessity of coordinating care and services, particularly for complex and, most often, chronic diseases. Physicians have a key role to play in that coordination, but the exponential growth of medical knowledge, together with a more and more sophisticated technology, requires this role to be based on interdisciplinarity and network organization. This article proposes a model to implement, around the primary care physician, a first level organization of care to ensure this organization. Such a model may better meet future challenges of the Swiss health care system.
Massimo Tarenghi, chronologically MPG/ESO project scientist, NTT project manager, VLT programme manager and first Director, ALMA Director and ESO Representative in Chile, has retired after 35 years at ESO. A brief summary of his achievements is presented.
Office of Personnel Management — A place for the U.S. Office of Personnel Management (OPM) to share information about retirement benefits for new, prospective, and current Federal employees, as well...
Describes career changes and retirement choices made by outgoing "career" superintendents. Choices ranged from teaching and consulting to administering philanthropic organizations and launching a charter-boat business. (MLH)
Hiemstra, Djoerd; Tait, J.; MacFarlane, A; Belkin, N.
Stephen Robertson retired from the Microsoft Research Lab in Cambridge during the summer of 2013 after a long career as one of the most influential, well-liked and eminent researchers in Information Retrieval throughout the world.
Cremer, Helmuth; Lozachmeur, Jean-Marie; Pestieau, Pierre
This Paper studies the design of retirement and disability policies. It illustrates the often observed exit from the labour force of healthy workers through disability insurance schemes. Two types of individuals, disabled and leisure-prone ones, have the same disutility for labour and cannot be distinguished. They are not, however, counted in the same way in social welfare. Benefits depend on retirement age and on the (reported) health status. We determine first- and second-best optimal benef...
Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya
Society demands competent and safe health care, which obligates professionals to deliver quality patient care using current knowledge and skills. Participation in continuous professional development programs is a way to ensure quality nursing care. Despite the importance of continuous professional development, however, critical care nurse practitioners' attendance rates at these programs is low. To explore critical care nurses' reasons for their unsatisfactory attendance at a continuous professional development program. A nominal group technique was used as a consensus method to involve the critical care nurses and provide them the opportunity to reflect on their experiences and challenges related to the current continuous professional development program for the critical care units. Participants were 14 critical care nurses from 3 critical care units in 1 private hospital. The consensus was that the central theme relating to the unsatisfactory attendance at the continuous professional development program was attitude. In order of importance, the 4 contributing priorities influencing attitude were communication, continuous professional development, time constraints, and financial implications. Attitude relating to attending a continuous professional development program can be changed if critical care nurses are aware of the program's importance and are involved in the planning and implementation of a program that focuses on the nurses' individual learning needs. ©2016 American Association of Critical-Care Nurses.
Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 21, No 5 (2003) >. Log in or Register to get access to full text downloads.
Biggs, John H.
In the late 1990s, the Andrew W. Mellon Foundation made grants to study people's attitudes toward retirement and to determine what factors influenced their decisions to retire. Although faculty were not talking to college administrators or human-resources departments about health care, the researchers found to their surprise that when they…
... to flexible retirement. It also found that flexible policy will have a positive welfare effect as many employees can then take care of their extended span of dependants for a longer period and employee productivity will also be improved. Key words: Retirement, Mandatory, Flexible, Pension Plan, Extended Family System.
Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I
To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.
Issues in treating depression in primary care. NR Horn. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...
Laut, Kristina Grønborg; Hjort, Jacob; Engstrøm, Thomas; Jensen, Lisette Okkels; Tilsted Hansen, Hans-Henrik; Jensen, Jan Skov; Pedersen, Frants; Jørgensen, Erik; Holmvang, Lene; Pedersen, Alma Becic; Christensen, Erika Frischknecht; Lippert, Freddy; Lang-Jensen, Torsten; Jans, Henning; Hansen, Poul Anders; Trautner, Sven; Kristensen, Steen Dalby; Lassen, Jens Flensted; Lash, Timothy L; Clemmensen, Peter; Terkelsen, Christian Juhl
System delay (delay from emergency medical service call to reperfusion with primary percutaneous coronary intervention [PPCI]) is acknowledged as a performance measure in ST-elevation myocardial infarction (STEMI), as shorter system delay is associated with lower mortality. It is unknown whether system delay also impacts ability to stay in the labor market. Therefore, the aim of the study was to evaluate whether system delay is associated with duration of absence from work or time to retirement from work among patients with STEMI treated with PPCI. We conducted a population-based cohort study including patients ≤67 years of age who were admitted with STEMI from January 1, 1999, to December 1, 2011 and treated with PPCI. Data were derived from Danish population-based registries. Only patients who were full- or part-time employed before their STEMI admission were included. Association between system delay and time to return to the labor market was analyzed using a competing-risk regression analysis. Association between system delay and time to retirement from work was analyzed using a Cox regression model. A total of 4,061 patients were included. Ninety-three percent returned to the labor market during 4 years of follow-up, and 41% retired during 8 years of follow-up. After adjustment, system delay >120 minutes was associated with reduced resumption of work (subhazard ratio 0.86, 95% confidence interval 0.81 to 0.92) and earlier retirement from work (hazard ratio 1.21, 95% confidence interval 1.08 to 1.36). In conclusion, system delay was associated with reduced work resumption and earlier retirement. This highlights the value of system delay as a performance measure in treating patients with STEMI. Copyright © 2014 Elsevier Inc. All rights reserved.
Wierdsma, Andre; Mulder, Cornelis; de Vries, Sanne; Sytema, Sjoerd
Continuity of mental health care is a key issue in the organization and evaluation of services for patients with disabling chronic conditions. Over many years, health services researchers have been exploring the conceptual boundaries between continuity of care and other service characteristics. On
Cozijnsen, M.R.; Stevens, N.L.; van Tilburg, T.G.
This study examines the consequences of retirement for the continuation of work-related personal ties. The hypothesis is that their inclusion in personal networks after retirement has become more likely because these relationships have become less role based in today's social-cultural context. Data
Hanzlíček, Petr; Zvárová, Jana; Zvára, K.; Bureš, V.; Špidlen, Josef
Roč. 11, - (2005), s. 1-6 ISSN 1727-1983. [EMBEC'05. European Medical and Biomedical Conference /3./. Prague, 20.11.2005-25.11.2005] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : electronic health record * shared health care * information technology Subject RIV: BD - Theory of Information
Hanzlíček, Petr; Zvárová, Jana
Roč. 9, - (2005), s. 275-280 ISSN 1335-2393. [YBERC 2005. Young Biomedical Engineers and Researchers Conference. Stará Lesná, 13.07.2005-15.07.2005] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : information society * telemedicine * electronic health record * digital signature * personal data protection * biomedical informatics Subject RIV: FQ - Public Health Care, Social Medicine
A M E Kotze
Full Text Available Objective. To study the needs of outpatients suffering from schizophrenia and their primary caregivers. Methods. A qualitative descriptive design was selected to study the needs of a non-probability purposive sample of 50 outpatients with schizophrenia and their primary caregivers. Data were collected on their compliance-related needs as well as psychosocial and aftercare treatment needs. Results. Compliance needs: Eighty-three per cent of the participants supported their medication treatment and aftercare, but needed more information on the illness than they had received or had managed to gather. Psychosocial needs: Participants had difficulty in accepting the illness and in understanding its consequences for their everyday functioning. Ninety-seven per cent of patients were aware that their illness had affected the health of their primary caregiver. The majority of participants had lost friendships since the diagnosis of schizophrenia. Eighty-eight of the primary caregivers supported the patient financially, despite the fact that many were over 60 years of age. Aftercare treatment needs: A strong need was expressed for services such as day-care centres, workshops, and psycho-educational and social work services. Conclusions. As South African health policy is moving towardsde-institutionalisation and treating mental health as part of primary care, support must be improved for sufferers of schizophrenia and their primary caregivers. Many people are prepared to face up to the challenge of caring for a mentally ill family member, yet are faced with significant needs that should be addressed.
Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas
Brand, Sarah; Pollock, Kristian
To explore patients' perceptions of continuity of care within a hospital-based specialist service. Patient journeys through health care are becoming increasingly complex. For patients with chronic conditions, the longevity of their illness and common multiple co-morbidities make this complexity more pronounced. Continuity of care is most challenging to provide for these patients. A multifaceted model of continuity is widely accepted, but despite this, much literature focuses exclusively on relational aspects. In addition, the majority of the literature has focused on primary and family care settings whilst continuity within specialist and hospital care has not been widely researched. A qualitative descriptive design was used. Thirteen semi-structured interviews with patients accessing services as at a Renal and Transplant Unit at a UK hospital were conducted in 2014. Data were analysed thematically to identify commonality as well as diversity amongst participants. Five themes of time, being known, knowledge, knowing the system and responsibility were identified within patient experiences of continuity. The multidisciplinary team was more important in relational continuity than literature has previously suggested. Patients' expectations in relation to continuity were notably different in their interactions with hospital-based services in comparison with community and family-based care. Patients accessing specialist care services may perceive continuity differently to those receiving care in the community. Generic guidance concerned with patient experience outcomes may be difficult to implement in practice. Nurses and the wider healthcare team play a fundamental role within the provision of continuity, even in predominantly medically led specialist services. The differences between primary and secondary care in terms of patient expectation and experience should be recognised to ensure effective models of care are implemented which both meet patient expectations and
Nyström, Sofia; Dahlberg, Johanna; Edelbring, Samuel; Hult, Håkan; Abrandt Dahlgren, Madeleine
The increasing complexity of health care practice makes continuing professional development (CPD) essential for health care professionals. Simulation-based training is a CPD activity that is often applied to improve interprofessional collaboration and the quality of care. The aim of this study is to explore simulation as a pedagogical practice for…
Klarare, Anna; Rasmussen, Birgit H; Fossum, Bjöörn; Fürst, Carl Johan; Hansson, Johan; Hagelin, Carina Lundh
Those who are seriously ill and facing death are often living with physical, emotional, social, and spiritual suffering. Teamwork is considered to be necessary to holistically meet the diverse needs of patients in palliative care. Reviews of studies regarding palliative care team outcomes have concluded that teams provide benefits, especially regarding pain and symptom management. Much of the research concerning palliative care teams has been performed from the perspective of the service providers and has less often focused on patients' and families' experiences of care. Our aim was to investigate how the team's work is manifested in care episodes narrated by patients and families in specialized palliative home care (SPHC). A total of 13 interviews were conducted with patients and families receiving specialized home care. Six patients and seven family members were recruited through SPHC team leaders. Interviews were transcribed verbatim and the transcripts qualitatively analyzed into themes. Two themes were constructed through thematic analysis: (1) security ("They are always available," "I get the help I need quickly"); and (2) continuity of care ("They know me/us, our whole situation and they really care"). Of the 74 care episodes, 50 were descriptions of regularly scheduled visits, while 24 related to acute care visits and/or interventions. Patients' and family members' descriptions of the work of SPHC teams are conceptualized through experiences of security and continuity of care. Experiences of security are fostered through the 24/7 availability of the team, sensitivity and flexibility in meeting patients' and families' needs, and practical adjustments to enable care at home. Experiences of continuity of care are fostered through the team's collective approach, where the individual team member knows the patients and family members, including their whole situation, and cares about the little things in life as well as caring for the family unit.
Rowley, M J; Hensley, M J; Brinsmead, M W; Wlodarczyk, J H
To compare continuity of care from a midwife team with routine care from a variety of doctors and midwives. A stratified, randomised controlled trial. 814 women attending the antenatal clinic of a tertiary referral, university hospital. Women were randomly allocated to team care from a team of six midwives, or routine care from a variety of doctors and midwives. Antenatal, intrapartum and neonatal events; maternal satisfaction; and cost of treatment. 405 women were randomly allocated to team care and 409 to routine care; they delivered 385 and 386 babies, respectively. Team care women were more likely to attend antenatal classes (OR, 1.73; 95% CI, 1.23-2.42); less likely to use pethidine during labour (OR, 0.32; 95% CI, 0.22-0.46); and more likely to labour and deliver without intervention (OR, 1.73; 95% CI, 1.28-2.34). Babies of team care mothers received less neonatal resuscitation (OR, 0.59; 95% CI, 0.41-0.86), although there was no difference in Apgar scores at five minutes (OR, 0.86; 95% CI, 0.29-2.57). The stillbirth and neonatal death rate was the same for both groups of mothers with a singleton pregnancy (three deaths), but there were three deaths (birthweights of 600 g, 660 g, 1340 g) in twin pregnancies in the group receiving team care. Team care was rated better than routine care for all measures of maternal satisfaction. Team care meant a cost reduction of 4.5%. Continuity of care provided by a small team of midwives resulted in a more satisfying birth experience at less cost than routine care and fewer adverse maternal and neonatal outcomes. Although a much larger study would be required to provide adequate power to detect rare outcomes, our study found that continuity of care by a midwife team was as safe as routine care.
Burns, T; Catty, J; White, S; Clement, S; Ellis, G; Jones, I R; Lissouba, P; McLaren, S; Rose, D; Wykes, T
Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalize a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness. A multi-axial model of continuity of care comprising eight facets was operationalized for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care. Factor analysis produced seven independent continuity factors accounting for 62.5% of the total variance. These factors, Experience and Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close but not identical to the original theoretical model. We confirmed that continuity of care is multi-factorial. Our seven factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders.
Kosteniuk, Julie G.; Morgan, Debra G.; O'Connell, Megan E.; Dal Bello-Haas, Vanina; Stewart, Norma J.
Home care staff who provide housekeeping and personal care to individuals with dementia generally have lower levels of dementia care training compared with other health care providers. The study's purposes were to determine whether the professional role of home care staff in a predominantly rural region was associated with preferences for delivery…
Laut, Kristina Grønborg; Hjort, Jacob; Engstrøm, Thomas
system delay also impacts ability to stay in the labor market. Therefore, the aim of the study was to evaluate whether system delay is associated with duration of absence from work or time to retirement from work among patients with STEMI treated with PPCI. We conducted a population-based cohort study...... including patients ≤67 years of age who were admitted with STEMI from January 1, 1999, to December 1, 2011 and treated with PPCI. Data were derived from Danish population-based registries. Only patients who were full- or part-time employed before their STEMI admission were included. Association between...... system delay and time to return to the labor market was analyzed using a competing-risk regression analysis. Association between system delay and time to retirement from work was analyzed using a Cox regression model. A total of 4,061 patients were included. Ninety-three percent returned to the labor...
Matthews, Janet R.
During the 1960s, there was extensive hiring of college and university faculty members. This large group of professors are now at or nearing retirement age. Concerns about the economy, the availability of good health insurance, increased life expectancy, and removal of mandatory retirement laws may influence decisions about when to retire.…
Brett, Thomas D; Arnold-Reed, Diane E; Hince, Dana A; Wood, Ian K; Moorhead, Robert G
To ascertain the retirement intentions of a cohort of Australian general practitioners. Postal questionnaire survey of members of four Divisions of General Practice in Western Australia, sent out November 2007 - January 2008. A sample of 178 GPs aged 45-65 years. Intention to work in general practice until retirement; reasons for retiring before age 65 years; factors that might encourage working beyond chosen retirement age; and perceived obstacles to working in general practice. 63% of GPs intended to work to at least age 65 years, with men more likely to retire early. Of 63 GPs intending to retire early, 46% gave pressure of work, exhaustion and burnout as reasons for early retirement. Better remuneration, better staffing levels and more general support were incentives to continue working for 46% of the 64 GPs who responded to the question about incentives, and more flexible working hours, part-time work and reduced workload for 41%. Of 169 participants, 65% gave increasing bureaucracy, poor job satisfaction and disillusionment with the medical system or Medicare as obstacles to working in general practice in Australia, whereas workforce shortage, increasing patient demands and diminishing lifestyle through overwork were obstacles named by 48%. Many GPs are planning to retire early, reflecting an emerging trend among professionals and society generally. Declining job satisfaction, falling workforce numbers, excessive workload and increasing bureaucracy were recurrent concerns of older WA GPs considering premature retirement.
On December 1st, 2002, after thirty- seven years of service, first in Chile and then in Garching, Ms. Christa Euler will leave ESO to enjoy a welldeserved retirement. Among the current staff, she is probably the only person who started her career at ESO just four years after the Organization was founded.
Following the Standing Concertation Committee meeting of 2 December 2008, please note that the Progressive Retirement Programme has been extended by one year, i.e. until 31 March 2010. Further information is available on : https://hr-services.web.cern.ch/hr-services/services-Ben/prp/prp.asp HR Department, tel. 73903
Bingley, Paul; Martinello, Alessandro
, which affect cognitive functioning at old ages, they are invalid as instruments without controlling for schooling. We show by means of simulation and a replication study that unless the model incorporates schooling, the estimated effect of retirement is negatively biased. This explains a large part...... of the “mental retirement” effects which have recently been found...
On 13 December 1990 Prof. Dr. Cornelis (Kees) Kalkman retired from the positions of Professor of Plant Systematics and Scientific Director of the Rijksherbarium/ Hortus Botanicus by presenting his valedictory lecture to the academic community of Leiden University and the assembled Dutch Botanical
Rappaport, Anna M
Employers can and should take steps to support retirement and financial wellness. This article provides a framework for retirement wellness informed by research conducted or supported by the Society of Actuaries. Research insights about Americans' finances, planning, decisions, money management, debt, retiree income shocks and other areas point to ways employers can provide retirement wellness support as a vital part of an overall benefit program. The author suggests several key considerations employers should pay attention to in order to improve retirement wellness.
Nik Sherina Hanafi
Full Text Available Continuity of care is an important quality outcome of patient care. This study aimed to investigate the relationship between personal continuity and blood pressure (BP control among the patients with hypertension in an academic primary care centre. Between January and May 2012, we conducted a retrospective review of medical records of patients with hypertension who had been followed up for at least 1 year in the Primary Care Clinic, University of Malaya Medical Centre, Malaysia. In this setting, doctors who provided care for hypertension included postgraduate family medicine trainees, non-trainee doctors and academic staff. Systematic random sampling (1:4 was used for patient selection. BP control was defined as less than 130/80 mm Hg for patients with diabetes mellitus, proteinuria and chronic kidney disease and less than 140/90 mm Hg for all other patients. Continuity of care was assessed using the usual provider continuity index (UPCI, which is the ratio of patient visits to the usual provider to the total number of visits to all providers in 1 year. A UPC index of zero denotes no continuity while an index of one reflects perfect continuity with only the usual provider. We reviewed a total of 1060 medical records. The patients' mean age was 62.0 years (SD 10.4. The majority was women (59.2% and married (85.7%. The mean number of visits in a year was 3.85 (SD 1.36. A total of 72 doctors had provided consultations (55 postgraduate family medicine trainees, 8 non-trainee doctors and 9 academic staff. The mean UPCI was 0.43 (SD 0.34. Target BP was achieved in 42% of the patients. There was no significant relationship between BP control and personal continuity after adjustment for total number of visits. Continuity of care was not associated with BP control in our centre. Further studies are needed to explore the reasons for this.
Maurits, Erica E M; de Veer, Anke J E; van der Hoek, Lucas S; Francke, Anneke L
It is important to learn how employers in European countries can prevent nursing staff from changing occupation or taking early retirement in order to counteract expected nursing shortages. However, to date research on nursing staff's ability to remain working until retirement age has been limited. The purpose of this study was to gain insight into the associations between different job and organisational characteristics, job satisfaction, occupational commitment and the self-perceived ability to continue working in the current line of work until the official retirement age. The questionnaire-based, cross-sectional study included 730 nursing staff members employed in Dutch hospitals, nursing homes, organisations for psychiatric care, homes for the elderly, care organisations for disabled people and home care organisations (mean age: 48; 89% female). Linear and logistic regression analyses and mediation analyses were applied to test hypothesised associations. Reducing work pressure and increasing appreciation by senior management in particular have positive consequences for nursing staff's self-perceived ability to continue working until the official retirement age. The job and organisational characteristics of autonomy, work pressure, supportive leadership, educational opportunities, communication within the organisation and appreciation of nursing staff by senior management together have substantial impact on nursing staff's job satisfaction. Job satisfaction in turn is related to the self-perceived ability to continue working until the retirement age. However, job satisfaction mainly summarises the joint effect of job and organisational characteristics and has no supplementary effect on the self-perceived ability to continue working. Employers should primarily focus on work pressure and the appreciation of nursing staff by senior management in order to retain nursing staff even as they get older.
Nobahar, Monir; Ahmadi, Fazlollah; Alhani, Fatemah; Khoshknab, Masood Fallahi
According to recent studies, the level of international interest in bridge employment, as return to work after retirement, has been growing. This study aimed to explore the experiences of retired nurses in Iran with regard to making a decision about whether or not to seek bridge employment. A qualitative study using a content analysis approach was conducted in an urban area of Iran. Semi-structured interviews were held with 20 Iranian male and female retired nurses chosen using purposive sampling. During the data analysis, two main themes were identified as the participants' thoughts supporting the decision of seeking bridge employment. The first theme was entitled motivational factors with categories of ``serving the society,'' ``maintaining and promoting health,'' ``tendency toward flexible work,'' and ``maintaining the role and activity.'' The second theme was entitled forcing factors with categories of ``ardent desire to work (pluralistic ignorance)'' and ``financial need.' ' While some Iranian retired nurses were not motivated to seek work for health reasons, most preferred to return to work after retirement. They were motivated to seek bridge employment out of a desire to serve the society, to promote their own physical and mental health, to continue to use their expertise and maintain the worker role, and because of financial needs and perceived societal expectations. Nurses seeking employment later in life tended to look for job flexibility and less stressful work. Therefore, the management of bridge employment by healthcare system authorities can be useful in making use of the invaluable experiences of retired nurses.
Aguirre Gas, Héctor G
Human beings have a natural resistance to think about their old age, both personally and professionally. Governments have targeted efforts to successfully prolong the life of the population, situation which already is a social and economic problem. “Old is a person with physical, intellectual and emotional limitations, who has a reduced autonomy and welfare, as a result of the years lived”. Not everyone ages at the same age; it will depend on health, habits, physical and intellectual activity, nutritional status, vices and attitude towards life. A physician may decide not to continue exercising medicine due to: health problems, because they do not want to, because they do not feel competent, because of the risk of having to deal with a complaint or a lawsuit, to have a new life project, or because they have no patients. The options available for a doctor at the time of retirement will depend on his/her age, health status, stage of the aging process: autonomy, dependency or old age; his/her physical and mental condition, professional development, economic situation and family environment. A doctor may remain independent, join another family or seek shelter in a retirement home.
retirement income security is whether a worker has access to a retirement plan at work. EBRI has found that voluntary enrollment in 401(k) plans under the current set of tax incentives has the potential to generate a sum that, when combined with Social Security benefits, would replace a sizeable portion of a worker's preretirement income, and that auto-enrollment could produce even larger retirement accumulations. POTENTIAL INCREASE OF AMERICANS FACING INADEQUATE RETIREMENT INCOME: The potential increase of at-risk percentages resulting from (1) employer modifications to existing plans, and (2) a substantial portion of low-income households decreasing or eliminating future contributions to savings plans as a reaction to the proposed elimination of the exclusion of employee contributions for retirement savings plans from taxable income, needs to be analyzed carefully when considering the overall impact of proposals to change existing tax incentives for retirement savings.
Cepoiu-Martin, Monica; Bischak, Diane P
The increase in the incidence of dementia in the aging population and the decrease in the availability of informal caregivers put pressure on continuing care systems to care for a growing number of people with disabilities. Policy changes in the continuing care system need to address this shift in the population structure. One of the most effective tools for assessing policies in complex systems is system dynamics. Nevertheless, this method is underused in continuing care capacity planning. A system dynamics model of the Alberta Continuing Care System was developed using stylized data. Sensitivity analyses and policy evaluations were conducted to demonstrate the use of system dynamics modelling in this area of public health planning. We focused our policy exploration on introducing staff/resident benchmarks in both supportive living and long-term care (LTC). The sensitivity analyses presented in this paper help identify leverage points in the system that need to be acknowledged when policy decisions are made. Our policy explorations showed that the deficits of staff increase dramatically when benchmarks are introduced, as expected, but at the end of the simulation period, the difference in deficits of both nurses and health care aids are similar between the 2 scenarios tested. Modifying the benchmarks in LTC only versus in both supportive living and LTC has similar effects on staff deficits in long term, under the assumptions of this particular model. The continuing care system dynamics model can be used to test various policy scenarios, allowing decision makers to visualize the effect of a certain policy choice on different system variables and to compare different policy options. Our exploration illustrates the use of system dynamics models for policy making in complex health care systems. © 2017 John Wiley & Sons, Ltd.
Objective: To reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. Methods: (1)To enhance the propaganda,education and guidance to patients. (2) To standardize the nursing care operations. (3) To establish the reasonable care rules and procedures. (4) The nurses should take the daily nursing care,observations and recording work seriously. Results: Through the analysis of a variety of problems occurred in patients with indwelling catheter during the course of continuous chemotherapy the nursing care experience was summed up. Conclusion: Proper and effective care can reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. (authors)
Baxter, Pamela; DiCenso, Alba; Donald, Faith; Martin-Misener, Ruth; Opsteen, Joanne; Chambers, Tracey
The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated. Copyright © 2012 Elsevier Ltd. All rights reserved.
McKay, James R; Hiller-Sturmhofel, Susanne
For many patients, alcohol and other drug (AOD) use disorders are chronic, recurring conditions involving multiple cycles of treatment, abstinence, and relapse. To disrupt this cycle, treatment can include continuing care to reduce the risk of relapse. The most commonly used treatment approach is initial intensive inpatient or outpatient care based on 12-step principles, followed by continuing care involving self-help groups, 12-step group counseling, or individual therapy. Although these programs can be effective, many patients drop out of initial treatment or do not complete continuing care. Thus, researchers and clinicians have begun to develop alternative approaches to enhance treatment retention in both initial and continuing care. One focus of these efforts has been the design of extended treatment models. These approaches increasingly blur the distinction between initial and continuing care and aim to prolong treatment participation by providing a continuum of care. Other researchers have focused on developing alternative treatment strategies (e.g., telephone-based interventions) that go beyond traditional settings and adaptive treatment algorithms that may improve outcomes for clients who do not respond well to traditional approaches.
Oomkens, Rosanne|info:eu-repo/dai/nl/314569286; Hoogenboom, Marcel|info:eu-repo/dai/nl/14667863X; Knijn, Trudie|info:eu-repo/dai/nl/072101032
This article aims to understand the evolution of health care governance in the Dutch hospital and home care sector. We pay particular attention to how institutionalized governance structures shape policy reform. Professionally-dominated governance structures are likely to continue to exist to some
The Human Resources Department is organizing a preparation for retirement seminar, which will take place on the afternoons of the 11, 13, 25 and 27 November 2009. Similar seminars in the past have always proved highly successful. Retirement marks the end of a person’s working life and the start of a new chapter. This period of transition is experienced differently from one individual to another. In all cases, being well-informed and prepared greatly facilitates the change in lifestyle. We would like to draw your attention to the following information: Staff concerned: All staff members aged 58 and above have been sent a personal invitation to attend. Spouses are welcome. Staff members below 58 who are interested in attending the seminar may also apply. Their applications will be accepted subject to availability of places. Registration: In view of the number of people concerned and the limited capacity of the main auditorium, you are requested to register in advance via ...
The Human Resources Department is organizing a preparation for retirement seminar, which will take place in the afternoons of 11, 13, 25 and 27 November 2009. Similar seminars in the past have always proved highly successful. Retirement marks the end of a person’s working life and the start of a new chapter. This period of transition is experienced differently from one individual to another. In all cases, being well-informed and prepared greatly facilitates the change in lifestyle. We would like to draw your attention to the following information: Staff concerned: All staff members aged 58 and above have been sent a personal invitation to attend. Spouses are welcome. Staff members below 58 who are interested in attending the seminar may also apply. Their applications will be accepted subject to the availability of places. Registration: In view of the number of people concerned and the limited capacity of the Main Auditorium, you are requested to register in advance via Ind...
The Human Resources Department is organizing a preparation for retirement seminar, which will take place on the afternoons of the 11, 13, 25 and 27 November 2009. Similar seminars in the past have always proved highly successful. Retirement marks the end of a person’s working life and the start of a new chapter. This period of transition is experienced differently from one individual to another. In all cases, being well-informed and prepared greatly facilitates the change in lifestyle. We would like to draw your attention to the following information: Staff concerned: All staff members aged 58 and above have been sent a personal invitation to attend. Spouses are welcome. Staff members below 58 who are interested in attending the seminar may also apply. Their applications will be accepted subject to the availability of places. Registration: In view of the number of people concerned and the limited capacity of the Main Auditorium, you are requested to register in advance ...
The Human Resources Department is organizing a preparation for retirement seminar, which will take place on the afternoons of the 11, 13, 25 and 27 November 2009. Similar seminars in the past have always proved highly successful. Retirement marks the end of a person’s working life and the start of a new chapter. This period of transition is experienced differently from one individual to another. In all cases, being well-informed and prepared greatly facilitates the change in lifestyle. We would like to draw your attention to the following information: Staff concerned: All staff members aged 58 and above have been sent a personal invitation to attend. Spouses are welcome. Staff members under the age of 58 who are interested in attending the seminar may also apply. Their applications will be accepted subject to the availability of places. Registration: In view of the number of people concerned and the limited capacity of the Main Auditorium, you are requested to register ...
RETIREMENT INCOME ADEQUACY IMPROVED SLIGHTLY IN 2013: Due to the increase in financial market and housing values during 2013, the probability that Baby Boomers and Generation Xers would NOT run short of money in retirement increases between 0.5 and 1.6 percentage points, based on the Employee Benefit Research Institute (EBRI) Retirement Readiness Ratings (RRRs). ELIGIBILITY FOR PARTICIPATION IN AN EMPLOYER-SPONSORED DEFINED CONTRIBUTION PLAN REMAINS ONE OF THE MOST IMPORTANT FACTORS FOR RETIREMENT INCOME ADEQUACY: RRR values double for Gen Xers in the lowest-income quartile when comparing those with 20 or more years of future eligibility with those with no years of future eligibility, while those in the middle income quartiles experience increases in RRR values by 27.1-30.3 percentage points. FUTURE SOCIAL SECURITY BENEFITS MAKE A HUGE DIFFERENCE FOR THE RETIREMENT INCOME ADEQUACY OF SOME HOUSEHOLDS, ESPECIALLY GEN XERS IN THE LOWEST-INCOME QUARTILE: If Social Security benefits are subject to proportionate decreases beginning in 2033 (according to the values in Figure 8), the RRR values for those households will drop by more than 50 percent: from 20.9 percent to 10.3 percent. LONGEVITY RISK AND STOCHASTIC HEALTH CARE RISK ARE ASSOCIATED WITH HUGE VARIATIONS IN RETIREMENT INCOME ADEQUACY: For both of these factors, a comparison between the most "risky" quartile with the least risky quartile shows a spread of approximately 30 percentage points for the lowest income range, approximately 25 to 40 percentage points for the highest income range, and even larger spreads for those in the middle income ranges. A GREAT DEAL OF THE VARIABILITY IN RETIREMENT INCOME ADEQUACY COULD BE MITIGATED BY APPROPRIATE RISK-MANAGEMENT TECHNIQUES AT OR NEAR RETIREMENT AGE: For example, the annuitization of a portion of the defined contribution and IRA balances may substantially increase the probability of not running short of money in retirement. Moreover, a well-functioning market in long
The Department of Human Resources is organising a preparation for retirement seminar which will take place on the four successive afternoons of 2 to 5 October 2007. Similar seminars in the past have always proved highly successful. Retirement marks the end of one’s working life and the start of a new period of life. This period of transition and change is experienced differently from one individual to another. In any case, being well-informed and prepared greatly facilitates the change in lifestyle. We would like to draw your attention to the following information: Staff concerned: All staff members aged 58 and above as well as those who have retired during the year have been sent a personal invitation to attend. Spouses are welcome. Staff members below 58 who are interested in attending the seminar may also apply. Their applications will be accepted subject to availability of places. Registration: In view of the number of people concerned and the limited capacity of th...
Ledwidge, S F C; Bryden, E; Halestrap, P; Galland, R B
Continuity of patient care is an important component of surgical education. This study assesses continuity of care in the current working climate. Data were collected prospectively on consecutive emergency general surgical admissions during one month. Our SpR rota is a partial shift 24 hour on call with the SpR's own consultant. The SpR is free of commitments the next day following post-take work. The on call general surgery SpR was designated the 'assessor'. Data were analysed according to involvement of the 'assessor' at subsequent stages of the admission--consent, operation, review during admission and review on discharge. Data were also collected defining whether the 'assessor' and operator followed-up the patient. There were 200 admissions; 108 female and 92 male. Overall 23% admissions had the same 'assessor' for all stages of patient care. The 'assessor' dealt with an aspect of patient care in 11% of admissions who underwent an operation and 29% of admissions who were conservatively managed. SpR follow-up of admissions on whom they operated was 70% but only 41% of admissions who were conservatively managed were followed-up by the assessing SpR. Complete in-hospital continuity of care was poor, although SpR follow-up of patients on whom they had operated was better. Introduction of shift patterns has reduced continuity of patient care. This will have a negative impact on both surgical training and patient care.
McGilton, Katherine S.; Guruge, Sepali; Librado, Ruby; Bloch, Lois; Boscart, Veronique
Research on the relationships between health care aides (HCAs) and families of clients has been situated mainly in long-term care settings and includes scant findings about the perceptions of HCAs. Based on the findings of a larger qualitative study using a grounded theory approach, this paper addresses the topic of HCA-family relationships in…
Ng, Reuben; Allore, Heather G.; Monin, Joan K.; Levy, Becca R.
Studies examining the association between retirement and health have produced mixed results. This may be due to previous studies treating retirement as merely a change in job status rather than a transition associated with stereotypes or societal beliefs (e.g., retirement is a time of mental decline or retirement is a time of growth). To examine whether these stereotypes are associated with health, we studied retirement stereotypes and survival over a 23-year period among 1,011 older adults. As predicted by stereotype embodiment theory, it was found that positive stereotypes about physical health during retirement showed a survival advantage of 4.5 years (hazard ratio = 0.88, p = .022) and positive stereotypes about mental health during retirement tended to show a survival advantage of 2.5 years (hazard ratio = 0.87, p = .034). Models adjusted for relevant covariates such as age, gender, race, employment status, functional health, and self-rated health. These results suggest that retirement preparation could benefit from considering retirement stereotypes. PMID:27346893
Perkiö-Mäkelä, Merja; Hirvonen, Maria
The aim of this paper is to present Finnish employees' opinions on continuing work until retirement pension and after the age of 63, and to find out if physical workload is related to these opinions. Altogether 39% of men and 40% of women had never had thoughts of early retirement, and 59% claimed (both men and women) that they would consider working beyond the age of 63. Own health (20%); financial gain such as salary and better pension (19%); meaningful, interesting and challenging work (15%); flexible working hours or part-time work (13%); lighter work load (13%); good work community (8%); and good work environment (6%) were stated as factors affecting the decision to continue working after the age of 63. Employees whose work involved low physical workload had less thoughts of early retirement and had considered continuing work after the age of 63 more often than those whose work involved high physical loads. Own health in particular was stated as a reason to consider continuing work by employees whose work was physically demanding.
Full Text Available Abstract Background The increased prevalence of obesity in pregnant women in Australia and other developed countries is a significant public health concern. Obese women are at increased risk of serious perinatal complications and guidelines recommend weight gain restriction and additional care. There is limited evidence to support the effectiveness of dietary and physical activity lifestyle interventions in preventing adverse perinatal outcomes and new strategies need to be evaluated. The primary aim of this project is to evaluate the effect of continuity of midwifery care on restricting gestational weight gain in obese women to the recommended range. The secondary aims of the study are to assess the impact of continuity of midwifery care on: women's experience of pregnancy care; women's satisfaction with care and a range of psychological factors. Methods/Design A two arm randomised controlled trial (RCT will be conducted with primigravid women recruited from maternity services in Victoria, Australia. Participants will be primigravid women, with a BMI≥30 who are less than 17 weeks gestation. Women allocated to the intervention arm will be cared for in a midwifery continuity of care model and receive an informational leaflet on managing weight gain in pregnancy. Women allocated to the control group will receive routine care in addition to the same informational leaflet. Weight gain during pregnancy, standards of care, medical and obstetric information will be extracted from medical records. Data collected at recruitment (self administered survey and at 36 weeks by postal survey will include socio-demographic information and the use of validated scales to measure secondary outcomes. Discussion Continuity of midwifery care models are well aligned with current Victorian, Australian and many international government policies on maternity care. Increasingly, midwifery continuity models of care are being introduced in low risk maternity care, and
Full Text Available Abstract Background Continuity of care has been explored largely from academic and service provider perspectives, and in relation to adult patient/client groups. We interviewed parents of children with complex chronic health conditions to examine how their experiences and perceptions of continuity of care fit with these perspectives; and to identify the salient factors in the experience of, and factors contributing to, continuity in this population. Methods Parents of 47 elementary school-aged children with spina bifida, Down syndrome, attention-deficit/hyperactivity disorder, Duchenne muscular dystrophy or cystic fibrosis participated in semi-structured interviews. Parents described and mapped the pattern of their interactions with service providers over time in all domains relevant to their child's health, well-being, and development (medical, rehabilitational, educational, and social supportive services, with particular attention paid to their perceptions of connectedness or coherency in these interactions. Verbatim transcripts were analyzed thematically using a framework approach to impose structure regarding parents' perspectives on continuity of care. Results Existing academic concepts of relational, informational and management continuity were all discernable in parents' narratives. A thorough knowledge of the child on the part of service providers emerged as extremely important to parents; such knowledge was underpinned by continuity of personal relationships, principally, and also by written information. For this population, notions of continuity extend to the full range of service providers these children and families need to achieve optimal health status, and are not limited to physicians and nurses. Communication among providers was seen as integral to perceived continuity. Compartmentalization of services and information led to parents assuming a necessary, though at times, uncomfortable, coordinating role. Geographic factors
Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A
A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.
Estep, Jerry D; Trachtenberg, Barry H; Loza, Laurie P; Bruckner, Brian A
Continuous-flow left ventricular assist devices (CF-LVADs) have been clinically adopted as a long-term standard of care therapy option for patients with end-stage heart failure. For many patients, shared care between the care providers at the implanting center and care providers in the community in which the patient resides is a clinical necessity. The aims of this review are to (1) provide a rationale for the outpatient follow-up exam and surveillance testing used at our center to monitor patients supported by the HeartMate II(®) CF-LVAD (Thoratec Corporation, Pleasanton, CA) and (2) provide the protocol/algorithms we use for blood pressure, driveline exit site, LVAD alarm history, surveillance blood work, and echocardiography monitoring in this patient population. In addition, we define our partnership outpatient follow-up protocol and the "shared care" specific responsibilities we use with referring health care providers to best manage many of our patients.
Marta Beatriz Aller
Full Text Available Background: The CCAENA questionnaire was developed to assess care continuity across levels from the patients’ perspective. The aim is to provide additional evidence on the psychometric properties of the scales of this questionnaire. Methods: Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care in three healthcare areas of the Catalan healthcare system. Data were collected in 2010 using the CCAENA questionnaire. To assess psychometric properties, an exploratory factor analysis was performed (construct validity and the item-rest correlations and Cronbach’s alpha were calculated (internal consistency. Spearman correlation coefficients were calculated (multidimensionality and the ability to discriminate between groups was tested. Results: The factor analysis resulted in 21 items grouped into three factors: patient-primary care provider relationship, patient-secondary care provider relationship and continuity across care levels. Cronbach’s alpha indicated good internal consistency (0.97, 0.93, 0.80 and the correlation coefficients indicated that dimensions can be interpreted as separated scales. Scales discriminated patients according to healthcare area, age and educational level. Conclusion: The CCAENA questionnaire has proved to be a valid and reliable tool for measuring patients’ perceptions of continuity. Providers and researchers could apply the questionnaire to identify areas for healthcare improvement.
Krishna, Lalit Kumar Radha
The application of continuous deep sedation (CDS) in the treatment of intractable suffering at the end of life continues to be tied to a number of concerns that have negated its use in palliative care. Part of the resistance towards use of this treatment option of last resort has been the continued association of CDS with physician-associated suicide and/or euthanasia (PAS/E), which is compounded by a lack clinical guidelines and a failure to cite this treatment under the aegis of a palliative care approach. I argue that reinstituting a palliative care-inspired approach that includes a holistic review of the patient's situation and the engagement of a multidisciplinary team (MDT) guided by clearly defined practice requirements that have been lacking amongst many prevailing guidelines will overcome prevailing objections to this practice and allow for the legitimization of this process.
Kênia Lara Silva
Full Text Available This is a qualitative study that aims at analyzing the Primary Health Care Strategic Planning in a continuing education process, as well as the professional’s formation to work as facilitators in it. Data was obtained through interviews with 11 nurses that had acted as the plan’s facilitators in a municipality within Belo Horizonte. The results indicate that the experience as facilitators allowed them to reflect on the work process and this practice contributed to the incorporation of new tools to the primary health care system. The participants reported the difficulties faced when conducting the experience and the gap in the professionals’ formation to act in the PHC and to put into practice the processes of continuing education on a day to day basis. In conclusion, the Planning represents an important continuing education strategy and it is significance to transform processes and practices in the primary health care service.
Vázquez Guillamet, B; Guillamet Lloveras, A; Martínez Estalella, G; Pérez Ramírez, F
Intensive care nursing is carried out in a dynamic environment characterized by the continuous incorporation of new technologies, approaches to care and a request for safety, participation and transparency by the public. Continuing/permanent intensive care nursing training in the acquisition of new competencies is key in this setting. In order to achieve this goal, simulation and problem based learning should be incorporated as essential methodologies to teach these skills. At the same time research should be done on which attitudes, competences, and knowledge are necessary to increase their intellectual knowledge. The core characteristics of ICU and its nursing should allow a deep change in their approach to continuing/permanent nursing education. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.
Suedfeld, Peter; Johnson, Phyllis J.; Gushin, Vadim; Brcic, Jelena
Motivational patterns have been shown to be related to outcomes such as occupational success and satisfaction, innovation, aggressiveness, cooperation, and conformity. They are likely to be important in adaptation to the demands of flying in a space crew. Autobiographical interviews with 20 retired long-duration male cosmonauts were scored for references to three core motives: the needs for Achievement, Power, and Affiliation. Overall, the cosmonauts mentioned need for Affiliation most often, followed by need for Achievement, with need for Power the least frequently mentioned. However, need for Power increased between reminiscences of one's pre-flight career to those concerning the in-flight and post-flight periods. Imagery related to both other needs decreased. Cosmonauts who had spent less than a year in space mentioned need for Achievement significantly more frequently than those who had spent more than a year. Other space-experience and demographic variables, and changes across pairs of career phases, were not significant. The high scores for need for Affiliation indicate the importance of selecting compatible teams and fostering friendship and cooperation during training and deployment. A relatively flat hierarchical organization would be harmonious with low Power motivation; but the increase during missions indicates a desire for autonomy. After retirement from spaceflight, former space crews should be afforded opportunities for leadership and decision-making to satisfy continuing need for Power. Comparison is made to the same measures applied to a sample of ISS crewmembers, and to the ISS vs. veteran data for 8 cosmonauts who were included in both sets of data.
Full Text Available Healthcare professionals, daily confronted with existential failty, feel themselves emotionally vulnerable too. For this reason, they need knowledge and tools in order to take care for themselves. Phenomenology provides an epistemological model that includes subjective and affective dimensions and legitimates lived experience as a source of cognition. In the undergraduate and continuing education of healthcare professionals, the phenomenological approach can represent a way of promoting self-care through personal narrative and reflection.
The Human Resources Department is organizing a Preparation for Retirement Seminar, which will take place on 18 and 21 October 2011 in the afternoon in the Main Auditorium and on 19 October and 15 and 16 November 2011 in the afternoon in the Council Chamber. Similar seminars in the past have always proved highly successful. Retirement marks the end of a person’s working life and the start of a new chapter. This period of transition is experienced differently from one individual to another. In all cases, being well-informed and prepared greatly facilitates the change in lifestyle. We would like to draw your attention to the following information: Staff concerned: All staff members aged 58 and above have been sent a personal invitation to attend. Spouses are welcome. Staff members under the age of 58 who are interested in attending the seminar may also apply. Their applications will be accepted subject to availability of places. Registration: In view of the number of people concerned, you are ...
The Human Resources Department is organizing a Preparation for Retirement Seminar, which will take place on 18 and 21 October 2011 in the afternoon in the Main Auditorium and on 19 October and 15 and 16 November 2011 in the afternoon in the Council Chamber. Similar seminars in the past have always proved highly successful. Retirement marks the end of a person’s working life and the start of a new chapter. This period of transition is experienced differently from one individual to another. In all cases, being well-informed and prepared greatly facilitates the change in lifestyle. We would like to draw your attention to the following information: Staff concerned: All staff members aged 58 and above have been sent a personal invitation to attend. Spouses are welcome. Staff members under the age of 58 who are interested in attending the seminar may also apply. Their applications will be accepted subject to availability of places. Registration: In view of the number of people concerned, you are r...
On 11 May a new web-based phonebook will take over from the 16-year old XWHO directory. It will provide access to basic contact information for people and services at CERN. A user-friendly interface will allow you to look for people and services using criteria such as first or last name, organisational unit and phone number. All requests submitted to the retired XWHO directory will be redirected to the new phonebook. The new CERN Phonebook's user interface. CERN’s first electronic phonebook was created in 1995. The XWHO directory was first presented in July that year in a CERN Computer Newsletter (CNL) article entitled “Migrating the access to central directory services” by Miguel Marquina and Bernd Pollermann. Since then, it has been used by thousands of people at CERN and around the world looking for contact details of other members of the Organization. The XWHO directory is now retiring and is to be replaced by the new web-based CERN Phonebook. For several month...
Special Meeting concerning the TAXATION OF PENSIONS IN FRANCE Following the pre-retirement seminar held at CERN in March 2001, the Human Resources Division and the CERN Pensioners Association (GAC) are organising a special information session on the Taxation of CERN pensions in France The speaker will be S. Agarrat, a barrister specialising in tax law (practising in Lyon) and the meeting will take the form of a general presentation of the subject, followed by a question-and-answer session. This meeting is intended for CERN pensioners residing in France, as well as for staff due to retire from the Organization in 2001/2002. Registration is not necessary. The meeting will take place on Wednesday, 28 November 2001, from 4.30 p.m. to 6.30 p.m., in the Main Auditorium N.B.: Questions concerning the taxation rules applicable to salaries paid by CERN, in particular questions relating to the CRDS tax, will not be dealt with during this meeting.
The Human Resources Department is organizing a preparation for retirement seminar, which will take place on the afternoons of the 25 and 27 November 2009. Similar seminars in the past have always proved highly successful. Retirement marks the end of a person’s working life and the start of a new chapter. This period of transition is experienced differently from one individual to another. In all cases, being well-informed and prepared greatly facilitates the change in lifestyle. We would like to draw your attention to the following information: Staff concerned: All staff members aged 58 and above have been sent a personal invitation to attend. Spouses are welcome. Staff members under the age of 58 who are interested in attending the seminar may also apply. Their applications will be accepted subject to the availability of places. Registration: In view of the number of people concerned and the limited capacity of the Main Auditorium, you are requested to register in advance via Indico. &a...
Dove, Marion; Dogba, Maman Joyce; Rodríguez, Charo
To examine the reasons why family physicians continue or discontinue providing intrapartum care in their clinical practice. Qualitative descriptive study. Two hospitals located in a multicultural area of Montreal, Que, in November 2011 to June 2012. Sixteen family physicians who were current or former providers of obstetric care. Data were collected using semistructured qualitative interviews. Thematic analysis was used to analyze the interview transcripts. Three overarching themes that help create understanding of why family doctors continue to provide obstetric care were identified: their attraction, often initiated by role models early in their careers, to practising complete continuity of care and accompanying patients in a special moment in their lives; the personal, family, and organizational pressures experienced while pursuing a family medicine career that includes obstetrics; and their ongoing reflection about continuing to practise obstetrics. The practice of obstetrics was very attractive to family physician participants whether they provided intrapartum care or decided to stop. More professional support and incentives might help keep family doctors practising obstetrics. Copyright© the College of Family Physicians of Canada.
Full Text Available Abstract Background People who struggle with mental health problems can provide valuable insight into understanding and improving the coordination of mental health and welfare services. The aims of the study were to explore service users’ experiences and perceptions of continuity of care within and across services relevant to personal recovery, to elicit which dimensions of continuity of care are most essential to service users, and to generate ideas for improving service users’ experiences of continuity of care. Methods In the context of a hermeneutic-phenomenological approach, ten service users at a community mental health centre were interviewed about their experiences of continuity of care in and across services. Eight of these were re-interviewed two years later. A collaborative research approach was adopted. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis. Results Following the analysis five themes representing experiences of continuity of care were developed. Each theme ranged from poor to good experiences of continuity of care: Relationship – from experiencing frequent setbacks and anxiety due to breaks in relationships, to feeling safe in an ongoing personal relationship; Timeliness – from experiencing frustrating waiting times with worsening of problems, to getting help when needed; Mutuality – from having a one-sided struggle, to a situation in which both professionals and service users take initiatives; Choice – from not having the opportunity to make practical arrangements within the context of one’s everyday life, to having an array of support options to choose from; Knowledge – from feeling confused and insecure because one does not know what is happening, to feeling safe because one is informed about what is going to happen. Participants provided a range of suggestions for improving experiences of continuity of care. Conclusions A discrepancy between aspects of
Kjerholt, Mette; Wagner, Lis; Delmar, Charlotte
professionals' communication concerning older patients, leading to lack of continuity and integration of the patient perspective in care and treatment. In spite of these problems being well investigated, they continue to prevail. OBJECTIVES: To examine conditions for continuity and integration of the patient...... perspective in older, chronically ill patients' care as reflected in nursing staff's communication about the patients. DESIGN: Explorative Participatory Action Research (PAR). SETTING: An acute, general medical ward at a Danish university hospital. PARTICIPANTS: Hospital and municipality nurses (n = 29......). Nursing records (n = 12). METHOD: Field studies: observations, interviews, nursing records audits and logs. Data were subject to manifest and latent content analysis. RESULTS: Participants were aware of the importance of ensuring continuity, a comprehensive approach and integration of the patient...
Carney, Patricia A; Conry, Colleen M; Mitchell, Karen B; Ericson, Annie; Dickinson, W Perry; Martin, James C; Carek, Peter J; Douglass, Alan B; Eiff, M Patrice
Evolutions in care delivery toward the patient-centered medical home have influenced important aspects of care continuity. Primary responsibility for a panel of continuity patients is a foundational requirement in family medicine residencies. In this paper we characterize challenges in measuring continuity of care in residency training in this new era of primary care. We synthesized the literature and analyzed information from key informant interviews and group discussions with residency faculty and staff to identify the challenges and possible solutions for measuring continuity of care during family medicine training. We specifically focused on measuring interpersonal continuity at the patient level, resident level, and health care team level. Challenges identified in accurately measuring interpersonal continuity of care during residency training include: (1) variability in empanelment approaches for all patients, (2) scheduling complexity in different types of visits, (3) variability in ability to attain continuity counts at the level of the resident, and (4) shifting make-up of health care teams, especially in residency training. Possible solutions for each challenge are presented. Philosophical issues related to continuity are discussed, including whether true continuity can be achieved during residency training and whether qualitative rather than quantitative measures of continuity are better suited to residencies. Measuring continuity of care in residency training is challenging but possible, though improvements in precision and assessment of the comprehensive nature of the relationships are needed. Definitions of continuity during training and the role continuity measurement plays in residency need further study.
Although domestic work scholarship in Canada has focused primarily on the immigration/migration and labour experiences of domestic workers under the Foreign Domestic Movement and the Live-in-Caregiver Program, research is scarce on how these workers retire and consequently age in Canadian society. This article focuses on the aging experiences of retired Filipino domestic workers who, upon entering retirement, find themselves working in the secondary and/or underground economy while providing and receiving care from spouses, grandchildren, and local/transnational family members. Data were drawn from six qualitative, in-depth interviews with older Filipina domestic workers who discussed experiences of immigration, caring labour, retirement, and aging. Findings underscore (1) the poverty that older Filipino domestic workers encounter as they approach their retirement; (2) the necessity but insufficiency of the state's retirement provisions; (3) the need to find work in the unreported labour market; and (4) how caring labour is provided intergenerationally as a survival strategy.
Estelle James; Alejandra Cox Edwards
Postponing retirement will become increasingly important as a means to increase the labor force, its output and old age security, as populations age. Recent research has focused on incentives stemming from the social security system that influence the worker’s decision to retire. Defined benefit systems (both public and private) often contain penalties for postponing access to pensions or continuing to work while receiving a pension. In contrast, the tight link between contributions and accum...
Corrales-Nevado, Dolores; Palomo-Cobos, Luis
Home care is essential for dependent persons, in order to support the high levels of morbidity, for the elderly as well as their caregivers, as it enables patients to remain in their familiar environment as long as possible, fulfilling the wish expressed by most of the population. Home care is the activity that best represents the essential attributes (longitudinality, comprehensiveness, continuity, coordination) of the primary, and that suffers most when these attributes are not included in the activities undertaken by primary care teams, or due to cuts in health-care. Home care requires highly skilled, versatile and committed nursing staff, with whom the population identifies as a source of care, and where they are assessed for their relevance and effectiveness. Nurses with wide clinical care skills, with a balanced content of treatment and prevention, and the freedom to develop their work, are needed in order to continuously monitor the health problems of their acute and chronic patients, in the family and community. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Chen, Yu-Chi; Chang, Polun
Kidney disease is a common complication of chronic diseases among adult and elderly populations. As early-stage chronic kidney disease (CKD) is asymptomatic, CKD patients are frequently unaware of their condition and fail to implement requisite self-care in a timely fashion. Furthermore, the shortage of case-management manpower and difficulties in follow-up have led to high incidence rates for CKD worldwide. Integrative and continuous care is key to preventing CKD. How to implement this care effectively is a challenge. However, innovative technologies, online information, and cloud technology are increasingly providing access to good-quality healthcare beyond the traditional limitations of time and location. This environment is not only increasing the participation of patients in their care and collaboration among healthcare team members but is also improving the continuity, accessibility, and promptness of care service in order to promote the effectiveness of disease management. While the primary aim of innovative technologies is to make healthcare more cost-effective, it is also causing disparities in healthcare. Within the high-tech e-healthcare system, the ability of patients to utilize these new services relates directly to their health behaviors and quality of care. Thus, emergent e-healthcare system services should be made as patient-centered as possible in order to maximize the benefits in terms of both cost and patient care. Furthermore, improving the eHealth literacy of patients is crucial to promoting innovative technology within healthcare services.
Davis, Jenny; Morgans, Amee; Burgess, Stephen
Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector.
... to implement phased retirement, a new human resources tool that allows full-time employees to work a..., 582, 831, et al. Phased Retirement; Proposed Rule #0;#0;Federal Register / Vol. 78 , No. 108 / Wednesday, June 5, 2013 / Proposed Rules#0;#0; [[Page 33912
Fasang, Anette Eva
How do social policies shape life courses, and which consequences do different life course patterns hold for individuals? This article engages the example of retirement in Germany and Britain to analyze life course patterns and their consequences for income inequality. Sequence analysis is used to measure retirement trajectories. The liberal…
Bodily, Gerald P.
Studies on retirement reporting that, compared to people not retired, recent retirees exhibited less income, more physical and mental illness, lower self-esteem, and less life satisfaction have been challenged and new findings have been revealed by longitudinal studies using data from large samples. It appears that perhaps the way individuals…
Fenwick, Jennifer; Sidebotham, Mary; Gamble, Jenny; Creedy, Debra K
Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives. To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity. Online survey. Measures included; Copenhagen Burnout Inventory (CBI); Depression, Anxiety and Stress Scale-21; and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The sample (n=862) was divided into two groups; midwives working in continuity (n=214) and those not working in continuity (n=648). Mann Whitney U tests were used to compare the groups. The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p=.002; CBI Work pwork-life balance. Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
This thesis covers several topics including studies on the accuracy of continuous glucose measurement (CGM) devices in the Intensive Care Unit (ICU). In addition, it is investigated whether an electronic nose (eNose) can be used to predict blood glucose levels in mechanically ventilated ICU
Robertson, Ethel M.; Higgins, Leslie; Rozmus, Cathy; Robinson, James P.
Continuing-education participation and job satisfaction of 85 licensed practical nurses and 25 registered nurses in long-term care were compared. There were no differences between full- and part-time staff. Nurses with higher family incomes participated more frequently. Registered nurses participated more and had greater job satisfaction. (SK)
Vernooy-Dassen, M.J.F.J.; Felling, A.J.A.; Persoon, J.M.G.
Objective. To investigate predictors of change in the sense of competence of primary caregivers and continuity in home care for dementia patients. Design. A prospective longitudinal study with a follow-up period of 10 months. Setting. Dementia patients living in the community selected by Dutch
Cummins, Allison M; Denney-Wilson, E; Homer, C S E
The aim of this paper was to explore the mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia. Most new graduates find employment in hospitals and undertake a new graduate program rotating through different wards. A limited number of new graduate midwives were found to be working in midwifery continuity of care. The new graduate midwives in this study were mentored by more experienced midwives. Mentoring in midwifery has been described as being concerned with confidence building based through a personal relationship. A qualitative descriptive study was undertaken and the data were analysed using continuity of care as a framework. We found having a mentor was important, knowing the mentor made it easier for the new graduate to call their mentor at any time. The new graduate midwives had respect for their mentors and the support helped build their confidence in transitioning from student to midwife. With the expansion of midwifery continuity of care models in Australia mentoring should be provided for transition midwives working in this way. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.
S.C. de Vries (Sjoerd); A.I. Wierdsma (André)
textabstractBackground/Aims: We used time-variant measures of continuity of care to study fluctuations in long-term treatment use by patients with alcohol-related disorders. Methods: Data on service use were extracted from the Psychiatric Case Register for the Rotterdam Region, The Netherlands.
Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M
Noise levels in neonatal intensive care units allow the appearance of symptoms associated with burnout such as stress, irritability, fatigue and emotional instability on health care personnel. The aim of this study was to evaluate the equivalent continuous noise levels in the neonatal intensive care unit and compare the results with noise levels associated with the occurrence of burnout syndrome on the care team. Continuous sampling was conducted for 20 days using a type I sound level meter on the unit. The maximum, the ninetieth percentile and the equivalent continuous noise level (Leq) values were recorded. Noise level is reported in the range of 51.4-77.6 decibels A (dBA) with an average of 64 dBA, 100.6 dBA maximum, and average background noise from 57.9 dBA. Noise levels exceed the standards suggested for neonatal intensive care units, are close to maximum values referred for noise exposure in the occupational standards and to noise levels associated with the onset of burnout; thus allowing to infer the probability of occurrence of high levels of noise present in the unit on the development of burnout in caregivers. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Colwell, Malinda J; Pettit, Gregory S; Meece, Darrell; Bates, John E; Dodge, Kenneth A
Variations in amounts of nonparental care across infancy, preschool, early elementary school, and early adolescence were examined in a longitudinal sample (N = 438). Of interest was (a) continuity in use of the different arrangements, (b) whether the arrangements were additively and cumulatively associated with children's externalizing behavior problems, and (c) whether predictive relations were accounted for by social-ecological (socioeconomic status, mothers' employment status, marital status) and social-experiential (parenting quality, exposure to aggressive peers) factors. Correlations among overall amounts of care provided little evidence of cross-time continuity. Consistent with the cumulative risk perspective, Grade 1 self-care and Grade 6 unsupervised peer contact incrementally predicted Grade 6 externalizing problems. Most of the predictive associations were accounted for by family background and social relationship factors.
Priest, Kelsey C; Lobingier, Hannah; McCully, Nancy; Lombard, Jackie; Hansen, Mark; Uchiyama, Makoto; Hagg, Daniel S
Health care delivery systems are challenged to support the increasing demands for improving patient safety, satisfaction, and outcomes. Limited resources and staffing are common barriers for making significant and sustained improvements. At Oregon Health & Science University, the medical intensive care unit (MICU) leadership team faced internal capacity limitations for conducting continuous quality improvement, specifically for the implementation and evaluation of the mobility portion of an evidence-based care bundle. The MICU team successfully addressed this capacity challenge using the person power of prehealth volunteers. In the first year of the project, 52 trained volunteers executed an evidence-based mobility intervention for 305 critically ill patients, conducting more than 200 000 exercise repetitions. The volunteers contributed to real-time evaluation of the project, with the collection of approximately 26 950 process measure data points. Prehealth volunteers are an untapped resource for effectively expanding internal continuous quality improvement capacity in the MICU and beyond.
Berggren, E; Orrevall, Y; Olin, A Ödlund; Strang, P; Szulkin, R; Törnkvist, L
Evaluate the effectiveness of a continuing educational intervention on primary health care professionals' familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care. Observational cohort study. 10 primary health care centers in Stockholm County, Sweden. 140 district nurses/registered nurses and general practitioners/physicians working with home care. 87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection. The intervention's effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression. In the intra-group analyses, statistically significant changes occurred in the IG's responses to 28 of 32 items and the CG's responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0. The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals' level of knowledge about important aspects of nutritional care.
Voeuk, Anna; Nekolaichuk, Cheryl; Fainsinger, Robin; Huot, Ann
Palliative sedation can be used for refractory symptoms during end-of-life care. However, continuous palliative sedation (CPS) for existential distress remains controversial due to difficulty determining when this distress is refractory. The aim was to determine the opinions and practices of Canadian palliative care physicians regarding CPS for existential distress. A survey focusing on experience and views regarding CPS for existential distress was sent to 322 members of the Canadian Society of Palliative Care Physicians. Eighty-one surveys returned (accessible target, 314), resulting in a response rate of 26%. One third (31%) of the respondents reported providing CPS for existential distress. On a 5-point Likert-type scale, 40% of participants disagreed, while 43% agreed that CPS could be used for existential distress alone. Differing opinions exist regarding this complex and potentially controversial issue, necessitating the education of health-care professionals and increased awareness within the general public.
The evolution of information technology and of telematics and increasing efforts to establish an electronic health record stimulate the development and introduction of new concepts in health care. However, compared to other application areas, e.g., tourism, banking, commerce etc. the use of information technology in health care is still of limited success. In hospitals as well in ambulatory medicine (General Practitioner systems) computers are often only used for administrative purposes. Fully operational Hospital Information Systems (HIS) are rare and often island solutions. The situation is somewhat better for department systems (DIS), e.g., where image analysis, processing of biochemical data or of biosignals is in the clinical focus. Even before we have solved the various problems in health care data processing and management within the "conventional" care institutions new challenges are coming up with concepts of telemedicine for assisted and non-assisted home care for patients with chronic diseases or people at high risk. The major challenges for provision of tele-monitoring and alarming services are improvement of communication and interoperability of devices and care providers. A major obstacle in achieving such goals are lack of standards for devices as well for procedures and a lack of databases with information on "normal" variability of many medical parameters to be monitored by serial comparison in continuous medical care. Some of these aspects will be discussed in more detail.
Thomas, David C; Johnston, Bree; Dunn, Kathel; Sullivan, Gail M; Brett, Belle; Matzko, Marilyn; Levine, Sharon A
Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.
Belling, Ruth; Whittock, Margaret; McLaren, Susan; Burns, Tom; Catty, Jocelyn; Jones, Ian Rees; Rose, Diana; Wykes, Til
The integration of mental health and social services for people diagnosed with severe mental illness (SMI) has been a key aspect of attempts to reform mental health services in the UK and aims to minimise user and carer distress and confusion arising from service discontinuities. Community mental health teams (CMHTs) are a key component of UK policy for integrated service delivery, but implementing this policy has raised considerable organisational challenges. The aim of this study was to identify and explore facilitators and barriers perceived to influence continuity of care by health and social care professionals working in and closely associated with CMHTs. This study employed a survey design utilising in-depth, semi-structured interviews with a proportionate, random sample of 113 health and social care professionals and representatives of voluntary organisations. Participants worked in two NHS Mental Health Trusts in greater London within eight adult CMHTs and their associated acute in-patient wards, six local general practices, and two voluntary organisations. Team leadership, decision making, and experiences of teamwork support were facilitators for cross boundary and team continuity; face-to-face communication between teams, managers, general practitioners, and the voluntary sector were facilitators for information continuity. Relational, personal, and longitudinal continuity were facilitated in some local areas by workforce stability. Barriers for cross boundary and team continuity were specific leadership styles and models of decision making, blurred professional role boundaries, generic working, and lack of training for role development. Barriers for relational, personal, and longitudinal continuity were created by inadequate staffing levels, high caseloads, and administrative duties that could limit time spent with users. Incompatibility of information technology systems hindered information continuity. Flexible continuity was challenged by the
Jones Ian Rees
Full Text Available Abstract Background The integration of mental health and social services for people diagnosed with severe mental illness (SMI has been a key aspect of attempts to reform mental health services in the UK and aims to minimise user and carer distress and confusion arising from service discontinuities. Community mental health teams (CMHTs are a key component of UK policy for integrated service delivery, but implementing this policy has raised considerable organisational challenges. The aim of this study was to identify and explore facilitators and barriers perceived to influence continuity of care by health and social care professionals working in and closely associated with CMHTs. Methods This study employed a survey design utilising in-depth, semi-structured interviews with a proportionate, random sample of 113 health and social care professionals and representatives of voluntary organisations. Participants worked in two NHS Mental Health Trusts in greater London within eight adult CMHTs and their associated acute in-patient wards, six local general practices, and two voluntary organisations. Results Team leadership, decision making, and experiences of teamwork support were facilitators for cross boundary and team continuity; face-to-face communication between teams, managers, general practitioners, and the voluntary sector were facilitators for information continuity. Relational, personal, and longitudinal continuity were facilitated in some local areas by workforce stability. Barriers for cross boundary and team continuity were specific leadership styles and models of decision making, blurred professional role boundaries, generic working, and lack of training for role development. Barriers for relational, personal, and longitudinal continuity were created by inadequate staffing levels, high caseloads, and administrative duties that could limit time spent with users. Incompatibility of information technology systems hindered information
Maria Carolina Monteiro
Full Text Available The Portuguese population is undergoing an irreversible aging process and must deal with this demographic issue. Many influencing factors have been identified, including biological, psychological and social changes which have led to this new social stratification. The increasing prevalence of chronic and debilitating illnesses as a direct result of human aging has increased the demand for answers on both a health and social level. Life expectancy at birth in Portugal is almost 81 years, one year above the OECD mean. Life expectancy for women is 84 years, compared to 78 years for men. The National Network for Continuous Care (REDE was formed in response to this new issue. The implementation of Continuous Care Units (UCCI provide an alternative to hospitalization for dependent people needing special care but who do not require the specific care of an acute unit. The UCCI present a model of multidisciplinary intervention that covers all aspects of a health, social and economic nature and, consists of multidisciplinary teams. Due to the characteristics of the elderly and / or their situation of dependency, the intervention from specialized professionals of UCCI must be carefully prepared. Focused training and team expertise are key factors of the REDE’s success.
Victor O. Kolade
Full Text Available Background: Transfer of clinic patients from graduating residents to interns or junior residents occurs every year, affecting large numbers of patients. Breaches in care continuity may occur, with potential for risk to patient safety. Several guidelines have been developed for implementing standardized inpatient sign-outs, but no specific guidelines exist for outpatient handover. Methods: Residents in primary care programs – internal medicine, family medicine, and pediatrics – at a US academic medical center were invited to participate in an online survey. The invitation was extended approximately 2 years after electronic medical record (EMR rollout began at the institution. Results: Of 71 eligible residents, 22 (31% responded to the survey. Of these, 18 felt that handover of ambulatory patients was at least moderately important – but only one affirmed the existence of a system for handover. IM residents perceived that they had the highest proportion of high-risk patients (p=0.042; transition-of-care letters were more important to IM residents than other respondents (p=0.041. Conclusion: There is room for improvement in resident acknowledgement of handover processes in continuity clinics. In this study, IM residents attached greater importance to a specific handover tool than other primary care residents. Thus, the different primary care specialties may need to have different handover tools available to them within a shared EMR system.
His astute counsel, knowing smile and distinguished eloquence will be missed by many. With a pang of regret, the man himself admits that 'CERN was like a drug for me'. Last week, Jean-Daniel Mandica retired, after 40 years of loyal service. He was the trusted counsellor of every Director of the Administration and Director-General for eighteen years, from 1986 to 2003. Head of the planning unit for the Directorate and the Administration from 1986 to 1996, he was then named Head of the Directorate Services Unit in 1996, a position he held until the end of 2003. Throughout that time, he conducted key tasks for the Organization, such as restructuring the Administration and carrying out audits. His role in the creation of Microcosm and his commitment to CERN's participation in the Universal Exposition at Seville in 1992 contributed in no small part to the spread of the Laboratory's fame. Jean-Daniel Mandica's incomparable knowledge of the Administration, sense of diplomacy and great ability to listen made him a v...
(Health insurance and wealth and succession planning) During the preparation for retirement seminar in November 2009, the sessions on health insurance in Switzerland and in France unfortunately had to be postponed. Participants in the seminar also expressed interest in an information session on “How to manage your wealth and organize your succession”. The sessions on health insurance will be held on 16 March 2010 and those on managing wealth and succession on 18 March 2010. Programme for Tuesday 16 March 2010 (TH Theory Conference Room, Building 4/3-006): 09:00 Health insurance in Switzerland by Mr. Sandro Breitenstein, Service de l'Assurance Maladie du Canton de Genève 10:00 Coffee break 10:20 Health insurance in France by Mr. Dominique Curtiaud, Caisse Primaire d'Assurance Maladie de l'Ain Programme for Thursday 18 March 2010 (TH Theory Conference Room, Building 4/3-006): 09:00 How to manage your wealth and organize your succession in Switzerland by Mr. Jean-Marc W...
May, P R
There are glaring, almost universal deficiencies in the organization of community resources for treating and rehabilitating the mentally ill, particularly psychotic patients, the author says. The deficiencies could be partly remedied by reorganizing psychiatric hospitals to play a key role in outpatient service delivery, and by paying more attention to the principles of continuity of care for psychotic patients. One way of doing both is through the model of a mini-mental-health-center adopted at a Veterans Administration hospital: the same terms provide active, continual care for patients regardless of whether they are in or out of the hospital. The program developed on one ward is described further in the next paper, written by ward staff members and others.
Human Resources Department
We would like to take the opportunity to inform you about a new programme related to retirement, organised by the Human Resources Department. Retirement marks the end of a career and the start of a new chapter in life. In all cases, being well-informed and prepared is necessary to cope successfully with this transition. The programme has been developed for staff members and consists of two seminars: Leaving CERN (half day seminar): short presentations by internal speakers, focusing on what options CERN offers at the end of your career: organised once per year, next session scheduled on 24 November 2015, in the afternoon, enrolment and more information on Indico. Preparation for retirement (2-day seminar): interactive workshop (in small groups) delivered by external experts, focusing on how to prepare psychologically as well as practically to cope with all the changes retirement brings: organised regularly in 2016, in English or ...
Clayton Arlen Looney; Andrew M. Hardin
As firms continue to abandon pensions in favor of employee-managed retirement plans, tremendous demands are being placed on the decision-making proficiency of future retirees. As reflected in the equity premium puzzle, individual investors tend to hold overly conservative portfolios that provide meager payoffs over time. Consequently, there is growing concern that the vast majority of retirement accounts might be insufficiently funded when employees reach retirement. Given that most retiremen...
... MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Reservists-Continued Treatment, Return to Limited Duty, Separation, or Retirement for Physical Disability § 728.102 Care from... 32 National Defense 5 2010-07-01 2010-07-01 false Care from other than Federal sources. 728.102...
Goda, Gopi Shah; Shoven, John B.; Slavov, Sita Nataraj
Media reports predicted that the stock market decline in October 2008 would cause changes in retirement intentions, due to declines in retirement assets. We use panel data from the Health and Retirement Study to investigate the relationship between stock market performance and retirement intentions during 1998-2008, a period that includes the…
Day, David S.; And Others
This article examines the retirement plans and personal characteristics of 273 senior law school faculty, focusing on health status, income, job satisfaction, and preferred age of retirement. The study suggests that early retirement incentives and a "senior faculty" alternative to full retirement are positive institutional options. (DB)
Keenan, G; Aquilino, M L
Standardized nursing nomenclatures must be included in clinical documentation systems to generate data that more accurately represent nursing practice than outcomes-related measures currently used to support important policy decisions. NANDA, NIC, and NOC--comprehensive nomenclatures for the needed variables of nursing diagnoses, interventions, and outcomes--are described. Added benefits of using NANDA, NIC, and NOC in everyday practice are outlined, including facilitation of the continuity of care of patients in integrated health systems.
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
Colwell, Malinda J.; Pettit, Gregory S.; Meece, Darrell; Bates, John E.; Dodge, Kenneth A.
Variations in amounts of nonparental care across infancy, preschool, early elementary school, and early adolescence were examined in a longitudinal sample (N = 438). Of interest was (a) continuity in use of the different arrangements, (b) whether the arrangements were additively and cumulatively associated with children’s externalizing behavior problems, and (c) whether predictive relations were accounted for by social-ecological (socioeconomic status, mothers’ employment status, marital stat...
Minore, Bruce; Boone, Margaret; Katt, Mae; Kinch, Peggy; Birch, Stephen; Mushquash, Christopher
Many of Canada's northern First Nation communities experience difficulty recruiting and retaining appropriate nursing staff and must rely on relief nurses for short-term coverage. The latter often are not adequately prepared for the demanding nature of the practice. This study examined the consequences of nursing turnover on the continuity of care provided to residents of three Ojibway communities in northern Ontario. The findings are based on a review of 135 charts of oncology, diabetes, and mental health clients, and on interviews with 30 professional and paraprofessional health-care providers who served the communities. Nursing turnover is shown to detrimentally affect communications, medications management, and the range of services offered; it also results in compromised follow-up, client disengagement, illness exacerbation, and an added burden of care for family and community members.
Full Text Available Abstract Background The study goal was to assess indices of continuity of care in the primary care setting and their association with health outcomes and healthcare services utilization, given the reported importance of continuity regarding quality of care and healthcare utilization. Methods The study included a random sample of enrollees from Clalit Health Services 19 years-of-age or older who visited their primary care clinic at least three times in 2009. Indices of continuity of care were computed, including the Usual Provider Index (UPC, Modified Modified Continuity Index (MMCI, Continuity of Care Index (COC, and Sequential Continuity (SECON. Quality measures of preventive medicine and healthcare services utilization and their costs were assessed as outcomes. Results 1,713 randomly sampled patients were included in the study (mean age: 48.9 ± 19.2, 42% males. Continuity of care indices were: UPC: 0.75; MMCI: 0.81; COC: 0.67; SECON: 0.70. After controlling for patient characteristics in a multivariate analysis, a statistically significant association was found between higher values of UPC, COC, and SECON and a decrease in the number and cost of ED visits. Higher MMCI values were associated with a greater number and higher costs of medical consultation visits. Continuity of care indices were associated with BMI measurements, and inversely associated with blood pressure measurements. No association was found with other quality indicators, e.g., screening tests for cancer. Conclusions Several continuity of care indices were associated with decreased number and costs of ED visits. There were both positive and negative associations of continuity of care indices with different aspects of healthcare utilization. The relatively small effects of continuity might be due to the consistently high levels of continuity in Clalit Health Services.
Quinn, Joseph F; Cahill, Kevin E
We have entered a new world of retirement income security in America, with older individuals more exposed to market risk and more vulnerable to financial insecurity than prior generations. This reflects an evolution that has altered the historical vision of a financially secure retirement supported by Social Security, a defined-benefit pension plan, and individual savings. Today, 2 of these 3 retirement income sources-pensions and savings-are absent or of modest importance for many older Americans. Retirement income security now often requires earnings from continued work later in life, which exacerbates the economic vulnerability of certain segments of the population, including persons with disabilities, the oldest-old, single women, and individuals with intermittent work histories. Because of the unprecedented aging of our society, further changes to the retirement income landscape are inevitable, but policymakers do have options to help protect the financial stability of older Americans. We can begin by promoting savings at all (especially younger) ages and by removing barriers that discourage work later in life. For individuals already on the cusp of retirement, more needs to be done to educate the public about the value of delaying the receipt of Social Security benefits. Inaction now could mean a return to the days when old age and poverty were closely linked. The negative repercussions of this would extend well beyond traditional economic measures, as physical and mental health outcomes are closely tied to financial security. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Raivio, Risto; Holmberg-Marttila, Doris; Mattila, Kari J
Continuity of care is an essential aspect of quality in general practice. This study is the first systematic follow-up of Finnish primary care patients' assessments with regard to personal continuity of care. To ascertain whether patient-reported longitudinal personal continuity of care is related to patient characteristics and their consultation experiences, and how this had changed over the study period. A 15-year follow-up questionnaire survey that took place at Tampere University Hospital catchment area, Finland. The survey was conducted among patients attending health centres in the Tampere University Hospital catchment area from 1998 until 2013. From a sample of 363 464 patients, a total of 157 549 responded. The responses of patients who had visited a doctor during the survey weeks (n = 97 468) were analysed. Continuity of care was assessed by asking the question: 'When visiting the health centre, do you usually see the same doctor?'; patients could answer 'yes' or 'no'. Approximately half of the responders had met the same doctor when visiting the healthcare centre. Personal continuity of care decreased by 15 percentage points (from 66% to 51%) during the study years. The sense of continuity was linked to several patients' experiences of the consultation. The most prominent factor contributing to the sense of continuity of care was having a doctor who was specifically appointed (odds ratio 7.28, 95% confidence interval = 6.65 to 7.96). Continuity of care was proven to enhance the experienced quality of primary care. Patients felt that continuity of care was best realised when they could consult a doctor who had been specifically appointed to them. Despite efforts of the authorities, over the past 15 years patient-reported continuity of care has declined in Finland. © British Journal of General Practice 2014.
Martínez Olmos, Miguel Ángel
Telemedicine represents the union of information technology and telecommunication services in health. This allows the improvement of health care, especially in underserved areas, bringing professionals working in continuing education and improving patient care at home. The application of telemedicine in various hospital complexes, clinics and health centers, has helped to provide a better service, within the parameters of efficiency, effectiveness, cost-benefit, with increasing satisfaction of medical staff and patients. The development and application of various types of telemedicine, the technological development of audio, text, video and data, and constant improvement of infrastructure in telecommunications, have favored the expansion and development of telemedicine in various medical specialties. The use of electronic health records by different health professionals can have a positive impact on the care provided to patients. This should also be supported by the development of better health policies, legal security and greater awareness in health professionals and patients regarding the potential benefits. Regarding the clinical activity in Nutrition, new technologies also provide an opportunity to improve in various educational, preventive, diagnostic and treatment aspects, including shared track between Nutrition Units and Primary Care Teams, for patients who need home nutritional care at, with shared protocols, providing teleconsultation in required cases and avoiding unnecessary travel to hospital.
Chen, Hsiao-Mei; Han, Tung-Chen; Chen, Ching-Min
Population aging has caused significant rises in the prevalence of chronic diseases and the utilization of healthcare services in Taiwan. The current healthcare delivery system is fragmented. Integrating medical services may increase the quality of healthcare, enhance patient and patient family satisfaction with healthcare services, and better contain healthcare costs. This article introduces two continuing care models: discharge planning and case management. Further, the effectiveness and essential components of these two models are analyzed using a systematic review method. Articles included in this systematic review were all original articles on discharge-planning or case-management interventions published between February 1999 and March 2013 in any of 6 electronic databases (Medline, PubMed, Cinahl Plus with full Text, ProQuest, Cochrane Library, CEPS and Center for Chinese Studies electronic databases). Of the 70 articles retrieved, only 7 were randomized controlled trial studies. Three types of continuity-of-care models were identified: discharge planning, case management, and a hybrid of these two. All three models used logical and systematic processes to conduct assessment, planning, implementation, coordination, follow-up, and evaluation activities. Both the discharge planning model and the case management model were positively associated with improved self-care knowledge, reduced length of stay, decreased medical costs, and better quality of life. This study cross-referenced all reviewed articles in terms of target clients, content, intervention schedules, measurements, and outcome indicators. Study results may be referenced in future implementations of continuity-care models and may provide a reference for future research.
Schnabel, Reinhard; Friedel, Heiko; Erfurth, Andreas; Angermayer, Matthias; Clouth, Johannes; Eichmann, Florian
Although early retirement causes major changes in the life of schizophrenic patients and is among the major cost factors to be covered by payers, the causes leading to early retirement of schizophrenic patients have not been investigated in detail. Therefore, the objective of this retrospective non-interventional case-control study was to generate hypotheses on predisposing factors for early retirement in schizophrenia. Logistic regression was used to explore potential predisposing parameters with regard to their effect on the outcome early retirement. As the study results indicate, schizophrenia severity, assistance or care in the patient's everyday life, age and antipsychotic treatment with typical antipsychotics are linked to the occurrence of early retirement. Further research should be planned to confirm or refute the hypotheses determined in this retrospective analysis and to determine whether atypical antipsychotics could help to avoid early retirement and to improve the situation of schizophrenic patients.
Background Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1) examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2) examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1) development of an individualized patient communication care plan; (2) a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3) a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion The Patient-Centred Communication Intervention will provide staff with strategies to facilitate interactions with
McGilton Katherine S
Full Text Available Abstract Background Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1 examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2 examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1 development of an individualized patient communication care plan; (2 a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3 a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion The Patient-Centred Communication Intervention will provide staff with strategies to
Sinozić, Tamara; Kovacević, Jadranka
A number of healthcare professionals, specialists in different fields and with different levels of education, as well as non-healthcare professionals, are involved in the care of chronic wound patients, thus forming a multidisciplinary team that is not only responsible for the course and outcome of treatment, but also for the patient quality of life. Family doctor is also member of the team the task of which is to prevent, diagnose, monitor and anticipate complications and relapses, as well as complete recovery of chronic wound patients, with the overall care continuing even after the wound has healed, or is involved in palliative care. A family medicine practitioner with specialized education and their team of associates in the primary health care, along with material conditions and equipment improvement, can provide quality care for patients with peripheral cardiovascular diseases and chronic wounds, organized according to the holistic approach. It is essential that all professional associations of family medicine as well as professional associations of other specialties - fields that are involved in wound prevention and treatment - be included in developing the continuous medical education program. The benefits of modern information technology should be used to good advantage. The education should be adapted to the needs of family practitioners in terms of the form, place, time, volume, financial affordability and choice of topic. The interest shown in team education should be transformed into specialized programs in the creation of which it is essential to include both physicians and nurses and their respective professional associations. Special attention should be paid to education and training of young doctors/nurses, those with less work experience, those that have not yet been part of such education, those that lack experience in working with wound patients, those whose teams deal mostly with elderly patients, and also residents in family medicine and
de Jonge, J.; Stuijt, R.; Eijke, I.; Westerman, M.J.
Background: Continuity of care during labour is important for women. Women with an intrapartum referral from primary to secondary care look back more negatively on their birh experience compared to those who are not referred. It is not clear which aspects of care contribute to this negative birth
Loh, Tiffany; Vazirnia, Aria; Afshar, Maryam; Dorschner, Robert; Paravar, Taraneh
As established by the AccreditationCouncil for Graduate Medical Education (ACGME),dermatology residents in the United States must participate in continuity clinic. This requirement may be achieved through multiple means, allowing for program variation. To better assess continuity clinic's role in resident learning, more data on this component of graduate medical education is needed. An anonymous online survey was distributed via the American Board of Dermatology list serv to all U.S. dermatology residents. Continuity clinic organization, setting, frequency, and patient and preceptor characteristics were assessed; resident satisfaction and learning were compared. Of 231 responses, 7.8% reported continuity clinic daily, 77.1% weekly, 9.1% every other week, 3.0%monthly, 0.4% once every several months, and 2.2%only during certain blocks. Of the clinics reported,80.1% were "resident-run with attending" and 11.3%were attending-run. The rest were "resident-run with no attending" (0.9%), both resident and attending run(3.0%), or "other" (4.8%). Trainees in resident-run clinics (with attendings) reported greater continuity of care than those in attending-run clinics (p<0.001).Residents reported better teaching with attending presence during patient encounters than when attendings were present only if concerns were raised(p<0.01).
Fatemeh Kianpour Ghahfarokhi
Full Text Available Objectives: The purpose of this study was to evaluate the relationship between demographic characteristics and retirement satisfaction in elderly members of registered retirement Education Center in Ahwaz. Methods & Materials: This study was descriptive-correlative. The sample of study includes ninety-six retirees referring to retirement center of Ahvaz Using Convenience of haphazard sampling in year 1388. Participants were requested to fill in Retirement Descriptive Index as well as a demographic questionnaire. Data were analyzed using descriptive statistic, Simple correlation and regression repeatedly analysis (by SPSS 16 versions. Results: There are significant positive correlation between health, employment, financial status, usefulness feeling, spouse employment with retirement satisfaction and negative correlation between retirement age and spouse retirement with retirement satisfaction. Conclusion: This study reveals that health, re-employment after retirement, having a good financial status and usefulness feeling increase retirement satisfaction. But retirement age and retirement satisfaction decrease it.
Elena Vital’evna Chistova
Full Text Available The paper assesses the possibility of raising the retirement age to mitigate the effects of ageing on the pension system of Russia. The authors make demographic forecasts based on hypotheses about the presence of global demographic trends in population reproduction and manifestations of development features specific for Russia. The demographic forecast is based on the age shifting method according to three scenarios. The forecast takes into account the provisions of a draft law that has already been approved and that provides for a gradual increase in age limit for civil servants, both men and women, to 65 years (by six months each year. The following assumption is made for the purpose of studying the effects of raising the retirement age to 65 years for all categories of Russian citizens. The increase in the retirement age begins in 2016 at the rate of 6 months per year, and it will end for men in 2026 and for women – in 2036. Thus, by 2036, the official retirement age will be 65 years for both sexes. The resulting forecasts show that population ageing in Russia is an inevitable process. Depending on whether demographic processes are in line with global trends or whether certain specific Russian features of development are revealed, ageing process will occur in the first case – “from above”, in the second case – “from below”. The forecast has confirmed a well-known paradox that if the situation regarding the decline in mortality is improved further, as has happened in recent years, then the pace of ageing that negatively affects the balance of the pension system will be even higher, at least in the medium term. Forecast calculations have shown that, first, demographic burden on the working population will continue to increase under any demographic development scenario implemented in Russia, and most significantly, under a scenario that describes a successful demographic policy. Second, the number of retirement age women is a
María de los Ángeles AGUILERA VELASCO
Full Text Available A documentary compilation of films about retirement was made. The data of films, in language or subtitles in Spanish, that had an argument related to retirement or that their protagonists evidenced experiences of the retirement were included. The documentary compilation was made through the stages of search and analysis. 54 films were found and organized into nine categories. The oldest film was from 1924 and the most recent of 2017. 61.11% of films were made as of 2010. In five films (9.25% the protagonists wanted to commit suicide when leaving work. Euthanasia (5.55% was performed in three films (5.55%. The problem of retirement in women was found only in four films (7.49%. In 18 films (33.33% the male protagonists went through widowhood. Twenty-one countries participated in productions, the United States produced 21 films (38.88%. It provides a very extensive collection of valuable films that convey great lessons, allow us to reflect and raise awareness of this stage of life. It is recommended to socialize the films through socio-educational interventions and investigations, as well as to begin to inquire scientifically about the relationship between suicide and euthanasia in retirement.
... retirement plans. 2550.404a-2 Section 2550.404a-2 Labor Regulations Relating to Labor (Continued) EMPLOYEE... RETIREMENT INCOME SECURITY ACT OF 1974 RULES AND REGULATIONS FOR FIDUCIARY RESPONSIBILITY § 2550.404a-2 Safe..., whether or not such return is guaranteed, consistent with liquidity; (ii) For purposes of paragraph (c)(3...
Sockalingam, Sanjeev; Tehrani, Hedieh; Lin, Elizabeth; Lieff, Susan; Harris, Ilene; Soklaridis, Sophie
To explore the perspectives of leaders in psychiatry and continuing professional development (CPD) regarding the relationship, opportunities, and challenges in integrating quality improvement (QI) and CPD. In 2013-2014, the authors interviewed 18 participants in Canada: 10 psychiatrists-in-chief, 6 CPD leaders in psychiatry, and 2 individuals with experience integrating these domains in psychiatry who were identified through snowball sampling. Questions were designed to identify participants' perspectives about the definition, relationship, and integration of QI and CPD in psychiatry. Interviews were recorded and transcribed. An iterative, inductive method was used to thematically analyze the transcripts. To ensure the rigor of the analysis, the authors performed member checking and sampling until theoretical saturation was achieved. Participants defined QI as a concept measured at the individual, hospital, and health care system levels and CPD as a concept measured predominantly at the individual and hospital levels. Four themes related to the relationship between QI and CPD were identified: challenges with QI training, adoption of QI into the mental health care system, implementation of QI in CPD, and practice improvement outcomes. Despite participants describing QI and CPD as mutually beneficial, they expressed uncertainty about the appropriateness of aligning these domains within a mental health care context because of the identified challenges. This study identified challenges with aligning QI and CPD in psychiatry and yielded a framework to inform future integration efforts. Further research is needed to determine the generalizability of this framework to other specialties and health care professions.
Drolet, Brian C; Hyman, Charles H; Ghaderi, Kimeya F; Rodriguez-Srednicki, Joshua; Thompson, Jordan M; Fischer, Staci A
Physicians' perceptions of duty hour regulations have been closely examined, yet patient opinions have been largely unstudied to date. We studied patient perceptions of residency duty hours, fatigue, and continuity of care following implementation of the Accreditation Council for Graduate Medical Education 2011 Common Program Requirements. A cross-sectional survey was administered between June and August 2013 to inpatients at a large academic medical center and an affiliated community hospital. Adult inpatients on teaching medical and surgical services were eligible for inclusion in the study. Survey response rate was 71.3% (513 of 720). Most respondents (57.1%, 293 of 513) believed residents should not be assigned to shifts longer than 12 hours, and nearly half (49.7%, 255 of 513) wanted to be notified if a resident caring for them had worked longer than 12 hours. Most patients (63.2%, 324 of 513) believed medical errors commonly occurred because of fatigue, and fewer (37.4%, 192 of 513; odds ratio, 0.56; P care. Given the choice between a familiar physician who "may be tired from a long shift" or a "fresh" physician who had received sign-out, more patients chose the fresh but unfamiliar physician (57.1% [293 of 513] versus 42.7% [219 of 513], P care.
O'Connor, S J; Lanning, J A
No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.
Full Text Available Abstract Background Central to establishing continuity of care is the development of a relationship between doctor and patient/caregiver. Transfer of information between these parties facilitates the development of continuity in general; and specifically informational continuity of care. We conducted a systematic review of published literature to gain a better understanding of the roles that different parties – specifically doctors, patients, family caregivers, and technology – play in establishing and maintaining informational continuity of care within family practice. Methods Relevant published articles were sought from five databases. Accepted articles were reviewed and appraised in a consistent way. Fifty-six articles were retained following title and abstract reviews. Of these, 28 were accepted for this review. Results No articles focused explicitly on the roles involved in establishing or maintaining informational continuity of care within family practice. Most informational continuity of care literature focused on the transfer of information between settings and not at the first point of contact. Numerous roles were, however, were interpreted using the data extracted from reviewed articles. Doctors are responsible for record keeping, knowing patients' histories, recalling accumulated knowledge, and maintaining confidentiality. Patients are responsible for disclosing personal and health details, transferring information to other practitioners (including new family doctors, and establishing trust. Both are responsible for developing a relationship of trust. Technology is an important tool of informational continuity of care through holding important information, providing search functions, and providing a space for recorded information. There is a significant gap in our knowledge about the roles that family caregivers play. Conclusion The number of roles identified and the interrelationships between them indicates that establishing and
Brinkman, William B; Baum, Rebecca; Kelleher, Kelly J; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua; Epstein, Jeffery N
To describe the relationships between attention-deficit/hyperactivity disorder (ADHD) care practices and subsequent medication use. A retrospective cohort from a random sample of medical records in 50 pediatric practices with 188 providers, including 1,352 children who started ADHD medication, was studied. Independent variables included physician behaviors related to medication titration and monitoring of treatment response. Primary outcomes were number of days covered with ADHD medication during the first year of treatment and time from starting medicine to the first 30-day gap in medication supply. Multilevel modeling and Cox proportional hazards regression models were conducted. Children had an average medication supply of 217 days in the first year. Half experienced a 30-day gap in medication supply in the first 3 months. Nearly three-fourths had a medication adjustment in the first year with the first adjustment usually being a dosage change. The average time to the first medication adjustment was over 3 months. Physician's first contact with parents occurred in the first month of treatment for less than half, with the average time being over 2 months. Little variation related to ADHD care quality was accounted for at the physician level. Early titration and early contact were related to greater medication supply and continuity of treatment. Earlier physician-delivered ADHD care (e.g., contact with parent after starting medication and medication adjustment) is related to greater medication supply and continuity. It remains to be determined whether interventions that improve the quality of titration and monitoring practices for children with ADHD would also improve medication continuity. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Full Text Available Abstract Background Continuity of care is regarded as a core quality element in healthcare. Continuity can be related to one or more specific caregivers but also applies to collaboration within a team or across boundaries of healthcare. Measuring continuity is important to identify problems and evaluate quality improvement of interventions. This study aimed to assess the feasibility and psychometric properties of a Norwegian version of the Nijmegen Continuity Questionnaire (NCQ. Methods The NCQ was developed in The Netherlands. It measures patients’ experienced continuity of care across multiple care settings and as a multidimensional concept regardless of morbidity. The NCQ comprises 28 items categorised into three subscales; two personal continuity scales, “care giver knows me” and “shows commitment”, asked regarding the patient’s general practitioner (GP and the most important specialist; and one “team/cross boundary continuity” scale, asked regarding primary care, specialised care and cooperation between GP and specialist, with a total of seven factors. The NCQ was translated and adapted to Norwegian (NCQ-N and distributed among patients referred to somatic rehabilitation (N = 984, response rate 34.5%. Confirmatory factor analyses (CFA, Cronbach’s alpha, intra-class correlation (ICC and Bland–Altman plots were used to assess psychometric properties. Results All patients (N = 375 who had responded to all parts of the NCQ-N were included in CFA. The CFA fit indices (CFI 0.941, RMSEA 0.064 (95% CI 0.059–0.070, SRMR 0.041 support a seven-factor structure in the NCQ-N based on the three subscales of the original NCQ. Cronbach’s alpha showed internal consistency (0.84–0.97, and was highest for the team/cross-boundary subscales. The NCQ-N showed overall high reliability with ICC 0.84–91 for personal continuity factors and 0.67–0.91 for team factors, with the lowest score for team continuity within primary care
... by the Board of Actuaries of the Civil Service Retirement System. DATES: The revised present value.... ADDRESSES: Send requests for actuarial assumptions and data to the Board of Actuaries, care of Gregory Kissel, Actuary, Office of Planning and Policy Analysis, Office of Personnel Management, Room 4307, 1900...
... adopted by the Board of Actuaries of the Civil Service Retirement System. DATES: The revised present value.... ADDRESSES: Send requests for actuarial assumptions and data to the Board of Actuaries, care of Gregory Kissel, Actuary, Office of Planning and Policy Analysis, Office of Personnel Management, Room 4307, 1900...
... in the economic assumptions adopted by the Board of Actuaries of the Civil Service Retirement System... data to the Board of Actuaries, care of Gregory Kissel, Actuary, Office of Planning and Policy Analysis...- 335, based on changed economic assumptions adopted by the Board of Actuaries of the CSRS. Those...
Bleasel, M D; Peterson, G M; Dunne, P F
We have investigated the steady-state plasma concentrations of midazolam during continuous subcutaneous administration in palliative care. Using a sensitive gas chromatography with electron capture detector assay, plasma concentrations of midazolam were measured in 11 patients (median age 68 years; range 47-82 years; six females) receiving the drug by continuous subcutaneous infusion (median rate 20 mg/day; range 10-60 mg/day). While not significant, the infusion rate tended to decrease with increasing age of the patient (Spearman's p = -0.51; p = 0.11). The steady-state plasma concentration range was 10-147 ng/ml, with a median of 30 ng/ml. Infusion rates and plasma concentrations of midazolam were correlated (Spearman's p = 0.71; p < 0.05). No other significant relationships were found between plasma concentrations and the variables of age, sex and liver function.
Pozzoli, Dario; Ranzani, Marco
is married, and amongst these 24 percent has a working wife. This results from dramatic changes in the labor force behaviour of both older men and older women after World War II. These trends signal a need of investigating retirement choices at a household level. Using an absolutely new international micro...... data (SHARE, Survey of Health, Ageing and Retirement in Europe - Release 2), we adopt a duration analysis approach and estimate both single and competing risks models by allowing for a exible speci cation with and without unobserved heterogeneity. Our findings show that joint retirement is signi cantly...... correlated with education, age, and health status, together with partner's employment status, partner's education and partner's health status. We also perform a sensitivity analysis in order to check whether the results on the correlation of health status are robust to two alternative measures of health...
Lee, Sok K
A retirement is a rite of passage that requires careful planning, because it forces a retiree to make a shift in the paradigm in life. For 37 years, I was a healing professional, a breadwinner, and a working spouse. I am now a jobless loner, an inactive pensioner, and a homebound spouse. In this retrospective autobiography, I suggest a few points to help my younger colleagues to better their upcoming retirement: professional, financial, social, and familial. To overcome Erikson's identity crisis, I volunteered to be a wounded healer at Warm Springs Indian Reservation. My volunteer medical service at Warm Springs Indian Reservation was a good antidote to creatively overcome my postretirement blues.
Hallberg, Daniel; Johansson, Per; Josephson, Malin
This paper studies empirically the consequences on health of an early retirement offer. To this end we use a targeted retirement offer to military officers 55 years of age or older. Before the offer was implemented, the normal retirement age in the Swedish defense was 60 years of age. Estimating the effect of the offer on individuals' health within the age range 56-70, we find support for a reduction in both mortality and in inpatient care as a consequence of the early retirement offer. Increasing the mandatory retirement age may thus not only have positive government income effects but also negative effects on increasing government health care expenditures. Copyright © 2015 Elsevier B.V. All rights reserved.
Dong, Francis Henry
In the wake of recent events, especially the Great Recession of 2007-2009, affecting the economy, resulting in job losses, personal financial distress, and gloomy perceptions of their future well-being, many Americans are concerned about their financial quality of life in retirement. The media is replete with a plethora of advertisements for…
Gyllensvärd, K; Qvarnström, M; Wolf, E
The aim was to analyse the care taking of dental fear patients from the perspective of the dentist, using a qualitative methodology. In total, 11 dentists from both the private and public dental service were selected through a purposive sampling according to their experience of treating dental fear patients, their gender, age, service affiliation and location of undergraduate education. Data were obtained using one semi-structured interview with each informant. The interviews were taped and verbatim transcribed. The text was analysed using qualitative content analysis. The theme, 'The transforming autodidactic process of care taking', covering the interpretative level of data content was identified. The first main category covering the descriptive level of data was 'The continuous and changing challenge', with the subcategories 'The emotional demand' and 'The financial stress'. The second main category identified was 'The repeated collection of experience', with the subcategories 'The development of resources' and 'The emotional change'. The dentists' experience of treating dental fear patients was considered a challenging self-taught process under continuous transformation. The competence and routine platform expanded over time, parallel to a change of connected emotions from frustration towards safety, although challenges remained. © 2016 John Wiley & Sons Ltd.
Helldán, Anni; Lallukka, Tea; Rahkonen, Ossi; Lahelma, Eero
Retirement is one of the major transitions in the life course. However, it is poorly understood how health behaviours, such as food habits, might change after retirement. This study aimed to examine whether healthy food habits change after the transition to old age retirement and whether socio-demographic or health-related factors explain the association between retirement, being continuously employed and healthy food habits at follow-up. The data were derived from the Helsinki Health Study cohort on the staff of the City of Helsinki, Finland. The baseline questionnaire survey data were collected in 2000-02 and the follow-up in 2007. We included only participants who were aged 55-60 years at baseline and entered old age retirement during the follow-up (n = 1156, 76% women) or remained continuously employed (n = 1269, 79% women). Food habits from a food frequency questionnaire included eight items formed according to the Finnish and Nordic dietary recommendations. Logistic regression models were fitted to examine the associations between retirement, being continuously employed and healthy food habits at follow-up. Healthy food habits increased more among retired women than those continuously employed (P = 0.03). At follow-up retired women had healthier food habits than continuously employed women after adjusting for baseline food habits [OR = 1.36 (1.12-1.65)]. Among men, healthy food habits were unassociated with retirement. Transition to old age retirement is likely to have beneficial effects on food habits among women. This helps prevent major diseases and supports better public health among ageing people.
Chandler, Rebecca C; Robinson, Oliver C
A retirement village consists of a collection of privately owned or leased flats or maisonettes for elderly adults that are supported by a central hub that provides catering, medical care and social activities. There have been studies of the psychological experience and impacts of such environments, however, there is lack of research that links the retirement village experience to overarching theories of eudaimonic wellbeing, and that uses qualitative methods to find out about how wellbeing manifests for the individual. This study used Ryff's (1989) model of wellbeing as a framework for analysis, while aiming to gain an in-depth understanding of the experiences and sources of wellbeing in residents of two retirement villages in the South East of England. Semi-structured interviews were carried out with 18 residents. Thematic analysis revealed a dialectical tension to retirement village living: while facilitating all six core components of eudaimonic wellbeing as conceptualized by Ryff's model, individuals living within the retirement villages also experience challenges to wellbeing on the same dimensions. An integrative model of these tensions between positive and negative experiences is presented and discussed. Copyright © 2014 Elsevier Inc. All rights reserved.
Quon, Bradley S; Goss, Christopher H
Continuous quality improvement (CQI) in healthcare can be described as a reiterative approach to improving processes to reduce unexpected variation in health outcomes. CQI represents one model to achieve quality improvement (QI) and has long been recognized as a key to success in the manufacturing industry with companies like Toyota leading the way. Healthcare, and specifically pulmonary, critical care and sleep medicine represent ideal settings for the application of CQI. This opinion piece will describe QI and CQI initiatives in the US Cystic fibrosis (CF) population. QI in CF care in the United States has been ongoing since inception of the US CF Foundation (CFF) in 1955. This effort has included work to improve the quality of clinical care provided at CF centers and work to improve clinical outcomes in CF. More recently, QI methods have been applied to the conduct of clinical research. The CF community has become a leader in the area of QI and has pointed out the opportunities for others to follow in the area of lung diseases.
Siu, Emily; Sadasivam, Kalaimaran; Christiansen, Nanna
Prescription errors, including continuous infusion prescriptions are one major source of concern in the paediatric population. Evidence suggests that use of an electronic or web-based calculator could minimise these errors. In our paediatric critical care unit (PCCU) we have created an electronic continuous infusion prescription chart to target errors in this area and conducted an audit to assess its effect on error reduction. To create an electronic continuous infusion prescription chart and audit its effect on prescription errors. Similar electronic continuous infusion prescription charts were evaluated. A Choice of electronic formats were considered and excel was chosen for its simplicity and flexibility. The choice of medications to be included, dilution method, and dosage range was agreed between PCCU consultant, pharmacy and nursing staff. Formulas for calculating each medication infusion was created and validated for different age and weight ranges by at least 2 PCCU trained pharmacists, accounting for capping at certain age and weight bands as appropriate for the medication. These were programmed into the spreadsheet for automatic calculation using inputted age and weight for the selected medications. Continuous infusion prescriptions were audited 6 months before and after implementation in April 2015 of this electronic chart. Parameters audited include medication dose, infusion rate, concentration, route, legibility, and missing or incorrect patient details. A trial period of 4 weeks preceded implementation. The electronic continuous infusion prescription form was created and used on PCCU. Hand written prescriptions had higher error rate (30.7%) as compared to electronic charts (0.7%) with a p-value <0.002. No errors were found in electronic prescriptions in regards to dose, volume and rate calculation. The use of an electronic continuous infusion prescription chart has been successfully set up and used on PCCU. Its use has significantly reduced continuous
Rode, David C.; Fischbeck, Paul S.; Páez, Antonio R.
This paper examines more than a century of U.S. power plant additions and retirements in conjunction with several decades of utility capital investment data. While policy analyses often invoke assumptions of power plant book life, relatively little analysis has focused on the physical life of power-generating assets. The average age of the U.S. generator fleet has increased significantly over time despite continued investment, in part because more recent investment has tended to focus on shorter-lived assets. This may be due in part to risk-averse power sector investors and lenders responding rationally to regulatory uncertainty in a deregulated market environment. Power plant retirement trends suggest that the pace of retirements will increase significantly in the decade after 2030 for most reasonable estimates of physical life. These capital investment trends have important consequences for carbon policy and highlight the importance of including consideration of the longer term—particularly when evaluating more significant decarbonization policies. - Highlights: • Many policy analyses neglect the physical lives of power plants. • A large database of U.S. power plant additions and retirements is examined. • The average age of power plants has steadily increased despite growing investment. • Long-term CO 2 reduction strategies are challenged by increases in plant retirements.
CERN's big Auditorium was packed on Friday 23 November for a 'Simon van der Meer Feest' to mark the formal retirement of the gifted Dutch accelerator physicist who has made so many valuable contributions to his field and to CERN's success
Cole, R J
The process of retirement planning is a difficult one for a physician. The Planning process should address the areas of Investment Planning, Estate Planning, and Risk Management. This article examines each of these dimensions with special emphasis on Modern Portfolio Theory as the basis for investment planning.
Full Text Available Pension systems are a major part of the political economy of current societies – much beyond providing old-age income security. The well-known demographics of population aging as well as globalization today challenge their financial viability. Later retirement seems to be a good way to meet these challenges. However, it is not only unpopular but also inequitable in terms of differential longevity. The paper first discusses these problems, with a particular focus on the social stratification of mortality. It then analyzes the preferences towards retirement age at several levels: in terms of attitudes towards public spending on pensions or towards the state’s responsibility in this matter, of support for pension policy alternatives, and of preferred individual age of retirement. Results show that large majorities across all age groups are in favour of more government spending on pensions. There is a substantial amount of ‘involuntary retirement’, meaning that people would have preferred to work longer than they actually did, as well as a somewhat lower amount of ‘involuntary work’, but the preferred ages are everywhere below 65, and in some countries still below 60. Finally, the paper examines the policies of raising the retirement age adopted during the last two decades. What has especially been lacking in these policies is a consideration of socially differentiated longevity.
Fields, Cheryl D.
Options available to college faculty for planning their retirement benefits are described, including defined benefit plans, defined contribution plans, and methods for customizing a pension plan. Data for 1993 on American households owning interest-earning assets (passbook savings, money market deposit accounts, certificates of deposit, checking…
Brougham, Ruby R.; Walsh, David A.
The current study proposes that personal need fulfillment (relatedness, generativity, identity, growth, and finances) predicts early and late retirement intentions. The personal needs of 160 full-time older employees were measured by personal goals, job satisfactions, job characteristics, and intrinsic motivation. Results suggest that the personal…
Elder, Jane D.
Free-lance librarianship is discussed, and retired librarians are urged to start their own information service as a business. Because computer based storage and retrieval systems are not socially, politically, or economically integrated, and one library cannot hold all information, new needs are emerging for information services. For example, a…
Scott, John W; Nyinawankusi, Jeanne D'Arc; Enumah, Samuel; Maine, Rebecca; Uwitonze, Eric; Hu, Yihan; Kabagema, Ignace; Byiringiro, Jean Claude; Riviello, Robert; Jayaraman, Sudha
Injury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014. The SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after. During the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (pRwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the injured in a resource-limited setting. Copyright © 2017 Elsevier Ltd. All rights reserved.
Hoving, J.L.; Koes, B.W.; Vet, H.C.W. de; Windt, D.A.W.M. van der; Assendelft, W.J.J.; Mameren, H. van; Devillé, W.L.J.M.; Pool, J.J.M.; Scholten, R.J.P.M.; Bouter, L.M.
BACKGROUND: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. OBJECTIVE: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. DESIGN: Randomized, controlled
Hoving, Jan Lucas; Koes, Bart W.; de Vet, Henrica C. W.; van der Windt, Danielle A. W. M.; Assendelft, Willem J. J.; van Mameren, Henk; Devillé, Walter L. J. M.; Pool, Jan J. M.; Scholten, Rob J. P. M.; Bouter, Lex M.
BACKGROUND: Neck pain is a common problem, but the effectiveness of frequently applied conservative therapies has never been directly compared. OBJECTIVE: To determine the effectiveness of manual therapy, physical therapy, and continued care by a general practitioner. DESIGN: Randomized, controlled
Mol, Meriel; van Kan, H. J. M.; Schultz, Marcus J.; de Jonge, Evert
OBJECTIVE: To study whether selective decontamination of the digestive tract (SDD) results in detectable serum tobramycin concentrations in intensive care unit (ICU) patients with acute renal failure treated with continuous venovenous hemofiltration (CVVH). DESIGN AND SETTING: Prospective,
Dr Jon D. Stanford; Michael Drew; Bill Stanhope
This paper examines the findings of the research project, 'Retirement Savings: Drivers and Desires', commissioned by the Investment and Financial Services Association Ltd (IFSA) in 2001. The paper investigates retirement savings decision-making and retirement income product stream choice. This paper presents a quantitative analysis of questionnaire data relating to decision-making and product stream choice and discusses these issues in the context of established research findings about retire...
M.Comm. Pension funds have risen to great prominence in the last two decades because they provide a service that fits the needs of individuals. The community at large are rapidly accepting and demanding facilities for proper retirement planning. Employees contribute towards retirement funds and their contributions are tax deductible while taxable to the employee upon retirement, generally at a lower rate. The employer, who has instituted the retirement fund, owes the fund because the emplo...
Cho, Hyejin; Suh, Wookyung; Lee, Jiyoung; Jang, Younju; Kim, Minjung
This study investigated a retirement coaching educational program using the mixed method research design. A structured survey was distributed to 48 financial planners who had undergone 50-hour retirement education including retirement coaching. The coaching was conducted in two sessions in 2015. Results revealed that first, the retirement coaching…
Slaughter, Susan E; Estabrooks, Carole A; Jones, C Allyson; Wagg, Adrian S; Eliasziw, Misha
Bridging the research-practice gap is an important research focus in continuing care facilities, because the population of older adults (aged 65 years and over) requiring continuing care services is the fastest growing demographic among countries in the Organisation for Economic Co-operation and Development (OECD). Unlicensed practitioners, known as health care aides, provide the majority of care for residents living in continuing care facilities. However, little research examines how to sustain health care aide behavior change following initial adoption of current research evidence. We will conduct a phase III, multicentre, cluster randomized controlled trial (RCT) using a stratified 2 × 2 additive factorial design, including an embedded process evaluation, in 24 supportive living facilities within the health zone of Edmonton, AB, Canada. We will determine which combination of frequency and intensity of reminders most effectively sustains the completion of the sit-to-stand activity by health care aides with residents. Frequency refers to how often a reminder is implemented; intensity refers to whether a reminder is social or paper-based. We will compare monthly reminders with reminders implemented every 3 months, and we will compare low intensity, paper-based reminders and high intensity reminders provided by a health care aide peer.Using interviews, questionnaires, and observations, Sustaining Transfers through Affordable Research Translation (START) will evaluate the processes that inhibit or promote the mobility innovation's sustainability among health care aides in daily practice. We will examine how the reminders are implemented and perceived by health care aides and licensed practical nurses, as well as how health care aides providing peer reminders are identified, received by their peers, and supported by their supervisors. START will connect up-to-date innovation research with the practice of health care aides providing direct care to a growing population
Price, William F.
With the trend toward early retirement and the fact that people are living to an older average age, more years of an individual's life will be spent in retirement. To examine personal values as psychological determinants of the retirement preparation process, 206 classified university employees, between the ages of 50 and 65 years of age,…
Bastable, C. W.; Brady, Gerald P.
The various retirement income options available to TIAA-CREF participants and federal taxes on each option are explained. The importance of early planning for retirement income is stressed and it is suggested that assessment of future financial needs will indicate the most appropriate settlement mode for retirement. (SF)
This paper discusses retirement as a learning process, where learning, be it formal or informal, enables retirees to adjust to the transition from work to retirement. Such discussion is important given the fact that the world population is aging and that more people are retiring in the next few decades. Moreover, people are experiencing an…
Bugaresti, J M; Tator, C H; Szalai, J P
The present study was conducted to determine whether automated, continuous turning beds would reduce the nursing care time for spinal cord injured (SCI) patients by freeing hospital staff from manual turning of patients every 2 hours. Seventeen patients were randomly assigned to continuous or intermittent turning and were observed during the 8 hour shift for 1 to 18 days following injury. Trained observers recorded the time taken for patient contact activities performed by the nursing staff (direct nursing care) and other hospital staff. The mean direct nursing care time per dayshift per patient was 130 +/- 22 (mean +/- SD) minutes for 9 patients managed with continuous turning and 115 +/- 41 (mean +/- SD) minutes for 8 patients managed with intermittent turning. The observed difference in care time between the two treatment groups was not significant (p greater than 0.05). Numerous factors including neurological level, time following injury, and medical complications appeared to affect the direct nursing care time. Although continuous turning did not reduce nursing care time it offered major advantages for the treatment of selected cases of acute SCI. Some major advantages of continuous turning treatment were observed. Spinal alignment was easier to maintain during continuous turning in patients with injuries of the cervical spine. Continuous turning allowed radiological procedures on the spine, chest and abdomen to be more easily performed without having to alter the patients' position in bed. Therapy and nursing staff indicated that the continuous turning bed facilitated patient positioning for such activities as chest physiotherapy. With continuous turning, one nurse was sufficient to provide care for an individual SCI patient without having to rely on the assistance of other nurses on the ward for patient turning every 2 hours.
during breast cancer trajectory. Overall, distress has been linked to suffering, and lower quality of life, increased admission rates, and greater health care costs. This thesis uses mixed methods to investigate the prevalence of distress among women taking part in surgical continuity of care at time...
Morgan, Debra G.; Kosteniuk, Julie G.; O'Connell, Megan E.; Dal Bello-Haas, Vanina; Stewart, Norma J.; Karunanayake, Chandima
An understanding of the specific dementia learning needs of home care staff is needed to plan relevant continuing education (CE) programs and supports. The study's objective was to examine frequency and perceived competence in performing 20 dementia-related work activities, and identify CE priorities among home care staff. A cross-sectional survey…
Full Text Available Netsanet Fentahun,1 Ashagre Molla21Department of Health Education and Behavioral Sciences, 2Department of Nursing, Jimma University, Jimma, EthiopiaBackground: An effectively prepared and continually updated workforce of health professionals is essential to maintenance and improvement in patient care. The major goal of continuing education is to improve and promote quality care. Continuing education is also important to an organization's strategic plan because of its positive influence on the quality of care provided. The purpose of this study was to identify the determinants of and opportunities for continuing education among health care professionals at public health facilities in Jimma township.Methods: A cross-sectional study of 319 health care professionals working in the public health facilities of Jimma township was conducted from January 10, 2012 to February 28, 2012. A self-administered questionnaire was used to collect the data. First, descriptive analysis was done to describe the characteristics of the study participants. Finally logistic regression was then used to determine the independent predictors of continuing education.Results: Only 70 (25% of the study participants were participating in continuing education. As working experience increased, participation in continuing education did not steadily increase. The working hours per week were higher for diploma holders than for those with any other qualification. One hundred and fifty-three (71.8% participants mentioned lack of support from their current employer as the reason for not participating in continuing education. Health care professionals with a lack of support from management were 2.4 times more likely not to participate in advanced education. Health care professionals with lack of funding were 0.3 times less likely to participate in advanced education. Health care professionals with lack of resources other than financial were 2.2 times more likely not to participate in
Srofenyoh, Emmanuel; Ivester, Thomas; Engmann, Cyril; Olufolabi, Adeyemi; Bookman, Laurel; Owen, Medge
To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies. In 2007, Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra, Ghana. A model encompassing continuous assessment, implementation, advocacy, outputs, and outcomes was designed. Key areas for improvement were grouped into "bundles" based on personnel, systems management, and service quality. Primary outcomes included maternal and perinatal mortality, and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri-annually between 2007 and 2009. During the study period, there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1% to 1.1% (Pcontinuous quality improvement were developed and employed. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Rewa, Oleksa G; Villeneuve, Pierre-Marc; Lachance, Philippe; Eurich, Dean T; Stelfox, Henry T; Gibney, R T Noel; Hartling, Lisa; Featherstone, Robin; Bagshaw, Sean M
Renal replacement therapy is increasingly utilized in the intensive care unit (ICU), of which continuous renal replacement therapy (CRRT) is most common. Despite CRRT being a relatively invasive and resource intensive technology, there remains wide practice variation in its application. This systematic review appraised the evidence for quality indicators (QIs) of CRRT care in critically ill patients. A comprehensive search strategy was developed and performed in five citation databases (Medline, Embase, CINAHL, Cochrane Library, and PubMed) and select grey literature sources. Two reviewers independently screened, selected, and extracted data using standardized forms. Each retrieved citation was appraised for quality using the Newcastle-Ottawa Scale (NOS) and Cochrane risk of bias tool. Data were summarized narratively. Our search yielded 8374 citations, of which 133 fulfilled eligibility. This included 97 cohort studies, 24 randomized controlled trials, 10 case-control studies, and 2 retrospective medical audits. The quality of retrieved studies was generally good. In total, 18 QIs were identified that were mentioned in 238 instances. Identified QIs were classified as related to structure (n = 4, 22.2 %), care processes (n = 9, 50.0 %), and outcomes (n = 5, 27.8 %). The most commonly mentioned QIs focused on filter lifespan (n = 98), small solute clearance (n = 46), bleeding (n = 30), delivered dose (n = 19), and treatment interruption (n = 5). Across studies, the definitions used for QIs evaluating similar constructs varied considerably. When identified, QIs were most commonly described as important (n = 144, 48.3 %), scientifically acceptable (n = 32, 10.7 %), and useable and/or feasible (n = 17, 5.7 %) by their primary study authors. We identified numerous potential QIs of CRRT care, characterized by heterogeneous definitions, varying quality of derivation, and limited evaluation. Further study is needed to prioritize a concise
Contemporary retirement research endeavours to identify the complex antecedents and consequences of retirement decisions and retirement planning. However, few research studies have examined how retirement decisions and planning behaviours have been implemented, nor has there been any significant research investigating the impact of the complex interactions that occur between individual traits and matching or non-matching strategic preferences on retirement outcomes. This research progra...
continuity of care by requiring compliance with the standards and guidelines of the Patient Centered Medical Home 3 (PCMH) model requiring the continuity...back Rheumatism – Pain associated with joints and connective tissues (back pain, neck pain and osteoarthritis ) Osteopathies, chondropathies, and...pain, neck pain and osteoarthritis ) Osteopathies, chondropathies, and acquired musculoskeletal deformities – Diseases associated with bones or
drs Limke Schopman; dr Corine Boon; dr Karianne Kalshoven
In this health care field study, we examined the link between human resource management (HRM), transformational leadership, intrinsic motivation and motivation to continue to work. Based on the social exchange theory, we proposed a mediation model linking HRM to motivation to continue to work in
Schopman, L.M.; Kalshoven, K.; Boon, C.
In this health care field study, we examined the link between human resource management (HRM), transformational leadership, intrinsic motivation and motivation to continue to work. Based on the social exchange theory, we proposed a mediation model linking HRM to motivation to continue to work in
Hosseini, Masoud; Jones, Josette; Faiola, Anthony; Vreeman, Daniel J; Wu, Huanmei; Dixon, Brian E
Due to the nature of information generation in health care, clinical documents contain duplicate and sometimes conflicting information. Recent implementation of Health Information Exchange (HIE) mechanisms in which clinical summary documents are exchanged among disparate health care organizations can proliferate duplicate and conflicting information. To reduce information overload, a system to automatically consolidate information across multiple clinical summary documents was developed for an HIE network. The system receives any number of Continuity of Care Documents (CCDs) and outputs a single, consolidated record. To test the system, a randomly sampled corpus of 522 CCDs representing 50 unique patients was extracted from a large HIE network. The automated methods were compared to manual consolidation of information for three key sections of the CCD: problems, allergies, and medications. Manual consolidation of 11,631 entries was completed in approximately 150h. The same data were automatically consolidated in 3.3min. The system successfully consolidated 99.1% of problems, 87.0% of allergies, and 91.7% of medications. Almost all of the inaccuracies were caused by issues involving the use of standardized terminologies within the documents to represent individual information entries. This study represents a novel, tested tool for de-duplication and consolidation of CDA documents, which is a major step toward improving information access and the interoperability among information systems. While more work is necessary, automated systems like the one evaluated in this study will be necessary to meet the informatics needs of providers and health systems in the future. Copyright © 2017 Elsevier Inc. All rights reserved.
Ghandehari, Omeed O; Hadjistavropoulos, Thomas; Williams, Jaime; Thorpe, Lilian; Alfano, Dennis P; Dal Bello-Haas, Vanina; Malloy, David C; Martin, Ronald R; Rahaman, Omar; Zwakhalen, Sandra M G; Carleton, R N; Hunter, Paulette V; Lix, Lisa M
The underassessment and undertreatment of pain in residents of long-term care (LTC) facilities has been well documented. Gaps in staff knowledge and inaccurate beliefs have been identified as contributors. To investigate the effectiveness of an expert-based continuing education program in pain assessment⁄management for LTC staff. Participants included 131 LTC staff members who were randomly assigned to either an interactive pain education (PE) program, which addressed gaps in knowledge such as medication management, or an interactive control program consisting of general dementia education without a specific clinical focus. Participants attended three sessions, each lasting 3 h, and completed measures of pain-related knowledge and attitudes⁄beliefs before, immediately after and two weeks following the program. Focus groups were conducted with a subset of participants to gauge perception of the training program and barriers to implementing pain-related strategies. Analysis using ANOVA revealed that PE participants demonstrated larger gains compared with control participants with regard to pain knowledge and pain beliefs. Barriers to implementing pain-related strategies certainly exist. Nonetheless, qualitative analyses demonstrated that PE participants reported that they overcame many of these barriers and used pain management strategies four times more frequently than control participants. Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers.
Jacopo M Legramante
Full Text Available The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with "elderly frequent users".A retrospective study was performed during the calendar year 2014 (1st January 2014 - 31st December 2014 analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models.A total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4-1.7 and hospitalization (OR 3.8: CI 3.7-4. Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9-3.2.Older patients presented clinical and social characteristics related to the definition of "elderly frail frequent users". The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established.Enhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating
Legramante, Jacopo M; Morciano, Laura; Lucaroni, Francesca; Gilardi, Francesco; Caredda, Emanuele; Pesaresi, Alessia; Coscia, Massimo; Orlando, Stefano; Brandi, Antonella; Giovagnoli, Germano; Di Lecce, Vito N; Visconti, Giuseppe; Palombi, Leonardo
The elderly, who suffer from multiple chronic diseases, represent a substantial proportion of Emergency Department (ED) frequent users, thus contributing to ED overcrowding, although they could benefit from other health care facilities, if those were available. The aim of this study was to evaluate and characterize hospital visits of older patients (age 65 or greater) to the ED of a university teaching hospital in Rome from the 1st of January to the 31st of December 2014, in order to identify clinical and social characteristics potentially associated with "elderly frequent users". A retrospective study was performed during the calendar year 2014 (1st January 2014 - 31st December 2014) analyzing all ED admissions to the University Hospital of Rome Tor Vergata. Variables collected included age, triage code, arrival data, discharge diagnosis, and visit outcome. We performed a risk analysis using univariate binary logistic regression models. A total number of 38,016 patients accessed the ED, generating 46,820 accesses during the study period, with an average of 1.23 accesses for patient. The elderly population represented a quarter of the total ED population and had an increased risk of frequent use (OR 1.5: CI 1.4-1.7) and hospitalization (OR 3.8: CI 3.7-4). Moreover, they showed a greater diagnostic complexity, as demonstrated by the higher incidence of yellow and red priority codes compared to other ED populations (OR 3.1: CI 2.9-3.2). Older patients presented clinical and social characteristics related to the definition of "elderly frail frequent users". The fact that a larger number of hospitalizations occurred in such patients is indirect evidence of frailty in this specific population, suggesting that hospital admissions may be an inappropriate response to frailty, especially when continued care is not established. Enhancement of continuity of care, establishment of a tracking system for those who are at greater risk of visiting the ED and evaluating fragile
Leap, Nicky; Sandall, Jane; Buckland, Sara; Huber, Ulli
An evaluation carried out at King's College Hospital Foundation National Health Service Trust in London identified that women who received continuity of carer from the Albany Midwifery Practice were significantly less likely to use pharmacological pain relief when comparisons were made with eight other midwifery group practices and the local maternity service as a whole. This study was designed to explore women's views of this phenomenon. We conducted a thematic analysis of semistructured, audiotaped, in-depth interviews with 10 women who reflected on their experiences of preparation and support for pain in labour and midwifery continuity of carer with Albany midwives, using a qualitative descriptive methodological approach. Women reflected positively on how, throughout pregnancy and labour, their midwives promoted a sense of their ability to cope with the challenge of labour pain. This building of confidence was enabled through a relationship of trust that developed with their midwives and the value of hearing other women's stories during antenatal groups. These experiences enhanced women's ability to overcome fears and self-doubt about coping with pain and led to feelings of pride, elation, and empowerment after birth. Women valued being encouraged and supported to labour without using pharmacological pain relief by midwives with whom they developed a trusting relationship throughout pregnancy. Features of midwifery approaches to pain in labour and relational continuity of care have important implications for promoting normal birth and a positive experience of pregnancy, labour, and birth for women. Copyright (c) 2010 American College of Nurse-Midwives. Published by Elsevier Inc. All rights reserved.
Human Resources Division
27 March 2001 from 2.00 p.m. to 5.30 p.m. 28 March 2001 from 2.00 p.m. to 5.30 p.m. 29 March 2001 from 2.00 p.m. to 5.30 p.m. 30 March 2001 from 2.00 p.m. to 4.45 p.m. Auditorium (Main Building) After the success of the preparation seminars held in recent years, it has been decided that the programme should continue. The forthcoming seminar has been prepared in close collaboration with the CERN Pensioners' Association. The programme will be organised over several half-day sessions. Once again this year, a special session will be devoted to the 10th revision of the Swiss state pension scheme, the 'AVS' (Assurance-Vieillesse et Survivants), and the consequences for international civil servants. A talk will be given by Mrs Danièle Siebold, Director of the Caisse Cantonale Genevoise de Compensation, aimed mainly at those residing in or intending to move to Switzerland, or who worked in Switzerland before joining CERN. To enable Mrs Siebold to respond to your concerns as effectively as possible, please ...
Polivka, Larry; Luo, Baozhen
The origins and trajectory of the crisis in the United States retirement security system have slowly become part of the discussion about the social, political, and economic impacts of population aging. Private sources of retirement security have weakened significantly since 1980 as employers have converted defined benefits precisions to defined contribution plans. The Center for Retirement Research (CRR) now estimates that over half of boomer generation retirees will not receive 70-80% of their wages while working. This erosion of the private retirement security system will likely increase reliance on the public system, mainly Social Security and Medicare. These programs, however, have increasingly become the targets of critics who claim that they are not financially sustainable in their current form and must be significantly modified. This article will focus on an analysis of these trends in the erosion of the United States retirement security system and their connection to changes in the United States political economy as neoliberal, promarket ideology, and policies (low taxes, reduced spending, and deregulation) have become dominant in the private and public sectors. The neoliberal priority on reducing labor costs and achieving maximum shareholder value has created an environment inimical to maintain the traditional system of pension and health care benefits in both the private and public sectors. This article explores the implications of these neoliberal trends in the United States economy for the future of retirement security. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
Carter, Amanda G; Wilkes, Elizabeth; Gamble, Jenny; Sidebotham, Mary; Creedy, Debra K
midwifery continuity of care experiences can provide high quality clinical learning for students but can be challenging to implement. The Rural and Private Midwifery Education Project (RPMEP) is a strategic government funded initiative to (1) grow the midwifery workforce within private midwifery practice and rural midwifery, by (2) better preparing new graduates to work in private midwifery and rural continuity of care models. this study evaluated midwifery students׳ experience of an innovative continuity of care clinical placement model in partnership with private midwifery practice and rural midwifery group practices. a descriptive cohort design was used. All students in the RPMEP were invited to complete an online survey about their experiences of clinical placement within midwifery continuity models of care. Responses were analysed using descriptive statistics. Correlations between total scale scores were examined. Open-ended responses were analysed using content analysis. Internal reliability of the scales was assessed using Cronbach׳s alpha. sixteen out of 17 completed surveys were received (94% response rate). Scales included in the survey demonstrated good internal reliability. The majority of students felt inspired by caseload approaches to care, expressed overall satisfaction with the mentoring received and reported a positive learning environment at their placement site. Some students reported stress related to course expectations and demands in the clinical environment (e.g. skill acquisition and hours required for continuity of care). There were significant correlations between scales on perceptions of caseload care and learning culture (r=.87 pflexible academic programme enabled students to access learning at any time and prioritise continuity of care experiences. Strategies are needed to better support students achieve a satisfactory work-life balance. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
Prado, Bernard Lobato; Gomes, Diogo Bugano Diniz; Usón Júnior, Pedro Luiz Serrano; Taranto, Patricia; França, Monique Sedlmaier; Eiger, Daniel; Mariano, Rodrigo Coutinho; Hui, David; Del Giglio, Auro
Palliative sedation (PS) is an intervention to treat refractory symptoms and to relieve suffering at the end of life. Its prevalence and practice patterns vary widely worldwide. The aim of our study was to evaluate the frequency, clinical indications and outcomes of PS in advanced cancer patients admitted to our tertiary comprehensive cancer center. We retrospectively studied the use of PS in advanced cancer patients who died between March 1st, 2012 and December 31st, 2014. PS was defined as the use of continuous infusion of midazolam or neuroleptics for refractory symptoms in the end of life. This study was approved by the Research Ethics Committee of our institution (project number 2481-15). During the study period, 552 cancer patients died at the institution and 374 met the inclusion criteria for this study. Main reason for exclusion was death in the Intensive Care Unit. Among all included patients, 54.2% (n = 203) received PS. Patients who received PS as compared to those not sedated were younger (67.8 vs. 76.4 years-old, p sedation were dyspnea (55%) and delirium (19.7%) and the most common drugs used were midazolam (52.7%) or midazolam and a neuroleptic (39.4%). Median initial midazolam infusion rate was 0.75 mg/h (interquartile range - IQR - 0.6-1.5) and final rate was 1.5 mg/h (IQR 0.9-3.0). Patient survival (length of hospital stay from admission to death) of those who had PS was more than the double of those who did not (33.6 days vs 16 days, p palliative care team was involved in the care of 12% (n = 25) of sedated patients. PS is a relatively common practice in the end-of-life of cancer patients at our hospital and it is not associated with shortening of hospital stay. Involvement of a dedicated palliative care team is strongly recommended if this procedure is being considered. Further research is needed to identify factors that may affect the frequency and outcomes associated with PS.
Kolls, Brad J; Mace, Brian E; Dombrowski, Keith E
Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program. We implemented an adult cvEEG service at Duke Regional Hospital (DRH), a community hospital affiliate, in June of 2012. Lead placement templates were used in the implementation to reduce the impact on technologists by using other bedside providers for EEG initiation. Utilization of the service, study quality, and patient outcomes were tracked over a 3-year period following initiation of service. Service was implemented at essentially no cost. Utilization varied from a number of factors: intensive care unit (ICU) attending awareness, limited willingness of bedside providers to perform lead placement, and variation in practice of the consulting neurologists. A total of 92 studies were performed on 88 patients in the first 3 years of the program, 24 in year one, 27 in year two, and 38 in year three, showing progressive adoption. Seizures were seen in 25 patients (27%), 19 were in status, of which 18 were successfully treated. Transfers to the main hospital, Duke University Medical Center, were prevented for 53 patients, producing an estimated cost savings of $145,750. The retained patients produced a direct contribution margin of about $75,000, and the margin was just over $100,000 for the entire monitored cohort. ICU cvEEG service is feasible and practical to implement at the community hospital level. Service was initiated at little to no cost and clearly enhanced care, increased breadth of care, increased ICU census, and reduced
Kallestrup-Lamb, Malene; Kock, Anders Bredahl; Kristensen, Johannes Tang
This article uses Danish register data to explain the retirement decision of workers in 1990 and 1998. Many variables might be conjectured to influence this decision such as demographic, socioeconomic, financial, and health related variables as well as all the same factors for the spouse in case ...... that this is the case for core variables such as age, income, wealth, and general health. We also point out the most important differences between these groups and explain why these might be present.......This article uses Danish register data to explain the retirement decision of workers in 1990 and 1998. Many variables might be conjectured to influence this decision such as demographic, socioeconomic, financial, and health related variables as well as all the same factors for the spouse in case...
Kallestrup-Lamb, Malene; Kock, Anders Bredahl; Kristensen, Johannes Tang
This paper uses Danish register data to explain the retirement decision of workers in 1990 and 1998.Many variables might be conjectured to influence this decision such as demographic, socio-economic, financially and health related variables as well as all the same factors for the spouse in case t...... such as age, income, wealth and general health. We also point out themost important differences between these groups and explain why these might be present.......This paper uses Danish register data to explain the retirement decision of workers in 1990 and 1998.Many variables might be conjectured to influence this decision such as demographic, socio-economic, financially and health related variables as well as all the same factors for the spouse in case...
As mentioned briefly in the previous issue (page 28), last year Gus Voss reached the age of 65 and therefore was released from official duties at DESY from the beginning of this year. However, as a senior scientist, he keeps an office at DESY and will continue his work in all the international committees of which he is a member, as well as giving colleagues and friends around the world the benefit of his advice - ''if requested'', as he likes to phrase it. Gus Voss was leader of DESY's Accelerator Division and as such a Laboratory Director for exactly 22 years. He contributed to planning the first electron synchrotron at DESY back in 1958-9. Then he went to CEA (Cambridge, Massachusetts), where he directed with Ken Robinson the famous bypass electron-positron collider project. He is also well known for his important contributions to accelerator technology, like low beta insertion for storage rings, which he made (again with Ken Robinson) in 1966. In January 1973 he returned to DESY, called by Wolfgang Paul, then chairman of the Board of Directors. He arrived in time to commission and inaugurate the DORIS electronpositron storage ring in 1974 and then directed the design and construction of the bigger PETRA ring, which began operation in 1978. Together with Bjorn Wiik he directed construction of the HERA electronproton collider, in operation since 1992. During the last few years he took strong interest in linear colliders, together with Norbert Holtkamp building a 400 MeV test section to develop new linear collider technology. Voss' position at DESY is taken over by Dieter Trines (52) who contributed to the construction and commissioning of PETRA from 1975. Dieter Trines spent two years in the TASSO Group at PETRA and in 1983 joined the HERA effort as head of the Proton Ring Vacuum Group
Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne; Krasnik, Allan; Norredam, Marie
The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.
This paper develops the view that employer-sponsored pension plans are best understood as retirement income insurance for employees and from that perspective addresses a number of questions regarding the reasons for their existence, their design, and their funding and investment policies. The most important of these questions are: - Why do employers provide pension plans for their employees and why is participation usually mandatory? - Why is the defined benefit form of pension plan the domin...
de Jonge, Ank; Stuijt, Rosan; Eijke, Iva; Westerman, Marjan J
Continuity of care during labour is important for women. Women with an intrapartum referral from primary to secondary care look back more negatively on their birh experience compared to those who are not referred. It is not clear which aspects of care contribute to this negative birth experience. This study aimed to explore in-depth the experiences of women who were referred during labour from primary to secondary care with regard to the different aspects of continuity of care. A qualitative interview study was conducted in the Netherlands among women who were in primary care at the onset of labour and were referred to secondary care before the baby was born. Through purposive sampling 27 women were selected. Of these, nine women planned their birth at home, two in an alongside midwifery unit and 16 in hospital. Thematic analysis was used. Continuity of care was a very important issue for women because it contributed to their feeling of safety during labour. Important details were sometimes not handed over between professionals within and between primary and secondary care, in particular about women's personal preferences. In case of referral of care from primary to secondary care, it was important for women that midwives handed over the care in person and stayed until they felt safe with the hospital team. Personal continuity of care, in which case the midwife stayed until the end of labour, was highly appreciated but not always expected.Fear of transportion during or after labour was a reason for women to choose hospital birth but also to opt for home birth. Choice of place of birth emerged as a fluid concept; most women planned their place of birth during pregnancy and were aware that they would spend some time at home and possibly some time in hospital. In case of referral from primary to secondary care during labour, midwives should hand over their care in person and preferrably stay with women throughout labour. Planned place of birth should be regarded as a
Morikane, Keita; Yamada, Miyuki
In Japan, the primary 'baby-boomer' generation, born between 1947 and 1949, is now in its retirement. This has caused a marked shortage of human resources nationwide. Clinical laboratory technologists are no exception, and many clinical laboratories in Japanese healthcare facilities are struggling with management because the number of new graduates, i.e., newly licensed technologists, is mostly fixed and, therefore, their recruitment is becoming more and more competitive. Our laboratory is now facing a wave of mass-retirement associated with our history. In addition, in the early 2000s, there was almost no position for new graduates replacing those retiring because of the change in the social healthcare system as well as our hospital's policy. This resulted in uneven numbers of technologists in generations, and it seemed to be getting worse. Fortunately, five years ago, the direction of social health care was changed and lots of positions became available as a result. We have been trying to recruit new graduates and experienced technologists as well, and were able to hire 18 people. Among them, 8 were non-freshmen. The generation gap has been mostly resolved. We will continue to make our laboratory more attractive not just to new graduates but also to experienced technologists, especially those who wish to return to work after a several-year absence to raise their children. We believe that this will energize our laboratory.
Matthews, Hannah; Schmit, Stephanie
Child care subsidies help make quality child care affordable for low-income parents, allowing them to attend work or school to support their families while ensuring their children's healthy development. The Child Care and Development Block Grant (CCDBG) is the primary source of federal funding for child care subsidies for low-income working…
Denier, Nicole; Clouston, Sean A P; Richards, Marcus; Hofer, Scott M
This study examines the relationship between retirement and cognitive aging. We build on previous research by exploring how different specifications of retirement that reflect diverse pathways out of the labor market, including reason for leaving the pre-retirement job and duration spent in retirement, impact three domains of cognitive functioning. We further assess how early-life factors, including adolescent cognition, and mid-life work experiences, condition these relationships. To do so, we draw on longitudinal data from the Wisconsin Longitudinal Study , a cohort study of Wisconsin high school graduates collected prospectively starting in 1957 until most recently in 2011 when individuals were aged 71. Results indicate that retirement, on average, is associated with improved abstract reasoning, but not with verbal memory or verbal fluency. Yet, when accounting for the reason individuals left their pre-retirement job, those who had retired for health reasons had both lower verbal memory and verbal fluency scores and those who had retired voluntarily or for family reasons had improved abstract memory scores. Together, the results suggest that retirement has an inconsistent effect on cognitive aging across cognitive domains and that the conditions surrounding the retirement decision are important to understanding cognitive functioning at older ages.
Soones, Tacara N; O'Brien, Bridget C; Julian, Katherine A
In order to teach residents how to work in interprofessional teams, educators in graduate medical education are implementing team-based care models in resident continuity clinics. However, little is known about the impact of interprofessional teams on residents' education in the ambulatory setting. To identify factors affecting residents' experience of team-based care within continuity clinics and the impact of these teams on residents' education. This was a qualitative study of focus groups with internal medicine residents. Seventy-seven internal medicine residents at the University of California San Francisco at three continuity clinic sites participated in the study. Qualitative interviews were audiotaped and transcribed. The authors used a general inductive approach with sensitizing concepts in four frames (structural, human resources, political and symbolic) to develop codes and identify themes. Residents believed that team-based care improves continuity and quality of care. Factors in four frames affected their ability to achieve these goals. Structural factors included communication through the electronic medical record, consistent schedules and regular team meetings. Human resources factors included the presence of stable teams and clear roles. Political and symbolic factors negatively impacted team-based care, and included low staffing ratios and a culture of ultimate resident responsibility, respectively. Regardless of the presence of these factors or resident perceptions of their teams, residents did not see the practice of interprofessional team-based care as intrinsically educational. Residents' experiences practicing team-based care are influenced by many principles described in the interprofessional teamwork literature, including understanding team members' roles, good communication and sufficient staffing. However, these attributes are not correlated with residents' perceptions of the educational value of team-based care. Including residents in
Jayita Kedar Deodhar
Full Text Available Context: Training programs for volunteers prior to their working in palliative care are well-established in India. However, few studies report on continuing professional development programs for this group. Aims: To conduct a preliminary assessment of educational needs of volunteers working in palliative care for developing a structured formal continuing professional development program for this group. Settings and Design: Cross-sectional observational study conducted in the Department of Palliative Medicine of a tertiary care cancer institute in India. Materials and Methods: Participant volunteers completed a questionnaire, noting previous training, years of experience, and a comprehensive list of topics for inclusion in this program, rated in order of importance according to them. Statistical Analysis Used: Descriptive statistics for overall data and Chi-square tests for categorical variables for group comparisons were applied using Statistical Package for Social Sciences version 18. Results: Fourteen out of 17 volunteers completed the questionnaire, seven having 5-10-years experience in working in palliative care. A need for continuing professional development program was felt by all participants. Communication skills, more for children and elderly specific issues were given highest priority. Spiritual-existential aspects and self-care were rated lower in importance than psychological, physical, and social aspects in palliative care. More experienced volunteers (>5 years of experience felt the need for self-care as a topic in the program than those with less (<5-years experience ( P < 0.05. Conclusions: Understanding palliative care volunteers′ educational needs is essential for developing a structured formal continuing professional development program and should include self-care as a significant component.
Quality of care in general practice is mainly based on effectiveness of clinical and inter-personal care, and access to care. Assessment has to focus on structures and processes, more than on outcomes. The sets of clinical indicators used in some european countries, though good starting points are still incomplete to encompass the complexity of activity. Assessment of care quality by the public authorities must be acceptable to the doctors who are the object of this assessment; otherwise its conclusions will be rejected. Continuous quality improvement can maintain quality of care at a high level and maintain costs under control. Health has to be managed, and doctors have a collective responsibility towards their patients. The procedures of the quality cycle are applicable in general practice for the development of community-based projects of health promotion, within the network of care. The discipline can find in it a new lease of life and perhaps curb the loss of interest among young doctors.
Hirsch, Irl B
Decreasing glycated hemoglobin (A1C) is the primary goal of current diabetes management due to intervention studies in type 1 and type 2 diabetes associating levels <7.0% (53 mmol/mol) with lower complication risk. Strategic self-monitoring of blood glucose (SMBG) is also recommended to achieve greater time in range, with fewer extremes of hypo- or hyperglycemia. Unlike A1C, SMBG can distinguish among fasting, prandial, and postprandial hyperglycemia; uncover glycemic variability, including potentially dangerous hypoglycemia; and provide feedback to patients about the effects of behavior and medication on glycemic control. However, it has the drawback of capturing only static glucose readings and users are often dependent on time-pressed clinicians to interpret numerous data points. A novel flash continuous glucose monitoring (FCGM) device used for a single 2-week period with a readily interpretable data report know as the ambulatory glucose profile (AGP) has the potential to overcome limitations of conventional technologies, with less cost and greater convenience. This review summarizes the rationale for using intermittent FCGM as a supplement to A1C in primary care, and provides a stepwise approach to interpreting the AGP visual display for efficient individualized therapy.
Xiao, Ning; Zhu, Dan; Xiao, Shuiyuan
Numerous studies have confirmed that brain tumor patients and their family members frequently exhibit negative emotional reactions, such as anxiety and depression, during diagnosis and treatment of the disease. Family members experience increasing pressure as the year of survival of patient progress. The aim of this study was to investigate the effects of the continued psychological care (CPC) toward the brain tumor patients and their family members' emotions. The asynchronous clinical control trial was performed, and 162 brain tumor patients and their family members were divided into the control group and the intervention group. The control group was only performed the telephone follow-up toward the patients. Beside this way, the intervention group was performed the CPC toward the patients and their family member. The self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were used to measure the negative emotions of the patients and their family members, and the patients' treatment compliance and the incidence of seizures were compared. The SAS and SDS scores of the intervention group on the 14 days, 28 days and 3 months of the CPC were significantly lower than the control group (P family members.
Arntson, P H; Philipsborn, H F
This study investigated pediatrician-parent communication by content, analyzing medical encounters in a setting providing continuity of care. Thirty-eight encounters between middle class families and three senior pediatricians were audio-taped, transcribed, and analyzed for content. The categories of medical communication coded from the interactions were related to each family's medical and demographic characteristics. Five patterns of results emerged: (1) There was a highly stylizied active-passive role relationship, with doctors asking twice as many questions and making twice as many commands as the parent did. (2) A strong reciprocity norm existed between pediatricians and parents for the communication of affect. (3) The higher the experience, income, and educational levels of the parents, the shorter the encounters were, the less frequently symptoms were discussed, and the more frequently medication and professional treatment were mentioned. (4) Parents discussed health more in terms of organicity of causes than did pediatricians who, more frequently, raised environmental factors. (5) The more the family had a history of past illnesses, the more frequently the doctors made affect comments during the encounters. Comparing the results to findings drawn from an emergency clinic documented the importance of sustained relationships between practitioners and patients.
Larson, Charles P; Saha, Unnati Rani; Islam, Rafiqul; Roy, Nikhil
Monitoring for disparities in health and services received based upon gender, income, and geography should continue as renewed efforts to reduce under-five mortality are made in response to millennium development goal #4. The purpose of this survey was to provide a nationally representative description of current childhood diarrhoea management practices and disparities in Bangladesh. A nationally representative, cross-sectional, cluster-sample survey was carried out in randomly selected rural and urban populations across Bangladesh. The survey was completed over an 8 month period between November 2003 and June 2004. A total of 7308 children with a prevalent diarrhoeal illness episode within 560 clusters were identified and enrolled in the survey. In 61% of the cases help was sought from a health care provider, with over 90% practicing in the private sector. Caretaker practice disparities favouring males and higher income households were identified. Significant trends (P gender disparities were limited to females being less likely to receive an antibiotic, adj OR 0.74 (95% CI 0.65, 0.86). Households seeking help from a health provider overwhelmingly utilize the private sector in Bangladesh. Gender inequities in the utilization of licensed providers and purchase of antibiotics, favouring males were identified. Findings suggest that higher income, urban households tend to practice greater gender discrimination. In order to better understand health dynamics in urban populations, in particular slum-dwellers, there is a need to disaggregate survey data by household location.
Wolpert Barraza, Enrique
In Mexico there is no legislation as to when a physician should retire from active practice as it is the case in other countries. The Mexican Social Security for instance, in its global working contract between the authorities and the employees, for the period 2009-2011 clearly stated that after 30 years of service for men and 27 for women the employee may retire but the physician can still work in another institution or in private practice for as long as he or she wants. In this article, the experience of distinguished Mexican surgeons who had written in the past in relation to this topic is acknowledged. A brief description of the retirement of physicians in Spain where the National Health System retire physicians from practice at age 65 and in some cases at age 70 is discussed. The author analyzes what happens in other activities of human mankind such as in the arts, painting, architecture, music, physics and philosophy, where there are plenty of outstanding examples of men and women doing their best work well over the age of 65. The names of some distinguished Mexican physicians past presidents of the Academy of Medicine are mentioned, all of them legends in the field of medicine who worked or continue to work many, many years after the age of 65. The author recognizes the process of accreditation and certification of medical specialists in Mexico that is carried out by the 47 specialty councils that have the recognition of the National Committee for Medical Specialties: CONACEM. Finally he offers his personal thoughts about what a physician may do when he or she is thinking of retiring and urges them not to throw away their personal experiences of many years in medical practice but instead to utilize the social networks such as Twitter or Facebook in order to continue to provide their expertise to young physicians who may benefit greatly.
Sibthorpe, Beverly; Agostino, Jason; Coates, Harvey; Weeks, Sharon; Lehmann, Deborah; Wood, Marianne; Lannigan, Francis; McAullay, Daniel
Otitis media is a common, generally self-limiting childhood illness that can progress to severe disease and have lifelong sequelae, including hearing loss and developmental delays. Severe disease is disproportionately prevalent among Aboriginal and Torres Strait Islander children. Primary health care is at the frontline of appropriate prevention and treatment. Continuous quality improvement in the prevention and management of important causes of morbidity in client populations is accepted best practice in primary health care and now a requirement of Australian Government funding to services providing care for Aboriginal and Torres Strait Islander children. To date, there have been no indicators for continuous quality improvement in the prevention and management of otitis media and its sequelae in primary health care. Through an expert group consensus process, seven evidence-based indicators, potentially extractable from electronic health records, have been developed. The development process and indicators are described.
Szinovacz, Maximiliane E; Davey, Adam; Martin, Lauren
The recent recession constitutes one of the macro forces that may have influenced workers' retirement plans. We evaluate a multilevel model that addresses the influence of macro-, meso-, and micro-level factors on retirement plans, changes in these plans, and expected retirement age. Using data from Waves 8 and 9 of the Health and Retirement Study (N=2,618), we find that individuals with defined benefit plans are more prone to change toward plans to stop work before the stock market declined, whereas the opposite trend holds for those without pensions. Debts, ability to reduce work hours, and firm unionization also influenced retirement plans. Findings suggest retirement planning education may be particularly important for workers without defined pensions, especially in times of economic volatility. © The Author(s) 2014.
Gad, Kamille Sofie Tågholt; Nielsen, Jeppe Woetmann
Uncertain time of retirement and uncertain structure of retirement benefits are risk factors for life insurance companies. Nevertheless, classical life insurance models assume these are deterministic. In this paper, we include the risk from stochastic time of retirement and stochastic benefit...... structure in a classical finite-state Markov model for a life insurance contract. We include discontinuities in the distribution of the retirement time. First, we derive formulas for appropriate scaling of the benefits according to the time of retirement and discuss the link between the scaling...... and the guarantees provided. Stochastic retirement creates a need to rethink the construction of disability products for high ages and ways to handle this are discussed. We show how to calculate market reserves and how to use modified transition probabilities to calculate expected cash flows without significantly...
experience unique stresses associated with parental deployments and frequent relocations that can adversely affect academic performance. A military...publicpolicy.wharton.upenn.edu/live/news/317-an-affordable-and-equitable-retirement-system-for. See also David B. Newman , Mitigating the Inequity of...insurance plans in the style of FEHBP would greatly expand choice in health care and consequently provide beneficiaries demonstrated value, as
Johnson, Debra J; Shenaq, Deana; Thakor, Manisha
Financial planning is critically important to ensure financial security both during a plastic surgical career and in retirement. Unfortunately, plastic surgery training includes very little in the way of financial planning. The information that is available in the literature is mostly geared toward men. Women, with longer lifespans and more family care responsibilities, have unique needs when it comes to financial planning. Adequate attention must also be paid to life after retirement. A plastic surgical career can be all-encompassing, and thus women need to carefully plan volunteer activities, new hobbies, and even a second career to make their retirement years fulfilling and enjoyable. Key points regarding financial planning during the various phases of a woman plastic surgeon's career are discussed. Options for retirement are presented.
Raymo, James M.; Sweeney, Megan M
Objectives: This study investigates relationships between perceived levels of work-family conflict and retirement preferences. Methods: Using the large sample of 52-54 year-old respondents to the 1992 Wisconsin Longitudinal Study, we estimate multinomial logistic regression models of preferences for partial and full retirement within the next ten years. We examine the association between preferences for retirement and perceived work-family conflict...
In practice, online health communities have passed the adoption stage and reached the diffusion phase of development. In this phase, patients equipped with knowledge regarding the issues involved in health care are capable of switching between different communities to maximize their online health community activities. Online health communities employ doctors to answer patient questions, and high quality online health communities are more likely to be acknowledged by patients. Therefore, the factors that motivate patients to maintain ongoing relationships with online health communities must be addressed. However, this has received limited scholarly attention. The purpose of this study was to identify the factors that drive patients to continue their use of online health communities where doctor-patient communication occurs. This was achieved by integrating the information system success model with online health community features. A Web spider was used to download and extract data from one of the most authoritative Chinese online health communities in which communication occurs between doctors and patients. The time span analyzed in this study was from January 2017 to March 2017. A sample of 469 valid anonymous patients with 9667 posts was obtained (the equivalent of 469 respondents in survey research). A combination of Web mining and structural equation modeling was then conducted to test the research hypotheses. The results show that the research framework for integrating the information system success model and online health community features contributes to our understanding of the factors that drive patients' relationships with online health communities. The primary findings are as follows: (1) perceived usefulness is found to be significantly determined by three exogenous variables (ie, social support, information quality, and service quality; R 2 =0.88). These variables explain 87.6% of the variance in perceived usefulness of online health communities; (2
Lin, Li-Jung; Yen, Hsin-Yen
The rising population of older adults is transforming Taiwan society. Although many long-term care facilities now operate for older adults, the transition from the home environment to long-term facilities may cause multiple issues, including relocation stress syndrome, for new residents. Autonomy is a critical element of the human experience. Leisure, as an expression of autonomy, has been shown to enhance self-image and promote feelings of competence and mastery. The aim of this study was to assess the relationship between participation in leisure activities and adjustment to residential care using the continuity theory. One hundred sixty-three qualified individuals from 11 long-term care institutions were recruited and completed the questionnaire. The sampling criteria for the study were age (55+ years), appropriate cognitive skills, and residency (less than 5 years). Interviews conducted by trained interviewers were used to collect data. Measured outcomes included leisure participation; physical, psychological, and social adjustments; and background information. Cluster analysis, descriptive analysis, multivariate analysis of variance, and least significant difference test were used in analysis. Type of admission (voluntary/mandated) and type of leisure participation significantly affected the level of relocation adjustment success. Four leisure behavior categories were identified, including reduced participation, expanded participation, active participation, and continuing participation. The participants in the active and continuing participation categories had significantly higher psychological adjustment than their peers in the reduced participation category. Moreover, the continuing participation category had a significantly better level of social adjustment than their expanded participation category peers. Continuous and active participation categories had a beneficial outcome in relocation adjustment. The findings support that, in general, residents of
The most significant change to private sector as well as civil service employee retirement systems over the past 15 years has been the transition from defined benefit to defined contribution retirement plans...
Discusses growth of North America's 40 largest for- profit child care centers. Identifies current threats, including staffing shortage and increasing competition from public schools and among chains. Identifies current opportunities to include employer and franchise child care, upscale child care, elementary school services, and flexible hours.…
Eva H. DuGoff
Full Text Available Follow us on Twitter Co-Editors-in-Chief Martin Fortin Jane Gunn Stewart W. Mercer Susan Smith Marjan van den Akker Society for Academic Primary Care Journal Help USER You are logged in as... avalster My Profile Log Out JOURNAL CONTENT Search Search Scope Search Browse By Issue By Author By Title By Sections By Identify Types OPEN JOURNAL SYSTEMS FONT SIZE Make font size smallerMake font size defaultMake font size larger INFORMATION For Readers For Authors For Librarians ARTICLE TOOLS Print this article Indexing metadata How to cite item Supplementary files Finding References Email this article Email the author Post a Comment NOTIFICATIONS View (378 new Manage IRCMO NEWS ‘Addressing the global challenge of... Publications on multimorbidity... The CARE Plus study Prevalence of multimorbidity in the... Multimorbidity in adults from a... CURRENT ISSUE Atom logo RSS2 logo RSS1 logo HOSTED BY Part of the PKP Publishing Services Network HOME ABOUT USER HOME SEARCH CURRENT ARCHIVES ANNOUNCEMENTS PUBLISHER AUTHOR GUIDELINES SUBMISSIONS WHY PUBLISH WITH US? Home > Vol 6, No 2 (2016 >\tDuGoff Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes Eva H. DuGoff, Karen Bandeen-Roche, Gerard F. Anderson Abstract Background: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed. Objective: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. Design: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. Multivariate regression models were used to examine the association of baseline continuity (the first 6 months and the composite outcome of any emergency room use or inpatient
Raymo, James M; Sweeney, Megan M
This study investigates relationships between retirement preferences and perceived levels of work-family conflict. Using the large sample of 52-54-year-old respondents to the 1992 Wisconsin Longitudinal Study, we estimated multinomial logistic regression models of preferences for partial and full retirement within the next 10 years. We examined the association between retirement preferences and perceived work-family conflict, evaluated the extent to which work-family conflict was a mediating mechanism between stressful work and family circumstances and preferences to retire, and explored potential gender differences in the association between work-family conflict and preferring retirement. Work-family conflict was positively related to preferences for both full and partial retirement. Yet work-family conflict did not appear to mediate relationships between stressful work and family environments and retirement preferences, nor did significant gender differences emerge in this association. Our analyses provide the first direct evidence of the role played by work-family conflict in the early stages of the retirement process, although we were not able to identify the sources of conflict underlying this relationship. Identifying the sources of this conflict and the psychological mechanisms linking work-family conflict to retirement preferences is an important task for future researchers.
... 29 Labor 4 2010-07-01 2010-07-01 false Calculating the amount of qualified retirement benefits for... Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION RECORDS TO BE... age of forced retirement. An employee's accumulated contributions are the sum of all contributions...
BACKGROUND: The desire of patients for personal continuity of care with a General Practitioner (GP) has been well documented, but not within non-registered private patients in Ireland. This study set out to examine the attitudes and reported behaviours of private fee-paying patients towards continuity of GP care and universal registration for patients. METHODS: Cross-sectional telephone survey of 400 randomly chosen fee-paying patients living within County Dublin. There is no formal system of registration with a GP for these patients. Main outcomes were attendance of respondents at primary health care facilities and their attitudes towards continuity of care and registration with a GP. Data was analysed using descriptive statistics and using parametric and non-parametric tests of association. Pearson correlation was used to quantify the association between the described variables and attitudes towards continuity and registration with a GP. Variables showing significance at the 5% level were entered into multiple linear regression models. RESULTS: 97% of respondents had seen a GP in the previous 5 years. The mean number of visits to the GP for respondents was 2.3 per annum. 89% of respondents had a regular GP and the mean length of time with their GP was 15.6 years. 96% preferred their personal medical care to be provided within one general practice. 16% of respondents had consulted a GP outside of their own practice in the previous year. They were more likely to be female, commute a longer distance to work or have poorer health status. 81% considered it important to be officially registered with a GP practice of their choice. CONCLUSION: Both personal and longitudinal continuity of care with a GP are important to private patients. Respondents who chose to visit GPs other than their regular GP were not easily characterised in this study and individual circumstances may lead to this behaviour. There is strong support for a system of universal patient registration
Chen, Chien-Yi; Chou, An-Kuo; Chen, Yu-Lien; Chou, Hung-Chieh; Tsao, Po-Nien; Hsieh, Wu-Shiun
Nasal continuous positive airway pressure (NCPAP) therapy is widely used in neonates, but the clinical practice varies. However, nursing practice differs among individuals, and an inappropriate application method may delay the respiratory therapy, influence the beneficial effect of NCPAP, and increase complications. We introduced a quality improvement project to expedite the application of NCPAP therapy and decrease the incidence of nasal trauma. A new strategy of mobile NCPAP cart with prepacked fixation kits and a written protocol was implemented from April 2006. All medical staff answered a questionnaire to assess their basic knowledge before and after intensive training. The records of the patients who were treated with NCPAP from October 2005 to November 2006 were reviewed. Fifty-nine medical staff were involved in the project, and their mean score for the questionnaire improved from 69.2 points to 98.3 points after training. From October 2005 to November 2006, 113 infants were recruited in total and 82 of them were admitted after the protocol was implemented. The NCPAP cart dramatically shortened the preparation time (from 520 seconds to 72 seconds) and the application time (from 468 seconds to 200 seconds). The use of the nursing protocol significantly decreased the incidence of nasal trauma in the study population (45.2% vs. 19.6%, p = 0.006), but not in infants with a birth weight of < 1000 g. Risk factors for nasal skin trauma included lower gestational age and birth weight, longer duration of NCPAP use, and lack of standardized nursing care. The mobile NCPAP cart with prepacked fixation kits is a practical way of expediting the initiation of NCPAP therapy. The written nursing protocol decreased the incidence of nasal trauma in infants, except for those with an extremely low birth weight. Copyright © 2016. Published by Elsevier B.V.
Gommans, Fleur G; Jansen, Nicole W H; Mackey, Martin G; Stynen, Dave; de Grip, Andries; Kant, I Jmert
Prospectively investigating whether different approaches of physical work demands are associated with need for recovery (NFR), employment status, retirement intentions, and ability to prolong working life among older employees from the industry and health care sector. A subsample from the Maastricht Cohort Study was studied (n = 1126). Poisson, Cox, and logistic regression analyses were performed to investigate outcomes. Perceiving physical work demands as strenuous was associated with higher NFR. Continuous physical strain was associated with being out of employment 4 years later. Employees with the highest amount of physical work demands perceived they were less able to prolong working life, although no significant associations between physical work demands and retirement intentions were found. Overall, physical work demands were associated with adverse outcomes, with divergent insights for the different approaches of physical work demands.
Lee, Ying-Li; Cui, Yan-Yan; Tu, Ming-Hsiang; Chen, Yu-Chi; Chang, Polun
Chronic kidney disease (CKD) is a global health problem with a high economic burden, which is particularly prevalent in Taiwan. Mobile health apps have been widely used to maintain continuity of patient care for various chronic diseases. To slow the progression of CKD, continuity of care is vital for patients' self-management and cooperation with health care professionals. However, the literature provides a limited understanding of the use of mobile health apps to maintain continuity of patient-centered care for CKD. This study identified apps related to the continuity of patient-centered care for CKD on the App Store, Google Play, and 360 Mobile Assistant, and explored the information and frequency of changes in these apps available to the public on different platforms. App functionalities, like patient self-management and patient management support for health care professionals, were also examined. We used the CKD-related keywords "kidney," "renal," "nephro," "chronic kidney disease," "CKD," and "kidney disease" in traditional Chinese, simplified Chinese, and English to search 3 app platforms: App Store, Google Play, and 360 Mobile Assistant. A total of 2 reviewers reached consensus on coding guidelines and coded the contents and functionalities of the apps through content analysis. After coding, Microsoft Office Excel 2016 was used to calculate Cohen kappa coefficients and analyze the contents and functionalities of the apps. A total of 177 apps related to patient-centered care for CKD in any language were included. On the basis of their functionality and content, 67 apps were recommended for patients. Among them, the most common functionalities were CKD information and CKD self-management (38/67, 57%), e-consultation (17/67, 25%), CKD nutrition education (16/67, 24%), and estimated glomerular filtration rate (eGFR) calculators (13/67, 19%). In addition, 67 apps were recommended for health care professionals. The most common functionalities of these apps were
Stephan, Yannick; Fouquereau, Evelyne; Fernandez, Anne
Little is known about the motivational forces leading retired individuals to engage in post-retirement activities and how they could be related to satisfaction with retirement. Using the self-determination framework, the purpose of the present exploratory study was to examine the nature of active retirees' motivation and its impact on satisfaction with life in retirement. The Global Motivation Scale and measures of satisfaction with retirement were administered to 150 active retired individuals engaged in organized post-retirement activities in a University-based organization. Results revealed that these individuals were mainly characterized by higher levels of intrinsic motivation for knowledge, stimulation and accomplishment, rather than extrinsic dimensions. Regression analysis further demonstrated that intrinsic motivation for both accomplishment and stimulation were positively related to satisfaction with retirement, over and above the significant contribution of time since retirement, anticipated satisfaction with retirement, and subjective health. This exploratory study highlights the motivational mechanisms through which post-retirement behaviors could positively influence satisfaction with life in retirement among active retirees.
The 500 or so participants in the fifth Preparation for Retirement seminar held at the end of March were unfortunately deprived of the planned session on the AVS due to the unavailability of the Director of the Caisse Cantonale Genevoise de Compensation (CCGC). We have since had formal confirmation that because of an extra workload due to important changes in the Swiss tax and social legislation and the implementation this summer of the maternity insurance in Geneva, the CCGC has suspended its participation in preparation for retirement seminars in the international organisations for the time being. Conscious of the necessity of offering a session dedicated to the AVS, it is with pleasure that we can inform you that one of our legal advisers, Mr Lorenz Stampfli, has accepted to lead this session. In order to allow for adequate preparation we have reserved the following date: Wednesday 26 September from 14.00 to 16.00 in the Main Amphitheatre The session will be open to all people already registered and any o...
Drachsler, Hendrik; Kicken, Wendy; Van der Klink, Marcel; Stoyanov, Slavi; Boshuizen, Els
Drachsler, H., Kicken, W., Van der Klink, M., Stoyanov, S., & Boshuizen, H. P. A. (2011, 21 March). The Handover project: Improving the continuity of patient care through identification and implementation of novel patient handoff processes in Europe. Presentation at Learning Networks meeting,
Sytema, S; Burgess, P
Objective: We compared service consumption, continuity of care and risk of readmission in a record linkage follow-up study of cohorts of patients with schizophrenia and related disorders in Victoria (Australia) and in Groningen (The Netherlands). These areas are interesting to compare because mental
Robertson, Duncan; And Others
Utilizing flexible community-supporting services integrated with a hospital-based program of planned intermittent relief of the patients' supporters, patients (N=50) were maintained in the community at an average cost of 79.5 hospital bed days per patient per annum. The Continuing Care Program is an alternative to institutionalization. (Author)
Tjin A Tsoi, Sharon L N M; de Boer, Anthonius; Croiset, Gerda; Koster, Andries S; Kusurkar, Rashmi A
INTRODUCTION: Continuing education (CE) can support health care professionals in maintaining and developing their knowledge and competencies. Although lack of motivation is one of the most important barriers of pharmacists' participation in CE, we know little about the quality or the quantity of
María Concepción ARROYO RUEDA
Full Text Available This paper intends to show from a comparative perspective of social policy, the provision of care in old age in Argentina and Mexico. It will also show the experience of the national policy of care in Argentina. In this country we carried out interviews with coordinators, operational personnel and users of the national program of care. The participants identify in the policy a vision of rights and social inclusion of the elderly and effective support for family caregivers. Meanwhile, in the case of Mexico, we observe scarce and ambiguous legislation on the subject, which is predominated by the practice of informal care to older people, given mainly by the women in the families. Basic care is outside the aging policy and confined within the «familist model» according to an exalted social assessment of the moral obligation of family care.
Arroyo Rueda, María Concepción
This paper intends to show from a comparative perspective of social policy, the provision of care in old age in Argentina and Mexico. It will also show the experience of the national policy of care in Argentina. In this country we carried out interviews with coordinators, operational personnel and users of the national program of care. The participants identify in the policy a vision of rights and social inclusion of the elderly and effective support for family caregivers. Meanwhile, in the c...
Hoover, Karen W; Parsell, Bradley W; Leichliter, Jami S; Habel, Melissa A; Tao, Guoyu; Pearson, William S; Gift, Thomas L
We assessed the characteristics of sexually transmitted disease (STD) clinic patients, their reasons for seeking health services in STD clinics, and their access to health care in other venues. In 2013, we surveyed persons who used publicly funded STD clinics in 21 US cities with the highest STD morbidity. Of the 4364 STD clinic patients we surveyed, 58.5% were younger than 30 years, 72.5% were non-White, and 49.9% were uninsured. They visited the clinic for STD symptoms (18.9%), STD screening (33.8%), and HIV testing (13.6%). Patients chose STD clinics because of walk-in, same-day appointments (49.5%), low cost (23.9%), and expert care (8.3%). Among STD clinic patients, 60.4% had access to another type of venue for sick care, and 58.5% had access to another type of venue for preventive care. Most insured patients (51.6%) were willing to use insurance to pay for care at the STD clinic. Despite access to other health care settings, patients chose STD clinics for sexual health care because of convenient, low-cost, and expert care. Policy Implication. STD clinics play an important role in STD prevention by offering walk-in care to uninsured patients.
McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla
Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271
Full Text Available Continuous quality improvement (CQI processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.
McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla
Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.
An inevitable reality that all athletes have to face is retirement from competition and this experience can lead an acute sense of loss in the athlete. Professional soccer players are no exception. While retirement traditionally occurs for most non-athletes after a long working career that allows them to plan and anticipate the ...
Prast, Henriette; van Soest, Arthur
To meet the challenges of an ageing population, eligibility ages for state pensions have increased, early retirement arrangements have been abolished, and a substantial part of the risk and responsibility for an adequate standard of living after retirement has been shifted from the government,
Morahan, John; Turner, Aaron
Currently, higher education is being roiled by class-action lawsuits filed against high-profile institutions, including MIT, Yale and New York University, over management of their retirement plans. As the lawyers are deployed and the billable hours accrue, it is timely to examine how those who have responsibility for retirement plan…
Dorfman, Lorraine; Kolarik, Douglas
Little attention has been given to the leisure activities of retired professors, whose activity patterns in retirement may be different from those of other occupational groups because of their lifetime commitment to work. This interview study uses both quantitative and qualitative data to investigate: (a) the leisure and professional activities of…
Brougham, Ruby R.; Walsh, David A.
The current study explored the contribution of personal goals to retirement decisions. A SMARTER methodology (to assess multiattribute utility) and taxonomy of human goals were used to investigate the relationship between older workers' personal goals and their retirement intentions. Two hundred and fifty-one employees of a large university,…
Abolhassani, Marzieh; Alessie, Rob
This paper studies the effect of both retirement and unemployment on life satisfaction, using subjective satisfaction indicators from the German Socio-Economic Panel. Moreover, we analyze how accurate individuals anticipate changes in satisfaction around retirement, as well as the correlation
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Retirement benefits. 20.4 Section 20.4 Foreign Relations DEPARTMENT OF STATE PERSONNEL BENEFITS FOR CERTAIN FORMER SPOUSES § 20.4 Retirement benefits. (a) Type of benefits. (1) A former spouse who meets the qualification requirements of § 20.3 is entitled to...
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Retirement benefits. 633.306 Section 633.306 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR MIGRANT AND SEASONAL FARMWORKER PROGRAMS Program Design and Administrative Procedures § 633.306 Retirement benefits. No funds...
Zuehlsdorff, Harry W.; Baldwin, Cynthia
Preparing for retirement can sometimes be problematic since it means that one is aging and moving into another life cycle change. This paper will review some factors to consider in making the transition a more positive experience. The impact of retirement on older citizens is frequently neglected in the counseling arena. In the current youth…
GURAN (TEODORESCU ILEANA
Full Text Available In the context of the population aging and the demographic crisis throughout Europe and the developed world, the public pension systems will become increasingly strained as the proportion of pensioners to the working population will continue to increase. Empirical evidence shows that individuals fail to save enough for retirement to compensate for the less than optimal level of public pensions, and thus are facing the risk of a decrease in the standard of living in their post-retirement years. This larger context makes the study of retirement saving behavior an important matter. The objective of this paper is to document current trends in retirement saving behavior from the data collected through an online survey of Romanian households. The survey was distributed as an online questionnaire that collected 1285 of responses. The survey’s objective was to document households’ financial situation, as well as other psychological and social factors that might explain saving behavior. The analysis of the survey results indicates that there is a gap between intentions and actions when it comes to retirement saving. This gap and the resulting suboptimal retirement saving rates are explained in behavioral economics literature by anomalies in the inter-temporal choices of individuals, subject to self-control issues. We will see to what extent this gap is due to self-control issues and to what extent it is explained by the current financial situation of individuals. We will also conclude about possible retirement saving behavior influencing factors and motives.
Schnee, Edward J.; And Others
Greater attention has been focused on the role that employer-sponsored retirement plans and individual savings must play in ensuring retirement income security. Alternative tax retirement planning opportunities currently available to college personnel are explored. (MLW)
Shore, Cheryl P; Buelow, Janice M; Austin, Joan K; Johnson, Cynthia S
Children with new-onset epilepsy and their parents have many psychosocial care needs, including concerns and fears and needs for information and support. No prospective studies address psychosocial care needs at 12 and 24 months after seizure onset. It is unknown if psychosocial care needs are associated with children's attitudes toward having epilepsy or with parental responses to their child's epilepsy. Our study addresses this knowledge gap. Members of 143 families took part in the study. Children were 8 to 14 years old and had at least two seizures. Parents and children completed Psychosocial Care Need Scales at 3, 6, 12, and 24 months after the first seizure. Children also completed the Child Attitude Toward Illness Scale, and parents completed the Parent Response to Child Illness scale. Data were analyzed using descriptive statistics and correlations. Although psychosocial care needs were highest at the 3-month data collection for both parents and children, some worries and concerns and needs for information and support persisted for 24 months. In children, more psychosocial care needs were associated with more negative attitudes toward having epilepsy. In parents, high psychosocial care needs were associated with a more negative impact on family life. A substantial number of parents and children have unmet psychosocial care needs that are associated with more negative child attitudes and a negative impact on family life, even 24 months after the onset of seizures. Nurses should assess both children and parents for these needs at every encounter with the healthcare system to address their needs.
States (OCONUS) temporary duty assignment (TDY) using a relational model of care delivery to complete a course of treatment that the patient sought...process, minimizing disruptions in psychotherapeutic interventions, working collaboratively between remote and local sites for comprehensive care, and...finalize procurement strategy 11 January 2017 D. Phase 1 of the research support services contract solicitation was posted on the Federal Business
Schildmann, Eva; Pörnbacher, Sebastian; Kalies, Helen; Bausewein, Claudia
Sedatives are frequently used towards the end of life. However, there is scarce information when their use is labelled as 'palliative sedation'. To assess the use and labelling of 'continuous administration of sedatives within the last 7 days of life', based on objective operational criteria, on a palliative care unit. Retrospective cohort study, using medical records. Explorative statistical analysis (SPSS 23). Patients who died on a palliative care unit from August 2014 to July 2015. Sedatives recorded were benzodiazepines, levomepromazine, haloperidol ⩾5 mg/day and propofol. Of the 192 patients, 149 (78%) patients received continuous sedatives within the last week of life. The prevalence of delirium/agitation was significantly higher in patients with continuous sedatives compared to those without continuous sedatives at admission to the unit (35% vs 16%, p = 0.02) and on the day before death (58% vs 40%, p = 0.04). The term '(palliative) sedation' was used in the records for 22 of 149 (15%) patients with continuous sedatives. These patients had significantly higher total daily midazolam doses 2 days before death (median (range), 15.0 (6.0-185.0) mg vs 11.5 (1.0-70.0) mg, p = 0.04) and on the day of death (median (range), 19.5 (7.5-240.0) mg vs 12.5 (2.0-65.0) mg, p = 0.01). The dose range was large in both groups. The prevalence of delirium/agitation was associated with the administration of continuous sedatives. There was no consistent pattern regarding labelling the use of continuous sedatives as '(palliative) sedation'. Multicentre mixed-methods research is needed for a better characterization of sedation practices in palliative care.
Siren, Anu; Haustein, Sonja
Baby boomers will comprise a considerable share of tomorrow's older population. Previous research has indicated higher travel activity and car use amongst baby boomers than amongst older cohorts. However, little evidence exists on the effects of boomers' ageing on the transportation system....... To analyse how retirement affects baby boomers' travel and the related future travel demand, we compared three groups, distinguished by employment status as ‘still working’, ‘early retirees’ and ‘recent retirees’, in a longitudinal setting. Data for 864 individuals were collected via standardised telephone...... working had a high car reliance that did not decline over time. This study suggests that retirement is a transition point associated with decreasing car use. Hence, the ageing of the population is likely to have a decreasing effect on transportation demand. However, informal care-giving, prolonged careers...
Full Text Available Coronary artery disease (CAD is a leading cause of disease burden worldwide. Referral to cardiac rehabilitation (CR is a class I recommendation for all patients with CAD based on findings that participation can reduce cardiovascular and all-cause mortality, as well as improve functional capacity and quality of life. However, programme uptake remains low, systematic progression through the traditional CR phases is often lacking, and communication between health care providers is frequently suboptimal, resulting in fragmented care. Only 30% to 50% of eligible patients are typically referred to outpatient CR and fewer still complete the programme. In contemporary models of CR, patients are no longer treated by a single practitioner, but rather by an array of health professionals, across multiples specialities and health care settings. The risk of fragmented care in CR may be great, and a concerted approach is required to achieve continuity and optimise patient outcomes. ‘Continuity of care’ has been described as the delivery of services in a coherent, logical, and timely fashion and which entails 3 specific domains: informational, management, and relational continuity. This is examined in the context of CR.
.... It reviews the structure of Individual Retirement Accounts and the Employee Retirement Income Security Act, which governs private-sector retirement plans and their treatment by the Internal Revenue Code...
Full Text Available The article deals with the issue of retirement in contemporary Polish society. The analysis is based on a qualitative research project conducted with people who had formally retired within the previous five years. The process of retiring is one of the most important turning points in the life course. The aim is to look more carefully at the experience of the initial years of retirement and the process of adjustment to a new social status. The article seeks to answer questions regarding how new pensioners comprehend and function in the current social and institutional settings, in particular how they perceive the process of changes and rebuild their relations with the younger generations.
... Privilege Card”; (iii) A front and back copy of a DD Form 1173, “Uniformed Services Identification and...). 199.20 Section 199.20 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED SERVICES (CHAMPUS...
Dill, Donna M; Keefe, Janice M; McGrath, Daniel S
This article examines the influence that intrinsic and extrinsic job values have on the turnover intention of continuing care assistants (CCAs) who work either in home care or facility-based care in Nova Scotia (n = 188). Factor analysis of job values identified three latent job values structures: "compensation and commitment," "flexibility and opportunity," and "positive work relationships." Using binary logistic regression, we examined the predictive utility of these factors on two indices of turnover intention. Regression results indicate that, in general, job values constructs did not significantly predict turnover intention when controlling for demographics and job characteristics. However, a trend was found for the "positive work relationships" factor in predicting consideration of changing employers. In addition, CCAs who work in facility-based care were significantly more likely to have considered leaving their current employer. With projected increases in the demand for these workers in both home and continuing care, more attention is needed to identify and address factors to reduce turnover intention.
Larkins, Sarah; Woods, Cindy E; Matthews, Veronica; Thompson, Sandra C; Schierhout, Gill; Mitropoulos, Maxwell; Patrao, Tania; Panzera, Annette; Bailie, Ross Stewart
Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining quality improvement initiatives. The aim of this study is to examine trends in quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time and examine health service characteristics associated with positive and negative trends in quality of care. PHC services providing care for Indigenous people in urban, rural, and remote northern Australia that had completed at least three annual audits of service delivery for at least one aspect of care (n = 73). Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analyzed. Health center performance was classified into six patterns of change over time: consistent high improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in quality of care. Trends in quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model, or accreditation status with positive or negative trends in quality of care. The variable trends in quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the
Rose Mari Olsen
Full Text Available Introduction: The successful transfer of an older patient between health care organizations requires open communication between them that details relevant and necessary information about the patient's health status and individual needs. The objective of this study was to identify and describe the process and content of the patient information exchange between nurses in home care and hospital during hospitalization of older home-living patients.Methods: A multiple case study design was used. Using observations, qualitative interviews and document reviews, the total patient information exchange during each patient's episode of hospitalization (n = 9, from day of admission to return home, was captured.Results: Information exchange mainly occurred at discharge, including a discharge note sent from hospital to home care, and telephone reports from hospital nurse to home care nurse, and meetings between hospital nurse and patient coordinator from the municipal purchaser unit. No information was provided from the home care nurses to the hospital nurses at admission. Incompleteness in the content of both written and verbal information was found. Information regarding physical care was more frequently reported than other caring dimensions. Descriptions of the patients’ subjective experiences were almost absent and occurred only in the verbal communication.Conclusions: The gap in the information flow, as well as incompleteness in the content of written and verbal information exchanged, constitutes a challenge to the continuity of care for hospitalized home-living patients. In order to ensure appropriate nursing follow-up care, we emphasize the need for nurses to improve the information flow, as well as to use a more comprehensive approach to older patients, and that this must be reflected in the verbal and written information exchange.
Boyle, Martin; Baldwin, Ian
Delivery of renal replacement therapy is now a core competency of intensive care nursing. The safe and effective delivery of this form of therapy is a quality issue for intensive care, requiring an understanding of the principles underlying therapy and the functioning of machines used. Continuous hemofiltration, first described in 1977, used a system where blood flowed from arterial to venous cannulas through a small-volume, low-resistance, and high-flux filter. Monitoring of these early systems was limited, and without a machine interface, less nursing expertise was required. Current continuous renal replacement therapy machines offer user-friendly interfaces, cassette-style circuits, and comprehensive circuit diagnostics and monitoring. Although these machines conceal complexity behind a user-friendly interface, it remains important that nurses have sufficient knowledge for their use and the ability to compare and contrast circuit setups and functions for optimal and efficient treatment.
OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.
Full Text Available Introduction. The purpose of this study was to evaluate a specialized yoga intervention for inpatients in a rehabilitation and complex continuing care hospital. Design. Single-cohort repeated measures design. Methods. Participants (N=10 admitted to a rehabilitation and complex continuing care hospital were recruited to participate in a 50–60 min Hatha Yoga class (modified for wheelchair users/seated position once a week for eight weeks, with assigned homework practice. Questionnaires on pain (pain, pain interference, and pain catastrophizing, psychological variables (depression, anxiety, and experiences with injustice, mindfulness, self-compassion, and spiritual well-being were collected at three intervals: pre-, mid-, and post-intervention. Results. Repeated measures ANOVAs revealed a significant main effect of time indicating improvements over the course of the yoga program on the (1 anxiety subscale of the Hospital Anxiety and Depression Scale, F(2,18 = 4.74, p<.05, and ηp2 = .35, (2 Self-Compassion Scale-Short Form, F(2,18 = 3.71, p<.05, and ηp2 = .29, and (3 Magnification subscale of the Pain Catastrophizing Scale, F(2,18 = 3. 66, p<.05, and ηp2 = .29. Discussion. The results suggest that an 8-week Hatha Yoga program improves pain-related factors and psychological experiences in individuals admitted to a rehabilitation and complex continuing care hospital.
Dorn, David; Sousa-Poza, Alfonso
In the past decade, Switzerland has experienced a large increase in the number of individuals going into early retirement. This paper examines the determinants of such early retirement using data from the newly implemented social-security module of the 2002 Swiss Labor Force Survey. In the sixteen-month period from January 2001 to April 2002, more than 36,000 older individuals, representing 8% of all workers within nine years of legal retirement age, became early retirees. One of the most imp...
Vorchheiner, Alan H; Zaleta, Cynthia O
Much of the discussion on the decumulation phase of retirement savings has focused on the lack of any lifetime annuities. But there is a whole range of options sponsors can employ to facilitate the generation of retirement income and bolster financial wellness. As U.S. employers show no sign of substantially increasing spending on compensation or benefits, it is imperative that human resources professionals help employees--particularly the retiring baby boomers--to maximize what they have saved. This article presents five first-step ideas toward achieving that goal.
Vagts, Dierk A; Martin, Jörg; Dahmen, Klaus
What is quality, what is quality management? Who is responsible for quality management in a hospital? Which tools, communication instruments and which instruments for feed back are necessary for institutions to control its tasks in a multi-disciplinary environment? Are there various requirements concerning quality management systems in different hospitals or departments? Which tools of quality management are used in German anaesthesia and intensive care departments? This paper gives an introduction to quality management systems in hospitals and an overview of current models in anaesthesia and intensive care medicine.
Pirhonen, Jari; Pietilä, Ilkka
Becoming a resident in a long-term care facility challenges older people's continuity of self in two major ways. Firstly, as they leave behind their previous home, neighborhood, and often their social surroundings, older people have to change their life-long lifestyles, causing fears of the loss of one's self. Secondly, modern-day care facilities have some features of 'total' institutions that produce patient-like role expectations and thus challenge older people's selves. Our ethnographic study in a geriatric hospital and a sheltered home in Finland aims to find out what features of daily life either support or challenge older people's continuity of self. A philosophical reading of the concept of recognition is used to explore how various daily practices and interactions support recognizing people as persons in long-term care. Categories of institution-centered and person-centered features are described to illustrate multiple ways in which people are recognized and misrecognized. The discussion highlights some ways in which long-term care providers could use the results of the study. Copyright © 2015 Elsevier Inc. All rights reserved.
Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus–Dieter; Spies, Claudia
Introduction Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. Methods All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Results Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, pimproved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Conclusion Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach. PMID:26327392
McWilliam, C L; Desai, K L; Sweetland, D
Theory suggests that in an "empowering" organization all individuals assume genuine decision-making roles and control over their work. Unfortunately, many organizations actually stifle empowerment through creating new bureaucratic barriers as they implement structures to deploy quality management principles. The Oxford County Home Care Program describes how it redesigned its organizational structure to facilitate empowerment.
Jones, Barbara; Phillips, Farya
A report from the Interprofessional Education Collaborative and another from the Institute of Medicine cite working as part of interdisciplinary teams as a core proficiency area for improving health care. This article discusses the core competencies of interprofessional education and the essential role for social workers as leaders and…
... TREASURY (CONTINUED) INCOME TAX (CONTINUED) TEMPORARY INCOME TAX REGULATIONS UNDER THE EMPLOYEE RETIREMENT... demonstrate to the satisfaction of the Commissioner that the manner in which he will administer the trust will...) relating to nonbank trustees of pension and profit-sharing trusts benefiting owner-employees. (Sec. 408(a...
Full Text Available The study examined retirement adjustment of teacher-retirees in Osun State, and explored the interaction effects of pre-retirement guidance and family in-volvement on retirement adjustment. Exposit-facto design was used. The population comprised retirees from public, civil and private establishments from which 122 teacher-retirees were selected using a multi-stage sampling technique. An instrument: Family Involvement, Pre-retirement Guidance and Retirement Adjustment Questionnaire was used for data collection. Three research questions and three hypotheses guided the study. Data were analyzed using descriptive and inferential statistics. Results revealed that retirees in Osun State are not optimally adjusted, and positive significant interaction effect was found between family involvement and pre-retirement guidance on retirees adjustment, among others. Appropriate policy implications are outlined.
Quinn, J F
During most of the post-World War II period, American men have been leaving the labor force at earlier and earlier ages. Evidence suggests that this trend has been under way for more than a century. However, in the mid-1980s, this trend came to an abrupt halt. Male labor force participation rates have been flat since 1985, and have actually increased over the past several years. Understanding these issues is especially important given the looming increase in the Social Security normal retirement age to 67 and the possibility of even more increases in the ages of eligibility under Social Security and Medicare reform. Because of the influx of married women into the labor market in the post-World War II period, older women's participation rates did not decline as men's did. In contrast, their rates were relatively steady, rising or falling very slowly. Since the mid-1980s, however, older women's participation rates have increased significantly. Many more older men and women are working today than the pre-1986 trends would have suggested. Many older Americans leave the labor force gradually, utilizing "bridge jobs" between employment on a full-time career job and complete labor force withdrawal. These bridge jobs are often part-time, often in a new line of work, and sometimes involve a switch from wage and salary work to self-employment. Estimates suggest that between one-third and one-half of older Americans will work on a bridge job before retiring completely, and for these workers retirement is best viewed as a process, not as a single event. These changes in retirement behavior are consistent with societal changes that have altered the relative attractiveness of work and leisure late in life. Mandatory retirement has been outlawed for most American workers. Social Security has become more age-neutral, no longer penalizing the average worker who wants to continue working after age 65. An increasing proportion of employer pension coverage has been in defined
Clark, Matthew T.; Calland, James Forrest; Enfield, Kyle B.; Voss, John D.; Lake, Douglas E.; Moorman, J. Randall
Background Charted vital signs and laboratory results represent intermittent samples of a patient’s dynamic physiologic state and have been used to calculate early warning scores to identify patients at risk of clinical deterioration. We hypothesized that the addition of cardiorespiratory dynamics measured from continuous electrocardiography (ECG) monitoring to intermittently sampled data improves the predictive validity of models trained to detect clinical deterioration prior to intensive care unit (ICU) transfer or unanticipated death. Methods and findings We analyzed 63 patient-years of ECG data from 8,105 acute care patient admissions at a tertiary care academic medical center. We developed models to predict deterioration resulting in ICU transfer or unanticipated death within the next 24 hours using either vital signs, laboratory results, or cardiorespiratory dynamics from continuous ECG monitoring and also evaluated models using all available data sources. We calculated the predictive validity (C-statistic), the net reclassification improvement, and the probability of achieving the difference in likelihood ratio χ2 for the additional degrees of freedom. The primary outcome occurred 755 times in 586 admissions (7%). We analyzed 395 clinical deteriorations with continuous ECG data in the 24 hours prior to an event. Using only continuous ECG measures resulted in a C-statistic of 0.65, similar to models using only laboratory results and vital signs (0.63 and 0.69 respectively). Addition of continuous ECG measures to models using conventional measurements improved the C-statistic by 0.01 and 0.07; a model integrating all data sources had a C-statistic of 0.73 with categorical net reclassification improvement of 0.09 for a change of 1 decile in risk. The difference in likelihood ratio χ2 between integrated models with and without cardiorespiratory dynamics was 2158 (p value: <0.001). Conclusions Cardiorespiratory dynamics from continuous ECG monitoring detect
The classical economics perspective is that public policy should be used to allow, not hinder, economic freedom. In some cases it may be possible for government to gently nudge individuals to change their behavior without hindering freedom. One example is a change from the default on pension program enrollment forms from "not contribute" to "contribute." This is generally viewed as a good nudge that gets people to do what the majority of people view as generally the correct behavior. However, a choice to contribute to a pension fund is not always in the individual's best interest - thus, it is a nudge, not a mandate. To maintain personal liberty, individuals should be fully informed about the consequences of their choice and the motives of the political authority. Saving for retirement is a complex issue, and pension contribution decisions are often made with little foresight or information. Pension contribution nudges may not always be freedom preserving because of complexity and unintended consequences. The benefits, risks, and limitations of default contribution pension nudges are discussed.
de Wind, Astrid; Leijten, Fenna Rm; Hoekstra, Trynke; Geuskens, Goedele A; Burdorf, Alex; van der Beek, Allard J
Objectives Before actual retirement, employees may already distance themselves from work, which could be referred to as "mental retirement". However, trajectories of work motivation, ie, work engagement, have not been studied yet. The present study aimed to (i) identify different trajectories of work engagement among older workers approaching the retirement age, and (ii) examine their associations with actual retirement. Methods In total 3171 employees aged 55-62 years, who participated in the Dutch Study on Transitions in Employment, Ability and Motivation were included in this study. Participants completed questionnaires in 2010, 2011, 2012, and 2013. Latent class growth mixture modeling was performed to identify groups of employees with similar three-year trajectories in work engagement. Logistic regression analyses were performed to study whether trajectory membership was associated with retirement. Results Of the 3171 employees, 16.2% made a transition from work to (early) retirement (N=513). Four trajectories of work engagement were identified: steady high (76.3%), steady low (12.7%), decreasing (6.2%), and increasing (4.8%). A steady low work engagement trajectory was associated with retirement [odds ratio (OR) 1.46], compared to a steady high work engagement trajectory. Although not statistically significant, an increasing work engagement trajectory seemed to be associated with retirement as well (OR 1.60). Conclusions This study did not support the concept of mental retirement before actual retirement, ie, a decrease in work engagement among those facing retirement. However, as one in eight employees did experience steady low work engagement in the years before retirement, interventions promoting work motivation are recommended to support the employability of these employees.
Sanders, P.M.H.; van Putten, Michel Johannes Antonius Maria; Jarm, T.; Kramar, P.; Zupanic, A.
Due to various technological advances, it is now possible to continuously monitor critically ill patients using EEG, including the extraction of various quantitative features. In this study, several beta scientific and management scientific aspects of the implementation and use of cEEg on the ICU
Following a recommendation by the Standing Concertation Commitee at its meeting on 9 November 2015 and approval by the Director-General, please note that: the Progressive Retirement Programme has been extended by one year, from 1 April 2016 until 31 March 2017; the Scheme of Part-Time Work as a Pre-retirement Measure has also been extended by one year, from 1 January 2016 until 31 December 2016. Further information is available from the following sites: - https://admin-eguide.web.cern.ch/en/procedure/progressive-retirement-programme-prp - https://admin-eguide.web.cern.ch/en/procedure/part-time-work-pre-retirement-measure-ptp Human Resources Department Tel.: 79257 / 73903
Butrica, Barbara A; Smith, Karen E
For decades, policymakers have discussed how to remedy the high poverty rates of older widows. Yet older divorced women are more likely to be poor than older widows, and historical divorce and remarriage trends suggest that in the future a larger share of retired women will be divorced. This article uses the Social Security Administration's Modeling Income in the Near Term (version 6) to project the retirement resources and wellbeing of divorced women. We find that Social Security benefits and retirement incomes are projected to increase for divorced women and that their poverty rates are projected to decline, due in large part to women's increasing lifetime earnings. However, not all divorced women will be equally well off economic well-being in retirement varies by Social Security benefit type.
Full Text Available We use a representative survey covering 1,500 households to document the level of financial literacy in Switzerland and to examine how financial literacy is related to retirement planning. We measure financial literacy with standardized questions that capture knowledge about three basic financial concepts: Compound interest, inflation, and risk diversification. We measure retirement planning by the incidence of a voluntary retirement savings account. Our results show that financial literacy in Switzerland is high by international standards--a result which is compatible with the high ranking of Switzerland on the PISA mathematical scales. Financial literacy is lower among low-income, less-educated, and immigrant, non-native-speaking households as well as among women. We find that financial literacy is strongly correlated with voluntary retirement saving. Our results also show that financial literacy is correlated with financial market participation and mortgage borrowing.
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Full Text Available We consider the financial planning problem of a retiree wishing to enter a retirement village at a future uncertain date. The date of entry is determined by the retiree’s utility and bequest maximisation problem within the context of uncertain future health states. In addition, the retiree must choose optimal consumption, investment, bequest and purchase of insurance products prior to their full annuitisation on entry to the retirement village. A hyperbolic absolute risk-aversion (HARA utility function is used to allow necessary consumption for basic living and medical costs. The retirement village will typically require an initial deposit upon entry. This threshold wealth requirement leads to exercising the replication of an American put option at the uncertain stopping time. From our numerical results, active insurance and annuity markets are shown to be a critical aspect in retirement planning.
Ahmad Zazili Ainol Sarin
Full Text Available The purpose of this study is to determine the factors influencing retirement planning among young professionals in private sector. There are three factors identified in this research which includes financial literacy, job satisfaction and savings behavior. Data used for this study are primary and secondary data such as from journal articles, periodicals and textbooks. A questionnaire is distributed and administered to extract data from the respondents consist of executives, non-executives and managers around Klang Valley, aged between 20 - 34 years old. The data is analyzed using frequency analysis, reliability test and Pearson correlation in order to obtain a clear findings and results. The findings show that financial literacy, job satisfaction and savings behavior has a positive association towards retirement planning. Furthermore, it is shown that financial literacy and saving behavior have a significant relationship with retirement planning. It is hope that this study will inform and encourage the young professionals to save and invest for the retirement.
Dorfman, Nancy S.
The discussion is confined to the Teachers Insurance and Annuity Association (TIAA) and College Retirement Equities Fund (CREF) and how they have remained effective with the rise of inflation. (Author/BP)
Oude Mulders, J.
Population aging and the resulting retirement-related policy reforms are leading to higher rates of labor market participation among older workers and later retirement ages. In addition, working beyond traditional retirement ages, thereby combining employment with retirement, is also increasingly
.... (a) To satisfy the requirements of § 838.804(b)(1), a court order must contain language identifying...) and (b)(2) of this section, language referring to benefits under another retirement system, such as military retired pay, Foreign Service retirement benefits and Central Intelligence Agency retirement...
... order must contain language identifying the retirement system to be affected. For example, “CSRS,” “FERS... in paragraphs (b)(1) and (b)(2) of this section, language referring to benefits under another retirement system, such as military retired pay, Foreign Service retirement benefits or Central Intelligence...
...' retirement pay. 3.754 Section 3.754 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... officers' retirement pay. A retired emergency officer of World War I has basic eligibility to retirement pay by the Department of Veterans Affairs under Pub. L. 87-875 (sec. 11(b), Pub. L. 85-857) from date...
served after December 31, 2014. 9 Department of Defense, Valuation of the Military Retirement System, September 30, 2006, DOD Office of the Actuary...provision twice; first in 2014 (P.L. 113-82 §10001; formerly known as South Utah Valley Electric Conveyance Act) to apply only to servicemembers...Actuary, Valuation of the Military Retirement System, September 30, 2014, rev. June 2016. DOD budget authority and outlays in each fiscal year that
Rook, Christopher J.
Prior to the financial crisis mortgage securitization models increased in sophistication as did products built to insure against losses. Layers of complexity formed upon a foundation that could not support it and as the foundation crumbled the housing market followed. That foundation was the Gaussian copula which failed to correctly model failure-time correlations of derivative securities in duress. In retirement, surveys suggest the greatest fear is running out of money and as retirement dec...
Thorsen, Sannie Vester; Jensen, Per H.; Bjorner, Jakob Bue
Purpose Retention of senior employees is a challenge for most developed countries. We aimed to identify psychosocial work environment factors of importance for the retention of older employees by evaluating the association between the psychosocial work environment and voluntary early retirement i...... at the labor market. However, we found no evidence that low demands or good relations between colleagues could influence older employees’ decision on early retirement....
Retirement implies an important change from a working environment to a new lifestyle. Every individual copes with this transition in his own way. In this video, registered already a few years ago, Dr. Sartorius from WHO addresses some of his colleagues close to retirement and explains what situations they can expect to encounter. We make this video available to CERN personnel to stimulate their own thinking on the subject.
Adenutsi, Deodat E.
The central objective of this paper is to explain the concept and relevance of retirement planning within a vibrant Christian organisation such as the Assemblies of God’s Church. In particular, an attempt is made to expose participants to the theoretical relevance and application of the benefits of retirement planning to the church as an employer, and the pastors as employees of the church. Accordingly, issues related to the role of the church and beneficiary pastors and other full-time worke...
reflect the opinions of its research clients and sponsors. Support RAND Make a tax -deductible charitable contribution at www.rand.org/giving...mandated accrual account - ing to fund the military retirement benefit liability and specified the use of the aggregate entry-age normal accounting ...tary retirees; military retirement was a pay-as-you-go (PAYGO) system. The shift to accrual accounting sought to meet the objective of recog- nizing
Dominguez Álvarez, Rocío; Calderón Carrasco, Justo; García Colchero, Francisco; Postigo Mota, Salvador; Alburquerque Medina, Eulalia
To achieve well-being in patients in Palliative Care is required to know which are the most common symptoms, which are the drugs used for relief, which are the routes of administration of drugs that are suitable, how effective the drugs are and what incompatibilities, interactions and adverse effects occur. The aim of this article is to review the relevant issues in the management of the drugs commonly used by nursing in Palliative Care and presenting recommendations to clinical practice. Management interventions drugs for nurses in Palliative Care recommended by the scientific literature after a search of Scopus, CINAHL, Medline, PubMed, UpToDate and Google Scholar are selected. The oral route is the choice for patients in palliative situation and subcutaneous route when the first is not available. The symptoms, complex, intense and moody, should be systematically reevaluated by the nurse, to predict when a possible decompensation of it needing extra dose of medication. Nurses must be able to recognize the imbalance of well-being and act quickly and effectively, to get relief to some unpleasant situations for the patient as the pain symptoms, dyspnea or delirium. For the proper administration of rescue medication, the nurse should know the methods of symptomatic evaluation, pharmacokinetics and pharmacodynamics of drugs, the time intervals to elapse between different rescues and nccocc rocnnnco t thocm
Gibson-Helm, Melanie E; Rumbold, Alice R; Teede, Helena J; Ranasinha, Sanjeeva; Bailie, Ross S; Boyle, Jacqueline A
Australian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Pregnancy care has a key role in identifying and addressing modifiable risk factors that contribute to adverse outcomes. We investigated whether participation in a continuous quality improvement (CQI) initiative was associated with increases in provision of recommended pregnancy care by primary health care centers (PHCs) in predominantly Indigenous communities, and whether provision of care was associated with organizational systems or characteristics. Longitudinal analysis of 2220 pregnancy care records from 50 PHCs involved in up to four cycles of CQI in Australia between 2007 and 2012. Linear and logistic regression analyses investigated associations between documented provision of pregnancy care and each CQI cycle, and self-ratings of organizational systems. Main outcome measures included screening and counselling for lifestyle-related risk factors. Women attending PHCs after ≥1 CQI cycles were more likely to receive each pregnancy care measure than women attending before PHCs had completed one cycle e.g. screening for cigarette use: baseline = 73 % (reference), cycle one = 90 % [odds ratio (OR):3.0, 95 % confidence interval (CI):2.2-4.1], two = 91 % (OR:5.1, 95 % CI:3.3-7.8), three = 93 % (OR:6.3, 95 % CI:3.1-13), four = 95 % (OR:11, 95 % CI:4.3-29). Greater self-ratings of overall organizational systems were significantly associated with greater screening for alcohol use (β = 6.8, 95 % CI:0.25-13), nutrition counselling (β = 8.3, 95 % CI:3.1-13), and folate prescription (β = 7.9, 95 % CI:2.6-13). Participation in a CQI initiative by PHCs in Indigenous communities is associated with greater provision of pregnancy care regarding lifestyle-related risk factors. More broadly, these findings support incorporation of CQI activities addressing systems level issues into primary care
Cai, Ying; Cao, Junhua; Kan, Ruixue; Liu, Yuping; Zhao, Li; Hu, Ming; Zhang, Xuemei
To analyze and summarize the effect of continuous care on the life quality and control of asthma of pediatric patients with asthma discharged from multiple hospitals. Retrospective analysis was carried out on 172 pediatric patients with asthma aged between 6 and 11 yr old randomly selected from those admitted to five hospitals between January 2014 and December 2015. Among these 172 patients, only 86 (intervention group) received the continuous care between January 2015 and December 2015, while the rest (control group) did not receive from January 2014 and December 2014. After the patients in the intervention group were discharged from the hospital, the ratio of practical forced expiratory volume in one second (FEV1) to the expected FEV1 at the 12 th month was (90.28±10.35)%, and the ratio of peak expiratory flow to the expected value was (84.24±3.43)%, respectively higher than those [(82.73±8.86)% and (75.80±4.67)%] in the control group. Regarding pediatric asthma quality of life questionnaire (PAQLQ) between the intervention group and the control group, the difference had statistical significance ( Z =-7.254, PContinuous care can improve the pediatric patient's pulmonary function and life quality, and effectively control the asthmatic symptoms.
Calvo, Esteban; Madero-Cabib, Ignacio; Staudinger, Ursula M
A destandardization of labor-force patterns revolving around retirement has been observed in recent literature. It is unclear, however, to which degree and of which kind. This study looked at sequences rather than individual statuses or transitions and argued that differentiating older Americans' retirement sequences by type, order, and timing and considering gender, class, and race differences yields a less destandardized picture. Sequence analysis was employed to analyze panel data from the Health and Retirement Study (HRS) for 7,881 individuals observed 6 consecutive times between ages 60-61 and 70-71. As expected, types of retirement sequences were identified that cannot be subsumed under the conventional model of complete retirement from full-time employment around age 65. However, these retirement sequences were not entirely destandardized, as some irreversibility and age-grading persisted. Further, the degree of destandardization varied along gender, class, and race. Unconventional sequences were archetypal for middle-level educated individuals and Blacks. Also, sequences for women and individuals with lower education showed more unemployment and part-time jobs, and less age-grading. A sequence-analytic approach that models group differences uncovers misjudgments about the degree of destandardization of retirement sequences. When a continuous process is represented as individual transitions, the overall pattern of retirement sequences gets lost and appears destandardized. These patterns get further complicated by differences in social structures by gender, class, and race in ways that seem to reproduce advantages that men, more highly educated individuals, and Whites enjoy in numerous areas over the life course. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Schofield Deborah J
Full Text Available Abstract Background The nursing population in Australia is ageing. However, there is little information on the rate and timing of nursing retirement. Methods Specifically designed health workforce extracts from the Australian Bureau of Statistics (ABS censuses from 1986 to 2001 are used to estimate the rate of nursing retirement. The 2001 nursing data are then "aged" and retirement of the nursing workforce projected through to 2026. ABS population projections are used to examine the future age structure of the population and the growth and age distribution of the pool of labour from which future nurses will be drawn. Results Attrition rates for nurses aged 45 and over are projected to be significantly higher between the base year of 2006 and 2026, than they were between 1986 and 2001 (p Between 2006 and 2026 the growth in the labour force aged 20 to 64 is projected to slow from 7.5 per cent every five years to about 2 per cent, and over half of that growth will be in the 50 to 64 year age group. Over this period Australia is projected to lose almost 60 per cent of the current nursing workforce to retirement, an average of 14 per cent of the nursing workforce every five years and a total of about 90,000 nurses. Conclusion The next 20 years will see a large number of nursing vacancies due to retirement, with ageing already impacting on the structure of the nursing workforce. Retirement income policies are likely to be a key driver in the retirement rate of nurses, with some recent changes in Australia having some potential to slow retirement of nurses before the age of 60 years. However, if current trends continue, Australia can expect to have substantially fewer nurses than it needs in 2026.
Chen, Lisa Y; Tee, Benjamin C-K; Chortos, Alex L; Schwartz, Gregor; Tse, Victor; Lipomi, Darren J; Wong, H-S Philip; McConnell, Michael V; Bao, Zhenan
Continuous monitoring of internal physiological parameters is essential for critical care patients, but currently can only be practically achieved via tethered solutions. Here we report a wireless, real-time pressure monitoring system with passive, flexible, millimetre-scale sensors, scaled down to unprecedented dimensions of 1 × 1 × 0.1 cubic millimeters. This level of dimensional scaling is enabled by novel sensor design and detection schemes, which overcome the operating frequency limits of traditional strategies and exhibit insensitivity to lossy tissue environments. We demonstrate the use of this system to capture human pulse waveforms wirelessly in real time as well as to monitor in vivo intracranial pressure continuously in proof-of-concept mice studies using sensors down to 2.5 × 2.5 × 0.1 cubic millimeters. We further introduce printable wireless sensor arrays and show their use in real-time spatial pressure mapping. Looking forward, this technology has broader applications in continuous wireless monitoring of multiple physiological parameters for biomedical research and patient care.
Mitchell, Olivia; Malatzky, Christina; Bourke, Lisa; Farmer, Jane
The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucault's concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated. © 2018 National Rural Health Alliance Ltd.
Thomas, Tabitha; Barclay, Stephen
Syringe drivers are widely used in palliative care, and this article reviews the challenges and outstanding questions associated with their use. Misperceptions among the lay public and some health professionals can be addressed by sensitive communication with patients and families and clear thinking in clinical teams concerning the drugs and doses used, particularly in non-malignant disease. Good levels of knowledge concerning syringe driver use has been found among GPs and community nurses, although this is not the case in some nursing home teams. The advantages of newer devices, safety and efficacy of drug combinations, selection of diluent, and management of site reactions are discussed.
Turco, Mary G; Baron, Robert B
The 2016 World Congress on Continuing Professional Development: Advancing Learning and Care in the Health Professions took place in San Diego, California, March 17-19, 2016. Hosts were the Association for Hospital Medical Education (AHME), Alliance for Continuing Education in the Health Professionals (ACEhp), and Society for Academic Continuing Medical Education (SACME). The target audience was the international community working to improve medical (CME), nursing (CNE), pharmacy (CPE), and interprofessional (CIPE) continuing education (CE) and continuing professional development (CPD). Goals included: addressing patients' concerns and needs; advancing global medical and interprofessional health sciences education; utilizing learning to address health disparities; and promoting international cooperation. The five keynote speakers were: patient advocate Alicia Cole ("Why What We Do Matters: The Patients Voice"); linguist Lorelei Lingard ("Myths about Healthcare Teamwork and Their Implications for How We Understand Competence"); futurist and philosopher Alex Jadad ("What Do We Need to Protect at All Costs in the 21st Century?"); ethicist and change agent Zeke Emanuel ("Learn to Change: Teaching Toward a Shifting Healthcare Horizon"); and technology innovator Stephen Downes ("From Individual to Community: The Learning Is in the Doing"). Organizers announced the new Dave Davis Distinguished Award for Excellence in Mentorship in Continuing Professional Development to honor the career of David Davis, MD, in CME/CPD scholarship in Canada, the United States, and beyond. Participants valued the emphasis on interprofessional education and practice, the importance of integrating the patient voice, the effectiveness of flipped classroom methods, and the power of collective competency theories. Attendee-respondents encouraged Congress planners to continue to strive for a broad global audience and themes of international interest.
Kanika Kapur; Jeannette Rogowski
This paper examines the role of employer provided health insurance in the retirement decisions of dual working couples. The near elderly have high-expected medical expenditures; therefore, availability of health insurance is an important factor in their retirement decisions. We determine if access to retiree health insurance for early retirement enables couples to time their retirement together %u2013 a behavior called %u201Cjoint retirement.%u201D We find that wives%u2019 retiree health insu...
Full Text Available Introduction: Phased retirement involves reducing working time in the final years before retirement. The aim of phased retirement is to extend working careers and retain older workers who would otherwise opt for full early retirement. This article investigates the effect of offering phased retirement on early-retirement behaviour in Norway.Method: The data used in the analysis covers the period between 2000 and 2010 and comprises all employees between 61 and 62 years of age (N= 18 174 who were employed in any of the 442 companies that participated in a 2010 survey carried out by the Fafo Institute for Labour and Social Research and Respons Analyse AS, a Norwegian research firm. I use a difference-in-differences approach and logistic regression, which enables the measurement of changes in the individual relative risk of retiring full-time on the contractual pension (AFP, avtalefestet pensjon, contractual early-retirement pension, before and after the introduction of phased retirement as a retention measure.Results: The results show that working in a company that offers reduced working hours for older workers does not have an effect on the relative risk of a 61- or 62-year-old withdrawing a full contractual pension in the next two years of their employment. This result is evident both before and after controlling for a range of known individual risk factors, as well as after controlling for company characteristics.Discussion: In the search for suitable measures for retaining older workers, offering phased retirement may still be part of the answer. Though my analysis does not support the idea that more flexible working hours is a decisive factor for those who choose to opt for full early retirement, a possible next step could be to investigate the impact of offering flexible working hours on the employment duration of those who do remain in employment.
Jeddi, Fatemeh Rangraz; Akbari, Hossein; Rasouli, Somayeh
Tele-homecare methods can be used to provide home care for the elderly, if information management is provided. The aim of this study was to compare the places and methods of the data collection and media that use Tele-homecare for the elderly in selected countries in 2015. A comparative-applied library study was conducted in 2015. The study population were five countries, including Canada, Australia, England, Denmark, and Taiwan. The data collection tool was a checklist based on the objectives of study. Persian and English papers from 1998 to 2014, related to the Electronic Health Record, home care and the elderly were extracted from authentic journals and reference books as well as academic and research websites. Data were collected by reviewing the papers. After collecting data, comparative tables were prepared and the weak and strong points of each case were investigated and analyzed in selected countries. Clinical, laboratory, imaging and pharmaceutical data were obtained from hospitals, physicians' offices, clinics, pharmacies and long-term healthcare centers. Mobile and tablet-based technologies and personal digital assistants were used to collect data. Data were published via Internet, online and offline databanks, data exchange and dissemination via registries and national databases. Managed care methods were telehealth management systems and point of service. For continuity of care, it is necessary to consider managed care and equipment with regard to obtaining data in various forms from various sources, sharing data with registries and national databanks as well as the Electronic Health Record. With regard to the emergence of wearable technology and its use in home care, it is suggested to study the integration of its data with Electronic Health Records.
McPhail-Bell, Karen; Matthews, Veronica; Bainbridge, Roxanne; Redman-MacLaren, Michelle Louise; Askew, Deborah; Ramanathan, Shanthi; Bailie, Jodie; Bailie, Ross; Matthews, Veronica
In Australia, Indigenous people experience poor access to health care and the highest rates of morbidity and mortality of any population group. Despite modest improvements in recent years, concerns remains that Indigenous people have been over-researched without corresponding health improvements. Embedding Indigenous leadership, participation, and priorities in health research is an essential strategy for meaningful change for Indigenous people. To centralize Indigenous perspectives in research processes, a transformative shift away from traditional approaches that have benefited researchers and non-Indigenous agendas is required. This shift must involve concomitant strengthening of the research capacity of Indigenous and non-Indigenous researchers and research translators—all must teach and all must learn. However, there is limited evidence about how to strengthen systems and stakeholder capacity to participate in and lead continuous quality improvement (CQI) research in Indigenous primary health care, to the benefit of Indigenous people. This paper describes the collaborative development of, and principles underpinning, a research capacity strengthening (RCS) model in a national Indigenous primary health care CQI research network. The development process identified the need to address power imbalances, cultural contexts, relationships, systems requirements and existing knowledge, skills, and experience of all parties. Taking a strengths-based perspective, we harnessed existing knowledge, skills and experiences; hence our emphasis on capacity “strengthening”. New insights are provided into the complex processes of RCS within the context of CQI in Indigenous primary health care. PMID:29761095
Although current systems for continuous glucose monitoring (CGM) are the result of progressive technological improvement, and although a beneficial effect on glucose control has been demonstrated, few patients are using them. Something similar has happened to telemedicine (TM); in spite of the long-term experience, which began in the early 1980s, no TM system has been widely adopted, and presential visits are still almost the only way diabetologists and patients communicate. The hypothesis developed in this article is that neither CGM nor TM will ever be routinely implemented separately, and their consideration as essential elements for standard diabetes care will one day come from their integration as parts of a telemedical monitoring platform. This platform, which should include artificial intelligence for giving decision support to patients and physicians, will represent the core of a more complex global agent for diabetes care, which will provide control algorithms and risk analysis among other essential functions. © 2010 Diabetes Technology Society.
In this article I discuss medical tourism, whereby patients go overseas for plastic surgery treatment in order to save money. However, if malpractice occurs abroad, there are several barriers that make it difficult for patients to recover damages. I explain these legal barriers and then discuss the possible causes of action patients can have over their "domestic physician" (their personal physician who might have referred surgery abroad or who gives postoperative follow-up care) and how these causes of action can create avenues of legal recovery not otherwise available. The possible liability of the domestic physician in the context of surgical malpractice abroad creates an ethical tension in the pursuit of higher-quality continuity of care, as the more involved the physician becomes in the process, the more likely he or she will assume liability. © 2018 American Medical Association. All Rights Reserved.
For 2003-2008, ThedaCare, a community health system in Wisconsin, achieved significant improvements in quality and the elimination of waste through the development of an improvement system, which included Value Stream analysis, rapid improvement events, and projects applied to specific processes. However, to meet its continuous daily improvement goals, particularly the goal of increasing productivity by 10% annually, ThedaCare needed to change the way its managers and leaders (in its hospital division) conduct and manage their daily work. Accordingly, it developed its Business Performance System (BPS) to achieve and sustain continuous daily improvement. BUILDING THE BPS: ThedaCare devised a multipart pilot project, consisting of "learning to see" and then, "problem solving." On completion of the 15-week alpha phase (6 units) in July 2009, the BPS was spread to the beta pilot (12 units; September 2009-January 2010) and then to cohort 3 (10 units; September 2010-January 2011). Each alpha unit improved performance on (1) the key driver metric of increasing productivity from 2008 to year-end 2009 (by 1%-11%) and (2) its respective safety/ quality drivers over the respective 2008 baselines. For 2010, improvements across the alpha, beta, and cohort 3 units were found for 11 of the 14 safety/quality drivers-85% of the 11 customer satisfaction drivers, 83% of 6 people engagement drivers; and 48% of 23 financial stewardship drivers. The tools developed for the BPS have enabled teams to see, prioritize, and pursue continuous daily improvement opportunities. Unit leaders now have a structured management reporting system to reduce variation in their management styles. Leaders all now follow leadership standard work, and their daily work is now consistently aligned with the hospital and system strategy.
Bosse, Goetz; Abels, Wiltrud; Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus-Dieter; Spies, Claudia
Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, pcontrol group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (pcontrol group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.
Huang, Yi-Chen; Hsu, Li-Ling
Many nurses have difficulty learning to use the complex, non-traditional, and regularly-updated critical care equipment. Failure to use such equipment properly can seriously compromise treatment and endanger patient health and lives. New self-learning materials for novice nurses are necessary to provide essential and effective guidance as a part of formal nursing training. Such materials can enhance the capabilities of critical care nurses and, thus, improve the general quality of critical care. The purpose of this research was to develop a continuous renal replacement therapy (CRRT)-themed self-learning manual that would provide easily absorbed and understood knowledge in an easy-to-carry format for ICU nursing staff. This study also investigated CCRT skill learning efficacy. This study adopted a quasi-experimental design with pretests and posttests. Purposive sampling generated a sample of 66 critical care nurses currently working at one hospital in Taipei City. Participants submitted a completed self-assessment survey that rated their command of continuous renal replacement therapy before and after the self-learning manual intervention. Survey data were analyzed using SPSS Version 17.0 for Windows. The two major findings derived from the study included: (1) The mean response score from the self-assessment survey filled out after the intervention was 91.06 and 79.75 (SD = 9.49 and 11.65), respectively, for experimental and control groups. Such demonstrated significant difference. (2) The mean posttest score after the intervention for the experimental group was 91.06 ± 9.49. This represents a significant increase of 10.35 ± 10.35 over their mean pretest score (80.71 ± 11.82). The experimental group showed other significant differences in terms of the CRRT self-assessment survey posttest. Self-learning manuals may be introduced in nursing education as useful aids and catalysts to achieve more effective and satisfying learning experiences.
Wind, A. de; Leijten, F.R.M.; Hoekstra, T.; Geuskens, G.A.; Burdorf, L.; Beek, A.J. van der
Objectives Before actual retirement, employees may already distance themselves from work, which could be referred to as "mental retirement". However, trajectories of work motivation, ie, work engagement, have not been studied yet. The present study aimed to (i) identify different trajectories of
The concept of career set is employed as the basis for a framework designed to analyze the impact of women's involvement in multiple careers on their adjustment to retirement. The author concludes that the familial careers engaged in by married, working women have a mediative effect on their transition to retirement. (Author/CT)
Chronic tic disorders including Tourette syndrome are defined as disorders with tics continuing for over a year. Although a substantial portion of patients with chronic tic disorders have improvement or remission of their tics until adulthood, some of them still have necessity to receive treatment for tic disorders in adulthood. Regardless of age and severity of tics, basic treatment for tic disorders consists of psycho-education and family guidance which encourage patients and people around them to understand, accept and cope with tics appropriately. In most of the adult cases with tic disorders who require aggressive treatment, tics and/or comorbidities including obsessive-compulsive symptoms are so severe that they usually have medication including antipsychotics.
in recent years, several initiatives have been launched by the Associazione medici diabetologi (AMD) in the context of a national quality improvement program.These activities include: identification of specific indicators of quality of diabetes care, development of a software to calculate such indicators by using routine clinical data, creation of a network of diabetes clinics and analysis and publication of the results in ad hoc reports (AMD Annals). Through the best performer approach, each centre could compare its own performance not only with the theoretical targets suggested by existing guidelines, but also with the results achieved by the best centres operating within the same healthcare system.We evaluated whether the involvement of diabetes clinics into the AMD Annals initiative improved the quality of care over 4 years. a controlled before and after study was performed to compare data collected from 2004 to 2007 by two groups of centres: group A included centres that had been involved in the project since the first edition of AMD Annals; group B included centres only involved in the last edition. overall, 124 diabetes clinics provided data on over 100,000 type 2 diabetes patients/year seen from 2004 to 2007. process indicators included the proportion of patients with at least one measurement of HbA1c, blood pressure and lipid profile during the previous 12 months. Intermediate outcomes included percentages of patients with levels of HbA1c ≤ 7%, blood pressure ≤ 130/85 mmHg and LDL-cholesterol improvements in the proportion of patients with LDL-cholesterol at target were documented in both groups (group A: +10.5%; group B: +12.2%.) The proportion of patients treated with insulin increased in group A only (+5.8%), while the use of statins grew by 20%in both groups.The proportion of individuals treated with two or more antihypertensive drugs increased by 3.6% in group A and by 1.6% in group B. the AMD Annals approach can be considered as a case model for
Sopeña-Sutil, R; Tejido-Sánchez, A; Galván-Ortiz de Urbina, M; Guerrero-Ramos, F; García-Álvarez, G; Passas-Martínez, J B
To analyze the evolution of primary care referrals to the Urology Department after the implementation of a joint protocol on prostate disease and a continuing education program in our healthcare area. In January 2011, we launched an action protocol on prostate disease, which was complemented by training sessions and an e-mail-based consultation system. We analyzed primary care referrals to the Urology Department between 2011 and 2013 and determined the reasons for the consultations and the compliance with the established criteria on prostate disease. We obtained data from the "Request for Appointment in Specialized Care" program of the Community of Madrid. We calculated the sample size with a 95% confidence level and a 50% heterogeneity. A total of 19,048 referrals were conducted. The most common reason for the referrals was lower urinary tract symptoms associated with benign prostate hyperplasia, with a 27% reduction and a compliance that went from 46% at 67%. Although prostate-specific antigen consultations increased by 40%, they improved their appropriateness (from 55% to 72%). This was the main type of consultation for suspicion of malignancy (30%). Also worth mentioning were female incontinence, which doubled in number, and a 41% reduction in erectile dysfunction, which could be due to the primary care training. The collaboration between the Department of Urology and primary care succeeded in improving the appropriateness of prostate disease referrals and modified the tendency to refer the rest of the diseases included in the project. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
Hilty, Donald M; Turvey, Carolyn; Hwang, Tiffany
Psychiatric practice continues to evolve and play an important role in patients' lives, the field of medicine, and health care delivery. Clinicians must learn a variety of clinical care systems and lifelong learning (LLL) is crucial to apply knowledge, develop skills, and adjust attitudes. Technology is rapidly becoming a key player-in delivery, lifelong learning, and education/training. The evidence base for telepsychiatry/telemental health via videoconferencing has been growing for three decades, but a greater array of technologies have emerged in the last decade (e.g., social media/networking, text, apps). Clinicians are combining telepsychiatry and these technologies frequently and they need to reflect on, learn more about, and develop skills for these technologies. The digital age has solidified the role of technology in continuing medical education and day-to-day practice. Other fields of medicine are also adapting to the digital age, as are graduate and undergraduate medical education and many allied mental health organizations. In the future, there will be more online training, simulation, and/or interactive electronic examinations, perhaps on a monthly cycle rather than a quasi-annual or 10-year cycle of recertification.
Sittig, Dean F; Gonzalez, Daniel; Singh, Hardeep
Reliable health information technology (HIT) in general, and electronic health record systems (EHRs) in particular are essential to a high-performing healthcare system. When the availability of EHRs are disrupted, alternative methods must be used to maintain the continuity of healthcare. We developed a survey to assess institutional practices to handle situations when EHRs were unavailable for use (downtime preparedness). We used literature reviews and expert opinion to develop items that assessed the implementation of potentially useful practices. We administered the survey to U.S.-based healthcare institutions that were members of a professional organization that focused on collaboration and sharing of HIT-related best practices among its members. All members were large integrated health systems. We received responses from 50 of the 59 (84%) member institutions. Nearly all (96%) institutions reported at least one unplanned downtime (of any length) in the last 3 years and 70% had at least one unplanned downtime greater than 8h in the last 3 years. Three institutions reported that one or more patients were injured as a result of either a planned or unplanned downtime. The majority of institutions (70-85%) had implemented a portion of the useful practices we identified, but very few practices were followed by all organizations. Unexpected downtimes related to EHRs appear to be fairly common among institutions in our survey. Most institutions had only partially implemented comprehensive contingency plans to maintain safe and effective healthcare during unexpected EHRs downtimes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Slivinske, Lee R.; Kosberg, Jordan I.
Describes a holistic health care program (Personal Health Management System) initiated within several retirement communities. Initial findings suggested that program participants experienced significant increases in their health and well-being while nonequivalent control group subjects did not. Conceptual and methodological issues are discussed.…
Full Text Available Abstract Background Empirical evidence investigating heterogeneous impact of retirement on mental health depending on social backgrounds is lacking, especially among older adults. Methods We examined the impact of changes in working status on changes in mental health using Japanese community-dwelling adults aged ≥65 years participating in the Japan Gerontological Evaluation Study between 2010 and 2013 (N = 62,438. Between-waves changes in working status (“Kept working”, “Retired”, “Started work”, or “Continuously retired” were used to predict changes in depressive symptoms measured by the Geriatric Depression Scale. First-difference regression models were stratified by gender, controlling for changes in time-varying confounding actors including equivalised household income, marital status, instrumental activities of daily living, incidence of serious illnesses and family caregiving. We then examined the interactions between changes in working status and occupational class, changes in marital status, and post-retirement social participation. Results Participants who transitioned to retirement reported significantly increased depressive symptoms (β = 0.33, 95% CI: 0.21–0.45 for men, and β = 0.29, 95% CI: 0.13–0.45 for women compared to those who kept working. Men who were continuously retired reported increased depressive symptoms (β = 0.13, 95% CI: 0.05–0.20, whereas males who started work reported decreased depressive symptoms (β = −0.20, 95% CI: -0.38–-0.02. Men from lower occupational class (compared to men from higher class reported more increase in depressive symptoms when continuously retired (β = −0.16, 95% CI: -0.25–-0.08. Those reporting recreational social participation after retirement appeared to be less influenced by transition to retirement. Conclusions Retirement may increase depressive symptoms among Japanese older adults, particularly men from lower occupational class backgrounds
Wilk, Adam S; Evans, Leigh C; Jones, David K
Six states that have rejected the Patient Protection and Affordable Care Act's (ACA) Medicaid expansion nonetheless extended the primary care "fee bump," by which the federal government increased Medicaid fees for primary care services up to 100 percent of Medicare fees during 2013-14. We conducted semistructured interviews with leaders in five of these states, as well as in three comparison states, to examine why they would continue a provision of the ACA that moderately expands access at significant state expense while rejecting the expansion and its large federal match, focusing on relevant economic, political, and procedural factors. We found that fee bump extension proposals were more successful where they were dissociated from major national policy debates, actionable with the input of relatively few stakeholder entities, and well aligned with preexisting policy-making structures and decision trends. Republican proposals to cap or reduce federal funding for Medicaid, if enacted, would compel states to contain program costs. In this context, states' established decision-making processes for updating Medicaid fee schedules, which we elucidate in this study, may shape the future of the Medicaid program. Copyright © 2018 by Duke University Press 2018.
Brotfain, Evgeni; Livshiz-Riven, Ilana; Gushansky, Alexander; Erblat, Alexander; Koyfman, Leonid; Ziv, Tomer; Saidel-Odes, Lisa; Klein, Moti; Borer, Abraham
A variety of hand hygiene monitoring programs (HHMPs) have come into use in hospitals throughout the world. In the present study, we compare continuous closed circle television (CCTV) with overt observation for monitoring the hand hygiene compliance of health care workers (HCWs) in a general intensive care unit (GICU). This is a cross-sectional and comparative study. In this study, we use a novel hand hygiene CCTV monitoring system for hand hygiene performance monitoring. The study population incorporated all the GICU HCWs, including registered nurses, staff physicians, and auxiliary workers. All HCWs of our GICU were observed, including ICU registered nurses, ICU staff physicians, and auxiliary workers participated in the present study. Overall, each observer team did 50 sessions in each arm of the study. Total number of hand hygiene opportunities was approaching 500 opportunities. The compliance rates when only overt observations were performed was higher than when only covert observations were performed with a delta of approximately 10% (209 out of 590 [35.43%] vs 130 out of 533 [24.39%]; P hand hygiene. However, there is no clear basis for incorporating a CCTV observation modality into a health care system that already operates an overt observation program. We have shown that CCTV methodology records a different distribution of opportunities for performing hand hygiene and of actual performances of hand hygiene compared with overt observation. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Gonzalez Eiras, Martin; Niepelt, Dirk
changes of taxes, government spending components and the retirement age in politico-economic equilibrium. Growth is driven by capital accumulation and productivity increases fueled by public investment. The closed-form solutions of the model predict taxation and the retirement age in OECD economies...... to increase in response to demographic ageing and per-capita growth to accelerate. If the retirement age were held constant, the growth rate in politico-economic equilibrium would essentially remain unchanged, due to a surge of social security transfers and crowding out of public investment.......We analyze the short and long run effects of demographic ageing - increased longevity and reduced fertility - on per-capita growth. The OLG model captures direct effects, working through adjustments in the savings rate, labor supply, and capital deepening, and indirect effects, working through...
McAullay, Daniel; McAuley, Kimberley; Bailie, Ross; Mathews, Veronica; Jacoby, Peter; Gardner, Karen; Sibthorpe, Beverly; Strobel, Natalie; Edmond, Karen
To determine whether participation in the continuous quality improvement (CQI) Audit and Best Practice for Chronic Disease programme improved care and outcomes for Indigenous children. Data were collected from 59 Australian primary health-care centres providing services to Indigenous people and participating in the programme (February 2008 and December 2013). Indigenous children aged less than 2 years and centres that completed three or more consecutive annual audits within the 6-year study period were included. Crude and adjusted logistic generalised estimating equation models were used to examine the effect of year of audit on the delivery of care. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Outcomes were related to age-relevant health issues, including prevention and early intervention. These included administrative, health check, anticipatory guidance and specific health issues. During the audit period, there were 2360 files from 59 centres. Those that had a recall recorded, improved from 84 to 95% (OR 2.44, 95% CI 1.44-4.11). Hearing assessments improved from 52 to 89% (OR 1.37, 95% CI 1.22-1.54). Improvement in anticipatory guidance, treatment and follow-up of medical conditions was almost universal. We documented significant improvements in quality of care of Indigenous children. Outcomes and their corresponding treatment and follow-ups improved over time. This appears to be related to services participating in annual CQI activities. However, these services may be more committed to CQI than others and therefore possibly better performing. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
Twig, Gilad; Lahad, Amnon; Kochba, Ilan; Ezra, Vered; Mandel, Dror; Shina, Avi; Kreiss, Yitshak; Zimlichman, Eyal
A survey conducted among Israel Defense Force primary care physicians in 2001 revealed that they consider patients' needs more than they do organizational needs and that the education PCPs currently receive is inadequate. In 2003 the medical corps initiated a multi-format continuous medical education program aimed at improving skills in primary care medicine. To measure and analyze the effect of the tailor-made CME program on PCPs' self-perception 3 years after its implementation and correlate it to clinical performance. In 2006 a questionnaire was delivered to a representative sample of PCPs in the IDF. The questionnaire included items on demographic and professional background, statements on self-perception issues, and ranking of roles. We compared the follow-up survey (2006) to the results of the original study (2001) and correlated the survey results with clinical performance as measured through objective indicators. In the 2006 follow-up survey PCPs scored higher on questions dealing with their perception of themselves as case managers (3.8 compared to 4.0 on the 2001 survey on a 5 point scale, P = 0.046), perceived quality of care and education (3.5 vs. 3.8, P = 0.06), and on questions dealing with organizational commitment (3.5 vs. 3.8, P = 0.01). PCPs received higher scores on clinical indicators in the later study (odds ratio 2.05, P < 0.001). PCPs in the IDF perceived themselves more as case managers as compared to the 2001 survey. A tailor-made CME program may have contributed to the improvement in skills and quality of care.
Kojola, Erik; Moen, Phyllis
Standard pathways for work and retirement are being transformed as the large Boomer cohort moves through typical retirement ages during a moment of economic, social and political change. People are delaying retirement and moving into and out of paid work as the standard lock-step retirement becomes less dominant. However, little research has explored how and why Boomers are taking on these diverse pathways in their later careers. Accordingly, we conduct in-depth interviews with working and retired white-collar Boomers, exploring how they are working and the meanings and motivations for their decisions and plans in their later careers. We find that there is no single dominant pattern for retirement, but rather a diverse mix of pathways shaped by occupational identities, finances, health and perceptions of retirement. Boomers express a desire to have control over their time and to find meaning and purpose in either paid or unpaid activities. However, life course transitions, normative cultural scripts, and gender and class locations as well as workplace and social policies constrain their decisions and plans. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Objectives: This research was administered with the aim of studying the relationship between retirement syndrome components with general health symptoms in retired adults in Esfahan city. Methods & Materials: This research carried out in descriptive and correlational method. Research statistical population was the retired adults in Esfahan city, among them, 461 persons for participating to research were selected using stratified random sampling, and then retirement syndrome questionnaire (helplessness and failure, older and idleness, trying and new direction and conflict and confusion and general health questionnaire (somatization, anxiety and insomnia, social dysfunction, and depression administered to them. Results: 1 Three components have predictive power for prediction of somatization, consisted of: helplessness and failure, older and idleness, trying and new directions, 2 for prediction of anxiety and insomnia, helplessness and failure, trying and new direction, older and idleness have significant predictive power, 3 For prediction of social dysfunction, helplessness and failure, and trying and new directions have significant predictive power, 4 For prediction of depression also, helplessness and failure and trying and new directions have significant predictive power. Conclusion: The finding of this research revealed that, helplessness and failure along with trying and new direction are the two components which must be considered in retired adults. Therefore, it is essential for this two dimensions established counseling centers related to retirement centers for helping retired adults.
Julie R. Agnew
Full Text Available Financial literacy and numeracy are closely tied. Furthermore, financial literacy has been shown to relate to important financial behaviors. This study examines the relationship between financial literacy and retirement planning using a measure that includes questions requiring numeracy. We implement a customized survey to a representative sample of 1,024 Australians. Overall, we find aggregate levels of financial literacy similar to comparable countries with the young, least educated, those not employed, and those not in the labor force most at risk. Our financial literacy measure is positively related to retirement planning in our sample.
Following a recommendation by the Standing Concertation Committee at its meeting on 27 November 2014 and approval by the Director-General, please note that: the Progressive Retirement Programme has been extended by one year, from 1 April 2015 until 31 March 2016; the Scheme of Part-Time Work as a Pre-retirement Measure has also been extended by one year, from 1 January 2015 until 31 December 2015. Further information is available at the following sites: https://admin-eguide.web.cern.ch/node/447 https://admin-eguide.web.cern.ch/node/484 Human Resources Department Tel. 79257 / 73903
Following a recommendation by the Standing Concertation Commitee at its meeting on 5 December 2013 and approval by the Director-General, please note that: the Progressive Retirement Programme has been extended by one year, from 1 April 2014 until 31 March 2015; the Scheme of Part-Time Work as a Pre-retirement Measure has also been extended by one year, from 1 January 2014 until 31 December 2014. Further information is available from the following sites: https://cern.ch/admin-eguide/retraite/proc_prp_fr.asp https://cern.ch/admin-eguide/retraite/proc_pTp_fr.asp Human Resources Department Tel. 79257/ 73903
Human Resources Department
Following recommendation by the Standing Concertation Committee and approval by the Director-General, please note that: the Progressive Retirement Programme has been extended by one year, from 1 April 2011 until 31 March 2012; and the Part-Time Work as a Pre-retirement Measure has also been extended by one year, from 1 January 2011 until 31 December 2011. Further information is available from the following sites: https://cern.ch/admin-eguide/retraite/proc_prp.asp https://cern.ch/admin-eguide/retraite/proc_pTp.asp Tel. 73903
Following recommendation by the Standing Concertation Committee at its meeting on 2 December 2011 and approval by the Director-General, please note that: the Progressive Retirement Programme has been extended by one year, from 1 April 2012 until 31 March 2013; and the Part-Time Work as a Pre-retirement Measure has also been extended by one year, from 1 January 2012 until 31 December 2012. Further information is available from the following sites: https://cern.ch/admin-eguide/retraite/proc_prp.asp https://cern.ch/admin-eguide/retraite/proc_pTp.asp Tel. 73903 Human Resources Department
Following a recommendation by the Standing Concertation Commitee at its meeting on 4 December 2012 and approval by the Director-General, please note that: the Progressive Retirement Programme has been extended by one year, from 1 April 2013 until 31 March 2014; and the Scheme of Part-Time Work as a Pre-retirement Measure has also been extended by one year, from 1 January 2013 until 31 December 2013. Further information is available from the following sites: https://cern.ch/admin-eguide/retraite/proc_prp_fr.asp https://cern.ch/admin-eguide/retraite/proc_pTp_fr.asp Human Resources Department Tel. 73903
22202-4302, and to the Office of Management and Budget , Paperwork Reduction Project (0704-0188) Washington DC 20503. 1. AGENCY USE ONLY (Leave...VALUE OF THE TSP ...........16 D. ELEMENTS OF RETIRE TOOL ANALYSIS .....................................18 1. Cash Flow Analysis...23 3. Cash Flow Comparison ...............................................................24 4. Volatility Analysis
D'Onofrio, Gail; Chawarski, Marek C; O'Connor, Patrick G; Pantalon, Michael V; Busch, Susan H; Owens, Patricia H; Hawk, Kathryn; Bernstein, Steven L; Fiellin, David A
Emergency department (ED)-initiated buprenorphine/naloxone with continuation in primary care was found to increase engagement in addiction treatment and reduce illicit opioid use at 30 days compared to referral only or a brief intervention with referral. To evaluate the long-term outcomes at 2, 6 and 12 months following ED interventions. Evaluation of treatment engagement, drug use, and HIV risk among a cohort of patients from a randomized trial who completed at least one long-term follow-up assessment. A total of 290/329 patients (88% of the randomized sample) were included. The followed cohort did not differ significantly from the randomized sample. ED-initiated buprenorphine with 10-week continuation in primary care, referral, or brief intervention were provided in the ED at study entry. Self-reported engagement in formal addiction treatment, days of illicit opioid use, and HIV risk (2, 6, 12 months); urine toxicology (2, 6 months). A greater number of patients in the buprenorphine group were engaged in addiction treatment at 2 months [68/92 (74%), 95% CI 65-83] compared with referral [42/79 (53%), 95% CI 42-64] and brief intervention [39/83 (47%), 95% CI 37-58; p < 0.001]. The differences were not significant at 6 months [51/92 (55%), 95% CI 45-65; 46/70 (66%) 95% CI 54-76; 43/76 (57%) 95% CI 45-67; p = 0.37] or 12 months [42/86 (49%) 95% CI 39-59; 37/73 (51%) 95% CI 39-62; 49/78 (63%) 95% CI 52-73; p = 0.16]. At 2 months, the buprenorphine group reported fewer days of illicit opioid use [1.1 (95% CI 0.6-1.6)] versus referral [1.8 (95% CI 1.2-2.3)] and brief intervention [2.0 (95% CI 1.5-2.6), p = 0.04]. No significant differences in illicit opioid use were observed at 6 or 12 months. There were no significant differences in HIV risk or rates of opioid-negative urine results at any time. ED-initiated buprenorphine was associated with increased engagement in addiction treatment and reduced illicit opioid use during the 2-month interval
Parshuram, Christopher S; Amaral, Andre C K B; Ferguson, Niall D; Baker, G Ross; Etchells, Edward E; Flintoft, Virginia; Granton, John; Lingard, Lorelei; Kirpalani, Haresh; Mehta, Sangeeta; Moldofsky, Harvey; Scales, Damon C; Stewart, Thomas E; Willan, Andrew R; Friedrich, Jan O
Shorter resident duty periods are increasingly mandated to improve patient safety and physician well-being. However, increases in continuity-related errors may counteract the purported benefits of reducing fatigue. We evaluated the effects of 3 resident schedules in the intensive care unit (ICU) on patient safety, resident well-being and continuity of care. Residents in 2 university-affiliated ICUs were randomly assigned (in 2-month rotation-blocks from January to June 2009) to in-house overnight schedules of 24, 16 or 12 hours. The primary patient outcome was adverse events. The primary resident outcome was sleepiness, measured by the 7-point Stanford Sleepiness Scale. Secondary outcomes were patient deaths, preventable adverse events, and residents' physical symptoms and burnout. Continuity of care and perceptions of ICU staff were also assessed. We evaluated 47 (96%) of 49 residents, all 971 admissions, 5894 patient-days and 452 staff surveys. We found no effect of schedule (24-, 16- or 12-h shifts) on adverse events (81.3, 76.3 and 78.2 events per 1000 patient-days, respectively; p = 0.7) or on residents' sleepiness in the daytime (mean rating 2.33, 2.61 and 2.30, respectively; p = 0.3) or at night (mean rating 3.06, 2.73 and 2.42, respectively; p = 0.2). Seven of 8 preventable adverse events occurred with the 12-hour schedule (p = 0.1). Mortality rates were similar for the 3 schedules. Residents' somatic symptoms were more severe and more frequent with the 24-hour schedule (p = 0.04); however, burnout was similar across the groups. ICU staff rated residents' knowledge and decision-making worst with the 16-hour schedule. Our findings do not support the purported advantages of shorter duty schedules. They also highlight the trade-offs between residents' symptoms and multiple secondary measures of patient safety. Further delineation of this emerging signal is required before widespread system change. ClinicalTrials.gov, no. NCT00679809. © 2015 Canadian Medical
What shapes the size of a personal network of family and friends? We concentrates here on the effect of retirement from the work force. Retirement provides time to develop personal relationships; but it deprives from a potential supply of colleague friends. We draw evidence from a new question on the number of confidants in the 4th wave of the Survey of Health, Ageing and Retirement in Europe. The survey allows to take into account many potential determinants of personal relations. A first re...
Tosh, Pritish K; Feldman, Henry; Christian, Michael D; Devereaux, Asha V; Kissoon, Niranjan; Dichter, Jeffrey R
During disasters, supply chain vulnerabilities, such as power, transportation, and communication, may affect the delivery of medications and medical supplies and hamper the ability to deliver critical care services. Disasters also have the potential to disrupt information technology (IT) in health-care systems, resulting in interruptions in patient care, particularly critical care, and other health-care business functions. The suggestions in this article are important for all of those involved in a large-scale pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The Business and Continuity of Operations Panel followed the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology in developing key questions regarding medication and supply shortages and the impact disasters may have on healthcare IT. Task force members met in person to develop the 13 key questions believed to be most relevant for Business and Continuity of Operations. A systematic literature review was then performed for relevant articles and documents, reports, and gray literature reported since 2007. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Eighteen suggestions addressing mitigation strategies for supply chain vulnerabilities including medications and IT were generated. Suggestions offered to hospitals and health system leadership regarding medication and supply shortages include: (1) purchase key medications and supplies from more than one supplier, (2) substituted medications or supplies should ideally be similar to those already used by an institution's providers, (3) inventories should be tracked electronically to monitor medication/supply levels, (4) consider higher inventories of medications
Trexler, Eric T; Smith-Ryan, Abbie E; Defreese, J D; Marshall, Stephen W; Guskiewicz, Kevin M; Kerr, Zachary Y
Elevated rates of cardiometabolic diseases have been observed in former American football players. The current study sought to determine whether change in body mass index (ΔBMI) after retirement influences the prevalence of CHD, diabetes, or high blood pressure (HBP) in former professional football players. Retired professional football players (n = 3729) were sent a survey with questions regarding health status, playing history, and demographic information. Self-reported BMI at the time of retirement was subtracted from current self-reported BMI to calculate ΔBMI. Prevalence of CHD, diabetes, and HBP were determined by asking participants if they had ever been diagnosed by a health care professional. Binomial regression with a Poisson residual and robust variance estimation was used to compute crude prevalence ratios (PR) and 95% confidence intervals (CI) for each outcome. Adjusted PR values were calculated by adjusting for BMI at the time of retirement, age, years of football experience, race, exercise habits, alcohol use, steroid history, smoking history, and playing position. Complete data were available for 2062 respondents. Prevalence of CHD increased 25%-31% for each five-point increase in ΔBMI after retirement (crude PR = 1.25, 95% CI = 1.03-1.52, P = 0.026; adjusted PR = 1.31, 95% CI = 1.11-1.55, P = 0.001). Diabetes prevalence increased 69%-88% for each five-point ΔBMI increase (crude = 1.88, 95% CI = 1.45-2.44, P football players.
Zick, Cathleen D; Mayer, Robert N; Smith, Ken R
Retirement confidence is a key social barometer. In this article, we examine how personal and parental health histories relate to working-age adults' feelings of optimism or pessimism about their overall retirement prospects. This study links survey data on retirement planning with information on respondents' own health histories and those of their parents. The multivariate models control for the respondents' socio-demographic and economic characteristics along with past retirement planning activities when estimating the relationships between family health histories and retirement confidence. Retirement confidence is inversely related to parental history of cancer and cardiovascular disease but not to personal health history. In contrast, retirement confidence is positively associated with both parents being deceased. As members of the public become increasingly aware of how genetics and other family factors affect intergenerational transmission of chronic diseases, it is likely that the link between family health histories and retirement confidence will intensify. © The Author(s) 2015.
Cristiane Pimentel Nalin
Full Text Available The increase in the elderly population has prompted research on retirement. This study investigated the importance of resilience, economic satisfaction, the length of retirement, and planning to well-being during retirement of 270 participants. The majority of this sample were men (64%, and the mean age was 65 years (SD = 5.7. The participants were retired members of 10 public and private organizations in Rio de Janeiro. Factor analysis and hierarchical regression were performed. The results showed that determined resilience (mastery, adaptability, confidence and perseverance and socioeconomic satisfaction were the main predictors of well-being in retirement and explained 28% of this model. The findings suggest that well-being in retirement is closely related to socioeconomic satisfaction and determined resilience. Additional research should address the importance of resilience for the well-being of retirees who are or not members of retirement associations. Resilience attitudes should be promoted in Retirement Education Programs.
Leder, Steven B; Suiter, Debra M; Agogo, George O; Cooney, Leo M
United States census data project dramatic increases in the geriatric population ageing demographics by 2060 with concomitant health-care consequences. The purpose of this replication and continuation study was to collect new 2014 demographic data relative to ageing, swallow evaluation referral rates, and oral feeding status in geriatric-hospitalized patients for comparison with published data from 2000 to 2007. This was a planned data acquisition study of consecutive hospitalized patients referred for swallow assessments. Swallow evaluation referral rates for 2014 were described according to inpatient discharges, age range 60-105 years grouped by decade, gender, admitting diagnostic category, results of swallow evaluations, and oral feeding status. Determination of aspiration risk status was made with the Yale Swallow Protocol and diagnosis of dysphagia made with fiberoptic endoscopic evaluation of swallowing (FEES). There were 1348 referrals and 961 patients ≥60 years of age participated. Overall swallow evaluation referral rates increased an average of 63 % between the comparison years 2007 and 2014 with consistent increases corresponding to the decades, i.e., 60-69 (46 %), 70-79 (68 %), 80-89 (53 %), and 90+ (222 %). A total of 75 % of participants resumed oral alimentation and oral medications. Swallow evaluation referral rates increased by 63 % for 60-90+ year-old acute care geriatric-hospitalized participants despite only a 23 % increase in inpatient discharges for the years 2007 versus 2014. This corroborated previously reported increases for individual years from 2000 to 2007. For timely, safe, and successful initiation of oral alimentation, it is important to perform a reliable swallow screen for aspiration risk assessment with the Yale Swallow Protocol and, if failed, instrumental testing with FEES. More dysphagia specialists are needed through 2060 and beyond due to projections of continued population ageing resulting in ever increasing
Menahem, Sasson; Shvartzman, Pesach
The purpose of this study was to evaluate safety, feasibility, and efficacy of continuous drug delivery by the subcutaneous route through a solution bag connected to an infusion set compared with an infusion pump in a home palliative care setting. Patients in need of continuous subcutaneous medication delivery for pain control, nausea, and/or vomiting were recruited. The study was designed as a double-blind, crossover study. The patient was connected to two parallel subcutaneous lines running simultaneously, connected together to a line entering the subcutaneous tissue. One line is connected to an infusion set and the other to a pump. The infusion set included a 500-cc solution bag connected to a 1.5-m plastic tube containing a drip chamber controlled by a roller clamp that is gravity driven without hyaluronidase. Active medications were randomly assigned to start in either administration method and switched after 24 h. An independent research assistant evaluated symptom control and side effects at baseline and every 24 h for 2 days using a structured questionnaire. Another independent research assistant connected the lines after adding medications and evaluated technical and clinical failures. Twenty-seven patients were recruited, and of them, 18 completed the study. Incidents in fluid administration were more common through the infusion set (18 times) compared to the pump (only twice). On the other hand, no clinical significant change was noted in the average symptom levels and side effects when medications were given through the infusion set versus the pump. No local edema or irritation was observed in either way of administration. In a home palliative care setting with a medical staff on call for 24 h, using medications for symptom control can be considered to be infused to a fluid solution bag through an infusion set instead of using a syringe driver or a pump when there is a responsible caregiver to follow up on the fluid. Subcutaneous constant drug delivery
Sewdas, Ranu; de Wind, Astrid; van der Zwaan, Lennart G L; van der Borg, Wieke E; Steenbeek, Romy; van der Beek, Allard J; Boot, Cécile R L
The aims of the present study were to: 1) gain insight into reasons for working beyond the statutory retirement age from older workers' perspectives, and 2) explore how the domains of the research framework Study on Transitions in Employment, Ability and Motivation (STREAM) can be applied to working beyond retirement age. A qualitative research design included individual interviews (n = 15) and three focus groups (n = 18 participants) conducted with older workers aged 65 years and older continuing in a paid job or self-employment. Interview participants were recruited from an existing STREAM cohort study. Focus group participants were recruited from companies and employment agencies. The data were subjected to thematic analysis. The most important motives for working beyond retirement age were maintaining daily routines and financial benefit. Good health and flexible work arrangements were mentioned as important preconditions. The themes emerging from the categorization of the motives and preconditions corresponded to the domains of health, work characteristics, skills and knowledge, and social and financial factors from the STREAM research framework. However, our analysis revealed one additional theme-purpose in life. This study offers important new insights into the various preconditions and motives that influence working beyond retirement age. In addition, the five domains of the STREAM research framework, including the additional domain of 'purpose in life', seem to be applicable to working beyond retirement age. This knowledge contributes to the development of work-related interventions that enhance older workers' motivation to prolong their working lives.
Topa, Gabriela; Lunceford, Gregg; Boyatzis, Richard E.
Retirement is a time of life that has grown ever longer in the developed world, and the number of pensioners has increased accordingly, questioning the strength of Social Security systems and the social safety net in general. Financial Planning for Retirement (FRP) consists of the series of activities involved in the accumulation of wealth to cover needs in the post-retirement stage of life. The negative short-, mid-, and long-term consequences of inadequate Financial Planning for Retirement do not only affect individuals, but also their extended families, homes, eventually producing an unwanted impact on the entire society. The Capacity-Willingness-Opportunity Model has been proposed to understand FPR, combined with Intentional Change Theory, a framework for understanding the process, antecedents and consequences of FPR. From this perspective, we propose this promising model, but there are a large number of variables that have not been included that offer novel ways to deepen our understanding of FPR. A focus on each dimension of the model, the role of age and psychosocial variables associated with demographic indicators such as gender, health status, and migration, allow us to provide a proposal of scientific advancement of FPR. PMID:29416519
Michinov, Estelle; Fouquereau, Evelyne; Fernandez, Anne
The purpose of this study was to examine the structure of retirees' social identity and its impact on satisfaction with retirement. From social identity theory formulations, we assumed that (1) retiree-identity was comprised of three distinct components (cognitive, evaluative, and affective), and (2) only the affective component would play a role…
It states that as one moves near retirement, one should calculate his or her net worth, invest in human capital, slow down strenuous activities and start a familiar business and learn to manage it. It suggests some sources of money to start some income generating ventures .It encourages employees to plan to build functional ...
Full Text Available Retirement is a time of life that has grown ever longer in the developed world, and the number of pensioners has increased accordingly, questioning the strength of Social Security systems and the social safety net in general. Financial Planning for Retirement (FRP consists of the series of activities involved in the accumulation of wealth to cover needs in the post-retirement stage of life. The negative short-, mid-, and long-term consequences of inadequate Financial Planning for Retirement do not only affect individuals, but also their extended families, homes, eventually producing an unwanted impact on the entire society. The Capacity-Willingness-Opportunity Model has been proposed to understand FPR, combined with Intentional Change Theory, a framework for understanding the process, antecedents and consequences of FPR. From this perspective, we propose this promising model, but there are a large number of variables that have not been included that offer novel ways to deepen our understanding of FPR. A focus on each dimension of the model, the role of age and psychosocial variables associated with demographic indicators such as gender, health status, and migration, allow us to provide a proposal of scientific advancement of FPR.
Montizaan, R.M.; de Grip, A.; Fouarge, D.
This paper investigates whether employers can induce employees to postpone retirement by offering access to training courses that maintain job proficiency. We use unique, matched employer-employee surveys for the Dutch public sector, which include detailed information on a wide range of HR practices
Topa, Gabriela; Lunceford, Gregg; Boyatzis, Richard E
Retirement is a time of life that has grown ever longer in the developed world, and the number of pensioners has increased accordingly, questioning the strength of Social Security systems and the social safety net in general. Financial Planning for Retirement (FRP) consists of the series of activities involved in the accumulation of wealth to cover needs in the post-retirement stage of life. The negative short-, mid-, and long-term consequences of inadequate Financial Planning for Retirement do not only affect individuals, but also their extended families, homes, eventually producing an unwanted impact on the entire society. The Capacity-Willingness-Opportunity Model has been proposed to understand FPR, combined with Intentional Change Theory, a framework for understanding the process, antecedents and consequences of FPR. From this perspective, we propose this promising model, but there are a large number of variables that have not been included that offer novel ways to deepen our understanding of FPR. A focus on each dimension of the model, the role of age and psychosocial variables associated with demographic indicators such as gender, health status, and migration, allow us to provide a proposal of scientific advancement of FPR.
... accumulated benefit under the plan is expressed in terms of only one safe-harbor formula measure and no... expressed in terms of any measure other than that same safe- harbor formula measure. Thus, for example, if a... expressed under the terms of the plan as a life annuity payable at normal retirement age (or current age, if...
Archibald, Douglas; Liddy, Clare; Lochnan, Heather A; Hendry, Paul J; Keely, Erin J
Continuing professional development (CPD) offerings should address the educational needs of health care providers. Innovative programs, such as electronic consultations (eConsults), provide unique educational opportunities for practice-based needs assessment. The purpose of this study is to assess whether CPD offerings match the needs of physicians by coding and comparing session content to clinical questions asked through eConsults. This study analyzes questions asked by primary care providers between July 2011 and January 2015 using a service that allows specialists to provide consultation over a secure web-based server. The content of these questions was compared with the CPD courses offered in the area in which these primary care providers are practicing over a similar period (2012-2014). The clinical questions were categorized by the content area. The percentage of questions asked about each content area was calculated for each of the 12 specialties consulted. CPD course offerings were categorized using the same list of content areas. Percentage of minutes dedicated to each content area was calculated for each specialty. The percentage of questions asked and the percentage of CPD course minutes for each content area were compared. There were numerous congruencies and discrepancies between the proportion of questions asked about a given content area and the CPD minutes dedicated to it. Traditional needs assessment may underestimate the need to address topics that are frequently the subject of eConsults. Planners should recognize eConsult questions as a valuable source of practice-associated challenges that can identify professional development needs of physicians.
Beshears, John Leonard; Choi, James J.; Hurwitz, Joshua Bayard; Laibson, David I.; Madrian, Brigitte
What is the socially optimal level of liquidity in a retirement savings system? Liquid retirement savings are desirable because liquidity enables agents to flexibly respond to pre-retirement events that raise the marginal utility of consumption. On the other hand, pre-retirement liquidity is undesirable when it leads to under-saving arising from, for example, planning mistakes or self-control problems. This paper compares the liquidity that six developed economies have built into their employ...
Monika Bütler; Olivia Huguenin; Federica Teppa
Early retirement is predominantly considered as the result of incentives set by social security and the tax system. But people seem to retire early even in the absence of such distortions as the Swiss example demonstrates. We look for determinants of early retirement, in particular the role of lifetime income and family status, using individual data from a selection of Swiss pension funds. Our findings suggest that affordability is a key determinant in retirement decisions: More affluent men,...
Sarnat, Harvey B
Many academic neurologists and neuropathologists who retire at the peak of their careers continue to be productive in research and teaching, enhanced by years of experience and mature perspective. The early 20th-century model of institutions depending upon the generosity of such individuals to donate their time and efforts without proper recognition or compensation, despite the service, prestige, and recognition they bring to their institutions, should be reconsidered in the early 21st century in the context of fairness, honesty, dignity, and increased longevity. University pensions do not distinguish retirees who continue to contribute from those who stop working. This essay represents the author's personal reflections and experience, reinforced by similar thoughts and encouragement by numerous distinguished colleagues named at the end of the text. Funding of stipends for active emeritus professors lacks precedent but should be sought. © 2018 American Academy of Neurology.
Leandro-Franca, Cristineide; Van Solinge, Hanna; Henkens, Kene; Murta, Sheila Giardini
Studies on the effectiveness of retirement planning programs are relatively scarce. Retirement preparation and planning programs may assist individuals to smooth the transition to retirement and subsequent adjustment. This qualitative study examines the effects of three retirement preparation
Human Resources Department
Following discussion at the Standing Concertation Committee at its meeting on 8 November 2004, the Director-General has approved the extension of the Progressive Retirement Programme with effect from 1 April 2005 until 31 March 2006; of the Part-time work scheme as a pre-retirement measure with effect from 1 January 2005 until 31 December 2005. Human Resources Department Tel. 72808/74128
Following discussion at the Standing Concertation Committee at its meeting on 25 January 2006, the Director-General has approved the extension of the Progressive Retirement Programme with effect from 1 April 2006 until 31 March 2007; of the Part-time work scheme as a pre-retirement measure for the year 2006, i.e. until 31 December 2006. Human Resources Department Tel. 72808/74128
Upon the proposal of the Standing Concertation Committee at its meeting on 25 November 2002, the Director-General has approved the extension for one year of the Progressive Retirement Programme with effect from 1 April 2003, and of the Part-time work scheme as a pre-retirement measure for requested effective dates commencing not later than 1 January 2004. Human Resources Division Tel. 72808/74128
Gubata, Marlene E; Packnett, Elizabeth R; Cowan, David N
Surveillance of trends in disability is necessary to determine the burden of disability on the U.S. military, the most common types of disability conditions, and the prevalence of combat exposures in the disability population. Previous studies of disability in the U.S. military have focused on a particular service or condition rather than examining the epidemiology of disability in the military overall. This study's objective is to describe rates of disability evaluation and retirement in U.S. Army, Navy, and Marine Corps. A cross-sectional study of 126,170 service members evaluated for disability discharge from the U.S. military in fiscal years 2005-2011 was conducted. Crude and standardized rates of disability evaluation and retirement were calculated per 10,000 service members by year of disability, demographic characteristics, and type of disability evaluation or retirement. Temporal trends in the prevalence of combat-related disability in the disability evaluated and retired population were also examined. Rates of disability evaluation and retirement were highest among female, enlisted, and active duty service members. Overall rates of disability evaluation significantly decreased, while rates of disability retirement increased. Rates of psychiatric disability evaluation and retirement significantly increased in all services during the same time period from 2005 to 2011. Combat-related disability evaluations and retirements have substantially increased in all services particularly among psychiatric disability cases. Psychiatric disability, combat-related disability, and disability retirement continue to increase in the military, despite observed decreases in the rates of disability the Department of Defense since 2005. Published by Elsevier Inc.
Full Text Available Abstract Background Longitudinal studies on physical activity patterns around retirement age are scarce and provide divergent findings. Little is known about changes in sedentary behaviour in this context. Our aim was to investigate relationships between retirement and 3-year changes in leisure-time physical activity (LTPA patterns and sedentary behaviour in middle-aged French adults. Methods Past-year LTPA and sedentary behaviour (watching television were assessed in 1998 and 2001 using the Modifiable Activity Questionnaire on participants in the SU.VI.MAX (Supplementation with Antioxidants and Minerals study. A total of 698 men and 691 women aged 45-64 were included in this analysis. Comparisons were made between subjects who had retired between 1998 and 2001 and those who continued to work, using the Chi-square test, Student t-test, Wilcoxon rank test or covariance analysis where appropriate. Results 20.1% of men and 15.6% of women retired during follow-up. The baseline LTPA level was similar between subjects who retired during follow-up and those who continued to work. Mean LTPA increased by about 2 h/week in men and women who had retired, whereas no change was observed in employed persons. The positive change in LTPA following retirement was mainly related to an increase in activities of moderate intensity, such as walking. Retirement did not modify the ranking of the most frequently performed LTPAs, but the number of participants and the duration increased through retirement. In men, the increase in time spent watching TV was more than twice as high in retirees as in workers (+40.5 vs. +15.0 min/day, P Conclusions Retirement was associated with both an increase in LTPAs and in time spent watching TV, suggesting that retirement is an important period not only for promoting physical activity, but also for limiting sedentary behaviour.
... mandatory retirement age); (2) early optional retirement eligibility; (3) enhanced annuity provisions (to... barred from reemployment in any position except a primary position after age 60. Service by a reemployed... Act provides early retirement and enhanced annuity benefits for customs and border protection officers...
... that gender does not constitute a barrier in the adult lives in retirement. The study concluded that retirement education is a panacea for positive crisis-free retirement life. It was recommended that counselors should emphasize the need for retirees to understand the factors capable of causing stress and broken homes.
Asseldonk, van M.A.P.M.; Veen, van der H.B.; Meulen, van der H.A.B.
– In self‐directed retirement plans, farmers are responsible for selecting the types of risky investments toward which the funds in their retirement plan are allocated. Furthermore, farmers do not necessarily purchase sufficient annuities with their savings upon retirement. There is
O'Connor, Lisa G.
This exploratory study examines the information seeking and use behaviors of a group of US retired or near-retirement investors from everyday life information seeking and serious leisure perspectives. Although primarily qualitative, it also collects and analyzes quantitative data to describe retired investors' information preferences and use.…
This study examined how retirement planning information search was related to retirement savings of working women. By controlling for sociodemographic variables, the study further explored factors associated with individual information sources for retirement planning. An online survey was developed to collect data from a national population,…
Price, Christine A.; Balaswamy, Shantha
Despite empirical support for the positive effects of health and wealth on retirement satisfaction, alternative variables also play a key role in helping to shape women's assessment of retirement. In the present study, we explore personal and psychosocial predictors of women's retirement satisfaction while controlling for financial security and…
... 7 Agriculture 12 2010-01-01 2010-01-01 false Extraordinary retirement losses. 1773.41 Section 1773... Documentation § 1773.41 Extraordinary retirement losses. The CPA's workpapers must contain an analysis of retirement losses, including any required approval by a regulatory commission with jurisdiction in the matter...
Keele, Shanna; Alpert, Patricia T
This integrative literature review examined the current research on RN retirement. The review identified 3 critical gaps in knowledge: (a) minimal knowledge regarding the economic impact on RN retirement, (b) incomplete information regarding the demographics of RN retirement, and (c) a scarcity of prospective longitudinal RN workforce studies. Future research must address these gaps to better address RN workforce sustainability.
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Marriage after retirement. 19.10-3 Section 19... PARTICIPANTS IN THE FOREIGN SERVICE RETIREMENT AND DISABILITY SYSTEM § 19.10-3 Marriage after retirement. If an... marriage irrevocably elect to receive a reduced annuity and to provide, subject to any obligation to...
.... It demonstrates that the inequity of the military retirement system is compounded by the fact that although the system does not comply with the minimum standards required of private-sector retirement...
Bertoni, Marco; Brunello, Giorgio; Mazzarella, Gianluca
By increasing the residual working horizon of employed individuals, pension reforms that raise minimum retirement age are likely to affect the returns to investments in healthpromoting behaviours before retirement, with consequences for individual health. Using the exogenous variation in minimum
Davies, E.M.M.; Heijden, B.I.J.M. van der; Flynn, M.
In the contemporary workplace, insight into retirement behaviors is of crucial importance. Previous empirical evidence has found mixed results regarding the relationship between work attitudes, such as job satisfaction, and retirement behaviors, suggesting that further scholarly examination
Silver, Michelle Pannor; Williams, Sarah A
Some professions foster expectations that individuals cultivate their work identity above all other aspects of life. This can be problematic when individuals are confronted with the expectation that they will readily terminate this identity in later-career stages as institutions seek to cycle in new generations. This study examines the relationship between work identity and retirement by examining multiple generations of academic physicians. This study used a multimethod qualitative design that included document analysis, participant observation, focus groups, and in-depth interviews with academic physicians from one of the oldest departments of medicine in North America. This study illustrates how participants were predisposed and then groomed through institutional efforts to embrace a career trajectory that emphasized work above all else and fostered negative sensibilities about retirement. Participants across multiple generations described a lack of work-life balance and a prioritization of their careers above nonwork commitments. Assertions that less experienced physicians were not as dedicated to medicine and implicit assumptions that later-career physicians should retire emerged as key concerns. Strong work identity and tensions between different generations may confound concerns about retirement in ways that complicate institutional succession planning and that demonstrate how traditional understandings of retirement are out of date. Findings support the need to creatively reconsider the ways we examine relations between work identity, age, and retirement in ways that account for the recent extensions in the working lives of professionals.
Full Text Available Introduction: Chronic patient care causes some problems, including pressure or burden of care, reducing the time for routine activities and self care, also causes compatibility decline in deal with stress and disorders of physical and mental health, emotional, social and financial prosperity of caregivers. The aim of this study was to determine the effect of continuous care model on social health status of family caregivers in patients underwent coronary artery bypass surgeries. Methods: This study was one-group clinical trial research, the samples consisted 48 family caregiver of the patients underwent coronary artery bypass graft surgeries, who were selected using purposive sampling method. Data collection tools included the standard questionnaire Data collection tool was Novak and Guest caring burden inventory (CBI s as well as demographic questionnaire, which was measured at the baseline and 8 weeks after intervention. Data were analyzed using descriptive and analytic statistic (paired t-test, and covariance analysis with SPSS version 16. Results: The mean score of caring burden realated to the social health status before intervention was 3.86±6.11 and after intervention was 1.81±2.33. In examining five dimensions burden of care, continuous care model had an impact on all aspects of the caring burden and it led to the reduction of the burden of care in all aspects. So, it had a significant decrease in the social health status (p <0.01. Conclusion: Implementation of continuous care model as the intervention of cheaper and available, can be an effective step inreducing the burden of care of the patients with coronary artery disease in health status of social.
de Wind, Astrid; Scharn, Micky; Geuskens, Goedele A; van der Beek, Allard J; Boot, Cécile R L
An increasing number of retirees continue to work beyond retirement despite being eligible to retire. As the prevalence of chronic disease increases with age, working beyond retirement may go along with having a chronic disease. Working beyond retirement may be different for retirees with and without chronic disease. We aim to investigate whether demographic, socioeconomic and work characteristics, health and social factors predict working beyond retirement, in workers with and without a chronic disease. Employees aged 56-64 years were selected from the Study on Transitions in Employment, Ability and Motivation (N = 1125). Questionnaire data on demographic and work characteristics, health, social factors, and working beyond retirement were linked to registry data from Statistics Netherlands on socioeconomic characteristics. Separate prediction models were built for retirees with and without chronic disease using multivariate logistic regression analyses. Workers without chronic disease were more likely to work beyond retirement compared to workers with chronic disease (27% vs 23%). In retirees with chronic disease, work and health factors predicted working beyond retirement, while in retirees without a chronic disease, work, health and social factors predicted working beyond retirement. In the final model for workers with chronic disease, healthcare work, better physical health, higher body height, lower physical load and no permanent contract were positively predictive of working beyond retirement. In the final model for workers without chronic disease, feeling full of life and being intensively physically active for > = 2 days per week were positively predictive of working beyond retirement; while manual labor, better recovery, and a partner who did not support working until the statutory retirement age, were negatively predictive of working beyond retirement. Work and health factors independently predicted working beyond retirement in workers with and
Chalermsri, Chalobol; Paisansudhi, Supalerg; Kantachuvesiri, Pitchaporn; Pramyothin, Pornpoj; Washirasaksiri, Chaiwat; Srivanichakorn, Weerachai; Nopmaneejumruslers, Cherdchai; Chouriyagune, Charoen; Pandejpong, Denla; Phisalprapa, Pochamana
Diabetes mellitus is one of the most common diseases in the Thai population, and it is well known that diabetic complications could be prevented with appropriate management. Despite published guidelines, most Thai patients with diabetes do not achieve treatment goals. Siriraj Continuity of Care clinic (CC clinic) was recently established in order to provide training for medical students and internal medicine residents. It is possible that the training component in the CC clinic may contribute to better overall outcomes in type 2 diabetes mellitus (type 2 DM) patients when compared with usual care at the medical out-patient department (OPD). To compare the effectiveness of diabetic management in type 2 diabetes mellitus patients who attended the CC clinic and the medical OPD. Retrospective chart review was performed in type 2 diabetes mellitus patients who were treated at either clinic at Siriraj Hospital in 2007-2011. Baseline demographics, treatment strategies and outcomes, and participation in an appropriate health maintenance program were assessed in both groups. Seven hundred and fifty seven medical records were reviewed, including 383 patients in the CC clinic group and 374 in the OPD group. Mean HbA1c was significantly lower in the CC clinic group compared with the OPD group (7.3 +/- 0.9% and 7.8 +/- 1.3%, respectively, < 0.001). The number of patients who achieved goal HbA1c of less than 7% in CC clinic group was 123 (32.1%) compared with 91 (24.3%) in the OPD group (p = 0.039). More patients were screened for diabetic complications in the CC clinic group compared with the OPD group, including screening for diabetic neuropathy (57.4% vs. 2.1%, p < 0.001), diabetic retinopathy (56.7% vs. 36.6%, p < 0.001), and diabetic nephropathy (80.9% vs. 36.9%, p < 0.001). Patients in the CC clinic group had a higher rate of age-appropriate cancer screening than those in the OPD group (54.2% vs. 13.3%, p < 0.001 for breast cancer; 24.0% vs. 0.9%, p < 0.001 for cervical
Cosin-Sales, J; Orozco Beltrán, D; Ledesma Rodríguez, R; Barbon Ortiz Casado, A; Fernández, G
To determine the perception of Primary Care (PC) physicians on the integration with cardiology (CA) through continuity of healthcare programs. A cross-sectional and multicentre study was conducted, in which a total of 200 PC physicians from all over Spain completed a qualitative survey that evaluated the level of integration with CA in secondary prevention. Physicians were grouped according to the level of PC-CA integration. The integration between CA and PC was good, but it was better in those centres with a higher integration (74.0% vs. 60.0%; p=.02) and in general, physicians considered that integration had improved (92.0% vs. 73.0%; pintegration. In 55.8%, 63.6%, and 51.3% of hospital discharge reports, indications were given on when to perform the follow-up blood analysis, as well as information about returning to working life and sexual activity, respectively. The most common communication method was the paper-based report (75 vs. 84%; p=NS). The communication between healthcare levels was greater in those Primary Care centres with a higher level of integration, as well as periodicity of the communication and the satisfaction of physicians (80.0% vs. 63.0%; p=.005). The level of integration between PC and CA is, in general, satisfactory, but those centres with a higher level of integration benefit more from a greater communication and satisfaction. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
Morimura, Naruki; Idani, Gen'ichi; Matsuzawa, Tetsuro
This article specifically examines several aspects of the human-captive chimpanzee bond and the effort to create the first chimpanzee sanctuary in Japan. We discuss our ethical responsibility for captive chimpanzees that have been used in biomedical research. On April 1, 2007, the Chimpanzee Sanctuary Uto (CSU) was established as the first sanctuary for retired laboratory chimpanzees in Japan. This initiative was the result of the continuous efforts by members of Support for African/Asian Great Apes (SAGA), and the Great Ape Information Network to provide a solution to the large chimpanzee colony held in biomedical facilities. However, the cessation of invasive biomedical studies using chimpanzees has created a new set of challenges because Japan lacks registration and laws banning invasive ape experiments and lacks a national policy for the life-long care of retired laboratory chimpanzees. Therefore, CSU has initiated a relocation program in which 79 retired laboratory chimpanzees will be sent to domestic zoos and receive life-long care. By the end of 2009, the number of chimpanzees living at CSU had decreased from 79 to 59 individuals. A nationwide network of care facilities and CSU to provide life-long care of retired laboratory chimpanzees is growing across Japan. This will result in humane treatment of these research animals. 2010 Wiley-Liss, Inc.
Chao, Chien-Ming; Lai, Chih-Cheng; Chan, Khee-Siang; Cheng, Kuo-Chen; Ho, Chung-Han; Chen, Chin-Ming; Chou, Willy
We conduct a retrospective study of patients with unplanned extubation (UE) in adult intensive care units (ICU) at a medical center. In 2001, a multidisciplinary team of intensivists, senior residents, nurses, and respiratory therapists was established at Chi Mei Medical Center. The improvement interventions, implemented between 2001 and 2015, were organized around 8 key areas: standardizing procedures, improving communication skills, revising sedation and weaning protocols, changing strategies for restraints, establishing a task force for identifying and managing high-risk patients, using new quality-improvement models as breakthrough series and team resource management, using the strategy of accountability without assigning blame, and changing a new method to secure endotracheal tube. We measured the outcome as the annual event and the rate of UE. During this 15-year period, there were 1404 episodes of UE, with 44,015 episodes of mechanical ventilation (MV) (319,158 ventilator-days). The overall rate of UE was 3.19/100 ventilated patients (4.40/1000 ventilator-days). In 2001, there were 188 episodes of UE and the rate of UE was 6.82/100 ventilated patients or 9.0/1000 ventilator-days. After this continue quality improvement project had been implemented, the annual number of episodes of UE declined to 27, and the rate fell to 0.95/100 ventilated patients or 1.36/1000 ventilator-days in 2015. Overall, the trend analysis showed the change was significant with P continuously and effectively reduced using multidisciplinary and sequential quality improvement interventions.
Helder, Onno K; van Goudoever, Johannes B; Hop, Wim C J; Brug, Johannes; Kornelisse, René F
Good hand hygiene compliance is essential to prevent nosocomial infections in healthcare settings. Direct observation of hand hygiene compliance is the gold standard but is time consuming. An electronic dispenser with built-in wireless recording equipment allows continuous monitoring of its usage. The purpose of this study was to monitor the use of alcohol-based hand rub dispensers with a built-in electronic counter in a neonatal intensive care unit (NICU) setting and to determine compliance with hand hygiene protocols by direct observation. A one-year observational study was conducted at a 27 bed level III NICU at a university hospital. All healthcare workers employed at the NICU participated in the study. The use of bedside dispensers was continuously monitored and compliance with hand hygiene was determined by random direct observations. A total of 258,436 hand disinfection events were recorded; i.e. a median (interquartile range) of 697 (559-840) per day. The median (interquartile range) number of hand disinfection events performed per healthcare worker during the day, evening, and night shifts was 13.5 (10.8 - 16.7), 19.8 (16.3 - 24.1), and 16.6 (14.2 - 19.3), respectively. In 65.8% of the 1,168 observations of patient contacts requiring hand hygiene, healthcare workers fully complied with the protocol. We conclude that the electronic devices provide useful information on frequency, time, and location of its use, and also reveal trends in hand disinfection events over time. Direct observations offer essential data on compliance with the hand hygiene protocol. In future research, data generated by the electronic devices can be supplementary used to evaluate the effectiveness of hand hygiene promotion campaigns.
Madland, David; Rowell, Alex
Policymakers need to act to protect Americans' retirement security. A significant portion of Americans are at risk of not being able to maintain their standard of living in retirement and research suggests that this percentage is likely to grow. This commentary provides background on the current state of American retirement, highlights recent efforts to reform retirement policy, and predicts what to expect under President Donald Trump. Retirement has not been a major focus of national policymakers in recent years. Early actions during the Trump administration to undo Obama administration policies may make it more difficult for individuals to save for retirement. While it is impossible to predict the future with any certainty, long standing trends and recent political developments suggest that major action will not be taken during the Trump presidency to boost retirement security.
Full Text Available Abstract Background The Australian dental workforce is ageing and current shortages have been predicted to worsen with the retirement of the growing contingent of older dentists. However, these predictions have been based on retirement trends of previous generations and little is known about the retirement intentions of today's older dentists. Methods The Dentist Retirement Intentions Survey was mailed to 768 NSW Australian Dental Association members aged over 50 and achieved a response rate of 20%. T-tests, ANOVAs and multivariate regression were used to analyse the data. Results On average, participants intend to retire at the age of 66, although they would prefer to do so earlier (p Conclusions The current generation of older dentists intends to retire later than their predecessors. Most wish to remain involved in dentistry in some capacity following retirement, and may assist in overcoming workforce shortages, either by practising part time or training dental students.
Jack M. Mintz
Full Text Available The 2008-2009 economic crisis dealt a serious blow to Canadians’ retirement savings. While markets have since partially recovered, the ratio of Canadians’ household net-worth relative to disposable income still remains below where it was in 2007. So much wealth that workers had accumulated to prepare for retirement has been wiped away, while the years since 2008 that might have otherwise been spent compounding retirement savings have been spent, instead, on trying to recover losses in a low-interest-rate environment that has limited returns. With large waves of older workers approaching retirement age, and these future retirees projected to live longer than previous cohorts, Canada now faces the very realistic scenario that a significant number of people will reach retirement age without the funds they will need to provide a comfortable post-working-life income. Canadian policy-makers may not have the ability to restore that destroyed wealth. And with most governments already struggling to resolve serious deficits, the situation is not likely to be ameliorated with anything that requires additional spending, or that could reduce tax revenues. But there are policy reforms available that can help at least in better preparing the coming waves of retirees for a financially secure retirement. The reforms need not be far-reaching to have a meaningful impact. And they need not be costly, either. They can include a modest expansion of the Canada Pension Plan (CPP to allow larger contributions — shared by employers and employees, or covered entirely by employees — that would, in turn, allow retiring workers to draw a larger maximum pension, rather than having to rely on the guaranteed income supplement (GIS. CPP contributions could also be made deductible from taxable income, like RRSP investments, to encourage workers to maximize contributions. To minimize an increase in payroll taxes, the eligibility age for CPP benefits could be increased to
Bingley, Paul; Datta Gupta, Nabanita; Jørgensen, Michael
There are large differences in labor force participation rates by health status. We examine to what extent these differences are determined by the provisions of Disability Insurance and other pension programs. Using administrative data for Denmark we find that those in worse health and with less...... schooling are more likely to receive DI. The gradient of DI participation across health quintiles is almost twice as steep as for schooling - moving from having no high school diploma to college completion. Using an option value model that accounts for different pathways to retirement, applied to a period...... spanning a major pension reform, we find that pension program incentives in general are important determinants of retirement age. Individuals in poor health and with low schooling are significantly more responsive to economic incentives than those who are in better health and with more schooling. Similar...
be made. However, others have argued that past modifications intended to save money have had a deleterious effect on military recruiting and...Savings Plan (TSP) coupled with government matching and early vesting. It will also reduce the defined benefit multiplier for calculating the retirement...In addition, some have argued that past modifications to the system intended to save money have had a deleterious effect on military recruiting and
Johan Almenberg; Jenny Säve-Söderbergh
We examine the relationship between financial literacy and retirement planning in a representative sample of Swedish adults. We find significant differences in financial literacy between planners and non-planners. Financial literacy levels are also lower among older people, women and those with low education or earnings. When we control for demographic variables we do not find an association between a narrow measure of financial literacy and planning, but with a broader measure the associatio...
Kim, Hong Pyo; Kim, J. S.; Hwang, S. S. and others
Degradation of steam generator leads to forced outage and extension of outage, which causes increase in repair cost, cost of purchasing replacement power and radiation exposure of workers. Steam generator tube rupture incident occurred in Uljin 4 in 2002, which made public sensitive to nuclear power plant. To keep nuclear energy as a main energy source, integrity of steam generator should be demonstrated. Quantitative relationship between ECT(eddy current test) signal and crack size is needed in assesment of integrity of steam generator in pressurized water reactor. However, it is not fully established for application in industry. Retired steam generator of Kori 1 has many kinds of crack such as circumferential and axial primary water stress corrosion crack and outer diameter stress corrosion crack(ODSCC). So, it can be used in qualifying and improving ECT technology and in condition monitoring assesment for crack detected in ISI(in service inspection). In addition, examination of pulled tube of Kori 1 retired steam generator will give information about effectiveness of non welded sleeving technology which was employed to repair defect tubes and remedial action which was applied to mitigate ODSCC. In this project, hardware such as semi hot lab. for pulled tube examination and modification transportation cask for pulled tube and software such as procedure of transportation of radioactive steam generator tube and non-destructive and destructive examination of pulled tube were established. Non-destructive and destructive examination of pulled tubes from Kori 1 retired steam generator were performed in semi hot lab. Remedial actions applied to Kori 1 retired steam generator, PWSCC trend and bulk water chemistry and crevice chemistry in Kori 1 were evaluated. Electrochemical decontamination technology for pulled tube was developed to reduce radiation exposure and enhance effectiveness of pulled tube examination. Multiparameter algorithm developed at ANL, USA was
contributions . Many of the MCRMC recommendations were adopted by Congress in the National Defense Authorization Act for FY2016 (P.L. 114-92) and amended by... contribution plan that would require the services to contribute up to 5% of annual base pay into a retirement account for each servicemember. The...TSP). Under the blended system, the services would begin monthly contributions of 1% of basic pay automatically into the servicemember’s TSP account
Mol, Meriel; van Kan, Hendrikus J M; Schultz, Marcus J; de Jonge, Evert
To study whether selective decontamination of the digestive tract (SDD) results in detectable serum tobramycin concentrations in intensive care unit (ICU) patients with acute renal failure treated with continuous venovenous hemofiltration (CVVH). Prospective, observational, single-center study in a mixed medical-surgical ICU. Adult ICU patients receiving SDD for at least 3 days and being treated with CVVH because of acute renal failure. Tobramycin serum concentrations were measured at the 3rd day after start of CVVH and every 3 days thereafter. Detectable serum concentrations of tobramycin were found in 12 (63%) of 19 patients and in 15 (58%) of the 26 samples. With a toxic tobramycin concentration defined as more than 2.0 mg/l, we found one patient with a toxic concentration of 3.0 mg/l. In three other patients tobramycin concentrations of >or=1.0 mg/l were found. In patients with acute renal failure treated with CVVH, administration of SDD with tobramycin can lead to detectable and potentially toxic serum tobramycin concentrations.
The fifth pre-retirement seminar has been a great success. The various sessions covered questions relating to rules and regulations, as well as financial and health issues, health insurance, residence permits and the psychological aspects of retirement. You will no doubt have noticed that the car parks near the Main Building were particularly full last week. In fact it was almost impossible to find a parking spot. A prestigious speaker? A sensational lecture series? Nothing of the sort. It was all due to the pre-retirement seminar, the fifth of its kind since 1993, which never fails to be a success. 'We sent out a thousand invitations to CERN staff aged 55 and above and received 500 positive replies' says William Blair, who has been organising the seminars for the Human Resources (HR) Division for the last eight years in collaboration with the CERN Pensioners Association and the Staff Association. The Main Auditorium was not big enough to accommodate everyone and the discussions also had to be retransmitted l...
Aalto-Korte, Kristiina; Kurimo, Ritva; Laitinen, Jaana; Pesonen, Maria; Takala, Esa-Pekka; Poutanen, Marjo
This paper describes the experiences of students and organizers of the Hair and beauty care, the prevention of health hazards (HIKAT) project which offered nationwide continuing vocational training (CVT) for teachers in beauty and hair care to be further disseminated in vocational secondary education. The development of occupational skin diseases is one of the most important health risks related to the exposure to chemical and physical risks in hairdressing. The prevention of occupational...
Full Text Available Objectives: Retirement impacts different dimensions of life such as physical, psychological, social, economic, and spiritual aspects. Since identification of the factors promoting or demoting health situation of retirees is important; this study aimed to determine the level of retirement syndrome in Babol retirees. Methods & Materials: This cross-sectional study was conducted on 205 retirees aged over 50 years. Data were gathered by a questionnaire consisting of 2 sections; Demographic characteristics and retirement syndromes. Retirement syndrome questionnaire consisted of 40 questions in 5-point scale (“never” to “always” in 4 dimensions of “helplessness and failure”, “older and idleness”, “trying and new directions”, and “conflict and confusion”. Data were analyzed by SPSS. The Pearson and Spearman tests were used to evaluate the within group variables. To analyze the data, the correlation coefficient test, t-test, and analysis of variance (ANOVA were performed. The significant level for all tests was set at 0.05. Results: About 53% of the participants were male and 47% female with an average (SD age 61.13(5.87 years. Means(SD scores of “helplessness and failure”, “older and idleness”, “trying and new directions”, and “conflict and confusion” were 2.08(0.52, 3.73(0.51, 3.47(0.65 and 2.49(0.56, respectively. There were a direct significant association between “feeling helplessness” and “conflict and confusion” (P<0.0001 and a reverse relationship between “older and idleness” and “trying and new directions” (P<0.0001. Conclusion: Findings of this research showed that retirees of Babol County partly suffer from retirement syndrome. Therefore, paying attention to them and promotion of the retirees’ situation seems necessary.
Full Text Available Sudden increase in the number of live births after the Second World War due to an increase in fertility rates has led to the formation of cohorts with specific characteristics or baby boom generation. This generation is unique in the history of the demographic phenomenon that has affected and affects the functioning of many segments of society. The aim of this paper is to assess structure of baby boomers who are few years away from retirement, using demographic data. Impact of baby boomer age structure of current and future retirees is described with a graphical display of current and projected age pyramid of baby boomers. Demographic pattern that women live longer than men is evident in the projected pyramid. In addition, the number of baby boomers will lead to a "younger" old population. The imbalance in the number of men and women pensioners, as well as older cohorts of women and female baby boomers was analyzed. As a result, an increasing trend of women's age pensioners who are members of the baby boom generation was clearly observed, which is opposite to the older cohort of women who often were family pensioners. Different circumstances and conditions in which female boomers lived and worked will form a new "pension model" because they will gain their benefits as well as men, for the first time in significant number, unlike their mothers, which gained the right to retire after they become widows. Number of women age pensioners is getting greater comparing to men, as the result of changes in the economic activities of women in the last half of the 20th century. When baby boomers retire and exit the working population, this will create a vacuum, because the numerically smaller generations will enter working population, while the sudden and very shortly, the number of population older than 60 or 65 will increase, most of them will likely to acquire the right to a pension. It is undeniable that baby boomers had impact on demographic structure